69 results found
Harrison JN, Welch J, Kailla C, et al., 2021, Cerebral desaturation and delirium in patients having non-cardiac surgery - a pilot study, Perioperative Care and Operating Room Management, Vol: 23
Background: Postoperative delirium (POD) is associated with increased short- and long-term mortality and several risk factors have been described. Decreased regional cerebral oxygen saturations (rScO2) may be a modifiable risk factor for POD yet its measurement is not used in routine clinical practice. Aims: The primary aim of this study was to assess the feasibility of measuring rScO2 and screening for POD in patients over 60 years of age having non-cardiac surgery. Our secondary aim was to perform exploratory analyses of the relationship between boluses of intra-operative vasopressor and rScO2 values. Methods: rScO2 were recorded in 60 patients over the age of 60 years having non-cardiac surgery in a single centre. Patients were screened daily for delirium for up to 7 days of the inpatient stay or until discharge, which ever occurred sooner. Results: Of the 60 patients recruited, 58 underwent complete daily assessment for POD. Of those, 2 developed POD (3.4%). Patients that developed POD tended to be older, but no other statistically significant differences were observed. Analysis of the effect of phenylephrine boluses on rScO2 observed a ‘rise, drop, return’ pattern in an 8-minute window post-bolus administration. Conclusion: The study protocol was found to be feasible to deliver. The study was unable to find any associations between rScO2 and POD, however, the study identified a relationship between intraoperative vasopressor boluses and subsequent rScO2.
Vogelaers D, Blot S, Van den Berge A, et al., 2021, Antimicrobial Lessons From a Large Observational Cohort on Intra-abdominal Infections in Intensive Care Units., Drugs, Vol: 81, Pages: 1065-1078
Severe intra-abdominal infection commonly requires intensive care. Mortality is high and is mainly determined by disease-specific characteristics, i.e. setting of infection onset, anatomical barrier disruption, and severity of disease expression. Recent observations revealed that antimicrobial resistance appears equally common in community-acquired and late-onset hospital-acquired infection. This challenges basic principles in anti-infective therapy guidelines, including the paradigm that pathogens involved in community-acquired infection are covered by standard empiric antimicrobial regimens, and second, the concept of nosocomial acquisition as the main driver for resistance involvement. In this study, we report on resistance profiles of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecalis and Enterococcus faecium in distinct European geographic regions based on an observational cohort study on intra-abdominal infections in intensive care unit (ICU) patients. Resistance against aminopenicillins, fluoroquinolones, and third-generation cephalosporins in E. coli, K. pneumoniae and P. aeruginosa is problematic, as is carbapenem-resistance in the latter pathogen. For E. coli and K. pneumoniae, resistance is mainly an issue in Central Europe, Eastern and South-East Europe, and Southern Europe, while resistance in P. aeruginosa is additionally problematic in Western Europe. Vancomycin-resistance in E. faecalis is of lesser concern but requires vigilance in E. faecium in Central and Eastern and South-East Europe. In the subcohort of patients with secondary peritonitis presenting with either sepsis or septic shock, the appropriateness of empiric antimicrobial therapy was not associated with mortality. In contrast, failure of source control was strongly associated with mortality. The relevance of these new insights for future recommendations regarding empiric antimicrobial therapy in intra-abdominal infections is discussed.
Pugin J, Daix T, Pagani J-L, et al., 2021, Serial measurement of pancreatic stone protein for the early detection of sepsis in intensive care unit patients: a prospective multicentric study., Crit Care, Vol: 25
BACKGROUND: The early recognition and management of sepsis improves outcomes. Biomarkers may help in identifying earlier sub-clinical signs of sepsis. We explored the potential of serial measurements of C-reactive protein (CRP), procalcitonin (PCT) and pancreatic stone protein (PSP) for the early recognition of sepsis in patients hospitalized in the intensive care unit (ICU). METHODS: This was a multicentric international prospective observational clinical study conducted in 14 ICUs in France, Switzerland, Italy, and the United Kingdom. Adult ICU patients at risk of nosocomial sepsis were included. A biomarker-blinded adjudication committee identified sepsis events and the days on which they began. The association of clinical sepsis diagnoses with the trajectories of PSP, CRP, and PCT in the 3 days preceding these diagnoses of sepsis were tested for markers of early sepsis detection. The performance of the biomarkers in sepsis diagnosis was assessed by receiver operating characteristic (ROC) analysis. RESULTS: Of the 243 patients included, 53 developed nosocomial sepsis after a median of 6 days (interquartile range, 3-8 days). Clinical sepsis diagnosis was associated with an increase in biomarkers value over the 3 days preceding this diagnosis [PSP (p = 0.003), PCT (p = 0.025) and CRP (p = 0.009)]. PSP started to increase 5 days before the clinical diagnosis of sepsis, PCT 3 and CRP 2 days, respectively. The area under the ROC curve at the time of clinical sepsis was similar for all markers (PSP, 0.75; CRP, 0.77; PCT, 0.75). CONCLUSIONS: While the diagnostic accuracy of PSP, CRP and PCT for sepsis were similar in this cohort, serial PSP measurement demonstrated an increase of this marker the days preceding the onset of signs necessary to clinical diagnose sepsis. This observation justifies further evaluation of the potential clinical benefit of serial PSP measurement in the management of critica
Zieleskiewicz L, Papinko M, Lopez A, et al., 2021, Lung Ultrasound Findings in the Postanesthesia Care Unit Are Associated With Outcome After Major Surgery: A Prospective Observational Study in a High-Risk Cohort., Anesth Analg, Vol: 132, Pages: 172-181
BACKGROUND: Postoperative pulmonary complications are associated with increased morbidity. Identifying patients at higher risk for such complications may allow preemptive treatment. METHODS: Patients with an American Society of Anesthesiologists (ASA) score >1 and who were scheduled for major surgery of >2 hours were enrolled in a single-center prospective study. After extubation, lung ultrasound was performed after a median time of 60 minutes by 2 certified anesthesiologists in the postanesthesia care unit after a standardized tracheal extubation. Postoperative pulmonary complications occurring within 8 postoperative days were recorded. The association between lung ultrasound findings and postoperative pulmonary complications was analyzed using logistic regression models. RESULTS: Among the 327 patients included, 69 (19%) developed postoperative pulmonary complications. The lung ultrasound score was higher in the patients who developed postoperative pulmonary complications (12 [7-18] vs 8 [4-12]; P < .001). The odds ratio for pulmonary complications in patients who had a pleural effusion detected by lung ultrasound was 3.7 (95% confidence interval, 1.2-11.7). The hospital death rate was also higher in patients with pleural effusions (22% vs 1.3%; P < .001). Patients with pulmonary consolidations on lung ultrasound had a higher risk of postoperative mechanical ventilation (17% vs 5.1%; P = .001). In all patients, the area under the curve for predicting postoperative pulmonary complications was 0.64 (95% confidence interval, 0.57-0.71). CONCLUSIONS: When lung ultrasound is performed precociously <2 hours after extubation, detection of immediate postoperative alveolar consolidation and pleural effusion by lung ultrasound is associated with postoperative pulmonary complications and morbi-mortality. Further study is needed to determine the effect of ultrasound-guided intervention for patients at high risk of postoperative pulmonary complications.
Beattie WS, Lalu M, Bocock M, et al., 2021, Systematic review and consensus definitions for the Standardized Endpoints in Perioperative Medicine (StEP) initiative: cardiovascular outcomes., Br J Anaesth, Vol: 126, Pages: 56-66
BACKGROUND: Adverse cardiovascular events are a leading cause of perioperative morbidity and mortality. The definitions of perioperative cardiovascular adverse events are heterogeneous. As part of the international Standardized Endpoints in Perioperative Medicine initiative, this study aimed to find consensus amongst clinical trialists on a set of standardised and valid cardiovascular outcomes for use in future perioperative clinical trials. METHODS: We identified currently used perioperative cardiovascular outcomes by a systematic review of the anaesthesia and perioperative medicine literature (PubMed/Ovid, Embase, and Cochrane Library). We performed a three-stage Delphi consensus-gaining process that involved 55 clinician researchers worldwide. Cardiovascular outcomes were first shortlisted and the most suitable definitions determined. These cardiovascular outcomes were then assessed for validity, reliability, feasibility, and clarity. RESULTS: We identified 18 cardiovascular outcomes. Participation in the three Delphi rounds was 100% (n=19), 71% (n=55), and 89% (n=17), respectively. A final list of nine cardiovascular outcomes was elicited from the consensus: myocardial infarction, myocardial injury, cardiovascular death, non-fatal cardiac arrest, coronary revascularisation, major adverse cardiac events, pulmonary embolism, deep vein thrombosis, and atrial fibrillation. These nine cardiovascular outcomes were rated by the majority of experts as valid, reliable, feasible, and clearly defined. CONCLUSIONS: These nine consensus cardiovascular outcomes can be confidently used as endpoints in clinical trials designed to evaluate perioperative interventions with the goal of improving perioperative outcomes.
King CE, Kermode A, Saxena G, et al., 2020, Postoperative continuous non-invasive cardiac output monitoring on the ward: a feasibility study, JOURNAL OF CLINICAL MONITORING AND COMPUTING, ISSN: 1387-1307
Bossy M, Nyman M, Madhuri TK, et al., 2020, The need for post-operative vasopressor infusions after major gynae-oncologic surgery within an ERAS (Enhanced Recovery After Surgery) pathway, PERIOPERATIVE MEDICINE, Vol: 9
Odor PM, Bampoe S, Gilhooly D, et al., 2020, Perioperative interventions for prevention of postoperative pulmonary complications: systematic review and meta-analysis., BMJ, Vol: 368
OBJECTIVE: To identify, appraise, and synthesise the best available evidence on the efficacy of perioperative interventions to reduce postoperative pulmonary complications (PPCs) in adult patients undergoing non-cardiac surgery. DESIGN: Systematic review and meta-analysis of randomised controlled trials. DATA SOURCES: Medline, Embase, CINHAL, and CENTRAL from January 1990 to December 2017. ELIGIBILITY CRITERIA: Randomised controlled trials investigating short term, protocolised medical interventions conducted before, during, or after non-cardiac surgery were included. Trials with clinical diagnostic criteria for PPC outcomes were included. Studies of surgical technique or physiological or biochemical outcomes were excluded. DATA EXTRACTION AND SYNTHESIS: Reviewers independently identified studies, extracted data, and assessed the quality of evidence. Meta-analyses were conducted to calculate risk ratios with 95% confidence intervals. Quality of evidence was summarised in accordance with GRADE methods. The primary outcome was the incidence of PPCs. Secondary outcomes were respiratory infection, atelectasis, length of hospital stay, and mortality. Trial sequential analysis was used to investigate the reliability and conclusiveness of available evidence. Adverse effects of interventions were not measured or compared. RESULTS: 117 trials enrolled 21 940 participants, investigating 11 categories of intervention. 95 randomised controlled trials enrolling 18 062 participants were included in meta-analysis; 22 trials were excluded from meta-analysis because the interventions were not sufficiently similar to be pooled. No high quality evidence was found for interventions to reduce the primary outcome (incidence of PPCs). Seven interventions had low or moderate quality evidence with confidence intervals indicating a probable reduction in PPCs: enhanced recovery pathways (risk ratio 0.35, 95% confidence interval 0.21 to 0.58), prophylactic mucolytics (0.40, 0.23
Blot S, Antonelli M, Arvaniti K, et al., 2019, Epidemiology of intra-abdominal infection and sepsis in critically ill patients: "AbSeS", a multinational observational cohort study and ESICM Trials Group Project, INTENSIVE CARE MEDICINE, Vol: 45, Pages: 1703-1717, ISSN: 0342-4642
Haller G, Bampoe S, Cook T, et al., 2019, Systematic review and consensus definitions for the Standardised Endpoints in Perioperative Medicine initiative: clinical indicators., Br J Anaesth, Vol: 123, Pages: 228-237
BACKGROUND: Clinical indicators are powerful tools to quantify the safety and quality of patient care. Their validity is often unclear and definitions extremely heterogeneous. As part of the International Standardised Endpoints in Perioperative Medicine (StEP) initiative, this study aimed to derive a set of standardised and valid clinical outcome indicators for use in perioperative clinical trials. METHODS: We identified clinical indicators via a systematic review of the anaesthesia and perioperative medicine literature (PubMed/OVID, EMBASE, and Cochrane Library). We performed a three-stage Delphi consensus-gaining process that involved 54 clinician-researchers worldwide. Indicators were first shortlisted and the most suitable definitions for evaluation of quality and safety interventions determined. Indicators were then assessed for validity, reliability, feasibility, and clarity. RESULTS: We identified 167 clinical outcome indicators. Participation in the three Delphi rounds was 100% (n=13), 68% (n=54), and 85% (n= 6), respectively. A final list of eight outcome indicators was generated: surgical site infection at 30 days, stroke within 30 days of surgery, death within 30 days of coronary artery bypass grafting, death within 30 days of surgery, admission to the intensive care unit within 14 days of surgery, readmission to hospital within 30 days of surgery, and length of hospital stay (with or without in-hospital mortality). They were rated by the majority of experts as valid, reliable, easy to use, and clearly defined. CONCLUSIONS: These clinical indicators can be confidently used as endpoints in clinical trials measuring quality, safety, and improvement in perioperative care. REGISTRATION: PROSPERO 2016 CRD42016042102 (http://www.crd.york.ac.uk/PROSPERO/display_record.php? ID=CRD42016042102).
Chhetri I, Hunt JEA, Mendis JR, et al., 2019, Repetitive vascular occlusion stimulus (RVOS) versus standard care to prevent muscle wasting in critically ill patients (ROSProx):a study protocol for a pilot randomised controlled trial., Trials, Vol: 20
BACKGROUND: Forty per cent of critically ill patients are affected by intensive care unit-acquired weakness (ICU-AW), to which skeletal muscle wasting makes a substantial contribution. This can impair outcomes in hospital, and can cause long-term physical disability after hospital discharge. No effective mitigating strategies have yet been identified. Application of a repetitive vascular occlusion stimulus (RVOS) a limb pressure cuff inducing brief repeated cycles of ischaemia and reperfusion, can limit disuse muscle atrophy in both healthy controls and bed-bound patients recovering from knee surgery. We wish to determine whether RVOS might be effective in mitigating against muscle wasting in the ICU. Given that RVOS can also improve vascular function in healthy controls, we also wish to assess such effects in the critically ill. We here describe a pilot study to assess whether RVOS application is safe, tolerable, feasible and acceptable for ICU patients. METHODS: This is a randomised interventional feasibility trial. Thirty-two ventilated adult ICU patients with multiorgan failure will be recruited within 48 h of admission and randomised to either the intervention arm or the control arm. Intervention participants will receive RVOS twice daily (except only once on day 1) for up to 10 days or until ICU discharge. Serious adverse events and tolerability (pain score) will be recorded; feasibility of trial procedures will be assessed against pre-specified criteria and acceptability by semi-structured interview. Together with vascular function, muscle mass and quality will be assessed using ultrasound and measures of physical function at baseline, on days 6 and 11 of study enrolment, and at ICU and hospital discharge. Blood and urine biomarkers of muscle metabolism, vascular function, inflammation and DNA damage/repair mechanism will also be analysed. The Health questionnaire will be completed 3 months after hospital discharge. DISCUSSION: If this st
Potter EK, Hodgson L, Creagh-Brown B, et al., 2019, Manipulating the Microcirculation in Sepsis - the Impact of Vasoactive Medications on Microcirculatory Blood Flow: A Systematic Review., Shock, Vol: 52, Pages: 5-12
BACKGROUND: Sepsis is life-threatening organ dysfunction because of a dysregulated host response to infection. Disturbed microvascular blood flow is associated with excess mortality and is a potential future target for interventions. This review addresses the evidence for pharmacological manipulation of the microcirculation in sepsis assessed by techniques that evaluate the sublingual microvasculature. METHODS: Systematic review using a published protocol. Eligibility criteria were studies of septic patients published from January 2000 to February 2018. Interventions were drugs aimed at improving perfusion. Outcome was improvement in microvascular flow using orthogonal polarization spectral, sidestream dark field, or incident dark field imaging (Grades of Recommendation, Assessment, Development, and Evaluation criteria used). RESULTS: Two thousand six hundred and six articles were screened and 22 included. (6 randomized controlled trials, 12 interventional, 3 observational, and 1 pilot, n = 572 participants). Multiple measurement techniques were described, including: automated analyses, subjective, and composite scoring systems. Norepinephrine was not found to improve microvascular flow (low-grade evidence, n = 6 studies); except in chronic hypertension (low, n = 1 study). Addition of arginine vasopressin or terlipressin to norepinephrine maintained flow while decreasing norepinephrine requirements (high, n = 2 studies). Neither dobutamine nor glyceryl trinitrate consistently improved flow (low, n = 6 studies). A single study (n = 40 participants) demonstrated improved flow with levosimendan (high). In a risk of bias assessment 16/16 interventional, pilot and observational studies were found to be high risk. CONCLUSIONS: There is no robust evidence to date that any one agent can reproducibly lead to improved microvascular flow. Furthermore, no study demonstrated outcome benefit of one therapeutic agent over another. Updated consensus guidelines could improve compara
Rayner LH, Mcgovern A, Sherlock J, et al., 2019, The impact of therapy on the risk of asthma in type 2 diabetes., Clin Respir J, Vol: 13, Pages: 299-305
BACKGROUND AND OBJECTIVES: There are limited data about the risk of asthma in people with diabetes. We examined the incidence of asthma in subjects with type 2 diabetes (T2DM) compared to controls, and the association with metformin, sulphonylureas and insulin therapy. MATERIALS AND METHODS: We conducted a retrospective cohort study using a representative UK primary care database (N = 894 646 adults). We used 1:1 propensity score matching (age, gender, socio-economic deprivation, body mass index and smoking status) to match 29 217 pairs of T2DM cases and controls. We used Cox proportional hazard regression to compare the incidence of asthma in both groups over 8 years of follow-up. In those with T2DM, we used Cox proportional hazard regression to assess for any impact of antidiabetic medications on asthma incidence. RESULTS: Individuals with T2DM were less likely to develop asthma than matched controls (hazard ratio [HR] 0.85, 95% CI 0.77-0.93). Insulin increased the risk of incident asthma (HR 1.25, 95% CI 1.01-1.56), whilst metformin and sulphonylureas were associated with reduced risk (HR 0.80, 95% CI 0.69-0.93 and HR 0.76, 95% CI 0.60-0.97, respectively). There was no association with diabetes duration, complications or glycaemic control. CONCLUSIONS: T2DM may have a protective effect against asthma development. Insulin use was associated with an increased risk of asthma, while metformin and sulphonylureas reduced the risk in those with T2DM.
Barnes J, Hunter J, Harris S, et al., 2019, Systematic review and consensus definitions for the Standardised Endpoints in Perioperative Medicine (StEP) initiative: infection and sepsis., Br J Anaesth, Vol: 122, Pages: 500-508
BACKGROUND: Perioperative infection and sepsis are of fundamental concern to perioperative clinicians. However, standardised endpoints are either poorly defined or not routinely implemented. The Standardised Endpoints in Perioperative Medicine (StEP) initiative was established to derive a set of standardised endpoints for use in perioperative clinical trials. METHODS: We undertook a systematic review to identify measures of infection and sepsis used in the perioperative literature. A multi-round Delphi consensus process that included more than 60 clinician researchers was then used to refine a recommended list of outcome measures. RESULTS: A literature search yielded 1857 titles of which 255 met inclusion criteria for endpoint extraction. A long list of endpoints, with definitions and timescales, was generated and those potentially relevant to infection and sepsis circulated to the theme subgroup and then the wider StEP-COMPAC working group, undergoing a three-stage Delphi process. The response rates for Delphi rounds 1, 3, and 3 were 89% (n=8), 67% (n=62), and 80% (n=8), respectively. A set of 13 endpoints including fever, surgical site, and organ-specific infections as defined by the US Centres for Disease Control and Sepsis-3 are proposed for future use. CONCLUSIONS: We defined a consensus list of standardised endpoints related to infection and sepsis for perioperative trials using an established and rigorous approach. Each endpoint was evaluated with respect to validity, reliability, feasibility, and patient centredness. One or more of these should be considered for inclusion in future perioperative clinical trials assessing infection, sepsis, or both, thereby permitting synthesis and comparison of future results.
Nikolakopoulou Z, Hector LR, Creagh-Brown BC, et al., 2019, Plasma S100A8/A9 heterodimer is an early prognostic marker of acute kidney injury associated with cardiac surgery, Biomarkers in Medicine, Vol: 13, Pages: 205-218, ISSN: 1752-0363
We investigated whether plasma levels of the inflammation marker S100A8/A9, could predict acutekidney injury (AKI) onset in patients undergoing cardiac surgery necessitating cardiopulmonary bypass(CPB). Patients & methods: Plasma levels of S100A8/A9 and other neutrophil cytosolic proteins were measured in 39 patients pre- and immediately post-CPB. Results: All markers increased significantly post-CPBwith S100A8/A9, S100A12 and myeloperoxidase levels significantly higher in patients who developed AKIwithin 7 days. S100A8/A9 had good prognostic utility for AKI, with an area under the receiver operating characteristic curve of 0.81 (95% CI: 0.676–0.949) and a cut-off value of 10.6 μg/ml (85.7% sensitivityand 75% specificity) irrespective of age. Conclusion: Plasma S100A8/A9 levels immediately after cardiacsurgery, can predict onset of AKI, irrespective of age.
Rayner L, McGovern A, Creagh-Brown B, et al., 2019, Type 2 Diabetes and Asthma: Systematic Review of the Bidirectional Relationship., Curr Diabetes Rev, Vol: 15, Pages: 118-126
BACKGROUND AND OBJECTIVE: Obesity is an important contributor to the risk of both asthma and Type 2 Diabetes (T2DM). However, it has been suggested that T2DM and asthma are also independently associated. The aim of this systematic review was to synthesize the evidence for an independent relationship between T2DM and asthma. METHODS: MEDLINE and EMBASE were searched for studies reporting the relationship between asthma and T2DM in adults. Given a potential bidirectional relationship, articles relating to T2DM as a risk factor for asthma, and asthma as a risk factor for T2DM were examined separately. RESULTS: Eight studies were identified for inclusion in the review (n=2,934,399 participants). Four studies examined incident diabetes in those with asthma. The pooled (random effects model) adjusted hazard ratio for incident T2DM in asthma was 1.37 (95%CI 1.12-1.69; p <0.001) after controlling for BMI. Four studies reported prevalence or incidence rates of asthma in people with T2DM; higher rates of asthma in those with T2DM were reported in all four studies. Meta-analysis of results was not possible due to methodological heterogeneity. The quality of included studies was good, but due to small numbers, publication bias cannot be excluded. CONCLUSION: The published literature suggests a bidirectional independent relationship between T2DM and asthma, although we cannot exclude publication bias.
Tyson E, Creagh-Brown B, 2018, Postoperative care, Medicine (United Kingdom), Vol: 46, Pages: 750-753, ISSN: 1357-3039
Optimal postoperative care involves a multidisciplinary team of healthcare professionals and a patient-centred approach to avoid postoperative complications and enable a rapid return to normal function. During the last decade, enhanced recovery after surgery programmes have been implemented worldwide to reduce complications and length of stay – challenging traditional models of perioperative care. Some aspects of perioperative care have consensus guidelines without significant controversy, whereas others, such as perioperative fluid therapy, remain contentious.
Lambden S, Creagh-Brown BC, Hunt J, et al., 2018, Definitions and pathophysiology of vasoplegic shock, Critical Care, Vol: 22, ISSN: 1364-8535
Vasoplegia is the syndrome of pathological low systemic vascular resistance, the dominant clinical feature of which is reduced blood pressure in the presence of a normal or raised cardiac output. The vasoplegic syndrome is encountered in many clinical scenarios, including septic shock, post-cardiac bypass and after surgery, burns and trauma, but despite this, uniform clinical definitions are lacking, which renders translational research in this area challenging. We discuss the role of vasoplegia in these contexts and the criteria that are used to describe it are discussed. Intrinsic processes which may drive vasoplegia, such as nitric oxide, prostanoids, endothelin-1, hydrogen sulphide and reactive oxygen species production, are reviewed and potential for therapeutic intervention explored. Extrinsic drivers, including those mediated by glucocorticoid, catecholamine and vasopressin responsiveness of the blood vessels, are also discussed. The optimum balance between maintaining adequate systemic vascular resistance against the potentially deleterious effects of treatment with catecholamines is as yet unclear, but development of novel vasoactive agents may facilitate greater understanding of the role of the differing pathways in the development of vasoplegia. In turn, this may provide insights into the best way to care for patients with this common, multifactorial condition.
Buggy DJ, Freeman J, Johnson MZ, et al., 2018, Systematic review and consensus definitions for standardised endpoints in perioperative medicine: postoperative cancer outcomes, BRITISH JOURNAL OF ANAESTHESIA, Vol: 121, Pages: 38-44, ISSN: 0007-0912
Abbott TEF, Fowler AJ, Pelosi P, et al., 2018, A systematic review and consensus definitions for standardised end-points in perioperative medicine: pulmonary complications, BRITISH JOURNAL OF ANAESTHESIA, Vol: 120, Pages: 1066-1079, ISSN: 0007-0912
Davies M, Allen M, Bentley A, et al., 2018, British Thoracic Society Quality Standards for acute non-invasive ventilation in adults, BMJ OPEN RESPIRATORY RESEARCH, Vol: 5, ISSN: 2052-4439
Rayner L, Sherlock J, Creagh-Brown B, et al., 2017, The prevalence of COPD in England: An ontological approach to case detection in primary care, RESPIRATORY MEDICINE, Vol: 132, Pages: 217-225, ISSN: 0954-6111
Seaton A, Hodgson LE, Creagh-Brown B, et al., 2017, The use of veno-venous extracorporeal membrane oxygenation following thrombolysis for massive pulmonary embolism., J Intensive Care Soc, Vol: 18, Pages: 342-347, ISSN: 1751-1437
A 59-year-old man was diagnosed with a massive pulmonary embolism. Despite thrombolysis there were two episodes of cardiac arrest and following recovery of spontaneous circulation profound cardiorespiratory failure ensued. An extracorporeal membrane oxygenation retrieval team initiated veno-venous extracorporeal membrane oxygenation on site to facilitate transfer to the extracorporeal membrane oxygenation centre. An excellent outcome is reported in the short term. This represents one of the few published cases of veno-venous extracorporeal membrane oxygenation for a massive pulmonary embolism following thrombolysis.
Hemmes SNT, Neto AS, Binnekade JM, et al., 2017, Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications: LAS VEGAS - an observational study in 29 countries, EUROPEAN JOURNAL OF ANAESTHESIOLOGY, Vol: 34, Pages: 492-507, ISSN: 0265-0215
Vandevala T, Pavey L, Chelidoni O, et al., 2017, Psychological rumination and recovery from work in intensive care professionals: associations with stress, burnout, depression and health, JOURNAL OF INTENSIVE CARE, Vol: 5, ISSN: 2052-0492
Salciccioli JD, Marshall DC, Komorowsk M, et al., 2016, ESICM LIVES 2016: part one : Milan, Italy. 1-5 October 2016, Intensive Care Medicine Experimental, Vol: 4, ISSN: 2197-425X
Velasquez T, Mackey G, Lusk J, et al., 2016, ESICM LIVES 2016: part three : Milan, Italy. 1-5 October 2016., Intensive Care Med Exp, Vol: 4, Pages: 28-28
Sivakumar S, Taccone FS, Desai KA, et al., 2016, ESICM LIVES 2016: part two : Milan, Italy. 1-5 October 2016, Intensive Care Medicine Experimental, Vol: 4, ISSN: 2197-425X
Creagh-Brown B, 2016, Respiratory failure, Medicine (United Kingdom), Vol: 44, Pages: 342-345, ISSN: 1357-3039
Respiratory failure is a common complication of acute cardiorespiratory disease and exacerbations of chronic respiratory disease. It can be a feature of advanced chronic cardiac, respiratory and neurological diseases. Respiratory failure can manifest as hypoxaemia, hypercapnia or both. This article reviews the pathophysiology of these perturbations in respiratory homeostasis, the clinical features of acute and chronic respiratory failure and a brief discussion of the management.
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