Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Feb 2017
Randomized Controlled Trial Multicenter Study Comparative StudyHigher vs. lower haemoglobin threshold for transfusion in septic shock: subgroup analyses of the TRISS trial.
Using a restrictive transfusion strategy appears to be safe in sepsis, but there may be subgroups of patients who benefit from transfusion at a higher haemoglobin level. We explored if subgroups of patients with septic shock and anaemia had better outcome when transfused at a higher vs. a lower haemoglobin threshold. ⋯ In exploratory analyses of a randomized trial in patients with septic shock and anaemia, we observed no survival benefit in any subgroups of transfusion at a haemoglobin threshold of 90 g/l vs. 70 g/l.
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Acta Anaesthesiol Scand · Feb 2017
Comparative StudyAn observational study of community-acquired severe sepsis comparing intensive care and non-intensive care patients.
Most studies of sepsis are from intensive care units (ICUs). We aimed to investigate community-acquired severe sepsis in a broader population, in order to compare patients treated in or outside an ICU . ⋯ Half of the subjects with community-acquired severe sepsis never received ICU treatment. Still, use of organ supportive therapy outside the ICU was considerable. Hospital mortality was higher, whereas 5-year survival was similar when comparing ICU with non-ICU patients.
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Acta Anaesthesiol Scand · Feb 2017
Adductor canal blocks: changing practice patterns and associated quality profile.
Femoral nerve blocks have been the gold standard approach for post-operative analgesia following total knee arthroplasty; however, the adductor canal block has recently gained popularity due to less block-induced motor weakness. The primary aim of this time-series analysis was to identify whether regional anesthesia practice changes have occurred for total knee arthroplasty. Our secondary aim was to assess for possible associated changes in safety and quality. ⋯ There was a large increase in the utilization of adductor canal blockade for TKAs among participating registry members. This change in practice was not associated with significant changes in safety or quality.
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Acta Anaesthesiol Scand · Feb 2017
Cumulative changes in weight but not fluid volume balances reflect fluid accumulation in ICU patients.
The cumulative fluid balance of critically ill patients seems to be an outcome-relevant variable. However, there are no validated data for their reliability calculated for longer (> 5 days) periods of time. ⋯ Assuming that changes in body weight reflect changes in whole body water content cumulative daily fluid volume balances without or with correction for insensible water loss are not useful for estimating cumulative fluid balance of ICU patients. Survivors but not nonsurvivors had a significant loss of weight over time.
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Acta Anaesthesiol Scand · Feb 2017
Extracorporeal cardiopulmonary resuscitation after out-of-hospital cardiac arrest in a Danish health region.
Extracorporeal Cardiopulmonary Resuscitation (ECPR) has emerged as a feasible rescue therapy for refractory, normothermic out-of-hospital cardiac arrest (OHCA). Reported survival rates vary and comparison between studies is hampered by heterogeneous study populations, differences in bystander intervention and in pre-hospital emergency service organisation. We aimed to describe the first experiences, treatment details, complications and outcome with ECPR for OHCA in a Danish health region. ⋯ Extracorporeal cardiopulmonary resuscitation is feasible as a rescue therapy in normothermic refractory OHCA in highly selected patients. Low-flow time was longer than previously reported. Survival with favourable neurological outcome is possible despite prolonged low-flow duration.