Anaesthesia and intensive care
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Anaesth Intensive Care · Sep 2015
Fluid administration, vasopressor use and patient outcomes in a group of high-risk cardiac surgical patients receiving postoperative goal-directed haemodynamic therapy: a pilot study.
The role of goal-directed therapy in high-risk cardiac surgical patients has not been determined. This study sought to observe the effect of a postoperative standardised haemodynamic protocol (SHP) on the administration of fluid and vasoactive drugs after high-risk cardiac surgery. This was an interventional pilot study. ⋯ There was no significant difference in the duration of noradrenaline infusion in the SHP cohort compared to historical controls (median [IQR] 18.5 hours [31.63] versus 18 hours [18.3]; P=0.35), despite patients receiving more fluid in their first 12 hours in the ICU (mean 4687 ml [SD ± 2284 ml] versus 1889 ml [SD ± 1344 ml]; P <0.001). The SHP cohort had a higher rate of reintubation (4 in 37 [10.8%] versus 0 in 40 [0%]; P=0.049). The SHP delivered significantly more fluid, but did not reduce the duration of noradrenaline infusion, compared to usual care.
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Anaesth Intensive Care · Sep 2015
ReviewCognitive function, quality of life and mental health in survivors of our-of-hospital cardiac arrest: a review.
There is growing interest in the long-term outcomes of patients surviving out-of-hospital cardiac arrest (OHCA). This paper aims to summarise the available literature on the long-term cognitive, health-related quality of life (QoL) and mental health outcomes of survivors of OHCA. Between 30% and 50% of survivors of OHCA experience cognitive deficits for up to several years post-discharge. ⋯ Carers of survivors of OHCA report high rates of depression, anxiety and post-traumatic stress, with insufficient social and financial support. The heterogeneous range of instruments used to assess cognitive function and QoL prevent any clear conclusions being drawn from the available literature. The potential biases inherent in this patient population and the interaction between QoL, cognitive performance and mental health warrant further investigation, as does the role of post-discharge support services in improving long-term patient outcomes.
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Anaesth Intensive Care · Sep 2015
Impact of increasing overnight intensive care unit registrar staffing on duration of intubation of elective cardiac surgery patients.
It is unclear whether increases to overnight junior medical staffing levels can improve ICU patient outcomes. We conducted a retrospective cohort study before and after the introduction of a third overnight ICU registrar at a 24-bed metropolitan ICU in February 2012. We hypothesised that this change would be associated with decreased intubation time for elective cardiac surgery patients and an increase in the proportion of these patients being extubated during the overnight period. ⋯ The proportion of elective cardiac surgery patients extubated during the overnight period was similar, 54.2% in the control group compared to 50.0% in intervention group (P=0.45). In our unit, increasing overnight ICU registrar staffing levels was not associated with a significant reduction in duration of intubation for elective cardiac surgery patients or a reduction in the proportion of these patients extubated overnight. This is likely due to factors other than medical staffing levels influencing timing of extubation of these patients.