Anaesthesia and intensive care
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Anaesth Intensive Care · Jan 2008
The use of epidural analgesia in a New Zealand tertiary hospital before and after publication of the MASTER study.
We audited the total number of perioperative epidural techniques performed at Christchurch Hospital, New Zealand, for three years, before and after The Lancet published the MASTER Anaesthesia Trial in 2002. We also looked specifically at the number of epidural anaesthetic and analgesic techniques performed in combination with general anaesthesia for colonic surgery over the same period. In both cases we found a statistically significant fall in epidural rate in the years after the publication (P < 0.001). A subsequent survey of local specialist anaesthetists, who have worked throughout this period, revealed the majority (75%) were knowingly performing fewer epidural techniques and that the findings of the MASTER Anaesthesia Trial had influenced their decisions.
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Anaesth Intensive Care · Jan 2008
Safety of percutaneous tracheostomy in obese critically ill patients: a prospective cohort study.
Obesity has been described as a relative contraindication for percutaneous tracheostomy. The objective of our study was to examine the safety and complications of percutaneous tracheostomy in obese patients. We conducted a prospective cohort study of all consecutive patients who underwent percutaneous tracheostomy at a tertiary medical-surgical intensive care unit between May 2004 and October 2005. ⋯ Major complications were significantly higher in obese patients (12% vs. 2%, P = 0.04), while the rate of minor complications was not significantly different between the two groups. There were no instances of death or pneumothorax, subcutaneous emphysema or need for surgical intervention during or in the postoperative period in either group. Our study suggests that percutaneous tracheostomy can be performed safely in the majority of obese patients.
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Anaesth Intensive Care · Jan 2008
Pre-existing cardiac disease, troponin I elevation and mortality in patients with severe sepsis and septic shock.
A prospective, observational study was undertaken to determine the frequency of troponin I elevation and the incidence of pre-existing cardiac disease in patients with severe sepsis and septic shock, and to determine their relationship to mortality. The setting was the surgical intensive care unit of a tertiary care medical centre. Sixty-six consecutive patients admitted with severe sepsis or septic shock requiring pulmonary artery catheterisation for haemodynamic monitoring were studied. ⋯ Troponin I elevation alone was not associated with increased mortality. We conclude that pre-existing cardiac disease and elevated troponin I are commonly found in surgical patients with severe sepsis and septic shock. In our study, pre-existing cardiac disease, and not troponin I elevation, was associated with increased mortality.
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Anaesth Intensive Care · Jan 2008
Attitudes towards and evaluation of medical emergency teams: a survey of trainees in intensive care medicine.
A survey was conducted to explore the perception of intensive care registrars on the impact of activities outside the intensive care unit (ICU), particularly in medical emergency teams, on their training and the care of patients. An anonymous mail-out survey was sent to 356 trainees registered with the Joint Faculty of Intensive Care Medicine, half of whom were determined to be involved in ICU duties. No patients were involved and respondents participated voluntarily. ⋯ Sixty-six percent of respondents reported that medical emergency team involvement had a positive effect on training but 77% reported little or no supervision of team duties. While trainees did not believe they spent too much time performing medical emergency team duties, the time spent on medical emergency teams at night, when ICU staffing levels are at their lowest, was the same as during the day. Serious concern was expressed about the negative impact of medical emergency team activities on their ability to care for ICU patients and the additional stress on ICU medical and nursing staff Overall, ICU trainees regarded participation in a medical emergency team as positive on training and on patient care in wards, but other results have resource implications for the provision of clinical emergency response systems, care of patients in ICUs and the training of the future intensive care workforce.
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Anaesth Intensive Care · Jan 2008
Case ReportsInsulin infusion via an intraosseous needle in diabetic ketoacidosis.
We report the successful management of a five-year-old child with severe diabetic ketoacidosis with dehydration, who received his initial resuscitative fluids and a continuous infusion of insulin via an intraosseous needle. The patient had presented to a remote community hospital and intravenous access could not be gained. The correction of hyperglycaemia and metabolic acidaemia was achieved at a rate comparable to intravenous therapy. ⋯ Alternatives to intravenous administration of insulin delivery recommended in such guidelines, such as the subcutaneous or intramuscular routes, may be less appropriate than the intraosseous route. This route can also allow resuscitation fluids and other drugs to be reliably administered in children with diabetic ketoacidosis and severe dehydration where intravenous access can not be attained. We suggest that the potential role of intraosseous access, when intravenous access can not be obtained, should be considered when management guidelines for paediatric diabetic ketoacidosis with dehydration are reviewed.