Abstract
Air ambulances and customized military aircraft are established modes of transporting critically ill patients. Defence services and aid agencies even have flying hospitals, replete with operating theatres and ICUs. With burgeoning travel by an increasingly elderly population, a growing number of travelling Australians suffer critical illnesses overseas. Transcontinental air ambulances are prohibitively expensive and many American and European commercial airlines ban travel by seriously ill patients. Transit intensive care on board commercial airline flights poses complex physiological and logistic challenges. We have transported hundreds of critically ill patients and report on 10 episodes of aero-intensive care with IPPV on board scheduled passenger services. These were from the Philippines, the USA, the United Kingdom, Thailand, France, Norway and Austria on Qantas, Singapore Airlines, Thai Airways and Malaysia Airlines. The aviation environment imposes a bewildering array of electronic, safety and security related issues to be overcome. The entire mobile ICU weighs 100 kg. A vacuum-mattress on a stretcher fitted to the cabin floor at the rear of the economy-class cabin and screened off from the other passengers ensures patient privacy (Fig. (Fig.1).1). Oxygen is scarce and extremely expensive during flight. We employed the 'circle system' with a CO2 absorber and in-line oxygen analyser. Mobile suction, infusion pumps, transit-care monitors and portable blood gas analysers were all adapted for use in commercial aircraft. Figure 1 Australia and New Zealand lead the world in transit care of the critically ill in commercial airliners.
Highlights
Tight blood glucose (BG) control has been shown to videos of the alveolar dynamics
1Royal Brompton Hospital, London, UK; 2Medical University Graz, observation from mechanical deformation due to the tip of the Austria; 3Charles University Hospital, Prague, Czech Republic; endoscope we developed a flushing catheter that continuously
Taurocholic acid into the pancreatic duct. This allowed us to separate and to determine the specific role of pancreatic blood vs Introduction In the frame of protective lung ventilation, alveolar normal blood on the expression of injury evidenced during isolated biomechanics become more and more the focus of scientific lung reperfusion
Summary
Tight blood glucose (BG) control has been shown to videos of the alveolar dynamics. The thorax remains intact.decrease morbidity and mortality in critically ill patients [1] but is Results Figure 1 shows a tissue area after lavage of 0.8 mm difficult to achieve using standard insulin infusion protocols. Results Patient characteristics (mean ± SD): age 57.4 ± 15.4 years, 28 female, 52 male, APACHE II score 28.2 ± 6.6; number of organ failures 4.0 ± 1.12; preceding ICU period 8.5 ± 9.3 days; continuous sedation with midazolam 31.2 ± 34.2 mg/hour, fentanyl 0.12 ± 0.08 mg/hour, propofol 45.6 ± 105.2 mg/hour; sedation assessment according to RS 5.65 ± 0.63, CPS 5.15 ± 1.67, CKS 0.65 ± 0.69, CS 9.34 ± 2.13 und LSS 1.78 ± 1.69, RASS –4.50 ± 1.27, FiO2 0.52 ± 0.17, PEEP 8.2 ± 2.4 cmH2O, ventilatory frequency 20.5 ± 4.8/min, pressure control 16.8 ± 4.4 cmH2O, tidal volume 540 ± 115 ml, TVV 2525.6 ± 11,366 ml (minimum 1.52; maximum 91,586). We hypothesized that S100β levels correlate with this tumor’s preoperative characteristics and with perioperative neurological injury despite its supratentorial location and non-neural origin
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