Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Feb 2023
Review Meta AnalysisThe Prognostic Value of Elevated Neutrophil-Lymphocyte Ratio for Cardiac Surgery Associated Acute Kidney Injury: A Systematic Review and Meta-Analysis.
Patients undergoing cardiac surgery are at significant risk of developing postoperative acute kidney injury (AKI). Neutrophil-lymphocyte ratio (NLR) is a widely available inflammatory biomarker which may be of prognostic value in this setting. ⋯ Elevated preoperative NLR is a reliable inflammatory biomarker for predicting AKI following cardiac surgery.
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Acta Anaesthesiol Scand · Feb 2023
Observational StudySevere Covid-19 and Acute Pulmonary Hypertension: 24-month follow-up regarding mortality and relationship to initial echocardiographic findings and biomarkers.
Critically ill Covid-19 patients are likely to develop the sequence of acute pulmonary hypertension (aPH), right ventricular strain, and eventually right ventricular failure due to currently known pathophysiology (endothelial inflammation plus thrombo-embolism) that promotes increased pulmonary vascular resistance and pulmonary artery pressure. Furthermore, an in-hospital trans-thoracic echocardiography (TTE) diagnosis of aPH is associated with a substantially increased risk of early mortality. The aim of this retrospective observational follow-up study was to explore the mortality during the 1-24-month period following the TTE diagnosis of aPH in the intensive care unit (ICU). ⋯ The mortality risk was increased up to 24 months after the initial examination in ICU-treated Covid-19 patients with a TTE diagnosis of aPH, compared to non-aPH patients. Certain individual TTE parameters were able to discriminate 24-month risk of morality.
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Acta Anaesthesiol Scand · Feb 2023
Frailty Assessment Tools and Associated Postoperative Outcomes in Older Patients Undergoing Elective Surgery: A Prospective Pilot Study.
There is a need for a feasible tool to assess the risk of frailty prior to surgery. We aimed to identify the ratio of abnormal results for three clinically applicable screening tools to assess the risk of frailty, and their association with adverse outcomes in a cohort of elderly surgical patients. ⋯ Approximately 40% of elderly surgical patients have abnormal PRISMA7, TUG, and CDT screening tests for frailty, and they are associated individually or in combination with increased risk of adverse postoperative outcomes. The results will aid in designing studies to further risk-stratify patients at risk of frailty and attempt to modify associated outcomes.
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Acta Anaesthesiol Scand · Feb 2023
Randomized Controlled TrialHeterogenous treatment effects of dexamethasone 12 mg vs. 6 mg in patients with COVID-19 and severe hypoxaemia - post hoc exploratory analyses of the COVID STEROID 2 trial.
Corticosteroids improve outcomes in patients with severe COVID-19. In the COVID STEROID 2 randomised clinical trial, we found high probabilities of benefit with dexamethasone 12 versus 6 mg daily. While no statistically significant heterogeneity in treatment effects (HTE) was found in the conventional, dichotomous subgroup analyses, these analyses have limitations, and HTE could still exist. ⋯ We found no strong evidence for HTE with 12 versus 6 mg dexamethasone daily on days alive without life support or mortality at Day 90 in patients with COVID-19 and severe hypoxaemia, although these results cannot rule out HTE either.
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Acta Anaesthesiol Scand · Feb 2023
Clinical Trial Observational StudyMinimal important difference in opioid consumption based on adverse event reduction - a study protocol.
The patient-relevant minimal important difference for opioid consumption remains undetermined, despite its frequent use as primary outcome in trials on postoperative pain management. A minimal important difference is necessary to evaluate whether significant trial results are clinically relevant. Further, it can be used as effect size to ensure that trials are powered to find clinically relevant effects. By exploring the dose-response relationship between postoperative opioid consumption and opioid-related adverse effects, we aim to approximate the minimal important difference in opioid consumption anchored to opioid-related adverse effects. ⋯ This study will hopefully bring us one step closer to determining relevant opioid reductions and thereby improve our understanding of intervention effects and planning of future trials.