Abstract
There is a growing consensus that, in selected patients, intracranial pressure (ICP) monitoring is an appropriate intervention in district general hospitals. It improves outcome in patients with traumatic brain injury [1] and is safe [2]. In the Southwest region two district general hospitals without on-site neurosurgical facilities have been inserting Camino- fibreoptic transducers in their ICUs since 1997. I conducted a retrospective case note audit of ICP monitored patients at the two centres. Fifty-one patients had monitors inserted between 6 October 1997 and 28 February 2001. Data were collected on: sex, age, initial Glasgow coma score (GCS), diagnosis, duration of ICP monitoring and incidence and nature of complications. Sixty-nine percent of patients were male, with a median age of 29 (range 1-71 years). Median GCS was 6 and 76% had an initial GCS of 8 or less. The most common indication for ICP monitoring was traumatic brain injury (72%). Other diagnoses were anoxic coma (12%), meningitis (8%), subarachnoid haemorrhage (4%), intracerebral bleed (2%) and encephalitis (2%). Median duration of monitoring was 3 days. Only two patients were monitored for more than 5 days; both these patients received two monitors. The complication rate was low. One (2%) patient had a minor scalp haemorrhage. One (2%) patient had a small intracerebral haemorrhage, detected as an incidental finding on CT scan; it had no clinical sequelae. One (2%) monitor developed a fault and had to be resited. No infectious complications were seen. The data from this audit adds to the weight of evidence that ICP monitoring in selected patient groups is safe in district general hospitals.
Highlights
Intra-abdominal pressure (IAP) is an important parameter and prognostic indicator of the patient’s underlying physiologic status [1]
Smaller aerosol particles resulted in greater drug delivery in vitro when using the modified Aeroneb Pro during controlled mechanical ventilation (CMV)
We retrospectively reviewed 107 procedures performed on 48 patients in the period between March 2000 and November 2001
Summary
Intra-abdominal pressure (IAP) is an important parameter and prognostic indicator of the patient’s underlying physiologic status [1]. The aim of this study was to assess the respiratory effects of sufentanil and remifentanil in postsurgical critically ill patients during spontaneous ventilation since the drugs show pharmacokinetic and pharmacodynamic properties which make them attractive for intensive care use. Preliminary evidence suggests that hU-II levels during cardiac surgery are increased in patients with myocardial dysfunction [2] It is not known, if hU-II plasma concentrations are related to pulmonary capillary wedge pressure (PCWP) as an estimate of left ventricular filling pressure. AAF in cardiac surgery postoperative period has been implicated as a complication that leads to longer ICU and hospital stay and to augmented costs It has not been associated with increased mortality rates. We aimed to investigate the effects of use of preoperative and early postoperative standard and immunonutrient products on immune system and acute inflammatory response in the patients undergoing gastrointestinal malignancy surgery.
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