Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Sep 2020
Randomized Controlled Trial Multicenter StudyLong-term mortality in the Intermediate care after emergency abdominal surgery (InCare) trial - a post-hoc follow-up study.
Patients undergoing emergency abdominal surgery are at high risk of post-operative complications. Although post-operative treatment at an intermediate care unit may improve early outcome, there is a lack of studies on the long-term effects of such therapy. The aim of this study was to assess the long-term effect of intermediate care versus standard surgical ward care on mortality in the Intermediate Care After Emergency Abdominal Surgery (InCare) trial. ⋯ We found no statistically significant difference in 6-year mortality between patients randomized to post-operative intermediate care or ward care after emergency abdominal surgery. However, we detected an absolute mortality risk reduction of 5% in favour of ward care, possibly due to random error.
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Acta Anaesthesiol Scand · Sep 2020
End-expiratory lung volume assessment using helium and carbon dioxide in an experimental model of pediatric capnoperitoneum.
Capnoperitoneum during laparoscopy leads to cranial shift of the diaphragm, loss in lung volume, and risk of impaired gas exchange. Infants are susceptible to these changes and bedside assessment of lung volume during laparoscopy might assist with optimizing the ventilation. Thus, the primary aim was to investigate the monitoring value of a continuous end-expiratory lung volume (EELV) assessment method based on CO2 dynamics ( EELV CO 2 ) in a pediatric capnoperitoneum model by evaluating the correlation and trending ability against helium washout (EELVHe ). ⋯ In this animal model of pediatric capnoperitoneum, reliable assessment of changes in EELV based on EELV CO 2 requires an open lung strategy, defined as EELV above approximately 20 mL kg-1 .
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Acta Anaesthesiol Scand · Sep 2020
Randomized Controlled TrialTransmuscular quadratus lumborum block for percutaneous nephrolithotomy: study protocol for a dose-finding trial.
The objective of this trial is to optimize the transmuscular quadratus lumborum (TQL) block, by investigating the minimal effective volume (MEV90 ) of ropivacaine 0.75% for single-shot TQL block in percutaneous nephrolithotomy (PNL) patients. ⋯ Recruiting will begin June 2020 and is expected to finish November 2020. Data analysis will be performed at interims during and after the study. Results will be published in an international peer-reviewed medical journal.
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The Starling Principle states that fluid movements between blood and tissues are determined by differences in hydrostatic and colloid osmotic (oncotic) pressures between plasma inside microvessels and fluid outside them. The Revised Starling Principle recognizes that, because microvessels are permeable to macromolecules, a balance of pressures cannot halt fluid exchange. In most tissues, steady oncotic pressure differences between plasma and interstitial fluid depend on low levels of steady filtration from plasma to tissues for which the Revised Principle provides the theory. ⋯ Fluid uptake is transient, being rapid at first then attenuating but low levels may continue for more than an hour. The Revised Principle highlights the role of oncotic pressure of small volumes of interstitial fluid within a sub-compartment surrounding the microvessels rather than the tissue's mean interstitial fluid oncotic pressure. This maximizes oncotic pressure differences when capillary pressure are high and enhances initial absorption rates when pressures are low, accelerating short-term regulation of plasma volume.
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Acta Anaesthesiol Scand · Sep 2020
Comparative StudyHypothermia during CRRT, a comparative analysis.
One of the most common adverse events during continuous renal replacement therapy (CRRT) is hypothermia, reported to occur in over 4/10 cases. In turn, hypothermia is known to be associated with higher mortality rates among patients treated in intensive care units (ICU). The present study examined if a novel warming device in the current generation of CRRT systems could lower incidence of hypothermia compared to previous generation technology. ⋯ The current generation CRRT system and blood warmer significantly decreases the risk of hypothermia among critically ill patients treated with continuous renal replacement therapy as compared to historic controls. Achieving target temperature is easier with the new system.