BMC anesthesiology
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Randomized Controlled Trial Comparative Study
Norepinephrine titration in patients with sepsis-induced encephalopathy: cerebral pulsatility index compared to mean arterial pressure guided protocol: randomized controlled trial.
Although surviving sepsis campaign (SSC) guidelines are the standard for sepsis and septic shock management, outcomes are still unfavourable. Given that perfusion pressure in sepsis is heterogeneous among patients and within the same patient; we evaluated the impact of individualized hemodynamic management via the transcranial Doppler (TCD) pulsatility index (PI) on mortality and outcomes among sepsis-induced encephalopathy (SIE) patients. ⋯ Individualizing hemodynamic management via the TCD pulsatility index in SIE patients was not associated with significant mortality reduction. However, it reduces episodes of cerebral hypoperfusion and improves GCS outcome but doesn't significantly affect heart rate values, SOFA score, serum lactate level, length of ICU stay, total NE dosing, and duration of NE infusion.
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Prolonged tracheal extubation time is defined as an interval ≥ 15 min from the end of surgery to extubation. An earlier study showed that prolonged extubations had a mean 12.4 min longer time from the end of surgery to operating room (OR) exit. Prolonged extubations usually (57%) were observed during OR days with > 8 h of cases and turnovers, such that longer OR times from prolonged extubation can be treated as a variable cost (i.e., each added minute incurs an expense). The current study addressed limitations of the generalizability of these earlier investigations. ⋯ Matching earlier findings, prolonged tracheal extubation times are important economically, increasing OR time by 13 min and usually performed in ORs with lists of cases of sufficient duration to treat the extra time as a variable cost.
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In medicine, Artificial intelligence has begun to be utilized in nearly every domain, from medical devices to the interpretation of imaging studies. There is still a need for more experience and more studies related to the comprehensive use of AI in medicine. The aim of the present study is to evaluate the ability of AI to make decisions regarding anesthesia methods and to compare the most popular AI programs from this perspective. ⋯ AI cannot fully master the guidelines and exceptional and specific cases that arrive in the course of medical treatment. Thus, we believe that AI can serve as a valuable assistant rather than replacing doctors.
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This study explores the association between serum chloride concentrations and all-cause mortality among patients in the Surgical Intensive Care Unit (SICU). Employing a retrospective cohort design, the study utilized data extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, specifically focusing on individuals admitted to the surgical/trauma ICUs. This dataset encompassed demographic profiles, laboratory findings, historical medical data, vital statistics, and variables pertinent to prognosis. ⋯ RCS analysis depicted an L-shaped curve demonstrating the dynamics between serum chloride concentrations and the risk of all-cause mortality across the 30-day, 90-day, and 180-day periods. Starting at a concentration of 104 mmol/L, a decrease in serum chloride levels was associated with an increased risk of mortality. These findings elucidate a marked nonlinear association between serum chloride levels and all-cause mortality in SICU patients, enhancing our comprehension of serum chloride's impact on clinical outcomes in this setting.
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Randomized Controlled Trial
Intravenous anesthesia with high-flow nasal cannula improves recovery in elderly undergoing ureteroscopic lithotripsy: a prospective controlled study.
Intravenous anesthesia with high-flow nasal cannula (HFNC) has been reported to benefit oxygen reserves and enhance postoperative recovery in surgeries requiring low neuromuscular blockade. This study investigated whether HFNC improves recovery quality in elderly undergoing ureteroscopic holmium laser lithotripsy (UHLL). ⋯ HFNC can improve recovery quality in elderly patients after UHLL compared to LMA-assisted general anesthesia.