Am J Crit Care 2001 Sep;10(5):367-9
[Medline record in process]
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PMID: 11548573, UI: 21433241
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Anaesthesia 2001 Sep;56(9):841-6
Critical Care Complex, Norfolk and Norwich Hospital, Brunswick Rd, Norwich NR1 3SR, UK.
Medical patients suffer a high mortality after critical illness; however, the causes of mortality after intensive care management are unclear. This study's aims were to (a) explore what factors affect outcome after intensive care and (b) identify medical patients at particularly high risk of mortality. During one year, all patients admitted with a medical cause to the Critical Care Complex were enrolled. Diagnosis on admission was recorded, and whether the reason for admission was a new clinical problem or an exacerbation of existing chronic illness. All patients were followed for a minimum of one year. A total of 186 medical patients were included in the study. Fifty-four medical patients died on intensive care (28.4% mortality), a further 16 died on the general ward after intensive care unit discharge (hospital mortality 36.8%) and six following discharge home (1 year's mortality 40.9%). Of the 16 patients who died on the general ward, 12 had been admitted to the intensive care unit with a new, previously unrecognised problem rather than exacerbation of a chronic pre-existing problem. However, on the general ward, 'Do Not Resuscitate' orders were placed on seven of these 12 patients. It would appear that some of the high post intensive care hospital mortality might be due to changes in resuscitation status in patients expected to survive following intensive care unit discharge.
PMID: 11531668, UI: 21422866
Anaesthesia 2001 Sep;56(9):836-40
Department of Anaesthesiology and Intensive Care Medicine, Klinikum Ludwigshafen, Bremserstrasse 79, D-67063, Ludwigshafen, Germany.
This prospective randomised controlled study evaluated the effects of postoperative sedation with propofol and midazolam on pancreatic function. We studied 42 intensive care unit patients undergoing elective major surgery who were expected to be sedated postoperatively. Patients were randomly assigned to a propofol group (n = 21) or a midazolam group (n = 21). To assess pancreatic function, the following parameters were measured: pancreatitis-associated protein, amylase, lipase, cholesterol and triglyceride prior to start of sedation on the intensive care unit, 4 h after the sedation was started and at the first postoperative day. Patients in the propofol group received on average (SD) 1292 (430) mg propofol and were sedated for 9.03 (4.26) h. The midazolam group received 92 (36) mg midazolam and were sedated for 8.81 (4.68) h. Plasma cholesterol concentrations did not differ significantly between groups. Triglyceride plasma levels 4 h after the start of infusion were significantly higher in the propofol group (140 (54) mg.dl(-1)) than the midazolam-treated patients (81 (29) mg.dl(-1)), but were within normal limits. There were no significant differences between the two groups regarding amylase, lipase and pancreatitis-associated protein plasma concentrations at any time. No markers of pancreatic dysfunction were outside the normal range. We conclude that postoperative sedation with propofol induced a significant increase of serum triglyceride levels but that pancreatic function is unchanged with standard doses of propofol.
PMID: 11531667, UI: 21422865
Respir Care 2001 Aug;46(8):789-97
Department of Anesthesiology, University of Florida College of Medicine, Gainesville FL 32610-0254, USA. blancpb@shands.ufl.edu.
INTRODUCTION: Mechanical ventilator failures expose patients to unacceptable risks and are expensive. By identifying factors that correlate with the amount of time between consecutive ventilator failures, we might reduce patient risk, save money, and shed light on a number of important questions concerning whether reliability changes as a function of time. OBJECTIVE: Investigate the correlation between several explanatory variables and the time between consecutive ventilator failures and address the following questions: (1) Are ventilators as safe and reliable following repairs as they were before failing? (2) Does reliability change significantly as a ventilator is used or ages? (3) Does a hospital's particular operating environment play a role in ventilator reliability? (4) Are ventilator service contracts worth the money? METHODS: A retrospective review was conducted using repair and maintenance records from 2 hospitals: a 570-bed teaching hospital and a 410-bed local community hospital. Records were examined from a total of 66 individual ventilators, of 5 different brands, used between July 1, 1991, and January 3, 2001. The ventilators included 13 Tyco-Mallinckrodt Infant Star, 10 Bird VIP, 11 Bird 6400ST, 16 Bird 8400STi, and 16 Tyco-Mallinckrodt 7200ae. The dependent variable was the operating time between or before unexpected mechanical failures; this was determined by the difference between hours logged on the ventilator hour meter at the time of failure and that recorded when the study began, or when the ventilator was new. Thereafter (when applicable), the time before failure was the difference in hours at consecutive failures. Seven independent explanatory covariates were selected and analyzed as potential correlates with time between failures. Another independent variable, the site of ventilator use (community or teaching hospital), was also tested for significance. Data were analyzed using the Cox proportional hazard model, the multiple-groups survival statistic, and the Cox-Mantel test. RESULTS: In 2,567,365 hours of ventilator operation, 290 observations were recorded (226 failures and 64 censored observations). Two of the 7 covariates were judged time-dependent, excluded from the Cox model, and evaluated using other techniques. Of the 5 remaining covariates, 2 were significantly related to reliability, both indirectly. There was no difference in reliability, regardless of how many times a ventilator had been previously repaired, but hospital environment did significantly affect reliability. CONCLUSIONS: Ventilator reliability depends on a number of factors. This study indicates that, on average, ventilator reliability improves the more a ventilator is used and the longer the brand has been commercially available. The number of previous ventilator repairs did not affect reliability, but the hospital environment did. These data, if validated, should help to enhance our understanding of ventilator reliability and could eventually have profound economic and safety implications as well.
PMID: 11463369, UI: 21357142
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