Anesthesiology
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Perioperative acute kidney injury is commonIt is unclear whether this merely represents a transient increase in creatinine or has prognostic value WHAT THIS ARTICLE TELLS US THAT IS NEW: Patients with mild postoperative kidney injury (stage I) after noncardiac surgery had an estimated 2.4 times higher odds of having long-term renal dysfunction compared with patients without postoperative kidney injuryA quarter of patients who had stage I acute kidney injury postoperatively still had stage I kidney injury 1 to 2 yr later, and an additional 11% had even worse renal function BACKGROUND:: Perioperative acute kidney injury is common. However, it is unclear whether this merely represents a transient increase in creatinine or has prognostic value. Therefore, the long-term clinical importance of mild postoperative acute kidney injury remains unclear. This study assessed whether adults who do and do not experience mild kidney injury after noncardiac surgery are at similar risk for long-term renal injury. ⋯ In adults recovering from noncardiac surgery, even small postoperative increases in plasma creatinine, corresponding to stage I kidney injury, are associated with renal dysfunction 1 to 2 yr after surgery. Even mild postoperative renal injury should therefore be considered a clinically important perioperative outcome.
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Transthoracic ultrasound may be clinically useful, but training is not standardized, and it remains unclear when naïve trainees have sufficient competency to perform exams unsupervised WHAT THIS ARTICLE TELLS US THAT IS NEW: A multicenter, international study was conducted in 10 intensive care units among residents and staff in anesthesiology, critical care, emergency medicine, and internal medicine who underwent supervised training, to determine the number of exams required to achieve basic competenceAfter 25 supervised examinations, 80% of lung regions were adequately classified by traineesUltrasound exam average duration was 8 to 10 min in experts and decreased from 19 (after 5 exams) to 12 min (after 25 exams) in trainees BACKGROUND:: Lung ultrasound is increasingly used in critically ill patients as an alternative to bedside chest radiography, but the best training method remains uncertain. This study describes a training curriculum allowing trainees to acquire basic competence. ⋯ A training curriculum including 25 transthoracic ultrasound examinations supervised by an expert provides the basic skills for diagnosing normal lung aeration, interstitial-alveolar syndrome, and consolidation in emergency and critically ill patients.