Anaesthesia and intensive care
-
Anaesth Intensive Care · Jan 2016
Characteristics of sepsis-induced cardiac dysfunction using speckle-tracking echocardiography: a feasibility study.
Septic cardiomyopathy is commonly encountered in patients with severe sepsis and septic shock. This study explores whether novel global and segmental echocardiographic markers of myocardial deformation, using two-dimensional speckle tracking, are associated with adverse sepsis outcomes. We conducted a retrospective observational feasibility study, at a tertiary care centre, of patients admitted to the ICU with a diagnosis of sepsis who underwent an echocardiogram within the first week of sepsis diagnosis. ⋯ Speckle-tracking echocardiography can be performed feasibly in patients in sepsis. Global and segmental left ventricular deformation indices are associated with ejection fraction. Further studies need to evaluate the ability of these new indices to predict sepsis outcomes.
-
Anaesth Intensive Care · Jan 2016
Discordance between ROTEM® clotting time and conventional tests during unfractionated heparin-based anticoagulation in intensive care patients on extracorporeal membrane oxygenation.
We hypothesised that ROTEM® (Basel, Switzerland) INTEM® (ROTEM, Basel, Switzerland) clotting time (CT) would have good agreement with activated partial thromboplastin time (aPTT) in determining whether a dose adjustment should be made to the unfractionated heparin (UFH) infusion in patients on extracorporeal membrane oxygenation. All patients treated with extracorporeal membrane oxygenation over a five-year period were included for data analysis. Retrospective analysis was performed of prospectively collected data points, wherein aPTT, activated CT and ROTEM was performed simultaneously to monitor UFH-based anticoagulation. ⋯ While haemorrhagic complications were frequent, no major clotting complications were encountered. Our results demonstrated that aPTT and INTEM CT do not provide equivalent information to guide UFH infusion rate titration during extracorporeal membrane oxygenation. Our study suggests caution regarding the use of ROTEM for guiding UFH-based anticoagulation as it may lead to excessive UFH exposure.
-
Anaesth Intensive Care · Jan 2016
Obesity prevalence and associated outcomes in cardiothoracic patients: a single-centre experience.
The objective of this study was to investigate the prevalence of obesity and its relationship with adverse outcomes in ICU cardiothoracic patients. We performed a retrospective analysis of cardiothoracic patients admitted to The Royal Melbourne Hospital ICU between 2002 and 2014. Eight thousand and sixty-four patients who underwent coronary artery bypass, valve replacement/repair, or both, were divided into six categories of body mass index using World Health Organization criteria. ⋯ In summary, a growing proportion of our obese ICU patients are morbidly obese, with a dramatically increased length of ICU stay. This has major implications for resource allocation in the ICU, and may inform modelling of future bed utilisation. Obesity, but not morbid obesity, conferred a mortality benefit.
-
Anaesth Intensive Care · Jan 2016
Intentions and barriers to research activities among Australian and New Zealand anaesthetists: a Survey.
A voluntary, anonymous, cross-sectional online survey was conducted among 997 Fellows of the Australian and New Zealand College of Anaesthetists, using an electronic questionnaire. Details about their demographics, employment, research experience and barriers they had encountered, their perception about research and their future intentions to participate in research, were collected. The survey response rate was 24.6%. ⋯ In terms of barriers encountered during previous projects, 91% of the respondents cited methodological issues, which included complicated ethics approval processes, difficulty in coordinating teams or recruiting participants, non-compliant patients and difficulty in publishing. Sixty-three percent of those surveyed believed more exposure to research activities during training would increase the number of anaesthetists involved in research and scholarly activities. Through this survey, we have identified several areas that, if satisfactorily addressed, could enhance interest and participation in research amongst anaesthetists in Australia and New Zealand.