Acta anaesthesiologica Scandinavica
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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
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.