Anaesthesia and intensive care
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Anaesth Intensive Care · Jul 2021
Māori health outcomes in an intensive care unit in Aotearoa New Zealand.
Māori are the indigenous people of New Zealand, and suffer disparate health outcomes compared to non-Māori. Waikato District Health Board provides level III intensive care unit services to New Zealand's Midland region. In 2016, our institution formalised a corporate strategy to eliminate health inequities for Māori. ⋯ Our study found significant ethnic inequity in the intensive care unit for Māori, who require more renal replacement therapy and are over-represented in admissions, especially for trauma and sepsis. These findings suggest upstream factors increasing Māori risk for critical illness. There was no difference in mortality outcomes.
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Anaesth Intensive Care · Jul 2021
Australian perspective on Fourth Consensus Guidelines for the management of postoperative nausea and vomiting.
This is a summary document that provides an Australian perspective on the Fourth Consensus Guidelines for the management of postoperative nausea and vomiting. The Australian Society of Anaesthetists has endorsed the Fourth Consensus Guidelines for the management of postoperative nausea and vomiting and has written this document with permission from the authors and the American Society for Enhanced Recovery to provide an Australia-specific summary.
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Anaesth Intensive Care · Jul 2021
Audit of low tidal volume ventilation in patients with hypoxic respiratory failure in a tertiary Australian intensive care unit.
A low tidal volume ventilation (LTVV) strategy improves outcomes in patients with acute respiratory distress syndrome (ARDS). Subsequently, a LTVV strategy has become the standard of care for patients receiving mechanical ventilation. This strategy is poorly adhered to within intensive care units (ICUs). ⋯ There was poor adherence to LTVV strategy in patients with hypoxic respiratory failure, which was associated with an increase in patient mortality. An electronic medical record intervention was successful in producing change, but this was not sustainable over time. Clinician ventilation prescribing habits were based on numerical simplicity rather than evidence-based practice.
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Anaesth Intensive Care · Jul 2021
Transtracheal jet ventilation in a general tertiary hospital: A 7-year audit.
Airway management in patients presenting with severe airway obstruction can present a challenge to the anaesthetist, as conventional difficult airway pathways are often inappropriate. The use of a transtracheal jet cannula is an alternative means of airway securement, but lack of familiarity has limited its use in general tertiary hospitals. We report a retrospective audit of the use of transtracheal jet ventilation in a general tertiary healthcare centre over the past seven years, with a total of 50 patients with severe airway compromise undergoing pharyngolaryngeal surgery. ⋯ We conclude that transtracheal jet ventilation for high-risk pharyngolaryngeal surgery can be performed using a high frequency jet ventilator, with a high rate of success and only minor complications. Cannulation of the trachea below the cricothyroid membrane is feasible but more challenging. Low-flow apnoeic oxygenation through the transtracheal jet ventilation cannula maintains oxygenation during initial surgical airway manipulation.