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  • 1
    Electronic Resource
    Electronic Resource
    The effect of casemix adjustment on mortality as predicted by APACHE II (1996)
    Springer
    Intensive care medicine 22 (1996), S. 415-419 
    Details
    ISSN: 1432-1238
    Keywords: Critical care ; Severity of illness index ; APACHE II ; Outcome assessment ; Casemix adjustment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To describe the effect of casemix on mortality as predicted by APACHE II scoring. Design Retrospective analysis of an ICU database. Patients and participants All patients admitted to 19 ICU between 1 January 1992 and 31 May 1994 on whom data had been entered into a database. Excluded from the analysis were those readmitted to ICU, those aged under 16 years, those admitted after cardiac surgery or with burns, those for whom physiological data was incomplete and those for whom hospital outcome was unknown. Data on the remaining 6258 patients are reported. Measurements and results APACHE II scores were calculated from the worst values within 24 h of ICU admission. Hospital mortality was predicted with the published equation and coefficients. Mortality ratios (observed hospital deaths divided by predicted hospital deaths) were calculated for various groups. Mortality ratios varied widely by subgroup, and observed hospital deaths were greater than predicted, particularly for the following patient groups: those with predicted mortality of less than 70%, those with APACHE II scores in the range of 5–19, those older than 55 years, those with a Glasgow Coma Score of 15 or in the range 9–14, those not having emergency surgery, those with either 0 or 4 chronic health points and those in non-operative respiratory or neurological categories. The mortality ratio was markedly less than 1.0 only among non-operative cardiovascular patients. Conclusions APACHE II did not accurately adjust for casemix in our data. Unless account is taken of differences in casemix, using mortality ratios to compare ICU is likely to be inaccurate and misleading.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01712157
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  • 2
    Electronic Resource
    Electronic Resource
    A model of gastric emptying using paracetamol absorption in intensive care patients (1997)
    Springer
    Intensive care medicine 23 (1997), S. 256-260 
    Details
    ISSN: 1432-1238
    Keywords: Key words Analgesics non-opioid ; Paracetamol ; Analgesics ; Opioids ; Gastrointestinal tract ; Emptying
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives: To describe the range and factors which may affect gastric emptying in the ICU patient. Design: Validation sample. Setting: The adult Intensive Care Unit (ICU) of a teaching hospital. Patients: Twenty-seven ICU patients, aged 18–65 years were studied within 3 days of their ICU admission. All patients had normal hepatic and renal chemistry and had no contraindications to enteral feeding. Measurements and main results: The area under the concentration curve from 0–60 min (AUC60) of a paracetamol absorption test was used as the measure of gastric emptying. The variables of the presence or absence of bowel sounds, volume of gastric aspirate ( 〉 50 ml or 〈 50 ml), an estimated risk of death (ROD), an APACHE II score calculated 24 h before the study, a pHi measurement, the use of dopamine (2.5–5 μg/kg , yes or no) and of opioids were included in a multiple regression analysis. Using Pearson correlation, AUC60 was positively correlated with the estimated ROD (r = 0.50, p 〈 0.05). There was a statistically significant difference in the mean AUC60 between those patients who did, and those who did not, receive dopamine (t = 3.06, p 〈 0.005). On multiple regression analysis the only variable which was significantly associated with AUC60 was estimated ROD, which accounted for 25 % of the variance in AUC60. Conclusion: The results suggest that there is a wide range in gastric emptying in critically ill patients. The results may be due to the case mix of the patients. The use of dopamine may adversely affect gastric emptying and requires further investigation in the ICU patient. Prediction of gastric emptying is difficult in these patients and further investigation is necessary in order to improve our understanding of this process.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050325
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  • 3
    Electronic Resource
    Electronic Resource
    The effect of casemix adjustment on mortality as predicted by APACHE II (1996)
    Springer
    Intensive care medicine 22 (1996), S. 415-419 
    Details
    ISSN: 1432-1238
    Keywords: Key words Critical care ; Severity of illness index ; APACHE II ; Outcome assessment ; Casemix adjustment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Objective: To describe the effect of casemix on mortality as predicted by APACHE II scoring. Design: Retrospective analysis of an ICU database. Patients and participants: All patients admitted to 19 ICU between 1 January 1992 and 31 May 1994 on whom data had been entered into a database. Excluded from the analysis were those readmitted to ICU, those aged under 16 years, those admitted after cardiac surgery or with burns, those for whom physiological data was incomplete and those for whom hospital outcome was unknown. Data on the remaining 6258 patients are reported. Measurements and results: APACHE II scores were calculated from the worst values within 24 h of ICU admission. Hospital mortality was predicted with the published equation and coefficients. Mortality ratios (observed hospital deaths divided by predicted hospital deaths) were calculated for various groups. Mortality ratios varied widely by subgroup, and observed hospital deaths were greater than predicted, particularly for the following patient groups: those with predicted mortality of less than 70%, those with APACHE II scores in the range of 5–19, those older than 55 years, those with a Glasgow Coma Score of 15 or in the range 9–14, those not having emergency surgery, those with either 0 or 4 chronic health points and those in non-operative respiratory or neurological categories. The mortality ratio was markedly less than 1.0 only among non-operative cardiovascular patients. Conclusions: APACHE II did not accurately adjust for casemix in our data. Unless account is taken of differences in casemix, using mortality ratios to compare ICU is likely to be inaccurate and misleading.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01712157
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    Paper (German National Licenses)
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  • 4
    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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  • 5
    Electronic Resource
    Electronic Resource
    Respiratory problems and acromegaly (1982)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 37 (1982), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: A case of an acromegalic patient who developed upper airway obstruction and acute pulmonary oedema after removal of a tracheal tube is described. The reasons for this and the significance of his history of hypersomnia and periodic breathing are discussed. Conclusions are reached about the management of acromegalics having general anaesthesia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1982.tb01788.x
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  • 6
    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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  • 7
    Electronic Resource
    Electronic Resource
    Reversal of pancuronium (1988)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 43 (1988), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Moderate to deep (67–99% single twitch depression) pancuronium-induced neuromuscular blockade was antagonised with neostigmine (30 μg/kg, 60 μg/kg, or 80 μg/kg) in combination with glycopyrronium. Twenty-seven patients were reversed from 91%-99% twitch depression. Recovery of the first twitch of a train-of-four to 95% of control twitch took at least 20 minutes with neostigmine 30 μg/kg. The higher doses were significantly faster (60 μg/kg p 〈 0.05, 80 μg/kg p 〈 0.01) and took 15.8 and 14.8 minutes respectively. Reversal to a train of four ratio of 0.75 was not consistently achieved in under 30 minutes with any dose of neostigmine.Nineteen patients were antagonised from a 67%-80% depression of first twitch and in all but two recovery to 95% of control took under 10 minutes. To achieve a train of four ratio of 0.75 took less than 12.5 minutes except in three patients, two of whom, both given neostigmine 30 μg/kg, took longer than 20 minutes. Neostigmine 60 μg/kg produced as rapid a degree of antagonism as SOμg/kg. Heart rates after reversal decreased gradually in all groups, although the decrease was initially greater in the low dose neostigmine (30 μg/kg) group. A fixed 5:1 ratio of neostigmine and glycopyrronium will usually antagonise a moderate (70%-80%) pancuronium block to a train of four of greater than 75% within 12.5 minutes if at least 60 μg/kg of neostigmine is administered. More than 30 minutes may be required for reversal whatever the dose of neostigmine, for antagonism from greater than 90% twitch depression.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1988.tb06627.x
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  • 8
    Electronic Resource
    Electronic Resource
    Antagonism of neuromuscular blockade (1988)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 43 (1988), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Glycopyrronium 5 or 10 μg/kg was administered either simultaneously with, or 1 minute before, edrophonium 1 mg/kg in order to antagonise competitive neuromuscular blockade in 80 children. Both doses of glycopyrronium given before the edrophonium resulted in an initial significant (p 〈 0.01) increase in heart rate. Heart rate decreased significantly (p 〈 0.01) in all groups after the edrophonium was given, and only glycopyrronium 10 μg/kg administered before edrophonium prevented a substantial decrease below baseline. Initial heart rate responses to glycopyrronium or edrophonium are rapid, and measurements at intervals of 30 seconds may be necessary to record these changes.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1988.tb05654.x
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  • 9
    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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  • 10
    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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