Assessment of diaphragmatic function with cervical magnetic stimulation in critically ill patients.

The objective of this study was to evaluate a non-volitional measurement to assess diaphragmatic function in intubated and mechanically ventilated patients in a prospective pilot interventional clinical trial. The study was conducted in an 18-bed postoperative intensive care unit based at a university hospital. Patients were prospectively assigned to two groups. Group 1 consisted of eight patients with ventilator weaning failure. Group 2 consisted of eight intubated and ventilated patients who were studied shortly after major surgery and were successfully extubated there-after The twitch pressure response after cervical magnetic stimulation of the phrenic nerves was measured at the endotracheal tube at different PEEP levels. In group 2 the twitch transdiaphragmatic pressure, defined as the difference between twitch gastric and twitch oesophageal pressure was also evaluated. In group 1 the mean twitch pressure at the endotracheal tube on PEEP 0, 5 and 10 cmH2O was 5.2, 4.5 and 2.6 cmH2O: In group 2 this was significantly higher (15.1 cmH2O on PEEP 0 and 12.2 cmH2O on PEEP 5). A good correlation was found between twitch diaphragmatic pressure and twitch pressure at the endotracheal tube (r2 = 0.96) and between twitch oesophageal pressure and twitch pressure at the endotracheal tube (r2 = 0.98). Patients with weaning failure have significantly lower twitch pressure at the endotracheal tube suggesting diaphragmatic dysfunction. Twitch pressure at the endotracheal tube may be a useful parameter to screen for diaphragmatic dysfunction in intubated critically ill patients. Further studies are needed to confirm these preliminary findings.

Intrahospital transport of critically ill patients: complications and difficulties.

An audit of 97 intrahospital transports of critically ill patients was undertaken within Westmead Hospital. The aims of this audit were to assess all factors that may lead to problems during intrahospital transports. At the completion of a transport medical staff were asked to provide information about their patient and their treatment, as well as any difficulties they may have encountered. Overall, 62% of transports reported some difficulty or complication. Of these, 31% were patient-related and 45% were related to equipment or the transport environment. (15% encountered problems in both areas). Many of the difficulties were preventable with adequate pre-transport communication and planning. Other problems were directly related to the increased severity of illness in these patients.

Ankylosing spondylitis in three Zulu men negative for the HLA B27 antigen.

Three cases of ankylosing spondylitis in Zulu men are presented. They are of interest in that all 3 patients were negative for HLA B27, a tissue-typing antigen that is present in the vast majority of Caucasians with the disease. We draw attention to the rarity of ankylosing spondylitis and also of the B27 antigen in Blacks and offer some postulates on the relationship between these two phenomena.