Anaesthesia
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The administration of a known concentration of oxygen is an important part of routine care of the sick patient. Many devices are currently available. The actual concentration of oxygen that can be delivered by these devices can be affected by several factors, both from the patient as well as the device itself. ⋯ Variable performance systems such as the Hudson mask deliver a significantly reduced oxygen concentration at high respiratory rates. Fixed performance systems delivering 24-40% oxygen deliver appropriate oxygen concentrations across the range of respiratory rates, whereas those delivering 60% show a reduction in performance. High flow systems show no failure of performance at increased respiratory rates.
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Case Reports Randomized Controlled Trial
The effect of cricoid pressure on intubation facilitated by the gum elastic bougie.
Tracheal tube impingement is common during gum elastic bougie facilitated intubation and a 90 degrees anti-clockwise rotation of the tube usually relieves it. We detail a case where this manoeuvre failed in the presence of cricoid pressure. We investigated the effect of cricoid pressure on gum elastic bougie facilitated intubation in 120 patients randomly allocated to receive sham cricoid pressure (n = 60) or 30 N cricoid pressure (n = 60). ⋯ Releasing cricoid pressure relieved the obstruction in the four cases where 90 degrees anti-clockwise rotation of the tube failed. Impingement is common and 90 degrees anti-clockwise rotation is highly effective in both the presence and absence of cricoid pressure. In a small number of cases, cricoid pressure may cause the manoeuvre to fail.
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Multicenter Study
Outcome after admission to ITU following out-of-hospital cardiac arrest: are non-survivors suitable for non-heart-beating organ donation?
We have reviewed retrospective data from two large UK teaching hospitals regarding outcome following out-of-hospital cardiac arrest and the suitability of non-survivors for non-heart-beating organ donation. Patients were selected retrospectively from consecutive admissions from two intensive care units who had presented following out-of-hospital cardiac arrest, to a total of 50 patients in each centre. They had all been resuscitated to achieve a spontaneous cardiac output at the scene, in transit or after arrival in hospital, and required further intensive care support due to cardiovascular, respiratory, or neurological impairment. ⋯ Fifty-seven (57%) of patients had active withdrawal of treatment with only four (4%) being potentially suitable for organ procurement having not been excluded because of age, medical history or the length of time to die following withdrawal of treatment. Our results show that only a small increase in donor organs could be potentially achieved from this population. Further work is required to determine whether such patients should be considered as non-heart-beating donors.
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Letter Case Reports
Use of the Airtraq laryngoscope for anticipated difficult laryngoscopy.