Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Jul 2018
Review Meta AnalysisStress ulcer prophylaxis in adult intensive care unit patients - a protocol for a systematic review.
In the intensive care unit (ICU), stress ulcer prophylaxis with proton pump inhibitors or histamine-2-receptor antagonists is standard of care although gastrointestinal bleeding remains uncommon. It remains unknown whether its use is associated with benefits or harms and the quality of evidence supporting the use of stress ulcer prophylaxis has been questioned. Accordingly, the objective of this systematic review was to critically assess the evidence from randomized clinical trials on the benefits and harms of stress ulcer prophylaxis vs. placebo or no prophylaxis in adult ICU patients. ⋯ The evidence on the benefits and harms of stress ulcer prophylaxis in adult ICU patients is unclear and an updated systematic review is warranted as new trials have been published. To control risks of systematic and random errors, we will use Cochrane and GRADE methodology and Trial Sequential Analysis. Our ambition with this systematic review is to provide updated, reliable and precise data to better inform decision makers on the use of stress ulcer prophylaxis in adult ICU patients.
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Acta Anaesthesiol Scand · Jul 2018
Multicenter Study Comparative StudyEpidural extension failure in obese women is comparable to that of non-obese women.
Management of labor epidurals in obese women is difficult and extension to surgical anesthesia is not always successful. Our previous retrospective pilot study found epidural extension was more likely to fail in obese women. This study used a prospective cohort to compare the failure rate of epidural extension in obese and non-obese women and to identify risk factors for extension failure. ⋯ The failure rate of epidural extension did not differ significantly between the groups. Further research is needed to determine the influence of body mass index > 50 kg/m2 on epidural extension for cesarean section.
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Acta Anaesthesiol Scand · Jul 2018
Randomized Controlled TrialA pilot study of hyperoxemia on neurological injury, inflammation and oxidative stress.
Normobaric hyperoxia is used to alleviate secondary brain ischaemia in patients with traumatic brain injury (TBI), but clinical evidence is limited and hyperoxia may cause adverse events. ⋯ Higher fraction of inspired oxygen did not increase blood concentrations of markers of oxidative stress, inflammation or neurological injury or the incidence of pulmonary complications in severe TBI patients on mechanical ventilation.
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Acta Anaesthesiol Scand · Jul 2018
A novel technique for endobronchial blocker placement for one-lung ventilation in children under 2 years.
The present study aimed to report our clinical experience with intraluminal calculated distance for endobronchial blocker placement (ICEB) and to find out whether ICEB could reduce the number of hypoxemia episodes during blocker placement compared with extraluminal blocker placement for one-lung ventilation in children under the age of 2 years. ⋯ Intraluminal calculated distance for endobronchial blocker placement is a feasible method to achieve lung isolation and could reduce hypoxemia episodes during blocker placement in children under the age of 2 years.
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Acta Anaesthesiol Scand · Jul 2018
Simulation-based point-of-care ultrasound training: a matter of competency rather than volume.
Point-of-care ultrasonography plays an increasingly important role in the initial resuscitation of critically ill patients but acquisition of the skill is associated with long learning curves. The skills required to perform ultrasound examinations can be practiced in a simulated setting before being performed on actual patients. The aim of this study was to investigate the learning curves for novices training the FAST protocol on a virtual-reality simulator. ⋯ Novices can attain mastery learning levels using simulation-based ultrasound training with less than, on average, 2 h of practice. However, we found large variations in the amount of training needed, which raises questions about the adequacy of current volume-based models for determining ultrasound competency.