Anaesthesia and intensive care
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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
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%.
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Anaesth Intensive Care · Sep 2013
Home blood pressure monitoring in an anaesthetic pre-admission clinic.
We suspected that many high blood pressure measurements taken in our anaesthetic pre-assessment clinic and immediately prior to induction of anaesthesia were unusually elevated due to a 'white coat' effect. These high blood pressure measurements were causing late cancellations of surgery, even though white coat measurements may not be representative of the patient's usual blood pressure or of their risk of end-organ damage due to hypertension. In this audit, patients with high blood pressure in our pre-admission clinic were provided with training and a home blood pressure monitor to use prior to surgery. ⋯ A total of 33% of general practice clinic measurements were also ≥ 20 mmHg higher than average home measurements. White coat hypertension was common in our audit population. Relying on average home blood pressure measurements rather than 'one off' in-hospital measurements may have helped to prevent the postponement or cancellation of surgery for 13 patients who had recorded blood pressure ≥ 180/110 mmHg in our pre-admission clinic.
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Cricothyroidotomy is infrequently performed in the intensive care unit but may be a lifesaving procedure. The aim of this study was to determine the number of attempts required by trainees to gain adequate skills for a successful cricothyroidotomy (defined as lung inflation <60 seconds). The effect of training on time to completion of cricothyroidotomy was also studied. ⋯ Age, years of postgraduate practice and level of seniority appeared to be associated with earlier success. Consecutive attempts on a manikin led to an improvement in the time to completion of cricothyroidotomy and rate of a successful outcome (<60 seconds). We recommend that clinicians undergo at least five training attempts on a manikin to gain proficiency in cricothyroidotomy.