Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Jan 2013
Intensive care and traumatic brain injury after the introduction of a treatment protocol: a prospective study.
Traumatic brain injury (TBI) treatment protocols have been introduced in the intensive care unit (ICU) to avoid secondary brain injury. In this study, we aimed to evaluate the deviations from such a treatment protocol and the frequency of extracranial complications, and relate these findings to outcome. ⋯ Deviations from the TBI treatment protocol were frequent. Pneumonia was the most frequent extracranial complication. Age, GCS score, pupil dilation, ISS, high ICP, hyperglycaemia and pneumonia predicted a worse outcome.
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Acta Anaesthesiol Scand · Jan 2013
Intensive buffering can keep pH above 7.2 for over 4 h during apnea: an experimental porcine study.
Ventilation with low tidal volumes reduces mortality in acute respiratory distress syndrome. A further reduction of tidal volumes might be beneficial, and it is known that apneic oxygenation (no tidal volumes) with arteriovenous CO(2) removal can keep acid-base balance and oxygenation normal for at least 7 h in an acute lung injury model. We hypothesized that adequate buffering might be another approach and tested whether tris-hydroxymethyl aminomethane (THAM) alone could keep pH at a physiological level during apneic oxygenation for 4 h. ⋯ With intensive buffering using THAM, pH can be kept in a physiologically acceptable range for 4 h during apnea.
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Acta Anaesthesiol Scand · Jan 2013
Predictors of laterality of motor block during epidural analgesia in a mixed surgical population.
Predictors of laterality of motor block during epidural analgesia are currently unknown, as studies so far have yielded conflicting results. We aimed to evaluate predictors of post-operative asymmetric lower extremity motor blockade in a mixed surgical population. ⋯ These results suggest that young patients with lumbar epidural analgesia or deep catheter insertion should be frequently monitored for the occurrence of laterality of motor block. Also, these results provide support for a prospective study to determine the optimal catheter insertion depth to decrease the risk of unilateral motor block.
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Acta Anaesthesiol Scand · Jan 2013
Acute respiratory distress syndrome: nationwide changes in incidence, treatment and mortality over 23 years.
The aim of this study was to assess population-based changes in incidence, treatment, and in short- and long-term survival of patients with acute respiratory distress syndrome (ARDS) over 23 years. ⋯ The incidence of ARDS has almost doubled, but hospital mortality has decreased during the 23 years of observation. The 10-year survival of ARDS survivors is poor compared with the reference population.
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Acta Anaesthesiol Scand · Jan 2013
ReviewContinuous evaluation of neurological prognosis after cardiac arrest.
Post-resuscitation care has changed in the last decade, and outcome after cardiac arrest has improved, thanks to several combined measures. Induced hypothermia has shown a treatment benefit in two randomized trials, but some doubts remain. General care has improved, including the use of emergency coronary intervention. ⋯ Based on our expert opinion, we suggest a multimodal approach with a continuous evaluation of prognosis based on repeated neurological examinations and electroencephalography. Somatosensory-evoked potential is an established method to help determine a poor outcome and is recommended, whereas biomarkers and magnetic resonance imaging are promising adjuncts. We recommend that a decisive evaluation of prognosis is performed at 72 h after normothermia or later in a patient free of sedative and analgetic drugs.