Outcomes

Early Acute Kidney Injury and Outcome in Acute Respiratory Distress Syndrome

The authors carried out a secondary analysis of an observational study. Patients with severe respiratory failure were categorized based on worst serum creatinine or urine output.

Highlighting the significance of renal dysfunction, they concluded: The development of acute kidney injury, even when mild-moderate in severity, is associated with a substantial increase in mortality in patients with acute respiratory distress syndrome.

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Emergency Department to ICU Time and Hospital Mortality

This was a retrospective observational cohort study using data from the Dutch quality registry National Intensive Care Evaluation evaluating ER to ICU times.

“Prolonged emergency departmentto ICU time (> 2.4 hr) is associated with increased hospital mortality after ICU admission, mainly driven by patients who had a higher Acute Physiology and Chronic Health Evaluation IV probability. We hereby provide evidence that rapid admission of the most critically ill patients to the ICU might reduce hospital mortality.”

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Neuraxial labour analgesia reduces risk of maternal depression at 2 years after childbirth

This prospective study suggests another potential advantage to neuraxial analgesia for vaginal delivery.

It concluded: “For nulliparous women with single-term cephalic pregnancy planning for vaginal delivery, the use of neuraxial analgesia during labour was associated with a reduced risk of maternal depression at 2 years after childbirth.”

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Association between complications and death within 30 days after noncardiac surgery

It is rare to die in the Operating Room.

This prospective study looked at the rate and cause of death after non-cardiac surgery.

“Among adults undergoing noncardiac surgery, 99.3% of deaths occurred after the procedure and 44.9% of deaths were associated with 3 complications: major bleeding, MINS and sepsis. Given these findings, focusing on the prevention, early identification and management of these 3 complications holds promise for reducing perioperative mortality”

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Major Neurologic Complications Associated With Postdural Puncture Headache in Obstetrics

Sometimes considered a nuisance, this study reminds us of the potential serious ramifications of accidental post-dural puncture headache (PDPH) during epidural placement in obstetrics.

The incidence of complications was not negligible in this retrospective review, including: composite of cerebral venous thrombosis and subdural hematoma, bacterial meningitis, depression, headache, and low back pain. PDPH and complications were identified during the delivery hospitalization and up to 1 year post-delivery. 

Early recognition and management is therefore important.

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Peripheral Nerve Blocks for Ambulatory Shoulder Surgery

Nerve blocks are now almost universal during shoulder surgery for their superior analgesia. This study reviewed post-discharge outcomes.

A decrease in unplanned admissions was found. There was no improvement in other postoperative outcomes such as emergency department visits, readmissions, mortality, or practical costs.

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Mortality and major morbidity after hip fracture surgery and Anesthesia

This retrospective analysis doesn’t prove causality but findings were in keeping with prior work.

Spinal anesthesia was weakly associated with a lower 90-day mortality following hip fracture surgery, and also associated with improved morbidity evidenced by a lower rate of pulmonary embolism and major blood loss and a shorter hospital length of stay.

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Mannitol in Critical Care

Mannitol has a long history of use to decrease intracranial pressure in neurosurgery and traumatic brain injury but it’s effect on long term outcome is still uncertain.

This free full text review – a meta-analysis and systematic review – surveys its history and usage. Its conclusion is essentially:

“Mannitol is effective in accomplishing short-term clinical goals, although hypertonic saline is associated with improved brain relaxation during craniotomy. Mannitol has a favorable safety profile although it can cause electrolyte abnormality and renal impairment. More research is needed to determine its impacts on long-term outcomes.”

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Spinal anesthesia compared with general anesthesia for neonates with hypertrophic pyloric stenosis

This retrospective study surveyed general vs. spinal anesthesia for infants with pyloric stenosis. While it may not be in the comfort zone for some practitioners, it was shown that it was a viable alternative to general anesthesia, reducing the respiratory morbidity associated with the latter, significantly reducing apneic episodes and desaturation.

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Stillbirth linked to more childbirth complications

A commentary on a journal study showing life-threatening delivery complications are more than four times as common during and after a stillbirth than a live birth. Some of these complications are more than 10 times as likely with stillbirths, per this Stanford study.

Complications included sepsis and shock, renal failure and cardiac problems. Certain causes if stillbirth like infection or hypertensive diseases were strongly linked to delivery complications for the mother.

This highlights another area to continuously improve maternal care, California also previously making important quality strides in maternal care improvement.

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