Anaesthesia and intensive care
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Anaesth Intensive Care · Nov 2012
Randomized Controlled Trial Comparative StudyA pilot study of cerebral and haemodynamic physiological changes during sedation with dexmedetomidine or propofol in patients with acute brain injury.
Sedation for the mechanically-ventilated, brain-injured patient remains challenging. The purpose of this pilot study was to compare the cerebral physiologic effects of sedation with propofol versus dexmedetomidine in mechanically-ventilated, brain-injured patients. Using a randomised, crossover, unblinded clinical trial, we enrolled patients with severe brain injury (Glasgow Coma Score ≤8) from traumatic injury, subarachnoid haemorrhage or intracerebral haemorrhage undergoing multimodal monitoring (intracranial pressure, brain temperature, oximetry and microdialysis). ⋯ Though differences were noted in cerebral metabolic substrates (lactate/pyruvate ratio), none were statistically significant. In our pilot cohort, dexmedetomidine and propofol appear equally effective in sedating severely brain-injured patients and neither is associated with adverse physiological effects as measured by multimodal monitoring. Larger long-term studies are required to determine whether clinically favourable benefits demonstrated in the medical critical care setting also apply to this patient population.
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Anaesth Intensive Care · Nov 2012
Performance of APACHE III over time in Australia and New Zealand: a retrospective cohort study.
The Acute Physiology and Chronic Health Evaluation (APACHE) III-j model has been used for benchmarking intensive care unit (ICU) outcomes in Australia and New Zealand for over a decade. This study assessed performance of the APACHE III-j model in adult patients admitted to Australasian ICUs during a ten-year period. Data were extracted from the Australian and New Zealand Intensive Care Society Adult Patient Database. ⋯ Although discrimination (as measured by AUROC) was preserved over time, all other markers of model performance showed deterioration. There was a significant decrease in SMR in eight of ten most common diagnoses examined. This study demonstrates that performance of APACHE III-j model has deteriorated in Australasian hospitals and there is now a clear need for an updated modelling approach to improve mortality prediction, performance monitoring and quality of research undertaken in Australian and New Zealand ICUs.
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Anaesth Intensive Care · Nov 2012
Approaching families for organ donation-intensivists' perspectives.
In Australia the initial approach to families for organ donation is almost always undertaken by intensivists. There is, however, a paucity of literature on intensivists' views on this approach and how their approach compares with recommendations in published literature on this subject. This study consisted of a survey of the views of intensive care consultants and senior intensive care registrars in the four major teaching hospitals in Perth, Western Australia, on how they approached families for organ donation. ⋯ The survey results indicate that most intensive care consultants felt adequately trained to approach families for organ donation, but almost half of the group surveyed would prefer a collaborative approach with either a donor co-ordinator or a colleague with additional training on this subject. Despite recommendations in the literature and from the Australian and New Zealand Intensive Care Society to determine the registration status of potential donors on the Australian Organ Donation Registry prior to discussions with families, this was not always undertaken. In addition, the benefits of organ donation were not always discussed with families, nor were the reasons for refusal of consent sensitively explored.
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Anaesth Intensive Care · Nov 2012
A pilot study of short-term high-pressure support ventilation in persistent sudden-onset rapid breathing.
Sudden-onset rapid breathing commonly occurs in previously calm, invasively-ventilated patients. In most cases it can be resolved easily by traditional management techniques, but other cases can be very challenging. We enrolled 40 patients who failed traditional interventions and performed short-term high-pressure support ventilation (HPSV). ⋯ The age and Glasgow Coma Scale also had high predicted ability (both with areas under the curve of ≥0.8). In conclusion, short-term HPSV relieved persistent sudden-onset rapid breathing. However, it was not effective in the relatively young and conscious patients with relatively high support pressure, peak pressure, minute ventilation and heart rate.