Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Mar 2013
What determines immediate use of invasive ventilation in patients with COPD?
The choice between non-invasive ventilation (NIV) and invasive ventilation in patients with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) may be irrational. The aim of this study was to examine those patient characteristics, and circumstances deemed important in the choice made between NIV and invasive ventilation in the intensive care unit (ICU). ⋯ Factors other than those deemed most important in guidelines appear to have an inappropriate influence on the choice between NIV and immediate intubation in AECOPD in the ICU. These factors must be identified to further increase the appropriate use of NIV.
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Acta Anaesthesiol Scand · Mar 2013
Case ReportsCardiac arrest during sulprostone administration--a case report.
Sulprostone, a synthetic prostaglandin analogue with potent uterotonic action, has been shown to have a low complication rate in a large series. We present a case of cardiac arrest in a parturient after Caesarean section during continuous infusion of intravenous sulprostone administered for atonic post-partum haemorrhage. She had cardiopulmonary resuscitation for 25 min before spontaneous circulation returned. The sequence of events, the results of investigations carried out during the intensive care unit stay, and the presence of multiple cardiovascular risk factors, suggest that sulprostone caused coronary spasm, bradycardia, and subsequent asystole, similar to other cases described in the literature.
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Acta Anaesthesiol Scand · Mar 2013
The incidence of delirium in Norwegian intensive care units; deep sedation makes assessment difficult.
Delirium in critically ill patients is associated with increased length of hospital stay, mortality and costs, and may lead to long-term cognitive impairment. It is often overlooked by clinicians if structured observation is not performed routinely. A national Norwegian survey reported that systematic screening and assessment of delirium were never or seldom performed. The purpose of this study was to test the usefulness of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and to describe the incidence of delirium in critically ill patients at two Norwegian hospitals. ⋯ Of the patients, 23% were classed as delirious (CAM-ICU positive) at least once during their stay. The CAM-ICU was difficult to use in patients with sedation so deep that they hardly gave eye contact and responded only weakly to verbal stimulation. Focusing on less sedation and further modifications to the CAM-ICU may benefit ICU patients in the future.
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Acta Anaesthesiol Scand · Mar 2013
Occurrence and determinants of poor response to short-term pre-operative erythropoietin treatment.
This study aimed to explore the occurrence and determinants of poor response to short-term pre-operative erythropoietin treatment and the effect of such poor response on transfusion in total hip arthroplasty patients. ⋯ Use of angiotensin II receptor antagonists and vitamin K antagonists, and having a high BMI were determinants of poor response to short-term pre-operative erythropoietin treatment in total hip arthroplasty patients. Poor responders had a higher risk for perioperative blood transfusion.