Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Jul 2021
Shock index as a predictor for short term mortality in helicopter emergency medical services: a registry study.
The value of shock-index has been demonstrated in hospital triage, but few studies have evaluated its prehospital use. The aim of our study was to evaluate the association between shock-index in prehospital critical care and short-term mortality. ⋯ The shock-index is associated with short time mortality in most critical patient categories in the prehospital setting. However, the marked overlap of shock-index in survivors and non-survivors in all patient categories limits its predictive value.
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Acta Anaesthesiol Scand · Jul 2021
The capacity of neurological pupil index to predict absence of somatosensory evoked potentials after cardiac arrest - a study protocol.
Anoxic-ischemic brain injury is the most common cause of death after cardiac arrest (CA). Robust methods to detect severe injury with a low false positive rate (FPR) for poor neurological outcome include the pupillary light reflex (PLR) and somatosensory evoked potentials (SSEP). The PLR can be assessed manually or with automated pupillometry which provides the neurological pupil index (NPi). We aim to describe the interrelation between NPi values and the absence of SSEP cortical response and to evaluate the capacity of NPi to predict the absence of cortical SSEP response in comatose patients after CA. ⋯ The PLR and SSEP may have a systematic interrelation, and a certain NPi threshold could potentially predict the absence of cortical SSEP response. If this can be concluded from the present study, SSEP testing could be excluded in certain patients to save resources in the multimodal prognostication after CA. Editorial comment The interrelation between loss of the pupillary light reflex (PLR) and the loss of cortical response to a somatosensory evoked potential (SSEP) in comatose cardiac arrest patients is not known. This exploratory prospective study is designed to evaluate whether a specific degree of attenuated PLR, as measured by semiautomated pupillometry, can predict the bilateral loss of cortical SSEP response in severe anoxic/ischemic brain injury. Such an interrelation between the two methods would enable the use of pupillometry rather than the more resource demanding SSEP for neurologic prognostication in post cardiac arrest patients.
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Acta Anaesthesiol Scand · Jul 2021
Sleep-wake rhythms determined by actigraphy during in-hospital stay following discharge from an intensive care unit.
Sleep and circadian disturbances play a major role in recovery after critical illness. Ample research has shown sleep to be disturbed during the stay at the intensive care unit (ICU); however, the trajectory of sleep after ICU discharge is sparsely described. The current study aimed to describe the development of the sleep-wake rhythm in subjects discharged from ICU to a hospital ward. ⋯ The duration of sleep and wake time did not improve during ward stay. However, sleep became less fragmented and naps during the day declined. Due to the small sample size further, larger trials are needed.
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Acta Anaesthesiol Scand · Jul 2021
Plasma concentrations of syndecan-1 are dependent on kidney function.
Elevated plasma concentrations of syndecan-1 and heparan sulfate in studies of trauma, sepsis, and major surgery are commonly assumed to indicate acute glycocalyx degradation. We explored a possible role of the kidneys for these elevations. ⋯ The renal elimination of syndecan-1 and heparan sulfate varied greatly. A change in kidney function, which is common after trauma and major surgery, might alone induce several-fold changes in their plasma concentrations.
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Acta Anaesthesiol Scand · Jul 2021
Clinical considerations for reposition of a dislocated hip: A qualitative study.
A well-known complication of having hip alloplasty surgery is dislocation of the prothesis. This affects 2%-4% of the patients, and 75% of the dislocations occur within the first year after surgery. The aim of our study was to gain knowledge about the clinical considerations underlying the choice of anaesthesia for, and treatment of, patients with dislocated hips by specialists in anaesthesiology and orthopaedic surgery. ⋯ Our study illustrates different clinical considerations made by specialists in anaesthesiology and orthopaedic surgery in relation to the treatment of patients with dislocated hips. Our results hope to promote mutual understanding in joint clinical decision-making in relation to patients with dislocated hips as well as to inspire less-experienced anaesthesiologists and orthopaedic surgeons. Additionally, our results suggest a set of "rules of thumb" for how jointly to decide on the repositioning site of the patient during the procedure.