Anaesthesia and intensive care
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Anaesth Intensive Care · May 2021
Diagnosis and incidence of acute kidney injury in a mixed paediatric intensive care unit: Retrospective analysis, 2005 and 2015.
Acute kidney injury (AKI) is common in intensive care patients. While creatinine definitions for AKI have been validated, oliguria criteria are less well evaluated in children. Our study compared the validity and agreement of creatinine and oliguria criteria for diagnosing AKI in a large mixed medical, surgical and cardiac paediatric intensive care unit (PICU), and assessed the significance of their independent and combined effects on predicted mortality relative to paediatric index of mortality (PIM risk of death) on admission. ⋯ Increasing severity of creatinine rise and oliguria confers increasing risk-adjusted mortality, especially for admissions with low PIM3 risk of death. The mortality of patients with AKI defined by oliguria alone is low. Defining AKI by oliguria alone has less clinical utility and may not represent true AKI.
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Anaesth Intensive Care · May 2021
Case ReportsIatrogenic pneumomediastinum followed by bilateral pneumothoraces: A case report.
Major respiratory catastrophe associated with iatrogenic airway injury during the Sistrunk operation is a rare event. A three-year-old patient underwent thyroglossal duct cyst removal under general anaesthesia. ⋯ The patient was managed with bilateral chest drains and endotracheal intubation, and he required mechanical ventilation for three days. So, even after repair of a recognised iatrogenic airway injury associated with the Sistrunk operation, it may be necessary to continue positive pressure ventilation in the postoperative period to avoid serious respiratory complications.
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Anaesth Intensive Care · May 2021
Massive transfusion experience, current practice and decision support: A survey of Australian and New Zealand anaesthetists.
Massive transfusions guided by massive transfusion protocols are commonly used to manage critical bleeding, when the patient is at significant risk of morbidity and mortality, and multiple timely decisions must be made by clinicians. Clinical decision support systems are increasingly used to provide patient-specific recommendations by comparing patient information to a knowledge base, and have been shown to improve patient outcomes. To investigate current massive transfusion practice and the experiences and attitudes of anaesthetists towards massive transfusion and clinical decision support systems, we anonymously surveyed 1000 anaesthetists and anaesthesia trainees across Australia and New Zealand. ⋯ The majority of respondents reported that they were likely, or very likely, both to use (73.1%) and to trust (85%) a clinical decision support system for massive transfusions, with no significant difference between anaesthesia trainees and specialists (P = 0.375 and P = 0.73, respectively). While the response rate to our survey was poor, there was still a wide range of massive transfusion experience among respondents, with multiple subjective factors identified limiting massive transfusion practice. We identified several potential design features and barriers to implementation to assist with the future development of a clinical decision support system for massive transfusion, and overall wide support for a clinical decision support system for massive transfusion among respondents.
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Anaesth Intensive Care · May 2021
Letter Randomized Controlled TrialSurvey of attitudes towards a randomised trial about sugammadex, neostigmine and pulmonary complications.