The ability of the APACHE II system in predicting group outcome is validated in this Canadian ICU population by receiver operating characteristic curve, 2 x 2 decision matrices and linear regression analysis. The Canadian patients had a higher overall hospital death rate than the United States patients. After controlling for severity of illness using APACHE II scores, the hospital death rate was comparable between the Canadian and United States patients.

In patients with normal intracranial pressure, PEEP at 5 cm H2O did not significantly alter intracranial pressure. The clinical relevance of the intracranial pressure increase at PEEP levels of 10 and 15 cm H2O is questionable because cerebral perfusion pressure did not change and remained > 60 mm Hg. In patients with increased intracranial pressure, higher levels of PEEP did not significantly change intracranial pressure or cerebral perfusion pressure.

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Purpose: To describe the presentation and management of complete upper airway obstruction with life threatening arterial oxygen desaturation that occurred during attempted awake fibreoptic intubation in two patients presenting with unstable C-spine injury. Clmic.~ F~tum: Complete upper airway obstruction occurred during awake fibreoptic intubation of two men (ASA II; 68 & 55 yr old) presenting with unstable C-spine fractures. In both cases, bag and mask ventilation with CPAP failed to relieve the progressive hypoxemia. A surgical airway was established urgently to oxygenate the two patients who were suffering progressive life-threatening oxygen desaturation. One patient had t~ns-cricothyroid jet ventilation performed through a 16G intravenous cannula prior to an urgent tracheostomy. In the other patient, an emergency tracheostomy was inserted. Interestingly, both patients had been sedated in the Neurosurgical Intensive Care Unit with morphine and benzodiazepines before their scheduled surgeries. The most likely etiology for the complete upper airway obstruction was laryngospasm due to inadequate topicalization of the airway and additional sedation given in the operating room. Neither patients suffered any new neurological deficits following these events. They went on to have uneventful surgeries. Condmion: This case report suggest that prior to awake fibreoptic intubation, oxygenation, adequate topicalization with testing to verify the lack of pharyngeal and laryngeal responses and careful assessment of sedation levels in the operating room are prudent for a safe endoscopic intubation. Obj~-tif: D&rire le tableau clinique et le traitement de robstruction compl&e des voies a~riennes sup&ieures, accompagn~e d'une dangereuse d&aturation du sang art~riel en oxyg~ne, survenue pendant qu'on tentait une fibroscopie vigile chez deux sujets souffrant d'une instabilit~ de la colonne cervicale. ~ealts dinique~ : Une obstruction complete des voies a&iennes sup&ieures s'est produite pendant une fibroscopie vigile chez deux hommes (ASA II ; 68 & 55 ans) qui pr~sentaient des fractures de la colonne cervicale. Dans les deux c.as, la ventilation manuelle au masque et au ballon et une ventilation spontan& avec pression expiratoire positive (PEP) n'a pu soulager I'hypox~mie progressive. Le r~tablissement chirurgical du conduit a&ien a ~t~ r~alis~ d'urgence pour oxyg~ner les deux patients qui souffraient d'une d~saturation progressive en oxyg~ne rnettant leur vie en danger. On a proc~d& chez run des patients, ~ une ventilation ~ jet transcricothyroidienne au moyen d'une canule intraveineuse 16G avant la trach~otomie d'urgence. Chez I'autre patient, une trach~otomie d'urgence a ~t~ pratiqu&. II est int&essant de rioter que les deux patients avaient re~u une s~dation ~ I'unit~ des soins intensifs neurochirurgicaux avec de la morphine et des benzodiaz~pines avant la chirurgie ~lective. I'~tiologie la plus probable de I'obstruction compl&e des voies a&i-ennes sup&ieures ~tait un laryngospasme caus~ par une puiv&isation inadequate du co...

In a Canadian medical-surgical ICU, patients with ICU LOS > or = 14 days accounted for 7.3% of total admissions but consumed 43.5% of total ICU days. Identification of patients with prolonged ICU LOS who would ultimately die in the ICU may lead to earlier withdrawal of therapy in these patients, resulting in a substantial reduction in suffering and cost savings. In our study population, outcome prediction using the APACHE II equation did not provide sufficient power to accurately discriminate between nonsurvivors and survivors.

Both APACHE II and TRISS scores were shown to accurately predict group mortality in ICU trauma patients. APACHE II and TRISS may be utilized for quality assurance in ICU trauma patients. However, neither APACHE II nor TRISS provides sufficient confidence for prediction of outcome of individual patients.

P Pu ur rp po os se e: : To report a non-fatal case of intraoperative venous air embolism (VAE) during an awake craniotomy. VAE presented with unusual clinical features.C Cl li in ni ic ca al l f fe ea at tu ur re es s: : VAE during an awake craniotomy has not been reported frequently. The patient we describe presented with persistent coughing followed by tachypnea, hypoxia and reduction in end-tidal CO 2 during dural opening while undergoing an awake craniotomy in the supine position. Cardiovascular variables were stable during the episode except for transient hypertension. Having ruled out airway obstruction and low cardiac output, we concluded that air embolism was the cause. The patient responded immediately to the standard treatment of air embolism and recovered without any complication.C Co on nc cl lu us si io on n: : This case illustrates a VAE during an awake craniotomy and emphasizes the importance of early diagnosis in the management. Objectif : Présenter un cas non mortel d'aéroembolie veineuse peropératoire (AEV) survenue pendant une craniotomie vigile. L'AEV présentait des caractéristiques cliniques inhabituelles.

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