Anaesthesia and intensive care
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Anaesth Intensive Care · May 2014
Long-term outcomes of minor troponin elevations in the intensive care unit.
The aim of our study is to determine the short-term and long-term outcomes of intensive care unit (ICU) patients with minor troponin elevations. The retrospective study compared ICU patients with peak troponin elevation less than 0.1 ng/ml to those with only negative tests during their hospital stay. Data were gathered from ICUs at Beth Israel Deaconess Medical Center between 2001 and 2008. ⋯ Minor elevations in troponin substantially increase one-year, all-cause mortality in a stepwise fashion; it was also independently associated with 30-day mortality. We propose that minor elevations in troponin should not be regarded as clinically unimportant, but rather be included as a prognostic element if measured. We recommend prospective ICU studies to assess prognostic value of routine troponin determination.
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Anaesth Intensive Care · May 2014
Validation of the vascular pedicle width as a diagnostic aid in critically ill patients with pulmonary oedema by novice non-radiology physicians-in-training.
Assessing intravascular volume status in the critically ill patient remains a challenge for intensivists, and the accuracy of such estimation based on bedside examination alone is reported to be nearly a coin toss. In this retrospective study we sought to validate a previously recommended chest radiographic vascular pedicle width (VPW) ≥70 mm for identifying cardiogenic pulmonary oedema (CPO). We additionally assessed whether novice physicians-in-training can reliably measure the VPW. ⋯ Kappa statistics for inter-rater reliability showed Kappa=0.41, 0.42 and 0.85 for each pair of the three raters. In conclusion, the previously accepted VPW cut-off of ≥70 mm is reasonably accurate in discriminating CPO from non-cardiogenic pulmonary oedema. VPW can be measured by physicians-in-training with a comparable performance to previous studies utilising expert radiologists.
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Anaesth Intensive Care · May 2014
Case ReportsPlatypnoea-orthodeoxia syndrome post laparoscopic surgery in a patient with a patent foramen ovale.
Platypnoea-orthodeoxia syndrome has the pathognomonic clinical findings of dyspnoea and arterial hypoxaemia relieved by recumbency. We report on a patient who presented with platypnoea-orthodeoxia syndrome post laparoscopic surgery. Platypnoea-orthodeoxia syndrome is an important diagnosis to consider when investigating hypoxia without an obvious cause.
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Anaesth Intensive Care · May 2014
Determinants of the relationship between cost and survival time after elective adult cardiac surgery.
Cardiac surgery is increasingly performed on elderly patients with multiple comorbid conditions, but the determinants of the relationship between cost and survival time after cardiac surgery for patients with a serious cardiac condition remain uncertain. Using the long-term outcome data of a cohort study on adult cardiac surgical patients, the relationship between cost and survival time after cardiac surgery from a hospital service perspective was determined. The total cost for each patient was estimated by the costs of the surgical procedures, intra-aortic balloon pump utilisation, operating theatre utilisation, blood products, intensive care unit stay and cumulative hospital stay up to a median follow-up time of 30 months. ⋯ Age, Charlson Comorbidity Index and EuroSCORE were all related to the cost per life-year after cardiac surgery, but EuroSCORE (odds ratio 1.26 per score increment, 95% confidence interval 1.18 to 1.35, P=0.001) was, by far, the most important determinant and explained 32% of the variability in cost per life-year after cardiac surgery. Patients with a high EuroSCORE were associated with a substantially longer length of intensive care unit stay and cumulative hospital stay, as well as a shorter survival time after cardiac surgery compared to patients with a lower EuroSCORE. Of all the subgroups of patients examined, only patients with a EuroSCORE >5 were consistently associated with a cost >A$100,000 per life-year (cost per life-year $183,148, 95% confidence interval 125, 394 to 240, 902).
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Anaesth Intensive Care · May 2014
Hybrid measurement to achieve satisfactory precision in perioperative cardiac output monitoring.
Advanced haemodynamic monitoring employing minimally invasive cardiac output measurement may lead to significant improvements in patient outcomes in major surgery. However, the precision (scatter) of measurement of available generic technologies has been shown to be unsatisfactory with percentage error of agreement with bolus thermodilution (% error) of 40% to 50%. Simultaneous measurement and averaging by two or more technologies may reduce random measurement scatter and improve precision. ⋯ Due to poor inherent precision of QtFT (% error 82.8), hybrid combination of QtFT with QtCO2 did not result in better precision than QtCO2 alone. Hybrid measurement can approach a 30% error, which is recommended as the upper limit for acceptability. This is a practical option where at least one component method, such as Capnotracking, is automated and does not increase the cost or complexity of the measurement process.