British journal of anaesthesia
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Clinical Trial
Extracorporeal membrane oxygenation for transport of hypoxaemic patients with severe ARDS.
Conventional inter-hospital transfer of patients with severe acute respiratory distress syndrome (ARDS) in need of extracorporeal membrane oxygenation (ECMO) may be risky and in severe hypoxaemic patients may be associated with cerebral hypoxia and death. Therefore, we began a phase 1 study to evaluate the feasibility, complications and outcome of inter-hospital transport of these patients using veno-venous ECMO. Eight patients with severe ARDS and a PaO2/FIO2 < 6.7 kPa at a PEEP > or = 10 cm H2O were placed on a mobile ECMO at the referring hospital. ⋯ No significant complications occurred. Six patients survived and were discharged from hospital; two patients died because of multiple organ failure. We conclude that initiation of ECMO in hypoxaemic patients before inter-hospital transfer is feasible and enables safe transport to an ECMO centre.
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We describe an obstetric patient who developed incapacitating headache after inadvertent dural tap and was treated with repeated blood patching. She subsequently developed severe lumbar back pain which, after exclusion of suspected extradural abscess, was treated successfully with simple analgesics and physiotherapy. Two possible explanations are offered to account for her symptoms. We compare this case with others in the literature.
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To clarify the effects of the pregnant uterus on the extradural venous plexus in the supine and lateral positions, we studied magnetic resonance (MR) images of the lumbar spine in three parturients. T2-weighted axial MR images were obtained with the parturient in the supine and lateral positions. ⋯ When the parturient lay supine, the pregnant uterus compressed the inferior vena cava and almost totally obstructed it; the extradural venous plexus was engorged. On turning the parturient into the lateral position, the inferior vena cava was free from compression, and the engorged extradural venous plexus was found to shrink to the level of the non-pregnant state.
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Critical illness polyneuropathy (CIP) is a recognized cause of muscle weakness and failure of weaning from a ventilator. In order to characterize the features of CIP, we have examined 28 consecutive surgical patients with severe sepsis using bedside electrophysiology. Of the 28 patients (median APACHE II score 31), 20 developed moderate to severe CIP, as shown by the presence of moderate to severe denervation activity on resting EMG. ⋯ Similar results were obtained from stimulation of the ulnar nerve. We conclude that CIP is a major complication in patients with severe sepsis and prolonged artificial ventilation. It predominantly involves motor fibres and thus markedly interferes with weaning from the ventilator.