Anaesthesia and intensive care
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Anaesth Intensive Care · May 2017
A snapshot of the oxygenation of mechanically ventilated patients in one Australian intensive care unit.
Hyperoxaemia in patients undergoing mechanical ventilation (MV) has been found to be an independent predictor of worse outcome and in-hospital mortality in some conditions. Data suggests that a fraction of inspired oxygen (FiO2) of 0.4 or lower may produce hyperoxaemia although it is commonly accepted without adjustment in ventilator settings. The primary aim of this study was to observe current practice at one Australian tertiary intensive care unit (ICU) with regard to prescription and titration of oxygen (O2) in patients undergoing MV, in particular whether they received higher FiO2 than required according to arterial blood gas (ABG) results, and whether there was FiO2 titration as a response to initial ABG results during the 12 hours following. ⋯ Oxygen titration (up or down) occurred in 31% of patients. Morning ABGs were taken at a time suggested by ICU guidelines, and on review of these measures, the mean FiO2 was lower than that purported to create toxicity. Subsequently, almost one-third of the cohort had their FiO2 titrated, however there was a floor effect whereby 39%-43% of the cohort received an FiO2 of 0.3.
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With increasing emphasis on patient autonomy, patients are encouraged to be more involved in end-of-life issues, including the use of extraordinary efforts to prolong their lives. Being able to make anticipatory decisions is seen to promote autonomy, empower patients and optimise patient care. To facilitate shared decision-making, patients need to have a clear and accurate understanding of cardiopulmonary resuscitation (CPR). ⋯ Most of the participants agreed that they should personally be involved in making end-of-life decisions (n=44, 86.3%). Many patients had a poor knowledge of CPR and other resuscitation measures and the majority overestimated the success rate of CPR. However, a majority were receptive to improving their knowledge and keen to discuss end-of-life issues with physicians.
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Anaesth Intensive Care · May 2017
Patient and community attitudes toward perioperative biobanking and genomic research.
We surveyed hospital patients and clinicians to ascertain their attitudes to the establishment of a perioperative biobank for future genomics research, and whether the requirements for an opt-out approach to consent can be met. We enrolled hospital patients (n=187), patient spouse/family members (n=64), ethics committee members (n=14), and clinical staff (doctors and nurses [n=67]), and unspecified community members (n=10). They were asked to rate and describe their views on medical research and biobanking, the need for individual consent, and the importance of confidentiality. ⋯ Participants with chronic medical and surgical conditions were significantly more supportive and comfortable with genetic research, as were most in the hospital community. Most hospital patients, community members and clinicians are supportive of the development of a perioperative biobank used for genomic research. This supports the adoption of an opt-out approach to consent model.