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  • 1
    Electronic Resource
    Electronic Resource
    Event-related potentials — neurophysiological tools for predicting emergence and early outcome from traumatic coma (1996)
    Springer
    Intensive care medicine 22 (1996), S. 39-46 
    Details
    ISSN: 1432-1238
    Keywords: Head injury ; Coma ; Prognosis ; Evokied and event-related potentials
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: abstract Objective To determine the prognostic value of multimodal evoked potentials (EPs) and eventrelated (ERPs) potentials in coma (Glasgow Coma Score 〈8), after severe traumatic brain injury (TBI). Design Prospective, longitudinal study of neurophysiological responses recorded during traumatic coma. Setting Intensive Care Unit, Frenchay Hospital, Bristol, UK. Participants Fifty-four comatose TBI patients (age range 1–80 years, mean 36.4). Methods Neurophysiological responses were recorded from 11 scalp electrodes with earlobe reference. Conduction times were measured for brainstem auditory, flash visual and somatosensory, shortlatency EPs. Peak latencies and amplituides were determined for long-latency components of visual and auditory ERPs, generated by passive “oddball” paradigms. These neurophysiological and various clinical parameters were correlated with patient outcome using Pearson's coefficient. Main outcome measure Three month Glassgow Outcome Scale (GOS). Results and conclusion Highly significant (P〈0.001) correlations exist between long-latency ERP components and 3-month outcome. Short-latency EPs, brainstem (wave I–V) and somatosensory conduction times, also correlate significantly with the GOS (P〈0.01). Of the clinical measurements, pupillary response patterns, APACHE II and Glasgow Coma Scores (GCS) correlate significantly with outcome, as do the retrospective measures of duration of coma and post-traumatic amnesia (PTA) in survivors. Unfortunately, due to variance of long-latency responses, even in controls, absolute values cannot be relied upon as prognosticators. The presence of “mismatch negativity” predicted the return of consciousness (89.7% sensitivity and 100% specificity) and preceded changes in GCS. Its latency was the single best indicator of 90-day outcome from coma (r=−0.641).
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01728329
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  • 2
    Electronic Resource
    Electronic Resource
    The pneuPAC ventilator with new patient valve and air compressors (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 pneuPAC Model 2-R pneumatic logic ventilator with a new air entrainment valve that offers the option of an Fio2 of l.0 or 0.45 is described. Its robustness, portability, variable Fio2, choice of positive end expiratory pressure and pressure relief valves make it versatile and suitable for transporting critically ill patients, as well as for resuscitation use when adverse conditions may be encountered. Two new medical air compressors, one mains driven and the other battery powered, designed for use with the ventilator, are also described. The function of the ventilator with the new valve was assessed using a piped gas supply and then reassessed when powered by the compressors.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1989.tb11344.x
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  • 3
    Electronic Resource
    Electronic Resource
    Ketamine infusion (1987)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 42 (1987), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: A patient with acute lymphatic leukaemia developed a bilateral fulminating Pseudomonas aeruginosa pneumonia and required controlled ventilation of the lungs. Marked agitation, hypotension and bronchospasm unresponsive to conventional bronchodilators presented a therapeutic challenge. A continuous intravenous infusion of midazolam failed to provide adequate sedation. A continuous intravenous infusion of ketamine resulted in better sedation, an increase in arterial pressure and a dimunition of bronchospasm. The clinical improvement was maintained for the 5 days during which ketamine was infused. Plasma concentrations of ketamine and its metabolites are reported.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1987.tb05370.x
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  • 4
    Electronic Resource
    Electronic Resource
    Manganese toxicity in a patient with cholestasis receiving total parenteral nutrition (1994)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 49 (1994), 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.1365-2044.1994.tb04339.x
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  • 5
    Electronic Resource
    Electronic Resource
    Brachial plexus block (1987)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 42 (1987), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: A supraclavicular brachial plexus block was performed which resulted in unilateral sensory and motor blockade of the thoracic and abdominal walls. General anaesthesia was therefore used and postoperatively it was noticed that analgesia of the upper limb had developed. It is likely that the blockade resulted from an intrapleural injection of local anaesthetic.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1987.tb05323.x
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  • 6
    Electronic Resource
    Electronic Resource
    Mortality from percutaneous dilatational tracheostomy. A report of three cases (2005)
    Oxford, UK : Blackwell Science Ltd
    Anaesthesia 60 (2005), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: We report three deaths following percutaneous dilatational tracheostomy in a series of 1187 procedures undertaken in a single intensive care unit over a 13-year period. All deaths were due to severe haemorrhage. The first patient died during the procedure from uncontrollable haemorrhage from the innominate vein. Delayed haemorrhage in the other two patients was caused by the tracheostomy tube eroding into the aorta in one patient and into the innominate vein in the other. In both these patients, the tracheal stoma was found at postmortem to be sited unexpectedly low. Fatal haemorrhage is a rare complication of percutaneous tracheostomy (0.25% in this series), but is probably under-reported. While bronchoscopy is now used routinely during percutaneous tracheostomy insertion in most units, we speculate that ultrasound examination of the neck is more likely to identify major vascular structures at risk. However, whilst intuitive, there is little evidence that either bronchoscopy or ultrasound scanning reduces the incidence of complications. Magnetic resonance images of normal subjects are presented to demonstrate the anatomical relations of the trachea to major vascular structures and their variability.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.2005.04137.x
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  • 7
    Electronic Resource
    Electronic Resource
    Reasons for withdrawing treatment in patients receiving intensive care (1998)
    Oxford : Blackwell Science Ltd, UK
    Anaesthesia 53 (1998), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: We studied the frequency with which treatment was withdrawn in intensive care patients and the primary reason for reaching this decision. The medical records of patients having had active treatment withdrawn between August 1992 and February 1996 inclusive were reviewed. Patients were classified into an imminent death group consisting of those expected to die, a qualitative group who had treatment withdrawn on quality of life considerations and a lethal conditions group who had associated disease that precluded long-term survival. There were 1745 patients admitted, of whom 338 (19.4%) died in ICU. In 220 patients death followed the withdrawal of treatment (12.6% of all ICU admissions), 203 dying on ICU (60% of ICU deaths) and a further 17 soon after discharge to a ward. The primary reason for treatment withdrawal was imminent death in 45% of patients, qualitative considerations in 50% and lethal conditions in 5%. The reason varied significantly depending on the patient's age. Treatment is withdrawn commonly in ICU, the primary reason being quality of life considerations as often as because death is the expected outcome.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2044.1998.t01-1-00407.x
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  • 8
    Electronic Resource
    Electronic Resource
    Long-term outcome after percutaneous dilational tracheostomy (1997)
    Oxford : Blackwell Science Ltd
    Anaesthesia 52 (1997), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: We studied 41 patients who had previously undergone percutaneous dilational tracheostomy at least 6 months following tracheal decannulation. The patients were examined using laryngotracheoscopy and spirometry to assess the long-term anatomical and functional consequences of percutaneous dilational tracheostomy. Apart from one patient who had requested a scar revision, no patient was symptomatic. A significant (〉10%) tracheal stenosis was identified in four asymptomatic patients, two of whom also had spirometric evidence of this obstruction. These results suggest that the long-term outcome after percutaneous tracheostomy is at least as good as that following conventional surgical tracheostomy. Refinements of the percutaneous technique, such as endoscopic guidance, may further improve the results.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1997.013-az013.x
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  • 9
    Electronic Resource
    Electronic Resource
    The impact of percutaneous tracheostomy on intensive care unit practice and training (1999)
    Oxford : Blackwell Science Ltd
    Anaesthesia 54 (1999), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: We studied the impact of introducing percutaneous tracheostomy to our intensive care unit on the incidence and timing of tracheostomy and on the implications for surgical training. The proportion of patients receiving intensive care who underwent tracheostomy doubled from a median of 8.5% to 16.8% (p 〈 0.01) following the introduction of the percutaneous technique with the procedure being undertaken significantly earlier during the intensive care stay. The opportunity for surgical trainees to gain experience in open surgical tracheostomy has been virtually lost. The increase in tracheostomy rate may reflect a previous under-utilisation caused by the logistic problems of transferring a critically ill patient to theatre, or alternatively a relaxation of the indications for tracheostomy caused by a perceived benefit for the patient. An increased workload may also have contributed to the rise. Surgical trainees should be encouraged to learn percutaneous techniques and training opportunities in open surgical techniques should be maximised.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2044.1999.00667.x
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  • 10
    Electronic Resource
    Electronic Resource
    Sensitivity of Near Infrared Spectroscopy to Cerebral and Extra-Cerebral Oxygenation Changes is Determined by Emitter-Detector Separation (1998)
    Springer
    Journal of clinical monitoring and computing 14 (1998), S. 353-360 
    Details
    ISSN: 1573-2614
    Keywords: Near infrared spectroscopy ; cerebral oxygenation ; oximeters
    Source: Springer Online Journal Archives 1860-2000
    Topics: Computer Science , Medicine
    Notes: Abstract Objective. To examine the effect of two emitter-detector separations (2.7 and 5.5 cm) on the detection of changes in cerebral and extra-cerebral tissue oxygenation using near infrared spectroscopy (NIRS). Methods. Two NIR detectors were placed on the scalp 2.7 and 5.5 cm from a single NIR emitter. Changes in deoxyhaemoglobin (HHb), oxyhaemoglobin (O2Hb),oxidised cytochrome C oxidase (Cyt) and total haemoglobin (tHb) were recorded from each detector during the induction of cerebral oligaemia (transition from hypercapnia to hypocapnia) and scalp hyperaemia (following release of a scalp tourniquet). Results. Cerebral oligaemia (mean decrease in middle cerebral artery blood flow velocity of 44%) induced by a mean reduction in end tidal CO2 of 18 mmHg was accompanied by a significant increase in the spectroscopic signal for HHb and a decrease in the O2Hb signal. The signal change per unit photon path length detected at 5.5 cm was significantly greater for HHb (p = 0.007) than that detected at 2.7 cm. In contrast, the increase in all chromophores detected at 5.5 cm during scalp hyperaemia was significantly less than that detected at 2.7 cm (p 〈 0.001). Conclusions. The differing sensitivity of the proximal and distal channels to changes in cerebral and extra-cerebral oxygenation is compatible with theoretical models of NIR light transmission in the adult head and may provide a basis for spatially resolving these changes. The optimal emitter-detector separation for adult NIRS requires further investigation and may differ between individuals.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1009957032554
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