Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · May 2015
ReviewThe demise of early goal-directed therapy for severe sepsis and septic shock.
A protocol for the quantitative resuscitation of severe sepsis and septic shock known as early goal-directed therapy (EGDT) was published in 2001. Despite serious limitations, this study became widely adopted around the world and formed the basis of the Surviving Sepsis Campaign 6 h resuscitation bundle. Subsequently, a large number of observational before-and-after studies were published which demonstrated that EGDT reduced mortality. ⋯ Furthermore, accruing data suggest an association between the amount of fluid administered in the first 72 h and the mortality of patients with severe sepsis. Patients in all arms of the ProCESS and ARISE trials received substantial and nearly equivalent amounts of fluid. It is proposed that a more conservative fluid strategy and the earlier use of norepinephrine in patients with septic shock may be associated with further improvements in the outcome of patients with sepsis.
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Acta Anaesthesiol Scand · May 2015
Stress ulcer prophylaxis in the intensive care unit: an international survey of 97 units in 11 countries.
Stress ulcer prophylaxis (SUP) may decrease the incidence of gastrointestinal bleeding in patients in the intensive care unit (ICU), but the risk of infection may be increased. In this study, we aimed to describe SUP practices in adult ICUs. We hypothesised that patient selection for SUP varies both within and between countries. ⋯ In this international survey, most participating ICUs reported using SUP, primarily proton pump inhibitors, but many did not have a guideline; indications varied considerably and concern existed about infectious complications.
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Acta Anaesthesiol Scand · May 2015
Accuracy of calculated volatile agent consumption from fresh gas content.
Case-by-case assessment of volatile anesthetic (VA) consumption is necessary to perform agent sparing dosing measures and for billing purposes. The gold standard technique for this purpose is to measure the weight difference of the vaporizer that occurs during VA delivery. Because suitable equipment is rarely available and weighing the vaporizer is only possible in prospectively planned fashion, a calculation method from recorded fresh gas flow (FGF) and VA courses is a viable alternative. The objective was to evaluate the accuracy of VA calculation from fresh gas composition vs. the gold standard of weighing the vaporizer before and after anesthesia. ⋯ The calculated VA consumption for sevoflurane and desflurane are sufficiently accurate to estimate the economic impact of VA delivery during inhalational anesthesia. This method enables the assessment of VA consumption both ways: (1) retrospectively from sufficiently detailed and accurate anesthesia recordings, as well as (2) by using this method in a prospective setting.
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Acta Anaesthesiol Scand · May 2015
Case ReportsThe ultrasound-assisted paraspinous approach to lumbar neuraxial blockade: a simplified technique in patients with difficult anatomy.
Pre-procedural ultrasound imaging of the spine to identify the interspinous and interlaminar space has been shown to facilitate subsequent performance of lumbar neuraxial blockade. However, adequate visualization of the vertebral canal can be challenging for less-experienced operators, and particularly in subjects with difficult anatomy. ⋯ Another key difference is the use of a paraspinous (or paramedian) needle approach rather than a midline approach that is advantageous where the interspinous spaces are narrowed by disease or suboptimal patient positioning. The anatomical basis and technical performance of this novel ultrasound-assisted paraspinous approach are presented in detail.
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Acta Anaesthesiol Scand · May 2015
Paediatric ventilation treatment of acute lung injury in Nordic intensive care units.
Treatment of acute respiratory distress syndrome (ARDS) in children is largely based on extrapolated knowledge obtained from adults and which varies between different hospitals. This study explores ventilation treatment strategies for children with ARDS in the Nordic countries, and compares these with international practice. ⋯ Ventilation treatment strategies for paediatric ARDS in the Nordic countries are relatively uniform and largely in accordance with international practice. The use of steroids and surfactant is more frequent than shown in other studies.