Anaesthesia and intensive care
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Anaesth Intensive Care · Jul 2013
Current oxygenation practice in ventilated patients-an observational cohort study.
Oxygen therapy is a mainstay of critical care medicine, yet its optimal therapeutic use has not been systematically evaluated. A detailed understanding of current practice in oxygen therapy in intensive care is required to enable future interventional studies. We aimed to describe current oxygenation practice in patients requiring ≥48 hours of mechanical ventilation (MV) at an academic tertiary referral centre. ⋯ Wide variability in the mean SpO2 and PaO2 was observed in patients with comparable ALI scores. Inspired oxygen therapy in these MV patients was 'liberal', with PaO2 and SpO2 values generally above 80 mmHg and 96% respectively. An interventional study comparing current practice to more conservative targets (PaO2≍60 to 65 mmHg and/or SpO2≍90 to 92%) appears possible.
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Anaesth Intensive Care · Jul 2013
Randomized Controlled Trial Comparative StudyEpidural versus continuous transversus abdominis plane catheter technique for postoperative analgesia after abdominal surgery.
Transversus abdominis plane block is an effective postoperative analgesic technique after abdominal surgery, but no study has compared continuous transversus abdominis plane block with continuous epidural analgesia. We designed a randomised controlled trial comparing these techniques for major abdominal surgery. Patients in the epidural group received a bolus of 8 to 15 ml of ropivacaine 0.2% and an infusion of 5 to 15 ml/hour and the transversus abdominis plane block group a bolus dose of 20 ml of ropivacaine 0.375% bilaterally and an infusion of 0.2% ropivacaine 8 ml/hour bilaterally, for three days. ⋯ No differences were found in regards to point pain scores or scores over time, either immediately postoperatively or in surgical wards; total fentanyl requirement and Likert satisfaction scores were also similar in both groups. In this underpowered study we found comparable results between continuous transversus abdominis plane technique and epidural analgesia in regard to pain, analgesic use and satisfaction after abdominal surgery. To confirm this finding, randomised trials with larger numbers of participants are needed.
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Anaesth Intensive Care · Jul 2013
Asialoglycoprotein receptor scintigraphy with 99mTc-galactosyl human serum albumin (99mTc-GSA) as an early predictor of survival in acute liver failure.
This study evaluated the usefulness of asialoglycoprotein receptor scintigraphy with 99mTc-galactosyl human serum albumin (99mTc-GSA scintigraphy) as an early predictor for prognosis of acute liver failure. Forty-eight patients with acute liver failure and without a past history of chronic liver disease were enrolled. Patients were divided into survival and non-survival groups by 28-day mortality. 99mTc-GSA scintigraphy to detect uptake ratio of the heart at 15 minutes to that at three minutes (HH15) and uptake ratio of the liver at 15 minutes to the liver plus the heart at 15 minutes (LHL15), and measurements of serum total bilirubin, hepatocyte growth factor and prothrombin time were performed immediately after the diagnosis of acute liver failure. ⋯ HH15 and LHL15 uptake ratios in the survival group were 0.670 and 0.875, and they were significantly lower and higher than those in the non-survival group, respectively. All patients with LHL15 <0.760 died, and the area under the receiver operating characteristic curve for LHL15 were significantly larger than the areas under the receiver operating characteristic curves of serum variables and model for end-stage liver disease score. In summary, in patients with acute liver failure without chronic liver disease, HH15 and LHL15 of 99mTc-GSA scintigraphy are more useful variables in predicting prognosis than serum variables and model for end-stage liver disease score.
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Anaesth Intensive Care · Jul 2013
Is comorbid status the best predictor of one-year mortality in patients with severe sepsis and sepsis with shock?
Understanding longer term outcomes in critically ill patients will assist treatment decisions, allocation of scarce resources and clinical research in that population. The aim of this study was to compare a well-validated means of determining comorbidity, the Charlson Comorbidity Score, to other verified risk stratification models in predicting one-year mortality and other outcomes in emergency department patients with severe sepsis and sepsis with shock. We conducted a planned subgroup analysis of a prospective observational study, the Critical Illness and Shock Study, in adult patients with sepsis meeting study criteria for critical illness. ⋯ For predicting one-year mortality, the area under the receiver-operating characteristic curve for age-weighted Charlson Comorbidity Score (0.71, 95% confidence interval 0.61 to 0.81) was at least as good or superior to other scoring systems analysed. The intensive care unit admission rate was 45% and the median hospital length-of-stay was eight days. We conclude that in patients who present to the emergency department with severe sepsis or sepsis with shock, age-weighted Charlson Comorbidity Score is a predictor of one-year mortality that is simple to calculate and at least as accurate as other validated scoring systems.
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Anaesth Intensive Care · Jul 2013
Decontamination of ultrasound equipment used for peripheral ultrasound-guided regional anaesthesia.
Portable ultrasound machines are frequently used in operating theatres for peripheral single-shot nerve block procedures. This equipment must be decontaminated by reducing the microbial load to a sufficient level to reduce the risk of nosocomial infection. In our institution we use a simple three-step decontamination protocol utilising 70% isopropyl alcohol as chemical disinfectant. ⋯ Of the remaining 15% (n=18), commensal organisms commonly found on skin, oral and environmental surfaces were isolated. Our results suggest that our decontamination protocol may be an effective, rapid and cost-effective method of cleaning ultrasound equipment used for peripheral invasive single-shot nerve blocks. Further guidance from national bodies is required to define appropriate cleaning protocols for these machines.