Anaesthesia and intensive care
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Anaesth Intensive Care · Nov 2024
Case ReportsIntraoperative 'pressure field' haemodynamic monitoring in a patient with severe aortic regurgitation having laparoscopic robot-assisted colorectal surgery.
Laparoscopic robot-assisted colorectal surgery can pose significant haemodynamic challenges for patients with severe aortic regurgitation. The increased afterload caused by pneumoperitoneum and aortic compression, along with concurrent factors like hypercarbia, Trendelenburg positioning and ventilatory impairment, can worsen aortic regurgitation, leading to myocardial ischaemia and heart failure. ⋯ Minimally invasive haemodynamic monitoring enabling real-time visualisation of a patient's 'pressure field' has been suggested as a potential adjunct or alternative to TOE, with the added advantage of providing continuous quantitative information about both stroke volume and the afterload to ventricular ejection in a single visualisation. We describe an example of successful concurrent use of pressure field haemodynamic monitoring and TOE in a patient with severe aortic regurgitation having a prolonged laparoscopic robot-assisted pelvic exenteration.
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Anaesth Intensive Care · Nov 2024
Multicenter Study Observational StudyAnaesthesia healthcare workers' interactions with COVID-19-positive and -suspect patients: A multi-site observational study from Queensland, Australia.
Occupationally acquired COVID-19 is a hazard for healthcare workers (HCWs). In four hospitals of the Metro North Hospitals and Health Service in Queensland, Australia, we invited HCWs to report the nature of any anaesthesia interactions with COVID-19-positive and COVID-19-suspect patients. This was to assist workforce planning in future pandemics. ⋯ Of 12 HCWs who subsequently tested positive to COVID-19, only four had cared for a COVID-19-positive patient in the two weeks prior to their diagnosis. Most responding HCWs perceived they contracted COVID-19 in the community, experiencing mild illness. We found relatively low COVID-19 case numbers, high PPE use and low transmission of COVID-19 within the hospital setting.
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Anaesth Intensive Care · Nov 2024
A cross-sectional study of the relationship between iron deficiency anaemia and chronic pain.
Iron deficiency and iron deficiency anaemia are frequently under-recognised in chronic conditions with non-specific symptoms, including fatigue. This study aimed to assess the prevalence of iron deficiency with or without anaemia in chronic pain patients, and the association between iron deficiency status, fatigue and health-related quality of life. Eighty-two patients attending chronic pain outpatient appointments were recruited into this cross-sectional study. ⋯ There was no significant association between iron deficiency status and the functional assessment of chronic illness therapy fatigue scale score or 36-item short form survey domain scores. There was a high prevalence of iron deficiency in this group of chronic pain patients, while the prevalence of iron deficiency anaemia was low. There was no statistically significant association found between iron deficiency status and fatigue or quality of life measures.
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Anaesth Intensive Care · Nov 2024
Skin injury: Associations with variables related to perfusion and pressure.
Skin injuries are a major healthcare problem that are not well understood or prevented in the critically ill, suggesting that underappreciated variables are contributing. This pilot study tested the hypothesis that perfusion-related factors contribute to skin injuries diagnosed as hospital-acquired pressure injuries (HAPIs). A total of 533 adult patients were followed over 2574 critical care days (mean age 62.4, standard deviation (SD) 14.3 years, mean body mass index 30.4 (SD 7.4) kg/m2, 36.4% female). ⋯ The finding that perfusion-related variables predicted HAPIs may warrant consideration of alternative diagnoses, such as skin failure due to impaired perfusion as a pathophysiological process that occurs concurrently with multisystem organ failure. Differentiation of skin injuries primarily from circulatory malfunction, rather than external pressure, may guide the development of more effective treatment and prevention protocols. This pilot study suggests that the contribution of perfusion to skin injuries should be explored further.
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Anaesth Intensive Care · Nov 2024
Observational StudyUrinary chloride excretion in critical illness and acute kidney injury: a paediatric hypothesis-generating cohort study post cardiopulmonary bypass surgery.
Renal chloride metabolism is currently poorly understood but may serve as both a diagnostic and a treatment approach for acute kidney injury. We investigated whether plasma chloride, ammonia and glutamine as well as urinary chloride, ammonium and glutamine concentrations may serve as markers for acute kidney injury in paediatric patients. We conducted a prospective observational trial in a tertiary care paediatric intensive care unit. ⋯ In conclusion, renal chloride excretion decreased in all patients, although this decrease was more pronounced in patients with acute kidney injury. Our findings may reflect a response of the kidneys to critical illness, and acute kidney injury may make these changes more pronounced. Targeting chloride metabolism may offer treatment approaches to acute kidney injury.