Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Feb 2017
Occult upper gastrointestinal mucosal abnormalities in critically ill patients.
The objectives of this study were to estimate the frequency of occult upper gastrointestinal abnormalities, presence of gastric acid as a contributing factor, and associations with clinical outcomes. ⋯ Occult mucosal abnormalities were observed in one-third of subjects. The presence of mucosal abnormalities appeared to be independent of prior acid-suppressive therapy and was not associated with reduced haemoglobin concentrations, increased transfusion requirements, or mortality.
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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
Termination of pre-hospital resuscitation by anaesthesiologists - causes and consequences. A retrospective study.
Differentiating between a newly deceased patient and the lifeless patient in whom immediate resuscitation is required may be facilitated by a pre-hospital anaesthesiologist. The purpose of our study was to investigate to what extent and why the pre-hospital anaesthesiologist pronounced life extinct in situations where an emergency medical technician (EMT) would have been required to resuscitate. ⋯ In one patient in 30, the MECU refrained from futile resuscitation in cases where legislation required an EMT to initiate resuscitation. This practice reduced unethical attempts of resuscitation, reduced unnecessary emergency ambulance transports, and reduced the work load of the hospital resuscitation teams for one unnecessary alarm every third day. Differentiating between lifeless patients and dead patients not exhibiting reliable signs of death, however, is a complex task which is only sparsely documented.
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Acta Anaesthesiol Scand · Feb 2017
Implementing point-of-care ultrasonography of the heart and lungs in an anesthesia department.
Implementation of point-of-care ultrasonography (POCUS) of the heart and lungs requires image acquisition skills among providers. We aimed to determine the effect of POCUS implementation using a systematic education program on image acquisition skills and subsequent use and barriers in a department of anesthesiology. ⋯ Implementation of POCUS by a systematic education program increased image acquisition skills across anesthesiologists employed at the department. POCUS was used in the intensive care setting, the pre-hospital setting, and to a lesser extent in the perioperative setting. Educational strategies for obtaining images under difficult conditions, practical equipment and evidence for effect on patient outcomes are required for full implementation of POCUS.