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Publisher: John Wiley and Sons   (Total: 1579 journals)

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Showing 1 - 200 of 1579 Journals sorted alphabetically
Abacus     Hybrid Journal   (Followers: 13, 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: 47, SJR: 0.547, h-index: 30)
ACEP NOW     Free   (Followers: 1)
Acta Anaesthesiologica Scandinavica     Hybrid Journal   (Followers: 52, SJR: 1.02, h-index: 88)
Acta Archaeologica     Hybrid Journal   (Followers: 156, 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: 35, SJR: 2.518, h-index: 113)
Acta Zoologica     Hybrid Journal   (Followers: 6, SJR: 0.459, h-index: 29)
Acute Medicine & Surgery     Hybrid Journal   (Followers: 4)
Addiction     Hybrid Journal   (Followers: 35, SJR: 2.086, h-index: 143)
Addiction Biology     Hybrid Journal   (Followers: 13, SJR: 2.091, h-index: 57)
Adultspan J.     Hybrid Journal   (SJR: 0.127, h-index: 4)
Advanced Energy Materials     Hybrid Journal   (Followers: 27, 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: 265, 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: 6, 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: 10)
African Development Review     Hybrid Journal   (Followers: 33, SJR: 0.275, h-index: 17)
African J. of Ecology     Hybrid Journal   (Followers: 15, 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: 6, 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: 31, 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: 143, 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: 90, SJR: 2.325, h-index: 51)
American J. of Economics and Sociology     Hybrid Journal   (Followers: 28, SJR: 0.211, h-index: 26)
American J. of Hematology     Hybrid Journal   (Followers: 33, SJR: 1.761, h-index: 77)
American J. of Human Biology     Hybrid Journal   (Followers: 12, 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: 269, SJR: 5.101, h-index: 114)
American J. of Primatology     Hybrid Journal   (Followers: 15, 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: 17, SJR: 2.792, h-index: 140)
American J. on Addictions     Hybrid Journal   (Followers: 9, SJR: 0.843, h-index: 57)
Anaesthesia     Hybrid Journal   (Followers: 134, SJR: 1.404, h-index: 88)
Analyses of Social Issues and Public Policy     Hybrid Journal   (Followers: 10, SJR: 0.397, h-index: 18)
Analytic Philosophy     Hybrid Journal   (Followers: 18)
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: 193)
Angewandte Chemie Intl. Edition     Hybrid Journal   (Followers: 218, SJR: 6.229, h-index: 397)
Animal Conservation     Hybrid Journal   (Followers: 39, 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: 47, SJR: 5.584, h-index: 241)
Annals of Noninvasive Electrocardiology     Hybrid Journal   (Followers: 2, SJR: 0.531, h-index: 38)
Annals of Public and Cooperative Economics     Hybrid Journal   (Followers: 9, 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: 48, SJR: 2.212, h-index: 69)
Anz J. of Surgery     Hybrid Journal   (Followers: 7, 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: 198, SJR: 1.023, h-index: 64)
Applied Psychology: Health and Well-Being     Hybrid Journal   (Followers: 49, 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: 31, 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: 27, 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: 25, SJR: 0.261, h-index: 9)
Archiv der Pharmazie     Hybrid Journal   (Followers: 4, 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: 12, SJR: 0.938, h-index: 57)
Art History     Hybrid Journal   (Followers: 243, SJR: 0.153, h-index: 13)
Arthritis & Rheumatology     Hybrid Journal   (Followers: 50, SJR: 1.984, h-index: 20)
Arthritis Care & Research     Hybrid Journal   (Followers: 26, 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: 14)
Asia & the Pacific Policy Studies     Open Access   (Followers: 16)
Asia Pacific J. of Human Resources     Hybrid Journal   (Followers: 321, 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   (SJR: 0.394, h-index: 7)
Asian J. of Organic Chemistry     Hybrid Journal   (Followers: 5, 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: 2, 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: 4, 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: 7, SJR: 0.482, h-index: 46)
Australian Economic History Review     Hybrid Journal   (Followers: 4, SJR: 0.171, h-index: 12)
Australian Economic Papers     Hybrid Journal   (Followers: 29, 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: 14, 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: 406, 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: 20, SJR: 0.459, h-index: 45)
Autism Research     Hybrid Journal   (Followers: 34, 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: 9, 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: 4, SJR: 6.469, h-index: 114)
Biologie in Unserer Zeit (Biuz)     Hybrid Journal   (Followers: 42, 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: 36, 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: 45, SJR: 0.415, h-index: 55)
Biotechnology and Bioengineering     Hybrid Journal   (Followers: 160, 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: 6, 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: 241, SJR: 2.083, h-index: 125)

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Journal Cover Acta Anaesthesiologica Scandinavica
  [SJR: 1.02]   [H-I: 88]   [52 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  [1579 journals]
  • 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
       
  • Skills among young and elderly laypersons during simulated dispatcher
           assisted CPR and after CPR training
    • Authors: M. A. Nebsbjerg; S. E. Rasmussen, K. B. Bomholt, L. Q. Krogh, K. Krogh, J. A. Povlsen, I. S. Riddervold, T. Grøfte, H. Kirkegaard, B. Løfgren
      Abstract: BackgroundDispatcher assisted cardiopulmonary resuscitation (DA-CPR) increase the rate of bystander CPR. The aim of the study was to compare the performance of DA-CPR and attainable skills following CPR training between young and elderly laypersons.MethodsVolunteer laypersons (young: 18–40 years; elderly:> 65 years) participated. Single rescuer CPR was performed in a simulated DA-CPR cardiac arrest scenario and after CPR training. Data were obtained from a manikin and from video recordings. The primary endpoint was chest compression depth.ResultsOverall, 56 young (median age: 26, years since last CPR training: 6) and 58 elderly (median age: 72, years since last CPR training: 26.5) participated. Young laypersons performed deeper (mean (SD): 56 (14) mm vs. 39 (19) mm, P < 0.001) and faster (median (25th–75th percentile): 107 (97–112) per min vs. 84 (74–107) per min, P < 0.001) chest compressions compared to elderly. Young laypersons had shorter time to first compression (mean (SD): 71 (11) seconds vs. 104 (38) seconds, P < 0.001) and less hands-off time (median (25th–75th percentile): 0 (0–1) seconds vs. 5 (2–10) seconds, P < 0.001) than elderly. After CPR training chest compressions were performed with a depth (mean (SD): 64 (8) mm vs. 50 (14) mm, P < 0.001) and rate (mean (SD): 111 (11) per min vs. 93 (18) per min, P < 0.001) for young and elderly laypersons respectively.ConclusionDespite long CPR retention time for both groups, elderly laypersons had longer retention time, and performed inadequate DA-CPR compared to young laypersons. Following CPR training the attainable CPR level was of acceptable quality for both young and elderly laypersons.
      PubDate: 2017-11-15T23:00:29.067011-05:
      DOI: 10.1111/aas.13027
       
  • In response: fluids in neurosurgery
    • Authors: R. G. Hahn
      PubDate: 2017-11-15T23:00:22.756681-05:
      DOI: 10.1111/aas.13035
       
  • 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
       
  • Perioperative fluid administration and effect on physiology and
           biochemistry of patients undergoing neurosurgical procedures
    • Authors: H. Eaton; C. McCarthy, S. Jürgens
      PubDate: 2017-11-09T22:55:21.347486-05:
      DOI: 10.1111/aas.13034
       
  • Untargeted antifungal therapy in adult patients with complicated
           intra-abdominal infection: a systematic review
    • Authors: M. W. Petersen; A. Perner, F. Ravn, F. Sjövall, M. H. Møller
      Abstract: BackgroundSystematic reviews comparing untargeted antifungal treatment with placebo or no treatment in critically ill patients have provided conflicting results. We aimed to assess patient-important benefits and harms of untargeted antifungal therapy vs. placebo or no treatment in adult patients with complicated intra-abdominal infection.MethodsWe conducted a systematic review with meta-analysis and trial sequential analysis of randomised clinical trials assessing untargeted antifungal therapy compared to placebo or no treatment in adults with complicated intra-abdominal infection. We used the Cochrane and GRADE methodologies and exclusively assessed patient-important outcomes. Two independent authors screened trials for eligibility, extracted data and assessed risk of bias. We performed conventional meta-analyses, including sensitivity and subgroup analyses, and trial sequential analysis to assess the risk of random errors and to estimate trial sequential analysis adjusted confidence intervals.ResultsWe included six trials (1,067 patients) in the review, and four trials reported data on the predefined outcome measures and were included in the meta-analysis. Three of the four trials had high risk of bias. We observed no statistically significant difference in mortality (relative risk 0.58, 95% confidence interval 0.24–1.39) or in any of the other patient-important outcomes between untargeted antifungal treatment and placebo or no treatment (low/very low quality of evidence). Trial sequential analysis demonstrated lack of data and high risk of random errors.ConclusionsThe quantity and quality of evidence supporting untargeted antifungal treatment in adult patients with complicated intra-abdominal infection are low to very low with no firm evidence for benefit or harm.
      PubDate: 2017-11-09T22:50:33.490534-05:
      DOI: 10.1111/aas.13031
       
  • 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
       
  • Stroke identification by criteria based dispatch – a register based
           study
    • Authors: E. N. Ellensen; H. Naess, T. Wisborg, S. Hunskaar, E. Zakariassen
      Abstract: BackgroundRapid and precise dispatch of resources is a key element in pre-hospital emergency medicine. Emergency medical communication centres (EMCCs) dispatch resources based on protocols and guidelines, balancing the acute need of the individual and the resource allocation of the pre-hospital emergency medical system. The aim of this study was to determine the validity of stroke identification by the Norwegian dispatch guidelines.Method and materialThis was a register-based study where patients suspected for stroke were compared to those with the final diagnosis of stroke as an indicator group for the guideline validation. One EMCC and its three associated hospitals participated with 13 months of data. Four subcodes of the stroke dispatch code were defined as suspicious of stroke and further analysed. Factors associated with stroke identification were explored.ResultsThe sensitivity for identifying a stroke patient at initial EMCC contact was 57.9% (51.5, 64.1), specificity was 99.1% (98.9, 99.2), positive predictive value was 45.7% (40.1, 51.4) and negative predictive value was 99.4% (99.3, 99.5). The emergency medical access telephone (113) was initial EMCC contact line in only 48% of the cases. Paralyses and admittance to a smaller hospital were associated with increased probability for stroke (OR 2.6, P = 0.001 and OR 2.7, P = 0.01), respectively.ConclusionThe sensitivity for identification of stroke patients by the dispatch guidelines is modest, while the specificity is high. The 113 telephone line was initial EMCC access point for less than half of the stroke patients.
      PubDate: 2017-11-05T22:51:22.474136-05:
      DOI: 10.1111/aas.13032
       
  • Outcomes after cancelled helicopter emergency medical service missions due
           to concurrencies: a retrospective cohort study
    • Authors: Ø. Østerås; J.-K. Heltne, K. Tønsager, G. Brattebø
      Abstract: BackgroundAppropriate dispatch criteria and helicopter emergency medical service (HEMS) crew decisions are crucial for avoiding over-triage and reducing the number of concurrencies. The aim of the present study was to compare patient outcomes after completed HEMS missions and missions cancelled by the HEMS due to concurrencies.MethodsMissions cancelled due to concurrencies (AMB group) and completed HEMS missions (HEMS group) in Western Norway from 2004 to 2013 were assessed. Outcomes were survival to hospital discharge, physiology score in the emergency department, emergency interventions in the hospital, type of department for patient admittance, and length of hospital stay.ResultsSurvival to discharge was similar in the two groups. One-third of the primary missions in the HEMS group and 13% in the AMB group were patients with pre-hospital conditions posing an acute threat to life. In a sub group analysis of these patients, HEMS patients were younger, more often admitted to an intensive care unit, and had an increased survival to discharge. In addition, the HEMS group had a greater proportion of patients with deranged physiology in the emergency department according to an early warning score.ConclusionPatients in the HEMS group seemed to be critically ill more often and received more emergency interventions, but the two groups had similar in-hospital mortality. Patients with pre-hospital signs of acute threat to life were younger and presented increased survival in the HEMS group.
      PubDate: 2017-11-03T05:15:26.794603-05:
      DOI: 10.1111/aas.13028
       
  • 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
       
  • Impact of age on cardiovascular function, inflammation, and oxidative
           stress in experimental asphyxial cardiac arrest
    • Authors: N. Secher; L. Østergaard, E. Tønnesen, F. B. Hansen, A. Granfeldt
      Abstract: BackgroundAdvanced age is an independent predictor of poor outcome after cardiac arrest (CA). From experimental studies of regional ischemia-reperfusion injury, advanced age is associated with larger infarct size, reduced organ function, and augmented oxidative stress. The objective of this study was to investigate the effect of age on cardiovascular function, oxidative stress, inflammation, and endothelial activation after CA representing global ischemia-reperfusion.MethodsAged (26 months) and young (5 months) rats were subjected to 8 min of asphyxia induced CA, resuscitated and observed for 360 min. Left ventricular pressure-derived cardiac function was measured at baseline and 360 min after CA. Blood samples obtained at baseline, 120 min, and 360 min after CA were analyzed for IL-1β, IL-6, IL-10, TNF-α, elastase, sE-selectin, sL-selectin, sI-CAM1, hemeoxygenase-1 (HO-1) and protein carbonyl. Tissue samples of brain, heart, kidney, and lung were analyzed for HO-1.ResultsCardiac function, evaluated by dP/dtmax and dP/dtmin, was decreased after CA in both young and aged rats, with no group differences. Mean arterial pressure increased after CA in young, but not old rats. Aged rats showed significantly higher plasma levels of elastase and sE-selectin after CA, and there was a significant different development over time between groups for IL-6 and IL-10. Young rats showed higher levels of HO-1 in plasma and renal tissue after CA.ConclusionIn a rat model of asphyxial CA, advanced age is associated with an attenuated hyperdynamic blood pressure response and increased endothelial activation.
      PubDate: 2017-10-26T05:15:45.056276-05:
      DOI: 10.1111/aas.13014
       
  • 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
       
  • Infrared Red Intubation System (IRRIS) guided flexile videoscope assisted
           difficult airway management
    • Authors: M. S. Kristensen; E. Fried, P. Biro
      Abstract: BackgroundTracheal intubation with a flexible scope is a cornerstone technique in patients with severely difficult airways, but may fail. We report on a technique, Infrared Red Intubation System (IRRIS), that seems to facilitate the identification of the glottis.MethodsThe IRRIS is placed over the patient's cricothyroid membrane and emits blinking infrared light through the patient's skin into the subglottic space. When a flexible videoscope (one that does not filter infrared light) is introduced into the airway, it will display this as a blinking white light emerging from the glottis, retrograde transillumination, showing the pathway to the trachea. We have introduced this as an adjunct when managing our patients with difficult airways. We describe the technique and retrospectively report on the first ten patients where it was used.ResultsAll ten patients had significant pathology in the airway, radiation therapy, predictors for difficult intubation and/or morbid obesity. In all cases the blinking light was visible during the flexible endoscopy and provided unambiguous identification of the glottis, from a distance. The blinking nature of the light from the IRRIS helped to distinguish it from the reflections in the mucosa that inevitably arise when the mucosa is hit by the light from the flexible scope itself.ConclusionThe addition of the IRRIS technique to intubation with flexible videoscopes may be a tool that will make intubation of the most difficult airways easier and may be of special help to the clinician who only rarely uses flexible videoscopes for tracheal intubation.
      PubDate: 2017-10-24T02:30:44.66398-05:0
      DOI: 10.1111/aas.13016
       
  • 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
       
  • Atelectasis is inversely proportional to transpulmonary pressure during
           weaning from ventilator support in a large animal model
    • Authors: M. Gudmundsson; G. Perchiazzi, M. Pellegrini, A. Vena, G. Hedenstierna, C. Rylander
      Abstract: BackgroundIn mechanically ventilated, lung injured, patients without spontaneous breathing effort, atelectasis with shunt and desaturation may appear suddenly when ventilator pressures are decreased. It is not known how such a formation of atelectasis is related to transpulmonary pressure (PL) during weaning from mechanical ventilation when the spontaneous breathing effort is increased. If the relation between PL and atelectasis were known, monitoring of PL might help to avoid formation of atelectasis and cyclic collapse during weaning. The main purpose of this study was to determine the relation between PL and atelectasis in an experimental model representing weaning from mechanical ventilation.MethodsDynamic transverse computed tomography scans were acquired in ten anaesthetized, surfactant-depleted pigs with preserved spontaneous breathing, as ventilator support was lowered by sequentially reducing inspiratory pressure and positive end expiratory pressure in steps. The volumes of gas and atelectasis in the lungs were correlated with PL obtained using oesophageal pressure recordings. Work of breathing (WOB) was assessed from Campbell diagrams.ResultsGradual decrease in PL in both end-expiration and end-inspiration caused a proportional increase in atelectasis and decrease in the gas content (linear mixed model with an autoregressive correlation matrix; P 
      PubDate: 2017-10-23T04:15:22.857442-05:
      DOI: 10.1111/aas.13015
       
  • A novel risk score for severe ARDS patients undergoing ECMO after
           retrieval from peripheral hospitals
    • Authors: C. Lazzeri; G. Cianchi, T. Mauri, A. Pesenti, M. Bonizzoli, S. Batacchi, M. Chiostri, F. Socci, A. Peris
      Abstract: BackgroundExtracorporeal Membrane Oxygenation in severe ARDS unresponsive to conventional protective ventilation is associated with elevated costs, resource and complications, and appropriate risk stratification of candidate patients could be useful to recognize those more likely to benefit from ECMO. We aimed to derive a new outcome prediction score for patients retrieved by our ECMO team from peripheral centers, including systematic echocardiographic evaluation before ECMO start.MethodsSixty-nine consecutive patients with refractory ARDS requiring ECMO transferred from peripheral centers to our ICU (a tertiary ECMO referral center), from 1 October 2009 to 31 December 2015, were assessed.ResultsAll patients were transported on ECMO (distance, median 77, range 4–456 km) The mortality rate was 41% (28/69). Our new risk score included age ≥ 42 years, BMI
      PubDate: 2017-10-23T04:05:21.174615-05:
      DOI: 10.1111/aas.13022
       
  • 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
       
  • Pleth variability index can predict spinal anaesthesia-induced hypotension
           in patients undergoing caesarean delivery
    • Authors: S. Kuwata; K. Suehiro, T. Juri, S. Tsujimoto, A. Mukai, K. Tanaka, T. Yamada, T. Mori, K. Nishikawa
      Abstract: BackgroundSpinal anaesthesia carries a risk of hypotension. We hypothesized that pleth variability index and perfusion index would assess maternal volume status, and thus, allow identification of patients at higher risk of developing hypotension after spinal anaesthesia for caesarean delivery.MethodsFifty patients undergoing elective caesarean delivery were enrolled. All patients received spinal anaesthesia with 0.5% hyperbaric bupivacaine (10 mg) and fentanyl (10 mcg). Blood pressure was measured every minute. Pleth variability index and perfusion index were automatically measured throughout the procedure using pulse oximetry on the index finger. In case of hypotension (systolic blood pressure below 90 mmHg or 80% of the baseline value), ephedrine 5 mg was administered. Receiver-operating characteristic and multivariate logistic regression analyses for spinal anaesthesia-induced hypotension were performed.ResultsHypotension occurred in 32 patients (64%). The areas under the receiver-operating characteristic curve were 0.751 (95% confidence interval: 0.597–0.904) for pleth variability index before anaesthesia, 0.793 (95% confidence interval: 0.655–0.930) for pleth variability index after anaesthesia and 0.731 (95% confidence interval: 0.570–0.892) for perfusion index change (percent change in perfusion index induced by spinal anaesthesia). The optimal threshold value of pleth variability index (after anaesthesia) for predicting hypotension was 18% (sensitivity: 78.1%, specificity: 83.3%). Pleth variability index after spinal anaesthesia was an independent factor for hypotension (odds ratio: 1.21, P = 0.041).ConclusionsPleth variability index after spinal anaesthesia was a good predictor of spinal anaesthesia-induced hypotension in patients undergoing caesarean delivery. In addition, perfusion index change after spinal anaesthesia has the potential to predict hypotension.
      PubDate: 2017-10-16T06:20:50.850684-05:
      DOI: 10.1111/aas.13012
       
  • Evaluation of a method for isocapnic hyperventilation: a clinical pilot
           trial
    • 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
       
  • A randomized trial of automated intermittent ropivacaine administration
           vs. continuous infusion in an interscalene catheter
    • Authors: J. Oxlund; A. H. Clausen, S. Venø, M. D. Nielsen, M. Pall, T. Strøm, P. Toft
      Abstract: BackgroundUltrasound-guided interscalene nerve block with ropivacaine as local anesthetic agent given as boluses or continuous infusion is the preferred pain management after major shoulder surgery. The use of automated intermittent boluses has been shown to be superior to continuous infusion in sciatic and epidural nerve block. Hypothesis: Automated intermittent boluses reduce pain after major shoulder surgery.MethodsSeventy patients aged 18–75 years, scheduled for major shoulder surgery under general anesthesia with interscalene nerve block were included in this randomized controlled trial. Patients were allocated to either automated intermittent boluses with 16 mg ropivacaine every 2 h combined with patient-controlled administration or to a conventional regimen of continuous infusion of 8 mg/h (4 ml/h) of ropivacaine combined with patient controlled administration (2 ml, lockout time 30 min). Pain (Visual Analog Scale, VAS) was assessed every 8 h postoperatively.ResultsFifty-seven patients completed the study, 29 in the continuous infusion group and 28 in the automated intermittent bolus group. Shoulder arthroplasty was performed in 49 (86%) of the cases. There were no significant differences in VAS score from 8 to 48 h post-operatively. No significant difference in opioid usage was observed. The automated intermittent bolus group reported significantly less force on coughing and more hoarseness. A significantly lower volume of ropivacaine was used in the automated intermittent bolus group.ConclusionAutomated intermittent boluses did not reduce pain or rescue opioid consumption compared with continuous infusion of ropivacaine. The automated intermittent bolus group had significantly less force on coughing and more hoarseness.
      PubDate: 2017-10-16T06:15:19.879752-05:
      DOI: 10.1111/aas.13011
       
  • Right heart masses demonstrated by echocardiography in a patient with
           amniotic fluid embolism during labour
    • Authors: K. H. Maack; K. Munk, K. Dahl, H. H. Jørgensen, A. Christiansen, R. B. Helmig
      PubDate: 2017-10-05T22:25:33.463634-05:
      DOI: 10.1111/aas.13006
       
  • Effect of maternal oxygen inhalation on foetal free radical activity: a
           prospective, randomized trial
    • Authors: V. Ahuja; S. Gombar, S. Jaswal, J. Kaur, P. Gupta, D. Chawla, A. Huria, S. Singh
      Abstract: BackgroundMaternal inhalation of 35–40% oxygen concentration has no significant effect on foetal partial pressure of oxygen, and 60–100% produced maternal and foetal hyperoxia with increased free radical activity. The benefit of 50% maternal oxygen inhalation on foetal oxygenation, oxidant stress and total antioxidant status (TAS) during Caesarean section (CS) has not been simultaneously evaluated.MethodsIn this prospective, randomized, controlled trial 120 ASA physical status I–II, term pregnant women were recruited to elective CS (n = 60) and emergency CS (n = 60) and received either 50% oxygen or air inhalation following subarachnoid block (SAB). Patients and investigators were blinded to the inhaled oxygen concentration. The primary outcome of the study was foetal umbilical artery (UA) malondialdehyde (MDA) at birth.ResultsIn both elective and emergency CS, there was no difference in foetal oxidative stress and TAS in spite of increase in maternal PaO2. In elective CS, maternal MDA was higher at delivery in mothers breathing 50% oxygen as compared to their own baseline values (P = 0.04). In emergency CS, maternal TAS at 10 min was lower in mothers inhaling 50% oxygen as compared to air (P = 0.01). The average duration of maternal oxygen supplementation was ~10.3 min in elective and ~7.4 min in emergency CS. Neonatal outcome, episodes of maternal hypotension and oxygen desaturation were similar in both the groups.ConclusionBrief duration of 50% oxygen maternal inhalation during elective or emergency CS did not significantly affect foetal MDA and TAS under SAB.
      PubDate: 2017-10-05T01:55:28.085142-05:
      DOI: 10.1111/aas.13007
       
  • Reply to What is the real incidence of Takotsubo syndrome in intensive
           care units'
    • Authors: J. Oras; B. Redfors, S.-E. Ricksten
      PubDate: 2017-09-26T22:55:23.594517-05:
      DOI: 10.1111/aas.13003
       
  • Does use of perioperative COX-2 inhibitors really increase risk of acute
           kidney injury'
    • Authors: Y. Y. Liu; F. S. Xue, H. X. Li
      PubDate: 2017-09-22T06:30:18.252286-05:
      DOI: 10.1111/aas.12998
       
  • Protection against cold – a survey of available equipment in Swedish
           pre-hospital services
    • Authors: O. Henriksson; U. Björnstig, B.-I. Saveman, P. J. Lundgren
      Abstract: BackgroundThe aim of this study was to survey the current equipment used for prevention, treatment and monitoring of accidental hypothermia in Swedish pre-hospital services.MethodsA questionnaire was sent to all road ambulance services (AS), the helicopter emergency medical services (HEMS), the national helicopter search and rescue service (SAR) and the municipal rescue services (RS) in Sweden to determine the availability of insulation, active warming, fluid heating, and low-reading thermometers.ResultsThe response rate was 77% (n = 255). All units carried woollen or polyester blankets for basic insulation. Specific windproof insulation materials were common in the HEMS, SAR and RS units but only present in about half of the AS units. Active warming equipment was present in all the SAR units, but only in about two-thirds of the HEMS units and about one-third of the AS units. About half of the RS units had the ability to provide a heated tent or container. Low-reading thermometers were present in less than half of the AS and HEMS units and were non-existent in the SAR units. Pre-warmed intravenous fluids were carried by almost all of the AS units and half of the HEMS units but infusion heaters were absent in most units.ConclusionBasic insulation capabilities are well established in the Swedish pre-hospital services. Specific wind and waterproof insulation materials, active warming devices, low-reading thermometers and IV fluid heating systems are less common. We suggest the development and implementation of national guidelines on accidental hypothermia that include basic recommendations on equipment requirements.
      PubDate: 2017-09-21T22:55:21.479787-05:
      DOI: 10.1111/aas.13002
       
  • Response letter (Dr. Mion's Letter to the Editor)
    • Authors: E. T. Moro; J. A. Bloomstone, L. H. C. Navarro
      PubDate: 2017-09-18T05:42:11.755334-05:
      DOI: 10.1111/aas.12995
       
  • Rapid response team patients triaged to remain on ward despite deranged
           vital signs: missed opportunities'
    • Authors: J. Tirkkonen; T. Kontula, S. Hoppu
      Abstract: BackgroundRapid response teams (RRTs) triage most patients to stay on ward, even though some of them have deranged vital signs according to RRTs themselves. We investigated the prevalence and outcome of this RRT patient cohort.MethodsA prospective observational study was conducted in a Finnish tertiary referral centre, Tampere University Hospital. Data on RRT activations were collected between 1 May 2012 and 30 April 2015. Vital signs of patients triaged to stay on ward without treatment limitations were classified according to objective RRT trigger criteria observed during the reviews.ResultsDuring the study period, 860 patients had their first RRT review and were triaged to stay on ward. Of these, 564 (66%) had deranged vital signs, while 296 (34%) did not. RRT patients with deranged vital signs were of comparable age and comorbidity index as stable patients. Even though the patients with deranged vital signs had received RRT interventions, such as fluids and medications, more often than the stable patients, they required new RRT reviews more often and had higher in-hospital and 30-day mortality. Moreover, the former group had substantially higher 1-year mortality than the latter (37% vs. 29%, P = 0.014). In a multivariate regression analysis, deranged vital signs during RRT review was found to be independently associated with 30-day mortality (OR 1.74; 95% CI 1.12–2.70).ConclusionPatients triaged to stay on ward despite deranged vital signs are high-risk patients who could benefit from routine follow-up by RRT nurses before they deteriorate beyond salvation.
      PubDate: 2017-09-15T03:39:11.435038-05:
      DOI: 10.1111/aas.12993
       
  • Assessment of futility in out-of-hospital cardiac arrest
    • Authors: P. Setälä; S. Hoppu, I. Virkkunen, A. Yli-Hankala, A. Kämäräinen
      Abstract: BackgroundOur aim was to evaluate the impact of futile resuscitation attempts to the outcome calculations of attempted resuscitation in out-of-hospital cardiac arrest (OHCA). Defined as partial resuscitations, we focused on a subgroup of patients in whom cardiopulmonary resuscitation (CPR) was initiated, but further efforts were soon abandoned due to evidence of futility.MethodsWe conducted this study using the Utstein template during a 12-month study period. We compared the event characteristics between full and partial resuscitation attempts and determined the incidence, survival and neurological outcome.ResultsEmergency Medical Services (EMS) attended a total of 314 OHCA cases. In 34 cases, resuscitation was not attempted due to futility. Seventy-four cases were partial resuscitation attempts where resuscitation was soon discontinued due to dismal prognostic factors. Partial attempts were associated with an unwitnessed OHCA, prolonged downtime, end-stage malignant disease, multiple trauma, asystole or pulseless electrical activity as the initial rhythm, and a first responding unit being the first unit on the scene (P 
      PubDate: 2017-09-14T05:05:38.601369-05:
      DOI: 10.1111/aas.12966
       
  • Return of spontaneous circulation and long-term survival according to
           feedback provided by automated external defibrillators
    • Authors: M. Agerskov; M. B. Hansen, A. M. Nielsen, T. P. Møller, M. Wissenberg, L. S. Rasmussen
      Abstract: BackgroundWe aimed to investigate the effect of automated external defibrillator (AED) feedback mechanisms on survival in out-of-hospital cardiac arrest (OHCA) victims. In addition, we investigated converting rates in patients with shockable rhythms according to AED shock waveforms and energy levels.MethodsWe collected data on OHCA occurring between 2011 and 2014 in the Capital Region of Denmark where an AED was applied prior to ambulance arrival. Patient data were obtained from the Danish Cardiac Arrest Registry and medical records. AED data were retrieved from the Emergency Medical Dispatch Centre (EMDC) and information on feedback mechanisms, energy waveform and energy level was downloaded from the applied AEDs.ResultsA total of 196 OHCAs had an AED applied prior to ambulance arrival; 62 of these (32%) provided audio visual (AV) feedback while no feedback was provided in 134 (68%). We found no difference in return of spontaneous circulation (ROSC) at hospital arrival according to AV-feedback; 34 (55%, 95% confidence interval (CI) [13–67]) vs. 72 (54%, 95% CI [45–62]), P = 1 (odds ratio (OR) 1.1, 95% CI [0.6–1.9]) or 30-day survival; 24 (39%, 95% CI [28–51]) vs. 53 (40%, 95% CI [32–49]), P = 0.88 (OR 1.1 (95% CI [0.6–2.0])). Moreover, we found no difference in converting rates among patients with initial shockable rhythm receiving one or more shocks according to AED energy waveform and energy level.ConclusionsNo difference in survival after OHCA according to AED feedback mechanisms, nor any difference in converting rates according to AED waveform or energy levels was detected.
      PubDate: 2017-09-13T05:45:49.987361-05:
      DOI: 10.1111/aas.12992
       
  • Effects of red blood cell storage time on transfused patients in the
           ICU—protocol for a systematic review
    • Authors: S. L. Rygård; A. B. Jonsson, M. B. Madsen, A. Perner, L. B. Holst, P. I. Johansson, J. Wetterslev
      Abstract: BackgroundPatients in the intensive care unit (ICU) are often anaemic due to blood loss, impaired red blood cell (RBC) production and increased RBC destruction. In some studies, more than half of the patients were treated with RBC transfusion. During storage, the RBC and the storage medium undergo changes, which lead to impaired transportation and delivery of oxygen and may also promote an inflammatory response. Divergent results on the clinical consequences of storage have been reported in both observational studies and randomised trials. Therefore, we aim to gather and review the present evidence to assess the effects of shorter vs. longer storage time of transfused RBCs for ICU patients.MethodsWe will conduct a systematic review with meta-analyses and trial sequential analyses of randomised clinical trials, and also include results of severe adverse events from large observational studies. Participants will be adult patients admitted to an ICU and treated with shorter vs. longer stored RBC units. We will systematically search the Cochrane Library, MEDLINE, Embase, BIOSIS, CINAHL and Science Citation Index for relevant literature, and we will follow the recommendation by the Cochrane Collaboration and the Preferred Reporting Items for Systemtic Review and Meta-Analysis (PRISMA)-statement. We will assess the risk of bias and random errors, and we will use the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach to evaluate the overall quality of evidence.ConclusionWe need a high-quality systematic review to summarise the clinical consequences of RBC storage time among ICU patients.
      PubDate: 2017-09-13T05:45:25.040602-05:
      DOI: 10.1111/aas.12991
       
  • The impact of fatigue on the non-technical skills performance of critical
           care air ambulance clinicians
    • Authors: J. A. Myers; D. M. C. Powell, S. Aldington, D. Sim, A. Psirides, K. Hathaway, M. F. Haney
      Abstract: BackgroundThe relationship between fatigue-related risk and impaired clinical performance is not entirely clear. Non-technical factors represent an important component of clinical performance and may be sensitive to the effects of fatigue. The hypothesis was that the sum score of overall non-technical performance is degraded by fatigue.MethodsNineteen physicians undertook two different simulated air ambulance missions, once when rested, and once when fatigued (randomised crossover design). Trained assessors blinded to participants’ fatigue status performed detailed structured assessments based on expected behaviours in four non-technical skills domains: teamwork, situational awareness, task management, and decision making. Participants also provided self-ratings of their performance. The primary endpoint was the sum score of overall non-technical performance.ResultsThe main finding, the overall non-technical skills performance rating of the clinicians, was better in rested than fatigued states (mean difference with 95% CI, 2.8 [2.2–3.4]). The findings remained consistent across individual non-technical skills domains; also when controlling for an order effect and examining the impact of a number of possible covariates. There was no difference in self-ratings of clinical performance between rested and fatigued states.ConclusionNon-technical performance of critical care air transfer clinicians is degraded when they are fatigued. Fatigued clinicians may fail to recognise the degree to which their performance is compromised. These findings represent risk to clinical care quality and patient safety in the dynamic and isolated environment of air ambulance transfer.
      PubDate: 2017-09-13T05:35:22.635263-05:
      DOI: 10.1111/aas.12994
       
  • Is it time to cease the single low-dose ketamine injection at induction of
           anesthesia'
    • Authors: G. Mion
      PubDate: 2017-09-13T05:30:25.653518-05:
      DOI: 10.1111/aas.12996
       
  • Use of urine N-acetyl-ß-D-glucosaminidase for early identification of
           renal tubular injury: more questions than solutions
    • Authors: Y. Y. Liu; F. S. Xue, C. Wen
      PubDate: 2017-09-07T01:30:30.095618-05:
      DOI: 10.1111/aas.12990
       
  • Reply to letter ‘Early identification of renal tubular injury: more
           questions than solutions’
    • Authors: L. Lannemyr; S.-E. Ricksten
      PubDate: 2017-09-07T01:30:26.791004-05:
      DOI: 10.1111/aas.12989
       
  • Assessment of plasma endostatin to predict acute kidney injury in
           critically ill patients
    • Authors: J. Mårtensson; S. T. Vaara, V. Pettilä, T. Ala-Kokko, S. Karlsson, O. Inkinen, A. Uusaro, A. Larsson, M. Bell
      Abstract: BackgroundWe evaluated whether plasma endostatin predicts acute kidney injury (AKI), need for renal replacement therapy (RRT), or death.MethodsProspective, observational, multicenter study from 1 September 2011 to 1 February 2012 with data from 17 intensive care units (ICUs) in Finland.ResultsA total of 1112 patients were analyzed. We measured plasma endostatin within 2 h of ICU admission. Early AKI (KDIGO stage within 12 h of ICU admission) was found in 20% of the cohort, and 18% developed late AKI (KDIGO criteria> 12 h from ICU admission). Median (IQR) admission endostatin was higher in the early AKI group, 29 (19.1, 41.9) ng/ml as compared to 22.4 (16.1, 30.1) ng/ml for the late AKI group, and 18 (14.0, 23.6) ng/ml for non-AKI patients (P < 0.001). Endostatin level increased with increasing KDIGO stage. Significantly higher endostatin levels were found in patients with sepsis as compared to those without. Predictive properties for AKI, RRT, and mortality were low with corresponding areas under the receiver operating characteristic curve (AUC) of 0.62, 0.67, and 0.59. Sensitivity analyses among patients with chronic kidney disease or sepsis did not improve the predictive ability of endostatin. Adding endostatin to a clinical AKI prediction model (illness severity score, urine output, and age) insignificantly changed the AUC from 0.67 to 0.70 (P = 0.14).ConclusionsEndostatin increases with AKI severity but has limited value as a predictor of AKI, RRT and 90-day mortality in patients admitted to ICU. Moreover, endostatin does not improve AKI risk prediction when added to a clinical risk model.
      PubDate: 2017-08-31T04:15:53.499608-05:
      DOI: 10.1111/aas.12988
       
  • Pregabalin reduces opioid consumption and hyperalgesia but not pain
           intensity after laparoscopic donor nephrectomy
    • Authors: M. Myhre; L. Romundstad, A. Stubhaug
      Abstract: BackgroundGabapentinoids are increasingly used to reduce acute postoperative pain, opioid consumption and opioid-related adverse effects. We explored the opioid-sparing, analgesic and anti-hyperalgesic effect of perioperative administered pregabalin in laparoscopic living donor nephrectomy.MethodsIn this randomized controlled trial, 80 patients were recruited and randomized to receive pregabalin 150 mg twice daily or placebo on the day of surgery and the first postoperative day as part of a multimodal analgesic regimen. Primary outcome was opioid consumption 0–48 h after surgery. Secondary outcomes were pain intensity at rest and with movement 0–48 h after surgery using the 0–10 Numeric Rating Scale and incisional hyperalgesia measured 24 h post-surgery and at hospital discharge. Further secondary outcomes were adverse effects. Persistent post-surgical pain was registered 6 weeks, 6 and 12 months after surgery.ResultsPregabalin significantly reduced opioid consumption compared with placebo 0–48 h after surgery (median mg [25th, 75th percentile]); 29.0 (22.0–45.5) vs. 41.8 (25.8–63.6) (P = 0.04). Pain intensity 0–48 h after surgery calculated as area under the pain (NRS) vs. time curve was not statistically different between groups at rest (P = 0.12) or with movement (P = 0.21). Pregabalin decreased incisional hyperalgesia 24 h after surgery (median cm [25th, 75th percentile] 8.5 (1.0–18.5) vs. 15.5 (9.5–24.0) (P = 0.02). Nausea (P ≤ 0.01), use of antiemetics (P ≤ 0.01) and pain-related sleep interference (P = 0.02) were reduced with pregabalin.ConclusionsPerioperative pregabalin added to a multimodal analgesic regimen was opioid-sparing, but made no difference to pain intensity score 0–48 h after surgery. Pregabalin may reduce incisional hyperalgesia on the first day after surgery.
      PubDate: 2017-08-28T22:55:27.518504-05:
      DOI: 10.1111/aas.12963
       
  • Impact of systemic inflammatory response syndrome and surgical Apgar score
           on post-operative acute kidney injury
    • Authors: Y. Toyonaga; K. Asayama, Y. Maehara
      Abstract: BackgroundSurgical Apgar Score (SAS) is relatively weakly associated with post-operative outcomes in emergency surgery, compared with elective surgery. A combination of systemic inflammatory response syndrome (SIRS) and SAS may be useful for prediction of poor outcomes after emergency surgery.MethodsA retrospective study was conducted in patients who underwent emergency abdominal or cerebral surgery from January 2005 to December 2010. AKI was diagnosed using Acute Kidney Injury Network criteria for 2 days after surgery. Pre-operative SIRS was defined as SIRS score ≥ 2. Patients were divided into those with SAS ≥ 5 and < 5. Independent risk factors for post-operative AKI were identified. Ability to predict post-operative AKI was determined using receiver operating characteristic (ROC) curve analysis.ResultsOf 742 patients, 175 (24%) had post-operative AKI. Pre-operative SIRS (OR 1.9, 95% CI: 1.2–2.9, P < 0.01) and SAS < 5 (OR 2.6, 95% CI: 1.7–4.1, P < 0.01) were independent risk factors for post-operative AKI. Patients without SIRS and SAS < 5 had an increased risk of post-operative AKI (odds ratio (OR) 3.6, 95% confidence interval (CI) 1.9–6.7, P < 0.01) and those with SIRS and SAS < 5 had increased risks of post-operative AKI (OR 5.9, 95% CI: 3.7–9.3, P < 0.01) and hospital mortality (OR 3.5, 95% CI: 1.9–6.3, P < 0.01). In ROC analysis, the c-statistic using both SIRS and SAS < 5 was 0.81 (95% CI: 0.77–0.84, P < 0.01) and higher than without use of these factors (P < 0.01).ConclusionPre-operative SIRS and SAS are independently associated with post-operative AKI. Simultaneous use of pre-operative SIRS and SAS may improve prediction of poor post-operative outcomes.
      PubDate: 2017-08-28T22:50:36.380425-05:
      DOI: 10.1111/aas.12965
       
  • End-tidal control vs. manually controlled minimal-flow anesthesia: a
           prospective comparative trial
    • Authors: A. J. Wetz; M. M. Mueller, K. Walliser, C. Foest, S. Wand, I. F. Brandes, R. M. Waeschle, M. Bauer
      Abstract: BackgroundTo ensure safe general anesthesia, manually controlled anesthesia requires constant monitoring and numerous manual adjustments of the gas dosage, especially for low- and minimal-flow anesthesia. Oxygen flow-rate and administration of volatile anesthetics can also be controlled automatically by anesthesia machines using the end-tidal control technique, which ensures constant end-tidal concentrations of oxygen and anesthetic gas via feedback and continuous adjustment mechanisms. We investigated the hypothesis that end-tidal control is superior to manually controlled minimal-flow anesthesia (0.5 l/min).MethodsIn this prospective trial, we included 64 patients undergoing elective surgery under general anesthesia. We analyzed the precision of maintenance of the sevoflurane concentration (1.2–1.4%) and expiratory oxygen (35–40%) and the number of necessary adjustments.ResultsTarget-concentrations of sevoflurane and oxygen were maintained at more stable levels with the use of end-tidal control (during the first 15 min 28% vs. 51% and from 15 to 60 min 1% vs. 19% deviation from sevoflurane target, P < 0.0001; 45% vs. 86% and 5% vs. 15% deviation from O2 target, P < 0.01, respectively), while manual controlled minimal-flow anesthesia required more interventions to maintain the defined target ranges of sevoflurane (8, IQR 6–12) and end-tidal oxygen (5, IQR 3–6). The target-concentrations were reached earlier with the use of end-tidal compared with manual controlled minimal-flow anesthesia but required slightly greater use of anesthetic agents (6.9 vs. 6.0 ml/h).ConclusionsEnd-tidal control is a superior technique for setting and maintaining oxygen and anesthetic gas concentrations in a stable and rapid manner compared with manual control. Consequently, end-tidal control can effectively support the anesthetist.
      PubDate: 2017-08-22T04:20:29.383371-05:
      DOI: 10.1111/aas.12961
       
  • Ultrasound-guided regional blockade for lipoma excision: a new approach to
           an old technique
    • Authors: T. F. Tammam; G. A. Kamhawy
      Abstract: BackgroundLocal anesthesia for lipoma excision can be feasible with anesthetic injection in the fascial plane between the lipoma and the surrounding soft tissues under real-time ultrasonography [ultrasound- guided lipoma plane (ULP) block]. The advantage of targeting a single anesthetic injection plane under ultrasound guidance may allow for technically easier block placement and long-term analgesic effects.MethodsForty-eight patients were randomly assigned to receive ULP block, group A (n = 24) or traditional block, group B (n = 24). Primary outcome measure was the number of needle passes required to perform the blockade. The level of procedure pain and the time to first request of analgesia were assessed.ResultsMedian (interquartile range) needle passes required to complete the blockade was significantly less in the group A 1(1, 1) in comparison with the group B 3 (2.5, 3); P = 0.0001. Group A required fewer needle redirections 1.5 (1, 2) than group B 2 (2, 2.5); P = 0.001. Group A showed significantly less procedure-related pain 2 (2, 3) when compared with group B 4 (3, 4); P = 0.0001. The time to first rescue analgesic was significantly longer in group A (21.3 ± 4.7 h) in comparison with group B (4.4 ± 1.2 h); P = 0.001.ConclusionUltrasound-guided lipoma plane blockade reduces the number of needle passes required to complete the block and provides less procedure pain and longer pain relief compared with the traditional block in patients undergoing lipoma excision.
      PubDate: 2017-08-22T04:15:48.334009-05:
      DOI: 10.1111/aas.12964
       
  • First-aid training in school: amount, content and hindrances
    • Authors: H. K. Bakke; H. K. Bakke, R. Schwebs
      Abstract: BackgroundTo increase knowledge and competence about first aid in the population, first-aid instruction is included in primary and secondary school curricula. This study aimed to establish how much time is spent on first-aid training, which first-aid measures are taught, and which factors prevent teachers from providing the quantity and quality of first-aid training that they wish to give.MethodsA questionnaire was distributed to teachers in physical education in primary and secondary schools and to teachers in vocational subjects in higher secondary schools.ResultsThe teachers taught a median of two lessons in first aid per year. Cardiopulmonary resuscitation (CPR) was taught by 64% of teachers, free airway and recovery position by 69% and stopping severe bleeding by 51%. Recognising heart attack and stroke was taught by 25% and 23%, respectively. The main factors that the teachers perceived as limiting the amount and quality of first-aid training were insufficient learning objective specifications in the curriculum, too many other competence aims, lack of CPR mannequins and lack of training as first-aid instructors.DiscussionNorwegian teachers provide an appreciable amount of first-aid training to their students. However, several potential life-saving measures are poorly covered. The curriculum needs to contain first aid but also should specify what first-aid measures to be taught. First-aid training of teachers should adequately prepare them to be first-aid instructors.
      PubDate: 2017-08-17T20:40:29.831686-05:
      DOI: 10.1111/aas.12958
       
  • Issue Information - TOC
    • Pages: 1235 - 1235
      PubDate: 2017-10-08T23:02:03.635725-05:
      DOI: 10.1111/aas.12807
       
  • Anaesthesia during endovascular stroke therapy – a strong or weak link
           in the treatment chain'
    • Authors: L. Romundstad
      Pages: 1236 - 1239
      PubDate: 2017-10-08T23:02:03.699028-05:
      DOI: 10.1111/aas.12997
       
  • Therapeutic bronchoscopy vs. standard of care in acute respiratory
           failure: a systematic review
    • Authors: K. L. Ellekjaer; T. S. Meyhoff, M. H. Møller
      Pages: 1240 - 1252
      Abstract: BackgroundWe aimed to assess patient-important benefits and harms of therapeutic bronchoscopy vs. standard of care (no bronchoscopy) in critically ill patients with acute respiratory failure (ARF).MethodsWe conducted a systematic review with meta-analysis and trial sequential analysis (TSA) according to the Cochrane Handbook and GRADE methodology, including a predefined protocol (PROSPERO no. CRD42016046235). We included randomized clinical trials (RCTs) comparing therapeutic bronchoscopy to standard of care in critically ill patients with ARF. Two reviewers independently assessed trials for inclusion, extracted data and assessed risk of bias. Risk ratios (RR) with 95% confidence intervals (CI) were estimated by conventional meta-analysis. The risk of random errors was assessed by TSA. Exclusively patient-important outcomes were evaluated.ResultsWe included five trials (n = 212); all were judged as having high risk of bias. There was no difference in all-cause mortality between therapeutic bronchoscopy and standard of care (TSA adjusted RR 0.39; 95% CI 0.14 to 1.07; I2 0%), and only 3% of the required information size had been accrued. There was no difference in ICU length of stay. A shorter duration of mechanical ventilation was suggested by conventional meta-analysis, however TSA highlighted that only 42% of the required information size had been accrued, indicating high risk of random errors. No trials reported data on adverse events, hospital length of stay, quality of life or performance status.ConclusionsThe quantity and quality of evidence supporting therapeutic bronchoscopy in critically ill patients with ARF is very low with no firm evidence for benefit or harm.
      PubDate: 2017-10-08T23:02:03.02285-05:0
      DOI: 10.1111/aas.13000
       
  • Validation of subjective rating scales for assessment of surgical
           workspace during laparoscopy
    • Authors: G. G. Nervil; R. Medici, J. L. D. Thomsen, A. K. Staehr-Rye, S. Asadzadeh, J. Rosenberg, M. R. Gätke, M. V. Madsen
      Pages: 1270 - 1277
      Abstract: BackgroundRecently, studies have focused on how to optimize laparoscopic surgical workspace by changes in intra-abdominal pressure, level of muscle relaxation or body position, typically evaluated by surgeons using subjective rating scales. We aimed to validate two rating scales by having surgeons assess surgical workspace in video sequences recorded during laparoscopic surgery.MethodVideo sequences were obtained from laparoscopic procedures. Eight experienced surgeons assessed the video sequences on a categorical 5-point scale and a numerical 10-point rating scale. Intraclass correlations coefficients (ICC) and 95% confidence intervals (CI) were calculated for intra- and inter-rater reliability.ResultsThe 5-point rating scale had an intra-rater ICC of 0.76 (0.69; 0.83) and an inter-rater ICC of 0.57 (0.45; 0.68), corresponding to excellent and fair reliability, respectively. The 10-point scale had an intra-rater ICC of 0.86 (0.82; 0.89) and an inter-rater ICC of 0.54 (0.39; 0.68), corresponding to excellent and fair as well. All surgeons used the full range of the 5-point scale, but only one surgeon used the full range of the 10-point scale.ConclusionIn conclusion, both scales showed excellent intra-rater and fair inter-rater reliability for assessing surgical workspace in laparoscopy. The 5-point surgical rating scale had all categories employed by all surgeons.
      PubDate: 2017-10-08T23:02:01.545265-05:
      DOI: 10.1111/aas.13001
       
  • Intensive care admissions due to poisoning
    • Authors: E. Lindqvist; G. Edman, J. Hollenberg, P. Nordberg, U. Ösby, S. Forsberg
      Pages: 1296 - 1304
      Abstract: BackgroundPoisoning represents a significant part of admissions to intensive care units. The aim of this nationwide study was to describe recent national quality register data of demographics and mortality for these patients.MethodA retrospective national observational study including all patients over 19 years admitted to an ICU in Sweden, between 1 January 2010 and 31 December 2011, with an ICD-10 code for poisoning. The data were collected from three national registers (The Swedish Intensive Care Register, The National Patient Register, and The Cause of Death Register).ResultsThe incidence of ICU-treated poisonings was 43/100,000. Twenty-one per cent (n = 8155) of all poisoned patients seeking medical care were admitted to the ICU. Their median age was 38 years (q1–q3: 26–51), as many men as women and 46.5% (n = 3790) had a previous registered poisoning. A mix of different substances was the most common type of suspected poisoning (29.7%, n = 2424). The in-hospital mortality was 1.9% and was correlated to invasive mechanical ventilation (OR 6.91 CI 95% 4.59–10.42), age> 40 (OR 4.54 CI 95% 2.86–7.21) and no previous hospitalisation for poisoning (OR 3.23 CI 95% 2.06–5.07). For 78.3% (n = 119) of the deceased patients, the fatal poisoning was their first diagnosed poisoning. The 30-day mortality was 2.7%, a majority died from poisoning (P 
      PubDate: 2017-10-08T23:01:58.425952-05:
      DOI: 10.1111/aas.13005
       
  • What is the real incidence of Takotsubo syndrome in intensive care
           units'
    • Authors: J. E. Madias
      Pages: 1371 - 1371
      PubDate: 2017-10-08T23:01:59.843903-05:
      DOI: 10.1111/aas.13004
       
  • Reply to “Does use of perioperative COX-2 inhibitors really increase
           risk of acute kidney injury'”
    • Authors: A. Abrahamsson; J. Oras, J. Snygg, L. Block
      Pages: 1376 - 1376
      PubDate: 2017-10-08T23:02:02.768926-05:
      DOI: 10.1111/aas.12999
       
  • Calendar of Events
    • Pages: 1398 - 1398
      PubDate: 2017-10-08T23:02:03.876365-05:
      DOI: 10.1111/aas.12806
       
 
 
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