Pharmacokinetics of colistin methanesulfonate and colistin in a critically ill patient receiving continuous venovenous hemodiafiltration.
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Colistin↗
Biomedical subjects
R Boots
Publications and source records attributed to R Boots.
High dependency units: issues to consider in their planning.
This review discusses the issues to be considered in establishing new or extending existing high dependency unit (HDU) services. A defined high dependency service becomes cost-effective when patient care requires more than one nurse for three patients. Professional guidelines for HDUs vary and there are no national accreditation criteria. Casemix and service delivery specifications for the HDU need to be defined and agreed upon within the institution. Establishing a new HDU service requires changes to care delivery. Many potential HDU patients are currently managed in general wards or in the intensive care unit. The service should be discussed widely and marketed within the institution, and the development of defined working relationships with the ICU and primary care teams on the wards is mandatory.
Australia↗
The continuous measurement of cerebrospinal fluid gas tensions in critically ill neurosurgical patients: a prospective observational study.
OBJECTIVE: To determine the feasibility and usefulness of continuous cerebrospinal fluid pH and gas tension monitoring in critically ill neurosurgical patients. DESIGN: Prospective, observational study. SETTING: Neurosurgical intensive care unit in a teaching hospital. PATIENTS: Five critically ill neurosurgical patients (GCS < 8) requiring intensive care intracranial pressure monitoring and intermittent positive pressure ventilation. INTERVENTIONS: Placement of a Paratrend 7 sensor into the external ventricular drain. MEASUREMENTS AND MAIN RESULTS: The cerebrospinal fluid (CSF) pH, PCO2 and PO2 were recorded at 1-min intervals. Intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were recorded at 15-min intervals. The mean baseline CSF pH, O2 and PO2 values were 7.28 +/- 0.08 pH units, 44 +/- 6 torr and 43 +/- 27 torr, respectively. The ranges of CSF pH, PCO2 and PO2 observed during the study were 6.3-7.8 pH units, 37-150 torr and 4-150 torr, respectively. A statistically significant correlation between ICP, CPP and CSF gas tensions occurred in patient 3. Significant changes in CSF PO2 and pH were observed with augmentation of CPP and preceded clinical improvement in patient 4. There were no complications attributable to sensor placement. CSF gas tensions and pH values obtained from patients 3 and 4 suggest that these measurements may be an indicator of cerebral perfusion. CONCLUSIONS: Continuous CSF gas tension measurements in critically ill patients are possible and may be an indicator of adequacy of cerebral perfusion. The relative merits and limitations of the technique are discussed.
Adult↗
Use of inhaled nitric oxide in pulmonary embolism.
Acute massive pulmonary embolism carries a high mortality with the majority of deaths occurring during the early phase. We describe a case of massive pulmonary embolism resulting in severe cardiovascular collapse and cardiac arrest which was treated successfully with inhaled nitric oxide.
Administration, Inhalation↗
Propofol-thiopentone admixture: recovery characteristics.
We have investigated, in a prospective double-blind study, recovery from anaesthesia induced by two admixtures of propofol and thiopentone and compared it with a third group of patients who received propofol and lignocaine. Ninety unpremedicated ASA 1 or 2 patients scheduled for elective gynaecological laparoscopy as a daycase procedure were randomly allocated to receive one of three different mixtures for induction of anaesthesia as part of a standardized anaesthetic: Group P50: propofol 1% 10 ml/thiopentone 2.5% 10 ml, Group P75: propofol 1% 15 ml/thiopentone 2.5% 5 ml, Group P100: propofol 1% 20 ml/lignocaine 1% 4 ml. Recovery from anaesthesia was assessed for up to four hours post-induction by critical flicker fusion threshold and best post-box toy completion time. Comparison was made with preoperative baseline performance. There was no significant difference in postoperative recovery between the three groups with either assessment but no group returned to their mean preoperative performance levels within the first four hours post-induction. Nor was there any difference between the groups with respect to postoperative analgesia or anti-emetic administration. Utilizing the most sensitive end-point, a sample of nearly 1000 patients in each group would be required to confirm the observed difference with a power of 0.8 based on the data from this study. In comparison with lignocaine, the addition of thiopentone to propofol does not delay recovery from anaesthesia and does not increase postoperative analgesic or anti-emetic requirements.
Adult↗
Survival following fulminant hepatic failure from fluconazole induced hepatitis.
We present a case of recovery from fulminant hepatic failure secondary to high serum levels of fluconazole precipitated by amphotericin B induced renal dysfunction. Fluconazole dose adjustment or alternative antifungal treatment should be considered in patients with impaired renal function.
Amphotericin B↗
Fatal encephalitis due to novel paramyxovirus transmitted from horses.
BACKGROUND: In September, 1994, an outbreak of severe respiratory disease affected 18 horses, their trainer, and a stablehand in Queensland, Australia. Fourteen horses and one human being died. A novel virus was isolated from those affected and named equine morbillivirus (EMV). We report a case of encephalitis caused by this virus. FINDINGS: A 35-year-old man from Queensland had a brief aseptic meningitic illness in August, 1994, shortly after caring for two horses that died from EMV infection and then assisting at their necropsies. He then suffered severe encephalitis 13 months later, characterised by uncontrolled focal and generalised epileptic activity. Rising titres of neutralising antibodies to EMV in the patient's serum at the time of the second illness suggested an anamnestic response. Distinctive cortical changes were shown on magnetic resonance neuroimaging and histopathological examination of the brain at necropsy. Immunohistochemistry and electronmicroscopy of brain tissue revealed pathology characteristic of the earlier cases of EMV infection. PCR on cerebrospinal fluid taken during the second illness, brain tissue, and serum retained from the original illness resulted in an amplified product identical to that previously described from EMV. INTERPRETATION: The results of serology, PCR, electronmicroscopy, and immunohistochemistry strongly suggest that EMV was the cause of this patient's encephalitis, and that exposure to the virus occurred 3 months before the fatal illness.
Adult↗
Use of phosphate buffered solution in gastric tonometry.
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Blood Gas Analysis↗