Anaesthesia and intensive care
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Anaesth Intensive Care · Jun 2007
Outcome of patients who have therapy withheld or withdrawn in ICU.
Many deaths among patients treated in intensive care units (ICUs) occur following the withdrawal or withholding of life support. Following limitation of life support, most of these patients die in the ICU or ward after the decision to limit life support is made, although some may survive to hospital discharge. This study described the characteristics of patients who had life support limitations in ICU and their subsequent in-hospital and out-of-hospital survival using linked data from the state's death registry. ⋯ Of these nine patients who survived to hospital discharge, four died within 10 days of hospital discharge and a further two died within six months. There were two patients, both with significant neurological disabilities at hospital discharge, who survived for longer than three years after hospital discharge. Long-term survival in critically ill patients who had life support limitations was very rare in this ICU.
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Anaesth Intensive Care · Jun 2007
Case ReportsMycoplasma pneumoniae associated with Stevens Johnson syndrome.
We describe a case of Mycoplasma pneumoniae chest infection associated with Stevens Johnson syndrome. The patient had extensive epidermal bullous vesicles, oropharyngeal and genital ulceration and required prolonged ventilation due to respiratory failure. ⋯ Secondary skin reactions are common (20 to 25%), although few patients infected develop Stevens Johnson syndrome. It has been suggested that Mycoplasma pneumoniae may be the most common infectious cause of Stevens Johnson syndrome.
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Anaesth Intensive Care · Jun 2007
Case ReportsThe use of activated protein C in severe Plasmodium falciparum malaria.
A 56-year-old man presented to a peripheral hospital in New Zealand with severe Plasmodium falciparum malaria with cerebral involvement and subsequently developed multi-system organ failure. Activated protein C was used in an attempt to stop the cascade of events into multi-organ failure. Severe infection with P. falciparum is life-threatening and appears to activate a hypercoagulable state similar to that of severe sepsis. Activated protein C is currently used in the treatment of severe sepsis and may provide a new adjuvant therapy for severe P. falciparum malaria.
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Anaesth Intensive Care · Jun 2007
High thoracic epidural analgesia for cardiac surgery: an audit of 874 cases.
Despite clinical use for over 10 years, high thoracic epidural analgesia for cardiac surgery remains controversial, due to a perceived increased risk of epidural haematoma resulting from anticoagulation for cardiac pulmonary bypass. There are no sufficiently large randomised studies to address this question and few large case series reported. ⋯ There were no neurological complications attributable to epidural use. Our findings suggest that major neurological complications related to high thoracic epidural use during cardiac surgery are rare.
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Morphine is administered intrathecally alone or in combination with other drugs to provide spinal analgesia. Dose-finding studies have recommended 100 microg be used intrathecally to optimise analgesia and minimise side-effects for caesarean section and hip replacement surgery. Dilute solutions of morphine are generally not available, mandating preparation from a 10 mg/ml ampoule. ⋯ A single-step dilution technique using 0.1 ml of a solution diluted to 1.0 mg/ml was more accurate than when a double-dilution technique was used (P = 0.047). Given that dose-finding studies suggest that analgesia and side-effects vary at the dose range found in this study, we advocate the use of prediluted solutions. If dilution is to be performed a single-step dilution technique should be used.