Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Aug 2020
Long-term Survival and Cognitive Function According to Blood Pressure Management During Cardiac Surgery. A Follow-up.
Cardiac surgery is associated with a risk of complications, including post-operative cognitive dysfunction (POCD). In the randomized Perfusion Pressure Cerebral Infarcts (PPCI) trial, we allocated cardiac surgery patients to either a low-target mean arterial pressure (40-50 mm Hg) or a high-target pressure (70-80 mm Hg). The study found no difference in the volume of new ischemic cerebral lesions nor POCD, but 30-day mortality tended to be higher in the high-target group. In the present study we did a long-term 3-year follow-up to assess survival and level of cognitive functioning. The primary hypothesis was that patients allocated to a high-target blood pressure had a higher long-term mortality at 3-year follow-up. ⋯ No difference in mortality nor in the level of cognitive functioning was found according to blood pressure target during cardiac surgery long-term at 3-year follow-up.
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Acta Anaesthesiol Scand · Aug 2020
Randomized Controlled TrialOpioid tapering after spine surgery: Protocol for a randomized controlled trial.
Patients are often prescribed opioids at discharge from hospital following surgery. Several studies have shown that a large number of patients do not taper off but continue to use opioids after surgery. Tapering plans and follow-up after discharge may reduce opioid consumption. ⋯ Our study is expected to provide valuable information on opioid tapering after surgery in patients with preoperative opioid use.
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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.
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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.
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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.