Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Mar 2019
Energy expenditure of patients on ECMO: A prospective pilot study.
An optimal nutritional approach sustained by convenient monitoring of metabolic status and reliable assessment of energy expenditure (EE) may improve the outcome of critically ill patients on extracorporeal membrane oxygenation (ECMO). We previously demonstrated the feasibility of indirect calorimetry (IC)-the standard of care technique to determine caloric targets-in patients undergoing ECMO. This study aims to compare measured with calculated EE during ECMO treatment. We additionally provide median EE values for use in settings where IC is not available. ⋯ Compared with measured EE, calculation of EE both over- and underestimated caloric needs during ECMO treatment. Despite a median EE of 21 kcal/kg/day, large variability in metabolic rate was found and demands further investigation.
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Acta Anaesthesiol Scand · Mar 2019
Randomized Controlled Trial Multicenter StudyIndications for fluid resuscitation in patients with septic shock: Post-hoc analyses of the CLASSIC trial.
Fluid resuscitation is recommended in septic shock, but the specific indications for fluids have not been established. Our aim was to investigate the indications currently used for fluid resuscitation and the effect of fluid on these indications in patients with septic shock admitted to the intensive care unit (ICU). ⋯ In ICU patients with septic shock, low blood pressure, high lactate, and low urinary output were the most frequent indications for fluid. The effects of fluids when given on these indications were less clear, but may dependent on the time course of sepsis resuscitation.
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Acta Anaesthesiol Scand · Mar 2019
Randomized Controlled TrialRemote real-time supervision via tele-ultrasound in focused cardiac ultrasound: A single-blinded cluster randomized controlled trial.
Supervision via tele-ultrasound presents a remedy for lacking on-site supervision in focused cardiac ultrasound, but knowledge of its impact is largely absent. We aimed to investigate tele-supervised physicians' cine-loop quality compared to that of non-supervised physicians and compared to that of experts. ⋯ Tele-supervised physicians performed scans of better quality than non-supervised physicians. The present study supports the use of tele-supervision for physicians with basic focused ultrasound competence in a setting where on-site supervision is unavailable.
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Acta Anaesthesiol Scand · Mar 2019
Randomized Controlled TrialPulmonary haemodynamics and right ventricular function in cemented vs uncemented total hip arthroplasty-A randomized trial.
Bone cement implantation syndrome (BCIS) is a feared complication in orthopaedic surgery with a huge impact on post-operative morbidity. In this randomized trial, we evaluated the effects of bone cement on pulmonary and systemic haemodynamics in patients receiving either cemented or uncemented hip arthroplasty for isolated femoral neck fracture. ⋯ The use of bone cement in total hip arthroplasty increases pulmonary vascular resistance and the afterload of the RV with potentially negative effects on RV performance.
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Acta Anaesthesiol Scand · Mar 2019
Patterns of cerebral tissue oxygen tension and cytoplasmic redox state in bacterial meningitis.
Compromised cerebral energy metabolism is common in patients with bacterial meningitis. In this study, simultaneous measurements of cerebral oxygen tension and lactate/pyruvate ratio were compared to explore whether disturbed energy metabolism was usually caused by insufficient tissue oxygenation or compromised oxidative metabolism of pyruvate indicating mitochondrial dysfunction. ⋯ This study demonstrated that compromised cerebral energy metabolism, evidenced by increased LP ratio, was common in patients with severe bacterial meningitis while not related to insufficient tissue oxygenation.