Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Aug 2011
Case ReportsParatracheal placement of orotracheal tube: a complication when aborting percutaneous tracheotomy.
Percutaneous dilatational tracheotomies (PT) are commonly performed in the ICU. The procedure carries the risk of complications, among them severe events as loss of airway or pneumothorax. In this case report we describe complications related to a PT procedure in the ICU. ⋯ Poor visual conditions may occur during PT because of bleeding. Importantly, there is a risk for the ET to exit an incision in the trachea when reintubating during a PT procedure, or after decannulation. This can be prevented using digital occlusion of the tracheal opening.
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Acta Anaesthesiol Scand · Aug 2011
Randomized Controlled Trial Multicenter StudyScandinavian glutamine trial: a pragmatic multi-centre randomised clinical trial of intensive care unit patients.
Low plasma glutamine concentration is an independent prognostic factor for an unfavourable outcome in the intensive care unit (ICU). Intravenous (i.v.) supplementation with glutamine is reported to improve outcome. In a multi-centric, double-blinded, controlled, randomised, pragmatic clinical trial of i.v. glutamine supplementation for ICU patients, we investigated outcomes regarding sequential organ failure assessment (SOFA) scores and mortality. The hypothesis was that the change in the SOFA score would be improved by glutamine supplementation. ⋯ In summary, a reduced ICU mortality was observed during i.v. glutamine supplementation in the PP group. The pragmatic design of the study makes the results representative for a broad range of ICU patients.
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Acta Anaesthesiol Scand · Aug 2011
ReviewHeart rate variability: a diagnostic and prognostic tool in anesthesia and intensive care.
The autonomic nervous system (ANS) plays an important role in the human response to various internal and external stimuli, which can modify homeostasis, and exerts a tight control on essential functions such as circulation, respiration, thermoregulation and hormonal secretion. ANS dysfunction may complicate the perioperative course in the surgical patient undergoing anesthesia, increasing morbidity and mortality, and, therefore, it should be considered as an additional risk factor during pre-operative evaluation. Furthermore, ANS dysfunction may complicate the clinical course of critically ill patients admitted to intensive care units, in the case of trauma, sepsis, neurologic disorders and cardiovascular diseases, and its occurrence adversely affects the outcome. ⋯ Measurement of heart rate variability (HRV) is an easily accessible window into autonomic activity. It is a low-cost, non-invasive and simple to perform method reflecting the balance of the ANS regulation of the heart rate and offers the opportunity to detect the presence of autonomic neuropathy complicating several illnesses. The present review provides anesthesiologists and intensivists with a comprehensive summary of the possible clinical implications of HRV measurements, suggesting that autonomic dysfunction testing could potentially represent a diagnostic and prognostic tool in the care of patients both in the perioperative setting as well as in the critical care arena.
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Acta Anaesthesiol Scand · Aug 2011
The intensive care delirium screening checklist: translation and reliability testing in a Swedish ICU.
The view of delirium has changed considerably over the last decade, and delirium is now a very topical issue within the intensive care unit (ICU) setting. Delirium has proved to be common in critically ill patients and is manifested as acute changes in mental status with reduced cognitive ability, incoherent thought patterns, impaired consciousness, agitation and acute confusion. In order to be able to prevent, identify and alleviate problems related to delirium it is important that validated instruments for delirium screening are implemented and evaluated. The aim of this study was to translate the Intensive Care Delirium Screening Checklist (ICDSC) into Swedish and test the inter-rater reliability in a Swedish general ICU setting. ⋯ The result of this study indicates that the Swedish version of the ICDSC scale has a very good inter-rater reliability. The high inter-rater reliability and the ease of administration make the ICDSC scale applicable for delirium screening in a Swedish ICU setting.
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Acta Anaesthesiol Scand · Aug 2011
Early detection of the graft failure after pediatric liver transplantation: a Bergamo experience.
Effective indicators of the early graft failure after pediatric liver transplantation are currently a crucial question. The aim of this study was to analyze retrospectively laboratory parameters that may help anticipate an early graft loss (GL). ⋯ This study suggests that routine blood tests may help to anticipate an early loss of liver grafts in children after transplantation and may improve our diagnostic investigation in the case of thrombosis suspicion. Further validation by a prospective study is needed to carefully assess the sensitivity and specificity of the identified criteria.