Two commercially available kits have been used to create 25 percutaneous tracheostomies, 20 using the Cook system and five using the Rapitrac system. The operation time and complication rates of these tracheostomies have been compared with those for 16 conventional tracheostomies performed for similar indications. Median operating times were 60 (range 30-105) min for conventional tracheostomy, 15 (range 8-70) min for Cook and 5 (range 3-15) min for Rapitrac systems (P less than 0.001). A significantly higher proportion of patients in the Rapitrac group had complications compared with the other two groups (P less than 0.05). The complication rate for the Cook group compared favourably with that for the conventional tracheostomy group. The Cook system of percutaneous tracheostomy is a simple, rapid and safe alternative to conventional tracheostomy.

SummaryThe Hypoalbuminaemia is associated with increased hospital morbidity and mortality [I] and has been shown to be a reliable prognostic indicator. Although serum albumin concentration was included in the APACHE Ill (Acute Physiology And Chronic Health Evaluation) illness severity scoring system [2], it is not a component of the more widely used APACHE I1 [3]. It is known that the accuracy of outcome prediction of APACHE I1 is impaired in patients with severe hypoalbuminaemia, which is itself an independent prognostic indictor in critically ill patients [4]. Previous studies evaluating the prognostic value of serum albumin concentration have often been of limited relevance to patients admitted to the intensive care unit (ICU) because the hypoalbuminaemia has been long-standing and reflective of either nutritional deficiency or chronic ill health.It is known that serum albumin concentration may decrease rapidly in critically ill patients with septic shock [S] and after major surgery [6]. Two of the most important determinants of acute hypoalbuminaemia are haemodilution during fluid resuscitation and capillary leakage into the interstitial space in patients with a systemic inflammatory response. Although it is likely that the development and degree of acute hypoalbuminaemia relates to illness severity and ultimate outcome, no previous studies have examined the acute changes in serum albumin concentration that occur following admission to the ICU and have subsequently evaluated the value of serial albumin measurements as an independent prognostic indicator. The present study was conducted to determine the prognostic value of serial measurements of serum albumin concentration measured during the first 72 h of ICU admission. We also examined the relationship between fluid resuscitation and the development of acute hypoalbuminaemia. MethodsAll admissions to a general adult ICU over a one year period were retrospectively reviewed. The admission APACHE I1 score was obtained from the ICU computer database. The database was also used to categorise those patients who died on the ICU (non-survivors) and those who were discharged to a general hospital ward (survivors). Measurements of serum albumin concentration during the first 72 h of admission were obtained from the biochemistry laboratory database. Serum albumin concentration was assayed using a standard dye-binding method on admission to the ICU and on each subsequent morning.

No abstract

Based on a systematic review of the scientific literature, the North West Oxygen Group have developed guidelines for oxygen therapy for patients who present with acute breathlessness. The above emergency medicine physicians, chest physicians and intensive care physicians have gained approval from their regional societies to have this document accepted as the agreed regional guidelines for the use of oxygen in the immediate care of breathless patients in the North West of England. Flow charts are also currently being developed, based on these guidelines, for use by ambulance and emergency department staV in the area. It is recognised that the present use of oxygen across these specialties is inconsistent. This protocol will help us to deliver standardised oxygen therapy to breathless patients by paramedics, doctors and nurses. This will also improve the consistency of medical training across these disciplines in the North West.

Haemofiltration is associated with an increased requirement for transfusion of blood. The temporal relationship between occurrence of haemofilter blood clots and transfusion of blood suggests that haemofilter lifespan may be an important determinant of this.