In the May 2008 BJA ...
Critical care Two studies in this month's British Journal of Anaesthesia deal with clinical problems in critical care. First, the problem of ICU patients who have made an initial recovery from severe illness and are discharged to other wards but subsequently deteriorate is addressed in a study by Campbell et al. (pages 656–62). They followed up over 6000 ICU patients and found that nearly 9% were readmitted to the ICU, many within 48 h. More than 11% died in hospital following discharge. A number of risk factors can be identified which may help to predict problems. Second, the need for routine ‘check’ chest X-ray following uncomplicated percutaneous dilational tracheostomy is questioned by Kumar et al. (pages 663–6). They reviewed over 380 check X-rays and found the incidence of new findings to be <3%.Microvascular effects of sepsis Some of the earliest systemic effects of sepsis occur at the endothelial level of blood vessels. There is considerable interest in the mechanisms involved both from the need to understand the process and as a potential therapeutic approach. Wei et al. (pages 612–21) have investigated the role of procalcitonin in an in vitro arterial model of sepsis. They found pro-inflammatory effects but no modulation of the vascular responses.
Bariatric surgery Maintaining adequate oxygenation in morbidly obese patients during anaesthesia can be difficult, particularly during laparoscopic surgery. Cadi et al. (pages 709–16), in a randomized study, have compared the effect of pressure- and volume-controlled ventilation in patients undergoing laparoscopic gastric banding. They found the use of the pressure-control mode improved all measures of oxygenation.
Preoperative assessment The move to preoperative assessment of patients being conducted on an outpatient basis is becoming standard practice in many centres. The positive and negative influences involved in setting up such a clinic are described by Lemmens et al. (pages 645–51) who have collated the experience of 130 Dutch hospitals. A number of common factors which drive or hinder the process are described.
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