Characteristics of patients admitted to the intensive care unit following self-poisoning and their impact on resource utilisation.

BACKGROUND: Self-poisoning accounts for up to 10 % of hospital admissions, some of whom require admission to ICU. Few studies have looked at the epidemiology of these patients in an Irish setting. AIMS: To quantify the proportion of ICU admissions attributable to self-poisoning, to examine the characteristics and outcome of these patients, and to assess their ICU resource utilisation. METHODS: Retrospective review of ICU admissions from 2006 to 2010. Data were collected on patient age, sex, admission diagnosis, substances involved, APACHE II score, length of stay, organ support, and outcome. RESULTS: There were 80 admissions to ICU following self-poisoning accounting for 3.8 % of ICU admissions and 13 % of all hospital admissions for self-poisoning. M:F ratio was 0.9:1. Mean age 35 (range 16-75), APACHE II score 14 (2-36). Commonest substances involved were benzodiazepines, opioids, tricycle antidepressants. Median ICU stay was 2 days (IQR 0.96-4.5). 84 % of patients were ventilated, 27.5 % required inotropic support, 14 % renal replacement therapy. When opioids were involved requirement for inotropes and CRRT were higher. ICU mortality was 6.3 %. These patients consumed 280 bed days. CONCLUSION: Self-poisoning accounted for 3.8 % of ICU admissions. Patients tend to require a short period of ventilation, with a minority requiring additional organ support. The cost of ICU care is calculated based on previously published methodology to be 7,717 per patient. Extrapolated nationally the annual cost for ICU care for self-poisoning is estimated to be in the order of 5 m.

Alcohol, drug misuse and suicide attempts: unrecognised causes of out of hospital cardiac arrests admitted to intensive care units.

AIM: To assess the contribution of alcohol, drug abuse and suicide attempts to out of hospital cardiac arrests (OHCA) who are admitted to our intensive care unit (ICU). METHODS: Retrospective review of all OHCA admitted to the ICU over a 2-year period. RESULTS: There were 26 OHCA. Six patients survived, all of whom had a cardiac aetiology for their arrest. Ten patients arrested due to external factors (drug misuse n = 4, alcohol excess n = 1, suicide attempts n = 4 and accidental choking n = 1). All of the patients who arrested secondary to external factors were young (37.2 +/- 13.58 years), 90% were male and all died in hospital. All of the cases of drug misuse involved cocaine. CONCLUSION: Alcohol, drug misuse and suicide attempts contribute significantly to the number of OHCA which are admitted to ICU. Moreover, cocaine usage has contributed to a number of OHCA in our study.

General anaesthesia and the environment.

Theatre pollution by anaesthetic agents has been the subject of considerable study and discussion. However the environmental effects of these agents has received little attention. In this paper we review the environmental effects of anaesthetic agents. Volatile anaesthetic agents such as halothane, isoflurane, and enflurane would appear to have minimal atmospheric polluting potential. Nitrous oxide however is a greenhouse gas and can also indirectly contribute to ozone layer depletion. We would suggest that the continued use of nitrous oxide in large quantities must be viewed with concern.

Role of xanthine oxidase inhibition in survival from hemorrhagic shock.

The irreversible loss of adenine nucleotides and the formation of free radicals have both been suggested as causes of irreversibility following prolonged hemorrhagic shock. This study was performed to assess the effect of xanthine oxidase inhibition (allopurinol 50 mg/kg/day), free radical scavenging (superoxide dismutase 15,000 u/kg, catalase 15,000 u/kg, dimethylsulfoxide 20 mg/kg, and alpha tocopherol 100 mg/kg/day) or both, on the 24-hr survival of dogs subjected to irreversible haemorrhagic shock. Twenty anesthetized dogs were bled to a mean arterial pressure of 30 mm Hg for 4 hr. The dogs were allocated to a control, an allopurinol pretreated, a free radical scavenger, or a combined treatment group. Both groups pretreated with allopurinol had significantly improved survival (P < 0.05) over that seen in the control group, but the free radical scavenger treated group was not significantly different from the control group. This study demonstrates the beneficial effect of xanthine oxidase inhibition on survival, and suggests that it may be due to preservation of adenine nucleotides rather than prevention of free radical formation.

Clinical audit in intensive care--the Meath Intensive Care Audit.

Audit is now recognised as being an essential component of clinical practice. We report on the first year of the Meath Intensive Care Audit (MICA). This audit was instituted to investigate the activity of the unit, to assess the feasibility of continuous audit in our ICU and to provide data for future development of ICU facilities. Two hundred and fifty four patients were admitted between July 1st 1990 and June 30th 1991. The mean age at admission was 58 years and the mean length of stay 5.2 days. The mean APACHE II score was 16. Thirty four patients (13.4%) died in the ICU and 17 patients died in hospital following discharge from the unit bringing the hospital mortality rate to 20%. The audit proved feasible to implement and data collection is now accepted as a routine part of our ICU work.

Intrathecal morphine in the management of pain following cardiac surgery. A comparison with morphine i.v.

Forty-four patients undergoing coronary revascularization received either intrathecal morphine 1 mg (n = 15), intrathecal morphine 2 mg (n = 15), or i.v. morphine 30 mg (n = 14) after the induction of anaesthesia. Morphine 2.5 mg i.v. was given, as required, in the postoperative period and pain score, respiratory rate and PaCO2 measured every 2 h. FVC, FEV1 and PEFR were measured before, and 24 h after, the induction of anaesthesia. Mean overall pain scores in both intrathecal groups were significantly lower than in the i.v. group (P less than 0.01), but did not differ significantly between the intrathecal groups. Consumption of supplementary morphine was significantly lower in both intrathecal groups (P less than 0.01). Mean PaCO2 was significantly higher in patients given intrathecal morphine 2 mg. This was significant at 12, 14 and 16 h after induction of anaesthesia. Respiratory rate did not differ significantly between the groups. Postoperative PEFR was significantly better in patients given intrathecal morphine (P less than 0.01). These results suggest that intrathecal morphine provided better analgesia after cardiac surgery than did a conventional regimen. The lower dose (1 mg) was associated with less respiratory depression as assessed by PaCO2 measurements.

Anaesthesia for congenital hypertrophic pyloric stenosis. A review of 350 patients.

The anaesthetic management of 350 consecutive patients with congenital hypertrophic pyloric stenosis over an 8-year period is reviewed. The anaesthetic technique is discussed and the complications encountered reviewed. The morbidity rate was 15.9%. The anaesthetic related morbidity rate was 3.7%. One patient in the series died (0.27%) 8 weeks after pyloromyotomy, as a result of an underlying myopathy.

Cerebral oedema and the fat embolism syndrome.

A 19-year-old woman who sustained multiple trauma, but no head injury, developed the fat embolism syndrome. Her severe, fulminant and reversible neurological deterioration was associated with cerebral oedema. We suggest that cerebral oedema may contribute to the neurological deterioration in the fat embolism syndrome.