British journal of anaesthesia
-
Randomized Controlled Trial Multicenter Study
The effect of high protein dosing in critically ill patients: an exploratory, secondary Bayesian analyses of the EFFORT Protein trial.
The EFFORT Protein trial assessed the effect of high vs usual dosing of protein in adult ICU patients with organ failure. This study provides a probabilistic interpretation and evaluates heterogeneity in treatment effects (HTE). ⋯ We found moderate to high probabilities of harm with high protein doses compared with usual protein in ICU patients for the primary and secondary outcomes. We found suggestions of heterogeneity in treatment effects with worse outcomes in participants randomised to high protein doses with renal dysfunction or acute kidney injury and greater illness severity at baseline.
-
Multicenter Study
Environmental and financial impacts of perioperative paracetamol use: a multicentre international life-cycle analysis.
Pharmaceuticals account for 19-32% of healthcare greenhouse gas (GHG) emissions. Paracetamol is a common perioperative analgesic agent. We estimated GHG emissions associated with i.v. and oral formulations of paracetamol used in the perioperative period. ⋯ Intravenous paracetamol has 12-fold greater life-cycle carbon emissions than the oral tablet form. Glass vials have higher greenhouse gas emissions than plastic vials. Intravenous administration should be reserved for cases in which oral formulations are not feasible.
-
Multicenter Study Observational Study
Effect of perioperative blood transfusion on preoperative haemoglobin levels as a risk factor for long-term outcomes in patients undergoing major noncardiac surgery: a prospective multicentre observational study.
Preoperative anaemia and red blood cell (RBC) transfusions are associated with poorer clinical outcomes. It is unknown whether perioperative RBC transfusions mediate the relationship between preoperative haemoglobin levels and postoperative outcomes. ⋯ Preoperative haemoglobin levels were significantly associated with 1-yr MACCEs and all-cause mortality. This effect was not mediated by perioperative RBC transfusions. Further research is needed to confirm these findings.
-
Multicenter Study Observational Study
Nitrous Oxide Manifold and Other Reduction of Emissions (NoMoreGas): a multicentre observational study evaluating pre-utilisation loss of nitrous oxide.
Nitrous oxide (N2O) is a potent greenhouse gas that contributes significantly to the healthcare sector's carbon footprint. Pre-utilisation losses of N2O are up to 95%. Decommissioning manifolds can reduce these losses. ⋯ Consistent with other reports, the data demonstrate a substantial discrepancy between the quantities of N2O procured and utilised clinically, indicative of significant pre-utilisation losses. Our findings support the decommissioning of N2O manifolds for environmental and economic benefits.
-
Multicenter Study
International multi-institutional external validation of preoperative risk scores for 30-day in-hospital mortality in paediatric patients.
Risk prediction scores are used to guide clinical decision-making. Our primary objective was to externally validate two patient-specific risk scores for 30-day in-hospital mortality using the Multicenter Perioperative Outcomes Group (MPOG) registry: the Pediatric Risk Assessment (PRAm) score and the intrinsic surgical risk score. The secondary objective was to recalibrate these scores. ⋯ The intrinsic surgical risk score performed better than the PRAm, but both resulted in large numbers of false positives. Both scores exhibited decreased performance compared with the original studies. ASA physical status scores in sicker patients drove the superior performance of the intrinsic surgical risk score, suggesting the use of a risk score does not improve prediction.