Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Jan 2019
Comparative StudyComparison of two prehospital predictive models for mortality and impaired consciousness after severe traumatic brain injury.
The primary aim was to investigate the performance of a National Advisory Committee for Aeronautics based predictive model (NACA-BM) for mortality at 14 days and a reference model using motor GCS (GCS-RM). The secondary aim was to compare the models for impaired consciousness of survivors at 14 days (IC-14; GCS ≤ 13). ⋯ Prehospital prediction of mortality after TBI was good with both models, and the NACA-BM was not inferior to the GCS-RM. Prediction of IC-14 was moderate in both models.
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Acta Anaesthesiol Scand · Jan 2019
Prolonged vasopressor support during hip-fracture surgery is a risk factor for enhanced mortality.
Hip fracture is a common injury in the elderly population and is associated with high morbidity and mortality. Intraoperative hypotension is commonly noted, and is often treated with vasopressors (VP), however, to what extent is unknown. We set out to examine retrospectively how many hip fracture-patients received VP perioperatively and further to investigate if VP treatment is connected to increased mortality. ⋯ Vasopressor treatment is common during hip fracture surgery. Patients treated with VP infusion ≥3 hours have increased mortality, while patients treated with injections or infusion <3 hours have not. We suggest that the prolonged use of VP treatment is linked to increased mortality.
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Acta Anaesthesiol Scand · Jan 2019
Observational StudyElevated serum S-100β in patients with septic shock is associated with delirium.
A high prevalence of delirium is observed in sepsis, yet specific markers for this brain dysfunction in sedated patients are still lacking. Cytoplasmic low molecular weight calcium-binding protein, S-100β, is a commonly used nonspecific marker for brain injury. Here, we evaluated whether delirium is associated with increases in S-100β levels. ⋯ Delirium in septic shock was associated with an elevated protein S-100β when using a laboratory cutoff value of 0.15 μg/L and with more severe organ dysfunction during the ICU stay.
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Acta Anaesthesiol Scand · Jan 2019
Changes in tissue oxygen tension, venous saturation, and Fick-based assessments of cardiac output during hyperoxia.
Hyperoxemia (arterial oxygen tension >100 mm Hg) may occur in critically ill patients and have effects on mixed venous saturation (SvO2 ) and on Fick-based estimates of cardiac output (CO). We investigated the effect of hyperoxemia on SvO2 and on assessments of CO using the Fick equation. ⋯ SvO2 acutely changes following changes in PaO2 even absent changes in measured DO2 . This may lead to errors in FickO2 estimates of CI. Further work is necessary to understand the impact of this phenomenon in disease states.
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Acta Anaesthesiol Scand · Jan 2019
ReviewBias and sample size in intensive care unit trials: Protocol for a meta-epidemiological study.
Systematic errors (bias) and random errors result in inflated and imprecise intervention effect estimates in randomised clinical trials (RCT) and meta-analyses. We aim to assess time trends in the Cochrane risk of bias domains and sample size in RCTs of intensive care unit (ICU) interventions. ⋯ The outlined meta-epidemiologic study will assess time trends in risk of bias and sample sizes in RCTs assessing ICU interventions. This will inform researchers, healthcare personnel and policymakers on the general reliability of findings from RCTs of ICU interventions over time, and inform future RCT design and reporting.