British journal of anaesthesia
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Machine learning (ML) algorithms hold significant potential for extracting valuable clinical information from big data, surpassing the processing capabilities of the human brain. However, it would be naïve to believe that ML algorithms can consistently transform data into actionable insights. ⋯ Additionally, ML algorithms might not be necessary for analysing 'small data', such as a limited number of haemodynamic variables. In this respect, whether haemodynamic profiling with an ML algorithm offers advantages over straightforward classification tables or simple visual decision support tools remains unclear.
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Postoperative mortality in Africa is twice that of wealthier countries. The SMARTER trial underscores this critical issue and aims to address the high mortality rates by harnessing a readily available resource requiring minimal funding. Conducted in Mbale, Uganda, this innovative trial trained family members to monitor basic vital signs following surgery. ⋯ Although the results demonstrate a potential for increasing the capacity to rescue in the postoperative period, there is a need for further research to assess real-world effectiveness. Any improvement in patient monitoring would be limited by the system's capacity to respond effectively to escalations made by family members and the possible inaccuracy of their monitoring. Intervening earlier in the preoperative pathway can reduce the need to rescue postoperatively, but the SMARTER intervention has the potential to contribute to the larger effort needed to reduce surgical deaths globally in resource-limited settings.
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Cefazolin is used as a prophylactic antibiotic to reduce surgical site infections (SSIs). Obesity has been identified as a risk factor for SSIs. Cefazolin dosing recommendations and guidelines are currently inconsistent for obese patients. As plasma and target-site exposure might differ, pharmacokinetic data from the sites of SSIs are essential to evaluate treatment efficacy: these data can be obtained via tissue microdialysis. This analysis was designed to evaluate the need for dosing adaptations in obese patients for surgical prophylaxis. ⋯ This model-based analysis, using fT>MIC = 100% as a target, showed that cefazolin dosing adaptations are not required for surgical prophylaxis in obese patients.
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Hypotension is associated with organ injury and death in surgical and critically ill patients. In clinical practice, treating hypotension remains challenging because it can be caused by various underlying haemodynamic alterations. We aimed to identify and independently validate endotypes of hypotension in big datasets of surgical and critically ill patients using unsupervised deep learning. ⋯ Unsupervised deep learning identified four endotypes of hypotension in surgical and critically ill patients: vasodilation, hypovolaemia, myocardial depression, and bradycardia. The algorithm provides the probability of each endotype for each hypotensive data point. Identifying hypotensive endotypes could guide clinicians to causal treatments for hypotension.
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We investigated the intraneural spread of injected fluid in brachial plexus nerve roots, examining the potential for intrafascicular spread and identifying influencing factors. ⋯ In contrast with multifascicular peripheral nerves, intrafascicular spread was possible after deliberate intraneural injections near the neuroforaminal canal exit of the brachial plexus nerve roots in several monofascicular or bifascicular ventral rami if the fascicle diameter was more than twice the needle opening length and the entire opening was inside the fascicle.