European journal of anaesthesiology
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Randomized Controlled Trial
Psychoacoustic analysis of noise and the application of earplugs in an ICU: A randomised controlled clinical trial.
Patients and medical staff are exposed to high noise levels in ICUs, which may have a negative impact on their health. Due to the diversity of noise sources present, including the operating noise of medical devices, staff conversations and the unwrapping of disposables, noise profiles are varied. Psychoacoustics deals with the analysis of sound, focusing on its effects on physiological perception and stress. ⋯ Noise in the ICU is of high clinical relevance. Diverse noise reduction methods, such as earplugs and active noise cancellation, are available. The avoidance of unnecessary noise, however, should be the primary focus.
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Statins reduce risk from coronary artery bypass graft (CABG) surgery, but the influence of angiotensin-converting enzyme inhibitors, alpha-2 adrenergic agonists, calcium channel blockers and beta-blockers is less clear. ⋯ Statins appear consistently protective against perioperative mortality from CABG surgery in multiple models, an effect not shared by the other cardiovascular drugs. Further data are needed on whether statins exert class and dose-response effects.
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Observational Study
The relationship between pulmonary artery acceleration time and mean pulmonary artery pressure in patients undergoing cardiac surgery: An observational study.
A noninvasive method of estimating pulmonary arterial pressures is required, as the use of the pulmonary artery catheter (PAC) is decreasing in cardiac anaesthesia. Pulmonary hypertension is defined as a mean pulmonary artery pressure (MPAP) at least 25 mmHg and this can be estimated echocardiographically by measuring the pulmonary acceleration time (PAT). This relationship has not been validated when measured using transoesophageal echocardiography (TOE) in anaesthetised patients having cardiac surgery. ⋯ Estimation of PAT with TOE in anaesthetised cardiac surgical patients is possible. PAT is good at discriminating between patients with and without pulmonary hypertension, with a cut-off of less than 107 ms detecting pulmonary hypertension with a sensitivity of 75% and specificity of 94.8%.
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Observational Study
Life-threatening complications after postoperative intermediate care unit discharge: A retrospective, observational study.
Postoperative patients who require intensive monitoring, intervention with an arterial line, vasoactive drugs and prolonged ventilator weaning are admitted to the postoperative intermediate care unit (IMCU). ⋯ More than 1% of patients had a life-threatening complication within 7 days after IMCU discharge, but with no deaths. Risk factors were an emergency operation before IMCU admission, higher cumulative perioperative fluid load and a short period of mechanical ventilation during the IMCU stay.