Anaesthesia and intensive care
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Anaesth Intensive Care · Sep 2015
Anti-seizure prophylaxis in critically ill patients with traumatic brain injury in an intensive care unit.
The objectives of this prospective observational study were to determine the proportion of patients with traumatic brain injury who received effective anti-seizure prophylaxis. The study was conducted in a tertiary level ICU of a major trauma referral centre between February 2012 and August 2013. A total of 2361 patients were admitted to the ICU in this study period, of whom125 patients (index) with traumatic head injury were included in this study. ⋯ Twenty-two (18%) of the index patients had post-traumatic seizures, indicating a high prevalence for this study. Poor compliance with guidelines could possibly explain this phenomenon. Future studies are needed to look at the dosing and monitoring of phenytoin and/or alternative anti-seizure prophylaxis in patients with traumatic brain injury.
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Anaesth Intensive Care · Sep 2015
Iron-restricted erythropoiesis and risk of red blood cell transfusion in the intensive care unit: a prospective observational study.
Intravenous (IV) iron can decrease transfusion requirements in selected patients with low, normal and moderately elevated ferritin. Whether the syndrome of iron-restricted erythropoiesis (IRE), diagnosed by iron studies, identifies critically ill patients at risk for subsequent red blood cell (RBC) transfusion, and hence, provides a simple method to determine response to IV iron therapy, is uncertain. We aimed to describe the characteristics of patients with IRE on admission to intensive care and determine the optimal variables to identify patients at risk of RBC transfusion who may benefit from early administration of IV iron. ⋯ The proportion of patients with IRE subsequently receiving RBC transfusion was significantly lower than the proportion of patients without IRE receiving RBC transfusion (absolute mean difference 18.9% [95% CI 4.7 to 33.1, P <0.001]). IRE was not independently associated with risk of transfusion on multivariate analysis, however, a prognostic model with three risk factors (RBC transfusion prior to ICU admission, Hb <100 g/l and ICU length of stay >3 days), had good discrimination and calibration for predicting transfusion (receiver operator curve area under the curve 0.87 [95% CI 0.79 to 0.94, P=0.88], Hosmer-Lemeshow 6.21; P=0.1). Excluding iron overload and using simple prognostic criteria to identify patients at high risk of RBC transfusion may be a preferable strategy for identifying critically ill patients who may benefit from IV iron.