Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Aug 2019
Review Meta Analysis Comparative StudyPiperacillin/tazobactam vs carbapenems for patients with bacterial infection: Protocol for a systematic review.
Early empirical broad-spectrum antimicrobial therapy is recommended for patients with severe infections, including sepsis. β-lactam/β-lactamase inhibitor combinations or carbapenems are often used to ensure coverage of likely pathogens. Piperacillin/tazobactam is proposed as a carbapenem-sparing agent to reduce the incidence of multidrug-resistant bacteria and superinfections. In the recently published MERINO trial, increased mortality from piperacillin/tazobactam was suggested in patients with bacteraemia with resistant Escherichia coli or Klebsiella species. Whether these findings also apply to empirical piperacillin/tazobactam in patients with other severe infections, including sepsis, is unknown. We aim to assess the benefits and harms of empirical and definitive piperacillin/tazobactam vs carbapenems for patients with severe bacterial infections. ⋯ This protocol has been prepared according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statement, the Cochrane Handbook and the Grading of Recommendations, Assessment, Development, and Evaluation approach. We will include randomised clinical trials assessing piperacillin/tazobactam vs carbapenems in patients with severe bacterial infections of any origin. The primary outcome will be all-cause short-term mortality ≤ 90 days. Secondary outcomes will include all-cause long-term mortality > 90 days, adverse events, quality of life, use of life support, secondary infections, antibiotic resistance, and length of stay. We will conduct meta-analyses, including pre-planned subgroup and sensitivity analyses for all assessed outcomes. The risk of random errors in the meta-analyses will be assessed by trial sequential analysis.
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Acta Anaesthesiol Scand · Aug 2019
Review Randomized Controlled Trial Multicenter StudyHandling Oxygenation Targets in the Intensive Care Unit (HOT-ICU)-Protocol for a randomised clinical trial comparing a lower vs a higher oxygenation target in adults with acute hypoxaemic respiratory failure.
Acutely ill adults with hypoxaemic respiratory failure are at risk of life-threatening hypoxia, and thus oxygen is often administered liberally. Excessive oxygen use may, however, increase the number of serious adverse events, including death. Establishing the optimal oxygenation level is important as existing evidence is of low quality. We hypothesise that targeting an arterial partial pressure of oxygen (PaO2 ) of 8 kPa is superior to targeting a PaO2 of 12 kPa in adult intensive care unit (ICU) patients with acute hypoxaemic respiratory failure. ⋯ The HOT-ICU trial will test the hypothesis that a lower oxygenation target reduces 90-day mortality compared with a higher oxygenation target in adult ICU patients with acute hypoxaemic respiratory failure.
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Acta Anaesthesiol Scand · Aug 2019
Randomized Controlled Trial Comparative StudyRestrictive vs liberal oxygen for trauma patients-the TRAUMOX1 pilot randomised clinical trial.
Hyperoxaemia is commonly observed in trauma patients but has been associated with pulmonary complications and mortality in some patient populations. The objectives of this study were to evaluate whether maintenance of normoxia is feasible using a restrictive oxygen strategy in the initial phase after trauma and to evaluate the incidence of 30-day mortality and/or major pulmonary complications. ⋯ Maintenance of normoxia using a restrictive oxygen strategy following trauma is feasible. This pilot study serves as the basis for a larger clinical trial.
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Acta Anaesthesiol Scand · Aug 2019
Randomized Controlled Trial Comparative StudyComparison of Pentax Airway Scope and Macintosh laryngoscope for orotracheal intubation in children: A randomised non-inferiority trial.
Pentax Airway Scope (AWS) is a recently developed videolaryngoscope for use in both normal and difficult airways, yet its use in paediatric patients has not been established. The purpose of this study was to evaluate the efficacy of the Pentax AWS regarding intubation time, laryngeal view and ease of intubation in paediatric patients with normal airway, compared to Macintosh laryngoscope. ⋯ Pentax Airway Scope provided similar intubation time and success rate, while improving laryngeal view, compared to Macintosh laryngoscopy in children with normal airway. When using Pentax AWS in children, however, the risk of teeth injury may increase.
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Acta Anaesthesiol Scand · Aug 2019
Observational StudyInfections and outcomes after cardiac surgery-The impact of outbreaks traced to transesophageal echocardiography probes.
Infections are a frequent complication of cardiac surgery. The intraoperative use of transesophageal echocardiography (TEE) may be an underrecognized risk factor for post-operative infections. The aim of this study was to investigate infection rates and outcomes after cardiac surgery in a nationwide cohort, especially in relation to periods where surface damaged TEE probes were used. ⋯ The intraoperative use of surface damaged TEE probes caused two serious infection outbreaks in patients after cardiac surgery. TEE probes need careful visual inspection during decontamination and probe sheaths are recommended.