British journal of anaesthesia
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Randomized Controlled Trial Multicenter Study Observational Study
Association between intraoperative electroencephalographic suppression and postoperative mortality.
Low bispectral index values frequently reflect EEG suppression and have been associated with postoperative mortality. This study investigated whether intraoperative EEG suppression was an independent predictor of 90 day postoperative mortality and explored risk factors for EEG suppression. ⋯ NCT00281489 and NCT00682825.
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Comparative Study
Acute kidney injury after infrarenal abdominal aortic aneurysm surgery: a comparison of AKIN and RIFLE criteria for risk prediction.
Although both Acute Kidney Injury Network (AKIN) and risk, injury, failure, loss, and end-stage (RIFLE) kidney disease criteria are frequently used to diagnose acute kidney injury (AKI), they have rarely been compared in the diagnosis of AKI in patients undergoing surgery for infrarenal abdominal aortic aneurysm (AAA). This study investigated the incidence of, and risk factors for, AKI, defined by AKIN and RIFLE criteria, and compared their ability to predict mortality after infrarenal AAA surgery. ⋯ Although AKI defined by either AKIN or RIFLE criteria was associated with overall mortality, AKIN criteria showed better prediction of mortality in patients undergoing infrarenal AAA surgery.
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The concept of rapid delivery of multiple blood products to the bedside of a massively haemorrhaging patient seems to be a logical approach to the management of the massively bleeding patient. However, controversy exists in the use of fixed blood component ratios. Assessing the extent of the coagulopathy through point-of-care testing might provide patients with product administration as needed, and avoid excessive transfusion and its associated complications.
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Comparative Study
Percutaneous transtracheal ventilation in an obstructed airway model in post-apnoeic sheep.
Temporizing oxygenation by percutaneous transtracheal ventilation (PTV) is a recommended emergency technique in 'can't intubate, can't oxygenate' (CICO) situations. Barotrauma risk increases if expiration is obstructed. The Ventrain(®) is a new PTV device that assists expiration. Our aim was to compare key physiological outcomes after PTV with the Ventrain and the Manujet(®) in a large animal obstructed airway model. ⋯ The Ventrain provided stable oxygenation and effective ventilation at low airway pressures during emergency PTV in critically obstructed airways. The Manujet provided effective temporizing oxygenation in this situation with hypoventilation necessary to minimize barotrauma risk. The nature and extent of airway obstruction may not be known in a CICO emergency but an understanding of device differences may help inform optimal ventilation device and method selection.
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Observational Study
Survival after postoperative morbidity: a longitudinal observational cohort study†
Previous studies have suggested that there may be long-term harm associated with postoperative complications. Uncertainty exists however, because of the need for risk adjustment and inconsistent definitions of postoperative morbidity. ⋯ Prolonged morbidity after surgery is associated with a risk of premature death for a longer duration than perhaps is commonly thought; however, this risk falls with time. We suggest that prolonged postoperative morbidity measured in this way may be a valid indicator of the quality of surgical healthcare. Our findings reinforce the importance of research and quality improvement initiatives aimed at reducing the duration and severity of postoperative complications.