identification of the high risk pregnant patient

... specifically the cardiac risk of the patient, not the mortality related to the surgical procedure Accordingly, mortality was 6% to 7% in the patients with RCRI scores of and more A high- risk surgical ... that beta-blockade therapy increased the risk of death in patients with RCRI scores below is much more robust, as this analysis included the vast majority of the patients (80% of the cohort) Second, ... assess the adequacy of DO2 Pearse et al [9] also measured ScvO2 in most of the patients investigated in their study assessing the efficacy of GDT [8] They reported that ScvO2 fluctuated over the...

Ngày tải lên: 12/08/2014, 23:20

... advanced age, the presence of a complicating medical condition or a combination of these factors was specified by 51 of the 81 (63%) high- risk HRGs, compared with 95 of 291 (33%) standard -risk HRG ... 80% of postoperative deaths occur in a subpopulation of high- risk surgical patients • There are limitations with the use of data extracted from large healthcare databases In the absence of a ... matter of public debate [12], other surgical specialties not routinely collect such data The NCEPOD provides information on those patients who die, but provides no indication of the size of the high- risk...

Ngày tải lên: 12/08/2014, 23:23

... trial of supranormal values of survivors as therapeutic goals in high- risk surgical patients Chest 1998, 94:1176-1186 Boyd O, Grounds RM, Bennett ED: A randomised controlled trial of the effect of ... increase of oxygen delivery on mortality and morbidity in high- risk surgical patients JAMA 1993, 270:2699-2707 Bishop MU, Shoemaker WC, Appel PL, et al: Prospective randomised trial of survivor ... Cite this article as: Bennett: The high- risk surgical patient revisited Critical Care 1998 2:1 Submit your next manuscript to BioMed Central and take full advantage of: • Convenient online submission...

Ngày tải lên: 12/08/2014, 18:20

... mortality The candidaemia rate of 4.5% in the placebo arm of this metaanalysis is consistent with the estimated risk of candidaemia in patients with at least one risk factor for candidaemia The risk ... rescue therapy by systemic amphotericin B treatment, the proportion of patients with an adverse effect requiring cessation of the study drug, the proportion of patients with fungal infections other ... was not performed in the studies included in this meta-analysis Based on the baseline risk of candidaemia of 4.5% in the placebo arm of this meta-analysis, the number of patients needed to treat...

Ngày tải lên: 12/08/2014, 23:20

... Despite the lack of a high- grade evidence base for either resection or transplantation, the result of these treatments provides 5-year survival rates of up to 70% in selected patients These are ... hepatectomy in this group of patients is a higher risk of recurrence than transplantation The aims of this study were to find the recurrence risk factors for those patients with a tumor/tumors ... were the risk factors of tumor recurrence For the patients without or with limited risk factors of tumor recurrence, hepatectomy rather than liver transplantation will be the first choice of treatment...

Ngày tải lên: 09/08/2014, 01:24

... calcification, there were no differences in the Framingham risk score in patients and controls, and the majority of the SLE patients with coronary calcification had a low 10-year risk according to the Framingham ... women, the utility of the Framingham risk score in this patient population is of interest, particularly considering that in patients with SLE, the Framingham risk score does not differ among patients ... between the Framingham risk score and the severity of coronary calcification in patients with RA However, although the Framingham score and the 10-year risk estimates were higher in patients...

Ngày tải lên: 09/08/2014, 08:23

... perioperative care for the high- risk patient A practical approach to perioperative care for the high- risk patient The first step in the care of such patients is to identify the individual at risk (Fig 1) ... to the fact that management is individually tailored to the requirements of each patient The use of a fixed dose will result in the unnecessary use of dopexamine in some patients, who are therefore ... group of the patients further benefit may be accrued with the additional use of vasoactive therapy Figure Identify at risk patient Investigate according to ACC/AHA Task Force guidelines Use of vasoactive...

Ngày tải lên: 12/08/2014, 20:20

Ngày tải lên: 12/08/2014, 23:21

... that used in the study and is run by the nurse assigned to the care of the patient Immediately on return from the operating theatre, the patient is connected to the Lidco monitor via the radial ... intravenous colloid and then with the addition of dopexamine at a dose no higher than µg/kg/min The target value is not reached in a minority of patients, usually because the heart rate increases ... estimated that because of the projected reduction in hospital stay there should be an annual cost saving of at least £2,000,000 It is encouraging to note that at the time of writing the Pearse and colleagues'...

Ngày tải lên: 12/08/2014, 23:22

... locus may improve the safety of gene therapy In conclusion, the identification of the HIR near exon of the LMO2 locus in the T cell lines and human CD34+ cells may partially explain the mechanism ... vector in the HIR near exon of the LMO2 locus in the leukemia patients who participated in the gene therapy trials for treatment of X-SCID [12] The integration frequencies calculated from the HIR ... vector in the hotspot region of the TNIK locus [11] We investigated the sensitivity of the PCR techniques utilized in this study One copy of the junction sequence between the virus gene and the TNIK...

Ngày tải lên: 12/08/2014, 23:22

... Management The patients were randomized with the use of sealed envelopes (blocks of 10 patients) to either the volume group or the dobutamine group To induce and maintain anesthesia the following ... on the 60-day mortality in high- risk general surgery patients The second outcome measure was the incidence of complications, particularly cardiovascular adverse events High- risk surgical patients ... and was withdrawn Fifty patients completed the study: 25 in the volume group and 25 in the dobutamine group The demographic data of the patients are presented in Table The therapeutic interventions...

Ngày tải lên: 12/08/2014, 23:23

... represent the highest -risk procedures EPIDEMIOLOGY AND IDENTIFICATION OF THE HIGH- RISK SURGICAL PATIENT Table 1.7 – Grade of risk (with reported cardiac risk) with type of surgical procedure Risk ... strategy of risk assessment based upon (figure 1.1): • • • 14 the identification of certain clinical predictors of risk, an assessment of the patients functional capacity, the type of surgery ... come down to assessing the role of the competence of the anaesthetist on risk and outcome • One study of patients undergoing coronary artery surgery found that the only non -patient related factors...

Ngày tải lên: 13/08/2014, 03:21

... NCEPOD and the lessons to be learnt in the management of the high risk surgical patient Note: The NCEPOD considers the quality of the delivery of care and not specifically causation of death • ... preparation for theatre is vital in the management of the high risk surgical patient The management of the patient at this time will greatly influence the subsequent outcome of the operation and it is crucial ... the meaning of risk! 25 ANAESTHESIA FOR THE HIGH RISK PATIENT Further reading Adams AM, Smith AF Risk perception and communication: recent developments and implications for anaesthesia Anaesthesia...

Ngày tải lên: 13/08/2014, 03:21

... objective in avoiding the common morbidities associated with surgery • The patient who is at high risk either because of the trauma of their surgery or their poor physiological reserve therefore requires ... and recording of 54 ANALGESIA FOR THE HIGH RISK PATIENT pain during the postoperative period.4 There is no objective measure of pain, the report of the patient is the only yardstick If pain is not ... volume of gas remaining in the lung at the end of normal expiration) of the lung • In elderly patients or those with concurrent lung disease the FRC may fall below the closing volume (the volume of...

Ngày tải lên: 13/08/2014, 03:21

... during any trip to the operating theatre These then are the patients who may fall into the category of critical illness Regardless of the source of both patient and surgical pathology the issues and ... down the corridor’ The principles of safe patient transfer are the same regardless of the distance involved There are a number of texts devoted to this topic The Association of Anaesthetists of ... management 81 ANAESTHESIA FOR THE HIGH RISK PATIENT Laboratories perform coagulation studies at 37°C – regardless of the temperature of the patient at the time the sample was taken Thus, these studies...

Ngày tải lên: 13/08/2014, 03:21

... anaesthetist to be of ASA or more One of the key points in the 2000 report was that: • The profile of patients who die within 30 days of an operation has changed since the report of 1990 Patients are ... contribute to the elastic recoil of the lung, hence the compliance of the ageing lung is increased (compliance being the reciprocal of elastance) Calcification of the costal cartilage and the rib articulations ... controlled trial of 340 high- risk surgical patients They recruited patients using their previously defined criteria for high risk Control patients were managed conventionally, whereas the protocol...

Ngày tải lên: 13/08/2014, 03:21

... supply and demand is the establishment of a level of monitoring appropriate to the disease severity of the patient and the magnitude of the surgery The Association of Anaesthetists of Great Britain ... assessment of the functional capacity of the patient and the cardiac risk (risk of myocardial infarction or cardiac death) associated with the specific surgical procedure to be performed The cardiac risk ... hypertension is essential to the successful anaesthetic management of 141 ANAESTHESIA FOR THE HIGH RISK PATIENT patients presenting for non-cardiac surgery Anticipation of the effects of surgical stresses...

Ngày tải lên: 13/08/2014, 03:21

... in the quality of the care we can offer these patients, the overall mortality for the condition remains stubbornly high • Death on the table, particularly following the induction of anaesthesia, ... related to two main factors: the level of the anastomosis and the surgeon Neither of these factors is within the control of the anaesthetist HYDRATION/FLUID THERAPY Patients for major gastrointestinal ... temperature The adverse effects of perioperative hypothermia are discussed in the chapter on the critically ill patient in the operating theatre • Monitoring should be appropriate to the status of the patient...

Ngày tải lên: 13/08/2014, 03:21

... rheumatic heart disease who face the stress of pregnancy, the risk of operation depends on the functional status of the heart 207 ANAESTHESIA FOR THE HIGH RISK PATIENT • Patients with symptomatic critical ... probabilities of effectiveness versus risk; in the process of further screening and treatment, the risks from the tests and treatments themselves may offset or even exceed the potential benefit of evaluation ... delivery ratio, the renal medulla (the metabolically active part of the kidney) has a very high ratio Indeed, the highest ratio in the body Higher than the heart, an organ anaesthetists are often preoccupied...

Ngày tải lên: 13/08/2014, 03:21

... ANAESTHESIA FOR THE HIGH RISK PATIENT They suggest the following levels of care: Level Patients whose needs can be met through normal ward care in an acute hospital Level Patients at risk of their condition ... in all patients 217 ANAESTHESIA FOR THE HIGH RISK PATIENT Transmission of infection by blood transfusion There remains an exceedingly small but real risk of infection from transfusion of stored ... during either surgery or the course of a critical illness at a time when the signs (hypotension, tachycardia, DIC, pyrexia) can be attributed to a more 219 ANAESTHESIA FOR THE HIGH RISK PATIENT...

Ngày tải lên: 13/08/2014, 03:21