Anaesthesia and intensive care
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Anaesth Intensive Care · Jul 2013
Current oxygenation practice in ventilated patients-an observational cohort study.
Oxygen therapy is a mainstay of critical care medicine, yet its optimal therapeutic use has not been systematically evaluated. A detailed understanding of current practice in oxygen therapy in intensive care is required to enable future interventional studies. We aimed to describe current oxygenation practice in patients requiring ≥48 hours of mechanical ventilation (MV) at an academic tertiary referral centre. ⋯ Wide variability in the mean SpO2 and PaO2 was observed in patients with comparable ALI scores. Inspired oxygen therapy in these MV patients was 'liberal', with PaO2 and SpO2 values generally above 80 mmHg and 96% respectively. An interventional study comparing current practice to more conservative targets (PaO2≍60 to 65 mmHg and/or SpO2≍90 to 92%) appears possible.
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Anaesth Intensive Care · Jul 2013
Asialoglycoprotein receptor scintigraphy with 99mTc-galactosyl human serum albumin (99mTc-GSA) as an early predictor of survival in acute liver failure.
This study evaluated the usefulness of asialoglycoprotein receptor scintigraphy with 99mTc-galactosyl human serum albumin (99mTc-GSA scintigraphy) as an early predictor for prognosis of acute liver failure. Forty-eight patients with acute liver failure and without a past history of chronic liver disease were enrolled. Patients were divided into survival and non-survival groups by 28-day mortality. 99mTc-GSA scintigraphy to detect uptake ratio of the heart at 15 minutes to that at three minutes (HH15) and uptake ratio of the liver at 15 minutes to the liver plus the heart at 15 minutes (LHL15), and measurements of serum total bilirubin, hepatocyte growth factor and prothrombin time were performed immediately after the diagnosis of acute liver failure. ⋯ HH15 and LHL15 uptake ratios in the survival group were 0.670 and 0.875, and they were significantly lower and higher than those in the non-survival group, respectively. All patients with LHL15 <0.760 died, and the area under the receiver operating characteristic curve for LHL15 were significantly larger than the areas under the receiver operating characteristic curves of serum variables and model for end-stage liver disease score. In summary, in patients with acute liver failure without chronic liver disease, HH15 and LHL15 of 99mTc-GSA scintigraphy are more useful variables in predicting prognosis than serum variables and model for end-stage liver disease score.
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Anaesth Intensive Care · Jul 2013
Feasibility of anaesthetic provision for paediatric patients undergoing off-site intraoperative MRI-guided neurosurgery: the Singapore experience from 2009 to 2012.
The benefits of using intraoperative magnetic resonance imaging (iMRI) for neurosurgery have been recognised. However, iMRI facilities are not available in all hospitals. For example, in Singapore iMRI is currently available only at the Singapore General Hospital, an adult hospital without facilities for intensive care management of patients less than 12 years of age. ⋯ Since July 2009 we have managed nine paediatric patients in this manner: three children with arteriovenous malformations and six children with brain tumours. There was no morbidity or mortality that could be attributed to the transport of patients either to or from Singapore General Hospital. Our experience suggests that with adequate planning and preparation, providing anaesthetic care and transporting children for off-site iMRI-guided neurosurgery is feasible and safe for selected children.
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Anaesth Intensive Care · Jul 2013
Decontamination of ultrasound equipment used for peripheral ultrasound-guided regional anaesthesia.
Portable ultrasound machines are frequently used in operating theatres for peripheral single-shot nerve block procedures. This equipment must be decontaminated by reducing the microbial load to a sufficient level to reduce the risk of nosocomial infection. In our institution we use a simple three-step decontamination protocol utilising 70% isopropyl alcohol as chemical disinfectant. ⋯ Of the remaining 15% (n=18), commensal organisms commonly found on skin, oral and environmental surfaces were isolated. Our results suggest that our decontamination protocol may be an effective, rapid and cost-effective method of cleaning ultrasound equipment used for peripheral invasive single-shot nerve blocks. Further guidance from national bodies is required to define appropriate cleaning protocols for these machines.
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Anaesth Intensive Care · Jul 2013
Does left ventricular tissue Doppler peak systolic velocity (Sm) reflect cardiac output in the critically ill?
Cardiac output (CO) is dependent on a number of factors, in particular, the systolic function of the heart. Tissue Doppler (TD) is a modality in echocardiography that measures myocardial velocity and is related to contractility. TD can therefore be used to measure the systolic function of the heart. ⋯ Sm was weakly correlated to heart rate only in the normal group but not in the combined cohort. Our data confirms a weak to moderate correlation between Sm and CO, probably resulting from a positive correlation of Sm and stroke volume. This correlation is not strong enough to support the use of an individual's Sm to estimate CO in intensive care patients.