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 Comparative Study
Double-lumen tube tracheal intubation using a rigid video-stylet: a randomized controlled comparison with the Macintosh laryngoscope.
Despite an increasing need, there is limited experience of double-lumen endobronchial tube (DLT) placement using video laryngoscope. We evaluated DLT intubation using an OptiScope, a rigid video-stylet with a malleable tip derived from the Clarus Video System, in comparison with a Macintosh laryngoscope. ⋯ The OptiScope® provides faster tracheal intubation and a higher success rate for the first intubation with less trauma and a better vocal cord view than the Macintosh laryngoscope.
-
Bioreactance estimates cardiac output in a non-invasive way. We evaluated the ability of a bioreactance device (NICOM®) to estimate cardiac index (CI) and to track relative changes induced by volume expansion. ⋯ The NICOM® device cannot accurately estimate the cardiac output in critically ill patients. Moreover, it could not predict fluid responsiveness through the PLR test.
-
Blood transfusion saves many lives but carries significant risk of injury. Currently, red blood cell (RBC) concentrates can be stored up to 42 days. Concerns have recently been raised about the safety and efficacy of transfusing stored RBCs. ⋯ A number of clinical studies, mostly observational or retrospective and from a single centre, have reported an association between transfusion of older RBCs and increased clinically significant outcomes, such as increased morbidity and mortality in certain patient populations, including trauma, critical care, and cardiac surgery. Others, however, have failed to indicate an influence of RBC age on outcome. The quality of evidence is currently too poor to make recommendations to change current transfusion practice; however, the transfusion community looks forward to the results of randomized trials currently addressing the long-standing question regarding the effects of RBC storage on clinically significant outcomes.
-
Observational Study
Neuro-ventilatory efficiency during weaning from mechanical ventilation using neurally adjusted ventilatory assist.
Neuro-ventilatory efficiency (NVE), defined as the tidal volume to electrical diaphragm-activity ratio (VT/EAdi) at the beginning and end of the weaning process after acute hypoxaemic respiratory failure, may provide valuable information about patient recovery. ⋯ These results suggest that in patients after respiratory failure and prolonged mechanical ventilation, changes in VT and NVE, between SBTs are indicative of patient recovery. Larger clinical trials are needed to clarify whether changes in NVE reliably predict weaning in patients ventilated with NAVA.