BMC anesthesiology
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Multicenter Study
Development and validation of an EHR-based risk prediction model for geriatric patients undergoing urgent and emergency surgery.
Clinical determination of patients at high risk of poor surgical outcomes is complex and may be supported by clinical tools to summarize the patient's own personalized electronic health record (EHR) history and vitals data through predictive risk models. Since prior models were not readily available for EHR-integration, our objective was to develop and validate a risk stratification tool, named the Assessment of Geriatric Emergency Surgery (AGES) score, predicting risk of 30-day major postoperative complications in geriatric patients under consideration for urgent and emergency surgery using pre-surgical existing electronic health record (EHR) data. ⋯ We developed a model to accurately predict major postoperative complications in geriatric patients undergoing urgent or emergency surgery using the patient's own existing EHR data. EHR implementation of this model could efficiently support clinicians' surgical risk assessment and perioperative decision-making discussions in this vulnerable patient population.
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A previous study showed that airway ultrasound, specifically the distance from the skin to the hyoid bone (DSHB), may be correlated with a higher risk of difficult mask ventilation (DMV). However, the study was conducted in Italy and lacks data for the Asian and Thai populations. This study aimed to predict DMV using pre-operative ultrasonography to measure the DSHB and from the skin to the thyroid isthmus (DSTI) in Thai patients undergoing elective surgery under general anesthesia. ⋯ This study showed that airway ultrasonography to determine DSHB and DSTI during patients' routine physical examinations significantly improved the prediction of DMV. Patients classified as having DMV-III require prompt management for airway difficulties. However, the individual factors DSHB and DSTI alone are insufficient to predict DMV.
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The use of a fluid co-load has been shown to enhance hemodynamic stability and diminish the occurrence of hypotension after spinal anesthesia when paired with prophylactic norepinephrine. This research aimed to identify the effective dosages (ED90 and ED50) of prophylactic norepinephrine boluses, in conjunction with a crystalloid co-load, for the prevention of hypotension after spinal anesthesia in cesarean delivery patients. ⋯ A prophylactic norepinephrine bolus of 5.35 µg, administered with a crystalloid co-load, effectively prevents hypotension following the spinal anesthesia in cesarean delivery patients.
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Multicenter Study
Reticulocyte hemoglobin content: a new frontier in iron deficiency diagnostics for major surgical patients.
Iron deficiency (ID) is the most common nutritional deficiency among patients undergoing major surgery. Treatment of ID is straightforward, however implementing a comprehensive anemia management strategy within clinical routines is complex. Recently, reticulocyte hemoglobin content (Ret-He) has been evaluated as an early marker for ID diagnosis. ⋯ This study highlights the potential of Ret-He as a promising alternative marker for diagnosing ID in patients undergoing major surgery, particularly in cases of elevated ferritin levels or non-anemic patients. Ret-He may serve as a valuable tool to prioritize patients for further iron status testing, especially when preoperative time is limited.
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Multicenter Study Observational Study
Predicting early diagnosis of intensive care unit-acquired weakness in septic patients using critical ultrasound and biological markers.
Early diagnosis of intensive care unit-acquired weakness (ICUAW) is crucial for improving the outcomes of critically ill patients. Hence, this study was designed to identify predisposing factors for ICUAW and establish a predictive model for the early diagnosis of ICUAW. ⋯ Conclusively, a nomogram model is constructed for diagnosing ICUAW in septic patients, which is simple and rapid and allows for visual representation, with excellent diagnostic capability.