Anaesthesia and intensive care
-
Anaesth Intensive Care · Jul 2013
Prediction of fluid responsiveness using dynamic preload indices in patients undergoing robot-assisted surgery with pneumoperitoneum in the Trendelenburg position.
We investigated the abilities of pulse pressure variation (PPV) and stroke volume variation (SVV) to predict fluid responsiveness during robot-assisted laparoscopic prostatectomy, requiring pneumoperitoneum and the Trendelenburg position. In 42 patients without cardiopulmonary disease, PPV and SVV were measured before and after administration of 500 ml colloid under pneumoperitoneum combined with the steep Trendelenburg position (35°). Fluid responsiveness was defined as a ≥15% increase in stroke volume after the fluid loading measured using transoesophageal echocardiography. ⋯ A PPV of ≥9.5% identified responders with a sensitivity of 77.3% and a specificity of 90.0%, and a SVV of ≥9.5% also identified responders with a sensitivity of 77.3% and a specificity of 75.0%. The area under receiver operating characteristic curves for PPV and SVV were 0.87 (P <0.001) and 0.81 (P=0.001), respectively. The findings suggest that both PPV and SVV could be useful predictors of fluid responsiveness in patients without cardiopulmonary disease undergoing robotic laparoscopic surgery with pneumoperitoneum in the Trendelenberg position.
-
Anaesth Intensive Care · Jul 2013
Bedside pleuroscopy in the management of undiagnosed exudative pleural effusion with acute respiratory failure.
Pleuroscopy is indicated in patients with acute respiratory failure due to an unresolved exudative pleural effusion but it may not be possible to move such patients to the operating theatre or endoscopy room for pleuroscopy due to their critical condition. We report our experience of using flexible bronchoscopy for pleuroscopy to diagnose pleural effusion in patients with acute respiratory failure at the bedside in the intensive care unit. Before pleuroscopy, patients were placed in the lateral decubitus position. ⋯ A 16 Fr pigtail catheter was inserted for drainage after the pleuroscopy. Chest radiographs were routinely obtained after the procedure. In summary, this modified pleuroscopy technique can be performed at the bedside in an intensive care unit.
-
Anaesth Intensive Care · Jul 2013
Does left ventricular tissue Doppler peak systolic velocity (Sm) reflect cardiac output in the critically ill?
Cardiac output (CO) is dependent on a number of factors, in particular, the systolic function of the heart. Tissue Doppler (TD) is a modality in echocardiography that measures myocardial velocity and is related to contractility. TD can therefore be used to measure the systolic function of the heart. ⋯ Sm was weakly correlated to heart rate only in the normal group but not in the combined cohort. Our data confirms a weak to moderate correlation between Sm and CO, probably resulting from a positive correlation of Sm and stroke volume. This correlation is not strong enough to support the use of an individual's Sm to estimate CO in intensive care patients.
-
The laryngeal plug is a little-known device developed by Arthur E. Guedel in the 1930s. The device was an alternative to the inflatable cuff used on tracheal tubes. Guedel did not publish a description of the laryngeal plug and the most detailed description of it was published by Gilbert Troup, an Australian anaesthetist.
-
Anaesth Intensive Care · Jul 2013
Critical airway obstruction by mediastinal masses in the intensive care unit.
Critical airway obstruction is a dreaded complication of a mediastinal mass. The acute management is difficult and catastrophic outcomes have been reported. A total of 19 patients, aged between 13 and 69 years, who had critical major airway obstruction due to mediastinal mass requiring mechanical ventilation were reviewed. ⋯ Patients who had benign pathologies and lymphoma (n=6, 32%) were still alive after a mean follow-up period of six years (range 3 to 10) and those with metastatic disease died after a mean survival period of 3.3 months (range 1 to 9). In summary, critical major airway obstruction is caused by a heterogeneous group of mediastinal pathologies, and the definitive treatment and long-term prognosis of these patients are highly dependent on the underlying aetiology. Combining various therapeutic modalities can lead to successful separation of these patients from mechanical ventilation within a short period of time.