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Bedford Park, Australia

Davidson B.,Intensive and Critical Care Unit | Sutherland P.,Royal Adelaide Hospital
Medicine Today | Year: 2011

Peyronie's disease can be a debilitating condition affecting a man's sexual function. A six-month duration of stable, not worsening, symptoms is necessary before surgical treatment can be considered. Otherwise, watchful waiting and patient reassurance are all that are needed. © Istockphoto/Sheryl Griffin, Person Depicted is a Model.

Prentice C.E.,Intensive and Critical Care Unit
Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine | Year: 2010

BACKGROUND: Critically ill patients are exposed to a combination of insults that affect both respiratory and peripheral skeletal muscle function. However, different muscle groups may not be affected to the same extent by a prolonged critical illness. OBJECTIVE: To review original observational studies that measured an aspect of respiratory and peripheral muscle function in adults in the intensive care setting. DESIGN: Systematic review strategy and qualitative data synthesis. DATA SOURCES AND REVIEW METHODS: Four major citation databases were searched. Search terms included intensive care, critical care, diaphragm, quadriceps, and skeletal, respiratory and limb muscle. Titles and abstracts were reviewed to identify studies that measured both respiratory and peripheral muscle function. Reference lists of suitable publications were screened. Studies sampling critically ill patients with a neurological condition were excluded. RESULTS: 1119 items were identified, and 19 full-text/ abstract publications were reviewed. Ten studies investigated patients with a critical illness-related neuromuscular disorder. Nine studies targeted septic patients with multiple organ failure or patients requiring prolonged mechanical ventilation. Clinical, electrophysiological and muscle biopsy specimen data were collected at different time-points and milestones relating to alertness, weaning criteria, respiratory support reduction and extubation. CONCLUSIONS: Currently available bedside methods of measuring respiratory and peripheral muscle function in critically ill patients are somewhat inadequate. Yet there is evidence suggesting that respiratory muscles may be relatively spared from the damage that can occur as a result of immobility, prolonged mechanical ventilation and systemic inflammation in critical illness.

Baldwin C.E.,Flinders University | Paratz J.D.,University of Queensland | Bersten A.D.,Flinders University | Bersten A.D.,Intensive and Critical Care Unit
Journal of Critical Care | Year: 2013

Purpose: Dynamometry is an objective tool for volitional strength evaluation that may overcome the limited sensitivity of the Medical Research Council scale for manual muscle tests, particularly at grades 4 and 5. The primary aims of this study were to investigate the reliability, minimal detectable change, and time to peak muscle force, measured with portable dynamometry, in critically ill patients. Materials and methods: Isometric hand grip, elbow flexion, and knee extension were measured with portable dynamometry. Results: Interrater consistency (intraclass correlation coefficient [95% confidence interval]) (0.782 [0.321-0.930] to 0.946 [0.840-0.982]) and test-retest agreement (0.819 [0.390-0.943] to 0.918 [0.779-0.970]) were acceptable for all dynamometry forces, with the exception of left elbow flexion. Despite generally good reliability, a mean change (upper 95% confidence interval) of 2.8 (7.8) kg, 1.9 (5.2) kg, and 2.6(7.1) kg may be required from a patient's baseline force measurement of right grip, elbow flexion, and knee extension to reflect real force changes. There was also a delay in the time for critically ill patients to generate peak muscle forces, compared with healthy controls (P ≤ .001). Conclusions: Dynamometry can provide reliable measurements in alert critically ill patients, but moderate changes in strength may be required to overcome measurement error, during the acute recovery period. Deficits in force timing may reflect impaired neuromuscular control. © 2013 Elsevier Inc.

Muecke S.,Flinders University | Bersten A.,Flinders University | Bersten A.,Intensive and Critical Care Unit | Plummer J.,Pain Management Unit
Journal of Clinical Monitoring and Computing | Year: 2010

Objectives: For some time, the inaccuracies of non-invasive blood pressure measurement in critically ill patients have been recognised. Measurement difficulties can occur even in optimal conditions, but in prehospital transportation vehicles, problems are exacerbated. Intra-arterial pressures must be used as the reference against which to compare the performance of non-invasive methods in the critically ill patient population. Intra-arterial manometer data observed from the patient monitor has frequently been used as the reference against which to assess the accuracy of noninvasive devices in the emergency setting. To test this method's validity, this study aimed to determine whether numerical monitor pressures can be considered interchangeable with independently sampled intra-arterial pressures. Methods: Intensive Care Unit nurses were asked to document arterial systolic, diastolic and mean pressures numerically displayed on the patient monitor. Observed pressures were compared to reference intra-arterial pressures independently recorded to a computer following analogue to digital conversion. Differences between observed and recorded pressures were evaluated using the Association for the Advancement of Medical Instrumentation (AAMI) protocol. Additionally, two-level linear mixed effects analyses and Bland-Altman comparisons were undertaken. Results: Systolic, diastolic and integrated mean pressures observed during 60 data collection sessions (n = 600) fulfilled AAMI protocol criteria. Integrated mean pressures were the most robust. For these pressures, mean error (reference minus observed) was 0.5 mm Hg (SD 1.4 mm Hg); 95% CI (two-level linear mixed effects analysis) 0.4-0.6 mm Hg; P < 0.001. Bland-Altman plots demonstrated tight 95% limits of agreement (-2.3 to 3.2 mm Hg), and uniform agreement across the range of mean blood pressures. Conclusions: Integrated mean arterial pressures observed from a well maintained patient monitor can be considered interchangeable with independently sampled intra-arterial pressures and may be confidently used as the reference against which to test the accuracy of non-invasive blood pressure measuring methods in the prehospital or emergency setting. © Springer 2009.

Baldwin C.E.,University of South Australia | Baldwin C.E.,Flinders Medical Center | Bersten A.D.,Flinders University | Bersten A.D.,Intensive and Critical Care Unit
Current Opinion in Clinical Nutrition and Metabolic Care | Year: 2015

Purpose of review Survivors of a critical illness may experience poor physical function and quality of life as a result of reduced skeletal muscle mass and strength during their acute illness. Patients diagnosed with sepsis are particularly at risk, and mechanical ventilation may result in diaphragm dysfunction. Interest in the interaction of these conditions is both growing and important to understand for individualized patient care. Recent findings This review describes developments in the presentation of both diaphragm and limb myopathy in critical illness, as measured from muscle biopsy and at the bedside with various imaging and strength-testing modalities. The influence of unloading of the diaphragm with mechanical ventilation and peripheral muscles with immobilization in septic patients has been recently questioned. Systemic inflammation appears to primarily accelerate and accentuate dysfunction, which may be remedied by early mobilization and augmented with developing muscle and/or nerve stimulation techniques. Summary Many acute muscle changes in septic patients are likely to stem from pre-existing impairments, which should provide context for clinical evaluations of strength. During illness, sarcolemmal injury promotes a cascade of intra-cellular abnormalities. As unique characteristics of ICU-acquired weakness and differential effects on muscle groups are understood, early diagnosis and management should be facilitated. © 2015 Wolters Kluwer Health, Inc. All rights reserved.

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