Biomedical subjects
Gavin D Perkins
Publications and source records attributed to Gavin D Perkins.
Bench-to-bedside review: beta2-Agonists and the acute respiratory distress syndrome.
The acute respiratory distress syndrome (ARDS) is a devastating constellation of clinical, radiological and pathological signs characterized by failure of gas exchange and refractory hypoxia. Despite nearly 30 years of research, no specific pharmacological therapy has yet proven to be efficacious in manipulating the pathophysiological processes that underlie this condition. Several in vitro and in vivo animal or human studies suggest a potential role for beta2-agonists in the treatment of ARDS. These agents have been shown to reduce pulmonary neutrophil sequestration and activation, accelerate alveolar fluid clearance, enhance surfactant secretion, and modulate the inflammatory and coagulation cascades. They are also used widely in clinical practice and are well tolerated in critically ill patients. The present review examines the evidence supporting a role for beta2-agonists as a specific pharmacological intervention in patients with ARDS.
Do different mattresses affect the quality of cardiopulmonary resuscitation?
OBJECTIVE: To determine the effect of different mattresses on cardiopulmonary resuscitation performance and establish whether emergency deflation of an inflatable mattress improves the quality of resuscitation. DESIGN AND SETTING: Randomised controlled cross-over trial performed in a general ICU PARTICIPANTS: Critical care staff from a general ICU. INTERVENTIONS: Cardiopulmonary resuscitation on a manikin on the floor or on a bed with a standard foam mattress and inflated and deflated pressure redistributing mattresses. Maximal compression force was measured at different bed heights. MEASUREMENTS AND RESULTS: Compression depth, duty cycle and rate and percentage correct expired air ventilation were recorded on a manikin. Compression depth was significantly lower on the foam (35.2 mm), inflated (37.2 mm) and deflated mattress (39.1 mm) than the floor (44.2 mm). There were no clinically important differences in duty cycle or compression rate. The quality of ventilation was poor on all surfaces. Maximal compression force declined as bed height increased. CONCLUSIONS: Resuscitation performance is adversely affected when performed on a bed (irrespective of mattress type) compared to the floor. There were no differences between the inflated and deflated mattresses, although the deflation process did not adversely affect performance. This study does not support the routine deflation of an inflated mattress during resuscitation and questions the potential benefits from using a backboard. The finding that bed height affects maximal compression forces, challenges the recommendation that cardiopulmonary resuscitation be performed with the bed at middle-thigh level and requires further investigation.
Discrepancies between clinical and postmortem diagnoses in critically ill patients: an observational study.
INTRODUCTION: The autopsy has long been regarded as an important tool for confirming the clinical cause of death, education and quality assurance. Concerns surrounding informed consent and the retention of organs have heightened clinicians' anxieties in requesting permission to perform an autopsy. The present study was conducted to determine whether the autopsy still has a role to play in extending knowledge about the cause of death in a group of patients who died while receiving intensive care. METHOD: We retrospectively investigated trends in postmortem examination rates and discrepancies between premortem clinical and postmortem diagnoses in a population of critically ill patients admitted to a 13 bed, general medical/surgical intensive care unit between January 1998 and June 2001. Agreement between diagnoses before death and postmortem findings were compared using the Goldman system. RESULTS: Out of total 636 deaths, 49 (7.7%) underwent postmortem examinations. Of these, 38 (78%) cases were available for review. We found that postmortem findings were in complete agreement with predeath diagnoses in fewer than half of the cases (n = 17, 45%). Major missed diagnoses were present in 15 cases (39%). Myocardial infarction, carcinoma and pulmonary embolism represented the most frequently missed diagnoses. CONCLUSION: Postmortem examinations remain a useful tool in confirming diagnostic accuracy and should be considered in all patients who die in the intensive care unit. Recognition of the diagnoses missed before death may improve outcome or avoid unnecessary prolongation of life where terminal disease is present.
CT-guided biopsy for diagnosis of malignant disease in pleural effusions.
Explore the source record for details and available documents.
Do changes in pulse oximeter oxygen saturation predict equivalent changes in arterial oxygen saturation?
INTRODUCTION: This study investigates the relation between changes in pulse oximeter oxygen saturation (SpO2) and changes in arterial oxygen saturation (SaO2) in the critically ill, and the effects of acidosis and anaemia on precision of using pulse oximetry to predict SaO2. PATIENTS AND METHODS: Forty-one consecutive patients were recruited from a nine-bed general intensive care unit into a 2-month study. Patients with significant jaundice (bilirubin >40 micromol/l) or inadequate pulse oximetry tracing were excluded. RESULTS: A total of 1085 paired readings demonstrated only moderate correlation (r= 0.606; P < 0.01) between changes in SpO2 and those in SaO2, and the pulse oximeter tended to overestimate actual changes in SaO2. Anaemia increased the degree of positive bias whereas acidosis reduced it. However, the magnitude of these changes was small. CONCLUSION: Changes in SpO2 do not reliably predict equivalent changes in SaO2 in the critically ill. Neither anaemia nor acidosis alters the relation between SpO2 and SaO2 to any clinically important extent.
The immediate life support course.
The immediate life support course (ILS) was launched by the Resuscitation Council (UK) in January 2002. This multi-professional 1-day resuscitation course teaches the essential knowledge and skills required to manage a patient in cardiac arrest for the short time before the arrival of a cardiac arrest team or other experienced medical assistance. The ILS course also introduces healthcare professionals to the role of a cardiac arrest team member. The course provides the candidate with the knowledge and skills to recognise and treat the acutely ill patient before cardiac arrest, to manage the airway with basic techniques, and to provide rapid, safe defibrillation using either manual or automated external defibrillators (AEDs). The course includes lectures, skill stations and cardiac arrest scenarios. The ILS course has standardised much of the life support training that already takes place in UK hospitals. In 2002, 16547 candidates attended ILS courses in 128 course centres. In this article, we discuss the rationale for, and the development and structure of the ILS course. We also present the first year's results and discuss possible future developments. It is hoped that this course may become established in counties in continental Europe through the European Resuscitation Council.
Use of advanced life support skills.
BACKGROUND: The Advanced Life Support (ALS) Provider Course trains healthcare professionals in a standardised approach to the management of a cardiac arrest. In the setting of limited resources for healthcare training, it is important that courses are fit for purpose in addressing the needs of both the individual and healthcare system. This study investigated the use of ALS skills in clinical practice after training on an ALS course amongst members of the cardiac arrest team compared to first responders. METHODS: Questionnaires measuring skill use after an ALS course were distributed to 130 doctors and nurses. RESULTS: 91 replies were returned. Basic life support, basic airway management, manual defibrillation, rhythm recognition, drug administration, team leadership, peri- and post-arrest management and resuscitation in special circumstances were used significantly more often by cardiac arrest team members than first responders. There was no difference in skill use between medically and nursing qualified first responders or arrest team members. CONCLUSION: We believe that the ALS course is more appropriately targeted to members of a cardiac arrest team. In our opinion the recently launched Immediate Life Support course, in parallel with training in the recognition and intervention in the early stages of critical illness, are more appropriate for the occasional or first responder to a cardiac arrest.
Peer-led resuscitation training for healthcare students: a randomised controlled study.
OBJECTIVE: To determine the efficacy of a peer-led tuition model for training healthcare students in basic life support compared to tuition delivered by clinical tutors. DESIGN AND SETTING: Randomised controlled trial in the Medical School, University of Birmingham, UK. PARTICIPANTS: 122 first-year medical, dental, nursing and physiotherapy students. INTERVENTIONS: Students were randomised to receive basic life support tuition from either second-year student instructors or from experienced clinical staff. MEASUREMENTS AND RESULTS: Students' practical skills, knowledge and satisfaction were tested at the end of the course. Instructor reliability was assessed throughout the course. Students taught by their peers were significantly more likely to be successful in the end-of-course practical CPR test than those taught by clinical staff (56/57 vs. 53/62). The student instructors were also found to be more reliable than clinical staff at attending the training sessions (48/48 vs. 36/48). There was no significant difference in the theoretical test results or the students' assessment of the quality of teaching. CONCLUSIONS: This model of peer-led undergraduate training in basic life support provides a quality of education which is at least as good as that provided by clinical staff, while offering advantages in terms of reliability. The re-deployment of clinical tutors from basic to more advanced training may allow the overall enhancement of undergraduate resuscitation and critical care training.
The assessment tool is only as good as the assessors.
Explore the source record for details and available documents.
Study on respiratory rate.
Explore the source record for details and available documents.
Training in the management of the acutely ill medical patient.
The care of acutely ill patients constitutes an important and increasing part of hospital practice. However, the care of the acutely ill by general physicians without adequate training in intensive care medicine is cause for concern. This article identifies ways in which the recognised deficiencies in the care of the acutely ill medical patient can be improved.