Crit Care Resusc
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Comparative Study
Measurement of cardiac output with a non-invasive continuous wave Doppler device versus the pulmonary artery catheter: a comparative study.
Cardiac index remains an important measured variable used to optimise fluid and haemodynamic support in the postoperative cardiac setting. Recent developments in non-invasive continuous wave Doppler devices enable rapid assessment of cardiac index with decreased morbidity. This study aimed to determine the clinical utility of one such device, the USCOM device (USCOM Ltd, Sydney, NSW), in assessing cardiac index compared with invasive continuous measurements of cardiac index using a pulmonary artery (PA) catheter. ⋯ In a heterogeneous population of postoperative cardiac patients, non-invasive determination of cardiac index using USCOM had limited clinical utility. Doppler flow signal quality may have been affected by intrathoracic air, patient position and operator learning curve. Given accepted inherent inaccuracies of continuous cardiac output assessment, further investigation is required to validate the suitability of USCOM in this patient population.
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Randomized Controlled Trial
Effect of heparin in arterial line flushing solutions on platelet count: a randomised double-blind study.
Arterial catheters are widely used in intensive care units for continuous blood pressure monitoring and blood sampling. Studies have examined the effect of heparin on patency of arterial catheters but not on platelet counts. Heparin is a naturally occurring anticoagulant that helps prevent clotting and is given to prevent and treat thrombosis. It has many other effects, including reducing platelet counts. ⋯ Use of heparin in normal saline as a continuous flush for an arterial catheter does not reduce platelet counts in critically ill patients.
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Review
Heparin-induced thrombocytopenia without thrombosis: an evidence-based review of current literature.
There has been a recent change in the management guidelines for patients with heparin-induced thrombocytopenia with the addition of a recommendation to commence parenteral anticoagulation in patients with isolated HIT without evidence of thrombosis. We assessed the evidence supporting this recommendation, to answer the following questions: in a patient with isolated HIT, should alternative anticoagulation be commenced, what alternative agent should be used, what is the recommended duration of anticoagulation, and when should warfarin be used? ⋯ Although patients with isolated HIT are at considerable risk of new thrombosis, there is limited evidence to support or reject the use of non-heparin anticoagulation in this group. Non-randomised, historically controlled trials support the use of lepirudin and argatroban; evidence favouring danaparoid is limited to large case series and one retrospective observational study. Duration of parenteral anticoagulation and warfarin use are guided by consensus opinion alone.
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We examined long-term outcome of pulmonary function, exercise capacity and health-related quality of life (HRQoL) in patients with acute respiratory distress syndrome (ARDS) caused by severe acute respiratory syndrome (SARS). ⋯ The mortality of SARS-related ARDS is similar to the mortality of ARDS from other causes. A substantial number of patients with SARS-related ARDS survived without receiving mechanical ventilation. Patients had good recovery of pulmonary function and HRQoL.
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Biography Historical Article
Notable Australian contributions to the management of ventilatory failure of acute poliomyelitis: with special reference to the Both respirator and Dr. John A. Forbes.
When Australia's 1937 epidemic of poliomyelitis created an urgent need for extra ventilating machines to compensate for respiratory paralysis, Edward Both, an innovative Adelaide biomedical engineer, invented a wooden-cabinet respirator capable of being made relatively quickly in sufficient quantity. His device, here called "the Both", alleviated the problem at Adelaide's Northfield Infectious Diseases Hospital and others, and in late 1938 was introduced into England when Both was visiting there. Appreciating its merits, Lord Nuffield financed assembly-line production at the Morris motor works in Cowley, Oxford. ⋯ Dr John Forbes at Fairfield became the foremost Australian clinician for expertise with the Both. Before the advent of intermittent positive pressure ventilation, the Both's usefulness had seen it tried for ventilatory failure in some non-polio conditions, but uptake of that application was limited. Nonetheless, Nuffield's philanthropy with the (Nuffield-)Both ultimately furthered progress along the 20th century pathway to intensive care medicine.