Anaesthesia and intensive care
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Anaesth Intensive Care · Jul 2008
The performance of Dräger Oxylog ventilators at simulated altitude.
Ventilated patients frequently require transport by air in a hypobaric environment. Previous studies have demonstrated significant changes in the performance of ventilators with changes in cabin pressure (altitude) but no studies have been published on the function of modem ventilators at altitude. This experiment set out to evaluate ventilatory parameters (tidal volume and respiratory rate) of three commonly used transport ventilators (the Dräger Oxylog 1000, 2000 and 3000) in a simulated hypobaric environment. ⋯ Tidal volume and respiratory rate remained constant with the Oxylog 3000 over the same range of altitudes. Changes were consistent with each ventilator regardless of oxygen content or lung model. It is important that clinicians involved in critical care transport in a hypobaric environment are aware that individual ventilators perform differently at altitude and that they are aware of the characteristics of the particular ventilator that they are using.
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Historically, anaesthetic equipment manufacturers used a number of differently-sized connectors in anaesthetic breathing systems. This gave rise to the potentially dangerous possibility of mismatched taper connections and a failure to create a gas-tight breathing system capable of ventilating a patient. ⋯ The problem was aggravated by a move to adopt a slightly different International Standards Organisation design. By the time that universally-interchangeable connectors were widespread twenty years later disposable breathing systems had replaced the old, heavy metal connectors.
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Anaesth Intensive Care · Jul 2008
Sequential organ failure assessment score and comorbidity: valuable prognostic indicators in chronically critically ill patients.
Chronically critically ill patients are defined as those who survive initial life-threatening, possibly reversible organ failure(s) but are unable to recover rapidly to a point at which they are fully independent of life support. Accordingly, these patients require mechanical ventilation and medical resources for a long time in an intensive care unit (ICU). The present study analysed demographic, clinical and survival data of chronically critically ill patients, to identify condition(s) related to poor prognosis. ⋯ Non-survivors had a significantly higher Sequential Organ Failure Assessment (SOFA) score than survivors on day 21 of ICU admission, as well as having significantly lower changes of SOFA scores between days three and 21. Multivariate analysis demonstrated that the SOFA score on day 21 and the Charlson Comorbidity Index were the best predictor of survival for six months after hospital discharge. The SOFA score on day 21 and comorbidity in the ICU appears to be a valuable prognostic indicators in chronically critically ill patients.
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Anaesth Intensive Care · Jul 2008
Historical ArticleHistory of analgesia and regional anaesthesia through philately.
Medical philately is the study of postage stamps commemorating events and pioneers in the field of medicine. In 1929, Dr Fielding H. ⋯ His prediction has hardly come to fruition in the years since then, with medical philatelic articles rarely seen in the medical press. The history of pain medicine is unique, diverse and extremely interesting, with many chemists, physicists, philosophers, contributing in their own way over centuries to pave the path to present day pain medicine.
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Anaesth Intensive Care · Jul 2008
Review Historical ArticleThe origins of the sniffing position and the Three Axes Alignment Theory for direct laryngoscopy.
The Three Axes Alignment Theory and the sniffing position for direct laryngoscopy are the anatomical basis for direct laryngoscopy. This position has been one of the hallmarks of airway management and yet its development is based on a small number of descriptive texts published between 1852 and 1944. This paper explores the origins of direct laryngoscopy and how the sniffing position came to be described. The seemingly incongruent techniques of the rigid bronchoscopist and direct laryngoscopist are discussed from an historical perspective.