Articles: function.
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Anesthesia and analgesia · Oct 2014
The Effect and Duration of Prophylactic Platelet Transfusions Before Insertion of a Central Venous Catheter in Patients with Bone Marrow Failure Evaluated with Point-of-Care Methods and Flow Cytometry.
Patients with bone marrow failure and severe thrombocytopenia are frequently given prophylactic platelet transfusion before interventions. The clinical effects of such transfusions, however, are poorly defined. We performed a prospective observational study on patients with bone marrow failure scheduled for prophylactic platelet transfusion before the insertion of a central venous catheter. The objectives were to evaluate the effect and duration of prophylactic platelet transfusions on central venous catheter insertion in thrombocytopenic patients with bone marrow failure. ⋯ Prophylactic platelet transfusions in thrombocytopenic patients with bone marrow failure improve hemostatic parameters on ROTEM and Multiplate by increasing the number of platelets, and not through enhancement of platelet function. Improved clotting parameters on ROTEM and platelet aggregation on Multiplate appear to persist between 1 and 4 hours after transfusion.
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Critical care medicine · Oct 2014
Basic Critical Care Echocardiography by Pulmonary Fellows: Learning Trajectory and Prognostic Impact Using a Minimally Resourced Training Model.
The spread of basic critical care echocardiography may be limited by training resources. Another barrier is the lack of information about the learning trajectory and prognostic impact of individual basic critical care echocardiography domains like acute cor pulmonale determination and left ventricular function estimation. We thus developed a minimally resourced training model and studied the latter outcomes. ⋯ Basic critical care echocardiography training using minimal resources is feasible. New trainees can achieve reasonable competency in most basic critical care echocardiography domains after performing about 30 examinations within the first year. The relatively high prevalence of abnormalities and the significant association of acute cor pulmonale with ICU mortality support the need for basic critical care echocardiography training.
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This case report illustrates the importance of proper assessment, management, and creation of an emergent surgical airway. Assessment after the establishment of surgical airways should include confirmation of correct surgical site and appropriate location and depth of tracheostomy, tracheal tube, or catheter placement within the trachea. Supraglottic surgical airway access, as occurred in this case, can lead to laryngotracheal and esophageal injury. Early recognition and appropriate management of this complication can increase the likelihood of preservation of voice and airway function and minimize the extent of esophageal injury.
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Left atrial pressure and its surrogate, pulmonary capillary wedge pressure (PCWP), are important for determining diastolic function. The role of transthoracic echocardiography (TTE) in assessing diastolic function is well established in awake subjects. The objective was to assess the accuracy of predicting PCWP by TTE and transesophageal echocardiography (TEE) during coronary artery surgery. ⋯ Doppler assessment of PCWP was neither sensitive nor specific enough to be clinically useful in anesthetized patients with mechanical ventilation. The fixed curve pattern of the interatrial septum was the best predictor of raised PCWP.
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Minerva anestesiologica · Oct 2014
Dysnatremia on intensive care unit admission is a stronger risk factor when associated with organ dysfunction.
Dysnatremia present at the time of intensive care unit (ICU) admission is associated with mortality. In this study, we investigated the epidemiology of dysnatremia present on ICU admission and the impact of organ dysfunction on the association between dysnatremia and mortality. We hypothesized that dysnatremia comorbid with organ dysfunction is associated with higher risk of mortality. ⋯ Below 125 and above 150 mmol/L sodium levels at ICU admission are risk factors for higher mortality rates in patients with comorbid organ dysfunction. The effect of dysnatremia on mortality is observed when organ dysfunction is present.