Anaesthesia and intensive care
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Anaesth Intensive Care · May 2015
Review Meta AnalysisSystematic review and meta-analysis of method comparison studies of Masimo pulse co-oximeters (Radical-7™ or Pronto-7™) and HemoCue® absorption spectrometers (B-Hemoglobin or 201+) with laboratory haemoglobin estimation.
We assessed agreement in haemoglobin measurement between Masimo pulse co-oximeters (Rad-7™ and Pronto-7™) and HemoCue® photometers (201+ or B-Hemoglobin) with laboratory-based determination and identified 39 relevant studies (2915 patients in Masimo group and 3084 patients in HemoCue group). In the Masimo group, the overall mean difference was -0.03 g/dl (95% prediction interval -0.30 to 0.23) and 95% limits of agreement -3.0 to 2.9 g/dl compared to 0.08 g/dl (95% prediction interval -0.04 to 0.20) and 95% limits of agreement -1.3 to 1.4 g/dl in the HemoCue group. Only B-Hemoglobin exhibited bias (0.53, 95% prediction interval 0.27 to 0.78). ⋯ Masimo devices and HemoCue 201+ both provide an unbiased, pooled estimate of laboratory haemoglobin. However, Masimo devices have lower precision and wider 95% limits of agreement than HemoCue devices. Clinicians should carefully consider these limits of agreement before basing transfusion or other clinical decisions on these point-of-care measurements alone.
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Anaesth Intensive Care · May 2015
ReviewDebriefing after simulation-based non-technical skill training in healthcare: a systematic review of effective practice.
Non-technical skills training in healthcare frequently uses high-fidelity simulation followed by a facilitated discussion known as debriefing. This type of training is mandatory for anaesthesia training in Australia and New Zealand. Debriefing by a skilled facilitator is thought to be essential for new learning through feedback and reflective processes. ⋯ There was no added performance improvement when review of a video recording was added to facilitator-led debriefing. One study reported no performance improvement after debriefing. Without empirical evidence that is specific to the healthcare domain, theories of learning from education and psychology should continue to inform practices and teaching for effective debriefing.
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Anaesth Intensive Care · May 2015
ReviewResearch without informed patient consent in incompetent patients.
Most patients needing intensive care cannot give informed consent to participation in research. This includes the most acutely and severely ill, with the highest mortality and morbidity where research has the greatest potential to improve patient outcomes. ⋯ Various models have been suggested for research without patient informed consent when intervention is urgent and cannot wait until first person consent is possible, including a waiver of consent if conditions are met. A nationally consistent model is proposed for Australia with a robust process for initial waiver of consent followed by first person consent to further research-related procedures or ongoing follow-up when this can be competently provided.
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Anaesth Intensive Care · May 2015
Predicting intensive care and hospital outcome with the Dalhousie Clinical Frailty Scale: a pilot assessment.
Frailty may help to predict intensive care unit (ICU) patient outcome. The Dalhousie Clinical Frailty Scale (DCFS) is validated to assess frailty in ambulatory settings but has not been investigated in Australian ICUs. We conducted a prospective three-month study of patients admitted to a tertiary level ICU. ⋯ Approximately 1 in 10 ICU patients were frail and this frequency increased with age. The DCFS was associated with patient age and comorbidities and potentially predicts increased hospital length-of-stay but not other outcomes. Strategies to improve compliance with DCFS completion are needed.