1,721,032 research outputs found
Genetophysiology: using genetic strategies to explore hypoxic adaptation
No full textThe common inheritance of the same 20,000 to 25,000 genes defines us as human. However, substantial variation exists in the human genome, which determines how each of us will respond to any given (identical) environmental stimulus. The interaction of this variation with diverse environmental stimuli makes us all different from one another. Rapid advances in the sequencing of the human genome and in the description of the common variation within it will help us identify genes and pathways that regulate hypoxic (mal)adaptation. The resultant knowledge will be of relevance not only to mountaineers: many disease states are complicated by low cellular oxygen availability, and a grasp of the mechanisms through which adaptation occurs will offer new therapeutic targets
Intravenous artificial oxygen carriers
No full textHaemoglobin-based oxygen carriers and perfluorocarbons have been developed as artificial oxygen carriers which can be safely administered intravenously. Mixed results from clinical trials to date suggest that further work is required to clearly demonstrate clinical efficacy and safety for these exciting products
Saline or Hartmann's solution: is it still a controversy?
No full textAnaesthetists and other clinicians have long debated the relative merits of using Hartmann’s (or lactated Ringer’s) solution instead of normal saline during operations. Until recently there have only been case reports that have highlighted the possibility of a ‘dilutional acidosis’ occurring when saline was used to replace massive blood loss
Can we measure the quality of perioperative care?
No full textData showing that perioperative interventions can significantly improve postoperative outcomes have become commonplace. In the 21st century being unable to measure the quality of perioperative care and the consequent outcomes is unacceptable. Any organization that consumes such huge amounts of public resources as the NHS has an obligation to justify this expenditure and demonstrate quality service delivery
Comparing opioid exposure and associated risk factors in adult patients admitted to ICU or HDU following right hemicolectomy
No full textIntroduction: following right hemicolectomy, patients at University Hospital Southampton (UHS) NHS Foundation Trust are often admitted to the intensive care unit (ICU) or high dependency unit (HDU). This decision is based on patients’ underlying co-morbidities and surgical complexity. Pain management here consistently features strong opioids (fentanyl, morphine, oxycodone) and adjuvant agents (paracetamol, regional anaesthesia) [1]. Postoperative opioid exposure and its associated risk factors are important to establish given opioids’ safety profile. There is a potential risk of relative overdose in intensive care where mechanical ventilation precludes titration to effect, though this has not yet been examined rigorously.Objectives: to compare patients’ opioid consumption within 24 hours of admission to an ICU or HDU following right hemicolectomy and identify clinically relevant factors associated with this opioid use.Methods: this retrospective cohort study was registered and approved by the University of Southampton’s ethics service (ERGO reference 88350.A1). It included adult patients admitted to the ICU or HDU at UHS (between 2017 and 2024) following right hemicolectomy that received opioids within 24 hours of admission. Clinical data was manually extracted from a local clinical information system (MetaVision) and opioid doses were converted into IV morphine milligram equivalents (MMEs) [2]. Multiple linear regression (MLR) analysis was then conducted. The dependent variable was log-transformed opioid consumption in IV MMEs within 24 hours of admission and the independent variables were demographic characteristics (gender, age, weight), history of substance dependence (alcohol, smoking, pre-hospital opioids), unit admitted to (ICU or HDU), mechanical ventilation and sequential organ failure assessment (SOFA) score.Results: a total of 254 patients were included: 57 were admitted to the ICU and 197 to the HDU. Median (IQR) opioid consumption in IV MMEs within 24 hours of admission was 68 (32-124) in ICU and 39 (20-70) in HDU patients (p=0.002). The MLR model explained 24% of the variance in opioid consumption (adjusted R2=0.24) and was statistically significant (p=<0.001). Age (B=0.97, p=<0.001) and history of alcohol dependence (B=1.98, p=0.038) were significant predictors of opioid consumption, while pre-hospital opioid exposure (B=1.50, p=0.054) was marginally significant. In contrast, gender, weight, history of smoking, unit admitted to, mechanical ventilation and SOFA score did not reach statistical significance. Conclusions: oioid consumption was significantly greater in patients admitted to the ICU compared to the HDU following right hemicolectomy. Younger age and history of alcohol dependence (>14 units per week) both positively predicted opioid consumption. Adequately powered research is needed to confirm these findings and should assess the clinical impact of greater opioid consumption in ICU patients.Reference(s): 1.Devlin JW, Skrobik Y, Gélinas C, Needham DM, Slooter AJ, Pandharipande PP, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Critical care medicine. 2018;46(9):e825-73.<br/
Preparing the patient for surgery to improve outcomes
No full textThe time between contemplation of surgery and the procedure offers a window of opportunity to optimize patients' nutritional, functional and psychological state prior to surgery. Traditionally, preoperative pathways have focused on the underlying disease process and 'fitness for surgery' with physical pre-assessment and risk counselling late in the pathway when little time is available to intervene. With an increasingly elderly and co-morbid surgical population, early physiological assessment and multidisciplinary collaborative decision-making is increasingly important. Multimodal prehabilitation programmes may improve surgical outcome, facilitating rapid recovery from surgery and limiting post-operative functional dependence. Patient education and engagement is important if compliance with behavioural change is to be achieved and maintained. To date, there has been evidence supporting preoperative exercise training, smoking cessation, reduction in alcohol intake, anaemia management and psychosocial support. Further research is needed to identify the most effective elements of these complex preoperative interventions, as well as their optimum timing and duration
Thiamine for agitation and delirium in critically ill patients: a survey of clinician perspectives
No full textPreoperative patient preparation, programs, and education in the United States: State of the art, state of the science, and state of affairs
No full textExogenous surfactant therapy in acute lung injury/acute respiratory distress syndrome: The need for a revised paradigm approach
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