BMC anesthesiology
-
Observational Study
Prediction of early postoperative major cardiac events after elective orthopedic surgery: the role of B-type natriuretic peptide, the revised cardiac risk index, and ASA class.
The aim of this study was to evaluate pre- and post-operative brain natriuretic peptide (BNP) levels and compare the power of this test in predicting in-hospital major adverse cardiac events (MACE: atrial fibrillation, flutter, acute heart failure or non-fatal/fatal myocardial infarction) in patients undergoing elective prosthesis orthopedic surgery to that of the Revised Cardiac Risk Index (RCRI) and American Society of Anesthesiology (ASA) class, the most useful scores identified to date. ⋯ Both pre- and post-operative BNP concentrations are predictors of MACE in patients undergoing elective prosthesis orthopedic surgery.
-
The toxicity of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) is less than that of cytotoxic agents. The reports of dramatic response and improvement in performance status with the use of EGFR TKIs may influence a physician's decision-making for patients with non-squamous non-small cell lung cancer (NSCLC) and life-threatening respiratory distress. The aim of this study was to evaluate the outcome of rescue or maintenance therapy with EGFR TKI for stage IIIb-IV non-squamous NSCLC patients requiring mechanical ventilation. ⋯ Rescue or maintenance therapy with EGFR TKI for stage IIIb-IV non-squamous NSCLC patients requiring mechanical ventilation was not associated with better outcome. An end-of-life discussion should be an important aspect in the care of this group of patients, since only 19% were successfully weaned from mechanical ventilation.
-
Comparative Study Observational Study
An evaluation of POSSUM and P-POSSUM scoring in predicting post-operative mortality in a level 1 critical care setting.
POSSUM and P-POSSUM are used in the assessment of outcomes in surgical patients. Neither scoring systems' accuracy has been established where a level 1 critical care facility (level 1 care ward) is available for perioperative care. We compared POSSUM and P-POSSUM predicted with observed mortality on a level 1 care ward. ⋯ Our data suggest a 30-60% reduction in O:E mortality. We suggest that the use of POSSUM models to predict mortality in patients admitted to level 1 care ward is inappropriate or that a recalibration of POSSUM is required to make it useful in a level 1 care ward setting.
-
Randomized Controlled Trial Multicenter Study Comparative Study
Does an additional structured information program during the intensive care unit stay reduce anxiety in ICU patients?: a multicenter randomized controlled trial.
Communication and information in order to reduce anxiety in the intensive care unit (ICU) has been described as area needing improvement. Therefore, the aim of this trial was to evaluate whether a structured information program that intensifies information given in standard care process reduces anxiety in ICU patients. ⋯ A structured information intervention additional to standard care during ICU stay had no demonstrated additional benefit compared to an unspecific communication of similar duration. Reduction of anxiety in ICU patients will probably require more continuous approaches to information giving and communication.
-
Randomized Controlled Trial Comparative Study
A modified technique to improve the outcome of intubation with a left-sided double-lumen endobronchial tube.
The use of a video-assisted laryngoscope (VL) has been shown to reduce the time to achieve intubation with a double-lumen endobronchial tube (DLT). As the blade of the VL is curved differently to a standard laryngoscope, the DLT must be angled into a hockey stick shape to fit properly. We conducted a study to establish which direction of angulation was best to facilitate correct positioning of the DLT when using a VL. ⋯ When placing a left-sided DLT using a VL, angling the bronchial lumen to a hockey stick shape that conceals the tracheal lumen saves time and ameliorates the severity of post-intubation complications.