Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Nov 2018
Randomized Controlled TrialLactate, lactate clearance and outcome after cardiac arrest: A post-hoc analysis of the TTM-Trial.
Admission lactate and lactate clearance are implemented for risk stratification in sepsis and trauma. In out-of-hospital cardiac arrest, results regarding outcome and lactate are conflicting. ⋯ Admission lactate and 12-hour lactate values were independently associated with 30-day mortality after out-of-hospital cardiac arrest while 12-hour lactate clearance was not. The clinical value of lactate as the sole predictor of outcome after out-of-hospital cardiac arrest is, however, limited.
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Acta Anaesthesiol Scand · Nov 2018
Multicenter StudyIntensive care doctors' preferences for arterial oxygen tension levels in mechanically ventilated patients.
Oxygen is liberally administered in intensive care units (ICUs). Nevertheless, ICU doctors' preferences for supplementing oxygen are inadequately described. The aim was to identify ICU doctors' preferences for arterial oxygenation levels in mechanically ventilated adult ICU patients. ⋯ Intensive care unit doctors preferred PaO2 to SaO2 in monitoring oxygen treatment when peripheral oxygen saturation was not included in the question. The identification of PaO2 as the preferred target and the thorough clarification of preferences are important when ascertaining optimal oxygenation targets. In particular when designing future clinical trials of higher vs lower oxygenation targets in ICU patients.
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Acta Anaesthesiol Scand · Nov 2018
ReviewThe role of prehabilitation in frail surgical patients: A systematic review.
A useful review of the role of rehabilitation in frail patients by Milder, Pillinger and Kam.
- They note that there is no gold standard to measure frailty, although there are many attempts to reliably identify and measure frailty across its many domains.
Nonetheless frailty is strongly associated with perioperative morbidity and mortality.
One proposed indicator of physical frailty is the presence of three of Fried's five factors: unintentional weight loss; grip strength weakness; exhaustion; slow walking speed; and low physical activity.
Frailty is "...a multidimensional state of reduced physiological reserve, resulting in increased vulnerability to stressors, decreased resilience, and loss of adaptive capacity."
Prehabilitation aims to increase physiological reserve through pre-operative intervention, including but not limited to exercise, nutrition and inspiratory muscle training.
Final word: although attractive, prehab has not yet been shown to improve outcomes in frail patients, though this is likely due to the absence of high quality studies.
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Acta Anaesthesiol Scand · Nov 2018
Review Meta AnalysisPerioperative goal-directed therapy: A systematic review without meta-analysis.
Perioperative goal-directed therapy aims to optimise haemodynamics by titrating fluids, vasopressors and/or inotropes to predefined haemodynamic targets. Perioperative goal-directed therapy is a complex intervention composed of several independent component interventions. Trials on perioperative goal-directed therapy show conflicting results. We aimed to conduct a systematic review and meta-analysis to investigate the benefits and harms of perioperative goal-directed therapy. ⋯ Clinical heterogeneity in patients, interventions and outcomes in perioperative goal-directed therapy trials is too large to perform meta-analysis on all trials. Future trials and meta-analyses highly depend on universally agreed definitions on aspects beyond type of surgery of the complex intervention and its evaluation.