Anaesthesia and intensive care
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Anaesth Intensive Care · Feb 2005
Clinical TrialThe influence of the Univent endotracheal tube on internal jugular vein cannulation.
This prospective clinical investigation assessed the effect of placement of a Univent tube on the anatomy of the internal jugular veins and the success of cannulation of the left internal jugular vein. After obtaining informed consent, 48 adult patients were enrolled. Of these, 42 patients were eligible and were divided into two groups: Univent tube (group U, n=21) and wire enforced endotracheal tube (group C, n=21). ⋯ There was a significant increase in the lateral diameter and a decrease in the cross-sectional area of the left internal jugular vein (t-test, P < 0.05). The first attempt at cannulation of the left internal jugular vein failed significantly more often in the Univent group (13/21 vs 5/21 in group C, Chi-square 6.22, P=0.025). Cannulation of the internal jugular vein before placement of the Univent tube, or placement with ultrasound guidance is suggested.
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Anaesth Intensive Care · Dec 2004
Comparative StudyWithholding and withdrawal of therapy in New Zealand intensive care units (ICUs): a survey of clinical directors.
Withdrawing and withholding life-support therapy in patients who are unlikely to survive despite treatment are common practices in intensive care units (ICUs). The literature suggests there is a large variation in practice between different ICUs in different parts of the world. We conducted a postal survey among all public ICUs in New Zealand to investigate the pattern of practice in withholding and withdrawal of therapy. ⋯ ICU nurses were more commonly involved in the decision making process in smaller ICUs (5 beds vs 10 beds, P = 0.03). The patient's pre-ICU quality of life, medical comorbidities, predicted mortality, predicted post-ICU quality of life, and the family's wishes were important factors in deciding whether ICU therapy would be withheld or withdrawn. Hospice ward or the patient's home was the preferred place for palliative care in 32% of the responses.
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Anaesth Intensive Care · Dec 2004
Comparative StudyBloodless intensive care: a case series and review of Jehovah's Witnesses in ICU.
The objective of this study was to assess the outcome of Jehovah's Witness (JW) patients admitted to a major Australasian ICU and to review the literature regarding the management of critically ill Jehovah's Witness patients. All Jehovah's Witness patients admitted to the ICU between January 1999 and September 2003 were identified from a prospective database. Their ICU mortality, APACHE II scores, APACHE II risk of death and ICU length of stay were compared to the general ICU population. ⋯ The lowest Hb recorded in a survivor was 23 g/l. Jehovah's Witness patients appear to be an uncommon patient population in a major Australasian ICU but are not over-represented when compared with their prevalence in the community. Despite similar severity of illness scores and predicted mortality to those in the general ICU population, there was a trend towards higher mortality in Jehovah's Witness patients.
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Anaesth Intensive Care · Dec 2004
Blood usage in an Australian intensive care unit: have we met best practice goals?
The transfusion of blood products, especially red cell concentrates, in critically ill patients is controversial and benefits of red cell concentrate transfusion in these patients have not been clearly demonstrated. We performed a prospective observational study to compare best evidence to actual practice of red cell concentrate and other blood product administration in an intensive care unit (ICU) in a university-associated tertiary hospital. All primary admissions during a 28-day period were included in the study and data collected included transfusion of red cells and blood products, patient demographics and ICU and hospital outcome. ⋯ Univariate analysis showed no significant difference in mortality between patients who did or did not receive red cell concentrate transfusion (P = 0.17). However, red cell concentrate transfusion was associated with a reduced adjusted mortality both in ICU (OR 0.13, 95% CI 0.02-0.73) and in hospital at 28 days (OR 0.10, 95% CI 0.02-0.58). The low red cell concentrate and blood product usage in our ICU were consistent with restrictive transfusion practice and selective red cell concentrate transfusion was associated with reduced mortality.
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Anaesth Intensive Care · Dec 2004
Comparative StudyDexmedetomidine infusion without loading dose in surgical patients requiring mechanical ventilation: haemodynamic effects and efficacy.
We investigated the haemodynamic effects and the efficacy of a continuous infusion of dexmedetomidine without a loading dose in 50 patients having had cardiac surgery (n = 33), complex major surgery (n = 9) and multiple trauma (n = 8). The mean age was 60 (+/- 16) years, and the mean APACHE II score was 13 (+/- 5). Dexmedetomidine was commenced at an initial rate of 0.2 to 0.4 microg/kg/h (depending on whether anaesthetic or sedative agents had already been used) and rescue analgesia and sedation was administered with morphine and midazolam respectively. ⋯ The systolic blood pressure fell from 125 (+/- 22) mmHg to a low of 112 (+/- 20) mmHg at 1.5 hours with minimal change afterwards. Dexmedetomidine was an effective sedative and analgesic in this group of complex surgical and trauma patients with pronounced benefit in the cardiac surgery group. Omitting the loading dose avoided undesirable haemodynamic effects without compromising sedation and analgesia.