Anaesthesia and intensive care
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Anaesth Intensive Care · Sep 2008
Case ReportsAbdominal compartment syndrome complicating paediatric extracorporeal life support: diagnostic and therapeutic challenges.
We report three paediatric cases, and summarise the reported experience in two others, with cardiorespiratory failure requiring extracorporeal life support for which supportive pump flows could not be maintained due to abdominal compartment syndrome. In two of our patients, the mechanism of abdominal compartment syndrome was massive intra-abdominal fluid extravasation secondary to sepsis, while in the third, the mechanism was post-traumatic intra-abdominal haemorrhage. ⋯ Once correctable causes of inadequate venous cannula drainage have been excluded, abdominal compartment syndrome should be considered in any patient on extracorporeal life support with a taut abdomen and reduced venous return. If abdominal compartment syndrome can be proven or is strongly suspected, there may be a role for selective decompressive laparotomy.
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Anaesth Intensive Care · Sep 2008
Case ReportsAnterior ultrasound-guided superior hypogastric plexus neurolysis in pelvic cancer pain.
The hypogastric plexus block is classically performed by a posterior approach, but there are recent reports of a computed tomography-guided anterior approach for patients who have difficult access to the hypogastric plexus by the posterior approach. We present two patients who were successfully given ultrasound-guided superior hypogastric plexus block by an anterior approach. ⋯ We believe this block can be useful in cancer patients who are having difficulty in lying prone, because it is a bedside procedure performed in the supine position and it is less time-consuming. It also avoids the radiation exposure involved with a computed tomography-guided anterior approach.
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Anaesth Intensive Care · Sep 2008
How well do serum sTREM-1 measurements prognosticate in septic shock?
The soluble triggering receptor expressed on myeloid cells (sTREM)-1 has emerged as a potentially useful biomarker for the diagnosis of sepsis. This study aimed to evaluate the prognostic utility of serum sTREM-1 in septic shock, in comparison with that of procalcitonin measurements. Thirty-one consecutive patients in a tertiary medical intensive care unit with septic shock were studied. sTREM-1 levels in blood were measured using a modified immunoblot array technique on days one to three of intensive care unit admission. ⋯ In contrast, procalcitonin levels were significantly higher in nonsurvivors than in survivors on days two and three. A significant relationship also existed between procalcitonin levels and the other variables. In conclusion, this study found that the prognostic utility of serum sTREM-1 in septic shock is poor and that procalcitonin measurements perform better in this regard.
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Anaesth Intensive Care · Sep 2008
Glomerular hyperfiltration and albuminuria in critically ill patients.
Glomerular hyperfiltration and albuminuria are two pathological conditions that could alter renal drug elimination, but they have been rarely studied in a critical care setting. The aims of this descriptive, prospective study performed on 89 critically ill patients are to determine rates of glomerular hyperfiltration (main objective) and albuminuria (secondary objective). ⋯ Seventy-five percent showed albuminuria on admission, with rates remaining high throughout the week of the study. Since glomerular hyperfiltration as well as albuminuria are frequent pathophysiological conditions in critical care patients, the implications that these phenomena may have regarding drug elimination need further evaluation.