Anaesthesia and intensive care
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Anaesth Intensive Care · Dec 2003
Randomized Controlled Trial Clinical TrialThe influence of a blood conserving device on anaemia in intensive care patients.
The contribution of iatrogenic blood loss through diagnostic testing to the anaemia of critical illness remains controversial. We measured the effect of an arterial line blood conservation device upon blood loss and anaemia in adult intensive care patients. This randomized controlled trial of 160 patients in a major Intensive Care Unit (ICU) compared a blood conservation device (Venous Arterial Blood Management Protection Plus, VAMP Plus system, Baxter Healthcare) (VAMP group) to a standard arterial pressure line set attached to an arterial catheter (control group). ⋯ Both groups had a similar (median [range]) change in Hb during ICU admission (VAMP-7 [-84 to +21] g/l; Control -4 [-67 to +40] g/l; P = 0.33). The VAMP patients lost significantly less blood for diagnostic testing while in ICU (VAMP 63 [0 to 787] ml; Control 133 [7 to 1227] ml; P = 0.001). We conclude that the VAMP Plus system significantly reduced iatrogenic blood loss in critically ill patients, but this reduction did not affect the fall in Hb that accompanies critical illness.
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A number of European studies have documented the ability of procalcitonin (PCT), a novel inflammatory marker, to discriminate patients with sepsis from those with other causes of systemic inflammatory response syndrome (SIRS). The aim of this study was to assess procalcitonin's performance in an Australian intensive care unit (ICU) setting to examine whether it could discriminate between these two conditions. One hundred and twenty-three consecutive adult ICU patients fulfilling criteria for SIRS were enlisted in the study. ⋯ Utilizing both tests resulted in a more sensitive screen than either one alone, while PCT was a more accurate diagnostic test for bacteraemia than CRP. The PCT value also differed between those who died in hospital and those who survived. Measurement of PCT alone or in combination with CRP can aid discrimination of septicaemia/bacteriemia with associated SIRS from non-infectious SIRS in an Australian ICU setting.
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Anaesth Intensive Care · Dec 2003
Decontamination issues and perceived reliability of the laryngoscope--a clinician's perspective.
The laryngoscope is identified as a potential vector for cross-infection. Case reports are presented, as are reports of bacterial and occult blood contamination of laryngoscope blades and handles. ⋯ Repeated decontamination of laryngoscope blades has resulted in a perceived decrease in reliability. This is reflected in a departmental survey where 86% of respondents consider the standard laryngoscope is only intermittently reliable and that there is room for improvement.
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Anaesth Intensive Care · Dec 2003
Severe cardiac failure associated with presumed jellyfish sting. Irukandji syndrome?
We present a retrospective review of twelve cases of Irukandji syndrome associated with pulmonary oedema. This is a life-threatening envenoming due to a presumed jellyfish sting throughout Northern Australia, although only one case occurred outside North Queensland. Patients presented with significant and ongoing pain, tachycardia and hypertension. ⋯ There was no death reported due to pulmonary oedema, but one patient died of intracerebral haemorrhage. We believe patients may develop a toxin associated cardiomyopathy, and jellyfish other than Carukia barnesi may be responsible. As there is confusion with nomenclature, Carukia barnesi should be known as the Barnes jellyfish, and the diagnosis of cardiotoxic marine envenoming is suggested for any patient who has been stung by a jellyfish, develops no or minimal skin markings, and develops cardiogenic pulmonary oedema associated with Irukandji syndrome.
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Anaesth Intensive Care · Dec 2003
Historical ArticleLocal anaesthesia--the early evolution of spinal needles.