Early high-volume resuscitation with crystalloid solution combined with albumin improves survival of critically ill patients: A retrospective analysis from MIMIC-IV database.

BACKGROUND: Volume resuscitation is often required in critically ill patients. However, we have no clear consensus on the choice between crystalloid solution and colloidal solution. This study aimed to explore the effect of albumin administration in massive fluid resuscitation. METHODS: This was a retrospective cohort study based on the Medical Information Mart for Intensive Care IV (MIMIC-IV) database (2008 and 2019). The prognosis of patients receiving albumin in combination with crystalloids and those receiving crystalloids alone was compared to assess the benefits of albumin in fluid resuscitation. RESULTS: 4426 patients received crystalloids alone (crystalloids group), 692 patients received albumin in combination with crystalloids within the first 24 h of initiation of crystalloids (early albumin combination group), and 382 patients received albumin after the first 24 h (late albumin combination group). Patients in early albumin combination group were more severe than those in Crystalloids group. Nevertheless, we found no statistically significant difference in mortality between the two groups. Multivariate logistic regression analysis using the propensity-score matched cohort showed that the 28-day and 60-day mortality in the early albumin combination group were lower than those in the crystalloids group (odds ratio: 0.64 [95% CI 0.50-0.82; P < 0.001] and 0.71 [95% CI 0.56-0.90; P = 0.004], respectively. Patients in early albumin combination group lived, on average, 1.16 days (95% CI 0.33-2.00; P < 0.01) and 3.3 days (95% CI 1.15-5.44; P < 0.01) longer than the crystalloids group during 28-day follow-up and 60-day follow-up. CONCLUSION: Administration of albumin within 24 h after the initiation of crystalloids was associated with a lower mortality and a longer restricted mean survival time during 28-day follow-up and 60-day follow-up compared with crystalloid infusion alone. However, administration of albumin 24 h after the initiation of crystalloids was not associated with better prognosis compared to crystalloid infusion alone.

Improving the quality of acute pain services: experiences of treatment of 5212 patients.

BACKGROUND: In a retrospective, non-randomized, observational study, we compared methods of postoperative analgesia in 5212 cases treated in 2003 and 2004. METHODS: Patients were allocated to two groups: Group A included 2,796 patients treated in 2004; Group B included 2,419 treated in 2003.The acute pain team was staffed by anaesthesiologists who performed daily visits to patients receiving the APS. They dealt with complaints and complications, evaluated the effectiveness of analgesia, and kept records. The visiting anaesthesiologists rotated weekly in group A, and daily in group B. RESULTS: Analgesic effects, VAS, patient satisfaction, and the incidence of complications were compared between the two groups. The number of patients with an analgesic effect evaluated as "bad" was significantly lower in group A than in group B (p < 0.05). The proportion of patients in whom satisfaction was evaluated as"good"was significantly higher in group A compared to group B (p < 0.05);"moderate" and "bad"satisfaction scores were significantly lower in group A than in group B (p < 0.05). There was no significant difference in the incidence of complications between the two groups (p > 0.05).The number of cases in which analgesia was no longer required was lower in group A than in group B (p < 0.05). CONCLUSION: During postoperative management of analgesia by an acute pain service, a weekly rotation of anaesthesiologist staffing is more effective in improving patient satisfaction than a daily rotation.