Anaesthesia 2001 Oct;56(10):1004-5

Secondary transfer of intensive care patients by helicopter.

Bristow A

St Bartholomew's Hospital, London EClA 7BE, UK.

[Medline record in process]

PMID: 11576106, UI: 21460203

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Anaesthesia 2001 Sep;56(9):859-64

Evaluation of a new percutaneous dilatational tracheostomy set apparatus.

Bewsher MS, Adams AM, Clarke CW, McConachie I, Kelly DR

The Intensive Care Unit, Blackpool Victoria Hospital NHS Trust, Whinney Heys Road, Blackpool FY3 8NR, UK.

Percutaneous tracheostomy is a well established technique used primarily to assist weaning from mechanical ventilation on many intensive care units. We report our experiences of a total of 36 procedures performed with the new Blue Rhino Percutaneous Tracheostomy Introducer Set developed by Ciaglia. The technique was successful in all cases and was simpler and quicker to perform than with the earlier Ciaglia percutaneous tracheostomy set. Difficulties were encountered when using Shiley tracheostomy tubes. Significant complications included one posterior wall tear and one tracheal cartilage ring fracture.

Publication Types:

PMID: 11531672, UI: 21422870

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BMJ 2001 Sep 15;323(7313):630

Mortality after discharge from intensive care. Only community debate on appropriate end of life care will limit ballooning budget.

O-Leary MJ, Bihari DJ

Publication Types:

PMID: 11575316, UI: 21459152

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BMJ 2001 Sep 15;323(7313):630

Mortality after discharge from intensive care. Research in intensive care needs to find balance between scientific method and ethics.

Bion J

Publication Types:

PMID: 11575315, UI: 21459149

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BMJ 2001 Sep 15;323(7313):629-30

Mortality after discharge from intensive care. Only normalisation of physiology will reduce risk of mortality after discharge.

Inglis A, Price R

Publication Types:

PMID: 11575314, UI: 21459148

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Br J Anaesth 2001 May;86(5):650-6

Effects of dexmedetomidine on adrenocortical function, and the cardiovascular, endocrine and inflammatory responses in post-operative patients needing sedation in the intensive care unit.

Venn RM, Bryant A, Hall GM, Grounds RM

Department of Anaesthesia and Intensive Care, Worthing Hospital, West Sussex, UK.

[Medline record in process]

We have compared the effects of dexmedetomidine and propofol on endocrine, metabolic, inflammatory and cardiovascular responses in patients in the intensive care unit (ICU) after major surgery. Twenty patients who were expected to require 8 h of post-operative sedation and ventilation were allocated randomly to receive either an infusion of dexmedetomidine 0.2-2.5 microg kg(-1) h(-1) or propofol 1-3 mg kg(-1) h(-1). Arterial pressure, heart rate and sequential concentrations of circulating cortisol, adrenocorticotrophic hormone (ACTH), growth hormone, prolactin, insulin, glucose and interleukin 6 were measured. An ACTH stimulation test was performed in all patients who received dexmedetomidine. Heart rate was significantly lower in the dexmedetomidine patients. There were no differences in arterial pressure, cortisol, ACTH, prolactin and glucose concentrations between the two groups. A positive response to the ACTH stimulation test varied depending on the diagnostic criteria used. The insulin concentration was significantly lower in the dexmedetomidine group at 2 h (P=0.021), although this did not affect blood glucose concentrations. Growth hormone concentrations were significantly higher in dexmedetomidine-treated patients overall (P=0.036), but circulating concentrations remained in the physiological range. Interleukin 6 decreased in the dexmedetomidine group. We conclude that dexmedetomidine infusion does not inhibit adrenal steroidogenesis when used for short-term sedation after surgery.

PMID: 11575340, UI: 21459182

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Br J Anaesth 2001 Mar;86(3):382-7

Analysis of the French health ministry's national register of incidents involving medical devices in anaesthesia and intensive care.

Beydon L, Conreux F, Le Gall R, Safran D, Cazalaa JB

Departement d'Anaesthesie, CHU d'Angers, France.

[Medline record in process]

This study details all incidents involving medical devices used in anaesthesia and intensive care reported to the relevant authorities in France in 1998. There were 1004 reports during that year. Incidents were classified as serious (harmful to patients) in 11% of cases; death resulted in 2% of cases. Equipment for ventilation and infusion, and monitors of all kinds, accounted for most of the reports, representing 37%, 30% and 12%, respectively, of all reports. The leading causes of failure varied according to the category of device. User errors, quality control problems during production of the device and design faults were the three main causes. The problems identified during the study period enabled the faulty medical devices to be improved in 12-44% of cases. We conclude that post-marketing vigilance is a useful way of improving the quality of medical devices.

PMID: 11573529, UI: 21457432

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Br J Anaesth 2001 Mar;86(3):327-9

Right heart catheterization in intensive care.

Young JD

[Medline record in process]

Publication Types:

PMID: 11573518, UI: 21457421

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J Trauma 2001 Sep;51(3):601-20

Micronutrient supplementation in the critically ill patient: strategies for clinical practice.

Prelack K, Sheridan RL

Burn and Trauma Services, Massachusetts General Hospital , 55 Fruit Street, Boston, MA 02114, USA.

Publication Types:

PMID: 11535921, UI: 21427373

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Lancet 2001 Feb 24;357(9256):606-7

Impaired fatty acid oxidation in propofol infusion syndrome.

Wolf A, Weir P, Segar P, Stone J, Shield J

Propofol infusion syndrome is a rare but frequently fatal complication in critically ill children given long-term propofol infusions. We describe a child who developed all the clinical features of propofol infusion syndrome and was treated successfully with haemofiltration. Biochemical analysis before haemofiltration showed a large rise in plasma concentrations of malonylcarnitine (3.3 micromol/L) and C5-acylcarnitine (8.4 micromol/L), which returned to normal after recovery. Abnormalities are consistent with specific disruption of fatty-acid oxidation caused by impaired entry of long-chain acylcarnitine esters into the mitochondria and failure of the mitochondrial respiratory chain at complex 11.

Publication Types:

PMID: 11558490, UI: 21442193

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