British journal of anaesthesia
-
Comparative Study
Comparison of haemoglobin measurement methods in the operating theatre.
Various methods of haemoglobin (Hb) measurement are available to guide transfusion including several methods that allow for measurement at the bedside. This study directly compared their absolute and trend accuracy compared with values from the central lab (reference method). ⋯ Bedside Hb measurement methods differ in their agreement to a laboratory haematology analyser but none would have led to transfusion errors. Trial Registry Number RCB 2009-AO1144-53.
-
Randomized Controlled Trial
Open-label, phase II study of routine high-flow nasal oxygen therapy in cardiac surgical patients.
Respiratory complications after cardiac surgery increase morbidity, mortality, and length of stay. Studies suggest that routine delivery of positive airway pressure after extubation may be beneficial. We sought to determine whether the routine administration of nasal high-flow oxygen therapy (NHF) improves pulmonary function after cardiac surgery. ⋯ Routine use of NHF did not increase / ratio on Day 3 but did reduce the requirement for escalation of respiratory support.
-
Randomized Controlled Trial Multicenter Study
Population pharmacokinetics of tranexamic acid in adults undergoing cardiac surgery with cardiopulmonary bypass.
Interest in antifibrinolytic tranexamic acid (TA) has grown since the widespread removal of aprotinin, but its dosing during cardiac surgery is still debated. The objectives of this study were to investigate the population pharmacokinetics (PK) of TA given with either low- or high-dose continuous infusion schemes in adult cardiac surgery patients during cardiopulmonary bypass (CPB). ⋯ The PK of TA was satisfactorily described by an open two-compartmental model, which was used to propose a dosing scheme suitable for obtaining and maintaining the desired plasma concentration in a stable and narrow range in cardiac surgery patients.
-
Microcirculatory alterations play a central role in the pathophysiology of sepsis. We investigated probe-based confocal laser endomicroscopy (pCLE) to assess alterations in mucosal microcirculatory perfusion in vivo in a porcine model of septic shock and in patients fulfilling consensus criteria for severe sepsis. ⋯ pCLE reliably detected and quantified microcirculatory alterations in the gastrointestinal mucosa in a porcine model of sepsis and in patients with severe sepsis. Our data suggest that pCLE is a promising tool to assess the efficacy of therapeutic interventions on mucosal microcirculation in real-time, even in the clinical context.
-
Respiratory rate is an important measurement in patient care, but accurate measurement is often difficult. We have developed a simple non-invasive device to measure respiratory movements in clinical circumstances, with minimal interference with the patient. We investigated respiratory patterns in patients receiving postoperative morphine analgesia to assess the capacity of the device to detect abnormalities. ⋯ In undisturbed subjects receiving patient-controlled morphine analgesia after surgery, abnormal breathing patterns are extremely common. Cyclical airway obstruction is frequent and associated with a typical pattern of changes in chest wall movement.