Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Feb 2017
Severe sepsis in the ICU is often missing in hospital discharge codes.
Different International Classification of Diseases (ICD)-based code abstraction strategies have been used when studying the epidemiology of severe sepsis. The aim of this study was to compare three previously used ICD code abstraction strategies to the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) consensus criteria for severe sepsis, in a setting of intensive care patients. ⋯ A majority of patients with severe sepsis according to the ACCP/SCCM criteria were not discharged with ICD codes corresponding to the ICD code abstraction strategies; thus, the abstraction strategies did not identify the correct patients.
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Acta Anaesthesiol Scand · Feb 2017
Randomized Controlled Trial Multicenter Study Comparative StudyHigher vs. lower haemoglobin threshold for transfusion in septic shock: subgroup analyses of the TRISS trial.
Using a restrictive transfusion strategy appears to be safe in sepsis, but there may be subgroups of patients who benefit from transfusion at a higher haemoglobin level. We explored if subgroups of patients with septic shock and anaemia had better outcome when transfused at a higher vs. a lower haemoglobin threshold. ⋯ In exploratory analyses of a randomized trial in patients with septic shock and anaemia, we observed no survival benefit in any subgroups of transfusion at a haemoglobin threshold of 90 g/l vs. 70 g/l.
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Acta Anaesthesiol Scand · Feb 2017
ReviewInterventions to reduce cognitive impairments following critical illness: a topical systematic review.
Critical illness is associated with cognitive impairments. Effective treatment or prevention has not been established. The aim of this review was to create a systematic summary of the current evidence concerning clinical interventions during intensive care admission to reduce cognitive impairments after discharge. ⋯ None of the interventions had significant positive effects on cognitive impairments following critical illness. Quality was negatively affected by study limitations, imprecision and indirectness in evidence. Clinical research on cognition is feasible, but large, well designed trials with a specific aim at reducing cognitive impairments are needed.
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Acta Anaesthesiol Scand · Feb 2017
Randomized Controlled TrialLaparoscopic-guided psoas blockade as a novel analgesic method during inguinal herniorrhaphy: a clinical trial.
Under laparoscopic guidance, block of ilioinguinal, iliohypogastric, and genitofemoral nerves can be possible with anesthetic injection in the plane between psoas major and the fasciae covering its anterior aspects [laparoscopic-assisted psoas (LAP) blockade]. This observer-blinded trial aimed to compare the opioid-sparing effect of LAP block with transversus abdominis plane (TAP) block after laparoscopic inguinal herniorrhaphy. ⋯ A single injection LAP blockade significantly reduces the post-operative analgesic requirements and provides longer pain relief compared with TAP block after laparoscopic inguinal herniorrhaphy.