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  • 1
    Electronic Resource
    Electronic Resource
    Blood component use in critically ill patients (2002)
    Oxford, UK : Blackwell Science Ltd
    Anaesthesia 57 (2002), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Summary This prospective observational study was conducted to assess the current transfusion practice in critically ill patients. One thousand two hundred and forty-seven consecutive critically ill patients admitted between February 1999 and October 1999 were included in the study. Overall 666 (53%) patients were administered red cells. Transfused patients had significantly higher intensive care unit␣mortality but also had higher Acute Physiology and Chronic Health Evaluation II scores and longer durations of stay. The average pretransfusion haemoglobin concentration was 〈 9 g.dl−1 in 75% of transfusion episodes. The common indications for transfusion were low haemoglobin (72%) and haemorrhage (25%). Overall, 202 (16%) and 281 (22%) of the patients were transfused platelets and fresh frozen plasma, respectively. The indications for transfusion were haemorrhage, low platelet counts, prolonged prothrombin time or to provide cover for invasive interventions. Most platelet transfusions were given at values in the order of 50–100 × 109.l−1. The pretransfusion platelet count varied according to the indications for transfusion. This study showed that transfusion practice is consistent and that in general there does not seem to be an excessive use of blood components in critically ill patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2044.2002.02514.x
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  • 2
    Electronic Resource
    Electronic Resource
    APACHE II, data accuracy and outcome prediction (1998)
    Oxford : Blackwell Science Ltd
    Anaesthesia 53 (1998), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: From review of 122 intensive care charts, Acute Physiology and Chronic Health Evaluation (APACHE) II points were determined for eight physiological values. Using a strict interpretation of APACHE II criteria, an average of 20.6% of these points were higher and 6.7% lower than the points entered originally into an intensive care database. The resulting 1.73 points mean increase in APACHE II score increased predicted mortality from 24.8% to 27.8% and decreased the mortality ratio (observed hospital deaths ÷ predicted deaths) from 1.52 (95% confidence interval: 1.11–2.03) to 1.35 (95% confidence interval: 0.99–1.81). There were few errors entering the data recorded on the audit form into the intensive care unit database with an optical mark reader and keyboard. Inaccuracy and inconsistency in data collection must be excluded before differences in mortality ratios are ascribed to intensive care unit performance.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2044.1998.00534.x
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  • 3
    Electronic Resource
    Electronic Resource
    Is excess intensive care mortality in the United Kingdom concealed by ICU mortality prediction models? (1998)
    Oxford : Blackwell Science Ltd
    Anaesthesia 53 (1998), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1998.00346.x
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  • 4
    Electronic Resource
    Electronic Resource
    Simple bedside assessment of level of consciousness: comparison of two simple assessment scales with the Glasgow Coma scale (2004)
    Oxford, UK : Blackwell Science Ltd
    Anaesthesia 59 (2004), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Neurological assessment is an essential component of early warning scores used to identify seriously ill ward patients. We investigated how two simple scales (ACDU – Alert, Confused, Drowsy, Unresponsive; and AVPU – Alert, responds to Voice, responds to Pain, Unresponsive) compared to each other and also to the more complicated Glasgow Coma Scale (GCS). Neurosurgical nurses recorded patients' conscious level with each of the three scales. Over 7 months, 1020 analysable measurements were collected. Both simple scales identified distinct GCS ranges, although some overlap occurred (p 〈 0.001). Median GCS scores associated with AVPU were 15, 13, 8 and 6 and for ACDU were 15, 13, 10 and 6. The median values of ACDU were more evenly distributed than AVPU and may therefore be better at identifying early deteriorations in conscious level when they occur in critically ill ward patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.2004.03526.x
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  • 5
    Electronic Resource
    Electronic Resource
    A new way of managing critical care? (2002)
    Oxford, UK : Blackwell Science Ltd
    Anaesthesia 57 (2002), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2044.2002.02868.x
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  • 6
    Electronic Resource
    Electronic Resource
    A survey of physicians' attitudes to transfusion practice in critically ill patients in the UK (2002)
    Oxford, UK : Blackwell Science Ltd
    Anaesthesia 57 (2002), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Summary This study aimed to examine the attitudes of intensivists and haematologists to the use of blood and blood products using a scenario-based postal questionnaire. One hundred and sixty-two intensivists and 77 haematologists responded to the survey. In four scenarios, the baseline haemoglobin thresholds for red cell transfusion ranged from 6 to 12 g.dl−1. There was significant variation between scenarios (p 〈 0.005). Increasing age, high Acute Physiology and Chronic Health Status II score, surgery, acute respiratory distress syndrome, septic shock and lactic acidosis significantly (p 〈 0.005) modified the transfusion threshold. There were greater variations in the baseline threshold for platelet transfusion. The majority of respondents (72.3%) selected a baseline haemoglobin threshold between 9 and 10 g.dl−1. The thresholds for platelet transfusion were far less consistent.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2044.2002.02509_1.x
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  • 7
    Electronic Resource
    Electronic Resource
    Gastric emptying in patients the day after cardiac surgery (1995)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 50 (1995), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Fourteen adults underwent cardiac surgery with a standard anaesthetic technique. Prior to surgery and the day after surgery, gastric emptying was determined using the paracetamol absorption technique. Results from 13 patients were available for analysis. The mean time to reach the maximum plasma concentration was 14.1 min (SEM 2.1)pre–operatively and 225.4min (SEM 42.3) postoperatively. The mean maximum concentration was 23.7mg l-1 (SEM 1.9) pre–operatively and 5.1mg.l-1 (SEM 0.8) postoperatively. The area under the curve (0–60 min) was 892 mg min.I -1 (SEM 57) pre –operatively and 131 mg min-1 (SEM 25) postoperatively. The differences between pre– and postoperative values were highly significant for all these three measurements. We conclude that gastric emptying is markedly delayed the day after elective cardiac surgery.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1995.tb15093.x
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  • 8
    Electronic Resource
    Electronic Resource
    Antagonism of atracurium with neostigmine (1991)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 46 (1991), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: In 36 patients in whom anaesthesia was maintained with nitrous oxide and 0.5% isoflurane an atracurium-induced neuromuscular block was either allowed to recover spontaneously or antagonised with one of four doses of neostigmine (15 μg/kg, 35 μg/kg, 55 μg/kg or 75 μg/kg). The recovery times to a train-of-four ratio of 0.5, 0.75 and 0.9 were recorded. In patients given neostigmine, antagonism was at an average TI of between 8.8% and 14.9%. There was no difference in the recovery times between the patients given neostigmine 35 μg/kg, 55 μg/kg or 75 μg/kg. Recovery after neostigmine 15 μg/kg was significantly slower than after the higher doses. One patient given neostigmine 75 μg/kg showed an unusual bimodal pattern of recovery. There appears to be no benefit in giving a larger dose than 35 μg/kg of neostogmine as a single bolus.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1991.tb11696.x
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  • 9
    Electronic Resource
    Electronic Resource
    Cardiovascular changes at antagonism of atracurium (1991)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 46 (1991), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The cardiovascular changes in the 10 minutes following antagonism of an atracurium-induced block were studied in 32 patients. A 5: 1 ratio combination of either 15, 35, 55 or 75 μg/kg neostigmine, with a corresponding dose of 3, 7, 11, or 15 μg/kg of glycopyrronium was used for antagonism. The least change in heart rate was with neostigmine 15 μg/kg with an increase of more than 15 beats/minute found in only one patient. Antagonism with 35, 55 and 75 μg/kg neostigmine mixture produced the greatest increase in heart rate at one minute and this was significantly different from the effect of the 15 μg/kg dose. Twenty out of 24 patients given the larger doses had heart rate increases in excess of 15 beats/minute and in nine patients this ranged from 30 to 52 beats/minute, representing increases of 46–80% above baseline values. Arterial pressure increases after antagonism were statistically significant in all four groups, with no between-group difference; these were clinically unimportant. When antagonising an atracurium-induced block with clinically useful doses of neostigmine, the standard 5: 1 ratio combination with glycopyrronium will result in an initial tachycardia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1991.tb09609.x
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  • 10
    Electronic Resource
    Electronic Resource
    Neostigmine after spontaneous recovery from neuromuscular blockade (1989)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 44 (1989), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The effect of neostigmine on neuromuscular function was examined after spontaneous recovery from an atracurium-induced neuromuscular blockade, which reached a train-of-four ratio of either 0.5 or 0.9. Two doses of neostigmine 2.5 mg were given 5 minutes apart. Neuromuscular recovery was assessed with train-of-four and tetanic stimuli. The first dose of neostigmine antagonised the neuromuscular blockade. The second dose diminished tetanic height and increased tetanic fade. The train-of-four measured mechanically was adversely affected to a small degree, but when measured with the electromyograph no significant change occurred. Neostigmine may adversely affect neuromuscular function after spontaneous recovery from a non-depolarising block. This is unlikely with a single modest dose and any effects are probably short-lived.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1989.tb11280.x
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