Predictors of outcomes of patients ≥ 80 years old admitted to intensive care units in Poland - a post-hoc analysis of the VIP2 prospective observational study.

INTRODUCTION: Elderly patients pose a significant challenge to intensive care unit (ICU) clinicians. In this study we attempted to characterise the population of patients over 80 years old admitted to ICUs in Poland and identify associations between clinical features and short-term outcomes. MATERIAL AND METHODS: The study is a post-hoc analysis of the Polish cohort of the VIP2 European prospective observational study enrolling patients > 80 years old admitted to ICUs over a 6-month period. Data including clinical features, clinical frailty scale (CFS), geriatric scales, interventions within the ICU, and outcomes (30-day and ICU mortality and length of stay) were gathered. Univariate analyses comparing frail (CFS > 4) to non-frail patients and survivors to non-survivors were performed. Multivariable models with CFS, activities of daily living score (ADL), and the cognitive decline questionnaire IQCODE as predictors and ICU or 30-day mortality as outcomes were formed. RESULTS: A total of 371 patients from 27 ICUs were enrolled. Frail patients had significantly higher ICU (58% vs. 44.45%, P = 0.03) and 30-day (65.61% vs. 54.14%, P = 0.01) mortality compared to non-frail counterparts. The survivors had significantly lower SOFA score, CFS, ADL, and IQCODE than non-survivors. In multivariable analysis CFS (OR 1.15, 95% CI: 1.00-1.34) and SOFA score (OR 1.29, 95% CI: 1.19-1.41) were identified as significant predictors for ICU mortality; however, CFS was not a predictor for 30-day mortality ( P = 0.07). No statistical significance was found for ADL, IQCODE, polypharmacy, or comorbidities. CONCLUSIONS: We found a positive correlation between CFS and ICU mortality, which might point to the value of assessing the score for every patient admitted to the ICU. The older Polish ICU patients were characterised by higher mortality compared to the other European countries.

Impact of Controlled Induced Hypotension on Cognitive Functions of Patients Undergoing Functional Endoscopic Sinus Surgery.

BACKGROUND: Controlled induced hypotension guarantees less blood loss and better visibility of the surgical site. The impact of hypotension on post-operative cognitive functions is still being discussed. The objective of this study was to evaluate the effects of controlled induced hypotension on the cognitive functions of patients undergoing functional endoscopic sinus surgery (FESS). MATERIAL/METHODS: We allocated 47 patients with a good grade of preoperative cognitive functions evaluated with the Mini-Mental State Examination to 3 groups (1 - mild hypotension, 2 - intermediate hypotension, 3 - severe hypotension) according to the degree of mean intraoperative arterial pressure compared with preoperative blood pressure. Cognitive functions were evaluated preoperatively, 6 h, and 30 h postoperatively with standardized tests: the Stroop Test, Trail Making Test (TMT), and Verbal Fluency Test (VFT). A decrease in the test results and increase in the number of mistakes made were considered an impairment of cognitive functions. RESULTS: A total of 47 patients (group 1 - mild hypotension - 15, group 2 - intermediate hypotension - 19, group 3 - severe hypotension - 13) were included in the study. A significant decrease was observed in all the 3 groups after Stroop A test 6h postoperatively but it improved 30h postoperatively, without differences between the groups. Neither a significant decrease in the test results nor an increase in the number of mistakes was noted for Stroop B tests, TMT A&B tests and VFT. CONCLUSIONS: The degree of controlled intraoperative hypotension during FESS did not influence the results of psychometric tests.

Non-word reading test vs anaesthesia. How do anaesthetised patients decode the contents without referring to the meaning?

BACKGROUND: The aim of this study was to examine the phonological functioning (reading speed and accuracy) of hospital patients under general anaesthesia administered during colonoscopy. METHODS: In this study the 'Latysz' non-word reading test was used to measure the impact of selected anaesthetics on the phonological aspect of language processing (defined as decoding without referring to the meaning) in a group of 22 anaesthetised patients compared to 23 non-anaesthetised patients from university clinics. RESULTS: Compared to the preoperative performance, a decrease in reading accuracy and reading speed was observed only in the Anaesthesia Group - AG (in the subjects aged ≥ 35 years) 1.5 h after the administration of anaesthetics. Postoperatively, the AG were significantly slower and less accurate than the Control Group - CG - after 1.5 h. After 3 h, the AG had regained their baseline values both in reading accuracy and reading speed. During the last assessment session, the AG pronounced 82% of the words correctly, while the CG pronounced 74% correctly. Moreover, subjects aged ≥ 35 years performed worse than younger subjects in their reading accuracy and speed. CONCLUSIONS: The patients who underwent colonoscopy under general anaesthesia manifested impaired phonological functioning shortly after the procedure, both in the speed and accuracy of reading non-words. However, the accuracy problems subsided relatively quickly.

Psychomotor functions and interval timing in patients receiving intravenous anesthesia for endoscopic procedures: the pilot study.

Introduction. The aim of this study was to evaluate two measures in a cognitive examination: psychomotor function and the perception of time (PT) in patients after intravenous anesthesia for endoscopic procedures. Material and Methods. We tested 23 anesthetized patients (Anesthesia Group, AG) and 17 not anesthetized patients (Control Group, CG). The Dufour Cross-Shaped Apparatus (DA) was used to assess quick reactions. Perception of time (PT) was measured for 1-, 2-, 5-, and 7-second intervals. The tests were performed before the anesthesia was administered and 1.5, 3, and 6 hours after the procedure was completed. Results. The intervals that were generated and the reproduced visual stimuli were shorter than the patterns. The reproduced 1- and 2-second auditory stimuli were longer than the patterns. The remaining reproduced auditory impulses were shorter than the patterns. Conclusions. In anesthetized patients, quick psychomotor reactions and the ability to time intervals are preserved 1.5 h and later after intravenous anesthesia for endoscopy.

A comparison of auditory evoked potentials derived from a monitor integrated module versus standard technique.

PURPOSE: Measurement of brain stem auditory evoked potentials (BAEP) and midlatency auditory evoked potentials (MLAEP) using a new monitor integrated module was compared with an established device. The aim of this study was to evaluate if the new system could replace the more inconvenient established technique. MATERIAL AND METHODS: MLAEP and BAEP were obtained from 19 anesthetized male patients using the AEP-Module for Monitor S/5 [GE, Helsinki, Finland (S/5)] and Neuropack 4 mini [Nihon Kohden, Tokyo, Japan (Neuropack)]. Significance of different results was calculated by paired t test. Bias was estimated by Bland-Altman statistics. RESULTS: Latencies of BAEP were significantly shorter and amplitudes of BAEP were significantly higher for Neuropack. Mean latencies of MLAEP (Pa and Nb) were not significantly different (Pa 44.1+/-4.4 ms vs. 41.9+/-5.4 ms/Nb 66.4+/-5.6 ms vs. 62.8+/-6.5 ms), but methods are not interchangeable owing to great variability (Pa -13.16 to 8.94 ms, Nb -19.15 to 11.79 ms). CONCLUSIONS: BAEP recorded by S/5 cannot be used for diagnostic interpretation using generally accepted normal values, but can be used for examining changes during the monitoring period. Mean values of Pa and Nb were not significantly different, but values of the S/5 varied above and below the values of Neuropack such that the measurements could not be used for diagnostic interpretation. However, this did not reduce their usefulness for determining adequate hypnosis.

[Effect of the selected parameters on the development of postoperative cognitive dysfunction]. / Wplyw wybranych czynników na wyst powanie pooperacyjnych zaburzen funkcji poznawczych.

BACKGROUND: Surgery and anaesthesia may account for postoperative complications such as cognitive impairment, depression, and delay of convalescence. The purpose of the study was to assess the influence of different risk factors on cognitive performance and emotional state. METHODS: This study included patients received general anaesthesia for various abdominal, urogenital and vascular surgery. All patients were induced with thiopentone and fentanyl. Succinylcholine was used to facilitate endotracheal intubation. Anaesthesia was maintained with sevoflurane, fentanyl and rocuronium. We assessed the effect of duration of anaesthesia, arterial blood oxygenation, body temperature, pain and neoplastic disease on cognitive function, evaluated using the Mini-Mental State Examination (MMSE) questionnaire. RESULTS: Forty-two women and thirty-three men, aged 65-83 years (mean 71.4) were enrolled in the study. Fourteen women and eleven men, aged 67-84 years (mean 74.2) and hospitalized for nonsurgical disease, served as controls. We found a positive correlation between the MMSE test and impaired SaO2 on the first day after surgery, and a negative correlation with the VAS pain score on the 1st and 5th days. The presence of neoplastic disease, body temperature and duration of anaesthesia had no influence on cognitive function. DISCUSSION: The relationship between low arterial oxygenation and cognitive impairment has been described previously, with the deterioration usually being observed in the immediate postoperative period. We could not find any relationship between severity of pain and cognitive function. Perhaps this was because patients did not properly understand the VAS score and could not rate severity o pain properly.