RESUMO
The cumulative incidence of candidaemia in an Irish intensive care unit (ICU) setting between January 2004 and August 2018 was 17/1000 ICU admissions. Candida albicans was responsible for 55% (N=41) of cases. C. glabrata (N=21, 28%) was the next most prevalent species, and has been identified most frequently since 2012. C. glabrata was associated with a higher mortality rate (57%) than C. albicans (29%). All isolates were susceptible to caspofungin (0.05 µg/mL). Notably, 37% of C. glabrata isolates were resistant to fluconazole, with 13% resistant to amphotericin B, highlighting the need for prudent antifungal stewardship to impede development of multi-drug-resistant C. glabrata in the ICU setting.
Assuntos
Candida albicans/isolamento & purificação , Candida glabrata/isolamento & purificação , Candidemia/epidemiologia , Infecção Hospitalar/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antifúngicos/farmacologia , Candidemia/microbiologia , Candidemia/mortalidade , Infecção Hospitalar/microbiologia , Infecção Hospitalar/mortalidade , Farmacorresistência Fúngica , Feminino , Humanos , Incidência , Unidades de Terapia Intensiva , Irlanda/epidemiologia , Masculino , Pessoa de Meia-Idade , Análise de Sobrevida , Adulto JovemRESUMO
Aim Our aim was to quantify blood transfusion rates in lower limb arthroplasty following the introduction of a multimodal enhanced recovery programme (ERP). We then sought to update the maximum surgical blood ordering schedule (MSBOS) and calculate cost savings achieved. Methods A retrospective cohort study was conducted of all patients who required blood transfusion following primary and revision total hip and knee arthroplasty in 2012 and 2015. A multimodal ERP was introduced in 2015. Cost savings were calculated following the introduction of a new MSBOS. Results During the two-year study period 1467 lower limb arthroplasty procedures were performed. The cross-match to transfusion ratio was 3.6:1 in 2012 and 9.9:1 in 2015. The updated MSBOS resulted in a 46% reduction of cross-matched blood and savings of 54,375 per annum. Conclusion Improved perioperative management in lower limb arthroplasty has reduced blood transfusion rates. Updating blood transfusion practice can result in considerable savings in blood, resources and costs.
Assuntos
Artroplastia de Quadril/economia , Artroplastia do Joelho/economia , Transfusão de Sangue/economia , Transfusão de Sangue/estatística & dados numéricos , Redução de Custos , Idoso , Idoso de 80 Anos ou mais , Tipagem e Reações Cruzadas Sanguíneas/economia , Tipagem e Reações Cruzadas Sanguíneas/estatística & dados numéricos , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória , Estudos RetrospectivosRESUMO
BACKGROUND: In Ireland, specialist paediatric surgery is carried out in paediatric hospitals in Dublin. General surgeons/consultants in other surgical specialities provide paediatric surgical care in regional centres. There has been a failure to train general surgeons with paediatric skills to replace these surgeons upon retirement. AIM: To assess paediatric surgical workload in one regional centre to focus the debate regarding the future provision of general paediatric surgery in Ireland. METHODS: Hospital in-patient enquiry (HIPE) system was used to identify total number of paediatric surgical admissions and procedures. Cases assessed requiring hospital transfer. RESULTS: Of 17,478 surgical patients treated, 2,584 (14.8%) were under 14 years. A total of 2,154 procedures were performed. CONCLUSION: Regional centres without dedicated paediatric surgeons deliver care to large numbers of paediatric patients. The demand for care highlights the need for formal paediatric services/appropriate surgical training for general surgical trainees.
Assuntos
Cirurgia Geral/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Pediatria/estatística & dados numéricos , Centro Cirúrgico Hospitalar/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Feminino , Geografia , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Irlanda , MasculinoRESUMO
PRIMARY OBJECTIVE: Each year in Ireland, 11 000 patients are admitted to hospital with a traumatic brain injury (TBI) but there are no data on subsequent disability in such patients. The objective of this study was to assess the management and outcome in patients of working age admitted with TBI to the unit. METHODS: Two hundred and sixteen patients admitted with TBI aged 16-65 were identified. Self-reported incidence of disability and access to appropriate services was assessed using the Glasgow outcome scale and a problem-orientated questionnaire. RESULTS: Eighty-five per cent of patients eligible for review agreed to participate. The majority of injuries (86%) were mild. An intracranial injury was identified on 35% of CT brain scans performed. Patients with an abnormality on CT scanning were more likely to report difficulties with headache, concentration and memory at time of follow-up. When questioned, 34% of patients still perceived difficulties since their injury. Of this group, 60% didn't receive any input from rehabilitation services. One year post-injury, 11% of patients remained unfit for work. CONCLUSION: A significant number of patients, even with mild TBI, continue to suffer sequelae from their injury augmented by difficulty in accessing appropriate rehabilitation services.
Assuntos
Lesões Encefálicas/reabilitação , Acidentes por Quedas , Acidentes de Trânsito , Adolescente , Adulto , Lesões Encefálicas/diagnóstico , Lesões Encefálicas/etiologia , Atenção à Saúde , Feminino , Escala de Resultado de Glasgow , Hospitais , Humanos , Irlanda , Masculino , Pessoa de Meia-Idade , Reabilitação Vocacional , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
PURPOSE: To compare the incidence of airway complications in children less than one year of age whose airways were maintained during anesthesia with either a laryngeal mask airway (LMA) or a facemask and oral airway (FM-OA). METHODS: We randomized 49 - ASA class 1&2 - infants to an LMA or FM-OA group. All infants were undergoing minor general, urological or orthopedic procedures. Anesthesia was induced and maintained with halothane in nitrous oxide 50% and oxygen. The airway was removed in both groups when the infant was awake. The occurrence of airway complications (breath-holding, coughing, laryngospasm, secretions, obstruction and oxygen saturation < 95%) at induction of anesthesia, intraoperatively and during emergence from anesthesia was recorded. RESULTS: Airway complications occurred perioperaively in 15 of 27 infants in the LMA group and in 5 of 22 infants in the FM-OA group (P: 0.02). CONCLUSION: In infants, the use of the LMA is associated with an increased incidence of airway complications compared with the use of the FM-OA.
Assuntos
Anestesiologia/instrumentação , Complicações Intraoperatórias/etiologia , Máscaras Laríngeas/efeitos adversos , Máscaras/efeitos adversos , Doenças Respiratórias/etiologia , Obstrução das Vias Respiratórias/epidemiologia , Obstrução das Vias Respiratórias/etiologia , Anestesia por Inalação , Tosse/epidemiologia , Tosse/etiologia , Feminino , Humanos , Lactente , Recém-Nascido , Complicações Intraoperatórias/epidemiologia , Laringismo/epidemiologia , Laringismo/etiologia , Masculino , Oxigênio/sangue , Mecânica Respiratória/efeitos dos fármacos , Doenças Respiratórias/epidemiologiaRESUMO
Acute pernicious or sho-shin beri-beri is characterised by haemodynamic and biochemical features which include hypotension, high cardiac output, low peripheral vascular resistance, lactic acidosis and high mixed venous content. The disorder is a metabolic emergency and requires immediate treatment with intravenous thiamine. Three cases are described which were successfully treated with intravenous thiamine (500 mg intravenously, followed by 100 mg 8-hourly for 24 hours then 100 mg daily) without using catecholamines or sodium bicarbonate. Digoxin was used in two cases to manage cardiac dysfunction which was poorly responsive to thiamine.
RESUMO
There is little clinical data in the literature on the anaesthetic management of paediatric patients with Eisenmenger's syndrome undergoing non-cardiac surgery. This paper reviews our experiences with either such patients who underwent a total of 11 surgical procedures. Of the eight children, six had Down's syndrome and an atrio-ventricular septal defect, one had a ventricular septal defect and one an atrial septal defect. Nine of the eleven operations consisted of minor dental, plastic or ENT procedures, while one patient underwent two laparotomies. Premedication (trimeprazine/ meperidine combination or midazolam) was administered on three occasions. Induction of anaesthesia was achieved by either inhalation of halothane (2), or intravenously with thiopentone (6), ketamine (2) or propofol (1). Muscle relaxation and mechanical ventilation were employed only for both intra-abdominal procedures, otherwise patients were allowed to breathe spontaneously with, or without, manual assistance. Halothane (8), isoflurane (2) and enflurane (1) were all used for maintenance of anaesthesia. Non-invasive monitoring was applied intraoperatively for minor procedures, and arterial and central venous catheters inserted for the laparotomies. Postoperative analgesia for both these cases was provided by an epidural infusion of bupivacaine 0.125% and fentanyl 5 micrograms x ml(-1). A single im bolus of morphine was required following a dental clearance, otherwise pain relief for the rest of the cases was achieved by local anaesthetic infiltration and NSAIDS. With the exception of a single episode of bradycardia, induction, maintenance and recovery from anaesthesia were well tolerated in all cases. In conclusion, our experience suggests that despite theoretical risks, children with Eisenmenger's syndrome appear to tolerate a variety of anaesthetic techniques.