Anaesthesia and intensive care
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Anaesth Intensive Care · May 2016
Multicenter Study Observational StudyRapid Response Team activation in New Zealand hospitals-a multicentre prospective observational study.
We aimed to describe the epidemiology of Rapid Response Team (RRT) activation in New Zealand public hospitals. We undertook a prospective multicentre observational study of RRT activations in 11 hospitals for consecutive 14-day periods during October-December 2014. A standardised case report form was used to collect data on patient demographics, RRT activation criteria and timing, vital signs on RRT arrival, team composition and intervention, treatment limitation and patient outcome at day 30. ⋯ Most patients remain on the ward. The RRT frequently implements treatment limitations. Given almost one in five patients die within 30 days, over half of whom die within 72 hours of RRT review, surviving the RRT call may provide false reassurance that the patient will subsequently do well.
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Anaesth Intensive Care · May 2016
Comparative StudyAutocalibrating pulse contour analysis based on radial artery applanation tonometry for continuous non-invasive cardiac output monitoring in intensive care unit patients after major gastrointestinal surgery-a prospective method comparison study.
The T-Line(®) system (Tensys(®) Medical Inc., San Diego, CA, USA) non-invasively estimates cardiac output (CO) using autocalibrating pulse contour analysis of the radial artery applanation tonometry-derived arterial waveform. We compared T-Line CO measurements (TL-CO) with invasively obtained CO measurements using transpulmonary thermodilution (TDCO) and calibrated pulse contour analysis (PC-CO) in patients after major gastrointestinal surgery. We compared 1) TL-CO versus TD-CO and 2) TL-CO versus PC-CO in 27 patients treated in the intensive care unit (ICU) after major gastrointestinal surgery. ⋯ For TL-CO versus PC-CO, we observed a mean of differences of -0.4 (±1.5; -3.4 to +2.5) l/minute with a percentage error of 43%. In ICU patients after major gastrointestinal surgery, continuous non-invasive CO measurement based on autocalibrating pulse contour analysis of the radial artery applanation tonometry-derived arterial waveform (TL-CO) is feasible in a clinical study setting. However, the agreement of TL-CO with TD-CO and PC-CO observed in our study indicates that further improvements are needed before the technology can be recommended for clinical use in these patients.
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Anaesth Intensive Care · May 2016
Observational StudyThe effect of augmenting early nutritional energy delivery on quality of life and employment status one year after ICU admission.
Augmenting energy delivery during the acute phase of critical illness may reduce mortality and improve functional outcomes. The objective of this sub-study was to evaluate the effect of early augmented enteral nutrition (EN) during critical illness, on outcomes one year later. We performed prospective longitudinal evaluation of study participants, initially enrolled in The Augmented versus Routine approach to Giving Energy Trial (TARGET), a feasibility study that randomised critically ill patients to 1.5 kcal/ml (augmented) or 1.0 kcal/ml (routine) EN administered at the same rate for up to ten days, who were alive at one year. ⋯ EuroQol-5D-5L data were also comparable between groups (P=0.70). However, at one-year follow-up, more patients who received 1.5 kcal/ml were employed (7 versus 2; P=0.022). The delivery of 1.5 kcal/ml for a maximum of ten days did not affect self-rated quality of life one year later.
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Anaesth Intensive Care · May 2016
Case ReportsEarly skin and challenge testing after rocuronium anaphylaxis.
We present a case of early skin and challenge testing in a patient following severe anaphylaxis to rocuronium. The patient presented for semi-elective laparoscopic cholecystectomy and developed anaphylaxis with severe cardiovascular collapse after induction of anaesthesia. ⋯ The subsequent surgery, 48 hours after the initial reaction, was uneventful. The case highlights the difficulties when anaesthetising patients with recent anaphylaxis who have not yet had formal allergy testing and presents a potential management strategy involving early skin testing.
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Anaesth Intensive Care · May 2016
Comparative StudyPotential rapid solutions to maintain ventilation in the event of anaesthesia machine failure with no access to the patient's airway.
Anaesthesia machine failure requires rapid solutions to maintain ventilation and anaesthesia. During procedures with poor access to the patient's airway, it may not be possible to use a self-inflating mechanical ventilation device (SIMVD) for emergency ventilation, and alternative solutions are needed. We evaluated five methods for rescue ventilation using a patient simulator. ⋯ In Method 3 ventilation was achieved with minimal rebreathing of expiratory gas, but with no inhalational agent. Methods 4 and 5 led to rebreathing. Our findings indicate that Methods 1 or 2 are the preferred rapid solutions to maintain ventilation and inhalational anaesthesia in the event of anaesthesia machine failure where there is poor airway access.