Anaesthesia and intensive care
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Anaesth Intensive Care · May 2011
Multicenter StudyThe critical care costs of the influenza A/H1N1 2009 pandemic in Australia and New Zealand.
The aim of this study was to determine the critical care and associated hospital costs for 2009 influenza A/H1N1 patients admitted to intensive care units (ICU) in Australia and New Zealand during the southern hemisphere winter All 762 patients admitted to ICUs in Australian and New Zealand between 1 June and 31 August 2009 with confirmed 2009 H1N1 influenza A were included. Costs were assigned based on ICU and hospital length-of-stay, using data from a single Australian ICU which estimated the daily cost of an ICU bed, along with published costs for a ward bed. ⋯ A multivariate analysis found death was significantly associated with a reduction in the log of total costs, while the use of mechanical ventilation and ICU admission with viral pneumonitis/acute respiratory distress syndrome or secondary bacterial pneumonia were significantly associated with an increase in the log of total costs. The cost of 2009 H1N1 patients in ICU was significantly higher than the previously published costs for an average ICU admission, and the total cost of treating 2009 H1N1 patients in ICU admitted during winter 2009 was more than $65,000,000.
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Anaesth Intensive Care · May 2011
Meta AnalysisMeta-analysis of randomised controlled trials on daily sedation interruption for critically ill adult patients.
Sedation is often used to improve comfort, reduce anxiety and stress and to facilitate nursing care of critically ill patients in the intensive care unit. This meta-analysis examined the benefits and risks of daily sedation interruption in critically ill adult patients. ⋯ Daily sedation interruption was associated with a reduced risk of requiring tracheostomy (odds ratio 0.57, 95% confidence interval 0.35 to 0.92, P = 0.02; F = 3%) but not an increased risk of removal of the endotracheal tube by the patients (odds ratio 1.3, 95% confidence interval 0.41 to 4.10, P = 0.65; F = 49%). The current evidence suggests that daily sedation interruption appears to be safe, but the significant heterogeneity and small sample sizes of the existing studies suggest that large randomised controlled studies with long-term survival follow-up are needed before daily sedation interruption can be recommended as a standard sedation practice for critically ill adult patients.
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Anaesth Intensive Care · May 2011
ReviewDoes the pulmonary artery catheter still have a role in the perioperative period?
The pulmonary artery catheter (PAC) was introduced into clinical practice in the early 1970s. Its use quickly expanded beyond patients with acute myocardial infarction to critically ill patients in the intensive care unit. Increasingly, it was used in the perioperative period in patients having major cardiac and noncardiac surgery. ⋯ Despite these flaws, there is no clear evidence of benefit, nor harm, in cardiac, intensive care or perioperative patients. Selected indications for the PAC may remain, such as complex cardiac surgery or solid organ transplantation. However, its routine use is difficult to justify and increasingly, most of the haemodynamic data available from the PAC can be obtained less invasively with echocardiography.