Acta anaesthesiologica Scandinavica
-
Acta Anaesthesiol Scand · Aug 2020
Review Meta AnalysisCritical Care Transition Programs on Readmission or Death: A Systematic Review and Meta-Analysis.
Deterioration after ICU discharge may lead to readmission or even death. Interventions (eg, critical care transition programs) have been developed to improve the clinical handover between the ICU and the ward. We conducted a systematic review with meta-analysis and trial sequential analysis (TSA) according to Cochrane Handbook and Grading of recommendations, assessment, development and evaluations (GRADE) methodology to assess the impact of these interventions on readmission and death (PROSPERO, no CRD42019121746). ⋯ We found no clear benefit in terms of reducing risk of readmission or death after ICU discharge, however, with overall very low certainty of evidence.
-
Acta Anaesthesiol Scand · Aug 2020
ReviewData quality ofGlasgow Coma Scale and Systolic Blood Pressure in scientific studies involvingphysician-staffed emergency medical services: systematic review.
Emergency physicians on-scene provide highly specialized care to severely sick or injured patients. High-quality research relies on the quality of data, but no commonly accepted definition of EMS data quality exits. Glasgow Coma Score (GCS) and Systolic Blood Pressure (SBP) are core physiological variables, but little is known about the quality of these data when reported in p-EMS research. This systematic review aims to describe the quality of pre-hospital reporting of GCS and SBP data in studies where emergency physicians are present on-scene. ⋯ Reporting of GCS and SBP is variable in scientific papers. We recommend standardized reporting to enable comparisons of p-EMS.
-
Acta Anaesthesiol Scand · Aug 2020
Observational StudyMortality after Severe Sepsis and Septic Shock in Swedish Intensive Care Units 2008 - 2016 - a nationwide observational study.
Recent studies have reported substantially decreased hospital mortality for sepsis, but data are scarcer on outcomes after hospital discharge. We studied mortality up to 1 year in Swedish intensive care unit (ICU) patients with and without sepsis. ⋯ Mortality in severe sepsis and septic shock is high, with more than one in three patients not surviving three months after ICU admission, and adjusted mortality has not decreased convincingly in Sweden 2008-2016.
-
Acta Anaesthesiol Scand · Aug 2020
Review Multicenter Study Observational StudyB-Lines for the assessment of extravascular lung water: just focused or semi-quantitative?
B-lines as typical artefacts of lung ultrasound are considered as surrogate measurement for extravascular lung water. However, B-lines develop in the sub-pleural space and do not allow assessment of the whole lung. Here, we present data from the first observational multi-centre study focusing on the correlation between a B-lines score and extravascular lung water in critically ill patients suffering from a variety of diseases. ⋯ Assessment of B-lines does not accurately reflect actual extravascular lung water. In presence of an impaired oxygenation, B-lines may reliably indicate increased extravascular lung water as cause of the oxygenation disorders.
-
Acta Anaesthesiol Scand · Aug 2020
Randomized Controlled Trial Multicenter Study Observational StudyEffects of simulated sample sizes on the mortality effect estimatesinthreerandomised intensive care unittrials.
Randomized clinical trials (RCTs) are occasionally stopped prematurely before reaching their planned sample sizes. It has been suggested that early stopped RCTs are associated with under- and overestimation of the effect estimates. We simulated the effect of hypothetical premature stopping of three large RCTs done in the intensive care unit (ICU) setting. ⋯ In this post hoc study of three international RCTs within intensive care, we found that the simulated interim mortality effect estimates showed considerable fluctuations until at least 20%-30% of the sample size was included, but remained instable until the final sample sizes had been included. Thus, this study illustrates the necessity for cautious interpretations of prematurely stopped trials.