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Taking slow vent weans by the collar

Our ICUs are crowded by patients that are slow to liberate from mechanical ventilation. In North America, such patients are often transferred to long term mechanical ventilation facilities (LTAC) – where they are weaned to liberation. There are many strategies for weaning tracheostomised ¬†patients from mechanical ventilation – a progressive reduction in pressure support, intermittent … Continue reading

High Frequency Oscillation – Shaken by Bad News!

Summary: Two Papers Published Online in the NEJM, OSCILLATE and OSCAR, have failed to demonstrate that HFOV benefits patients with ARDS. In the OSCILLATE study there was an 11% increase in 28 day mortality (NNH 9). HFOV should not be used in routine management of patients with ARDS. For the past two decades many intensivists … Continue reading

Beachchair and Blood Pressure

It is now more than 5 years since the Anesthesia Patient Safety Foundation highlighted the risk of central nervous system injury following anesthesia for shoulder surgery (SS) in the Beachchair position (BCP)¬†(click here). Although we can never be certain, it appears likely that such injuries – principally devastating stroke, results from hypoperfusion and watershed ischaemia. … Continue reading

Tuesday morning meetings January 2013

22nd Advanced Airway Management Dr Brian Harte 29th Airway challenges in Maxillofacial surgery Dr Jane Bruton

Transfusion Strategy – Think Restrictive

A half generation ago, the TRICC trial (here) suggested that routine blood transfusion in critically ill patients did not confer benefit if the haemoglobin level was above 7g/dl. This resulted in a evidence based paradigm for lower transfusion triggers. The problem was – how do you deal with the bleeding patients? A recent study in … Continue reading

Troponin Leak Postop – what does it mean?

Twenty years ago perioperative myocardial ischaemia was a relatively easy thing to diagnose – we checked ECG looking for ST segment and T wave changes, and looked for an MB-CK rise. Then troponin arrived, and suddenly the proportion of patients with perioperative ischaemia increased drastically. For many of us, the report of a “postoperative troponin … Continue reading

The Obesity Paradox – Weight there’s more!

The media are constantly harping on about the obesity epidemic – “two in three of us are fat – this is going to lead to an explosion of obesity related morbidity – heart disease, cancer, cerebrovascular disease, crumbling joints etc.” It never seems to occur to the same talking heads on television and in print … Continue reading