bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of Pressure Support in Compensating for Apparatus Work
Authors: Bersten A. D. , Rutten A. J. , Vedig A. E. 
Published: January 2019

Breathing through an endotracheal tube, connector, and ventilator demand valve imposes an added load on the respiratory muscles. As respiratory muscle fatigue is thought to be a frequent cause of ventilator dependence, we sought to examine the efficacy of five different ventilators in reducing this imposed work through the application of pressure support ventilation. Using a model of spontaneous breathing, we examined the apparatus work imposed by the Servo 900-C, Puritan Bennett 7200a, Engstrom Erica, Drager EV-A or Hamilton Veolar ventilators, a size 7.0 and 8.0 mm endotracheal tube, and inspiratory flow rates of 40 and 60 l/min. Pressure support of 0, 5, 10, 15, 20 and 30 cm H2O was tested at each experimental condition. Apparatus work was greater with increased inspiratory flow rate and decreased endotracheal tube size, and was lowest for the Servo 900-C and Puritan Bennett 7200a ventilators. Apparatus work fell in a curvilinear fashion when pressure support was applied, with no major difference noted between the five ventilators tested. At an inspiratory flow rate of 40 l/min, a pressure support of 5 and 8 cm H2O compensated for apparatus work through size 8.0 and 7.0 endotracheal tubes and the Servo 900-C and Puritan Bennett 7200a ventilators. However, the maximum negative pressure was greater for the Servo 900-C. The added work of breathing through endotracheal tubes and ventilator demand valves may be compensated for by the application of pressure support. The level of pressure support required depends on inspiratory flow rate, endotracheal tube size, and type of ventilator.
The Stethoscope: Applications and Limitations– An Analysis of 2000 Incident Reports
Authors: Klepper I. D. , Webb R. K. , Van Der Walt J. H. , Ludbrook G. L. , Cockings J. 
Published: January 2019

The first 2000 incidents reported to the Australian Incident Monitoring Study (AIMS) were analysed with respect to the role of the oesophageal or precordial stethoscope as a continuous monitor. There were 1099 of the 1256 incidents during general anaesthesia in which one might have been used in this way, but use was reported in only 65 cases (5%), predominantly during paediatric cases. In only one report, a cardiac arrest, was the stethoscope the first to detect the incident. In a theoretical analysis it was considered that the stethoscope, used on its own for continuous monitoring, could have detected 54% of the 1256 incidents (almost 25% before any potential for organ damage), had they been allowed to evolve. However, AIMS data suggest that the actual yield using a stethoscope as a continuous monitor may be much lower than this, and that even the use of a “mobile” stethoscope can not be relied upon to detect oesophageal or endobronchial intubation. These reports confirm that there is limited use of the stethoscope for continuous monitoring in current anaesthetic practice in Australia; it has been superseded by the sophisticated electronic monitors now available. However, in areas with limited resources continuous auscultation with a stethoscope remains a basic requirement.
Pneumothorax: An Analysis of 2000 Incident Reports
Authors: Williamson J. A. , Webb R. K. , Van Der Walt J. H. , Runciman W. B. 
Published: January 2019

Eighteen (1%) of the first 2000 incidents reported to the Australian Incident Monitoring Study (AIMS) involved actual or suspected pneumothoraces; 17 were confirmed. Eleven of the patients were seriously ill beforehand. Four developed tension pneumothoraces, and in 2 incidents (1 tension) the pneumothoraces were bilateral. Nine of the 17 were iatrogenic; 6 (35%) followed neck vein cannulation, and 3 (18%) were surgical complications of tracheotomies. No death was attributed to a pneumothorax. In 8 of the 17 incidents, diagnostic delay or difficulties occurred. Contributing factors identified included urgency, distorted anatomy, failure to check, and haste on the part of the anaesthetist. Desaturation detected by pulse oximetry and hypotension detected by invasive blood pressure monitoring warned the anaesthetist on 2 occasions each. Indications for central vein cannulation or trans-tracheal airway manoeuvres must be firm. Such procedures should always be followed by a closely scrutinised erect chest X-ray as soon as practicable. The possibility of a pneumothorax must always be considered when unexpected cardiorespiratory deterioration occurs.
A Survey of Personal and Professional Attitudes of Intensivists to Organ Donation and Transplantation
Authors: Pearson I. Y. , Zurynski Y. 
Published: January 2019

A questionnaire survey was carried out to examine the attitudes and practices of Australian and New Zealand intensivists with regard to brain death and organ donation. A return rate of 82.5% was achieved. Fifty-eight per cent had written evidence of their own wishes to donate organs and 94% would agree to donation from a dependent. At least one intensivist is involved in certifying brain death on 95% of occasions. Intensivists are involved in the request for organ donation over 90% of the time although one-third do not believe that it is their role to request organ donation. Although two-thirds believe that the family should always be approached for organ donation, another 52 out of 254 indicated that it was their (the intensivist's) role to decide if families should be asked for organ donation. Possible reasons for not requesting are language or other communication problems, perceptions of cultural differences and degrees of family distress. Twenty per cent of respondents do not provide haemodynamic support before brain death confirmation. Australian and New Zealand intensivists overwhelmingly support the concept of brain death, current methods of confirmation of brain death, organ donation and transplantation. Possible reasons behind loss of potential donors include decisions not to resuscitate both before and after brain death is confirmed. Perceptions of family grief and cultural differences clearly inhibit requests for organ donation. A very few units have an effective policy on approaching families about organ donation. Intensivists have almost exclusive control over requests for organ donation and thus bear a full professional responsibility for this element of hospital practice.
Donor Families’ Experience of Organ Donation
Authors: Douglass G. E. , Daly M. 
Published: January 2019

This retrospective study surveyed families who consented to organ donation in the State of Queensland, Australia, from January 1991 to December 1992 inclusive, and evaluated their experience of the organ donation process. The survey questioned families in relation to the preparation they received, their understanding of brain death, the request process, influencing factors, and post donation follow-up. One hundred and eight families consented to organ donation over this 24-month period. Twelve families of paediatric donors under the age of twelve years were excluded, and twelve families were not able to be contacted. Of the remaining 84 families, 42 participated in this study. Overall the study results indicated a positive attitude towards the organ donation process. The majority of families did not find the process stressful and indicated that they were provided with sufficient information and preparation, and that the request was made in a sensitive manner. A few important issues and areas for improvement were highlighted: in particular, the need for families to have an opportunity to view the body after procurement, and the importance of counselling throughout and after the donation process.
Parental Presence at Induction of Anaesthesia: A Survey of N.S.W. Hospitals and Tertiary Paediatric Hospitals in Australia
Authors: Baines D. , Overton J. H. 
Published: January 2019

We undertook a survey of N.S.W. hospitals and tertiary paediatric hospitals in other States to determine their practice in relation to parental presence at induction of anaesthesia of children. There were 135 responses to 174 questionnaires. Twenty-one indicated that no children were anaesthetized at their institution and one was inadequately filled out. One hundred and thirteen questionnaires were assessed. Only 44% of departments had an official policy on parental attendance. A quarter of all hospitals described their facilities as entirely suitable, and a half compromised to allow parents to be present. The remaining quarter described their facilities as unsuitable. Overall, two-thirds of hospitals never or only sometimes had parents present at induction, and this applied equally to daystay patients and inpatients. Tertiary hospitals were more likely to have parents present, however they were more likely to have suitable facilities. The most common reason cited for parental attendance was parental expectation of being present, closely followed by the individual anaesthetist's philosophy. The most common reason for parents not attending was the individual anaesthetist's philosophy, followed by inadequate staffing.
Maxima and Bain Breathing Systems Compared in Controlled Ventilation
Authors: Miller D. M. 
Published: January 2019

The Maxima is a new universal breathing system, which, despite its being valveless, functions with near maximal efficiency in spontaneous and controlled ventilation. It was compared to the Bain system in controlled ventilation by adjusting fresh gas flows (V̇F) to achieve an endtidal CO2 of 5% in 40 patients aged from one to seventy-six years. They received a combined regional and general anaesthetic technique. The overall V̇F requirement of the Maxima system was: weight in kg x 35 ml.min−1 .kg−1 + 1160 ml.min−1; the Bain system required V̇F of: weight in kg x 42 ml.min-1 .kg-1 + 2070 ml.min−1. The mean V̇F requirement for the Bain system was greater by 45%. Of these forty patients, the results from the twenty-four adult patients weighing 50 kg or more gave the respective V̇F requirements for the Maxima and Bain systems of 52 and 71 ml.min−1 .kg−1. In a separate study using twenty-nine patients, the fractional utilization of fresh gas (FU) (or VAe/VF where VAe = effective alveolar ventilation) in the Maxima and Bain systems was shown to be 0.94 and 0.71 respectively.
Detection of Cerebral venous Desaturation by Continuous Jugular Bulb Oximetry following Acute Neurotrauma
Authors: Lewis S. B. , Myburgh J. A. , Reilly P. L. 
Published: January 2019

A prospective observational study was performed to assess the reliability of fibreoptic oximetric catheters and to identify the incidence and causes of jugular bulb oxygen desaturation in patients with acute closed head injury. There were twenty- five patients (30± 16 years) with GCS ≤8 in this study. Jugular bulb oximetry, mean arterial pressure, intracranial pressure, end-tidal CO2 and pulse oximetry were monitored continuously. Catheter calibration against a laboratory oximeter was performed post insertion and thereafter eight-hourly. Cerebral venous desaturation was defined as a jugular bulb oxygen saturation <55% of >10 minutes duration. There was a poor correlation for the first in vivo calibration (r2 = 0.602, P<0.001, n=25). Thereafter a close correlation between jugular bulb catheter and oximetry values was demonstrated (r2 = 0.868, P<0.001, n=205). Forty-two episodes of jugular bulb oxygen desaturation of 88 minutes mean duration (range 10 to 555) were observed. 83% occurred within 48 hours following injury. Hypocapnia was associated in 45% of episodes; hypoperfusion in 22%; raised ICP in 9% and a combination of the above in 24%. Validation with a laboratory oximeter is essential prior to continuous jugular bulb oximetry. Sustained episodes of cerebral venous desaturation are frequent within the first 48 hours following acute head injury. Factors such as hypocapnia and cerebral hypoperfusion that primarily reduce cerebral blood flow are predominant.
The Application of EMLA and Glyceryl Trinitrate Ointment Prior to Venepuncture
Authors: Michael A. , Andrew M. 
Published: January 2019

The efficacy of EMLA® cream combined with glyceryl trinitrate (GTN) ointment was assessed by a double-blind prospective study. Adult female patients were randomly allocated to receive either EMLA 1 ml or 2 ml combined with GTN 2 mg, or EMLA 2 ml only. The difference in pain scores between the three groups was not statistically significant. When GTN was used with EMLA, the quality of the veins was superior and aided intravenous cannulation. There were no significant side-effects. It is concluded that if GTN is used with EMLA, the dose of EMLA can be reduced and intravenous cannulation is technically easier compared with EMLA alone.
Respiratory Variables during Thoracotomy for PDA Ligation
Authors: Puri G. D. , Hariwir Singh , Chari P. , Gujral J. S. 
Published: January 2019

Physiological deadspace fraction of tidal volume (VD/VT), arterial to end-tidal carbon dioxide tension differences [P(a-é)CO2], arterial oxygen tension (PaO2) and respiratory system compliance were studied in twenty patients with patent ductus ateriosus scheduled for multiple ligation and transfixation through posterolateral thoracotomy under general anaesthesia with controlled ventilation. The study period was divided into six stages: stage 1—supine posture under anaesthesia, stage 2—lateral posture before start of surgery, stage 3—after chest opening before lung manipulation, stage 4—after ductus ligation and lung re-expansion before chest closure, stage 5—lateral posture, chest closed, stage 6—supine stage before reversal. There was a significant (P<0.01) increase of VD/VT on attaining the lateral posture. The fraction decreased significantly (P<0.05) on opening of the chest (stage 3) and subsequently increased at stage 4. There was no significant change in mean P(a-é)CO2 at various stages of thoracotomy. PaO2 fell significantly on opening of the chest and was lowest before chest closure (stage 4). PaO2 increased following chest closure but was still significantly lower than the pre-surgical supine stage. Respiratory system compliance was lowest at stage 4. Changes in deadspace fraction VD /VT do not correspond favourably to arterial oxygen tensions during posterolateral thoractomy.
Uterine Rupture and Scar Dehiscence. A Five-Year Survey
Authors: Lynch J. C. , Pardy J. P. 
Published: January 2019

A review of the medical records from two public hospitals in Sydney was undertaken to determine the incidence of this uncommon complication. Twenty-seven cases of uterine rupture were reported out of 31,115 deliveries with an incidence of 0.086% (versus 0.05% in the current literature). The incidence associated with previous caesarean section was 0.038% (versus 0.8% in the current literature). Predisposing and associated factors in this review were similar to those reported by others. There was no maternal mortality in our series but the fetal mortality rate was 5 out of 27 cases. Uterine ruptures in the midtrimester were associated with high rates of maternal morbidity and fetal loss. Forty-eight per cent of patients with uterine rupture received epidural analgesia. The associated factors and outcomes are discussed. The current literature is reviewed in relation to this high-risk group of patients.
Acute Haemodynamic Effects of Sodium Bicarbonate Administration in Respiratory and Metabolic Acidosis in Anaesthetized Dogs
Authors: Tanaka M. , Nishikawa T. 
Published: January 2019

Twenty-seven halothane-anaesthetized, mechanically ventilated adult mongrel dogs were randomly assigned to either respiratory acidosis group [pHa 7.22 (0.03, SD), PaCO2 9.6 (1.1) kPa, base excess –0.5 (1.4) mmol.l–1, n=9], metabolic acidosis group [pHa 7.20 (0.05), PaCO2 5.5 (0.4) kPa, base excess –11.1 (2.1) mmol.l–1, n=9], or non-acidosis group [pHa 7.37 (0.07), PaCO2 5.2 (0.4) kPa, base excess –1.1 (1.5) mmol.l–1, n=9]. Respiratory acidosis and metabolic acidosis were induced by decreasing respiratory rate and continuous infusion of 2 mmol.l–1 hydrochloric acid, respectively. Sodium bicarbonate solution 1 mmol.kg–1 was injected into the right atrium over five seconds when haemodynamic stability was obtained. In all three groups, acute administration of sodium bicarbonate produced transient decreases in mean arterial pressure and RV dP/dtmax, and transient increase in right atrial pressure 30 seconds after injections, but these variables returned to the pre-injection values by the end of the three minutes observation period. Although no significant differences were seen in haemodynamic variables among the three groups at 30 seconds, one and three minutes, maximum reductions in both RV dP/dtmax and PBF in the metabolic acidosis group (260 (143) mmHg.s–1 and 0.38 (0.26) l.min–1) were significantly greater than those in the non-acidosis group (127 (34) mmHg.s–1 and 0.08 (0.09) l.min–1; P<0.05).
Anaesthetic Considerations for Children Undergoing Stereotactic Radiosurgery
Authors: Baker K. C. , Isert P. R. 
Published: January 2019

An anaesthetic case report of children undergoing stereotactic radiosurgery is presented, with a review of the inherent unique anaesthetic challenges. Twelve stereotactic radiosurgery procedures performed at The Prince of Wales Hospital, Sydney, were retrospectively reviewed. Despite differences in approach by individual anaesthetists to managing these children, an overall safe sequence may be evolved. The use of stereotactic radiosurgery for paediatric neuropathology is reviewed. The potential anaesthetic problems related to the paediatric patient and the peculiarities of the procedure are discussed and related to our series.
Implications for maintaining vascular access device patency and performance: Application of science to practice
Authors: Hawthorn Alexandra , Bulmer Andrew C , Mosawy Sapha , Keogh Samantha 
Published: January 2019

Introduction: Vascular access devices are commonly inserted devices that facilitate the administration of fluids and drugs, as well as blood sampling. Despite their common use in clinical settings, these devices are prone to occlusion and failure, requiring replacement and exposing the patient to ongoing discomfort/pain, local vessel inflammation and risk of infection. A range of insertion and maintenance strategies are employed to optimize device performance; however, the evidence base for many of these mechanisms is limited and the mechanisms contributing to the failure of these devices are largely unknown. Aims/objectives: (1) To revisit existing understanding of blood, vessel physiology and biological fluid dynamics; (2) develop an understanding of the implications that different clinical practices have on vessel health, and (3) apply these understandings to vascular access device research and practice. Method: Narrative review of biomedical and bioengineering studies related to vascular access practice. Results/outcomes: Current vascular access device insertion and maintenance practice and policy are variable with limited clinical evidence to support the theoretical assumptions underpinning these regimens. This review demonstrates the physiological response to vascular access device insertion, flushing and infusion on the vein, blood components and blood flow. These appear to be associated with changes in intravascular fluid dynamics. Variable forces are at play that impact blood componentry and the endothelium. These may explain the mechanisms contributing to vascular access failure. Conclusion: This review provides an update to our current knowledge and understanding of vascular physiology and the hemodynamic response, challenging some previously held assumptions regarding vascular access device maintenance, which require further investigation.
Time to First Cigarette and Self-Reported Health Among US Adult Smokers
Authors: Sung Baksun 
Published: January 2019

Background: Numerous studies have reported that shorter time to first cigarette (TTFC) is linked to elevated risk for smoking-related morbidity. However, little is known about the influence of early TTFC on self-reported health among current smokers. Hence, the objective of this study was to examine the association between TTFC and self-reported health among US adult smokers. Methods: Data came from the 2012-2013 National Adult Tobacco Survey (NATS). Current smokers aged 18 years and older (N = 3323) were categorized into 2 groups based on TTFC: ≤ 5 minutes (n = 1066) and >5 minutes (n = 2257). Propensity score matching (PSM) was used to control selection bias. Results: After adjusting for sociodemographic and smoking behavior factors, current smokers with early TTFC had higher odds for poor health in comparison with current smokers with late TTFC in the prematching (adjusted odds ratio [AOR] = 1.65; 95% confidence interval [CI] = 1.31-2.08) and postmatching (AOR = 1.60; 95% CI = 1.22-2.09) samples. Conclusions: In conclusion, smokers with early TTFC were associated with increased risk of poor health in the United States. To reduce early TTFC, elaborate efforts are needed to educate people about harms of early TTFC and benefits of stopping early TTFC.
Association between angiotensinogen T174M polymorphism and the risk of diabetic nephropathy: A meta-analysis
Authors: Liu Nina , Wang Youmin 
Published: January 2019

Objective: Although the angiotensinogen ( AGT) gene T174M polymorphism has been implicated in the pathogenesis of diabetic nephropathy (DN), study results have been inconsistent. The present meta-analysis was conducted to determine the correlation of AGT T174M polymorphism with DN. Methods: We retrospectively extracted relevant studies from Embase as well as PubMed databases. Additionally, a fixed- or random-effects model was employed for calculation of pooled odds ratio (OR) along with 95% confidence interval (CI). Results: In total, we identified six studies (1179 cases and 927 controls) regarding the AGT gene T174M polymorphism. The pooled ORs for the association between the AGT T174M polymorphism and DN risk were not statistically significant under all genetic models (M vs T: OR = 1.22, 95% CI = 0.84–1.75; MM vs TT: OR = 1.94, 95% CI = 0.93–4.04; MT vs TT: OR = 1.11, 95% CI = 0.76–1.63; the dominant model: OR =1.19, 95% CI = 0.80–1.77; the recessive model: OR = 1.94, 95% CI = 0.93–4.03). Subgroup analyses based on the type of race showed the M allele of the AGT T174M polymorphism increased DN risk in Asians, but not in Caucasians. Conclusions: Our study indicated that the T174M polymorphism in the AGT gene was associated with DN in Asians.