Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Jan 2025
Accuracy of estimating equations for the assessment of glomerular filtration rate in critically ill patients versus outpatients.
Estimating equations for the assessment of glomerular filtration rate (GFR) have been poorly investigated in the critical care setting. We evaluated the agreement between the GFR measured with 51CrEDTA/iohexol (mGFR) and four estimating equations based on serum concentrations of creatine and/or cystatin C (eGFR) in two cohorts: critically ill patients and outpatients with normal-to-moderately reduced GFR. ⋯ For the assessment of glomerular filtration rate (GFR), it can be measured directly, but is frequently estimated using a point measure of serum creatinine concentration. In this study, ICU case GFR estimations, by different adjusted equations, done also for a cohort of outpatients, showed that these serum creatinine-based estimations for ICU cases are not highly precise or reliable.
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Acta Anaesthesiol Scand · Jan 2025
Time to detection of serious adverse events by continuous vital sign monitoring versus clinical practice.
Continuous vital sign monitoring detects far more severe vital sign deviations (SVDs) than intermittent clinical rounds, and deviations are to some extent related to subsequent serious adverse events (SAEs). Early detection of SAEs is pivotal to allow for effective interventions but the time relationship between detection of SAEs by continuous vital sign monitoring versus clinical practice is not well-described at the general ward. ⋯ Continuous vital sign monitoring detects signs of oncoming SAEs in the form of SVD hours before CSD, potentially allowing for earlier and more effective treatments to reduce the extent of SAEs.
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Acta Anaesthesiol Scand · Jan 2025
Are labor epidural catheters after a combined spinal epidural (CSE) technique more reliable than after a traditional epidural? A retrospective review of 9153 labor epidural catheters.
The combined spinal epidural (CSE) technique may associate with a lower failure rate of epidural catheters compared to traditional epidural catheters. This may be significant for the parturients as failure of neuraxial analgesia has been associated with a negative impact on birth experience. ⋯ CSE technique was not associated with a better survival rate of epidural catheters for provision of analgesia or epidural top-up anesthesia for intrapartum CD. In addition, the time to replacement of the catheter was significantly longer when analgesia was initiated with the CSE technique. Maternal satisfaction scores were lower if catheters required replacement.
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Acta Anaesthesiol Scand · Jan 2025
Different measures of ventilatory efficiency in preoperative cardiopulmonary exercise testing are useful for predicting postoperative complications in abdominal cancer surgery.
Ventilation as a function of elimination of CO2 during incremental exercise (VE/VCO2 slope) has been shown to be a valuable predictor of complications and death after major non-cardiac surgery. VE/VCO2 slope and partial pressure of end-tidal carbon dioxide (PetCO2) are both affected by ventilation/perfusion mismatch, but research on the utility of PetCO2 for risk stratification in major abdominal surgery is limited. ⋯ Both preoperative VE/VCO2 slope and PetCO2 could identify subjects with a very high risk of complications following oesophageal resection, with similar prognostic utility. PetCO2 can be measured with simpler equipment and could therefore be useful when CPET is not available.
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Acta Anaesthesiol Scand · Jan 2025
Observational StudyRe-arrest immediately after return of spontaneous circulation: A retrospective observational study of in-hospital cardiac arrest.
Patients who achieve return of spontaneous circulation (ROSC) after in-hospital cardiac arrest (IHCA) may re-arrest. This phenomenon has not been sufficiently investigated. The aim of this study was to examine the immediate (1-min) and short-term (20-min) risks of re-arrest in IHCA. ⋯ The immediate risk of re-arrest was approximately 2% per minute, with the highest risk occurring as a reversion to VF/VT if ROSC was obtained from VF/VT. The risk of re-arrest within 20 min of the initial arrest was 27%, and the overall risk of at least one re-arrest per episode was 33%.