Search

Modern near-infrared spectroscopy technology is increasingly adopted to measure cerebral tissue oxygen saturation. However, the normal range of cerebral tissue oxygen saturation in adults with such technology is unknown. We sought to measure cerebral tissue oxygen saturation in healthy volunteers using the novel O3 Regional Oximetry® device (Masimo Corporation, Irvine, CA, USA) and assess its relationship with key physical and haemodynamic characteristics. For ≥5 minutes, we continuously recorded cerebral tissue oxygen saturation, pulse oximetry, cardiac index and mean arterial pressure. We assessed for differences in cerebral tissue oxygen saturation between hemispheres, sex, skin type, comorbidity or smoking status, and for associations between cerebral tissue oxygen saturation and age, height, weight, SpO2and haemodynamic parameters. We recorded >32,000 observations in 98 volunteers aged 22 to 60 years, including 41 (42%) males. One-fifth had one or more co morbidities ( n=22, 22.5%), one-tenth were either current or former-smokers ( n=13, 13%), and most had a Fitzpatrick skin type of 3 or lower ( n=84, 86%). The mean combined average cerebral tissue oxygen saturation was 67.6% (95% confidence interval 66.8%-68.6%). We found statistically significant differences in cerebral tissue oxygen saturation according to hemisphere and an association between cerebral tissue oxygen saturation and mean arterial pressure and cardiac index. The combined average cerebral tissue oxygen saturation in 98 healthy volunteers was 67.6% with a narrow confidence interval and no combined average cerebral tissue oxygen saturation was below 56%. We also observed statistically significant yet quantitatively small cerebral tissue oxygen saturation differences between hemispheres, and an association between cerebral tissue oxygen saturation and mean arterial pressure and cardiac index. [ABSTRACT FROM AUTHOR]

The article discusses a study which examined the use of electronic automated advisory vital signs to monitor general hospital wards. The study included 18,305 patients at 12 general wards in 10 hospitals in the U.S., Europe and Australia. Study authors concluded that the use of electronic automated advisory vital signs monitors can improve rapid response team-calls due to respiratory criteria.

The author focuses on the acute vital organ injuries with emphasis to kidney attacks that vary few clinicians, researchers and the public know about as compared to the brain attacks and heart attack in the U.S. Acute kidney injury leads to early mortality despite the availability of dialysis and hemofiltration and also the setting of diseases like sepsis result in the occurrence of acute kidney injury.

Aim: The study was developed to characterize short-term outcomes of deteriorating ward patients triggering a Rapid Response Team (RRT), and describe variability between hospitals or groups thereof.Methods: We performed an international prospective study of Rapid Response Team (RRT) activity over a 7-day period in February 2014. Investigators at 51 acute hospitals across Australia, Denmark, the Netherlands, USA and United Kingdom collected data on all patients triggering RRT review concerning the nature, trigger and immediate outcome of RRT review. Further follow-up at 24h following RRT review focused on patient orientated outcomes including need for admission to critical care, change in limitations of therapy and all cause mortality.Results: We studied 1188 RRT activations. Derangement of vital signs as measured by the National Early Warning Score (NEWS) was more common in non-UK hospitals (p=0.03). Twenty four hour mortality after RRT review was 10.1% (120/1188). Urgent transfer to ICU or the operating theatre occurred in 24% (284/1188) and 3% (40/1188) of events, respectively. Patients in the UK were less likely to be admitted to ICU (31% vs. 22%; p=0.017) and their median (IQR) time to ICU admission was longer [4.4 (2.0-11.8) vs. 1.5 (0.8-4.4)h; p<0.001]. RRT involvement lead to new limitations in care in 28% of the patients not transferring to the ICU; in the UK such limitations were instituted in 21% of patients while this occurred in 40% of non-UK patients (p<0.001).Conclusion: Among patients triggering RRT review, 1 in 10 died within 24h; 1 in 4 required ICU admission, and 1 in 4 had new limitations in therapy implemented. We provide a template for an international comparison of outcomes at RRT level. [ABSTRACT FROM AUTHOR]

Objective : To compare the characteristics, use of invasive ventilation and outcomes of patients admitted with critical asthma syndrome (CAS) to ICUs in Australia and New Zealand (ANZ), and a large cohort of ICUs in the United States (US). Methods : We examined two large databases of ICU for patients admitted with CAS in 2014 and 2015. We obtained, analyzed, and compared information on demographic and physiological characteristics, use of invasive mechanical ventilation, and clinical outcome and derived predictive models. Results : Overall, 2202 and 762 patients were admitted with a primary diagnosis of CAS in the ANZ and US databases respectively (0.73% vs. 0.46% of all ICU admissions, P  < 0.001). A similar percentage of patients received invasive mechanical ventilation in the first 24 h (24.7% vs. 24.4%, P  = 0.87) but ANZ patients had lower respiratory rates and higher PaCO 2 levels. Overall mortality was low (1.23 for ANZ and 1.71 for USA; P  = 0.36) and even among invasively ventilated patients (2.4% for ANZ vs. 1.1% for USA; P  = 0.38). However, ANZ patients also had longer length of stay in ICU (43 vs. 37 h, P  = 0.001) and hospital (105 vs. 78 h, P  = 0.003). Conclusions : Patients admitted to ANZ and USA ICU with CAS are broadly similar and have a low and similar rate of invasive ventilation and mortality. However, ANZ patients made up a greater proportion of ICU patients and had longer ICU and hospital stays. These findings provide a modern invasive ventilation and mortality rates benchmark for future studies of CAS.

Importance: No effective pharmaceutical agents have yet been identified to treat acute kidney injury after cardiac surgery., Objective: To determine whether fenoldopam reduces the need for renal replacement therapy in critically ill cardiac surgery patients with acute kidney injury., Design, Setting, and Participants: Multicenter, randomized, double-blind, placebo-controlled, parallel-group study from March 2008 to April 2013 in 19 cardiovascular intensive care units in Italy. We randomly assigned 667 patients admitted to intensive care units after cardiac surgery with early acute kidney injury (≥50% increase of serum creatinine level from baseline or oliguria for ≥6 hours) to receive fenoldopam (338 patients) or placebo (329 patients). We used a computer-generated permuted block randomization sequence for treatment allocation. All patients completed their follow-up 30 days after surgery, and data were analyzed according to the intention-to-treat principle., Interventions: Continuous infusion of fenoldopam or placebo for up to 4 days with a starting dose of 0.1 μg/kg/min (range, 0.025-0.3 µg/kg/min)., Main Outcomes and Measures: The primary end point was the rate of renal replacement therapy. Secondary end points included mortality (intensive care unit and 30-day mortality) and the rate of hypotension during study drug infusion., Results: The study was stopped for futility as recommended by the safety committee after a planned interim analysis. Sixty-nine of 338 patients (20%) allocated to the fenoldopam group and 60 of 329 patients (18%) allocated to the placebo group received renal replacement therapy (P = .47). Mortality at 30 days was 78 of 338 (23%) in the fenoldopam group and 74 of 329 (22%) in the placebo group (P = .86). Hypotension occurred in 85 (26%) patients in the fenoldopam group and in 49 (15%) patients in the placebo group (P = .001)., Conclusions and Relevance: Among patients with acute kidney injury after cardiac surgery, fenoldopam infusion, compared with placebo, did not reduce the need for renal replacement therapy or risk of 30-day mortality but was associated with an increased rate of hypotension., Trial Registration: clinicaltrials.gov Identifier: NCT00621790.

Background: Knowledge is limited on how surgical outcomes compare between different geographical and health organisation settings., Objective: To compare demographic features, surgery rates and in-hospital outcomes for 14 major types of surgery in older patients between the state of Victoria in Australia and the United States., Methods: We obtained US Medicare data and data from the Department of Human Services Victorian Admitted Episodes Database for patients older than 65 years who underwent one of six major cardiovascular procedures or eight major cancer resections in a 5-year period (1994-1999 and 1998- 2003, respectively). Data comprised patient age, sex and elective versus non-elective status, operation type, surgical volume and postoperative hospital mortality., Results: The number of operations performed per capita was 2.6 times greater in the US system than in Victoria. Overall, postoperative hospital mortality was lower in Victoria (3.96% v 4.47%, P < 0.001). It was also lower in Victoria for four major cardiothoracic procedures (coronary artery bypass grafting: 2.79% v 4.63% in the US, P < 0.001; aortic valve replacement, 5.30% v 7.94%, P < 0.001; mitral valve replacement, 6.52% v 13.24%, P < 0.001; pulmonary lobectomy, 2.16% v 4.72%, P = 0.01), but was higher for nephrectomy (3.59% v 2.33%, P = 0.04) and colectomy (7.33% v 4.67%, P < 0.001). The Victorian patients included a smaller proportion of women (35.24% v 41.23%, P < 0.001) and people older than 75 years (39.58% v 44.48%, P < 0.001). US patients were significantly more likely to have their admission status classified as non-elective (45.45% v 34.98% in Victoria, P < 0.001)., Conclusions: Despite limitations on interpretation inherent in comparing outcomes from different jurisdictions, these findings suggest major differences between Victoria and the US in surgical management of patients older than 65 years. Surgical intervention rates appear lower in Victoria, particularly in patients older than 75 years. For patients who receive major cardiothoracic procedures, in-hospital mortality is lower in Victoria than in the US; for colectomy and nephrectomy, it is higher in Victoria; and for other procedures, it is similar.

Background: Studies have established that physiologic instability and services mismatching precede adverse events in hospitalized patients. In response to these considerations, the concept of a Rapid Response System (RRS) has emerged. The responding team is commonly known as a medical emergency team (MET), rapid response team (RRT), or critical care outreach (CCO). Studies show that an RRS may improve outcome, but questions remain regarding the benefit, design elements, and advisability of implementing a MET system., Methods: In June 2005 an International Conference on Medical Emergency Teams (ICMET) included experts in patient safety, hospital medicine, critical care medicine, and METs. Seven of 25 had no experience with an RRS, and the remainder had experience with one of the three major forms of RRS. After preconference telephone and e-mail conversations by the panelists in which questions to be discussed were characterized, literature reviewed, and preliminary answers created, the panelists convened for 2 days to create a consensus document. Four major content areas were addressed: What is a MET response? Is there a MET syndrome? What are barriers to METS? How should outcome be measured? Panelists considered whether all hospitals should implement an RRS., Results: Patients needing an RRS intervention are suddenly critically ill and have a mismatch of resources to needs. Hospitals should implement an RRS, which consists of four elements: an afferent, "crisis detection" and "response triggering" mechanism; an efferent, predetermined rapid response team; a governance/administrative structure to supply and organize resources; and a mechanism to evaluate crisis antecedents and promote hospital process improvement to prevent future events.