Anaesthesia and intensive care
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Anaesth Intensive Care · Feb 2007
Comparative StudyTrends in intra-aortic balloon counterpulsation: comparison of a 669 record Australian dataset with the multinational Benchmark Counterpulsation Outcomes Registry.
The aim of this study was to review and describe indications for intraaortic balloon counterpulsation (IABP) use and identify the impact these have on outcomes at an Australian cardiothoracic tertiary referral hospital. A secondary aim was comparison of the Australian practice with a large multinational IABP data registry. Patient demographics, IABP indication, IABP complication rate and mortality in 662 patients treated with IABP at The Prince Charles Hospital (TPCH), Brisbane, between January 1994 and December 2004 inclusive were compared with The Benchmark Counterpulsation Outcomes Registry. ⋯ TPCH indications for IABP were: weaning from cardiopulmonary bypass (34.2%); cardiogenic shock (24.4%); preoperative support (13%); catheter laboratory support (10.6%); refractory ventricular failure (7.3%); ischaemia related to intractable ventricular arrhythmias (4.5%); unstable refractory angina (4%); mechanical complications due to acute myocardial infarction (1.2%) and other (0.4%) (0.4% not reported). In comparison to Benchmark, IABP at TPCH demonstrated a prejudice toward intraoperative use (34.2% versus 16.6%; P < or = 0.0001) and an aversion to catheter laboratory support (10.6% versus 19%; P < or = 0.0001). TPCH and Benchmark IABP outcomes demonstrated comparable mortality (22% versus 20.8%; P = ns) but increased TPCH complications (10.3% vs. 6.2%; P < or = 0.0001) owing to a 2% difference in observed insertion site bleeding.
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Anaesth Intensive Care · Feb 2007
Case ReportsPurpura fulminans associated with Lactobacillus paracasei liver abscess.
Purpura fulminans is a rare but devastating haemorrhagic condition often associated with sepsis. Many different organisms have been implicated in the aetiology of purpura fulminans, most commonly Neisseria meningitidis and Streptococcus pneumoniae. We report a case of purpura fulminans associated with Lactobacillus paracasei liver abscess. Purpura fulminans has not previously been associated with this organism and specific bacteriological testing was used to exclude the presence of other species.
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Anaesth Intensive Care · Feb 2007
Survival and quality of life after prolonged intensive care unit stay.
There are few data on long-term outcomes in mixed groups of intensive care unit (ICU) patients with prolonged stays. We evaluated the relationship between length of stay in the ICU and long-term outcome in all patients admitted to our 31-bed department of medico-surgical intensive care over a one-year period who stayed in the department for more than 10 days (n = 189, 7% of all ICU admissions). Mortality increased with length of stay from 1 to 10 days (1 day 5%, 5 days 15%, 9 days 24%, 10 days 33%) but remained stable at about 35% for longer ICU stays. ⋯ In conclusion, in ICU patients, mortality increases with length of stay up to 10 days. Patients staying in the ICU for more than 10 days have a relatively good long-term survival. Most survivors have an acceptable quality of life.
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Anaesth Intensive Care · Feb 2007
Long-term neurological complications associated with surgery and peripheral nerve blockade: outcomes after 1065 consecutive blocks.
Peripheral nerve blockade is gaining popularity as an analgesic option for both upper or lower limb surgery. Published evidence supports the improved efficacy of regional techniques when compared to conventional opioid analgesia. The incidence of neurological deficit after surgery associated with peripheral nerve block is unclear. ⋯ Overall incidence of block-related neuropathy was 0.22%. Persistent postoperative neuropathy is a rare but serious complication of surgery associated with peripheral nerve block. Formal follow-up of all such blocks is recommended to assess causality and allow for early intervention.
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Anaesth Intensive Care · Feb 2007
Case ReportsAscites misdiagnosed as a left pleural effusion during cardiac surgery: case report and suggested echocardiographic features to differentiate these entities.
The spleen and ascitic fluid are rarely imaged by transoesophageal echocardiography. In this case perisplenic ascitic fluid was misdiagnosed as a left pleural effusion and led to unnecessary surgical opening of the left pleural space during aortic valve replacement. ⋯ Second, perisplenic ascitic fluid can be seen to communicate with a lateral space (unlike pleural fluid). Third, perisplenic ascitic fluid lies entirely lateral to the descending aorta (unlike pleural fluid).