ABSTRACT
BACKGROUND: Echocardiography has been shown to positively impact on the management of the critically ill patient. However, many published studies have a significant bias towards inclusion of cardiothoracic patients. We present an audit of the impact of echocardiography on the management of patients in a district general hospital intensive care unit (ICU). METHODS: We conducted a prospective audit of all echocardiograms, both transthoracic (TTE) and transoesophageal (TOE), performed on our ICU between October 1, 2005, and December 31, 2007. In addition to patient characteristics, we recorded the indication for the echocardiogram, and any change in management that occurred as a result of the study. RESULTS: Two hundred and fifty-eight echocardiograms were performed in 217 patients, of which 224 (86.8%) were performed by intensive care consultants. One hundred and eighty-seven studies (72.4%) were TTEs and 71 (27.8%) were TOEs. TTE provided diagnostic images in 91.3% of spontaneously breathing and 84.2% of mechanically ventilated patients. Management was changed directly as a result of information provided in 51.2% of studies. Changes included fluid administration, inotrope or drug therapy, and treatment limitation. CONCLUSIONS: Echocardiography may have a significant impact on the management of patients in the general ICU. We recommend that appropriate training in echocardiography should be incorporated into the intensive care curriculum in the UK.
Subject(s)
Critical Illness/therapy , Echocardiography/statistics & numerical data , Intensive Care Units/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Critical Care/methods , Echocardiography, Transesophageal/statistics & numerical data , England , Female , Hospitals, District/statistics & numerical data , Hospitals, General/statistics & numerical data , Humans , Male , Medical Audit , Middle Aged , Professional Practice/statistics & numerical data , Prospective Studies , Young AdultABSTRACT
We report the case of a 25-year-old woman in the second trimester of pregnancy with acute respiratory distress syndrome associated with miliary tuberculosis. Delivery of the baby by caesarean section at 24 weeks gestation resulted in an immediate and sustained improvement in respiratory function and maternal survival. We believe this to be the first report suggesting a role for caesarean section, performed with the aim of an improvement in maternal respiratory function, at such an early point in pregnancy.
Subject(s)
Pregnancy Complications, Infectious/physiopathology , Respiratory Distress Syndrome/physiopathology , Adult , Cesarean Section , Female , Humans , Infant, Newborn , Mycobacterium tuberculosis/isolation & purification , Mycobacterium tuberculosis/pathogenicity , Pregnancy , Pregnancy Complications, Infectious/microbiology , Pregnancy Trimester, Second , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/microbiology , Tuberculosis, Miliary/complicationsABSTRACT
A 15-year-old female survived a total of 65 minutes cardiac arrest following ingestion of verapamil and selective serotonin re-uptake inhibitors. We consider that the lack of neurological damage, despite evidence of significant renal and myocardial injury, may be related to the possible neuroprotective effect of a large dose of verapamil.
