Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Nov 2019
Observational StudyPoint-of-care analyses of blood samples from intraosseous access in pre-hospital critical care.
Intraosseous (IO) access is used for fluid and medication administration in emergency situations when difficulties with vascular access are encountered. IO access would be readily available to take samples for point-of-care (POC) analysis, but there is scarce evidence about the reliability of POC analysis of IO samples among emergency patients. The aim of this study was to evaluate the feasibility and reliability of POC analysis of IO samples in critically ill pre-hospital patients. ⋯ When vascular access is challenging, IO access can be used for emergency POC analyses to help guide clinical decision-making. However, the limitations of IO POC analyses must be carefully considered.
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Acta Anaesthesiol Scand · Nov 2019
Comparative StudyPercutaneous versus surgical emergency cricothyroidotomy: An experimental randomised crossover study on an animal-larynx model.
Airway management is a paramount clinical skill for the anaesthesiologist. The Emergency Cricothyroidotomy (EC) constitutes the final step in difficult airway algorithms securing a patent airway via a front-of-neck access. The main distinction among available techniques is whether the procedure is surgical and scalpel-based or percutaneous and needle-based. ⋯ Our study demonstrated that anaesthesiologists achieved successful airway access on an animal experimental model with both EC methods within a reasonable time frame, but the scalpel-based EC is performed more promptly. Recent EC training affected the time expenditure positively, while seniority and clinical EC experience did not. EC procedures should be regularly trained for.
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Acta Anaesthesiol Scand · Nov 2019
Neutrophil activation in septic acute kidney injury: A post-hoc analysis of the FINNAKI study.
Inflammation, reflected by high plasma interleukin-6 concentration, is associated with acute kidney injury (AKI) in septic patients. Neutrophil activation has pathophysiological significance in experimental septic AKI. We hypothesized that neutrophil activation is associated with AKI in critically ill sepsis patients. ⋯ Interleukin-8 in plasma and urine was associated with septic AKI. Elevated plasma activin A indicates intravascular neutrophil activation in septic AKI. Concomitant plasma and urine myeloperoxidase measurements suggest neutrophil accumulation into injured kidneys.
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Acta Anaesthesiol Scand · Nov 2019
Observational StudyC-Reactive Protein for Risk Prediction of Postoperative Delirium and Postoperative Neurocognitive Disorder.
Post-operative delirium (POD) and post-operative neurocognitive disorder (NCD) are frequently seen in the elderly. Development of biomarkers for pre-operative risk prediction is of major relevance. As inflammation present before surgery might predispose to POD and post-operative NCD development, we aim to determine associations between pre-operative C-reactive protein (CRP) and the incidence of POD and post-operative NCD. ⋯ Pre-operative CRP levels were independently associated with POD but not post-operative NCD after three months. Moreover, higher pre-operative CRP levels showed higher risk for POD. This strengthens the role of inflammation in the development of POD. Assessment of CRP before surgery might allow risk stratification of POD.
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Acta Anaesthesiol Scand · Nov 2019
Agents Intervening against Delirium in the Intensive Care Unit (AID-ICU) - Protocol for a randomised placebo-controlled trial of haloperidol in patients with delirium in the ICU.
Delirium among patients in the intensive care unit (ICU) is a common condition associated with increased morbidity and mortality. Haloperidol is the most frequently used pharmacologic intervention, but its use is not supported by firm evidence. Therefore, we are conducting Agents Intervening against Delirium in the Intensive Care Unit (AID-ICU) trial to assess the benefits and harms of haloperidol for the treatment of ICU-acquired delirium. ⋯ The AID-ICU trial is based on gold standard methodology applied to a large sample of clinically representative patients and will provide pivotal high-quality data on the benefits and harms of haloperidol for the treatment ICU-acquired delirium.