Anaesthesia and intensive care
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Anaesth Intensive Care · Nov 2012
Comparative StudyCost analysis of real-time polymerase chain reaction microbiological diagnosis in patients with septic shock.
Antibiotic treatment for septic shock is generally prescribed on an empirical basis using broad-spectrum antibiotics. Molecular diagnostic techniques can detect the presence of microbial DNA in blood within a few hours and facilitate early, targeted treatment. The aim of this study was to evaluate the economic impact of a real-time polymerase chain reaction technique, LightCycler SeptiFast (LSC), in patients with sepsis. ⋯ The study involved 48 patients in the LSC group and 54 patients in the control group. The total cost was €42,198 in the control group versus €32,228 in the LCS group with statistically significant differences (P <0.05), giving rise to an average net saving of €9970 per patient. The mortality rate was similar in both groups. The main finding of this study was the significant economic saving afforded by the use of the LCS technique, due to the shortening of intensive care unit stay and the use of fewer antibiotics.
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Anaesth Intensive Care · Nov 2012
An audit of level two and level three checks of anaesthesia delivery systems performed at three hospitals in South Australia.
Anaesthetists may subject patients to unnecessary risk by not checking anaesthetic equipment thoroughly before use. Numerous adverse events have been associated with failure to check equipment. The Australian and New Zealand College of Anaesthetists and anaesthetic delivery system manufactures have made recommendations on how anaesthetic equipment should be maintained and checked before use and for the training required for staff who use such equipment. ⋯ Structured interviews with staff who check the anaesthetic machine were carried out to determine the training they had received. The results indicated poor compliance with recommendations: significantly, the backup oxygen cylinders' pressure/contents were not checked in 45% of observations; the emergency ventilation device was not checked in 67% of observations; the breathing circuit was not tested between patients in 79% of observations; no documentation of the checks performed was done in any cases; and no assessment or accreditation of the staff who performed these checks was performed. It was concluded that the poor compliance was a system failing and that patient safety might be increased with training and accrediting staff responsible for checking equipment, documenting the checks performed, and the formulation and use of a checklist.
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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
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.