Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Feb 2020
Observational StudyPrevalence of risk -drinking in critically ill patients, screened with carbohydrate-deficient transferrin and AUDIT-C score: a retrospective study.
Background Studies demonstrate that up to one-third of intensive care unit (ICU) admissions are directly or indirectly related to alcohol. Screening for alcohol use is not routine. This study examined the prevalence of elevated %CDT (carbohydrate-deficient transferrin) and above risk-level AUDIT-C (Alcohol Use Disorders Identification Test, Consumption) in patients admitted to ICU. ⋯ Diagnosis of alcohol overconsumption though is problematic due to low sensitivity in screening. In a pilot study, a biomarker and a screening tool are compared. The finding is that multiple tools are needed to achieve an adequate sensitivity for detection.
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Acta Anaesthesiol Scand · Feb 2020
APACHE II score validation in emergency abdominal surgery. A post-hoc analysis of the InCare trial.
Patients undergoing emergency abdominal surgery are at high risk of morbidity and mortality. Accurate identification of high-risk patients is important. The Acute Physiology and Chronic Health Evaluation (APACHE) II score needs to be validated in a larger heterogeneous population before implementation. We aimed to assess the predictive value of the APACHE II score in emergency abdominal surgical patients. Furthermore, we compared the APACHE II score with the American Society of Anesthesiologists (ASA) physical status score and the Charlson Comorbidity Index (CCI). ⋯ The APACHE II score predicted mortality moderately and admission to intensive care unit poorly in emergency abdominal surgical patients.
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Acta Anaesthesiol Scand · Feb 2020
Observational StudyProspective, observational study of carbon dioxide gaps and free energy change and their association with fluid therapy following cardiac surgery.
Background Venoarterial carbon dioxide pressure (pv-a CO2 ) and content (Cv-a CO2 ) differences, including the ratio to arteriovenous oxygen content difference (Ca-v O2 ), and free energy changes (-∆∆Ga-v ) may reflect tissue hypoperfusion. The associations with changes in cardiac output (CO) or oxygen consumption (VO2 ) following fluid bolus administration were investigated. Methods Single-centre, observational study of 89 adult post-operative cardiac surgical patients admitted to ICU. ⋯ Fluid challenges are used as an "ex juvantebus" method to dose fluid therapy, but it is not clear if a positive response reflects a state of hypoperfusion or the existence of a cardiac reserve. Still, a better understanding on how to target and guide fluid therapy is welcome, and studies digging into the problem are needed. Here, invasively monitored post-operative cardiac surgery patients are assessed as a model to investigate if carbon dioxide gaps and free energy charge may be useful in detecting possible tissue hypoperfusion.
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Acta Anaesthesiol Scand · Feb 2020
Incidence of residual neuromuscular blockade in children below 3 years after a single bolus of cisatracurium 0.1 mg/kg A quality assurance study.
The aim of this quality assurance study was to determine the proportion of patients with residual block (train-of-four (TOF) ratio <0.9) upon conclusion of surgery after a bolus of cisatracurium 0.1 mg/kg. It was considered good quality if less than 10% of the study population had residual block upon conclusion of surgery. ⋯ We found that 8% of the children had residual neuromuscular blockade (TOF ratio <0.9) after administration of a single bolus of cisatracurium 0.1 mg/kg but we cannot exclude that the true proportion is around 20%.