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Publisher: John Wiley and Sons   (Total: 1589 journals)

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Showing 1 - 200 of 1589 Journals sorted alphabetically
Abacus     Hybrid Journal   (Followers: 12, SJR: 0.48, h-index: 22)
About Campus     Hybrid Journal   (Followers: 5)
Academic Emergency Medicine     Hybrid Journal   (Followers: 65, SJR: 1.385, h-index: 91)
Accounting & Finance     Hybrid Journal   (Followers: 48, SJR: 0.547, h-index: 30)
ACEP NOW     Free   (Followers: 1)
Acta Anaesthesiologica Scandinavica     Hybrid Journal   (Followers: 53, SJR: 1.02, h-index: 88)
Acta Archaeologica     Hybrid Journal   (Followers: 168, SJR: 0.101, h-index: 9)
Acta Geologica Sinica (English Edition)     Hybrid Journal   (Followers: 3, SJR: 0.552, h-index: 41)
Acta Neurologica Scandinavica     Hybrid Journal   (Followers: 5, SJR: 1.203, h-index: 74)
Acta Obstetricia et Gynecologica Scandinavica     Hybrid Journal   (Followers: 15, SJR: 1.197, h-index: 81)
Acta Ophthalmologica     Hybrid Journal   (Followers: 6, SJR: 0.112, h-index: 1)
Acta Paediatrica     Hybrid Journal   (Followers: 56, SJR: 0.794, h-index: 88)
Acta Physiologica     Hybrid Journal   (Followers: 6, SJR: 1.69, h-index: 88)
Acta Polymerica     Hybrid Journal   (Followers: 9)
Acta Psychiatrica Scandinavica     Hybrid Journal   (Followers: 37, SJR: 2.518, h-index: 113)
Acta Zoologica     Hybrid Journal   (Followers: 7, SJR: 0.459, h-index: 29)
Acute Medicine & Surgery     Hybrid Journal   (Followers: 5)
Addiction     Hybrid Journal   (Followers: 36, SJR: 2.086, h-index: 143)
Addiction Biology     Hybrid Journal   (Followers: 14, SJR: 2.091, h-index: 57)
Adultspan J.     Hybrid Journal   (SJR: 0.127, h-index: 4)
Advanced Energy Materials     Hybrid Journal   (Followers: 26, SJR: 6.411, h-index: 86)
Advanced Engineering Materials     Hybrid Journal   (Followers: 26, SJR: 0.81, h-index: 81)
Advanced Functional Materials     Hybrid Journal   (Followers: 51, SJR: 5.21, h-index: 203)
Advanced Healthcare Materials     Hybrid Journal   (Followers: 14, SJR: 0.232, h-index: 7)
Advanced Materials     Hybrid Journal   (Followers: 295, SJR: 9.021, h-index: 345)
Advanced Materials Interfaces     Hybrid Journal   (Followers: 6, SJR: 1.177, h-index: 10)
Advanced Optical Materials     Hybrid Journal   (Followers: 7, SJR: 2.488, h-index: 21)
Advanced Science     Open Access   (Followers: 5)
Advanced Synthesis & Catalysis     Hybrid Journal   (Followers: 17, SJR: 2.729, h-index: 121)
Advances in Polymer Technology     Hybrid Journal   (Followers: 13, SJR: 0.344, h-index: 31)
Africa Confidential     Hybrid Journal   (Followers: 21)
Africa Research Bulletin: Economic, Financial and Technical Series     Hybrid Journal   (Followers: 13)
Africa Research Bulletin: Political, Social and Cultural Series     Hybrid Journal   (Followers: 11)
African Development Review     Hybrid Journal   (Followers: 33, SJR: 0.275, h-index: 17)
African J. of Ecology     Hybrid Journal   (Followers: 16, SJR: 0.477, h-index: 39)
Aggressive Behavior     Hybrid Journal   (Followers: 15, SJR: 1.391, h-index: 66)
Aging Cell     Open Access   (Followers: 11, SJR: 4.374, h-index: 95)
Agribusiness : an Intl. J.     Hybrid Journal   (Followers: 3, SJR: 0.627, h-index: 14)
Agricultural and Forest Entomology     Hybrid Journal   (Followers: 16, SJR: 0.925, h-index: 43)
Agricultural Economics     Hybrid Journal   (Followers: 45, SJR: 1.099, h-index: 51)
AIChE J.     Hybrid Journal   (Followers: 32, SJR: 1.122, h-index: 120)
Alcoholism and Drug Abuse Weekly     Hybrid Journal   (Followers: 7)
Alcoholism Clinical and Experimental Research     Hybrid Journal   (Followers: 7, SJR: 1.416, h-index: 125)
Alimentary Pharmacology & Therapeutics     Hybrid Journal   (Followers: 33, SJR: 2.833, h-index: 138)
Alimentary Pharmacology & Therapeutics Symposium Series     Hybrid Journal   (Followers: 3)
Allergy     Hybrid Journal   (Followers: 51, SJR: 3.048, h-index: 129)
Alternatives to the High Cost of Litigation     Hybrid Journal   (Followers: 3)
American Anthropologist     Hybrid Journal   (Followers: 152, SJR: 0.951, h-index: 61)
American Business Law J.     Hybrid Journal   (Followers: 24, SJR: 0.205, h-index: 17)
American Ethnologist     Hybrid Journal   (Followers: 93, SJR: 2.325, h-index: 51)
American J. of Economics and Sociology     Hybrid Journal   (Followers: 29, SJR: 0.211, h-index: 26)
American J. of Hematology     Hybrid Journal   (Followers: 35, SJR: 1.761, h-index: 77)
American J. of Human Biology     Hybrid Journal   (Followers: 13, SJR: 1.018, h-index: 58)
American J. of Industrial Medicine     Hybrid Journal   (Followers: 16, SJR: 0.993, h-index: 85)
American J. of Medical Genetics Part A     Hybrid Journal   (Followers: 16, SJR: 1.115, h-index: 61)
American J. of Medical Genetics Part B: Neuropsychiatric Genetics     Hybrid Journal   (Followers: 4, SJR: 1.771, h-index: 107)
American J. of Medical Genetics Part C: Seminars in Medical Genetics     Partially Free   (Followers: 6, SJR: 2.315, h-index: 79)
American J. of Physical Anthropology     Hybrid Journal   (Followers: 37, SJR: 1.41, h-index: 88)
American J. of Political Science     Hybrid Journal   (Followers: 290, SJR: 5.101, h-index: 114)
American J. of Primatology     Hybrid Journal   (Followers: 16, SJR: 1.197, h-index: 63)
American J. of Reproductive Immunology     Hybrid Journal   (Followers: 3, SJR: 1.347, h-index: 75)
American J. of Transplantation     Hybrid Journal   (Followers: 18, SJR: 2.792, h-index: 140)
American J. on Addictions     Hybrid Journal   (Followers: 9, SJR: 0.843, h-index: 57)
Anaesthesia     Hybrid Journal   (Followers: 138, SJR: 1.404, h-index: 88)
Analyses of Social Issues and Public Policy     Hybrid Journal   (Followers: 9, SJR: 0.397, h-index: 18)
Analytic Philosophy     Hybrid Journal   (Followers: 20)
Anatomia, Histologia, Embryologia: J. of Veterinary Medicine Series C     Hybrid Journal   (Followers: 3, SJR: 0.295, h-index: 27)
Anatomical Sciences Education     Hybrid Journal   (Followers: 1, SJR: 0.633, h-index: 24)
Andrologia     Hybrid Journal   (Followers: 2, SJR: 0.528, h-index: 45)
Andrology     Hybrid Journal   (Followers: 2, SJR: 0.979, h-index: 14)
Angewandte Chemie     Hybrid Journal   (Followers: 179)
Angewandte Chemie Intl. Edition     Hybrid Journal   (Followers: 229, SJR: 6.229, h-index: 397)
Animal Conservation     Hybrid Journal   (Followers: 41, SJR: 1.576, h-index: 62)
Animal Genetics     Hybrid Journal   (Followers: 8, SJR: 0.957, h-index: 67)
Animal Science J.     Hybrid Journal   (Followers: 6, SJR: 0.569, h-index: 24)
Annalen der Physik     Hybrid Journal   (Followers: 5, SJR: 1.46, h-index: 40)
Annals of Anthropological Practice     Partially Free   (Followers: 2, SJR: 0.187, h-index: 5)
Annals of Applied Biology     Hybrid Journal   (Followers: 7, SJR: 0.816, h-index: 56)
Annals of Clinical and Translational Neurology     Open Access   (Followers: 1)
Annals of Human Genetics     Hybrid Journal   (Followers: 9, SJR: 1.191, h-index: 67)
Annals of Neurology     Hybrid Journal   (Followers: 48, SJR: 5.584, h-index: 241)
Annals of Noninvasive Electrocardiology     Hybrid Journal   (Followers: 1, SJR: 0.531, h-index: 38)
Annals of Public and Cooperative Economics     Hybrid Journal   (Followers: 8, SJR: 0.336, h-index: 23)
Annals of the New York Academy of Sciences     Hybrid Journal   (Followers: 5, SJR: 2.389, h-index: 189)
Annual Bulletin of Historical Literature     Hybrid Journal   (Followers: 13)
Annual Review of Information Science and Technology     Hybrid Journal   (Followers: 14)
Anthropology & Education Quarterly     Hybrid Journal   (Followers: 25, SJR: 0.72, h-index: 31)
Anthropology & Humanism     Hybrid Journal   (Followers: 17, SJR: 0.137, h-index: 3)
Anthropology News     Hybrid Journal   (Followers: 15)
Anthropology of Consciousness     Hybrid Journal   (Followers: 11, SJR: 0.172, h-index: 5)
Anthropology of Work Review     Hybrid Journal   (Followers: 11, SJR: 0.256, h-index: 5)
Anthropology Today     Hybrid Journal   (Followers: 91, SJR: 0.545, h-index: 15)
Antipode     Hybrid Journal   (Followers: 50, SJR: 2.212, h-index: 69)
Anz J. of Surgery     Hybrid Journal   (Followers: 8, SJR: 0.432, h-index: 59)
Anzeiger für Schädlingskunde     Hybrid Journal   (Followers: 1)
Apmis     Hybrid Journal   (Followers: 1, SJR: 0.855, h-index: 73)
Applied Cognitive Psychology     Hybrid Journal   (Followers: 70, SJR: 0.754, h-index: 69)
Applied Organometallic Chemistry     Hybrid Journal   (Followers: 7, SJR: 0.632, h-index: 58)
Applied Psychology     Hybrid Journal   (Followers: 209, SJR: 1.023, h-index: 64)
Applied Psychology: Health and Well-Being     Hybrid Journal   (Followers: 50, SJR: 0.868, h-index: 13)
Applied Stochastic Models in Business and Industry     Hybrid Journal   (Followers: 5, SJR: 0.613, h-index: 24)
Aquaculture Nutrition     Hybrid Journal   (Followers: 14, SJR: 1.025, h-index: 55)
Aquaculture Research     Hybrid Journal   (Followers: 32, SJR: 0.807, h-index: 60)
Aquatic Conservation Marine and Freshwater Ecosystems     Hybrid Journal   (Followers: 36, SJR: 1.047, h-index: 57)
Arabian Archaeology and Epigraphy     Hybrid Journal   (Followers: 11, SJR: 0.453, h-index: 11)
Archaeological Prospection     Hybrid Journal   (Followers: 12, SJR: 0.922, h-index: 21)
Archaeology in Oceania     Hybrid Journal   (Followers: 13, SJR: 0.745, h-index: 18)
Archaeometry     Hybrid Journal   (Followers: 29, SJR: 0.809, h-index: 48)
Archeological Papers of The American Anthropological Association     Hybrid Journal   (Followers: 15, SJR: 0.156, h-index: 2)
Architectural Design     Hybrid Journal   (Followers: 26, SJR: 0.261, h-index: 9)
Archiv der Pharmazie     Hybrid Journal   (Followers: 3, SJR: 0.628, h-index: 43)
Archives of Drug Information     Hybrid Journal   (Followers: 5)
Archives of Insect Biochemistry and Physiology     Hybrid Journal   (SJR: 0.768, h-index: 54)
Area     Hybrid Journal   (Followers: 13, SJR: 0.938, h-index: 57)
Art History     Hybrid Journal   (Followers: 274, SJR: 0.153, h-index: 13)
Arthritis & Rheumatology     Hybrid Journal   (Followers: 54, SJR: 1.984, h-index: 20)
Arthritis Care & Research     Hybrid Journal   (Followers: 27, SJR: 2.256, h-index: 114)
Artificial Organs     Hybrid Journal   (Followers: 1, SJR: 0.872, h-index: 60)
ASHE Higher Education Reports     Hybrid Journal   (Followers: 15)
Asia & the Pacific Policy Studies     Open Access   (Followers: 16)
Asia Pacific J. of Human Resources     Hybrid Journal   (Followers: 326, SJR: 0.494, h-index: 19)
Asia Pacific Viewpoint     Hybrid Journal   (Followers: 1, SJR: 0.616, h-index: 26)
Asia-Pacific J. of Chemical Engineering     Hybrid Journal   (Followers: 8, SJR: 0.345, h-index: 20)
Asia-pacific J. of Clinical Oncology     Hybrid Journal   (Followers: 6, SJR: 0.554, h-index: 14)
Asia-Pacific J. of Financial Studies     Hybrid Journal   (SJR: 0.241, h-index: 7)
Asia-Pacific Psychiatry     Hybrid Journal   (Followers: 4, SJR: 0.377, h-index: 7)
Asian Economic J.     Hybrid Journal   (Followers: 8, SJR: 0.234, h-index: 21)
Asian Economic Policy Review     Hybrid Journal   (Followers: 4, SJR: 0.196, h-index: 12)
Asian J. of Control     Hybrid Journal   (SJR: 0.862, h-index: 34)
Asian J. of Endoscopic Surgery     Hybrid Journal   (Followers: 1, SJR: 0.394, h-index: 7)
Asian J. of Organic Chemistry     Hybrid Journal   (Followers: 6, SJR: 1.443, h-index: 19)
Asian J. of Social Psychology     Hybrid Journal   (Followers: 5, SJR: 0.665, h-index: 37)
Asian Politics and Policy     Hybrid Journal   (Followers: 12, SJR: 0.207, h-index: 7)
Asian Social Work and Policy Review     Hybrid Journal   (Followers: 5, SJR: 0.318, h-index: 5)
Asian-pacific Economic Literature     Hybrid Journal   (Followers: 5, SJR: 0.168, h-index: 15)
Assessment Update     Hybrid Journal   (Followers: 4)
Astronomische Nachrichten     Hybrid Journal   (Followers: 3, SJR: 0.701, h-index: 40)
Atmospheric Science Letters     Open Access   (Followers: 29, SJR: 1.332, h-index: 27)
Austral Ecology     Hybrid Journal   (Followers: 15, SJR: 1.095, h-index: 66)
Austral Entomology     Hybrid Journal   (Followers: 9, SJR: 0.524, h-index: 28)
Australasian J. of Dermatology     Hybrid Journal   (Followers: 8, SJR: 0.714, h-index: 40)
Australasian J. On Ageing     Hybrid Journal   (Followers: 6, SJR: 0.39, h-index: 22)
Australian & New Zealand J. of Statistics     Hybrid Journal   (Followers: 14, SJR: 0.275, h-index: 28)
Australian Accounting Review     Hybrid Journal   (Followers: 3, SJR: 0.709, h-index: 14)
Australian and New Zealand J. of Family Therapy (ANZJFT)     Hybrid Journal   (Followers: 3, SJR: 0.382, h-index: 12)
Australian and New Zealand J. of Obstetrics and Gynaecology     Hybrid Journal   (Followers: 47, SJR: 0.814, h-index: 49)
Australian and New Zealand J. of Public Health     Hybrid Journal   (Followers: 11, SJR: 0.82, h-index: 62)
Australian Dental J.     Hybrid Journal   (Followers: 6, SJR: 0.482, h-index: 46)
Australian Economic History Review     Hybrid Journal   (Followers: 6, SJR: 0.171, h-index: 12)
Australian Economic Papers     Hybrid Journal   (Followers: 31, SJR: 0.23, h-index: 9)
Australian Economic Review     Hybrid Journal   (Followers: 6, SJR: 0.357, h-index: 21)
Australian Endodontic J.     Hybrid Journal   (Followers: 3, SJR: 0.513, h-index: 24)
Australian J. of Agricultural and Resource Economics     Hybrid Journal   (Followers: 3, SJR: 0.765, h-index: 36)
Australian J. of Grape and Wine Research     Hybrid Journal   (Followers: 5, SJR: 0.879, h-index: 56)
Australian J. of Politics & History     Hybrid Journal   (Followers: 15, SJR: 0.203, h-index: 14)
Australian J. of Psychology     Hybrid Journal   (Followers: 18, SJR: 0.384, h-index: 30)
Australian J. of Public Administration     Hybrid Journal   (Followers: 419, SJR: 0.418, h-index: 29)
Australian J. of Rural Health     Hybrid Journal   (Followers: 5, SJR: 0.43, h-index: 34)
Australian Occupational Therapy J.     Hybrid Journal   (Followers: 72, SJR: 0.59, h-index: 29)
Australian Psychologist     Hybrid Journal   (Followers: 12, SJR: 0.331, h-index: 31)
Australian Veterinary J.     Hybrid Journal   (Followers: 23, SJR: 0.459, h-index: 45)
Autism Research     Hybrid Journal   (Followers: 36, SJR: 2.126, h-index: 39)
Autonomic & Autacoid Pharmacology     Hybrid Journal   (SJR: 0.371, h-index: 29)
Banks in Insurance Report     Hybrid Journal   (Followers: 1)
Basic & Clinical Pharmacology & Toxicology     Hybrid Journal   (Followers: 11, SJR: 0.539, h-index: 70)
Basic and Applied Pathology     Open Access   (Followers: 2, SJR: 0.113, h-index: 4)
Basin Research     Hybrid Journal   (Followers: 5, SJR: 1.54, h-index: 60)
Bauphysik     Hybrid Journal   (Followers: 2, SJR: 0.194, h-index: 5)
Bauregelliste A, Bauregelliste B Und Liste C     Hybrid Journal  
Bautechnik     Hybrid Journal   (Followers: 1, SJR: 0.321, h-index: 11)
Behavioral Interventions     Hybrid Journal   (Followers: 9, SJR: 0.297, h-index: 23)
Behavioral Sciences & the Law     Hybrid Journal   (Followers: 24, SJR: 0.736, h-index: 57)
Berichte Zur Wissenschaftsgeschichte     Hybrid Journal   (Followers: 10, SJR: 0.11, h-index: 5)
Beton- und Stahlbetonbau     Hybrid Journal   (Followers: 2, SJR: 0.493, h-index: 14)
Biochemistry and Molecular Biology Education     Hybrid Journal   (Followers: 6, SJR: 0.311, h-index: 26)
Bioelectromagnetics     Hybrid Journal   (Followers: 1, SJR: 0.568, h-index: 64)
Bioengineering & Translational Medicine     Open Access  
BioEssays     Hybrid Journal   (Followers: 10, SJR: 3.104, h-index: 155)
Bioethics     Hybrid Journal   (Followers: 14, SJR: 0.686, h-index: 39)
Biofuels, Bioproducts and Biorefining     Hybrid Journal   (Followers: 1, SJR: 1.725, h-index: 56)
Biological J. of the Linnean Society     Hybrid Journal   (Followers: 16, SJR: 1.172, h-index: 90)
Biological Reviews     Hybrid Journal   (Followers: 5, SJR: 6.469, h-index: 114)
Biologie in Unserer Zeit (Biuz)     Hybrid Journal   (Followers: 41, SJR: 0.12, h-index: 1)
Biology of the Cell     Full-text available via subscription   (Followers: 9, SJR: 1.812, h-index: 69)
Biomedical Chromatography     Hybrid Journal   (Followers: 6, SJR: 0.572, h-index: 49)
Biometrical J.     Hybrid Journal   (Followers: 5, SJR: 0.784, h-index: 44)
Biometrics     Hybrid Journal   (Followers: 37, SJR: 1.906, h-index: 96)
Biopharmaceutics and Drug Disposition     Hybrid Journal   (Followers: 10, SJR: 0.715, h-index: 44)
Biopolymers     Hybrid Journal   (Followers: 18, SJR: 1.199, h-index: 104)
Biotechnology and Applied Biochemistry     Hybrid Journal   (Followers: 44, SJR: 0.415, h-index: 55)
Biotechnology and Bioengineering     Hybrid Journal   (Followers: 152, SJR: 1.633, h-index: 146)
Biotechnology J.     Hybrid Journal   (Followers: 14, SJR: 1.185, h-index: 51)
Biotechnology Progress     Hybrid Journal   (Followers: 39, SJR: 0.736, h-index: 101)
Biotropica     Hybrid Journal   (Followers: 20, SJR: 1.374, h-index: 71)
Bipolar Disorders     Hybrid Journal   (Followers: 9, SJR: 2.592, h-index: 100)
Birth     Hybrid Journal   (Followers: 38, SJR: 0.763, h-index: 64)
Birth Defects Research Part A : Clinical and Molecular Teratology     Hybrid Journal   (Followers: 2, SJR: 0.727, h-index: 77)
Birth Defects Research Part B: Developmental and Reproductive Toxicology     Hybrid Journal   (Followers: 7, SJR: 0.468, h-index: 47)
Birth Defects Research Part C : Embryo Today : Reviews     Hybrid Journal   (SJR: 1.513, h-index: 55)
BJOG : An Intl. J. of Obstetrics and Gynaecology     Partially Free   (Followers: 247, SJR: 2.083, h-index: 125)

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Journal Cover Acta Anaesthesiologica Scandinavica
  [SJR: 1.02]   [H-I: 88]   [53 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0001-5172 - ISSN (Online) 1399-6576
   Published by John Wiley and Sons Homepage  [1589 journals]
  • In-bed cycling in the ICU; patient safety and recollections with
           motivational effects
    • Authors: M. Ringdal; M. Warren Stomberg, K. Egnell, E. Wennberg, R. Zätterman, C. Rylander
      Abstract: BackgroundIn-bed cycling (IBC) is gaining interest for implementation in intensive care units. Our main objective was to explore patient recollections and experiences of early mobilization, including IBC. Secondly, we aimed to examine if IBC was safe and feasible.MethodsEleven participants were interviewed about their experiences during their critical illnesses and active mobilization in the intensive care unit. The interviews were analyzed thematically. Six participants were also monitored for physiological reactions and adverse events during IBC while mechanically ventilated.ResultsFrom the interviews, one main theme with three subthemes was identified. The main theme was: Early mobilization gave a direction toward normalization. The three subthemes were: (1) IBC gave a feeling of control over recovery early on during the critical illness (2) Early mobilization, including IBC, with continuous support from health care professionals gave a feeling of safety and hope for recovery for the patient; and (3) Unpleasant experiences and disorientation were felt during the critical illness and IBC. Furthermore, IBC did not induce large physiological changes or major adverse events in the participants who were monitored for feasibility and safety.ConclusionsPatient interviews indicated that the patients’ participation in early mobilization with emphasis on IBC motivated them to be active in their recovery to regain a good level of health after their earlier critical illness during their intensive care stay. IBC was, in this small study, safe and feasible in the two participating intensive care units.
      PubDate: 2018-01-18T22:36:58.185161-05:
      DOI: 10.1111/aas.13070
  • Analysis of hypo- and hypermagnesemia in an intensive care unit cohort
    • Authors: M. Broman; F. Hansson, B. Klarin
      Abstract: IntroductionThe aim of this study was to evaluate if magnesium deviations correlate with higher 180 day overall mortality or increased morbidity, compared to controls.MethodsWe conducted a retrospective study on 5369 patients with 22,003 magnesium values treated at the Adult Intensive Care Unit at Skåne University Hospital, Lund, Sweden during 2006–2014. The patients were retrospectively divided into a control group with only normal magnesium values 0.7–1.0 mmol/l, and three study groups; hypomagnesemic; Mg2+ < 0.7 mmol/l, hypermagnesemic; Mg2+> 1.0 mmol/l and an unstable mixed group showing both hypo/hypermagnesemia.Gender, age, disease severity represented by maximum organ system SOFA score, renal SOFA score, lowest potassium value and diagnoses classes were included in a Cox hazard model in order to adjust for confounding factors, with time to death in the first 180 days from the ICU admission as outcome.ResultsThe hypermagnesemic study group and the mixed group showed increased hazard ratios for mortality; 1.4 (CI 98.3% 1.2, 1.6, P < 0.0001) and 2.1 (CI 98.3% 1.2, 2.8, P < 0.0001) respectively, compared to controls, while the hypomagnesemic group did not reach significance.In addition, patients in the hypermagnesemic and the mixed groups are older, more ill with significantly higher EMR and SOFA scores and show significantly longer ventilator times and ICU stays, compared to controls.ConclusionsPatients with magnesium deviations are more ill compared to patients with explicitly normal magnesium values throughout the ICU stay. Cox analysis suggests that the magnesium deviation itself might have an impact on mortality.
      PubDate: 2018-01-16T23:05:50.020481-05:
      DOI: 10.1111/aas.13061
  • Changes in colloid solution sales in Nordic countries
    • Authors: U. E. Kongsgaard; A. Holtan, A. Perner
      Abstract: BackgroundAdministration of resuscitation fluid is a common intervention in the treatment of critically ill patients, but the right choice of fluid is still a matter of debate. Changes in medical practice are based on new evidence and guidelines as well as traditions and personal preferences. Official warnings against the use of hydroxyl-ethyl-starch (HES) solutions have been issued. Nordic guidelines have issued several strong recommendations favouring crystalloids over colloids in all patient groups. Our objective was to describe the patterns of colloid use in Nordic countries from 2012 to 2016.MethodsThe data were obtained from companies that provide pharmaceutical statistics in different countries. The data are sales figures from pharmaceutical companies to pharmacies and health institutions.ResultsWe found a 56% reduction in the total sales of all colloids in Nordic countries over a 5-year period. These findings were mainly related to a 92% reduction in the sales of HES solutions. A reduction in sales of other synthetic colloids has also occurred. During the same period, we found a 46% increase in albumin sales, but these numbers varied between Nordic countries.ConclusionThe general reduction in colloid sales likely reflects the recommendation that colloids should be used only in special circumstances. The dramatic reduction in the sales of HES solutions was expected given evidence of harm and the official warnings. The steady increase in albumin sales and the notable differences between the five Nordic countries cannot be explained.
      PubDate: 2018-01-07T23:00:25.552064-05:
      DOI: 10.1111/aas.13057
  • Pre-hospital emergency anaesthesia in awake hypotensive trauma patients:
           beneficial or detrimental'
    • Authors: K. Crewdson; M. Rehn, K. Brohi, D. J. Lockey
      Abstract: BackgroundThe benefits of pre-hospital emergency anaesthesia (PHEA) are controversial. Patients who are hypovolaemic prior to induction of anaesthesia are at risk of severe cardiovascular instability post-induction.This study compared mortality for hypovolaemic trauma patients (without major neurological injury) undergoing PHEA with a patient cohort with similar physiology transported to hospital without PHEA.MethodsA retrospective database review was performed to identify patients who were hypotensive on scene [systolic blood pressure (SBP) < 90 mmHg], and GCS 13–15. Patient records were reviewed independently by two pre-hospital clinicians to identify the likelihood of hypovolaemia. Primary outcome measure was mortality defined as death before hospital discharge.ResultsTwo hundred and thirty-six patients were included; 101 patients underwent PHEA. Fifteen PHEA patients died (14.9%) compared with six non-PHEA patients (4.4%), P = 0.01; unadjusted OR for death was 3.73 (1.30–12.21; P = 0.01). This association remained after adjustment for age, injury mechanism, heart rate and hypovolaemia (adjusted odds ratio 3.07 (1.03–9.14) P = 0.04).Fifty-eight PHEA patients (57.4%) were hypovolaemic prior to induction of anaesthesia, 14 died (24%). Of 43 PHEA patients (42.6%) not meeting hypovolaemia criteria, one died (2%); unadjusted OR for mortality was 13.12 (1.84–578.21). After adjustment for age, injury mechanism and initial heart rate, the odds ratio for mortality remained significant at 9.99 (1.69–58.98); P = 0.01.ConclusionOur results suggest an association between PHEA and in-hospital mortality in awake hypotensive trauma patients, which is strengthened when hypotension is due to hypovolaemia. If patients are hypovolaemic and awake on scene it might, where possible, be appropriate to delay induction of anaesthesia until hospital arrival.
      PubDate: 2018-01-07T23:00:19.831029-05:
      DOI: 10.1111/aas.13059
  • Ventilation strategy and anesthesia management in patients with severe
           tracheal stenosis undergoing urgent tracheal stenting
    • Authors: J.-H. Zhu; M. Lei, E.-G. Chen, Q. Qiao, T.-D. Zhong
      Abstract: BackgroundStenting of airway stenosis is a common procedure in specialized centers. The aim of this study was to summarize our clinical experience in ventilation strategy and anesthesia management of patients undergoing urgent tracheal stenting.MethodsClinical data of 22 patients with severe tracheal stenosis who underwent urgent endoscopic placement of a tracheal stent during a 2-year period were retrospectively reviewed. The efficacy and safety of different ventilation strategies and veno-arterial extracorporeal membrane oxygenation (ECMO), individualized based on the cause and location of tracheal narrowing, were evaluated.ResultsSufficient ventilation was successfully established in all patients; ECMO was used in five patients with stenosis in the mid-trachea who were unable to tolerate conventional intubation; a laryngeal mask airway (LMA) was used in five patients with post-intubation tracheal stenosis; a cuffed tracheal tube was used in eight patients with lower tracheal stenosis; and low-frequency jet ventilation in rigid bronchoscopy was used in four patients with mid- or lower tracheal stenosis. Tracheal stents were successfully placed and there were significant improvements in dyspnea. There were significant increases in the partial pressure of carbon dioxide in patients ventilated with the LMA and cuffed tracheal tube. There was no hypoxia during the operative period.ConclusionEstablishment of effective airway ventilation in patients with severe tracheal stenosis should be based on the cause, location, and severity of tracheal narrowing. Veno- arterial ECMO may be considered in patients with severe stenosis, if they are judged unable to tolerate conventional ventilation or jet ventilation.
      PubDate: 2018-01-07T22:55:51.184202-05:
      DOI: 10.1111/aas.13062
  • Good quality of life before cardiac arrest predicts good quality of life
           after resuscitation
    • Authors: H. Hellevuo; M. Sainio, H. Huhtala, K. T. Olkkola, J. Tenhunen, S. Hoppu
      Abstract: BackgroundThe survival rate of cardiac arrest patients is increasing. Our aim was to compare the quality of life before and after cardiac arrest and analyse the factors associated with outcome.MethodsAll adult cardiac arrest patients admitted to the Tampere University Hospital intensive care unit between 2009 and 2011 were included in a retrospective follow-up study if surviving to discharge and were asked to return a questionnaire after 6 months. Data on patient demographics and pre-arrest quality of life were retrieved from medical records. Data are given as means (SD) or medians [Q1, Q3]. We used logistic regression to identify factors associated with better quality of life after cardiac arrest.ResultsSix months after cardiac arrest, 36% (79/222) were alive and 70% (55/79) of those patients completed the follow-up EuroQoL (EQ-5D) quality of life questionnaire. Median values for the EQ-5D before and after cardiac arrest were 0.89 [0.63, 1] and 0.89 [0.62, 1], respectively (P = 0.75). Only the EQ-5D prior to cardiac arrest was associated with better quality of life afterwards (OR 1.2; 95% CI 1.0–1.3; P = 0.02).ConclusionsQuality of life remained good after cardiac arrest especially in those patients who had good quality of life before cardiac arrest.
      PubDate: 2018-01-07T22:55:18.761472-05:
      DOI: 10.1111/aas.13065
  • Early prognostic factors in septic shock cancer patients: a prospective
           study with a proteomic approach
    • Authors: D. Mokart; C. Saillard, C. Zemmour, M. Bisbal, A. Sannini, L. Chow-Chine, J.-P. Brun, M. Faucher, J.-M. Boher, Y. Toiron, C. Chabannon, J.-P. Borg, A. Gonçalves, L. Camoin
      Abstract: BackgroundOrgan failures are the main prognostic factors in septic shock. The aim was to assess classical clinico-biological parameters evaluating organ dysfunctions at intensive care unit admission, combined with proteomics, on day-30 mortality in critically ill onco-hematology patients admitted to the intensive care unit for septic shock.MethodsThis was a prospective monocenter cohort study. Clinico-biological parameters were collected at admission. Plasma proteomics analyses were performed, including protein profiling using isobaric Tag for Relative and Absolute Quantification (iTRAQ) and subsequent validation by ELISA.ResultsSixty consecutive patients were included. Day-30 mortality was 47%. All required vasopressors, 32% mechanical ventilation, 33% non-invasive ventilation and 13% renal-replacement therapy. iTRAQ-based proteomics identified von Willebrand factor as a protein of interest. Multivariate analysis identified four factors independently associated with day-30 mortality: positive fluid balance in the first 24 h (odds ratio = 1.06, 95% CI = 1.01–1.12, P = 0.02), severe acute respiratory failure (odds ratio = 6.14, 95% CI = 1.04–36.15, P = 0.04), von Willebrand factor plasma level> 439 ng/ml (odds ratio = 9.7, 95% CI = 1.52–61.98, P = 0.02), and bacteremia (odds ratio = 6.98, 95% CI = 1.17–41.6, P = 0.03).ConclusionEndothelial dysfunction, revealed by proteomics, appears as an independent prognostic factor on day-30 mortality, as well as hydric balance, acute respiratory failure and bacteremia, in critically ill cancer patients admitted to the intensive care unit. Endothelial failure is underestimated in clinical practice and represents an innovative therapeutic target.
      PubDate: 2018-01-07T22:46:04.427403-05:
      DOI: 10.1111/aas.13060
  • Patients’ opinions on outcomes following critical illness
    • Authors: H. K. Nedergaard; T. Haberlandt, P. D. Reichmann, P. Toft, H. I. Jensen
      Abstract: BackgroundOur aim was to explore which outcomes are most important to patients following ICU-discharge, and to explore whether intensive care unit (ICU)-nurses and anesthesiologists are aware of patients’ priorities.MethodsFirst, interviews with adult ICU-survivors were conducted until data saturation was achieved (10 interviews), and six areas with 36 items were identified. Second, interviews with another eight ICU-survivors were conducted, narrowing the list to 20. Finally, patients (inclusion criteria: consecutive adults, medical and surgical, ICU-admission> 5 days, 2–8 months post-ICU discharge) rated the items, as did ICU-nurses and anesthesiologists.ResultsA total of 32 patients participated (44% women, medians: age 70.5, time since discharge 179 days, length of stay in ICU 9 days, APACHEII 19.5). The three most important outcomes defined by patients were: lack of physical strength, fatigue, and decreased walking distance. The top three for ICU-nurses (54 participants) were: fatigue, difficulties concentrating, sadness/depression, and for anesthesiologists (17 participants): fatigue, difficulties in activities of daily living, and lack of physical strength.ConclusionPatients chose lack of physical strength, fatigue, and decreased walking distance as the three most important outcomes following critical illness. Physicians had a higher focus on these physical impairments than ICU-nurses.
      PubDate: 2018-01-07T22:45:25.903635-05:
      DOI: 10.1111/aas.13058
  • When do trauma patients lose temperature' – a prospective
           observational study
    • Authors: S. C. Eidstuen; O. Uleberg, G. Vangberg, E. Skogvoll
      Abstract: BackgroundThe prevalence of hypothermia in trauma patients is high and rapid recognition is important to prevent further heat loss. Hypothermia is associated with poor patient outcomes and is an independent predictor of increased mortality. The aim of this study was to analyze the changes in core body temperature of trauma patients during different treatment phases in the pre-hospital and early in-hospital settings.MethodsA prospective observational cohort study in severely injured patients. Continuous core temperature monitoring using an epitympanic sensor in the auditory canal was initiated at the scene of injury and continued for 3 h. The degree of patient insulation was photo-documented throughout, and graded on a binary scale. The outcome variable was temperature change in each treatment phase.ResultsTwenty-two patients were included with a median injury severity score (ISS) of 21 (IQR 14–29). Most patients (N = 16, 73%) were already hypothermic (< 36°C) on scene at their first measurement. Twenty patients (91%) became colder at the scene of injury; on average, the decline was −1.7°C/h. Full clothing reduced this value to −1.1°C/h. Temperature remained essentially stable during ambulance and emergency department phases.ConclusionTrauma patients are at risk for hypothermia already at the scene of injury. Lay persons and professionals should focus on early prevention of heat loss. An active, individually tailored approach to counter hypothermia in trauma should begin immediately at the scene of injury and continue during transportation to hospital. Active rewarming during evacuation should be considered.
      PubDate: 2018-01-07T22:45:23.818668-05:
      DOI: 10.1111/aas.13055
  • Aprepitant as a fourth antiemetic prophylactic strategy in high-risk
           patients: a double-blind, randomized trial
    • Authors: L. C. Morais; A. M. Sousa, G. F. Flora, T. R. Grigio, G. M. N. Guimarães, H. A. Ashmawi
      Abstract: BackgroundPost-operative nausea and vomiting (PONV) is one of the most important causes of patient discomfort after laparoscopic surgeries despite the use of a multimodal pharmacological approach. This study assessed whether the addition of aprepitant to a multimodal regimen would further decrease the incidence of PONV in high-risk patients.MethodsApfel-score three or four patients, scheduled for laparoscopic procedures to treat abdominal or pelvic cancer, were randomized to receive oral starch (control group) or 80 mg of oral aprepitant (treatment group) before induction of anaesthesia in a double-blind study. All patients received 4–8 mg of intravenous dexamethasone (at induction) and 4–8 mg of ondansetron (at the end) and a standardized total intravenous anaesthesia (TIVA) technique combined with neuraxial blockade. PONV was defined as any episode of nausea, vomiting or retching in the first 24 h after anaesthesia.ResultsSixty-six patients completed the study. Vomiting occurred in 13/32 (40.6%) patients in the control group and in 1/34 (2.9%) patients in the treatment group (P = 0.0002, 95%CI: 18–54%) in the first 24 h after anaesthesia. Severe nausea occurred in two (6.3%) patients, and severe vomiting occurred in four (12.5%) patients in the control group. One patient presented with severe vomiting in the treatment group in the first 24 post-operative hours.ConclusionEighty milligrams of aprepitant added to a three-drug multimodal prophylaxis strategy can bring benefits to a high-risk population by reducing PONV episodes and rescue antiemetic requirements. This study was registered in the (NCT 02357693) database.
      PubDate: 2018-01-07T22:35:35.701316-05:
      DOI: 10.1111/aas.13064
  • Regional anesthesia decreases complications and resource utilization in
           shoulder arthroplasty patients
    • Authors: M. D. Herrick; H. Liu, M. Davis, J.-E. Bell, B. D. Sites
      Abstract: BackgroundRegional anesthesia can be used as part of the anesthetic to optimize anesthesia and analgesia during shoulder arthroplasty, but little is known about the overall effect that regional anesthesia has on perioperative outcomes and resource utilization. We hypothesized that regional anesthesia may decrease complication rates and resource utilization in shoulder arthroplasty patients.MethodsWe examined administrative data from 588 US hospitals from 2010 to 2015. Logistic regression was used to examine the relationship between type of anesthesia and perioperative complications.ResultsAmong patients who underwent shoulder arthroplasty, 79.1% (53,243) had general anesthesia alone, 17.8% (12,011) had general anesthesia and a nerve block, and 3.1% (2062) had a nerve block alone. Overall, the complication rate was 13.3% and 30-day mortality was 1.2 per 1000 (95% CI 0.9, 1.4). In adjusted analyses, patients who had general anesthesia alone (compared to general anesthesia and nerve block) had a 16% increase in all cause infectious complications (OR 1.16, 95% CI: 1.03, 1.31) and were 2.6 times more likely to develop pulmonary complications (OR 2.6, 95% CI: 1.14, 5.78). General anesthesia alone (relative to either block only or general anesthesia and block) was associated with substantial increases in the likelihood of blood transfusions, intensive care unit transfers, and prolonged length of stay.ConclusionPatients receiving regional anesthesia for shoulder arthroplasty may have a reduction in perioperative complications, the need for intensive care unit transfers, blood transfusions, and prolonged hospital stays.
      PubDate: 2018-01-07T22:35:19.849722-05:
      DOI: 10.1111/aas.13063
  • Implementation and effectiveness of a video-based debriefing programme for
           neonatal resuscitation
    • Authors: C. Skåre; T. E. Calisch, E. Sæter, T. Rajka, A. M. Boldingh, B. Nakstad, D. E. Niles, J. Kramer-Johansen, T. M. Olasveengen
      Abstract: BackgroundApproximately 5%–10% of newly born babies need intervention to assist transition from intra- to extrauterine life. All providers in the delivery ward are trained in neonatal resuscitation, but without clinical experience or exposure, training competency is transient with a decline in skills within a few months. The aim of this study was to evaluate whether neonatal resuscitations skills and team performance would improve after implementation of video-assisted, performance-focused debriefings.MethodsWe installed motion-activated video cameras in every resuscitation bay capturing consecutive compromised neonates. The videos were used in debriefings led by two experienced facilitators, focusing on guideline adherence and non-technical skills. A modification of Neonatal Resuscitation Performance Evaluation (NRPE) was used to score team performance and procedural skills during a 7 month study period (2.5, 2.5 and 2 months pre-, peri- and post-implementation) (median score with 95% confidence interval).ResultsWe compared 74 resuscitation events pre-implementation to 45 events post-implementation. NRPE-score improved from 77% (75, 81) to 89% (86, 93), P < 0.001. Specifically, the sub-categories “group function/communication”, “preparation and initial steps”, and “positive pressure ventilation” improved (P < 0.005). Adequate positive pressure ventilation improved from 43% to 64% (P = 0.03), and pauses during initial ventilation decreased from 20% to 0% (P = 0.02). Proportion of infants with heart rate> 100 bpm at 2 min improved from 71% pre- vs. 82% (P = 0.22) post-implementation.ConclusionImplementation of video-assisted, performance-focused debriefings improved adherence to best practice guidelines for neonatal resuscitation skill and team performance.
      PubDate: 2018-01-07T22:30:22.892228-05:
      DOI: 10.1111/aas.13050
  • Response to ‘Objective neuromuscular monitoring: the challenges limiting
           its use’ by Dr. El-Orbany
    • Authors: C. M. Söderström; K. Z. Eskildsen, M. R. Gätke, A. K. Staehr-Rye
      PubDate: 2018-01-05T02:30:20.113873-05:
      DOI: 10.1111/aas.13049
  • Issue Information
    • Pages: 143 - 143
      PubDate: 2018-01-10T03:01:45.54433-05:0
      DOI: 10.1111/aas.12971
  • Trauma team activation – common rules, common gain
    • Authors: T. Dehli; O. Uleberg, T. Wisborg
      Pages: 144 - 146
      PubDate: 2018-01-10T03:01:45.443655-05:
      DOI: 10.1111/aas.13013
  • Calendar of Events
    • Pages: 280 - 280
      PubDate: 2018-01-10T03:01:46.423865-05:
      DOI: 10.1111/aas.12970
  • Factors associated with non-response at health-related quality of life
           follow-up in a septic shock trial
    • Authors: M. N. Kjær; C. B. Mortensen, P. B. Hjortrup, S. L. Rygård, I. Andersen, A. Perner
      Abstract: BackgroundFollow-up of intensive care unit (ICU) patients often includes health-related quality of life (HRQoL) surveying, but non-responders hamper the interpretation. Our aim was to assess factors for non-response to HRQoL survey in ICU patients with septic shock at follow-up in a clinical trial.MethodsIn a post hoc follow-up registry study, we assessed all the Danish survivors in the Transfusion-Requirements in Septic Shock trial patients, who were mailed the Short Form 36-item Survey (SF-36) 1-year after randomization. We used covariates from the trial database merged with covariates from nation-wide registries using the unique national identification number to explore possible factors for not responding. Five covariates were pre-specified to be included in the primary multivariate analysis: age, number of days in hospital from randomization to follow-up, level of education, cohabitation and employment status at follow-up. We compared the mortality from 1-year survival (2012–2014) till end of final follow-up (January 2016) between non-responders and responders.ResultsWe assessed 308 survivors of whom 108 (35%) were non-responders. In the primary analysis lower age (odds ratio 1.03, 95% CI [1.01–1.05]), more admission days in hospital (1.006 [1.001–1.011]) and living alone (4.33 [2.46–7.63]) were associated with non-responding, whereas the level of education and employment status were not. Non-responders had a hazard ratio of 1.63 [0.97–2.72] for mortality from 1-year follow-up to final follow-up as compared to the responders.ConclusionBeing younger, spending more days in hospital and living alone were all associated with non-response at 1-year HRQoL follow-up among ICU patients with septic shock.
      PubDate: 2017-12-27T22:55:24.517508-05:
      DOI: 10.1111/aas.13056
  • The effect of perineural dexamethasone on duration of sciatic nerve
           blockade: a randomized, double-blind study
    • Authors: R. W. Hauritz; K. E. Hannig, C. W. Henriksen, J. Børglum, S. Bjørn, T. F. Bendtsen
      Abstract: BackgroundMajor hindfoot and ankle surgery is associated with severe postoperative pain, which is effectively alleviated by combined sciatic and saphenous nerve blockade. Local anaesthetics with added dexamethasone consistently prolongs the duration of pain relief compared to local anaesthetics alone. However, whether the extended duration of pain relief is due to an effect on duration of sensorimotor block per se vs. systemic absorption of the dexamethasone is still not fully elucidated. We aimed to investigate the postoperative duration of sensorimotor blockade with either dexamethasone or saline added to bupivacaine-epinephrine.MethodsFifty six patients scheduled for surgery were randomly assigned to a popliteal sciatic nerve block of 18 ml 0.5% bupivacaine-epinephrine with either 2 ml of 0.4% dexamethasone or 2 ml 0.9% normal saline added. Sensory and motor functions were tested every 30 min until normalized nerve functions. Primary outcome was time until complete return of sensorimotor functions.ResultsMean (SD) time until return of normal sensory and motor functions was 26 (6) vs. 16 (4) hours, P 
      PubDate: 2017-12-20T20:52:07.046331-05:
      DOI: 10.1111/aas.13054
  • Witnessed out-of-hospital cardiac arrest˗ effects of emergency
           dispatch recognition
    • Authors: S. Syväoja; A. Salo, A. Uusaro, H. Jäntti, M. Kuisma
      Abstract: BackgroundSurvival from an out-of-hospital cardiac arrest (OHCA) depends on the sequence of interventions in “the chain of survival”. If OHCA is recognized in the emergency medical communication centre (EMCC), the proper emergency medical service (EMS) should be dispatched and cardiopulmonary resuscitation (CPR) instructions should be given to a bystander. The study aimed to examine the impact of OHCA recognition in the EMCC on survival rates and the main elements of the chain of survival.MethodsData from the Helsinki University Hospital's registry of OHCA patients between 1997 and 2013 were studied. Altogether, 2054 EMCC-handled and bystander-witnessed OHCA proven events of cardiac origin were analysed.ResultsIn 80.5% of the victims, two EMS units were correctly dispatched and the OHCA was classified as recognized. Achieved return of spontaneous circulation (ROSC) and survival to hospital discharge were 49% and 23%, respectively, if cardiac arrest was recognized by the EMCC and 40% and 16% when it was not (P = 0.003 and 0.002). Dispatchers gave CPR instructions in 60% of the recognized OHCA cases. Bystander-performed CPR increased over time and was given in 58% of the recognized OHCAs and also in 17% of the unrecognized events. EMS delays were shorter if OHCA was recognized as opposed to unrecognized (8 min with an IQR 6.5–10 min vs. 9 min with an IQR 6.5–11 min; P = 0.001).ConclusionsRecognition of OHCA by the EMCC was significantly associated with an increased rate of bystander-performed CPR, reduced EMS response time, and increased OHCA patient ROSC and survival rates.
      PubDate: 2017-12-19T22:40:34.323613-05:
      DOI: 10.1111/aas.13051
  • Objective neuromuscular monitoring: The challenges limiting its use
    • Authors: M. El-Orbany
      PubDate: 2017-12-19T21:05:35.573478-05:
      DOI: 10.1111/aas.13052
  • Incidence of hyperoxia and related in-hospital mortality in critically ill
           patients: a retrospective data analysis
    • Authors: F. Kraft; H. Andel, J. Gamper, K. Markstaller, R. Ullrich, K. U. Klein
      Abstract: BackgroundMechanical ventilation with oxygen is life-saving, however, may result in hyperoxia. The aim was to analyse the incidence and duration of hyperoxia burden and related in-hospital mortality in critically ill patients.MethodsPatients of all ages admitted to intensive care units (ICUs) and with mechanical ventilation for at least seven consecutive days were included in this single centre retrospective medical record audit. The main outcome measure was time-weighted arterial partial pressure of oxygen (PaO2) over 7 days. Logistic regression for association with in-hospital mortality and propensity score matching was performed.ResultsIn total, 20,889 arterial blood gases of 419 patients were analysed. Time-weighted mean PaO2 was 14.0 ± 2.4 kPa. Time-weighted mean FiO2 was 49.2 ± 12.1%. Seventy-six (18.1%) patients showed continuous hyperoxia exposure, defined as time-weighted mean PaO2> 16 kPa. Duration of hyperoxia, hypoxia (PaO2 < 8 kPa) and normoxia (PaO2 8–16 kPa) were 37.9 ± 31.0 h (23.7%), 4.9 ± 9.5 h (3.1%), and 116.8 ± 29.6 h (73.2%). Hyperoxia occurred especially at low to moderate FiO2 in patients of first and second age quartiles (1–57 years) with smaller SAPS2 score. In-hospital mortality of patients with hyperoxia (32.9%) or normoxia did not differ (35.9%; P = 0.691). Conditional logistic regression showed no association between hyperoxia and in-hospital mortality (OR 1.46; 95%CI 0.72–2.96; P = 0.29).ConclusionSubstantial hyperoxia burden was observed in ICU patients. Young patients with less comorbidities showed hyperoxic episodes more often, especially with lower FiO2. Hyperoxia during 7 days of mechanical ventilation did not correlate to increased in-hospital mortality.
      PubDate: 2017-12-06T02:16:31.734087-05:
      DOI: 10.1111/aas.13047
  • Development and internal validation of the Simplified Mortality Score for
           the Intensive Care Unit (SMS-ICU)
    • Authors: A. Granholm; A. Perner, M. Krag, P. B. Hjortrup, N. Haase, L. B. Holst, S. Marker, M. O. Collet, A. K. G. Jensen, M. H. Møller
      Abstract: BackgroundIntensive care unit (ICU) mortality prediction scores deteriorate over time, and their complexity decreases clinical applicability and commonly causes problems with missing data. We aimed to develop and internally validate a new and simple score that predicts 90-day mortality in adults upon acute admission to the ICU: the Simplified Mortality Score for the Intensive Care Unit (SMS-ICU).MethodsWe used data from an international cohort of 2139 patients acutely admitted to the ICU and 1947 ICU patients with severe sepsis/septic shock from 2009 to 2016. We performed multiple imputations for missing data and used binary logistic regression analysis with variable selection by backward elimination, followed by conversion to a simple point-based score. We assessed the apparent performance and validated the score internally using bootstrapping to present optimism-corrected performance estimates.ResultsThe SMS-ICU comprises seven variables available in 99.5% of the patients: two numeric variables: age and lowest systolic blood pressure, and five dichotomous variables: haematologic malignancy/metastatic cancer, acute surgical admission and use of vasopressors/inotropes, respiratory support and renal replacement therapy. Discrimination (area under the receiver operating characteristic curve) was 0.72 (95% CI: 0.71–0.74), overall performance (Nagelkerke's R2) was 0.19 and calibration (intercept and slope) was 0.00 and 0.99, respectively. Optimism-corrected performance was similar to apparent performance.ConclusionsThe SMS-ICU predicted 90-day mortality with reasonable and stable performance. If performance remains adequate after external validation, the SMS-ICU could prove a valuable tool for ICU clinicians and researchers because of its simplicity and expected very low number of missing values.
      PubDate: 2017-12-06T02:16:03.290662-05:
      DOI: 10.1111/aas.13048
  • Low vs high haemoglobin trigger for transfusion in vascular surgery:
           protocol for a randomised trial
    • Authors: A. Møller
      PubDate: 2017-12-01T03:46:08.95257-05:0
      DOI: 10.1111/aas.13044
  • The transfusion trigger in major surgery
    • Authors: R. G. Hahn
      PubDate: 2017-12-01T03:45:21.190205-05:
      DOI: 10.1111/aas.13042
  • Abdominal girth and dorso-sacral distance can be used to estimate
           lumbosacral cerebral fluid volume
    • Authors: Q. H. Zhou; C. Shen, G. Chen
      Abstract: BackgroundPatients’ abdominal girth and vertebral column length are highly correlated with the spread of local anaesthetics after spinal anaesthesia. Lumbosacral cerebrospinal fluid volume is the primary determinant for spinal spread. Thus, we attempted to verify the hypothesis that abdominal girth and dorso-sacral distance are correlated with lumbosacral cerebrospinal fluid volume.MethodsForty-five healthy volunteers were enrolled in this study to measure lumbosacral cerebrospinal fluid volume using magnetic resonance imaging. The age, height, weight, abdominal girth, dorso-sacral distance and lumbosacral cerebrospinal fluid volume of the volunteers were recorded. Multiple linear regression analysis was used to analyse the correlation between age, height, weight, abdominal girth, dorso-sacral distance and lumbosacral cerebrospinal fluid volume.ResultsTwo volunteers were excluded because of lumbar disc herniation, leaving 43 volunteers for analysis. Multiple linear regression analysis showed a strong correlation between abdominal girth, dorso-sacral distance and lumbosacral cerebrospinal fluid volume (both P < 0.01). The adjusted R2 was 0.644. Volunteers with small abdominal girth showed clear images of cerebrospinal fluid in the nerve root cuff at the intervertebral foramen in the three-dimensional magnetic resonance imaging reconstruction of lumbosacral cerebrospinal fluid, while the images were vague in volunteers with large abdominal girth. Clearer images implied larger lumbosacral cerebrospinal fluid volume, while vaguer images, smaller lumbosacral cerebrospinal fluid volume.ConclusionsMultiple regression analysis revealed that abdominal girth and dorso-sacral distance were correlated with lumbosacral cerebrospinal fluid volume. Smaller abdominal girths and larger dorso-sacral distances predict larger lumbosacral cerebrospinal fluid volume.
      PubDate: 2017-11-27T04:25:26.212161-05:
      DOI: 10.1111/aas.13046
  • The adequate rocuronium dose required for complete block of the adductor
           muscles of the thigh
    • Authors: M. Fujimoto; K. Kawano, T. Yamamoto
      Abstract: BackgroundRocuronium can prevent the obturator jerk during transurethral resection of bladder tumors. We investigated the adequate rocuronium dose required for complete block of the thigh adductor muscles, and its correlation with individual responses of the adductor pollicis muscle to rocuronium.MethodsEleven patients scheduled for transurethral resection of bladder tumors under general anesthesia were investigated. After general anesthesia induction, neuromuscular monitoring of the adductor pollicis muscle and ultrasonography-guided stimulation of the obturator nerve was commenced. Rocuronium, 0.15 mg/kg, was repeatedly administered intravenously. The adequate rocuronium dose required for complete block of the thigh muscles, defined as the cumulative dose of rocuronium administered until that time, and its correlation with the first twitch response of the adductor pollicis muscle on train-of-four stimulation after initial rocuronium administration was analyzed.ResultsThe rocuronium dose found adequate for complete block of the thigh muscles was 0.30 mg/kg in seven patients and 0.45 mg/kg in the remaining four patients, which did not correlate with the first twitch response. At the time of complete block of the thigh muscles, the neuromuscular blockade level of the adductor pollicis muscle varied greatly, although the level was never more profound than a post-tetanic count of 1.ConclusionAlthough the response of the adductor pollicis muscle to rocuronium cannot be used to determine the adequate rocuronium dose required for complete block of the thigh muscles, intense blockade, with maintenance of post-tetanic count at ≤ 1 in the adductor pollicis muscle is essential to prevent the obturator jerk.
      PubDate: 2017-11-26T23:05:28.084796-05:
      DOI: 10.1111/aas.13045
  • A comparison between McGrath MAC videolaryngoscopy and Macintosh
           laryngoscopy in children
    • Authors: J. E. Kim; H. J. Kwak, W. S. Jung, M. Y. Chang, S. Y. Lee, J. Y. Kim
      Abstract: BackgroundThis prospective, randomised, controlled study was performed to evaluate the usefulness of the McGrath VL compared with Macintosh laryngoscopy in children with expected normal airway during endotracheal intubation, by comparing the time to intubation and difficulty of intubation.MethodsEighty-four patients aged 1–10 years who underwent endotracheal intubation for elective surgery were randomly assigned to the McGrath group (n = 42) or the Macintosh group (n = 42). Anaesthesia was induced with 2.5–3.0 mg/kg of propofol and sevoflurane 5–8 vol%. Orotracheal intubation was performed 2 min after injection of rocuronium 0.6 mg/kg with McGrath VL or Macintosh laryngoscope; the primary outcome was the time to intubation. The Cormack and Lehane glottic grade, intubation difficulty score (IDS), and success rate on intubation were assessed. Haemodynamic changes were also recorded.ResultsAs the primary outcome, median time to intubation [interquartile range] did not differ between the McGrath group and the Macintosh group (25.0 [22.8–28.3] s vs. 26.0 [24.0–29.0] s, P = 0.301). The incidence of grade I glottic view was significantly higher in the McGrath group than in the Macintosh group (95% vs. 74%, P = 0.013). Median IDS was lower in the McGrath group than in the Macintosh group (0 [0–0] vs. 0 [0–1], P = 0.018). There were no significant differences in success rate on intubation or haemodynamics between the two groups.ConclusionsMcGrath VL provides better laryngeal views and lower IDS but similar intubation times and success rates compared with the Macintosh laryngoscope in children with normal airway.
      PubDate: 2017-11-26T23:05:22.776362-05:
      DOI: 10.1111/aas.13043
  • Reliability of body-weight scalars on the assessment of propofol induction
           dose in obese patients
    • Authors: A. M. Araújo; H. S. Machado, A. C. Falcão, P. Soares-da-Silva
      Abstract: BackgroundObese patients require specific perioperative care when compared with non-obese patients. The present study aimed to analyse the ability of size descriptors to estimate propofol induction dose in class II and III obese patients.MethodsA cross-sectional study on adult patients with body mass index (BMI) equal to or greater than 35 kg/m2 and on adult patients with BMI lower than 35 kg/m2 was carried out. General anaesthesia was induced with remifentanil, propofol and rocuronium. Propofol infusion was started at 2000 mg/h until loss of consciousness. Bioelectrical impedance analysis and Brice modified interview was completed during pre- and post-operative evaluation, respectively. Measurements of propofol plasma concentration were performed using gas chromatography/ion trap-mass spectrometry.ResultsForty patients were enrolled in the study. The median values of fat free mass (FFM) in BMI 
      PubDate: 2017-11-21T00:30:31.562228-05:
      DOI: 10.1111/aas.13039
  • S100β in newborns after C-section with general vs. epidural anesthesia: a
           prospective observational study
    • Authors: Z. Xu; Z. Liu, Y. Zhang, C. Jin, F. Shen, Y. Yu, T. Cheek, O. Onuoha, G. Liang, R. Month, J. Atkins, K. M. Tran, H. Wei
      Abstract: BackgroundPreclinical evidence suggests that general anesthetics can dose dependently induce neurodegeneration in the developing brains of animals which can be reliably determined by measurement of blood S100β, but this correlation remains unclear in humans. We hypothesized that S100β would not be increased in cord arterial blood of fetuses exposed briefly to general anesthetics during a C-section, compared with epidural anesthesia.MethodsA prospective observational clinical study comparatively measured changes of brain damage biomarker S100β ratio of umbilical artery over vein (changes after fetus circulation) immediately after delivery under C-section with either epidural or general anesthesia. Newborn blood gas measurements, APGAR scores, and maternal well-being were also compared.ResultsCompared with epidural anesthesia, general anesthesia resulted in the lower S100β ratio of umbilical artery over the vein (medium 2.64 [quartiles 1.39, 3.45] vs. medium 1.59 [quartiles 0.88, 2.01], P = 0.031), without changing the S100β level in the vein of the mother. There was no significant difference between general and epidural anesthesia when comparing other maternal and newborn parameters.ConclusionS100β levels in newborn after C-section is lower with general anesthesia than epidural anesthesia, with unclear mechanisms.
      PubDate: 2017-11-20T21:05:34.833394-05:
      DOI: 10.1111/aas.13038
  • 4218T/C polymorphism associations with post-cesarean patient-controlled
           epidural fentanyl consumption and pain perception
    • Authors: W. Xie; W. Zhuang, L. Chen, W. Xie, C. Jiang, N. Liu
      Abstract: BackgroundThe utilization of intrathecal opioids is an efficacious component of post-cesarean section pain management. Given that growing evidence indicates that calcitonin gene-related peptide (CGRP) plays a key role in the development of peripheral sensitization and is associated with enhanced pain, we hypothesized that CGRP 4218T/C polymorphism is associated with the variability in fentanyl consumption for post-cesarean analgesia.MethodsWe recruited 548 patients who presented for elective cesarean delivery, and used polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method to analyze CGRP 4218T/C polymorphism. We examined the association of CGRP 4218T/C polymorphism and post-operative fentanyl consumption for analgesia as well as adverse reactions to fentanyl in those patients who received cesarean section surgeries.ResultsWe found that the CGRP 4218T/C polymorphism has a significant effect on pain perception, analgesic requirement, and nausea and vomiting for the first 24 h after cesarean delivery in patients who received PCEA fentanyl. Individuals with the C/C genotype had more pain, required more PCEA fentanyl, and experienced a lower incidence of nausea and vomiting.ConclusionThese results indicated that patients with C/C genotype may have reduced sensitivity to fentanyl analgesia and/or increased pain perception, and were more willing to use PCEA fentanyl to manage their pain.
      PubDate: 2017-11-17T04:35:43.040576-05:
      DOI: 10.1111/aas.13040
  • Delirium and effect of circadian light in the intensive care unit: a
           retrospective cohort study
    • Authors: S. Estrup; C. K. W. Kjer, L. M. Poulsen, I. Gøgenur, O. Mathiesen
      Abstract: BackgroundDelirium is a serious condition often experienced by critically ill patients in intensive care units (ICUs). The role of circadian light for this condition is unclear. The aim of this study was to describe incidence of delirium, risk factors for delirium, and the association between delirium and circadian light for patients in the ICU.MethodsThis is a retrospective cohort study of all patients at a Danish ICU from 1 August 2015 to 31 January 2016. Exclusion criteria were heavy sedation, no Confusion Assessment Method for the ICU (CAM-ICU) scores, or inability to communicate in Danish. Delirium was defined as at least one positive CAM-ICU score or treatment with haloperidol. Three of nine beds at the ICU had a circadian light installation. Allocation to ICU beds with or without circadian light depended on availability at admission. Risk factors for development of delirium were analyzed by simple and multiple logistic regression.ResultsWe included 183 patients in the study. The incidence of delirium was 28% (95% CI 22, 35). Allocation to beds with or without circadian lighting was not associated with delirium incidence (OR 1.14; 95% CI 0.55, 2.37; P = 0.73). We found that Simplified Acute Physiology Score II (SAPS II) (OR 1.03; 95% CI 1.01, 1.06; P = 0.002), and dexmedetomidine was associated with delirium (OR 4.14; 95% CI 1.72, 10.03; P = 0.002).ConclusionIn this population of patients admitted to an ICU during 6 months, the incidence of delirium was 28%. We did not find an association between circadian light and development of delirium.
      PubDate: 2017-11-17T04:35:31.102854-05:
      DOI: 10.1111/aas.13037
  • Lactate improves SAPS 3 prognostication
    • Authors: P. Andersson; A. Frigyesi
      Abstract: IntroductionLactate concentration is known to be a strong predictor of mortality, but is not included in any of the major intensive care scorings systems such as the Simplified Acute Physiology Score (SAPS 3). The objective of this study was to investigate the prognostic value of lactate concentration when combined with SAPS 3.Materials and methodsIn the period of 2008 to June 2017 the general intensive care unit at Skåne University Hospital in Lund, Sweden had 5141 first-time admissions. Of these, 3039 patients had lactate concentrations analysed within 1 h of admission.ResultsAs expected, lactate concentration was found to be strongly related to 30-day mortality. Lactate concentration was found to be a SAPS 3 independent predictor of mortality (odds ratio 1.08, 95% confidence interval 1.05–1.11, P < 0.001), but did not improve the area under the receiver operating characteristic curve (AUC) (AUC 78.9% vs. 78.7%, P = 0.053). However, we found that lactate added prognostic value to SAPS 3 for patients with cardiac arrest (AUC 79.6% vs. 76.4%, P = 0.0082) and sepsis (AUC 75.1% vs. 72.7%, P = 0.033).ConclusionEven compared to our current prognostication model, SAPS 3, lactate concentration was found to be an independent predictor for all diagnoses, cardiac arrest and sepsis. The addition of lactate concentration level improved the AUC for cardiac arrest and sepsis, but not for all diagnoses.
      PubDate: 2017-11-10T04:46:26.989599-05:
      DOI: 10.1111/aas.13033
  • Prediction of bleeding and thrombosis by standard biochemical coagulation
           variables in haematological intensive care patients
    • Authors: L. Russell; M. B. Madsen, M. Dahl, P. Kampmann, A. Perner
      Abstract: PurposeWe assessed the value of standard biochemical coagulation parameters in predicting bleeding, thrombosis and mortality in adult Intensive Care Unit (ICU) patients with haematological malignancies.MethodsWe screened all patients with acute leukaemia and myelodysplastic syndrome admitted to a university hospital ICU during 2008–2012. Data were obtained from the clinical chemistry laboratory database and patient files. We graded bleeding according to the World Health Organisation (WHO)-system within 24-h, within 5-days and during the whole ICU stay. We analysed the predictive values of laboratory parameters using multiple logistic regression and receiver operator characteristics (ROC) curves. As we previously have established that platelet count at admission was associated with bleeding, we focused on International Normalised Ratio (INR), activated pro-thrombin time (APTT), anti-thrombin, D-dimer and fibrinogen, and markers of infection (C-reactive protein, pro-calcitonin), kidney function (creatinine) and tissue damage (lactate dehydrogenase (LDH)).ResultsWe included 116 patients; 66 (57%) had at least one bleeding episode and 11 (9%) patients had at least one thrombotic event. The differences in coagulation values when bleeding compared to baseline values were minor. INR was the only variable we found associated with subsequent bleeding within 24 h from admission to ICU (odds ratio 2.91, 95% CI: 1.01–8.43, P = 0.048). ROC analyses did not show predictive value of any of the other variables with regards to bleeding and none of the variables were associated with thrombosis in adjusted analyses. Increased levels of LDH at admission were associated with increased 7-day and 30-day mortality.ConclusionsIncreased INR at admission was associated with a higher rate of bleeding in ICU patients with haematological malignancies. No other biochemical coagulation or other parameter had any association with bleeding, thrombosis or mortality except increased LDH, which at ICU admission was associated with increased 30-day mortality.
      PubDate: 2017-11-09T22:50:27.523733-05:
      DOI: 10.1111/aas.13036
  • Validating performance of TRISS, TARN and NORMIT survival prediction
           models in a Norwegian trauma population
    • Authors: N. O. Skaga; T. Eken, S. Søvik
      Abstract: IntroductionAnatomic injury, physiological derangement, age, injury mechanism and pre-injury comorbidity are well-founded predictors of trauma outcome. Statistical prediction models may have poorer discrimination, calibration and accuracy when applied in new locations. We aimed to compare the TRISS, TARN and NORMIT survival prediction models in a Norwegian trauma population.MethodsConsecutive patients admitted to Oslo University Hospital Ullevål within 24 h after injury, with Injury Severity Score ≥ 10, proximal penetrating injuries, or received by trauma team, were studied. Original NORMIT coefficients were updated in a derivation dataset (NORMIT 2; n = 5923; 2005–2009). TRISS, TARN and NORMIT prediction models were evaluated in the validation dataset (n = 6348; 2010–2013) using two different AIS editions for injury coding. Exclusion due to missing data was 0.26%. Outcome was 30-day mortality. Validation included AUROC, scaled Brier statistics, and calibration plots.ResultsThe NORMIT models had significantly better discrimination, calibration, and overall fit than the TRISS 09, TARN 09 and TARN 12 models. The updated NORMIT 2 had higher numerical values of AUROC and scaled Brier than the original NORMIT, but with overlapping 95%CI. Overlapping 95%CI for AUROCs and Discrimination slopes indicated that the TARN and TRISS models performed similarly. Calibration plots showed tight and consistent predictions over all Ps strata for NORMIT 2 run on AIS'98 coded data, and only little deterioration when AIS'08 data was substituted.ConclusionsIn a Norwegian trauma population, the updated Norwegian survival prediction model in trauma (NORMIT 2) performed better than well-established British and US alternatives. External validation of these three models in other Nordic populations is warranted.
      PubDate: 2017-11-08T22:35:27.829877-05:
      DOI: 10.1111/aas.13029
  • A prototype small-bore ventilation catheter with a cuff: cuff inflation
           optimizes ventilation with the Ventrain
    • Authors: M. W. P. Wolf; T. Beek, A. E. Hamaekers, M. Theunissen, D. Enk
      Abstract: BackgroundVentilation through small-diameter tubes typically precludes use of a cuff as this will impede the necessary passive outflow of gas alongside the tube's outer surface. Ventrain assists expiration and enables oxygenation and normoventilation through small-bore cannulas or catheters, particularly in obstructed airways. A small-bore ventilation catheter (SBVC; 40 cm long, 2.2 mm inner diameter) with a separate pressure monitoring lumen and a cuff was developed. Efficacy of oxygenation and ventilation with Ventrain through this catheter was investigated in sealed and open airways in a porcine cross-over study.MethodsSix pigs were ventilated with Ventrain (15 l/min oxygen, frequency 30 breaths per min, I : E-ratio 1 : 1) through the SBVC, both with the cuff inflated and deflated. Prior to each test they were ventilated conventionally until steady state was achieved.ResultsWith an inflated cuff, PaO2 rose instantly and remained elevated (median [range] PaO2 61 [52–69] kPa after 30 min; P = 0.027 compared to baseline). PaCO2 remained stable at 4.9 [4.2–6.2] kPa. After cuff deflation, PaO2 was significantly lower (9 [5–28] kPa at 10 min, P = 0.028) and interventional ventilation had to be stopped prematurely in five pigs as PaCO2 exceeded 10.6 kPa. Pulmonary artery pressures increased markedly in these pigs. Intratracheal pressures were kept between 5 and 20 cmH2O with the cuff inflated, but never exceeded 2 cmH2O after cuff deflation.ConclusionThe SBVC combines the benefits of a small diameter airway and a cuff. Cuff inflation optimizes oxygenation and ventilation with Ventrain.
      PubDate: 2017-11-08T22:30:43.430065-05:
      DOI: 10.1111/aas.13030
  • Specific anesthesia-induced lung volume changes from induction to
           emergence: a pilot study
    • Authors: P. Kostic; A. LoMauro, A. Larsson, G. Hedenstierna, P. Frykholm, A. Aliverti
      Abstract: BackgroundStudies aimed at maintaining intraoperative lung volume to reduce post-operative pulmonary complications have been inconclusive because they mixed up the effect of general anesthesia and the surgical procedure. Our aims were to study: (1) lung volume during the entire course of anesthesia without the confounding effects of surgical procedures; (2) the combination of three interventions to maintain lung volume; and (3) the emergence phase with focus on the restored activation of the respiratory muscles.MethodsEighteen ASA I–II patients undergoing ENT surgery under general anesthesia without muscle relaxants were randomized to an intervention group, receiving lung recruitment maneuver (LRM) after induction, 7 cmH2O positive end-expiratory pressure (PEEP) during anesthesia and continuous positive airway pressure (CPAP) during emergence with 0.4 inspired oxygen fraction (FiO2) or a control group, ventilated without LRM, with 0 cmH2O PEEP, and 1.0 FiO2 during emergence without CPAP application. End-expiratory lung volume (EELV) was continuously estimated by opto-electronic plethysmography. Inspiratory and expiratory ribcage muscles electromyography was measured in a subset of seven patients.ResultsEnd-expiratory lung volume decreased after induction in both groups. It remained low in the control group and further decreased at emergence, because of active expiratory muscle contraction. In the intervention group, EELV increased after LRM and remained high after extubation.ConclusionA combined intervention consisting of LRM, PEEP and CPAP during emergence may effectively maintain EELV during anesthesia and even after extubation. An unexpected finding was that the activation of the expiratory muscles may contribute to EELV reduction during the emergence phase.
      PubDate: 2017-11-03T05:10:26.907687-05:
      DOI: 10.1111/aas.13026
  • Prospective study on long-term outcome after abdominal surgery
    • Authors: E. D. Brynjarsdottir; M. I. Sigurdsson, E. Sigmundsdottir, P. H. Möller, G. H. Sigurdsson
      Abstract: BackgroundComplications following major abdominal surgery are common and an important cause of morbidity and mortality. The aim of this study was to describe 1-year mortality and identify factors that influence adverse outcomes after abdominal surgery.MethodsThis prospective observational cohort study was performed in Landspitali University Hospital and included all adult patients undergoing abdominal surgery requiring> 24-h hospital admission over 13 months. The follow-up period was 60 days for complications and 24 months for mortality.ResultsData were available for 1113 (99.5%) of the 1119 patients who fulfilled inclusion criteria. A total of 23% of patients had at least one underlying co-morbidity. Non-elective surgeries were 48% and 13% of the patients were admitted to ICU post-operatively. A total of 20% of patients developed complications. Mortality at 30 days, 1 and 2 years was 1.8%, 5.6%, and 8.3% respectively. One-year mortality for those admitted to ICU was 18%. The long-term survival of the individuals surviving 30 days was significantly worse than for an age- and gender-matched population control group. Independent predictors for 1-year mortality were age, pre-operative acute kidney injury and intermediate- or major surgery.ConclusionPost-operative complication rates and mortality following abdominal surgery in Iceland were comparable or in the lower range of previously published outcomes, validating the utility of offering a full host of abdominal surgical services in geographically isolated region with a relatively small referral base.
      PubDate: 2017-11-01T23:44:29.62319-05:0
      DOI: 10.1111/aas.13025
  • Necrotizing soft tissue infections – a multicentre, prospective
           observational study (INFECT): protocol and statistical analysis plan
    • Authors: M. B. Madsen; S. Skrede, T. Bruun, P. Arnell, A. Rosén, M. Nekludov, Y. Karlsson, F. Bergey, E. Saccenti, V. A. P. Martins dos Santos, A. Perner, A. Norrby-Teglund, O. Hyldegaard
      Abstract: BackgroundThe INFECT project aims to advance our understanding of the pathophysiological mechanisms in necrotizing soft tissue infections (NSTIs). The INFECT observational study is part of the INFECT project with the aim of studying the clinical profile of patients with NSTIs and correlating these to patient-important outcomes. With this protocol and statistical analysis plan we describe the methods used to obtain data and the details of the planned analyses.MethodsThe INFECT study is a multicentre, prospective observational cohort study. Patients with NSTIs are enrolled in five Scandinavian hospitals, which are all referral centres for NSTIs. The primary outcomes are the descriptive variables of the patients. Secondary outcomes include identification of factors associated with 90-day mortality and amputation; associations between affected body part, maximum skin defect and Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score and 90-day mortality; 90-day mortality in patients with and without acute kidney injury (AKI) and LRINEC score of six and above or below six; and association between affected body part at arrival and microbiological findings. Exploratory outcomes include univariate analyses of baseline characteristics associations with 90-day mortality. The statistical analyses will be conducted in accordance with the predefined statistical analysis plan.ConclusionNecrotizing soft tissue infections result in severe morbidity and mortality. The INFECT study will be the largest prospective study in patients with NSTIs to date and will provide important data for clinicians, researchers and policy makers on the characteristics and outcomes of these patients.
      PubDate: 2017-10-29T21:45:30.175197-05:
      DOI: 10.1111/aas.13024
  • Modifications of the National Early Warning Score for patients with
           chronic respiratory disease
    • Authors: N. E. Pedersen; L. S. Rasmussen, J. A. Petersen, T. A. Gerds, D. Østergaard, A. Lippert
      Abstract: BackgroundThe National Early Warning Score (NEWS) uses physiological variables to detect deterioration in hospitalized patients. However, patients with chronic respiratory disease may have abnormal variables not requiring interventions. We studied how the Capital Region of Denmark NEWS Override System (CROS), the Chronic Respiratory Early Warning Score (CREWS) and the Salford NEWS (S-NEWS) affected NEWS total scores and NEWS performance.MethodsIn an observational study, we included patients with chronic respiratory disease. The frequency of use of CROS and the NEWS total score changes caused by CROS, CREWS and S-NEWS were described. NEWS, CROS, CREWS and S-NEWS were compared using 48-h mortality and intensive care unit (ICU) admission within 48 h as outcomes.ResultsWe studied 11,266 patients during 25,978 admissions; the use of CROS lowered NEWS total scores in 40% of included patients. CROS, CREWS and S-NEWS had lower sensitivities than NEWS for 48-h mortality and ICU admission. Specificities and PPV were higher. CROS, CREWS and S-NEWS downgraded, respectively, 51.5%, 44.9% and 32.8% of the NEWS total scores from the ‘mandatory doctor presence’ and ‘immediate doctor presence and specialist consultation’ total score intervals to lower intervals.ConclusionCapital Region of Denmark NEWS Override System was frequently used in patients with chronic respiratory disease. CROS, CREWS and S-NEWS reduced sensitivity for 48-h mortality and ICU admission. Using the methodology prevalent in the NEWS literature, we cannot conclude on the safety of these systems. Future prospective studies should investigate the balance between detection rate and alarm fatigue of different systems, or use controlled designs and patient-centred outcomes.
      PubDate: 2017-10-26T05:15:36.90443-05:0
      DOI: 10.1111/aas.13020
  • Attitudes of physicians towards the care of critically ill elderly
           patients – a European survey
    • Authors: B. Guidet; D. W. De Lange, S. Christensen, R. Moreno, J. Fjølner, G. Dumas, H. Flaatten
      Abstract: BackgroundVery elderly patients are one of the fastest growing population in ICUs worldwide. There are lots of controversies regarding admission, discharge of critically ill elderly patients, and also on treatment intensity during the ICU stay. As a consequence, practices vary considerably from one ICU to another. In that perspective, we collected opinions of experienced ICU physicians across Europe on statements focusing on patients older than 80.MethodsWe sent an online questionnaire to the coordinator ICU physician of all participating ICUs of an recent European, observational study of Very old critically Ill Patients (VIP1 study). This questionnaire contained 12 statements about admission, triage, treatment and discharge of patients older than 80.ResultsWe received answers from 162 ICUs (52% of VIP1-study) spanning 20 different European countries. There were major disagreements between ICUs. Responders disagree that: there is clear evidence that ICU admission is beneficial (37%); seeking relatives’ opinion is mandatory (17%); written triage guidelines must be available either at the hospital or ICU level (20%); level of care should be reduced (25%); a consultation of a geriatrician should be sought (34%) and a geriatrician should be part of the post-ICU trail (11%). The percentage of disagreement varies between statements and European regions.ConclusionThere are major differences in the attitude of European ICU physicians on the admission, triage and treatment policies of patients older than 80 emphasizing the lack of consensus and poor level of evidence for most of the statements and outlining the need for future interventional studies.
      PubDate: 2017-10-26T05:15:20.572191-05:
      DOI: 10.1111/aas.13021
  • Electrophysiological effects of desflurane in children with
           Wolff-Parkinson-White syndrome: a randomized crossover study
    • Authors: H. Hino; Y. Oda, Y. Yoshida, T. Suzuki, M. Shimada, K. Nishikawa
      Abstract: BackgroundWe hypothesized that, compared with propofol, desflurane prolongs the antegrade accessory pathway effective refractory period (APERP) in children undergoing radiofrequency catheter ablation for Wolff-Parkinson-White (WPW) syndrome.MethodsIn this randomized crossover study, children aged 4.1−16.1 years undergoing radiofrequency catheter ablation for WPW syndrome were randomly divided into four groups according to the concentration of desflurane and anesthetics used in the first and the second electrophysiological studies (EPS). After induction of general anesthesia with propofol and tracheal intubation, they received one of the following regimens: 0.5 minimum alveolar concentration (MAC) desflurane (first EPS) and propofol (second EPS) (Des0.5-Prop group, n = 8); propofol (first EPS) and 0.5 MAC desflurane (second EPS) (Prop-Des0.5 group, n = 9); 1 MAC desflurane (first EPS) and propofol (second EPS) (Des1.0-Prop group, n = 10); propofol (first EPS) and 1 MAC desflurane (second EPS) (Prop-Des1.0 group, n = 9). Radiofrequency catheter ablation was performed upon completion of EPS. Sample size was determined to detect a difference in the APERP.ResultsDesflurane at 1.0 MAC significantly prolonged the APERP compared with propofol, but did not affect the sinoatrial conduction time, atrio-His interval or atrioventricular node effective refractory period. Supraventricular tachycardia was induced in all children receiving propofol, but not induced in 1 and 4 children receiving 0.5 MAC and 1.0 MAC desflurane, respectively.ConclusionDesflurane enhances the refractoriness and may block the electrical conduction of the atrioventricular accessory pathway, and is therefore not suitable for use in children undergoing radiofrequency catheter ablation for WPW syndrome.
      PubDate: 2017-10-25T05:01:09.575714-05:
      DOI: 10.1111/aas.13023
  • High volatile anaesthetic conservation with a digital in-line vaporizer
           and a reflector
    • Authors: A. Mashari; L. Fedorko, J. A. Fisher, M. Klein, M. Wąsowicz, M. Meineri
      Abstract: BackgroundA volatile anaesthetic (VA) reflector can reduce VA consumption (VAC) at the cost of fine control of its delivery and CO2 accumulation. A digital in-line vaporizer and a second CO2 absorber circumvent both of these limitations. We hypothesized that the combination of a VA reflector with an in-line vaporizer would yield substantial VA conservation, independent of fresh gas flow (FGF) in a circle circuit, and provide fine control of inspired VA concentrations.MethodProspective observational study on six Yorkshire pigs. A secondary anaesthetic circuit consisting of a Y-piece with 2 one-way valves, an in-line vaporizer and a CO2 absorber in the inspiratory limb was connected to the patient's side of the VA reflector. The other side was connected to the Y-piece of a circle anaesthetic circuit. In six pigs, an inspired concentration of sevoflurane of 2.5% was maintained by the in-line vaporizer. We measured VAC at FGF of 1, 4 and 10 l/min.ResultsWith the secondary circuit, VAC was 55% less than with the circle system alone at FGF 1 l/min, and independent of FGF over the range of 1–10 l/min. Insertion of a CO2 absorber in the secondary circuit reduced PetCO2 by 1.3–2.0 kpa (10–15 mmHg).ConclusionA secondary circuit with reflector and in-line vaporizer provides highly efficient anaesthetic delivery, independent of FGF. A second CO2 absorber was necessary to scavenge the CO2 reflected by the anaesthetic reflector. This secondary circuit may turn any open circuit ventilator into an anaesthetic delivery unit.
      PubDate: 2017-10-25T05:00:26.550836-05:
      DOI: 10.1111/aas.13017
  • Spinal or general anaesthesia for lower-limb amputation in peripheral
           artery disease – a retrospective cohort study
    • Authors: M. Niskakangas; S. Dahlbacka, J. Liisanantti, M. Vakkala, T. Kaakinen
      Abstract: BackgroundThe present study aimed to determine which method of anaesthesia (spinal anaesthesia or general anaesthesia) is better in reducing post-operative analgesic requirements in patients undergoing major limb amputation for lower-limb ischaemia. Another aim was to find out if anaesthesiologists use neuraxial anaesthesia in high-risk patients despite abnormal coagulation profile or use of anticoagulation.MethodsThe study was a retrospective cohort study. All patients undergone above-the-knee amputation or below-the-knee amputation due to peripheral artery disease between 1996 and 2010 were reviewed to evaluate post-operative opioid consumption and complications.ResultsA total of 434 amputations in 323 patients were included in the study. The number of surgical complications, the need for surgical revision and the number of intensive care unit admissions were significantly higher in the general anaesthesia group. The need for post-operative opioid medication was significantly lower in patients with above-the-knee amputation and spinal anaesthesia. The use of post-operative epidural analgesia did not reduce analgesic requirements. In the present study, there were patients who received neuraxial anaesthesia despite abnormal coagulation profile or uninterrupted warfarin or clopidogrel. There were no reported cases of spinal or epidural haematoma.ConclusionPatients with spinal anaesthesia had a lower rate of surgical complications, re-operations and intensive care unit admissions. Patients with above-the-knee amputation and spinal anaesthesia had a lesser need for opioid medication in the post-operative period than patients with general anaesthesia. Anaesthesiologists performed neuraxial anaesthesia and/or analgesia in high-risk patients despite abnormal coagulation profile or ongoing anticoagulation, but no adverse outcomes were reported.
      PubDate: 2017-10-24T02:30:28.961239-05:
      DOI: 10.1111/aas.13019
  • Insertion methods comparison for The Streamlined Liner of the Pharynx
           Airway in children by novice
    • Authors: Y. Chen; J. Bai, R. Wang
      Abstract: BackgroundThe Streamlined Liner of the Pharynx Airway (SLIPA™) is a popular supraglottic airway device used for pediatric anesthesia. However, based on the anatomical features of pediatric patients, novice residents are expected to have difficulties inserting the device. The objective of this work was to improve the SLIPA insertion by modifying the device.MethodsA total of 134 children were randomized into two groups. Anesthesia was standardized among all patients except for the way in which the SLIPA was inserted. One group underwent the conventional method of insertion (Group C), while the modified group received a SLIPA that was bent120° at the ‘bridge’ point with an intubating stylet (Group M). The primary outcome was insertion success rate, and the secondary outcomes included insertion time, incidence of complications and hemodynamic responses to insertion.ResultsThe insertion success rate was significantly higher in Group M than Group C (94% vs. 73%, Χ2 = 10.659, P = 0.001). The insertion time for Group M [29.31 (25.91–35.60) seconds] was shorter than for Group C [34.72 (26.81–42.58) seconds] (Z = −2.381, P = 0.017). Trends in heart rate (F = 0.260, P = 0.794), mean blood pressure (F = 0.167, P = 0.683) did not significantly differ between the two groups over time. In terms of complications, we found no significant differences between groups (P> 0.05).ConclusionThe 120° bend improved SLIPA insertion when performed by novice, as reflected by higher insertion success rates and shorter insertion times, with no statistical differences in hemodynamic response to insertion or the incidence rates of complications between the two groups.
      PubDate: 2017-10-23T23:23:43.376918-05:
      DOI: 10.1111/aas.13018
  • Urgency of caesarean section, grading, alarm chain and intrauterine
           resuscitation – a survey of Scandinavian practice
    • Authors: K. Wildgaard; M. Ismaiel, F. Hetmann
      Abstract: BackgroundAbout 40,000 women have caesarean section in Scandinavia each year. Organizational factors for emergency caesarean section (CS), classification, anaesthetic practice, alarm chain, intrauterine resuscitation has all been investigated in the United Kingdom, but no information from the Scandinavian countries exists.MethodsUsing publicly available data from the National Board of Health, obstetric anaesthetic departments were identified. The heads of the departments provided e-mail contact details of two anaesthesiologists regularly practicing obstetric anaesthesia who were then surveyed.ResultsOne hundred and forty-five specialists from 82 departments in Scandinavia replied to our survey. Ninety-five percent of Danish specialists reported a three-grade classification system for urgency CS. Where classification in Denmark was enumerative classification, Norwegians equally reported enumerative and verbal descriptors, whereas Swedish specialists mostly reported verbal descriptors. Local guidelines describing decision-to-delivery interval for emergency CS was reported by 100% of Danish specialists vs. 47% from Norway and 85% from Sweden. Mean benchmark decision-to-delivery interval for emergency CS was 12.7 min. General anaesthesia for emergency CS was highly favoured in Norway (95%) and Sweden (97%), compared to Denmark (49%). Twenty specialists reported existence of local guidelines for intrauterine resuscitation.ConclusionOur survey of Scandinavian specialists indicate emergency CS practise differs from United Kingdom practices in several aspects; general anaesthesia is by the majority of Scandinavian specialists reported as the default choice for emergency CS and benchmark for decision-to-delivery interval is
      PubDate: 2017-10-18T04:50:25.393047-05:
      DOI: 10.1111/aas.13009
  • Evaluation of a method for isocapnic hyperventilation: a clinical pilot
    • Authors: K. Hallén; P. Jildenstål, O. Stenqvist, S.-E. Ricksten, S. Lindgren
      Abstract: BackgroundIsocapnic hyperventilation (IHV) is a method that shortens time to extubation after inhalation anaesthesia using hyperventilation (HV) without lowering airway CO2. In a clinical trial on patients undergoing long-duration sevoflurane anaesthesia for major ear–nose–throat (ENT) surgery, we evaluated the utility of a technique for CO2 delivery (DCO2) to the inspiratory limb of a closed breathing circuit, during HV, to achieve isocapnia.MethodsFifteen adult ASA 1–3 patients were included. After end of surgery, mechanical HV was started by doubling baseline minute ventilation. Simultaneously, CO2 was delivered and dosed using a nomogram developed in a previous experimental study. Time to extubation and eye opening was recorded. Inspired (FICO2) and expired (FETCO2) CO2 and arterial CO2 levels were monitored during IHV. Cognition was tested pre-operatively and at 20, 40 and 60 min after surgery.ResultsA DCO2 of 285 ± 45 ml/min provided stable isocapnia during HV (13.5 ± 4.1 l/min). The corresponding FICO2 level was 3.0 ± 0.3%. Time from turning off the vaporizer (1.3 ± 0.1 MACage) to extubation (0.2 ± 0.1 MACage) was 11.3 ± 1.8 min after 342 ± 131 min of anaesthesia. PaCO2 and FETCO2 remained at normal levels during and after IHV. In 85% of the patients, post-operative cognition returned to pre-operative values within 60 min.ConclusionsIn this cohort of patients, a DCO2 nomogram for IHV was validated. The patients were safely extubated shortly after discontinuing long-term sevoflurane anaesthesia. Perioperatively, there were no adverse effects on arterial blood gases or post-operative cognition. This technique for IHV can potentially be used to decrease emergence time from inhalation anaesthesia.
      PubDate: 2017-10-16T06:15:26.371-05:00
      DOI: 10.1111/aas.13008
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