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Biomedical subjects

C J Runcie

Publications and source records attributed to C J Runcie.

At least 19 recordsLinked to original sources
PubMed1996

Interhospital transfer of the critically ill trauma patient: the potential role of a specialist transport team in a trauma system.

A specialist transfer team based in the regional intensive therapy unit (ITU) at the Western Infirmary, Glasgow, acts as a central interhospital retrieval team for Glasgow and the west of Scotland. The establishment of trauma systems has been proposed. This paper describes the activities of the specialist transfer team to illustrate the potential role of a central retrieval team within such a system.

Adolescent↗
PubMed1995

Transfer of the critically ill obstetric patient: experience of a specialist team and guidelines for the non-specialist.

Transfer of the critically ill obstetric patient between hospitals is increasingly common. The specialist transfer team based at the Western Infirmary Intensive Therapy Unit, Glasgow has transported 60 such patients in the years 1985-1994. Monitoring was by direct arterial pressure measurement in 56 patients and central venous pressure measurement in 45. Forty-one patients were mechanically ventilated in transit. There were no deaths in transit but 3 patients died later in intensive care. The majority of patients had pregnancy induced hypertension or had suffered a post partum haemorrhage. A clinical impression that these two groups had different treatment requirements and outcomes was not substantiated. We conclude that the transfer of even the sickest obstetric patient is feasible and safe and suggest guidelines to non-specialists for the management of these patients before and during interhospital transfer.

Journal Article↗
PubMed1993

Comparison of recovery from anaesthesia induced in children with either propofol or thiopentone.

We studied 102 children undergoing day-case surgery, allocated randomly to receive either thiopentone 5 mg kg-1 or propofol 3 mg kg-1 i.v. at induction of anaesthesia. They then inhaled nitrous oxide and halothane in oxygen until a laryngeal mask airway could be inserted. Thereafter, halothane was substituted by isoflurane and analgesia provided by regional nerve block. Recovery from anaesthesia was assessed by the time taken to reach clinically-defined criteria and by calculation of sedation, pain and vomiting scores. In children aged less than 5 yr, only the time to spontaneous eye opening was shorter after propofol induction (P < 0.05). In children aged 5-11 yr, times of spontaneous eye opening, giving name and discharge were shorter after propofol induction (P < 0.05). These results indicate that propofol hastened early recovery in children undergoing day-case surgery, but earlier discharge occurred only in older children.

Ambulatory Surgical Procedures↗
PubMed1992

Preparation of the critically ill for interhospital transfer.

Changes in monitoring and therapy during the preparation of 100 critically ill patients for interhospital transfer by a specialist team were documented prospectively with the aim of providing guidelines for nonspecialists. Severity of illness scores were recorded before and after preparation. Median duration of preparation for ambulance journeys was 50 min and for aeroplane journeys was 82 min. During preparation, a portable electrocardiogram and pulse oximeter were attached to 21 and 76 patients respectively and intra-arterial pressure monitoring was continued or instituted in 88 patients. Supplemental oxygen and intravenous fluids were the therapies most commonly increased or instituted by the transport team; mechanical ventilation, positive end-expiratory pressure and inotropic drugs were increased or instituted less frequently. Median therapeutic intervention scores before and after preparation were 21 and 23 respectively, highlighting the need to increase rather than withdraw support for transfer.

Adolescent↗
PubMed1992

Lung, chest wall, and total respiratory system resistances and elastances in the normal range of breathing.

We measured total respiratory system and lung and chest wall resistances (Rrs, Rl, and Rcw) and elastances (Ers, El, and Ecw) in awake, relaxed human subjects during sinusoidal volume forcing at the mouth from 0.2 to 0.6 Hz with tidal volumes (VT) of 6 to 18% VC at constant mean airway pressure. In addition, we repeated measurements with the lowest VT at a lower airway pressure and therefore at a lower mean lung volume (Vl). Rrs and Rcw decreased with increasing respiratory frequency (f) and VT, but Rl was independent of f and VT. All resistances were higher at the lower Vl. Ers and Ecw increased with increasing f and decreased with increasing VT. El increased slightly with increasing f but was not affected by VT. All elastances tended to increase at the lower Vl. We conclude that in the normal range of breathing amplitude and frequency, (1) lung properties are nearly constant if mean lung volume does not change, and (2) f and VT dependencies of total respiratory system properties are caused by the chest wall.

Adult↗
PubMed1990

Current practice in transferring critically ill patients among hospitals in the west of Scotland.

OBJECTIVE: To identify the requirements of an interhospital transfer service for critically ill patients. DESIGN: Retrospective survey of the current functions of a specialist interhospital transfer team from data collected at the time of transfer and from records of intensive care unit. SETTING: Mobile intensive care unit based at a tertiary referral centre, which serves the west of Scotland. PATIENTS: All critically ill patients (378) transferred between hospitals by the unit from 1986 to 1988. RESULTS: 365 Patients were transferred by road and 13 by air. There was a wide variation in age (range 6 weeks to 87 years), diagnosis, reason for transfer, support required, and distance travelled. Most patients (232) were transferred for respiratory or cardiovascular support; 100 were trauma cases. 300 Patients (79%) were mechanically ventilated during transfer. No patient died in transit, although the eventual mortality was 28% (105 patients). Mortality was significantly higher in patients transferred from hospitals with intensive care units than from those without (38% (125 patients) v 23% (253); p less than 0.005). IMPLICATIONS: Safe interhospital transfer of critically ill patients is feasible; the high eventual mortality in some patient groups emphasises the need for accurate prediction of outcome if inappropriate transfer is to be avoided. The findings may help in organising secondary transfer services in future.

Adolescent↗
PubMed1990

A comparison of measurements of blood pressure, heart-rate and oxygenation during inter-hospital transport of the critically ill.

Critically ill patients transferred between hospitals are often inadequately monitored in transit, with outcome adversely affected. In 22 such patients, we compared direct and palpated measurements of systolic pressure, oscilloscopic and aneroid manometric measurements of mean pressure, ECG and palpated measurements of heart-rate and clinical and oximetric assessments of oxygenation. On average palpated readings of systolic pressure under-read direct readings by 29% and palpated readings of heart-rate under-read ECG readings by 2%. The mean difference between oscilloscopic and manometric readings of mean pressure was zero. Oxygen saturation readings did not reach a level which allowed valid comparison. If direct measurement of heart-rate and blood pressure by battery-powered monitors is not feasible, palpation of heart-rate and manometric measurement of mean arterial pressure are acceptable alternatives during secondary transport of the critically ill.

Adolescent↗
PubMed1990

Blood pressure measurement during transport. A comparison of direct and oscillotonometric readings in critically ill patients.

This study assessed the accuracy of oscillotonometric blood pressure measurement in critically ill patients during transfer. Direct intra-arterial pressure measurements were taken in 44 transported patients as a 'gold standard' and compared with readings from four portable automatic oscillotonometers--the Dinamap 8100, Lifestat 100, Propaq 102 and Takeda UA711. All under-read systolic pressure (by 13%, 21%, 19% and 13% respectively) and over-read diastolic pressure (by 15%, 5%, 27% and 15% respectively) in comparison to direct pressure measurement. The limits of agreement for 95% of comparisons were broad. The systematic difference between direct and oscillotonometric measurements and the variability between and within patients show that direct oscillotonometric measurements are not interchangeable in these patients. Portable automatic oscillotonometers should not be substituted for direct monitoring in such circumstances.

Blood Pressure↗
PubMed1989

How to perform arterial cannulation.

Arterial cannulation is a common and informative procedure. This article outlines its indications and contra-indications and illustrates the common methods of insertion. Good technique minimises subsequent complications, even when insertion is difficult.

Catheterization, Peripheral↗