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Objective To identify PaCO2 trajectories and assess their associations with mortality in critically ill patients with coronavirus disease 2019 (COVID-19) during the first and second waves of the pandemic in Denmark. Design A population-based cohort study with retrospective data collection. Patients All COVID-19 patients were treated in eight intensive care units (ICUs) in the Capital Region of Copenhagen, Denmark, between March 1, 2020 and March 31, 2021. Measurements Data from the electronic health records were extracted, and latent class analyses were computed based on up to the first 3 weeks of mechanical ventilation to depict trajectories of PaCO2 levels. Multivariable Cox regression analyses were used to calculate adjusted hazard ratios (aHRs) for Simplified Acute Physiology Score 3, sex and age with 95% confidence intervals (CIs) for death according to PaCO2 trajectories. Main results In latent class trajectory models, including 25,318 PaCO2 measurements from 244 patients, three PaCO2 latent class trajectories were identified: a low isocapnic (Class I; n = 130), a high isocapnic (Class II; n = 80), as well as a progressively hypercapnic (Class III; n = 34) trajectory. Mortality was higher in Class II [aHR: 2.16 {1.26–3.68}] and Class III [aHR: 2.97 {1.63–5.40}]) compared to Class I (reference). Conclusion Latent class analysis of arterial blood gases in mechanically ventilated COVID-19 patients identified distinct PaCO2 trajectories, which were independently associated with mortality., Objective: To identify PaCO2 trajectories and assess their associations with mortality in critically ill patients with coronavirus disease 2019 (COVID-19) during the first and second waves of the pandemic in Denmark. Design: A population-based cohort study with retrospective data collection.Patients: All COVID-19 patients were treated in eight intensive care units (ICUs) in the Capital Region of Copenhagen, Denmark, between March 1, 2020 and March 31, 2021. Measurements: Data from the electronic health records were extracted, and latent class analyses were computed based on up to the first 3 weeks of mechanical ventilation to depict trajectories of PaCO2 levels. Multivariable Cox regression analyses were used to calculate adjusted hazard ratios (aHRs) for Simplified Acute Physiology Score 3, sex and age with 95% confidence intervals (CIs) for death according to PaCO2 trajectories. Main results: In latent class trajectory models, including 25,318 PaCO2 measurements from 244 patients, three PaCO2 latent class trajectories were identified: a low isocapnic (Class I; n = 130), a high isocapnic (Class II; n = 80), as well as a progressively hypercapnic (Class III; n = 34) trajectory. Mortality was higher in Class II [aHR: 2.16 {1.26-3.68}] and Class III [aHR: 2.97 {1.63-5.40}]) compared to Class I (reference). Conclusion: Latent class analysis of arterial blood gases in mechanically ventilated COVID-19 patients identified distinct PaCO2 trajectories, which were independently associated with mortality.

BACKGROUND: A key point in pathways for optimal rehabilitation and enhanced recovery is an effective postoperative multimodal pain treatment regimen.OBJECTIVE: To investigate the analgesic effects of transversus abdominis plane (TAP) block in conjunction with paracetamol and ibuprofen in patients undergoing laparoscopic colonic resection.DESIGN: Randomised placebo-controlled double-blind study.SETTING: Herlev University Hospital, Copenhagen, Denmark, from March 2010 to February 2013.PATIENTS: Eighty adult patients scheduled for elective laparoscopic colectomy.INTERVENTIONS: Bilateral TAP block with 20 ml of either ropivacaine or isotonic saline.MAIN OUTCOME MEASURES: Visual analogue scale (VAS) pain scores (0 to 100 mm) while coughing at 6 h after surgery (primary outcome). Secondary outcomes were area under the curve pain scores (2 to 24 h) at rest and while coughing, 24-h morphine consumption and incidence of nausea and vomiting.RESULTS: VAS pain scores at 6 h while coughing was not different between groups (median, interquartile range), TAP, 27 (11 to 45) mm vs. placebo, 33 (20 to 49) mm (P = 0.20). Total 24-h morphine consumption was reduced in the TAP block group vs. placebo group, 30 (15 to 41) mg vs. 43 (30 to 67) mg, respectively (P = 0.008). This difference was most pronounced in the first postoperative hours. The remaining outcomes did not differ between groups.CONCLUSION: TAP block used in combination with paracetamol and ibuprofen did not reduce pain after laparoscopic colonic surgery. However, we found a 30% reduction in opioid use, most marked in the early postoperative period.TRIAL REGISTRATION: www.clinicaltrials.gov (NCT01418144).

This study explores whether simulation plays a role in health care failure mode and effects analysis (HFMEA); it does this by evaluating whether additional data are found when a traditional HFMEA is augmented with simulation. Two multidisciplinary teams identified vulnerabilities in a process by brainstorming, followed by simulation. Two means of adding simulation were investigated as follows: just simulating the process and interrupting the simulation between substeps of the process.By adding simulation to a traditional HFMEA, both multidisciplinary teams identified additional data that were relevant for deeper analysis. The study indicates that simulation has a role in HFMEA. Both ways of using simulation seemed feasible, and our results are not conclusive in selecting one over the other.

Laparoscopic cholecystectomy is associated with postoperative pain of moderate intensity in the early postoperative period. Recent randomized trials have demonstrated the efficacy of transversus abdominis plane (TAP) block in providing postoperative analgesia after abdominal surgery. We hypothesized that a TAP block may reduce pain while coughing and at rest for the first 24 postoperative hours, opioid consumption, and opioid side effects in patients undergoing laparoscopic cholecystectomy in day-case surgery.

BACKGROUND: Postpartum haemorrhage (PPH) remains a leading cause of maternal mortality worldwide. In Denmark 2 % of parturients receive blood transfusion. During the course of bleeding fibrinogen (coagulation factor I) may be depleted and fall to critically low levels impairing haemostasis and thus worsening the ongoing bleeding. A plasma level of fibrinogen below 2 g/L in the early phase of postpartum haemorrhage is associated with subsequent development of severe haemorrhage. Use of fibrinogen concentrate allows high-dose substitution without the need for blood type cross match. So far no publications of randomised controlled trials involving acutely bleeding patients in the obstetrical setting have been published. This trial aims to investigate if early treatment with fibrinogen concentrate reduces the need for blood transfusion in women suffering severe PPH. METHODS: In this randomised placebo controlled double blind multicenter trial, parturients with primary PPH are eligible following vaginal delivery in case of: Manual removal of placenta (blood loss [greater than or equal to] 500 ml) or manual exploration of the uterus after the birth of placenta (blood loss [greater than or equal to] 1000 ml). Caesarean sections are also eligible in case of perioperative blood loss [greater than or equal to] 1000 ml. The exclusion criteria are known inherited haemostatic deficiencies, prepartum treatment with anti-thrombotics, pre-pregnancy weight

Elevated blood levels of lidocaine and ropivacaine have been described after transversus abdominis plane (TAP) block.

INTRODUCTION: Many foreign doctors work in Danish hospitals. This study concerns the opportunities available to and difficulties encountered by these doctors. MATERIALS AND METHODS: A questionnaire concerning guidance available to foreign doctors, their linguistic and professional competence and their cultural backgrounds was sent to foreign doctors, to Danish doctors, to Danish nurses, and to patients in Greater Copenhagen. A total of 1539 questionnaires were sent. RESULTS: 49-57% in each group replied. The majority of both foreign doctors and Danish doctors found that introductory guidance was adequate, but nurses thought otherwise. A large majority of Danish personnel (78-89%) had experienced that they themselves or patients could not understand a foreign doctor. A lesser number of foreign doctors (27-33%) had the same experience with Danish personnel or patients. Foreign doctors' language difficulties gave rise to feelings of insecurity and doubts about professional competence in both Danish personnel and patients (53-69%). Danish personnel estimate that European Union (EU) doctors' professional competence is equal to Danish doctors' professional competence, while non-EU foreign doctors are not so highly esteemed. 90% of patients are of the opinion that foreign doctors are professionally competent. Cultural background can influence clinical practice in the opinion of 50% of Danish personnel and 42% of foreign doctors. CONCLUSION: Insufficient communication is the biggest challenge for foreign doctors, and can influence the evaluation of their professional competence. Cultural differences may influence foreign doctors' cooperation with Danish personnel. Patients are satisfied with treatment given by foreign doctors Udgivelsesdato: 2008/5/19, Many foreign doctors work in Danish hospitals. This study concerns the opportunities available to and difficulties encountered by these doctors.