Anaesthesia and intensive care
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Anaesth Intensive Care · Nov 2011
Comparative StudyA comparison of the forces applied to a manikin during laryngoscopy with the GlideScope and Macintosh laryngoscopes.
The force applied during laryngoscopy can cause local tissue trauma and can induce cardiovascular responses and cervical spine movement in susceptible patients. Previous studies have identified numerous operator and patient factors that influence the amount of force applied during intubation. There are few studies evaluating the effect of different laryngoscope blades and no study involving video laryngoscopes. ⋯ Compared to Macintosh intubations, the GlideScope intubations had equal or superior views of the glottis with 55%, 58% and 66% lower median peak, average and impulse forces applied to the tongue base. The distal sensor registered the most force in both devices and the force distribution pattern was similar between the devices. The findings suggest that the GlideScope requires less force for similar or better laryngoscopic views, at least in a manikin model.
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Anaesth Intensive Care · Nov 2011
Comparative StudyComparison of fluid compartments and fluid responsiveness in septic and non-septic patients.
Our objective was to study the response to a fluid load in patients with and without septic shock, the relationship between the response and baseline fluid distributions and the ratios of the various compartments. A total of 18 patients with septic shock and 14 control patients without pathologies that increase capillary permeability were evaluated prospectively. We used transpulmonary thermodilution to measure the extravascular lung water index, intrathoracic blood volume index and pulmonary blood volume. ⋯ The pulmonary permeability ratios did not correlate with the systemic permeability ratios, and in the septic group, the percentage volume retained in the intrathoracic blood volumes after fluid loading did not correlate with the systemic permeability ratios. Septic shock can cause a redistribution of fluids. Fluid administration in these patients produced a minimal increase in intrathoracic blood volume, and the percentage of volume retained in this space was not correlated with the interstitial/plasma volume ratio.
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Anaesth Intensive Care · Nov 2011
Benefits and risks associated with the R100 high frequency oscillatory ventilator for patients with severe hypoxaemic respiratory failure.
High frequency oscillatory ventilation has been shown to improve oxygenation of patients with severe respiratory failure. This prospective study examined the potential benefits and risks of the latest generation high frequency oscillatory ventilator (R100, Metran, Saitama, Japan), initiated when the target oxygenation could not be achieved by conventional mechanical ventilation in adult patients with severe hypoxaemic respiratory failure. Thirty-six patients with severe respiratory failure treated with the R100 high frequency oscillatory ventilator were considered. ⋯ Of the 36 patients included in the study (including one who had developed pneumothorax before high frequency oscillatory ventilation), 12 (33%) developed barotrauma during the course of their intensive care unit stay. In the multivariate analysis, only exacerbation of interstitial pneumonia was a significant risk factor for barotrauma. In summary, the latest generation high frequency oscillatory ventilator could improve oxygenation in adult patients with life-threatening hypoxaemic respiratory failure but the incidence of barotrauma was substantial.
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Anaesth Intensive Care · Nov 2011
Case ReportsAcute dapsone overdose: the effects of continuous veno-venous haemofiltration on the elimination of dapsone.
A 15-year-old girl presented after intentional ingestion of dapsone (7.2 g) and small quantities of azathioprine, methotrexate and prednisolone. The resulting methaemoglobinaemia and lactic acidosis persisted despite treatment with methylene blue, multiple-dose activated charcoal and ascorbic acid. ⋯ The rate of elimination of dapsone was over three times higher during, compared to after, continuous veno-venous haemofiltration. Continuous renal replacement therapy successfully reduced toxic dapsone concentrations in this patient with a good outcome.
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Anaesth Intensive Care · Nov 2011
Optimal dose of vancomycin for treating methicillin-resistant Staphylococcus aureus pneumonia in critically ill patients.
A prospective cohort study was performed to determine the optimal dose of vancomycin to maintain a serum trough concentration of at least 15 to 20 mg/l and to assess the efficacy of this target vancomycin concentration in the treatment of methicillin-resistant Staphylococcus aureus pneumonia. Vancomycin pharmacokinetic parameters were estimated using a CAPSIL software program from serum concentrations of 141 patients with pneumonia treated with vancomycin, regardless of methicillin-resistant Staphylococcus aureus status, at a 28-bed medical intensive care unit. ⋯ More than 70% of patients failed to reach the recommended therapeutic serum trough concentrations: a higher dose of vancomycin is necessary to maintain serum trough concentration at 15 to 20 mg/l, particularly in critically ill patients with creatinine clearance above 60 ml/minute and in those on intermittent haemodialysis. Among patients with methicillin-resistant Staphylococcus aureus pneumonia, no significant differences were observed in the treatment success rate, length of intensive care unit stay, and intensive care unit mortality rate between patients with vancomycin trough concentrations of >20 mg/l, 15 to 20 mg/l and <15 mg/l.