Anaesthesia and intensive care
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Anaesth Intensive Care · Nov 2011
Case ReportsInternational retrieval of adults on extracorporeal membrane oxygenation support.
A retrieval service was established in New South Wales to provide mobile extracorporeal membrane oxygenation support to patients with severe, acute cardiac or respiratory failure. This service has also retrieved four adult patients from Nouméa, New Caledonia to Sydney on extracorporeal membrane oxygenation support, which are the first international retrievals of this type from Australia. We discuss our experience with these patients, three of whom survived to hospital discharge. However, one patient referred from New Caledonia died before extracorporeal membrane oxygenation could be established.
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Anaesth Intensive Care · Nov 2011
ReviewLaryngeal mask airway for airway control during percutaneous dilatational tracheostomy.
Percutaneous dilatational tracheostomy is a common bedside procedure in critical care for patients requiring prolonged mechanical ventilation. The traditional technique requires withdrawal of the endotracheal tube to a proximal position to facilitate tracheostomy insertion, but this carries the risk of inadvertent extubation and does not prevent cuff rupture. ⋯ We found reasonable evidence to show improved ventilation and bronchoscopic visualisation with the laryngeal mask airway, but this has not been translated into improved outcome. There is currently insufficient evidence to draw conclusions about the safety of the laryngeal mask airway during percutaneous dilatational tracheostomy.
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Anaesth Intensive Care · Nov 2011
Aminotransferase levels in relation to short-term use of acetaminophen four grams daily in postoperative cardiothoracic patients in the intensive care unit.
A volunteer study suggested that taking paracetamol 4 g daily could result in elevated alanine aminotransferase plasma levels in a substantial proportion of healthy volunteers. The safety of this dose of paracetamol for acute postoperative pain remains controversial. This study aimed to examine the incidence of alanine aminotransferase elevations after short-term use of paracetamol 4 g daily, as part of the standard pain management protocol, for 93 consecutive patients after cardiothoracic surgery. ⋯ These four patients all had right ventricular failure or cardiogenic shock during the postoperative period which could explain the significant rises in alanine aminotransferase after surgery. In conclusion, the incidence of significant alanine aminotransferase elevations after using daily paracetamol as an analgesic agent for cardiac surgery, at a dose of 4 g per day, was low and mostly due to complications after surgery. Our results, albeit still very limited, provided some reassurance about the safety of paracetamol 4 g daily, as a supplementary analgesic agent for adult patients undergoing cardiac surgery.
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Anaesth Intensive Care · Nov 2011
Benefits and risks associated with the R100 high frequency oscillatory ventilator for patients with severe hypoxaemic respiratory failure.
High frequency oscillatory ventilation has been shown to improve oxygenation of patients with severe respiratory failure. This prospective study examined the potential benefits and risks of the latest generation high frequency oscillatory ventilator (R100, Metran, Saitama, Japan), initiated when the target oxygenation could not be achieved by conventional mechanical ventilation in adult patients with severe hypoxaemic respiratory failure. Thirty-six patients with severe respiratory failure treated with the R100 high frequency oscillatory ventilator were considered. ⋯ Of the 36 patients included in the study (including one who had developed pneumothorax before high frequency oscillatory ventilation), 12 (33%) developed barotrauma during the course of their intensive care unit stay. In the multivariate analysis, only exacerbation of interstitial pneumonia was a significant risk factor for barotrauma. In summary, the latest generation high frequency oscillatory ventilator could improve oxygenation in adult patients with life-threatening hypoxaemic respiratory failure but the incidence of barotrauma was substantial.