Prevalence of augmented renal clearance and performance of glomerular filtration estimates in Indigenous Australian patients requiring intensive care admission
This study aimed to describe the prevalence of ARC in critically ill Indigenous Australian patients and explore the accuracy of commonly employed mathematical estimates of glomerular filtration. We completed a single-centre, prospective, observational study in the intensive care unit (ICU), Alice Springs Hospital, Central Australia. Participants were critically ill adult Indigenous and non-Indigenous Australian patients with a urinary catheter in situ. Exclusion criteria were anuria, pregnancy or the requirement for renal replacement therapy. Daily eight-hour measured creatinine clearances (CrCLm) were collected throughout...
Source: Anaesthesia and Intensive Care - January 23, 2018 Category: Anesthesiology Source Type: research
High flow humidified nasal oxygen in pregnant women
Failed airway management in the obstetric patient undergoing general anaesthesia is associated with major sequelae for the mother and/or fetus. Effective and adequate pre-oxygenation is an important safety strategy and a recommendation in all current major airway guidelines. Pre-oxygenation practice in the obstetric population may be suboptimal based on current literature. Recently, clinical applications for high flow nasal oxygen, also known as transnasal humidified rapid insufflation ventilatory exchange or THRIVE, are expanding in the non-obstetric population and may have theoretical benefits if used for pre-oxygenation...
Source: Anaesthesia and Intensive Care - January 23, 2018 Category: Anesthesiology Source Type: research
Anaesthetic issues in robotic-assisted minimally invasive surgery
Over the past decade there has been an exponential increase in the number of robotic-assisted surgical procedures performed in Australia and internationally. Despite this growth, there are no level I or II studies examining the anaesthetic implications of these procedures. Available observational studies provide insight into the significant challenges for the anaesthetist. Most anaesthetic considerations overlap with those of non-robotic surgery. However, issues with limited patient access and extremes of positioning resulting in physiological disturbances and risk of injury are consistently demonstrated concerns specific ...
Source: Anaesthesia and Intensive Care - January 23, 2018 Category: Anesthesiology Source Type: research
Basic and advanced echocardiographic evaluation of myocardial dysfunction in sepsis and septic shock
Sepsis continues to be a leading cause of mortality and morbidity in the intensive care unit. Cardiovascular dysfunction in sepsis is associated with worse short- and long-term outcomes. Sepsis-related myocardial dysfunction is noted in 20% –65% of these patients and manifests as isolated or combined left or right ventricular systolic or diastolic dysfunction. Echocardiography is the most commonly used modality for the diagnosis of sepsis-related myocardial dysfunction. With the increasing use of ultrasonography in the intensive care unit, there is a renewed interest in sepsis-related myocardial dysfunction. This review ...
Source: Anaesthesia and Intensive Care - January 23, 2018 Category: Anesthesiology Source Type: research
Feasibility and pilot studies: small steps before giant leaps
(Source: Anaesthesia and Intensive Care)
Source: Anaesthesia and Intensive Care - January 23, 2018 Category: Anesthesiology Source Type: research
Monitoring the nervous system: it's time to up our game
(Source: Anaesthesia and Intensive Care)
Source: Anaesthesia and Intensive Care - January 23, 2018 Category: Anesthesiology Source Type: research
Coramine and other analeptics
(Source: Anaesthesia and Intensive Care)
Source: Anaesthesia and Intensive Care - January 23, 2018 Category: Anesthesiology Source Type: research
All Blood Counts —a manual for blood conservation and patient blood management
(Source: Anaesthesia and Intensive Care)
Source: Anaesthesia and Intensive Care - November 15, 2017 Category: Anesthesiology Source Type: research
Gastric decompression before laparoscopic entry via Palmer's point
(Source: Anaesthesia and Intensive Care)
Source: Anaesthesia and Intensive Care - November 15, 2017 Category: Anesthesiology Source Type: research
Sodium –glucose linked transporter 2 inhibitor–associated perioperative euglycaemic diabetic ketoacidosis: a case for a perioperative guideline
(Source: Anaesthesia and Intensive Care)
Source: Anaesthesia and Intensive Care - November 15, 2017 Category: Anesthesiology Source Type: research
A lung model to demonstrate dynamic gas trapping and intrinsic positive end-expiratory pressure at realistic ventilation settings
We describe an Intrinsic PEEP Model that is able to demonstrate dynamic gas trapping and intrinsic PEEP at realistic ventilation settings, and demonstrate its ability to develop intrinsic PEEP in a timeframe useful for teaching. The model uses a Heimlich valve to permit a lower resistance on inspiration than expiration. The model was tested using a series of typical ventilation settings which, when applied in a clinical setting on patients with airflow obstruction issues, would result in prolonged low expiratory flow and the development of intrinsic PEEP of 10 to 20 cmH2O, and ultimately significant gas trapping. The IPM c...
Source: Anaesthesia and Intensive Care - November 15, 2017 Category: Anesthesiology Source Type: research
Burnout and the learning environment of anaesthetic trainees
Burnout has a high prevalence among healthcare workers and is increasingly recognised as an environmental problem rather than reflecting a personal inability to cope with work stress. We distributed an electronic survey, which included the Maslach Burnout Inventory Health Services Survey and a previously validated learning environment instrument, to 281 Victorian anaesthetic trainees. The response rate was 50%. We found significantly raised rates of burnout in two of three subscales. Ninety-one respondents (67%) displayed evidence of burnout in at least one domain, with 67 (49%) reporting high emotional exhaustion and 57 (...
Source: Anaesthesia and Intensive Care - November 15, 2017 Category: Anesthesiology Source Type: research
Association of positive fluid balance and mortality in sepsis and septic shock in an Australian cohort
In patients with septic shock, a correlation between positive fluid balance and worsened outcomes has been reported in multiple observational studies worldwide. No published data exists in an Australasian cohort. We set out to explore this association in our institution. We conducted a retrospective audit of patient records from August 2012 to May 2015 in a single-centre, 24-bed surgical and medical intensive care unit (ICU) in Sydney, Australia. All patients with septic shock were included. Exclusion criteria included length of stay less than 24 hours or vasopressors needed for less than six hours. Data was gathered on fl...
Source: Anaesthesia and Intensive Care - November 15, 2017 Category: Anesthesiology Source Type: research
Dexmedetomidine-associated hyperthermia: a retrospective cohort study of intensive care unit admissions between 2009 and 2016
Dexmedetomidine-associated hyperthermia has not been previously studied. Analysis is warranted to determine whether this potentially dangerous complication is more prevalent than previously realised. We aimed to examine the association between dexmedetomidine and temperature ≥39.5°C, including patient characteristics, temporality and potential risk factors. We conducted a retrospective cohort study of all intensive care unit (ICU) admissions between 1 July 2009 and 31 May 2016 in a tertiary ICU in Australia. Temperature data was available for 9,782 ICU admissions. D exmedetomidine was given intravenously to 611 (6.3%) ...
Source: Anaesthesia and Intensive Care - November 15, 2017 Category: Anesthesiology Source Type: research
The effect of intensive care unit admission on smokers ’ attitudes and their likelihood of quitting smoking
We sought to estimate the proportion of patients admitted to a metropolitan intensive care unit (ICU) who were current smokers, and the relationships between ICU survivors who smoked and smoking cessation and/or reduction six months post –ICU discharge. We conducted a prospective cohort study at a metropolitan level III ICU in Melbourne, Victoria. One hundred consecutive patients who met the inclusion criteria were included in the study. Inclusion criteria consisted of patients who were smokers at time of ICU admission, had an ICU length of stay greater than one day, survived to ICU discharge, and provided written inform...
Source: Anaesthesia and Intensive Care - November 15, 2017 Category: Anesthesiology Source Type: research
