British journal of anaesthesia
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Older patients undergoing cardiac surgery have a 40-60% risk of developing postoperative delirium (POD), which is associated with increased morbidity and mortality. In animals, xenon has been found to be neuroprotective. Little is known about its neuroprotective effects in humans. We evaluated whether xenon anaesthesia prevents POD in patients undergoing cardiac surgery. ⋯ EudraCT: 2014-005370-11 (May 13, 2015; https://www.clinicaltrialsregister.eu/ctr-search/search?query=2014-005370-11).
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Dehydration is common in hospitals and is associated with increased mortality and morbidity. Clinical assessment and diagnostic measures of dehydration are unreliable. We sought to investigate the novel concept that individuals might control their own intravenous rehydration, guided by thirst. ⋯ NCT03932890.
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Impaired cerebrovascular reactivity in adult moderate and severe traumatic brain injury (TBI) is known to be associated with worse global outcome at 6-12 months. As technology has improved over the past decades, monitoring of cerebrovascular reactivity has shifted from intermittent measures, to experimentally validated continuously updating indices at the bedside. Such advances have led to the exploration of individualised physiologic targets in adult TBI management, such as optimal cerebral perfusion pressure (CPP) values, or CPP limits in which vascular reactivity is relatively intact. ⋯ In this narrative review paper, we focus on the concept of cerebral autoregulation, proposed mechanisms of control and methods of continuous monitoring used in TBI. We highlight multimodal cranial monitoring approaches for continuous cerebrovascular reactivity assessment, physiologic and neuroimaging correlates, and associations with outcome. Finally, we explore the recent 'state-of-the-art' advances in personalised physiologic targets based on continuous cerebrovascular reactivity monitoring, their benefits, and implications for future avenues of research in TBI.