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
Multicenter Study Observational StudyPeripheral nerve-blocks and associations with length of stay and readmissions in fast-track total hip and knee arthroplasty.
Peripheral nerve blocks (PNB) have recently been recommended in total hip (THA) and knee (TKA) arthroplasty as they may reduce pain, morphine consumption, length of stay (LOS) and complications. However, whether PNBs are associated with early discharge within an enhanced recovery protocol including multimodal analgesia is uncertain. ⋯ Routine use of peripheral nerve blocks was not associated with early discharge or 30-days readmissions in fast-track THA and TKA. Future studies should focus on benefits of PNB in high-risk patients.
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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
Observational StudyIssuing of isotonic crystalloid solutions to Danish public hospitals in 2021 - a retrospective nationwide observational study.
Intravenous (IV) fluid therapy is a ubiquitous intervention in daily clinical practice. However, nationwide detailed hospital- and departmental-level information on IV fluid use is limited. Hence, we aimed to describe the current issuing of isotonic crystalloid solutions across Danish public hospitals. ⋯ IV fluid administration practices can be assessed across specialties by examining hospital purchasing. This study analysed the use of IV isotonic crystalloid solutions across all major departments of Danish public hospitals for 1 year. Isotonic sodium chloride was the most commonly used fluid in emergency medicine (71%), internal medicine (85%) and surgical departments (71%). Only anaesthesia and intensive care medicine departments used more buffered crystalloid solutions (57%) than isotonic natrium chloride.
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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.