Publications
134 results found
Fertleman M, Mani S, Nurse B, et al., 2009, Effective cognitive assessment in the management of post-operative delirium, 13th Congress of the European-Federation-of-Neurological-Societies, Publisher: WILEY-BLACKWELL PUBLISHING, INC, Pages: 199-199, ISSN: 1351-5101
Vizcaychipi MP, Heaviside V, Knight A, et al., 2009, DELAY IN EXECUTION AND REMOVAL OF CENTRAL VENOUS CATHETER INCREASES THE POTENTIAL FOR CATHETER RELATED BLOOD STREAM INFECTION, 22nd Annual Congress of the European-Society-of-Intensive-Care-Medicine, Publisher: SPRINGER, Pages: 9-9, ISSN: 0342-4642
Vizcaychipi MP, Heaviside V, George-Knight A, et al., 2009, The identification of reversible clinical factors which may perpetuate central venous catheter related Systemic Inflammatory Response Syndrome, Publisher: Oxford Journals Medicine BJA: British Journal of Anaesthesia
Dear Editor, There are approximately 6000 central venous catheter (CVC) related bloodstream infections (CR-BSI) reported annually in the United Kingdom, the large majority occurring in intensive care units. These catheter- associated infections increase the length of patient stay, morbidity, mortality and financial burden. The efforts made at improving infection free catheter life longevity include the development of antibiotic impregnated catheters and infection control guidelines or ‘bundles’. An area of central venous catheter care, which hasn’t been addressed in great detail to date, is the time frame during which old and new catheters overlap. Our aim of this observational study was to identify how areas of key clinical decision making influence the incidence of CR-BSI. We conducted a prospective observational study, which was registered and approved by the clinical effectiveness committees at Chelsea and Westminster Hospital and Hillingdon Hospital. CVC insertion is standard practice in most intensive care units hence, the need to gain consent was waived. Data was accrued from critically ill patients from a one year period. A total of 41 patients were included in this study. Twenty two patients were medical and the rest were surgical in origin. The average intensive care stay was 16.63 days (3 - 53 days). Eight patients were excluded from the analysis of results, 2 because of missing data and 6 because they were having CVCs inserted for the first time. Systemic inflammatory response (SIRS) with CVC in situ was an indication for CVC replacement in 15 cases. The clinical decision to replace a CVC was made by the consultant in charge at the morning ward round in 24 of the cases. The insertion of new and removal of the old CVCs were performed in the afternoon in 23 and 24 cases respectively. Radiological confirmation of CVC was made in 84 % of the cases (27 patients). A femoral catheter was inserted in 4 patients and in one patient a chest radiog
Vizcaychipi MP, Xu L, Xiong X, et al., 2008, Role of Chaperones on hippocampal-dependent memory after tibial fracture on wild type and over expressor Hsp72 mice.Collaborative study, Stanford University, CA, USA and Imperial College, London, UKPreliminary data, Neuroscience Research Meeting
Background: Postoperative cognitive dysfunction (POCD) is a common complication observed in elderly population after surgery1. There is some supporting evidence linking acute systemic and neuroinflammatory changes and hippocampal-dependent memory deficit after surgery2 3.We hypnotized that HSP72 would prevents POCD after tibia fracture under general anesthesia.Methods: A total of 100 adult male mice (50 BL6 and 50 HSP72) were randomly allocated into the following group: Control, Anesthesia and Tibia fracture surgery. Surgical animals received systemic and topical analgesia and were followed up to 7 days post intervention. All cognitive tests were performed prior to surgical intervention. The training protocol consisted of Fear Conditioning response to 6-coupled conditional – unconditional stimulus (CS-US) with pseudorandom inter-trial intervals (iTi). 24 hours after surgical intervention animals were assessed in their normal context and also in a novel context. Assessment was performed at day 1, 3, 5 and 7 post-surgery.Pain threshold, acoustic startle reflex and locomotion were tested in all animals to identify inter-group difference prior to fear conditional trials.Animals were euthanized after last assessment and blood and brain tissue retrieved for analysis of inflammatory markers.Results: The conditional response at 1 day and 3 days post surgery revealed an increased in freezing behavior in the group of HSP72 mice. However, the percentage of freezing behavior during conditional stimulus remained the same in both groups throughout the assessment period.There were no differences in acquisition, pain threshold, acoustic startle reflex and locomotion between BL6 and HSP72 over expressing mice.Conclusion: These preliminary results suggest that HSP72 produces a transient amelioration on hippocampal-dependent memory deficit.References: 1. Moller JT et al. Lancet 1998; 35:857-61. 2. Wan Y et al. Anesthesiology 2007; 106: 436-43. 3. Barrientos RM et al. Brain Behav
Cibelli M, Ma D, Rei Fidalgo A, et al., 2008, Microglial Activation in the Hippocampus Is Related to Postoperative Cognitive Dysfunction in Mice, http://www.asaabstracts.com/ASA/asaabstracts/images/asaAbstractBanner.gif
Vizcaychipi MP, Walker S, Palazzo M, 2007, Serotonin syndrome triggered by tramadol, BRITISH JOURNAL OF ANAESTHESIA, Vol: 99, Pages: 919-919, ISSN: 0007-0912
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Helmy A, Vizeaychipi M, Gupta AK, 2007, Traumatic brain injury: intensive care management, BRITISH JOURNAL OF ANAESTHESIA, Vol: 99, Pages: 32-42, ISSN: 0007-0912
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- Citations: 112
Vizcaychipi MP, Svoren EM, 2007, Reversible posterior leucoencephalopathy syndrome / Accelerated hypertension
Our first impression after reading this fascinating case was accelerated hypertension leading to acute vascular damage resulting in end organ dysfuction ( retina, brain, kidney, liver).The cause of malignant hypertension may be Thrombocytopenic Thrombocytopenic Purpura (TTP) charachterised by thrombocytopenia, microangiopathic haemolytic anaemia, acute renal failure and reversible posterior leukoencephalopathy syndrome (RPLS).TTP may be accompanying vascular collagen diseases such as Systemic Lupus Erythematosus (SLE).Regarding the first question: what does leucoencephalopathy found on the patient's MRI indicate? These clear symmetric areas of hyperintensity involving the occipital lobes may be part of the reversible posterior leucoencephalopathy syndrome that has been reported in association with malignant hypertension, toxemia of pregnancy or immunosupresant drugs.The mechanisms of injury or pathophysiology is not well understood. There are few theories. One of them postulated that the brain autoregulation is overcomed by the sudden increased in blood pressure leading to arteriolar dilatation, capillary leakage and consequently extracellular oedema secondary to extrasudation of plasma. Another mechanisms postulated is ischaemia secondary to severe vasoconstriction that seems to be supported by angiography. Other authors postulate hypoalbuminemia and steroids as a couse of leucoencephalopathy.Regarding the second question: How quickly should you lower the patient's blood presure? This is a difficult one as we have two organs of interest to preserve function and the mechanism and urgency of control the blood pressure may differe between them. For instance to avoid further neurological damage the blood pressure should be controlled in hours, however, this may afect the perfusion pressure of the kidney aggravating the renal function.In consequence our goal would be to reduce the mean arterial pressure by approximately 25-30% over the first 24-48 hours by using Na Nitr
Vizcaychipi MP, Keays R, Soni N, 2007, Anaesthesia and intensive care for HIV patients, http://www.sciencedirect.com/science/journal/14720299, Vol: 8, Pages: 44-47
The anaesthetic problems presented by patients with HIV infection remain a challenge. Longer survival with treatment is overlaying these problems with age-related comorbidities. Intensive care demand is increasingly warranted for treatment-related side effects and oncological manifestations of the HIV. New treatments may offer the promise of fewer side effects and better safety profiles but, as with other infections, drug resistance is increasing. This article provides an overview of HIV infection, its diagnosis, complications and treatment, and highlights areas of specific concern to anaesthetists and intensivists, including the risks of blood-borne infections, and advice regarding post-exposure prophylaxis.
Colorado L, Vizcaychipi MP, Herbert S, et al., 2007, Incidence of bacteraemia in a neurocritical care unit, http://ccforum.com/content/11/S2/P68, http://www.biomedcentral.com/content/pdf/cc5570.pdf
Svoren E, Vizcaychipi MP, 2007, Rapid Responses to:CLINICAL REVIEW:Susannah K Leaver and Timothy W EvansAcute respiratory distress syndromeBMJ 2007; 335: 389-394 [Full text], http://www.bmj.com/cgi/eletters/335/7616/389
Vizcaychipi MP, Burt C, Burnstein R, 2007, Pulmonary embolism: An Unusual Cause Of Acute Liver Failure, The Internet Journal of Emergency and Intensive Care Medicine™ ISSN: 1092-4051, Vol: 10
Pulmonary embolism is still a challenging diagnosis and a very high index of suspicion is required. Symptoms and signs of acute right heart failure are still non-specific and often vary according to the precipitating condition. In this particular case, evolving liver failure and severe coagulation disorder as the initial presentation made the management of this patient very challenging and several causes of sudden decompensated liver failure were ruled out. Acute reduction of splanchnic flow was considered but in the context of relative good oxygenation and no history or clinical signs of deep venous thrombosis, the diagnosis of pulmonary embolism was not considered as a primary cause of liver failure and evolving multiple organ failure. Complementary studies, namely echocardiogram and use of a pulmonary artery catheter immediately raised the suspicion of a saddle pulmonary embolus. In view of the findings, an emergency contrast-enhanced spiral computed tomography was performed and the diagnosis of pulmonary embolism was made.
Vizcaychipi MP, Laban M, Bradshaw E, et al., 2004, ITU outcome of postcardiac arrest patients
Vizcaychipi M, Pickworth A, Watters M, et al., 2002, Trainee performance at percutaneous tracheostomy, 15th Annual Congress on European-Society-of-Internsive-Care-Medicine, Publisher: SPRINGER-VERLAG, Pages: S30-S30, ISSN: 0342-4642
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