Articles: cations.
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Frailty is increasingly prevalent in the aging neurosurgical population and is an important component of perioperative risk stratification and optimization to reduce complications. Frailty is measured using the phenotypic or deficit accumulation models, with simplified tools most commonly used in studies of neurosurgical patients. ⋯ Evidence for interventions to improve outcomes for frail neurosurgical patients is limited, and the role of bundled care pathways, prehabilitation, and multidisciplinary involvement requires further investigation. Surgery itself may be an intervention to improve frailty in selected patients, and future research should focus on identifying effective interventions to improve both short-term complications and long-term outcomes.
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Curr Opin Anaesthesiol · Apr 2024
ReviewHow much does it cost to be fit for operation? The economics of prehabilitation.
Prehabilitation before elective surgery can include physical, nutritional, and psychological interventions or a combination of these to allow patients to return postoperatively to baseline status as soon as possible. The purpose of this review is to analyse the current date related to the cost-effectiveness of such programs. ⋯ Prehabilitation before elective surgery has been shown to minimize the periprocedural complications and optimization of short term follow up after surgical procedures. Recent studies included cost analysis, either based on hospital accounting data or on estimates costs. The healthcare cost was mainly reduced by shortening the number of hospitalization day. Other factors included length of ICU stay, place of the prehabilitation program (in-hospital vs. home-based) and compliance to the program.
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Randomized Controlled Trial
The effects of video double-lumen tubes on intubation complications in patients undergoing thoracic surgery: A randomised controlled study.
Tracheal injuries, vocal cord injuries, sore throat and hoarseness are common complications of double-lumen tube (DLT) intubation. ⋯ There was no statistically significant difference in the incidence of moderate-to-severe tracheal injury and vocal cord injury between DLTs and VDLTs. While improving the first-attempt success rate, intubation with VDLT increased the incidence of postoperative 24 h sore throat and hoarseness.
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Critical care medicine · Apr 2024
Observational StudyModification in ICU Design May Affect Delirium and Circadian Melatonin: A Proof of Concept Pilot Study.
Nonpharmacologic delirium management is recommended by current guidelines, but studies on the impact of ICU design are still limited. The study's primary purpose was to determine if a multicomponent change in room design prevents ICU delirium. Second, the influence of lighting conditions on serum melatonin was assessed. ⋯ Modifications in ICU room design may influence the incidence and severity of delirium. Dedicated light therapy could potentially influence delirium outcomes by modulating circadian melatonin levels.
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Observational Study
Coronary Artery Calcification and Risk of Cardiac Complication in Geriatric Trauma Population.
Better means of identifying patients with increased cardiac complication (CC) risk is needed. Coronary artery calcification (CAC) is reported on routine chest CT scans. We assessed the correlation of CAC and CCs in the geriatric trauma population. ⋯ CAC as reported on chest CT scans demonstrates a significant correlation with CC and should warrant additional cardiac monitoring.