Anaesthesia and intensive care
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Anaesth Intensive Care · May 2017
The effect of Rapid Response System revision on standard and specific intensive care unit outcomes in a regional hospital.
Hospital systems for the recognition (afferent limb) and management (efferent limb) of deteriorating patients, or Rapid Response Systems (RRSs), are being mandated worldwide, in spite of conflicting evidence regarding their efficacy. We have evaluated the impact of an Adult Deterioration Detection System (Q-ADDS)-based RRS specifically on illness severity at intensive care unit (ICU) admission and ICU length of stay (LOS), as well as previously studied endpoints. We undertook a retrospective, single-centre observational study comparing equivalent 18-month periods before the Q-ADDS-based RRS, and after implementation. ⋯ This Q-ADDS form-based RRS has resulted in lower illness severity at ICU admission from the ward, and fewer patients with scores associated with a >50% predicted mortality. Overall, ICU length of stay was reduced. These specific outcomes may reliably reflect RRS efficacy, even in smaller centres.
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Anaesth Intensive Care · May 2017
Efficacy and safety of ultra rapid iron polymaltose infusion during general anaesthesia.
To assess the efficacy and safety of ultra rapid (15 minute) infusion of iron polymaltose to iron deficient patients during general anaesthesia, we performed a prospective, interventional non-randomised study on 99 adult patients with iron deficiency with or without anaemia presenting for surgery under general anaesthesia. Over 15 minutes during the maintenance phase of anaesthesia, patients were given iron polymaltose, 500 mg if not anaemic, or 1,000 mg if anaemic. Haemodynamic stability, immediate or delayed iron-related side-effects and efficacy at six weeks were assessed. ⋯ The incidence of immediate or delayed side-effects was similar to patients undergoing outpatient iron polymaltose infusions and reflective of a post-surgical population. We conclude that up to 1,000 mg of iron polymaltose can be given over 15 minutes without significant haemodynamic compromise to selected patients undergoing general anaesthesia. Iron polymaltose administered in this way appears efficacious in treating iron deficiency.
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Anaesth Intensive Care · May 2017
ReviewEndothelial glycocalyx: basic science and clinical implications.
The classic Starling principle proposed that microvascular fluid exchange was determined by a balance of hydrostatic and oncotic pressures relative to the vascular wall and this movement of water was regulated by gaps in the intercellular spaces. However, current literature on the endothelial glycocalyx (a jelly-like protective layer covering the luminal surface of the endothelium) has revised Starling's traditional concepts. ⋯ Pathological shedding of the glycocalyx occurs in response to mechanical cellular stress, endotoxins, inflammatory mediators, atrial natriuretic peptide, ischaemia-reperfusion injury, free oxygen radicals and hyperglycaemia. Increased understanding of the endothelial glycocalyx may change perioperative fluid management, and therapeutic strategies aimed at its preservation may improve patient outcomes.