Lipid profiles and persisting inflammation following critical illness in a central Australian population: a prospective longitudinal observational study.

No published data exist following the changes in lipid profile during and after an episode of acute illness for the Australian Indigenous population. This paper presents data focusing on lipid profiles and inflammatory markers in a group of survivors of critical illness in Central Australia, prospectively recruited to a larger trial exploring the medium-term sequelae of an intensive care unit admission. This data confirm that lipid profiles in acute illness are deranged, and that recovery may differ between indigenous and non-indigenous populations.

Changes in serum procalcitonin and C-reactive protein following antimicrobial therapy as a guide to antibiotic duration in the critically ill: a prospective evaluation.

Serial procalcitonin is reported to be useful to titrate duration of antibiotic therapy in the non critically ill patient with pneumonia. The aim of this study was to examine the relationship between antibiotic therapy and serial serum procalcitonin concentrations in a cohort of critically ill septic patients and examine for any differences between culture positive (CP) and culture negative (CN) sepsis. Seventy-five critically ill patients with suspected sepsis were enrolled in this prospective observational study. Serial procalcitonin and C-reactive protein assays were measured on days one, three, five, seven, 10 and 14. The mean duration of antibiotic therapy was similar in the two groups (10.4 +/- 5.1 (CP) vs. 8.4 +/- 5.1 (CN) days, P = 0.09). Serum procalcitonin concentrations were significantly higher at baseline in the CP than the CN group (14.9 +/- 22.9 vs. 6.8 +/- 21.5 ng/ml, P = 0.04). During the study period, serum concentrations of procalcitonin and C-reactive protein declined in both groups. Serum procalcitonin consistently remained higher in the CP group (P < 0.05) and did not return to normal values. In the CN group, procalcitonin concentrations fell below 0.5 only on day 10. There was no significant difference in C-reactive protein profile between the two groups. Four patients in the CP group (11%) had relapse of sepsis. The mean procalcitonins in the relapsed subgroup were lower than those in the remission subgroup (P = 0.02). Therapy for proven or presumed infections was associated with declining serum procalcitonin and C-reactive protein in critically ill septic patients. The marked variability and overlap in plasma profile of these markers between CP and CN sepsis makes it difficult to define a nadir plasma concentration at which one can recommend discontinuation of antibiotic therapy.

The pulmonary artery catheter in Australasia: a survey investigating intensive care physicians' knowledge and perception of future trends in use.

A survey was conducted to assess the knowledge and trends of use of the pulmonary artery catheter amongst intensive care practitioners in Australasia. A 31-item multiple choice questionnaire, identical to one previously trialled in studies in the United States and Europe, was distributed to all registered intensive care specialists and trainees working in intensive care units in Australasia. Five-hundred-and-forty-one questionnaires were distributed and 151 (27.9%) were returned, with an average mark of 82.7% +/- 9.3% and a range of 53.3 to 100%. Total score was significantly associated with years of experience in intensive care (P < 0.04), number of pulmonary artery catheters inserted (P < 0.015) and whether or not the respondent had passed the Joint Faculty of Intensive Care Medicine examination (P < 0.01). Scores were significantly higher amongst trainees (P < 0.0001) and physicians who had passed the Joint Faculty of Intensive Care Medicine examination (P < 0.0001). Overall, 44.9% of respondents indicated their use of the pulmonary artery catheter was decreasing, with 42.6% indicating their use was the same over the past five years. Sixty-one percent of respondents indicated they either agreed or strongly agreed with the statement that the use of echocardiography should supersede the use of the pulmonary artery catheter by intensive care specialists in the future. We concluded that in this study, knowledge of the pulmonary artery catheter and its use is better in Australasia than in previous studies in North America and Europe. The majority of respondents in Australasia believe that echocardiography will supersede the use of the pulmonary artery catheter in the future.

Pseudo-renal failure following the delayed diagnosis of bladder perforation after diagnostic laparoscopy.

We present a case of bladder injury as a complication of gynaecological laparoscopic surgery. A young female presented with peritonitis, an acute systemic inflammatory response and biochemical features of acute renal failure secondary to urinary peritonitis. Laparotomy with drainage of urine from the peritoneal cavity and repair of the bladder perforation resulted in rapid resolution of the biochemical abnormalities.

A study of a hospital staff's knowledge of pulse oximetry.

A selection of medical and nursing staff and anaesthetic technicians at work on a particular day at a regional Base Hospital were invited to complete a questionnaire to assess their knowledge of the principles of pulse oximetry. A 98.5% response rate (203 respondents) was achieved from staff in a broad cross section of hospital wards participating in the study. Most of the participants (nursing [N] 87%, medical [M] 91%, anaesthetic technicians [AT] 100%) used pulse oximetry regularly in their daily work. Less than half of the participants (N 36%, M 48% and AT 50%) felt they had adequate training in the use of pulse oximetry. Only 68.5% of participants correctly stated what pulse oximeters measure. Answers to the questions regarding the principles of pulse oximetry, potential errors, normal ranges or the physiology of oxygen haemoglobin dissociation varied but generally reflected limited understanding. As the use of pulse oximeters extends beyond the operating theatre and intensive care environment, appropriate staff education must ensure a basic understanding of the operating principles of the instrument.

Conservative surgical treatment of tubal pregnancy: factors affecting future fertility.

The results of conservative surgical treatment of tubal pregnancy (salpingotomy in 10 cases, partial salpingectomy and anastomosis in two cases) were compared with radical treatment in seven cases. The subsequent pregnancy rate was 55% and 71% for the conservative and radical groups, respectively. There were no recurrent tubal pregnancies in either group. Prior presence of pelvic adhesions did not have an effect on fertility in these patients. The rate of multiparity was significantly higher in patients who became pregnant after the surgery than those patients who did not become pregnant.

The effect of oral contraceptive steroids on branches of the uterine artery.

Uteri from 38 patients exposed to oral contraceptive steroids and from 7 unexposed controls were examined for lesions in small branches of the uterine artery. Moderate or severe cellular proliferation of the intimal layer was found in 82% of patients exposed to exogenous steroids, but minimal or no involvement was found in the remaining 18% and in unexposed patients. The severity of involvement correlated with duration of exposure to contraceptive steroids but decreased in those patients who had stopped medication prior to surgery. This lesion has been reported previously in autopsy studies of women receiving contraceptive steroids and dying from vascular disease, but is now shown to be common in asymptomatic women receiving oral contraceptive pills.