Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Nov 2019
Randomized Controlled TrialTime to onset of gastrointestinal bleeding in the SUP-ICU trial: a preplanned substudy.
The aetiology and risk factors for clinically important gastrointestinal bleeding (CIB) in adult ICU patients may differ according to the onset of CIB, which could affect the balance between benefits and harms of stress ulcer prophylaxis (SUP). ⋯ Clinically important gastrointestinal bleeding mostly occurred more than 2 days after randomization. University hospital admission was associated with significantly decreased risk of CIB in the earlier period only.
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Acta Anaesthesiol Scand · Nov 2019
Impact of norepinephrine on right ventricular afterload and function in septic shock-a strain echocardiography study.
In this observational study, the effects of norepinephrine-induced changes in mean arterial pressure (MAP) on right ventricular (RV) systolic function, afterload and pulmonary haemodynamics were studied in septic shock patients. We hypothesised that RV systolic function improves at higher doses of norepinephrine/MAP levels. ⋯ Higher doses of norepinephrine to a target MAP of 90 mm Hg improved RV systolic function while RV afterload was not affected.
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Acta Anaesthesiol Scand · Nov 2019
Observational StudyPoint-of-care analyses of blood samples from intraosseous access in pre-hospital critical care.
Intraosseous (IO) access is used for fluid and medication administration in emergency situations when difficulties with vascular access are encountered. IO access would be readily available to take samples for point-of-care (POC) analysis, but there is scarce evidence about the reliability of POC analysis of IO samples among emergency patients. The aim of this study was to evaluate the feasibility and reliability of POC analysis of IO samples in critically ill pre-hospital patients. ⋯ When vascular access is challenging, IO access can be used for emergency POC analyses to help guide clinical decision-making. However, the limitations of IO POC analyses must be carefully considered.
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Acta Anaesthesiol Scand · Nov 2019
Duration of critically low oxygen delivery is associated with acute kidney injury after cardiac surgery.
Acute kidney injury is a serious complication following cardiac surgery associated with mortality. Restricted oxygen delivery is a potential risk factor for acute kidney injury. The aim of this study was to investigate the impact of the duration of low oxygen delivery (<272 mL min-1 m-2 ), during cardiopulmonary bypass on kidney function. ⋯ A low oxygen delivery during cardiopulmonary bypass was in a dose-dependent manner associated with an increased risk of renal injury.
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Acta Anaesthesiol Scand · Nov 2019
Myocardial injury and mortality in patients with excessive oxygen administration before cardiac arrest.
Hyperoxia after cardiac arrest may be associated with higher mortality, and trials have found that excess oxygen administration in patients with myocardial infarction is associated with increased infarct size. The effect of hyperoxia before cardiac arrest is sparsely investigated. Our aim was to assess the association between excessive oxygen administration before cardiac arrest and the extent of subsequent myocardial injury. ⋯ Of 163 patients with cardiac arrest, 28 had excessive oxygen administration (17%), 105 had normal oxygen administration (64%) and 30 had insufficient oxygen administration (18%) before cardiac arrest. Peak troponin was median 224 ng/L in the excessive oxygen administration group vs 365 ng/L in the normal oxygen administration group (P = .54); 20 of 28 (71%) in the excessive oxygen administration group died within 30 days compared to 54 of 105 (51%) in the normal oxygen administration group. (OR 1.87, 95% CI 0.56-6.19) CONCLUSIONS: Excessive oxygen administration within 48 hours before in-hospital cardiac arrest was not statistically associated with significantly higher peak troponin or mortality.