Anaesthesia and intensive care
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Anaesth Intensive Care · Nov 2014
Factors influencing escalation of care by junior medical officers.
Patients can acutely deteriorate unexpectedly. Junior medical officers (JMOs) are often first to review patients who become unwell. Opportunities to escalate care to a senior colleague may exist prior to the need for a rapid response team review. ⋯ Although 36% agreed that they were concerned about waking seniors overnight, only 6% feared that escalating care overnight would affect their future career prospects. Escalation of care appears to be mostly influenced by the confidence and familiarity of the JMO with the cause of deterioration. JMOs identified clear handover with documented goals of treatment and suggested actions in event of clinical deterioration as the best means by which to improve the process of escalation of care for clinically deteriorating patients.
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Anaesth Intensive Care · Nov 2014
The association between early arterial oxygenation in the ICU and mortality following cardiac surgery.
Many studies have been conducted to investigate the relationship between hyperoxia and mortality in cohorts of intensive care unit (ICU) patients with varied and often contradictory results. The impact of early hyperoxia post ischaemia remains uncertain in various ICU cohorts. We aimed to investigate the association between arterial oxygenation (PaO2) in the first 24 hours in ICU and mortality in patients following cardiac surgery, using a retrospective cohort study of data from the Australian and New Zealand Intensive Care Society adult patient database. ⋯ There was no association between hyperoxia and in-hospital or ICU mortality compared to normoxia. There was a small increased hospital and ICU length-of-stay for hyperoxic compared to normoxic patients. We concluded that there was no association between mortality and hyperoxia in the first 24 hours in ICU after cardiac surgery.
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Anaesth Intensive Care · Nov 2014
Case ReportsToxic leukoencephalopathy in the intensive care unit.
In this article, we report two cases of acute toxic leukoencephalopathy to highlight this acute clinicoradiological syndrome as an important, although uncommon, consideration in the undifferentiated comatose patient who fails to wake following drug overdose or has unexplained neurology with a history of drug exposure. We then review the current literature and discuss potential differential diagnoses in this setting, along with proposed treatments for this condition. The cases presented demonstrate a more fulminant onset than previously well-defined acute toxic leukoencephalopathy subtypes and highlight the prognostic importance of magnetic resonance imaging in diagnosing a condition from which significant functional recovery seems possible.
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Anaesth Intensive Care · Nov 2014
Select critically ill patients at risk of augmented renal clearance: experience in a Malaysian intensive care unit.
Augmented renal clearance (ARC) refers to increased solute elimination by the kidneys. ARC has considerable implications for altered drug concentrations. The aims of this study were to describe the prevalence of ARC in a select cohort of patients admitted to a Malaysian intensive care unit (ICU) and to compare measured and calculated creatinine clearances in this group. ⋯ In conclusion, critically ill patients with 'normal' serum creatinine concentrations have varied Crcl. Many are at risk of ARC, which may necessitate individualised drug dosing. Furthermore, significant bias and imprecision between calculated and measured Crcl exists, suggesting clinicians should carefully consider which method they employ in assessing renal function.