Publications by authors named "Robert Orme"
Focused transoesophageal TOE (fTOE): A new accreditation pathway.
J Intensive Care Soc
November 2023
The concept of a focused ultrasound study to identify sources of haemodynamic instability has revolutionized patient care. Point-of-care ultrasound (POCUS) using transthoracic scanning protocols, such as FUSIC Heart, has empowered non-cardiologists to rapidly identify and treat the major causes of haemodynamic instability. There are, however, circumstances when a transoesphageal, rather than transthoracic approach, may be preferrable.
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- Myocardial dysfunction is prevalent in sepsis, but a study called the LeoPARDS trial found that the inodilator levosimendan does not improve organ dysfunction or reduce mortality in septic shock patients.
- The research measured cardiac biomarkers and inflammatory mediators in patients to assess the drug's effects, revealing no benefits in reducing the SOFA score or 28-day mortality rates.
- Specifically, patients with high NT-proBNP who received levosimendan showed worse SOFA scores compared to those on placebo, indicating that levosimendan added to standard care does not enhance outcomes in septic patients with cardiac dysfunction.
A 75-year-old man was admitted with abdominal pain and fresh rectal bleeding. Significantly, he had no risk factors for infection. An abdominal CT demonstrated colonic thickening, and flexible sigmoidoscopy identified pseudomembranous colitis-like lesions.
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- Levosimendan is a drug that may help patients with sepsis by improving organ function, and a clinical trial was conducted to test its effectiveness compared to a placebo.
- The study included 516 patients, with no significant differences found in mean organ dysfunction scores or 28-day mortality rates between the levosimendan and placebo groups.
- However, patients receiving levosimendan had a lower success rate in weaning off mechanical ventilation and experienced more cases of a specific heart rhythm issue (supraventricular tachyarrhythmia) compared to those receiving placebo.
Background: Organ dysfunction consequent to infection ('severe sepsis') is the leading cause of admission to an intensive care unit (ICU). In both animal models and early clinical studies the calcium channel sensitizer levosimendan has been demonstrated to have potentially beneficial effects on organ function. The aims of the Levosimendan for the Prevention of Acute oRgan Dysfunction in Sepsis (LeoPARDS) trial are to identify whether a 24-hour infusion of levosimendan will improve organ dysfunction in adults who have septic shock and to establish the safety profile of levosimendan in this group of patients.
View Article and Find Full Text PDFBackground: Electronic nose (E-nose) technology has been successfully used to diagnose a number of microbial infections. We have investigated the potential use of an E-nose for the diagnosis of ventilator-associated pneumonia (VAP) by detecting micro-organisms in bronchoalveolar lavage (BAL) fluid in a prospective comparative study of E-nose analysis and microbiology.
Materials And Methods: BAL samples were collected using a blind technique from 44 patients following a minimum of 72 h mechanical ventilation.