Anaesthesia and intensive care
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Anaesth Intensive Care · Mar 2010
Assessment of a cardiac output device using arterial pulse waveform analysis, Vigileo, in cardiac surgery compared to pulmonary arterial thermodilution.
Many devices are available to assess cardiac output (CO) in critically ill patients and in the operating room. Classical CO monitoring via a pulmonary artery catheter involves continuous cardiac output (CCO) measurement. The second generation of Flotrac/Vigileo monitors propose an analysis of peripheral arterial pulse waves to calculate CO (APCO) without calibration. ⋯ Large inter-individual variability does exist. During cardiac surgery and after leaving the operating room, Vigileo is not clinically equivalent to continuous thermodilution by pulmonary artery catheter Nevertheless, the connection between CCO and ICO relates the difference between APCO and CCO more to the different algorithms used. Further efforts should be concentrated on assessing the ability of this device to track changes in cardiac output.
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Anaesth Intensive Care · Mar 2010
Effects of skin traction on cross-sectional area of the internal jugular vein in infants and young children.
Internal jugular veins (IJV) are commonly used to obtain central venous access. However percutaneous cannulation of the IJVis difficult in infants and young children because of its diminutive size. The aim of this study was to evaluate the effect of skin traction on the cross-sectional area of the IJV in anaesthetised infants (younger than one year) and young children (one to six years) using ultrasound. ⋯ The measurements were made after the induction of anaesthesia with patients in the supine position and with positive pressure ventilation. Skin traction increased the maximum cross-sectional area of the IJV by 39.9 +/- 29.6% in infants and by 33.8 +/- 21.9% in children (P < 0.01). This increase might facilitate easier and safer IJV cannulation in infants and children.
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Anaesth Intensive Care · Mar 2010
Case ReportsPlasmapheresis treatment in Guillain-Barré syndrome: potential benefit over intravenous immunoglobulin.
Guillain-Barré syndrome includes acute inflammatory demyelinating polyradiculoneuropathy, acute motor axonal neuropathy, acute motor and sensory axonal neuropathy, Miller Fisher syndrome and acute pandysautonomia. Plasma exchange was the first treatment in Guillain-Barrd syndrome proven to be superior to supportive treatment alone and intravenous immunoglobulin was subsequently shown to be equally effective and is now commonly used as first-line treatment. We describe a 78-year-old woman who presented with a two-day history of progressive generalised weakness and left facial nerve palsy, preceded by a flu-like illness lasting for one week. ⋯ A gradual improvement of respiratory function and peripheral muscle strength was observed after the first plasma exchange and on the eighth day the patient was weaned off mechanical ventilation. This case suggests that patients with severe Guillain-Barrd syndrome may benefit from plasma exchange after immunoglobulin treatment in refractory cases. Plasma exchange should be considered early in Guillain-Barrć syndrome cases with axonal involvement, and in the recurrent or familial Guillain-Barré syndrome forms.
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Anaesth Intensive Care · Mar 2010
Case ReportsTotal spinal following labour epidural analgesia managed with non-invasive ventilation.
A 30-year-old woman developed total spinal anaesthesia during establishment of labour analgesia via an epidural catheter The subsequent respiratory failure was successfully managed with non-invasive ventilation. This report describes the use of non-invasive ventilation in the parturient and the process of managing the parturient safely in an appropriately monitored environment. This case displays the potential benefit of this technique in the setting of a total spinal block in preventing the need for intubation and ventilation (and subsequent emergency caesarean section) and providing adequate ventilatory function until the block subsided adequately.
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Anaesth Intensive Care · Mar 2010
Prognostic factors in critically ill patients with solid tumours admitted to an oncological intensive care unit.
The mortality and prognostic factors for patients admitted to the intensive care unit (ICU) with solid tumours are unclear The aim of this study was to describe demographic, clinical and survival data and to identify factors associated with mortality in critically ill patients with solid tumours. A prospective observational cohort study of 177 critically ill patients with solid tumours admitted to a medical-surgical oncological ICU was undertaken. There were no interventions. ⋯ The mortality rate in the ICU was 21.4%. Improved outcomes in critically ill cancer patients extended to the subgroup of patients with solid tumours. Independent prognostic factors for in-ICU death were the need for vasopressors and the APACHE IL score, while the length of stay in the ICU, Charlson comorbidity index score >2, and the need for vasopressors were independent predictors of death after ICU discharge.