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Items 1 - 5 of 5 |
One page. |
Anaesthetic and intensive care management of a patient with Ehlers-Danlos type IV syndrome after laparotomy.
Solan K, Davies P.
Department of Anaesthesia, Guy's Hospital, St Thomas' Street, London, SE1 9RT, UK. handkhastings@aol.com
A 31-year-old woman with Ehlers-Danlos type IV syndrome developed multiple intensive care related complications following laparotomy for perforated bowel. Complications are more likely to occur with the Ehlers-Danlos syndrome.
Publication Types:
PMID: 15549985 [PubMed - indexed for MEDLINE]
[Evidence-based intensive care treatment of intracranial hypertension after traumatic brain injury.]
[Article in German]
Pannen BH, Loop T.
Anaesthesiologische Universitatsklinik, Universitatsklinikum Freiburg.
Traumatic brain injury (TBI) occurs frequently and is associated with a poor prognosis. Severe TBI results in substantial disability or death in more than 40% of cases. The major aim of treatment of these patients is to minimize secondary brain injury and in this respect, the prevention of intracranial hypertension plays a key role. In addition to surgical approaches, various conservative treatment options exist, such as the use of osmodiuretics, barbiturates, or corticosteroids, hyperventilation as well as induced therapeutic hypothermia. This review analyzes these treatment options and the therapeutic goals of lowering intracranial pressure (ICP) in patients after TBI using evidence-based criteria, and provides recommendations for clinical practice.
PMID: 15565388 [PubMed - as supplied by publisher]
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Returning home after intensive care: A comparison of symptoms of anxiety and depression in ICU and elective cardiac surgery patients and their relatives.
Young E, Eddleston J, Ingleby S, Streets J, McJanet L, Wang M, Glover L.
Department of Behavioural Medicine, Hope Hospital, Clinical Sciences Building, Stott Lane, Salford, M6 8HD, Manchester, UK.
OBJECTIVE. This study gathered data on symptoms of anxiety and depression in patients and relatives after discharge from intensive care and examined whether the intensive care population differ from an elective cardiac surgery group with regards to their anxiety and depression symptom reporting. DESIGN AND SETTING. A single measurement point matched group comparison study in an ICU follow-up programme. PATIENTS AND PARTICIPANTS. Twenty ICU patients and their relatives and a matched comparison group of 15 elective cardiac surgery patients and their relatives. MEASUREMENTS AND RESULTS. Patients and relatives completed the Hospital Anxiety and Depression Scale. Relatives answered an open question to explore the perceived impact of Intensive care/cardiac surgery on their lives. ICU patients' relatives reported significantly higher number of symptoms of anxiety than did ICU patients, higher number of symptoms of depression than cardiac surgery patients' relatives, and more troubling and life-altering experiences than the relatives of cardiac surgery patients. CONCLUSIONS. Relatives of ICU patients also suffer anxiety and depression, and services should address this need. Group differences suggest that ICU patients' relatives have 'unique' characteristics of depression symptom reporting.
PMID: 15565363 [PubMed - as supplied by publisher]
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Analysis of blood glucose measurements using capillary and arterial blood samples in intensive care patients.
Kulkarni A, Saxena M, Price G, O'leary MJ, Jacques T, Myburgh JA.
Department of Intensive Care Medicine, St. George Hospital, Gray St., Kogarah, 2217, Sydney, Australia.
OBJECTIVE. To analyse agreement between two methods for blood glucose measurement in intensive care patients: capillary blood using a reagent strip and glucometer with arterial blood using a blood gas analyser. DESIGN AND SETTING. Prospective, single-centre, observational study in a 12-bed tertiary referral intensive care unit. MEASUREMENTS. Blood glucose levels were measured in consecutive patients using simultaneous measurements of capillary blood samples using glucometry and from a multi-electrode arterial blood gas analyser. An a priori subgroup of patients with tissue hypoperfusion was identified (defined as systolic blood pressure <90 mmHg or vasopressor dependency). A total of 493 paired measurements were obtained; 75 of these were from patients with systemic hypoperfusion. RESULTS. Overall, the mean difference (bias) was 0.12 mmol/l (2.15 mg/dl) and precision 0.77 mmol/l (13.8 mg/dl); 95% limits of agreement were -0.14 and 1.66 mmol/l (-2.5 and 29.8 mg/dl). In patients with systemic hypoperfusion the bias was 0.24 mmol/l (4.0 mg/dl) and precision 0.9 mmol/l (16.2 mg/dl); 95% limits of agreement -2.05 and 1.58 mmol/l (36.8 and 28.4 mg/dl). CONCLUSIONS. In a general population of intensive care patients, there is statistical agreement between blood glucose measured from capillary blood glucometry and arterial blood gas analysis. However, in patients with systemic hypoperfusion, the accuracy of agreement between these two measurement techniques may be such that that biochemical hypoglycaemia (<2.5 mmol/l, 44.9 mg/dl) may go undetected if used interchangeably.
PMID: 15565362 [PubMed - as supplied by publisher]
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Characteristics and immediate outcome of childhood meningitis treated in the pediatric intensive care unit.
Odetola FO, Bratton SL.
Department of Pediatrics and Communicable Diseases, Division of Pediatric Critical Care Medicine, University of Michigan Medical School and the University of Michigan Health System, MI 48109, Ann Arbor, USA.
OBJECTIVE. To describe patient characteristics, use of technology and mortality in children with meningitis admitted to the pediatric intensive care unit (PICU). DESIGN. Retrospective cohort study. SETTING. Fifteen US PICUs. PATIENTS. All admissions with a diagnosis of meningitis between 1995 and 2000 in the Pediatric Intensive Care Unit Evaluations (PICUEs) database. MEASUREMENTS AND RESULTS. Of 559 patients with meningitis, 58% were male. The median age was 19 months and the median length of PICU stay was 2 days. The crude PICU mortality rate was 7%. Three hundred thirty-four (60%) patients had bacterial meningitis. Non-survivors had significantly higher Pediatric Risk of Mortality (PRISM) III scores and also constituted a larger proportion of the patients with bacterial meningitis, coma and shock upon PICU admission. The use of invasive devices was higher among non-survivors, patients with bacterial meningitis or those who were in coma or shock upon PICU admission. There was significant variation in the use of intracranial pressure (ICP) monitors by coma status and by institution. In multivariate analysis, patients had 1.26 higher odds of mortality for each unit increase in PRISM III score (odds ratio 1.26, 95% confidence interval: 1.19-1.34), while adjusting for other variables. CONCLUSION. In a large cohort of children admitted to the PICU with meningitis, severity of illness, particularly the presence of shock or coma, was significantly associated with both the higher use of invasive medical devices and higher mortality. There was significant variation in the use of ICP monitors among the various PICUs without statistical association with survival.
PMID: 15565361 [PubMed - as supplied by publisher]
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