Anaesthesia
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Bottom-up costs of sedative, analgesic and neuromuscular blocking drugs used in the intensive care unit have not been reported. We performed a prospective audit of the cost of these drugs using a bottom-up approach by prospectively recording the daily amount of drugs administered to patients over a 3-month period. Of 172 admissions, complete data were collected for 155 (92%). ⋯ Ninety-four per cent of the cost was for drugs administered to the 50% of patients who stayed in the intensive care unit longer than 48 h. The median (interquartile range [range]) cost per day was 9.30 pounds sterling (3.60-20.10 [0-61.20]). This represents less than 1% of reported total daily cost of intensive care per patient.
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Infusion devices for continuous and precise drug administration are indispensable tools in anaesthesia and critical care medicine. Problems such as start-up delays, non-continuous flow and susceptibility to hydrostatic pressure changes at low infusion rates resulting in accidental bolus release or prolonged flow interruption are inherent to current infusion technology. ⋯ The performance of the MVIP prototype has been evaluated and compared with standard syringe infusion pump assemblies. The novel MVIP concept has thereby proven to eliminate most problems during infusion start-up, steady state flow and vertical pump displacement, and has the potential of revolutionising infusion technology and setting a new dimension in patient safety.
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Comparative Study Clinical Trial Controlled Clinical Trial
Continuous assessment of right ventricular ejection fraction: new pulmonary artery catheter versus transoesophageal echocardiography.
In 25 cardiac surgical patients, right ventricular ejection fraction was continuously measured with a new pulmonary artery catheter and transoesophageal echocardiography, scanning the 'fractional area change' in a standardised transatrial cross section area. Measurements were recorded at three predefined time points (pre-, intra-, and postoperatively). ⋯ Bias and precision significantly improved when the heart rate was less than 100 beats.min(-1), pulmonary artery pressures were low and cardiac performance adequate. In conclusion, the new continuous pulmonary artery catheter system appears to be a valid and useful bedside monitoring device in the haemodynamic management of critically ill patients.
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Alterations of electrolytes and albumin cause metabolic acid-base disorders. It is unclear, however, to what degree these plasma components affect the overall metabolic acid-base state in the course of critical illness. We performed serial analyses of the metabolic acid-base state in 30 critically ill patients over the course of 1 week. ⋯ Changes in serum chloride and unmeasured anions were responsible for changes of 41% and 22% in the metabolic acid-base state, respectively. Sodium and albumin played a minor role. In conclusion, chloride is the major determinant of metabolic acid-base state in critical illness.
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Randomized Controlled Trial Clinical Trial
Effect of xenon anaesthesia on accuracy of cardiac output measurement using partial CO2 rebreathing.
Cardiac output (CO) determination based on partial CO(2) rebreathing has recently been introduced into clinical practice. The determination of flow is crucial for exact CO readings and the physical properties of xenon, i.e. high density and viscosity, may influence flow readings. This study compared echocardiography-derived CO measurements with the partial rebreathing method during total intravenous (TIVA) vs. xenon-based anaesthesia. ⋯ Xe -4.0 +/- 2.1 l.min(-1)). In the TIVA group, bias and precision after declamping increased significantly (P < 0.01) compared to all time points except baseline. In its current application, the NICO cardiac output monitor appears to be inappropriate for determination of CO during xenon based anaesthesia.