Anaesthesia and intensive care
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Anaesth Intensive Care · Jan 2019
Observational StudyHigh serum potassium level is associated with successful electrical cardioversion for new-onset atrial fibrillation in the intensive care unit: A retrospective observational study.
Electrical cardioversion (ECV) is a potentially life-saving treatment for haemodynamically unstable new-onset atrial fibrillation (AF); however, its efficacy is unsatisfactory. We aimed to elucidate the factors associated with successful ECV and prognosis in patients with AF. This retrospective observational study was conducted in two mixed intensive care units (ICUs) in a university hospital. ⋯ ECV was successful in 48% of patients with new-onset AF developed in the ICU. A serum potassium level ≥3.8 mol/L was independently associated with successful ECV, and sinus rhythm maintained until ICU discharge was independently associated with ICU survival. These results suggested that maintaining a high serum potassium level may be important when considering the effectiveness of ECV for AF in the ICU.
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Anaesth Intensive Care · Jan 2019
The effect of guideline implementation on discharge analgesia prescribing (two years on).
The provision of appropriate discharge analgesia can be challenging and is often prescribed by some of the most junior members of the medical team. Opioid abuse has been considered a growing public health crisis and physician overprescribing is a major contributor. In 2015 an initial audit of discharge analgesia at the Royal Perth Hospital led to the development of discharge analgesia guidelines. ⋯ The quantity of oxycodone IR given on discharge complied with quantity guidelines in only 56% of cases. Overall there has been a significant and sustained improvement in appropriateness of discharge analgesia prescribing since 2015, though the results from 2017 show less compliance than 2016 and that achieving compliance with quantity guidelines is an ongoing challenge. This demonstrates the challenge of obtaining high adherence to guidelines over a longer time period.
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Anaesth Intensive Care · Jan 2019
Frequency and clinical spectrum of in-flight medical incidents during domestic and international flights.
Most medical practitioners are not specifically trained to diagnose or manage in-flight medical incidents, yet there may occur a moral obligation to do so when least expected. We felt that knowledge of the frequency of emergency versus non-serious medical incidents, in addition to the clinical spectrum of incidents most often encountered, would be of interest to medical practitioners and, in particular, critical care physicians, who happen to find themselves asked to assist with such events. To this end we collaborated with the Department of Medical Services of a major Australian airline to define the incidence, severity, and type of all in-flight medical events encountered over the course of a year's flights. ⋯ Six of these 915 emergencies proved fatal. Twenty-one flights were diverted due to medical incidents (<0.016% of all flights), with 52% of these attributed to suspected cardiac events. In this series, medical in-flight events were recorded in approximately one in 40 flights, whereas medical emergencies occurred in approximately one in 150 flights.
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Anaesth Intensive Care · Jan 2019
Randomized Controlled TrialA comparison of different modes of pneumatic compression on muscle tissue oxygenation: An intraparticipant, randomised, controlled volunteer study.
Intermittent pneumatic compression (IPC) to the lower limbs is widely used as a mechanical means to prevent deep vein thrombosis in hospitalised patients. Due to a theoretical concern about impairing blood flow, thromboembolic-deterrent stockings and IPC are considered contraindicated for patients with peripheral vascular diseases by some clinicians. This study assessed whether IPC would alter peripheral limb muscle tissue oxygenation (StO2), and whether such changes were different during 10 minutes of sequential and single-compartment compressions. ⋯ Both sequential (3.5%, 95% confidence intervals (CI) 2.7-4.2; p < 0.001) and single-compartment IPC (1.6%, 95% CI 0.4-2.8; p = 0.039) significantly increased muscle StO2 within 10 minutes compared to no compression; and the increments were higher during sequential compressions compared to during single-compartment compressions (2.1%, 95% CI 0.7-3.5; p = 0.023). This mechanistic study showed that both modes of IPC increased upper limb muscle StO2 compared to no compression, but the StO2 increments were higher with the multiple-chamber sequential compressions mode. Contrary to the theoretical concern that IPC may impair peripheral limb tissue oxygenation, our results showed that IPC actually increases oxygenation of the peripheral limb muscles, especially during the sequential compressions mode.