Anestezjologia intensywna terapia最新文献

Background: Patient satisfaction with perioperative care plays an important role in the assessment of quality of care. Written evaluation forms are commonly used all over the world for this purpose. The aim of this study was to assess the quality of perioperative care, with special attention being directed to anaesthesia-associated side effects.

Methods: Forty-two adult patients, of both sexes, scheduled for abdominal surgery, were asked to complete a questionnaire consisting of 11 questions on anaesthesia, side effects and the general quality of perioperative care. The results were analysed using the X2 test, and p < 0.05 was considered significant. The Pearson correlation coefficient was used for comparison.

Results: There was a strong correlation between the quality of the pre-anaesthesia visit, including the information obtained on possible complications and alternative methods of anaesthesia, and the assessment of quality of the anaesthesia service. Post-anaesthesia care facilities were also found to be of major importance for patients.

Conclusions: Adequate, detailed and easily understandable information plays a crucial role in patients satisfaction with anaesthesia. Special attention should be paid to the most common side effects and complications. Residents should be trained in communication in the early stages of their training.

Background: Systemic connective tissue diseases are relatively rare disorders of unknown origin, possibly related to autoimmunity. In the retrospective study, we analysed the records of nine patients suffering from connective tissue disorders who were treated during a two-year period in an intensive therapy unit.

Methods: Hospital medical records, observational charts and all other available medical documents were analysed.

Results: The clinical courses of 9 patients were studied. They included 4 with scleroderma, 3 with systemic lupus erythematosus, and 2 with inflammatory myopathy. They were admitted to the ITU because of sepsis and/or pneumonia, pulmonary haemorrhage, or cardiovascular failure. Three patients (2 with systemic sclerosis, 1 with systemic lupus erythematosus) died.

Conclusions: A multidisciplinary approach to treatment is a key factor in the successful management of patients with rare diseases, such as connective tissue pathologies. Frequent infections with respiratory and/or circulatory complications are the most common causes of severe morbidity in these patients.

Until the outbreak of WW II, anaesthesiology, as a separate specialty, did not exist in Poland. After the fall of Poland, a large section of the Polish Armed Forces was evacuated to France and after that, to the UK, where Polish military physicians had a unique opportunity to obtain training in modern anaesthesia. The first regular courses were established at the University of Edinburgh. After WW II, doctor Stanisław Pokrzywnicki, a pioneer of Polish anaesthesiology, who was trained by Sir Robert Macintosh, and doctor Bolesław Rutkowski, an anaesthesiologist in London, returned to Poland and started regular services. This led to the registering of anaesthesiology as a separate specialty in 1951. In the article, the wartime and post-war stories of the first Polish anaesthesiologists are presented.

Coagulopathies of various origins have been mentioned among the leading causes of morbidity in hospitals all over the world. Time-consuming coagulation assays delay the diagnosis and response to a dynamic pathology. The need to analyse whole blood for the accurate identification of coagulopathies has led to a revival of interest in thromboelastography (TEG). This simple test can be performed at the bedside using non-anticoagulated blood, and enables complex assessment of extrinsic and intrinsic pathways of coagulation and fibrinolysis. TEG can be also used to predict postoperative bleeding and/or organ dysfunction. TEG has been widely used in research, but poor understanding of the technique has limited its clinical use. Controversies regarding the relationship between traditional tests and TEG have made the bedside use of TEG less popular than it should be. In the review, the authors discuss details of the process and practical aspects of its use in clinical settings.

Background: The risk of perioperative death in general surgery wards depends on many factors, including the underlying disease, type of surgical intervention and model of perioperative management. The aim of the study was to determine the reasons for major differences in mortality rates recorded in general surgery wards of the three university hospitals.

Methods: The retrospective study was carried out and involved the data of 32 231 surgical patients. In one of the hospitals, postoperative patients were treated in the recovery room supervised by anaesthetists; in the remaining two, perioperative care was delivered by surgical ward staff. A multiple regression model with random effects was used to adjust for differences in three death risk groups of patients according to underlying diseases: low, moderate and high.

Results: In the hospital with postoperative care administered by anaesthetic staff the mortality rate was 0.45 whereas in the two remaining ones with postoperative patients supervised by surgical staff - 1.86 and 2.52. In each group, increased mortality was observed among patients receiving therapy in general surgery wards after transfer from another hospital ward.

Conclusion: The major factor determining the mortality rates in general surgery wards is the model of perioperative management.

Background: Blunt chest trauma is frequently associated with cardiac contusion and structural damage, most cases only being recognized after death. We report a case of multiple organ trauma, where cardiac failure, caused by tricuspid valve rupture, was markedly delayed.

Case report: A 21 yr old man was admitted to hospital after a car accident. He was suffering from cerebral contusion and oedema, pulmonary contusion, and a left pneumothorax. He also had multiple fractures of the facial bones, orbit, L4 vertebra and left tibia. He was tracheotomised, and a subdural sensor was inserted for continuous monitoring of intracranial pressure. He was sedated and ventilated for two weeks. On the 12th day, his jaw was reconstructed, and immediately after surgery, mild signs of cardiac failure were observed, which were attributed to cardiac contusion. Two weeks after admission, the patient was weaned from the ventilator, and three days later, his facial bones were reconstructed. Four days later, the signs of cardiac failure reappeared. Transoesophageal echocardiography revealed rupture of a head of papillary muscle, with 4th degree tricuspid insufficiency and enlargement of the right ventricle. The ruptured muscle was reconstructed under extracorporeal circulation, and the patient made a satisfactory recovery.

Discussion: Acute tricuspid valve insufficiency, albeit rare, may occur in patients with blunt chest trauma. Sedation and lack of physical activity may delay the definite diagnosis, especially when only transthoracic echocardiography is used. Cardiac arrhythmias, diastolic murmur, or signs of congestive cardiac failure in a chest trauma patient may all suggest some structural damage; therefore, transoesophageal echocardiography should be performed as early as possible in such situations.

Background: It has been suggested that red blood cell transfusions may affect the outcome and frequency of infection in patients treated in ITU settings. We have therefore retrospectively analysed the records of one hundred and sixty-three patients treated in a large tertiary intensive care unit, in order to find any relationship between red blod cell transfusions and the frequency of nosocomial infections.

Methods: The patients were allocated to two groups: T - those who were transfused and N - those who were not. Among the transfused patients, two further subgroups were selected: those who were transfused within 48 h before any signs of infection were observed (n), and those in whom the transfusion was more than 48 h before infection was noted (t).

Results: There was a statistically significant difference between groups T and N (50.9% vs 38.1% infected patients), but not between subgroups t and n.

Conclusions: Nosocomial infections were more frequently observed in patients who required red blood cell transfusion. Red blood cell transfusion cannot be regarded a sole factor affecting nosocomial infection rates.

Background: Pain on admission, especially after trauma, is the most common complaint (over 80%) of patients in the emergency department. During a four-week period, an anonymous, voluntary survey on the quality of pain management was conducted among adult patients reporting to the emergency department.

Methods: Five hundred questionnaires were distributed during admission, and 260 were returned. Patients were asked about localisation and severity of pain (NRS - Numerical Rating Scale), the quality and speed of assistance in the emergency department, and the effectiveness of analgesia.

Results: Ninety percent of patients reported pain of varying intensity. The median pain scores on admission were 5.2, 7.3 during management, and 3.8 on discharge. Over 90% of patients were questioned about pain, but only 20% received some medication. Nevertheless, 80% of those surveyed were satisfied, and there was no correlation between the severity of pain and administration of analgesics. Fifty percent of patients received analgesics for home use, and 66% were instructed about further treatment.

Conclusions: Despite the frequency and intensity of pain, analgesics were rarely offered in the emergency department. A surprisingly high level of satisfaction was reported, despite suboptimal pain management. This indicates either that non-pharmacologic methods of pain treatment play an important role, or that the severity of pain is overestimated by patients.