Anaesthesia and intensive care
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A 'can't intubate, can't oxygenate' scenario in a child is fortunately extremely rare. We report a case of this life-threatening event in a four-year-old boy suffering from a rare genetic disorder, fibrodysplasia ossificans progressiva. ⋯ This report highlights the small evidence base and lack of definitive algorithms relating to how best to rescue a paediatric 'can't intubate, can't oxygenate' situation. Paediatric anatomical factors dictate that immediate procession to a tracheal surgical airway may be the optimal management.
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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.
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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.