The Prehospital Emergency Anaesthetic in 2022.

Prehospital emergency anesthesia (PHEA) is a commonly performed prehospital procedure with inherent risks. The processes and drug regimens behind PHEA are continually updated by prehospital teams across the country as part of their governance structure. Essex & Herts Air Ambulance has recently updated this practice by reviewing the entire process of performing PHEA.

Beneficial effect of intra-operative methylprednisolone on immediate post liver transplant intensive care course.

Background: Concern about the effect of corticosteroids on outcomes following liver transplantation (LT), especially in recipients with hepatitis C infection (HCV) has lead many centres to abandon the use of perioperative steroids. Avoidance of corticosteroids in immunosuppressive regimens may have beneficial effects in terms of reducing the incidence of infection, new onset diabetes mellitus and HCV recurrence however perioperative use may have beneficial effects such as attenuation of ischaemia-reperfusion injury (IR) and treatment of underlying adrenal insufficiency (AI). Due to a high prevalence of adrenal insufficiency in patients on our waiting list for LT, we reintroduced the use of intraoperative methyl-prednisolone and hypothesised that this would improve early post operative outcome.

Resource implications of expanding the use of donation after circulatory determination of death in liver transplantation.

In the United Kingdom, liver transplantation using donation after circulatory determination of death (DCDD) organs has increased steadily over the last few years and now accounts for 20% of UK transplant activity. The procurement of DCDD livers is actively promoted as a means of increasing the donor pool and bridging the evolving disparity between the wait-list length and the number of transplants performed. The objective of this retrospective study of a cohort of patients who were matched for age, liver disease etiology, and Model for End-Stage Liver Disease score was to determine whether differences in perioperative costs and resource utilization are associated with the use of such organs.

Long-term survival of chronic dialysis patients following survival from an episode of multiple-organ failure.

Introduction: This study aimed to examine the long-term outcome for patients with end-stage renal failure (ESRF) who survived multiple-organ failure.

Methods: We performed a review of databases from the renal medicine service and intensive care units (ICU) of the participating hospitals within Imperial College Healthcare NHS Trust, London, UK. Patients with ESRF admitted to ICU who required support of two or more organ systems or were ventilated for more than 36 hours were included.

Clinical review: Intensive care follow-up--what has it told us?

The majority of intensive care practitioners, until comparatively recently, was content to discharge surviving patients to the care of referring primary specialty colleagues who would undertake subsequent inpatient and outpatient care. With the exception of mortality statistics from clinical studies, the practitioners were thus denied the opportunity of understanding the full impact of critical illness on a patient and their family. The concept of the intensive care follow-up clinic has developed more recently, and is run commonly on multidisciplinary lines.