Long-term outcomes in COVID-19 patients admitted to intensive care in Denmark: A nationwide observational study.

BACKGROUND: Among ICU patients with COVID-19, it is largely unknown how the overall outcome and resource use have changed with time, different genetic variants, and vaccination status. METHODS: For all Danish ICU patients with COVID-19 from March 10, 2020 to March 31, 2022, we manually retrieved data on demographics, comorbidities, vaccination status, use of life support, length of stay, and vital status from medical records. We compared patients based on the period of admittance and vaccination status and described changes in epidemiology related to the Omicron variant. RESULTS: Among all 2167 ICU patients with COVID-19, 327 were admitted during the first (March 10-19, 2020), 1053 during the second (May 20, 2020 to June 30, 2021) and 787 during the third wave (July 1, 2021 to March 31, 2022). We observed changes over the three waves in age (median 72 vs. 68 vs. 65 years), use of invasive mechanical ventilation (81% vs. 58% vs. 51%), renal replacement therapy (26% vs. 13% vs. 12%), extracorporeal membrane oxygenation (7% vs. 3% vs. 2%), duration of invasive mechanical ventilation (median 13 vs. 13 vs. 9 days) and ICU length of stay (median 13 vs. 10 vs. 7 days). Despite these changes, 90-day mortality remained constant (36% vs. 35% vs. 33%). Vaccination rates among ICU patients were 42% as compared to 80% in society. Unvaccinated versus vaccinated patients were younger (median 57 vs. 73 years), had less comorbidity (50% vs. 78%), and had lower 90-day mortality (29% vs. 51%). Patient characteristics changed significantly after the Omicron variant became dominant including a decrease in the use of COVID-specific pharmacological agents from 95% to 69%. CONCLUSIONS: In Danish ICUs, the use of life support declined, while mortality seemed unchanged throughout the three waves of COVID-19. Vaccination rates were lower among ICU patients than in society, but the selected group of vaccinated patients admitted to the ICU still had very severe disease courses. When the Omicron variant became dominant a lower fraction of SARS-CoV-2 positive patients received COVID treatment indicating other causes for ICU admission.

Waking Up in Pain: a prospective unselected cohort study of pain in 3702 patients immediately after surgery in the Danish Realm.

BACKGROUND: Acute and persistent pain after surgery is well described. However, no large-scale studies on immediate postoperative pain in the operating room (OR) exist, hindering potential areas of research to improve clinical outcomes. Thus, we aimed to describe the occurrence and severity of immediate postoperative pain in a large, unselected cohort. METHODS: This was a prospective cohort study, encompassing all procedures in 31 public hospitals in the Danish Realm, during a 5-day period including the weekend. Data on procedures and anesthesia were collected and the main outcome was occurrence of moderate or severe pain in the OR. Secondary outcomes included pain, sedation and nausea in the OR or during the first 15 min in the postanesthesia care unit (PACU) including relevant risk factors. Descriptive and logistic regression statistics were used. RESULTS: A total of 3675 procedures were included for analysis (87% inclusion rate). Moderate or severe pain occurred in 7.4% (95% CI 6.5% to 8.3%) of cases in the OR immediately after awakening, rising to 20.2% in the OR and/or PACU. Large intraprocedure and interprocedure variations occurred (0.0%-37.5%), and in 20% of cases with epidural-general anesthesia patients experienced moderate or severe pain. Independent risk factors were female sex, younger age, preoperative pain, daily opioid use and major surgical procedures. CONCLUSION: Moderate or severe pain in the immediate postoperative phase occurred in 20% of all cases with procedure and anesthesiological technique variations, suggesting a need for identification of relevant procedure-specific risk factors and development of preventive treatments. TRIAL REGISTRATION NUMBER: RoPR ID 43191.

[Knotted femoral catheter]. / Knudedannelse på femoraliskateter.

An 89-year-old woman was admitted with a fractured hip. For pain relief a femoral catheter was placed. Later, it was not possible to remove the catheter by traction. After X-ray visualisation, the catheter was removed surgically. The catheter was knotted around connective tissue 4 cm below skin level. Knotting of catheters for regional anaesthesia is a rare, but known complication which should be suspected when resistance is met during catheter removal. If necessary, the catheter should be removed surgically. The entire catheter should be removed, since any remains may increase the risk of infection.

[Complications of unnecessary arterial puncture]. / Komplikation til unødig arteriepunktur.

This case describes the complications of an arterial puncture in an 83-year-old female with a femoral neck fracture. Two arterial punctures were performed in the perioperative period. Ten days after surgery the patient was re-admitted with a pseudo aneurysm in the radial artery above the wrist. The artery was ligated and no signs of infection were found. Arterial puncture is an important source of information, but it is essential to use the correct aseptic technique and to apply compression to the artery afterwards. The indication should always be considered, as a venous blood sample can often provide the information needed.

Haemodynamic and respiratory effects of an abdominal compression binder.

In order to elucidate the circulatory and respiratory effects of a newly developed abdominal compression binder 25 healthy, normal weight subjects were studied. In supine position the central haemodynamics were measured and estimated with a Finapress device. Lower extremity venous haemodynamics were measured in supine position with venous occlusion plethysmography. In an upright-seated position arterial oxygen saturation was measured by a pulseoxymeter for 1 h before spirometry was performed with a turbine flow measurement device. All the tests were performed in a randomized order with or without the abdominal compression binder. The results show that the compression binder significantly increases the venous volume in the lower extremities as showed by a reduction in the venous capacitance in the lower extremities and a reduction in the stroke volume and cardiac output, while it does not influence the pulmonary volumes. It is concluded that the applied abdominal binder significantly affects peripheral and central haemodynamics. It should therefore be used with caution when in the supine position for longer periods, as the pooling of blood it induces in the lower extremities may have implications for the risk of deep venous thrombosis formation.

The size distribution of neurons in the motor cortex in amyotrophic lateral sclerosis.

The motor cortex of eight patients with amyotrophic lateral sclerosis (ALS) and nine control subjects was used in the study. Recent stereological tools, the disector and the rotator method, were applied to the motor cortex of patients with ALS and control subjects to obtain estimates of mean perikaryon volume, mean neuronal nuclear volume, total perikaryon volume and total neuronal nuclear volume. No significant differences were found in any of the estimates. In vivo proton magnetic resonance spectroscopy studies show a decrease in the concentration of neuronal markers. We expected to find changes in perikaryon and/or nuclei neuronal volume because the total neuron number is unchanged in ALS compared with control subjects. However, this was not the case; our results suggest that metabolic changes take place in the motor cortex of ALS patients without these concomitant anatomical changes.