Anaesthesia and intensive care
-
Anaesth Intensive Care · May 2009
ReviewPoint-of-care assessment of antiplatelet agents in the perioperative period: a review.
The aim of this paper was to review the strengths and limitations of current 'point-of-care' techniques for the detection of antiplatelet drug effects. The review was based on a Medline search for articles with key words related to "platelet function tests", "point-of-care", and "anaesthesia", published in English between January 1996 and September 2008. It was found that global assessments of 'haemostasis', such as the standard thrombelastograph, Sonoclot, Clot Signature Analyser and Hemodyne, are not specific for platelet function and are essentially insensitive to cyclooxygenase inhibitors (aspirin, non-steroidal anti-inflammatory drugs) and P2Y12 antagonists (ticlopidine, clopidogrel). ⋯ All three categories of devices detect G(p)II(b)/III(a) antagonists (abciximab, tirofiban, eptifibatide) activity, but not all provide quantitative assessments for monitoring therapy. The limitations appeared to be related to the complexity of platelet function, the multiple pathways of platelet activation, the wide interpatient variability in platelet responses and the interdependence between platelets and other aspects of coagulation. The strengths and limitations of point-of-care devices should be appreciated before they are used to assist clinical decision-making in the perioperative period.
-
Anaesth Intensive Care · May 2009
Comparative StudyLaboratory validation of the M-COVX metabolic module in measurement of oxygen uptake.
A practical method of breath-by-breath monitoring of metabolic gas exchange has previously been developed by GE Healthcare and can now be easily incorporated into existing anaesthetic and critical care monitoring (M-COVX). Previous research using this device has shown good accuracy and precision between the M-COVX measurements and a traditional measurement of gas uptake at the mouth and also against the reverse Fick method during cardiac surgery and critical care, but its accuracy in the paediatric situation and across a range of ventilatory settings awaits validation. We tested the M-COVX metabolic monitor in the laboratory comparing its measurement to a traditional Haldane transformation across a wide range of oxygen consumption values, from 50 ml/minute to just under 300 ml/minute, typical of those expected in anaesthetised adults and children. ⋯ Excellent linearity was found, by y = 0.96x + 0.5 ml/minute, r = 0.99. The device showed acceptable robustness to ventilatory changes examined, including changes in respiratory rate, I:E ratio, FiO2 up to 75% and simulated spontaneous breathing. However any induced leak from around the simulated endotracheal tube caused a significant error in paediatric scenarios.
-
Anaesth Intensive Care · May 2009
Comparative StudyA comparison of eosinopenia and C-reactive protein as a marker of bloodstream infections in critically ill patients: a case control study.
Diagnosis of bloodstream infections in critically ill patients is difficult. This case control study involved a total of 22 patients with confirmed bloodstream infections and 44 concurrent controls from an intensive care unit in Western Australia. We aimed to assess whether eosinopenia and C-reactive protein are useful markers of bloodstream infections in critically ill patients. ⋯ C-reactive protein concentration was, however the only significant predictor in the multivariate analysis (odds ratio 1.21 per 10 mg/l increment, 95% CI 1.01 to 1.39, P = 0.007). C-reactive protein concentration appears to be a better marker of bloodstream infections than eosinopenia in critically ill patients. A large prospective cohort study is needed to assess whether eosinopenia is useful in addition to C-reactive protein concentrations as a marker of bloodstream infections.
-
Our 850-bed, academic, tertiary care hospital uses a four-bed dedicated 'shock room' situated between the Departments of Emergency Medicine and Intensive Care to stabilise all acutely ill patients from outside or inside the hospital before transfer to the intensive care unit or other department. Admitted patients stay a maximum of four hours in the shock room. ⋯ After diagnosis and initial treatment, 54% of patients were transferred to an intensive care unit or a coronary care unit; 2.5% of patients died in the shock room. The shock room provides a useful area of collaboration between emergency department and intensive care unit staff and enables acutely ill patients to be assessed and treated rapidly to optimise outcomes.