Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · May 2020
Observational StudyCoagulation tests on admission correlate with mortality and morbidity in general ICU-patients: an observational study.
It is well known that low platelet count on admission to intensive care units (ICU) is associated with increased mortality. However, it is unknown whether prothrombin time (PT-INR) and activated partial thromboplastin time (APTT) on admission correlate with mortality and organ failure. Therefore, the aim of this study was to investigate whether PT-INR and APTT at admission can predict outcome in the critically ill patient after adjusting for severity of illness measured with Simplified Acute Physiology Score 3 (SAPS 3). ⋯ Activated partial thromboplastin time prolongation was associated with mortality and all morbidity outcomes except the DAF ventilator. PT-INR increase at admission was associated with DAF vasopressor and DAF ventilator. APTT and PT-INR at admission correlate with morbidity, which is not accounted for in the SAPS 3 model.
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Acta Anaesthesiol Scand · May 2020
Observational StudyImpact of hypotension on cerebral perfusion during general anesthesia induction: a prospective observational study in adults.
During anesthesia, decreases in mean arterial pressure (MAP) are common but the impact on possible cerebral hypoperfusion remains a matter of debate. We evaluated cerebral perfusion in patients with or without cardiovascular comorbidities (Hi-risk vs Lo-risk) during induction of general anesthesia and during hypotensive episodes. ⋯ Our results showed that Hi-risk patients had a higher decrease in MAP and Vm, and a higher occurrence of SR during induction of anesthesia than Lo-risk patients. Correction of MAP with norepinephrine increased Vm mainly in Hi-rik patients.
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Acta Anaesthesiol Scand · May 2020
A prospective journey of the peripherally inserted Central Catheter service, at a Tertiary Paediatric centre in Western Australia.
To document the evolution of the Peripherally Inserted Central Catheter service at Princess Margaret Hospital, now Perth Children's Hospital. ⋯ The evolution of the Peripherally Inserted Central Catheter service at our free standing Tertiary Paediatric Hospital is well documented following these 2 audits. The introduction of a dedicated Anaesthesia led Peripherally Inserted Central Catheter service at our centre has resulted in improved insertion success rates and a reduction in complications.
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Acta Anaesthesiol Scand · May 2020
Swedish intensivists' experiences and attitudes regarding end-of-life decisions.
To make end-of-life (EOL) decisions is a complex and challenging task for intensive care physicians and a substantial variability in this process has been previously reported. However, a deeper understanding of intensivists' experiences and attitudes regarding the decision-making process is still, to a large extent, lacking. The primary aim of this study was to address Swedish intensivists' experiences, beliefs and attitudes regarding decision-making pertaining to EOL decisions. Second, we aimed to identify underlying factors that may contribute to variability in the decision-making process. ⋯ Swedish intensivists' wish to make end-of-life decisions based on sufficient information, medically certain prognosis and consensus with the patient, family, staff and other physicians. Swedish intensivists' experience a variability in end-of-life decisions, which is generally accepted and not questioned.