Br J Anaesth 2001 Apr;86(4):581-6
Department of Anaesthesia, Treliske Hospital, Truro, Cornwall, UK.
Purpura fulminans (PF) is a haemorrhagic condition usually associated with sepsis or previous infection. Features include tissue necrosis, small vessel thrombosis and disseminated intravascular coagulation. Gram-negative organisms are the commonest cause of the acute infectious type, which is often associated with multi-organ failure. An idiopathic variety, however, is often confined to the skin. The mortality rate has decreased with better treatment of secondary infections, supportive care and new treatments, but it remains a disabling condition often requiring major amputations. We describe two cases and review the various treatments for this condition.
PMID: 11573639, UI: 21457542
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Br J Anaesth 2001 Jun;86(6):754-62
Service d'Anesthesie-Reanimation chirurgicale, Hjpital Tenon, Paris, France.
The circulating blood volume (CBV) of critically ill patients may be difficult to estimate on the basis of history and physical examination. The aim of this study was to evaluate the ability of seven clinical signs and central venous pressure (CVP) to predict CBV in critically ill patients; CBV was evaluated with the [125I]human serum albumin technique. A scoring system was constructed using a combination of independence Bayes method and logistic regression. Sixty-eight patients constituted a 'model development' sample and 30 patients a validation sample. Thirty-six patients (53%) in the model development sample were found to have a low CBV (measured CBV at least 10% lower than the predicted mean normal CBV). Neither the haemodynamic variables monitored in ICU, nor the spot urinary sodium concentrations were different between patients with and without a low CBV. Individually, none of the clinical signs tested have a good positive or negative predictive value. For CVP, only extreme values seem to have clinical significance. To construct the score, the signs tested were ranked according to their discriminating efficacy. The probability of a low CBV was obtained by adding the weights of each sign tested and converting the score obtained into a probability. On a validation sample of 30 patients, the predictions are reliable as assessed by Z statistics ranging between -2 and +2. Our results suggest that: (1) individually, no clinical sign presented a clinical useful predictive value; and (2) a clinical scoring system may be helpful for the evaluation of CBV in critically ill patients.
PMID: 11573580, UI: 21457483
Br J Anaesth 2001 Jun;86(6):743-6
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PMID: 11573577, UI: 21457480
Br J Anaesth 2001 Mar;86(3):451-3
PMID: 11573542, UI: 21457445
Br J Anaesth 2001 Mar;86(3):437-41
Department of Anaesthetics, Poole General Hospital, UK.
Metabolic acidosis is encountered frequently in intensive care and common causes include lactic acidosis, ketoacidosis, or renal failure. We describe a patient presenting to intensive care with a rare cause of metabolic acidosis associated with an increased anion gap: multiple acyl-CoA dehydrogenase deficiency. The pathophysiology of this condition is discussed along with potential treatment options.
PMID: 11573539, UI: 21457442
Chest 2001 Sep;120(3):694-6
PMID: 11555490, UI: 21439026
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