Anaesthesia and intensive care
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Anaesth Intensive Care · Sep 2011
Review Meta AnalysisC-reactive protein as a predictor of mortality in critically ill patients: a meta-analysis and systematic review.
C-reactive protein is a marker of inflammatory response and has been widely investigated in cardiovascular and infectious diseases, especially to monitor therapeutic success. However, its role as a predictor of clinical outcome in critically ill patients remains uncertain and controversial. The objective of this study was to investigate the predictive value of C-reactive protein in critically ill patients. ⋯ The subgroup analysis showed that the weighted mean difference in early (within 48 hours) C-reactive protein levels between survivors and non-survivors was not significantly different, in contrast to the late (beyond 48 hours) C-reactive protein level. This was significantly greater in non-survivors with a weighted mean difference of 63.80 mg/l (95% confidence interval 35.67 to 91.93). Our systematic review shows that while the early C-reactive protein concentration is not a good predictor of survival in critically ill patients, the late C-reactive protein concentration may help to identify patients who are at risk of death.
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Anaesth Intensive Care · Sep 2011
Compliance with processes of care in intensive care units in Australia and New Zealand--a point prevalence study.
There are indications that compliance with routine clinical practices in intensive care units (ICU) varies widely internationally, but it is currently unknown whether this is the case throughout Australia and New Zealand. A one-day point prevalence study measured the prevalence of routine care processes being delivered in Australian and New Zealand ICUs including the assessment and/or management of: nutrition, pain, sedation, weaning from mechanical ventilation, head of bed elevation, deep venous thrombosis prophylaxis, stress ulcer prophylaxis, blood glucose, pressure areas and bowel action. Using a sample of 50 adult ICUs, prevalence data were collected for 662 patients with a median age of 65 years and a median Acute Physiology and Chronic Health Evaluation II score of 18. ⋯ Care components that were delivered more consistently included nutrition delivery (100%, IQR 100 to 100%), deep venous thrombosis (96%, IQR 89 to 100%) and stress ulcer (90%, IQR 78 to 100%) prophylaxis, and checking blood sugar levels (93%, IQR 88 to 100%). This point prevalence study demonstrated variability in the delivery of 'routine' cares in Australian and New Zealand ICUs. This may be driven in part by lack of consensus on what is best practice in intensive care units, prompting the need for further research in this area.
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Anaesth Intensive Care · Sep 2011
Experience with high frequency oscillation ventilation during the 2009 H1N1 influenza pandemic in Australia and New Zealand.
During the 2009 H1N1 pandemic, large numbers of patients had severe respiratory failure. High frequency oscillation ventilation was used as a salvage technique for profound hypoxaemia. Our aim was to compare this experience with high frequency oscillation ventilation during the 2009 H1N1 pandemic with the same period in 2008 by performing a three-month period prevalence study in Australian and New Zealand intensive care units. ⋯ Survival rates were comparable to published extracorporeal membrane oxygenation outcomes. High frequency oscillation ventilation was used successfully as a rescue therapy for severe respiratory failure. High frequency oscillation ventilation was only available in a limited number of intensive care units during the H1N1 pandemic.
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Anaesth Intensive Care · Sep 2011
The association between intraoperative electroencephalogram-based measures and pain severity in the post-anaesthesia care unit.
This observational study aimed to identify simple electroencephalogram indices of inadequate intraoperative opioid-mediated nociceptive blockade and to compare these indices with routinely used clinical predictors of severe postoperative pain in adults. Intraoperative trend and waveform data (electrocardiogram, pulse oximetry and electroencephalogram) were collected, pain intensity in the post-anaesthesia care unit was quantified using an 11-point Verbal Rating Score, and opioid administration was recorded. ⋯ Fifty-two patients had moderate or severe pain (Verbal Rating Score > or = 5). State entropy was lower (46.5 +/- 2.9 vs 43.1 +/- 1.9, P = 0.04) and spindle-like activity higher (0.42 +/- 0.03 vs 0.50 +/- 0.02, P = 0.03) in the moderate/severe pain group. [corrected] These findings suggest that there is a modest association between electroencephalogram measures near the end of surgery and the severity of postoperative pain.
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Naltrexone implants are used as an abstinence therapy for patients with opioid, amphetamine and alcohol abuse. This study was designed to assess the implications of this therapy in patients presenting for anaesthesia for removal of these implants. We conducted a retrospective case-note review of 37 patients undergoing removal of naltrexone implants in the period 2001 to 2008 at Sir Charles Gairdner Hospital. ⋯ The majority of patients were discharged home by the first postoperative day. Anaesthesia for the removal of naltrexone implants was associated with a wide range of opioid analgesia requirements and a high incidence of pain postoperatively. Concern regarding increasing opioid sensitivity after removal of implants does not seem to preclude use of generous opioid analgesia in this group of patients.