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Biomedical subjects

Richard Venn

Publications and source records attributed to Richard Venn.

11 recordsLinked to original sources
PubMed2006

Recently published papers: dying Swans and other stories.

The use of pulmonary artery catheters is under debate yet again. We look at two recent trials evaluating their impact on mortality. Our suspicions regarding obesity are proven and we also look at a simple, cost effective method of reducing ventilator-associated pneumonia. Finally, an intervention to improve the poor outcome associated with out-of hospital cardiac arrests is evaluated.

Catheterization, Swan-Ganz↗
PubMed2005

Recently published papers: out with the old and in with the new ... then something new for the old!

New therapies are challenging older, established practices. One recently published report shows us that we may be able to avoid endotracheal intubation in patients with a reduced level of consciousness. Recombinant activated factor VII is proving to be useful in many coagulation disorders, and intracerebral haemorrhage can be added to this list. Homeopathy, in the form of potassium dichromate, shows promise as a new treatment for excessive tracheal secretions. Rotation protocols for antibiotics have been evaluated with respect to their ability to prevent the development of new resistant micro-organisms in our hospitals and units. Finally, glucocorticoids may be of benefit to septic patients outside the intensive care unit (ICU) and may prevent their deterioration and admission to the ICU.

Critical Care↗
PubMed2004

Recently published papers: clunk-click every trip, smile, but don't stop for a drink on the way.

Reviews of the risks associated with intrahospital transfer and prolonged spinal immobilization made uncomfortable reading in August. Studies on the timing of tracheotomy and a potential role for exogenous surfactant will have done little to allay controversy. We are reminded of the neutrality of the Swiss, and gain valuable insight into prognostic tools in mechanically ventilated patients with cirrhotic liver disease.

APACHE↗
PubMed2004

Clinical review: Vasculitis on the intensive care unit--part 1: diagnosis.

The first part of this review addresses the diagnosis and differential diagnosis of the primary vasculitides Wegener's granulomatosis, microscopic polyangiitis, Churg-Strauss syndrome and polyarteritis nodosa. Prompt diagnosis and treatment of these conditions ensures an optimal prognosis. The development of assays for antineutrophil cytoplasmic antibodies has aided the diagnosis of Wegener's granulomatosis and microscopic polyangiitis. However, even in cases where there is high clinical likelihood that these conditions are present, up to 20% may be antibody negative, whereas alternative diagnoses may be antibody positive. The final diagnosis rests on a balance of clinical, laboratory, radiological and histological features. The exclusion of alternative diagnoses is important in assuring appropriate therapy. Particular attention is paid to the more fulminant presentations of these conditions and the role of the critical care physician in their diagnosis and management.

Antibodies, Antineutrophil Cytoplasmic↗
PubMed2004

Clinical review: Vasculitis on the intensive care unit -- part 2: treatment and prognosis.

The second part of this review addresses the treatment and prognosis of the vasculitides Wegener's granulomatosis, microscopic polyangiitis, Churg-Strauss syndrome and polyarteritis nodosa. Treatment regimens consist of an initial remission phase with aggressive immunosuppression, followed by a more prolonged maintenance phase using less toxic agents and doses. This review focuses on the initial treatment of fulminant vasculitis, the mainstay of which remains immunosuppression with steroids and cyclophosphamide. For Wegener's granulomatosis and microscopic polyangiitis plasma exchange can be considered for first-line therapy in patients with acute renal failure and/or pulmonary haemorrhage. Refractory disease is rare and is usually due to inadequate treatment. The vasculitides provide a particular challenge for the critical care team. Particular aspects of major organ support related to these conditions are discussed. Effective treatment has revolutionized the prognosis of these conditions. However, mortality is still approximately 50% for those requiring admission to intensive care unit. Furthermore, there is a high morbidity associated with both the diseases themselves and the treatment.

Acute Kidney Injury↗
PubMed1993

CSF and plasma concentrations of morphine and morphine glucuronides in cancer patients receiving epidural morphine.

Thirty-five cancer patients, treated with chronic epidural morphine, were assayed for plasma and cerebrospinal fluid (CSF) minimum steady-state concentrations (Css min) of morphine (M), morphine-3-glucuronide (M3G) and morphine-6-glucuronide (M6G) by high performance liquid chromatography (HPLC). A linear dose-concentration relationship was found for the 3 substances in plasma and for morphine and M3G in CSF. The mean +/- S.E.M. CSF/plasma morphine ratio was 158 +/- 43. In CSF, the concentrations of morphine exceeded those of the metabolites substantially and, normalized to morphine, the mean CSF M/M3G/M6G ratio was 1:0.05:0.02. In plasma, the metabolite concentrations were higher than the parent drug and the plasma M/M3G/M6G ratio was 1:12:3. The mean M3G and M6G concentrations in CSF were 40-60% of those found in plasma. Indication of cerebral formation of M3G was found in 1 patient. Pain relief, evaluated by a visual analogue scale (VAS), did not correlate with the CSF M3G concentrations or with the M3G/M ratio. CSF M6G concentrations were low and did not contribute to any detectable analgesia. We conclude that after epidural administration of morphine, the M3G and M6G metabolites in CSF are low compared to unchanged morphine and seem to have little influence on analgesia. However, the fact that a significant passage of the glucuronide metabolites occurs to the CSF may indicate a role in morphine analgesia after other routes of administration.

Analgesia, Epidural↗