Anaesthesia and intensive care
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Anaesth Intensive Care · Oct 2007
Multicenter StudyAnticoagulation, bleeding and blood transfusion practices in Australasian cardiac surgical practice.
We surveyed contemporary Australasian cardiac surgical and anaesthetic practice, focusing on antiplatelet and antifibrinolytic therapies and blood transfusion practices. The cohort included 499 sequential adult cardiac surgical patients in 12 Australasian teaching hospitals. A total of 282 (57%) patients received red cell or component transfusion. ⋯ Despite frequent (67%) use of antifibrinolytic therapy, there was a marked variability in red cell transfusion rates between centres (range 17 to 79%, P < 0.001). This suggests opportunities for improvement in implementation of guidelines and effective blood-sparing interventions. Many patients presenting for surgery receive antiplatelet and/or antifibrinolytic therapy, yet the subsequent benefits and risks remain unclear.
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Anaesth Intensive Care · Aug 2007
Multicenter StudyAfter-hours discharge from intensive care increases the risk of readmission and death.
Despite reports showing night discharge from an intensive care unit (ICU) is associated with increased mortality, it is unknown if this has resulted in changes in practice in recent years. Our aim was to determine prevalence, trends and effect on patient outcome of discharge timing from ICU throughout Australia and New Zealand. Two datasets from the Australian and New Zealand Intensive Care Society Adult Patient Database (ANZICS APD) were examined: (1) All submissions to the APD from 1.1.2003 to 31.12.2004 to determine contemporary practices. (2) Forty hospitals which had submitted continuous data between 1.1.2000 and 31.12.2004 to determine trends in practice over time. ⋯ After-hours discharge from ICU is associated with increased risk of death and readmission to ICU. It has become more frequent. The risk of death increases as more after-hours discharges occur.
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Anaesth Intensive Care · Aug 2007
Multicenter StudyAirway management equipment in a metropolitan region: an audit.
Difficult airway equipment containers are commonly found in operating rooms, but the availability of airway equipment beyond that environment is unknown. Using the Difficult Airway Society (U. K.) and American Society of Anesthesiologists' guidelines, we conducted an inspection audit of airway equipment at all anaesthetic sites in our region. ⋯ One third of the items with an expiry date were expired. Quality control and implementation of airway guidelines could rectify these deficiencies. Anaesthesia organisations should be encouraged to publish detailed equipment guidelines.
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Anaesth Intensive Care · Dec 2006
Multicenter StudyNear-hanging as presenting to hospitals in Queensland: recommendations for practice.
Near-hanging is an increasing presentation to hospitals in Australasia. We reviewed the clinical management and outcome of these patients as they presented to public hospitals in Queensland. A retrospective clinical record audit was made at five public hospitals between 1991 and 2000. ⋯ Near-hanging presenting to hospital with a poor conscious state or even cardiac arrest can have a favourable clinical outcome. Radiological investigations are infrequently performed despite a low GCS precluding early accurate assessment. Given the general favourable outcome, an aggressive approach to searching for correctable injuries is recommended.
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Anaesth Intensive Care · Oct 2006
Multicenter StudyRelative adrenal insufficiency in etomidate-naïve patients with septic shock.
A recent study reported that 77% of patients with septic shock had relative adrenal insufficiency. However, all patients were mechanically ventilated and received high-dose inotropes. In addition, at least 24% had prior exposure to etomidate, a drug known to suppress adrenal function. ⋯ We conclude that the incidence of relative adrenal insufficiency in etomidate-naive septic shock patients was lower than observed in the steroid supplementation trial. Further, in those who fulfilled inclusion criteria for the trial, the incidence of relative adrenal insufficiency was half that reported by the trial. Our observations raise concerns about the generalizability of the findings of the above trial to etomidate-naïve patients.