Anaesthesia and intensive care
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Anaesth Intensive Care · Mar 2014
Comparative StudyComparison of a Trigger Tool and voluntary reporting to identify adverse events in a paediatric intensive care unit.
Reduction of adverse events depends on accurate detection. The utility of a Trigger Tool to detect and classify severity of adverse events in an intensive care unit of a paediatric university hospital was compared to voluntary reporting. Sixty patient records were randomly selected from 314 admissions over three months. ⋯ Of the 56 events rated similarly by both investigators, 13 (23%) were insignificant, 19 (34%) were minor, 17 (30%) were moderate, 4 (7%) were major and 3 (6%) were catastrophic. Only four adverse events had been reported voluntarily, of which two were detected using the Trigger Tool. Whereas the Trigger Tool is a simple, efficient and robust method, voluntary reporting is inadequate and captures very few adverse events in the intensive care unit environment.
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Anaesth Intensive Care · Mar 2014
Case ReportsManagement of severe hypercapnia post cardiac arrest with extracorporeal carbon dioxide removal.
Normocapnia is recommended in intensive care management of patients after out-of-hospital cardiac arrest. While normocapnia is usually achievable, it may be therapeutically challenging, particularly in patients with airflow obstruction. ⋯ These are simpler and less invasive than conventional extracorporeal devices. We report the first case of using a novel, extracorporeal carbon dioxide removal device in Australia on a patient with out-of-hospital cardiac arrest where mechanical ventilation failed to achieve normocapnia.
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Anaesth Intensive Care · Mar 2014
Limited sampling strategy for estimation of amikacin optimal sampling time in critically ill adults.
Aminoglycosides are a class of antibiotics that are commonly used in the treatment of gram-negative pathogens in the critically ill population. Unfortunately, dosing of these aminoglycosides in critically ill patients is difficult due to their altered pharmacokinetics in the critically ill and narrow therapeutic index. In this study, we evaluated whether a limited sampling strategy can be used to predict the area under the concentration (AUC) curve of amikacin concentrations over a 24-hour period after a single dose of intravenous amikacin (25 mg/kg). ⋯ Using a jackknife procedure, the AUC of amikacin over a 24-hour period was estimated by choosing a combination of the amikacin concentrations measured at different time-points. Overall, the mean prediction error of all models was not statistically different from zero (P >0.05). Based on bias and imprecision, all models gave good estimate of AUC of amikacin over a 24-hour period, but a two-point sampling strategy at 1.5 and 6 hours post-dose appeared to offer the best compromise between accuracy and cost-effectiveness in optimising the dosing of amikacin in critically ill patients.