Anaesthesia and intensive care
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Anaesth Intensive Care · Sep 2013
Differential associations between body mass index and outcomes after elective adult cardiac surgery: a linked data cohort study.
This study assessed the relationships between body mass index (BMI) and different outcomes after adult cardiac surgery by linking detailed preoperative comorbidity data with the long-term mortality and morbidity outcomes of 2131 consecutive patients who had elective cardiac surgery at a major cardiac surgical hospital in Western Australia. Patients with a high BMI had more comorbidities and were more likely to have had coronary artery bypass grafting than valve surgery. A total of 143 patients (6.7%) died during a median follow-up period of 30 months. ⋯ BMI had an inverse relationship with the risk of requiring allogeneic blood transfusion, postoperative intra-aortic balloon pump, or surgical re-exploration. In summary, BMI had differential associations with different short- and long-term outcomes after elective adult cardiac surgery. After adjusting for important confounders including the presence of cancers, we did not observe any 'obesity paradox' and patients with a high BMI were not associated with an increased probability of long-term survival.
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Anaesth Intensive Care · Sep 2013
A preliminary evaluation of plasma b-type natriuretic peptide as a screening test for left ventricular diastolic dysfunction in non-cardiac intensive care.
Left ventricular filling and thus diastolic function are frequently monitored and managed in critical care. However, scant data exist regarding possible screening tests for diastolic dysfunction in the intensive care unit (ICU). The present study aimed to evaluate plasma b-type natriuretic peptide (BNP) as a marker of diastolic dysfunction in a single-centre cohort of 'non-cardiac' ICU patients. ⋯ BNP correlated independently with E/e' (R=0.425; P=0.015) (E/e': peak early transmitral velocity [E]/early diastolic mitral annular velocity [e']) but not left ventricular ejection fraction (P=0.8), illness severity (Acute Physiological and Chronic Health Evaluation II; P=0.3) or fluid balance (P=0.4). Diastolic dysfunction was common in this cohort of non-cardiac ICU patients and was independently associated with a significantly higher BNP. The potential application as a screening test for diastolic dysfunction is likely to require a threshold lower than previously proposed for heart failure.
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Anaesth Intensive Care · Sep 2013
Type 2 diabetes mellitus, independent of insulin use, is associated with an increased risk of cardiac complications after vascular surgery.
Previous reports on the prognostic value of diabetes mellitus for cardiac complications after vascular surgery show divergent results, especially in regards to the role of type 2 diabetes as a cardiac risk factor, which remains unclear. The aim of this study was to assess the impact of type 2 diabetes on 30-day cardiac complications after vascular surgery. Patients undergoing elective vascular surgery between 2002 and 2011 were included in this retrospective cohort study. ⋯ In multivariate analysis, type 2 diabetes was associated with a significantly increased risk of 30-day cardiac complications (odds ratio 1.80; 95% confidence interval 1.25 to 2.60). Results were similar for type 2 diabetes patients managed with (odds ratio 1.84; 95% confidence interval 1.01 to 3.37) and without (odds ratio 1.79; 95% confidence interval 1.19 to 2.70) insulin. Type 2 diabetes is an independent risk factor for cardiac complications after vascular surgery and should be treated as such in preoperative cardiac risk stratification.
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Anaesth Intensive Care · Sep 2013
Binding of local anaesthetics to the lipid emulsion Clinoleic™ 20%.
Lipid emulsions have been used to treat cardiovascular collapse due to local anaesthetic toxicity. However, there are few data available on the comparative efficiency of the partitioning properties of available lipid emulsions in clinical use. This in vitro study compared the buffering properties of the lipid emulsions Clinoleic™ 20% (Baxter, Old Toongabbie, NSW) and Intralipid® 20% (Fresenius Kabi, Pymble, NSW) using both bupivacaine (Marcain® 0.5%, AstraZeneca, North Ryde, NSW) and ropivacaine (Naropin® 1%, AstraZeneca, North Ryde, NSW). ⋯ Bupivacaine was more effectively bound by the lipid agents, with a 40% reduction in initial concentration. Ropivacaine demonstrated a 20% reduction in concentration with the addition of lipid agents. Importantly, there was no significant difference between Intralipid and Clinoleic in terms of their buffering behaviour, suggesting equivalent binding efficacy.
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Anaesth Intensive Care · Sep 2013
Diagnostic potential of open lung biopsy in mechanically ventilated patients with diffuse pulmonary infiltrates of unclear aetiology.
Acute respiratory failure with bilateral pulmonary infiltrates is a clinical problem with a wide differential diagnosis. We evaluated whether open lung biopsy offered a diagnosis and therapeutic guidance in cases of unclear diagnosis after non-invasive tests. For this purpose, we reviewed 60 cases of open lung biopsy performed between 2002 and 2009 in patients with acute respiratory failure and bilateral infiltrates at the intensive care unit of Ghent University Hospital. ⋯ Open lung biopsy contributed to patient management in 53 cases (88%) as it led to the initiation, modification or discontinuation of therapeutic drugs in 36, and contributed to the decision to continue or withdraw ventilator support in 17. Complications of open lung biopsy were noted in 14 patients (23%). We conclude that open lung biopsy was a useful diagnostic intervention in of a selected group of patients with acute respiratory failure and bilateral infiltrates of unclear clinical diagnosis, as it offered a specific diagnosis in 65%.