Anaesthesia and intensive care
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Anaesth Intensive Care · Jul 2018
Randomized Controlled TrialThe use of Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) for pre-oxygenation in neurosurgical patients: a randomised controlled trial.
This study explored the use of high-flow nasal oxygen (HFNO) in both pre-oxygenation and apnoeic oxygenation in adults who were intubated following a non-rapid sequence induction. Fifty patients were randomised to receive pre-oxygenation via a standard facemask or the Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) device. After five minutes of pre-oxygenation, induction and muscle relaxant agents were given. ⋯ No complications were observed in either group. HFNO produces a higher PaO2 after pre-oxygenation and safe PaO2 during intubation. However, the subsequent fall in PaO2 and rise in PaCO2 indicates that it is not as effective as BMV in maintaining oxygenation and ventilation following neuromuscular blockade.
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Anaesth Intensive Care · Jul 2018
Observational StudyOptimised dosing of vancomycin in critically ill Indigenous Australian patients with severe sepsis.
Vancomycin is a commonly used antibiotic due to the high burden of methicillin-resistant Staphylococcus aureus infections. This study aimed to describe the pharmacokinetics (PK) of vancomycin in Australian Indigenous patients with severe sepsis, and advise an optimal dosing strategy. A population PK study was conducted in a remote Australian intensive care unit (ICU). ⋯ Therapeutic loading doses were significantly dependent on both weight and CrCL, whereas maintenance doses were dependent on CrCL. In the absence of severe renal impairment, initiation of maintenance dose eight hours post-loading dose achieved higher probability of target attainment at 24 hours. This is the first report of vancomycin PK in this patient group.
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Anaesth Intensive Care · Jul 2018
Observational StudyAudit of ten years of donation after circulatory death experience in Queensland: observations of agonal physiology following withdrawal of cardiorespiratory support.
An audit of ten years' experience in all patients undergoing withdrawal of cardiorespiratory support (WCRS) in the context of donation after circulatory death (DCD) was conducted in Queensland, Australia (2008 to 2017). One hundred and seventy-one patients proceeded to donation after declaration of death by circulatory criteria with loss of pulsatile arterial blood pressure (circulatory arrest) for five minutes. The demographics, times and haemodynamic observations were abstracted, de-identified and collated. ⋯ Following periods of circulatory arrest, five patients were documented to have spontaneous return of pulsatile arterial pressure. Two patients had return of circulation after two minutes, but less than five minutes of circulatory arrest and three patients had return of circulation where circulatory arrest had been documented for less than two minutes. Following WCRS, transient restoration of circulation following circulatory arrest may occur, even following two minutes of circulatory asystole, albeit rarely.
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Anaesth Intensive Care · Jul 2018
Randomized Controlled TrialIntravenous tranexamic acid and lower limb arthroplasty-a randomised controlled feasibility study.
Tranexamic acid (TA) is widely reported to reduce bleeding and the risk of blood transfusion in patients undergoing lower limb arthroplasty. No study in this setting has had adequate power to examine for the effect of TA on either uncommon, but clinically important, adverse events or patient-centric endpoints. A large randomised controlled trial (RCT) is required to address these questions. ⋯ No significant differences were seen between groups in the secondary endpoints. Despite a lower rate of transfusion than that widely reported, IV TA reduced transfusion in patients undergoing lower limb arthroplasty. Our trial methodology would be feasible in the setting of a large multicentre study to investigate whether TA is safe and reduces bleeding in lower limb arthroplasty.
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Anaesth Intensive Care · Jul 2018
Observational StudyA prospective observational study of the change in systemic ionised calcium following 4% citrate locking of venous haemodialysis catheters in intensive care patients.
Traditionally heparin has been the anticoagulant of choice for venous dialysis catheter locking. There is systemic leakage of heparin catheter locking solutions at the time of injection. Alternative agents, such as citrate, are increasingly being used. ⋯ There was no evidence this difference differed by length of catheter P=0.26) or site of catheter P=0.85) insertion, but there was some evidence that this differed by receipt of citrate dialysis circuit anticoagulation P=0.013). Patients who received citrate dialysis circuit anticoagulation had an increase in catheter locking iCa2+ by 0.017 mmol/l (95% CI 0.00 to 0.028). Locking of venous dialysis catheters with 4% citrate solution has no clinically significant effect on systemic iCa2+ in intensive care patients with indwelling venous dialysis catheters.