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Biomedical subjects

G J McHugh

Publications and source records attributed to G J McHugh.

At least 19 recordsLinked to original sources
PubMed2004

Quality and reliability of data collected in a regional hospital intensive care unit.

OBJECTIVE: To examine the accuracy of the existing data collection system in an intensive care unit (ICU). METHODS: Prospective audit of data collection for APACHE II in a six-bedded general ICU in a region-al hospital for consecutive ICU admissions over a 12 month period. The existing resident medical officer (RMO) data collection system continued unaltered while concurrent collection of APACHE II data completed by one senior medical officer (SMO) was also performed. RMO-APACHE scores were compared to SMO-APACHE scores. RESULTS: The median (interquartile range) APACHE II scores were: 15 (9-21) for RMO data; 17 (12 - 22) for SMO data (p = 0.0001), with a mean difference (SD) of 4.2 (4.2) (p < 0.0001). A rapid survey of New Zealand ICU's indicated that only 4 of 11 APACHE II users employed substantial medical specialist involvement in APACHE II data collection and/or scrutiny prior to database entry. CONCLUSIONS: The existing APACHE II data collection is often imperfect and requires further attention as it is not yet reliable enough to allow for accurate SMR calculations, or for external use for comparative purposes.

Journal Article↗
PubMed2001

Current usage of dopamine in New Zealand intensive care units.

A nation-wide evaluation of dopamine usage in New Zealand Intensive Care Units (ICUs) was undertaken. Twenty-six public hospital ICUs participated. Twenty-two ICUs (85%) use dopamine as an inotrope. Seventeen ICUs use dopamine for presumed selective renal effects at least occasionally, but with wide variation in what is considered to be "renal-dose". Level 3 ICUs were less likely to use "renal-dose" dopamine than levels 1 and 2 (P= 0.01). Nineteen units (83%) use weight-referenced (i.e., microg x kg(-1) x min(-1)) dopamine administration. Weight-referenced administration and "renal-dose" dopamine were likely to be in use together (P=0.02). Standard dopamine dilutions varied widely with a median of 2 mg x ml(-1) (range 0.4 to 8 mg x ml(-1)). Given a demonstrated association between weight-referenced administration and "renal-dose" dopamine, along with particular pharmacokinetic and pharmacodynamic reservations, the value of weight-referenced administration of dopamine in adult patients is questioned.

Body Weight↗
PubMed1999

Norpethidine accumulation and generalized seizure during pethidine patient-controlled analgesia.

A 35-year-old, 47 kg female presented for elective laparatomy, adhesiolysis and ileostomy formation. Pre-existing neurological problems precluded placement of an epidural and IV PCA was used for postoperative analgesia. A patient request for pethidine was allowed. Twenty-three hours postoperatively, a brief generalized seizure occurred without adverse sequelae. This had been immediately preceded by myoclonic-type jerking. The cumulative pethidine dose was 3,000 mg and the norpethidine level was 1.8 micrograms.ml-1. Avoidance of pethidine for IV PCA where large cumulative doses are anticipated is advised. Seizures associated with pethidine/norpethidine toxicity can occur early during pethidine usage, and there is considerable variation in measured norpethidine levels.

Adult↗
PubMed1999

Paediatric admissions to the general intensive care unit at palmerston north hospital.

OBJECTIVES: To report Palmerston North Hospital's (PNH) recent experiences with paediatric admissions to the general Intensive Care Unit (ICU), and to identify any aspects relevant to regionalisation of paediatric intensive care. METHODS: Retrospective review of the ICU database and admission register to enable clinical and demographic profiling of all paediatric (aged < 15 years) admissions to PNH ICU from 1996 to 1998. Observed and predicted mortalities were compared using the Paediatric Index of Mortality (PIM). RESULTS: Seventy-five paediatric patients had 76 admissions, comprising 7.4% of ICU admissions during the study period. Forty-eight (64%) were male, and 59 (79%) of the patients received mechanical ventilatory support. The median ICU stay was 21.5 hours (range 0.1 to 568 hours). There were 3 deaths in the ICU, and one following ICU discharge but prior to hospital discharge, compared with 6.37 predicted deaths. The median PIM score overall was 5.3% predicted probability of death (range 0.8 - 61.4%), with 6 patients (7.9%) having a PIM score of greater than 30%. Fifteen patients (20%) were transferred to tertiary services. CONCLUSIONS: If the PNH experience reflects that of other similar institutions, then non-tertiary ICUs admit small numbers of critically ill paediatric patients who tend to be of low to moderate severity, but who cover the full spectrum of severity. Most cases can be well managed locally, but appropriate referral and transfer is an important component in the delivery of a rational and integrated paediatric intensive care service.

Journal Article↗
PubMed1998

Anaphylactoid reaction to pentastarch.

PURPOSE: To report a probable anaphylactoid reaction to pentastarch, a low molecular weight hydroxyethyl starch (HES) colloid solution. CLINICAL FEATURES: Following a closed head injury, an 18-yr-old male was admitted to the Intensive Care Unit. Therapy was directed towards control of intracranial pressure (ICP) and maintenance of cerebral perfusion pressure (CPP). In the first 12 hr after admission, he had received 2500 ml polygeline (Haemaccel, Hoechst Marion Roussel Ltd.) and a dopamine infusion (up to 10 micrograms.kg-1.min-1) titrated to achieve a mean arterial pressure (MAP) of > or = 80 mmHg. Subsequent failure to achieve the target MAP resulted in commencement of a noradrenaline infusion (2.67 micrograms.min-1), and rapid administration of 500 ml pentastarch (Pentaspan, DuPont Pharmaceuticals). During the HES infusion, marked hypotension (MAP < 60 mmHg) developed associated with marked truncal urticaria. The hypotension was resistant to escalation of noradrenaline to 36 micrograms.min-1. Haemodynamic stability was rapidly restored and maintained with adrenaline boluses (total 450 micrograms) and infusion (1.67 micrograms.min-1). The remainder of the patient's ICU and hospital stay was unremarkable. A serum tryptase drawn in the first 40 min of the reaction was not elevated. Other biochemical markers were not assayed. Skin testing has not been carried out. CONCLUSION: The temporal relationship and clinical manifestations observed in this case, together with the resistance to inotropes/vasopressors other than adrenaline is highly suggestive of an anaphylactoid reaction to pentastarch. The diagnostic value of serum tryptase may be compromised when blood samples are drawn too early.

Accidents, Traffic↗
PubMed1997

Follow up of elderly patients after cardiac surgery and intensive care unit admission, 1991 to 1995.

AIMS: To examine the outcome of cardiac surgery and resulting intensive care admission in elderly (> or = 75 years) cardiac surgery patients at Waikato Hospital, 1991 to 1995. METHODS: Clinical records of all elderly cardiac surgery patients admitted to the intensive care unit were reviewed. All survivors were sent a postal questionnaire evaluating cardiac related symptom control and quality of life (QOL). Outcomes in the 'old' (75-79 years) and in the 'very old' (> or = 80 years) were compared. RESULTS: Seventeen of 97 patients had died. Mean survival time was 32.2 months. Survivor followup (100%) was at a mean of 34.8 months. Mean functional class (New York Heart Association or Canadian Cardiovascular Society) improved from 3.0 preoperatively to be 1.7. Cardioactive medications fell by a mean of 0.7 drugs per patient. Twenty-seven percent of survivors became more dependent as assessed by domicile type. Outcomes between the two groups were not different except for some improved individual changes in functional class. The 'very old' group have a similar postoperative QOL to that of the 'old' group. Ninety-two percent of survivors indicated that they would opt for cardiac surgery again if given the time over. CONCLUSIONS: Following cardiac surgery and intensive care admission at Waikato Hospital, surviving elderly patients have experienced a favourable outcome in terms of symptom control and quality of life. Mortality rates are acceptably low.

Activities of Daily Living↗
PubMed1997

Polyurethane central venous catheters, hydrochloric acid and 70% ethanol: a safety evaluation.

Three groups of polyurethane central venous catheters (CVC) were infused daily for twenty days with 0.1 normal hydrochloric acid, 70% ethanol and normal saline (control) respectively to look for any changes in microscopic structural integrity. A 1 cm segment was cut from the distal end of each CVC daily. All sections were examined in a scanning electron microscope, looking for evidence either of damage to the lumen surface or of wall thinning. No significant damage to the lumen surfaces was observed with either treatment. Sporadic fine surface-pitting appeared late in the study without any clear temporal or treatment-related pattern. The mean CVC wall thickness did not change significantly over the study period (P = 0.15). Qualitative softening of ethanol treated catheters was observed, and this finding limits the recommendations for the use of ethanol. 0.1N HCl does not compromise the structural safety of the catheters, and its use should be considered when polyurethane CVC. become occluded.

Catheterization, Central Venous↗
PubMed1997

Heart rate variability following cardiac surgery fails to predict short-term cardiovascular instability.

The heart rate variability of 40 patients has been examined by spectral analysis following cardiac surgery. The heart rate variability was measured upon patient arrival in ICU in both a resting supine position, and following passive straight-leg raising. After 12 hours in ICU, the patients were classified as having been cardiovascularly stable or unstable according to a specially devised inventory. Their heart rate variability data was then examined to seek any predictor of instability. Passive straight-leg raising induced a decrease in spectral power across all of the component frequency bands. The LF/HF ratio rose with passive straight-leg raising, but failed to reach significance. None of these changes were sustained. There was no significant difference in heart rate variability patterns between the stable and unstable groups, and so no predictor was identified. Initial clinical assessment was also studied, and it too provided no reliable prediction of short-term cardiovascular instability.

Adolescent↗
PubMed1995

Propofol emulsion and bacterial contamination.

Package insert information provided with propofol advises prompt administration following its drawing-up. This study has examined the delays which occur between drawing-up and administration of propofol in clinical practice and the incidence of bacterial contamination occurring under such conditions. Two hundred and fifty-four clinical uses of propofol were examined. Mean elapsed times (range) from drawing-up to induction were 28.8 min (1-172), and 11.6 min (1-65) from induction to culture inoculation. The delay to induction exceeded ten minutes in 68.5% of propofol uses. Sixteen cultures (6.3%) grew bacteria. Delay to induction was not associated with increased chances of bacterial growth in any of the samples. Increasing delay between induction and culture inoculation was associated with greater odds of bacterial growth, which is consistent with contamination occurring at or after induction. Whilst the manufacturers advise prompt administration, our findings show that when inadvertent delays occur, propofol remains bacteriologically safe to use under standard clinical conditions. Microbial contamination can occur at any stage, thus attention to asepsis remains important throughout the administration period.

Anesthetics, Intravenous↗