Empirical carbapenems or piperacillin/tazobactam for infections in intensive care: An international retrospective cohort study.

BACKGROUND: Critically ill patients in intensive care units (ICU) are frequently administered broad-spectrum antibiotics (e.g., carbapenems or piperacillin/tazobactam) for suspected or confirmed infections. This retrospective cohort study aimed to describe the use of carbapenems and piperacillin/tazobactam in two international, prospectively collected datasets. METHODS: We conducted a post hoc analysis of data from the "Adjunctive Glucocorticoid Therapy in Patients with Septic Shock" (ADRENAL) trial (n = 3713) and the "Antimicrobial de-escalation in the critically ill patient and assessment of clinical cure" (DIANA) study (n = 1488). The primary outcome was the proportion of patients receiving initial antibiotic treatment with carbapenems and piperacillin/tazobactam. Secondary outcomes included mortality, days alive and out of ICU and ICU length of stay at 28 days. RESULTS: In the ADRENAL trial, carbapenems were used in 648 out of 3713 (17%), whereas piperacillin/tazobactam was used in 1804 out of 3713 (49%) participants. In the DIANA study, carbapenems were used in 380 out of 1480 (26%), while piperacillin/tazobactam was used in 433 out of 1488 (29%) participants. Mortality at 28 days was 23% for patients receiving carbapenems and 24% for those receiving piperacillin/tazobactam in ADRENAL and 23% and 19%, respectively, in DIANA. We noted variations in secondary outcomes; in DIANA, patients receiving carbapenems had a median of 13 days alive and out of ICU compared with 18 days among those receiving piperacillin/tazobactam. In ADRENAL, the median hospital length of stay was 27 days for patients receiving carbapenems and 21 days for those receiving piperacillin/tazobactam. CONCLUSIONS: In this post hoc analysis of ICU patients with infections, we found widespread initial use of carbapenems and piperacillin/tazobactam in international ICUs, with the latter being more frequently used. Randomized clinical trials are needed to assess if the observed variations in outcomes may be drug-related effects or due to confounders.

A riddle yet unsolved: two case reports of primary cardiac sarcoma.

Primary malignant cardiac tumors are exceedingly rare and dangerous, often leading to very early death after initial symptom presentation. Each case poses a unique challenge, as no standardized practice guidelines have been developed due to their sheer rarity. Surgical excision and adjuvant therapy remain the mainstays of treatment. However, resection is impeded by the unique challenges of cardiac surgery and growth characteristics of the tumors, both contributing to high rates of recurrence. We present two cases of successfully treated primary cardiac sarcoma with survival rates exceeding expectations.

Are We Meeting the Current Standards of Consent for Anesthesia? An International Survey of Clinical Practice.

BACKGROUND International application of existing guidelines and recommendations on anesthesia-specific informed consent is limited by differences in healthcare and legal systems. Understanding national and regional variations is necessary to determine future guidelines. MATERIAL AND METHODS Anonymous paper surveys on their practices regarding anesthesia-specific patient informed consent were sent to anesthesiologists in Estonia, Latvia, and Lithuania. RESULTS A total of 233 responses were received, representing 36%, 26%, and 24% of the practicing anesthesiologists in Lithuania, Latvia, and Estonia, respectively. Although 85% of responders in Lithuania reported using separate forms to secure patient informed consent for anesthesia, 54.5% of responders in Estonia and 50% in Latvia reported using joint forms to secure patient informed consent for surgery and anesthesia. Incident rates were understated by 14.2% of responders and overstated by 66.4% (P<0.001), with the latter frequently quoting incident rates that are several to tens of times higher than those published internationally. Physicians obtaining consent in the outpatient setting were more satisfied with the process than those obtaining consent on the day of surgery, with 62.5% and 42.6%, respectively, agreeing that the informed consent forms provided a satisfactory description of complications (P=0.03). Patients were significantly less likely to read consent information when signing forms on the day of surgery than at earlier times (8.5% vs. 67.5%, P<0.001). Only 46.2% of respondents felt legally protected by the current consent process. CONCLUSIONS Anesthesia-specific informed patient consent practices differ significantly in the 3 Baltic states, with these practices often falling short of legal requirements. Efforts should be made to improving information accuracy, patient autonomy, and compliance with existing legal standards.

Sevoflurane and desflurane effects on early cognitive function after low-risk surgery: A randomized clinical trial.

BACKGROUND AND OBJECTIVES: Deleterious effects on short-term and long-term quality of life have been associated with the development of postoperative cognitive dysfunction (POCD) after general anesthesia. Yet, the progress in the field is still required. Most of the studies investigate POCD after major surgery, so scarce evidence exists about the incidence and effect different anesthetics have on POCD development after minor procedures. In this study, we compared early postoperative cognitive function of the sevoflurane and desflurane patients who experienced a low-risk surgery of thyroid gland. MATERIALS AND METHODS: Eighty-two patients, 40 years and over, with no previous severe cognitive, neurological, or psychiatric disorders, appointed for thyroid surgery under general anesthesia, were included in the study. In a random manner, the patients were allocated to either sevoflurane or desflurane study arms. Cognitive tests assessing memory, attention, and logical reasoning were performed twice: the day before the surgery and 24 h after the procedure. Primary outcome, magnitude of change in cognitive testing, results from baseline. POCD was diagnosed if postoperative score decreased by at least 20%. RESULTS: Median change from baseline cognitive results did not differ between the sevoflurane and desflurane groups (-2.63%, IQR 19.3 vs. 1.13%, IQR 11.0; p = .222). POCD was detected in one patient (1.22%) of the sevoflurane group. Age, duration of anesthesia, postoperative pain, or patient satisfaction did not correlate with test scores. Intraoperative temperature negatively correlated with total postoperative score (r = -0.35, p = .007). CONCLUSIONS: Both volatile agents proved to be equivalent in terms of the early cognitive functioning after low-risk thyroid surgery. Intraoperative body temperature may influence postoperative cognitive performance.

Comparison of preoxygenation efficiency with Intersurgical Economy and Intersurgical QuadraLite anaesthetic face masks.

BACKGROUND: Sufficient preoxygenation prevents arterial oxygen desaturation prior to intubation. An optimally sealed facemask is necessary for fast preoxygenation. The study was aimed at comparing the efficiency of preoxygenation using two different face masks. MATERIALS AND METHODS: In 2018, a prospective study was conducted. Patients were classified into two groups: group A - Intersurgical Economy face masks, group B - Intersurgical QuadraLite masks. The circuit was flushed with 100% O2 for 30s, preoxygenation started with flow of 8l/min, FiO2100. The patients were asked to breathe deeply. Fentanyl (1-2 mcg/kg) was administered to increase mask toleration. End-tidal oxygen concentration (EtO2) ≥90% was the goal. EtO2 was monitored after 30, 60, 90, 120, 180, 210, 240, 270 and 300 seconds. Data was analyzed using the Independent-Samples T-test and the Mann-Whitney-U test. RESULTS: Twelve patients were enrolled in group A and 19 in group B. Differences in sex, age, BMI and Mallampati class in the groups were statistically insignificant (p = 0.13, 0.39, 0.65, 0.43 respectively). Patients assigned to ASA I - 25.8% (n = 8->2/6), ASA II - 71.0 % (n = 22->10/12), ASA III - 3.2% (n = 1->0/1), p = 0.64. The success rate of preoxygenation to EtO290 within 5 min was statistically significantly different in the groups, with 33.3% in group A and 94.7% in group B (p < 0.01). Mean time to EtO290 was 228.3 ± 104.0/164.4 ± 84.3. Mean EtO2 after: 30s - 56.0 ± 13.5/69.3 ± 11.2 (p < 0.01); 60s - 63.8 ± 15.3/76.1 ± 11.7 (p = 0.02), 90s - 67.8 ± 17.7/80.7 ± 10.1 (p = 0.03); 120s-69.6 ± 18.2/83.4 ± 10.0 (p = 0.03), 150s-71.1 ± 19.0/87.1 ± 6.5 (p = 0.01); 180s - 72.9 ± 16.8/88.5 ± 5.3 (p = 0.01), 210s - 72.6 ± 18.0/89.2 ± 5.1 (p < 0.01); 240s - 74.17 ± 15.4/90.0 ± 4.3 (p < 0.01), 270s-76.3 ± 16.3/90.2 ± 3.6; 300s - 77.8 ± 14.6/90.2 ± 1.5 (p < 0.01). CONCLUSIONS: Preoxygenation was significantly more efficient and faster with Intersurgical QuadraLite face masks.