Anaesthesia and intensive care
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Anaesth Intensive Care · Jul 2008
Randomized Controlled Trial Comparative StudyContinuous infusion of subcutaneous compared to intravenous insulin for tight glycaemic control in medical intensive care unit patients.
The aim of this randomised controlled study was to compare continuous subcutaneous insulin infusion using an insulin pump with the traditional continuous intravenous infusion method for tight glycaemic control. Sixty patients admitted to our University Hospital medical intensive care unit with an initial blood glucose level over 6.1 mmol/l, were enrolled and randomised into two treatment groups: the subcutaneous insulin group received continuous subcutaneous insulin infusion and the intravenous group received insulin by traditional intravenous infusion with infusers. Three patients died in the first 24 hours and were excluded from the final analysis. ⋯ According to Vogelzang's hyperglycaemic index, better glycaemic control was achieved in the subcutaneous insulin group while there was no significant difference in terms of hypoglycaemic events. Daily insulin bolus and infusion requirements were also significantly lower in the subcutaneous insulin group. Despite the small number of patients involved in this study in a medical intensive care unit, strict blood glucose control using a subcutaneous insulin pump was achieved more efficiently than the traditional intravenous infusion method without increasing hypoglycaemic events.
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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.
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Anaesth Intensive Care · Jul 2008
Randomized Controlled TrialThe effect of timing of application of positive end-expiratory pressure on oxygenation during one-lung ventilation.
Many studies have confirmed that applying positive end-expiratory pressure (PEEP) to the dependent lung during one-lung ventilation (OLV) improves oxygenation. Our purpose was to investigate the best time and level of PEEP application. Thirty patients undergoing thoracic surgery were randomised into three groups. ⋯ When PEEP was set to 10 cmH2O, the airway pressure increased significantly (P <0.05). These findings indicate that PEEP applied at the initial time of OLV improves oxygenation most beneficially. Five cmH2O PEEP may produce this beneficial effect without the increase in airway pressure associated with 10 cmH2O PEEP.
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Chlorhexidine is a widely used skin antisepsis preparation and is an ingredient in toothpaste and mouthwash. It is an especially effective antiseptic when combined with alcohol. Its antimicrobial effects persist because it is binds strongly to proteins in the skin and mucosa, making it an effective antiseptic ingredient for handwashing, skin preparation for surgery and the placement of intravascular access. ⋯ The incidence of contact dermatitis to chlorhexidine in atopic patients is approximately 2.5 to 5.4%. Acute hypersensitivity reactions to chlorhexidine are often not recognised and therefore may be underreported. This review discusses the pharmacology, microbiology, clinical applications and adverse effects of chlorhexidine.
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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.