ABSTRACT
PURPOSE: Cardiac surgery, post-cardiotomy cardiogenic shock (PCCS), and temporary mechanical circulatory support (tMCS) provoke substantial inflammation. We therefore investigated whether a selenium-based, anti-inflammatory strategy would benefit PCCS patients treated with tMCS in a post-hoc analysis of the sustain CSX trial. METHODS: Post-hoc analysis of patients receiving tMCS for PCCS in the Sustain CSX trial, which investigated the effects of high-dose selenium on postoperative organ dysfunction in cardiac surgery patients. PRIMARY OUTCOME: duration of tMCS therapy. SECONDARY OUTCOMES: postoperative organ dysfunction and 30-day mortality. RESULTS: Thirty-nine patients were treated with tMCS for PCCS. There was no difference in the median duration of tMCS between the selenium and the placebo group (3 days [IQR: 1-6] vs. 2 days [IQR: 1-7], p = 0.52). Median dialysis duration was longer in the selenium group (1.5 days [0-21.8] vs. 0 days [0-1.8], p = 0.048). There was no difference in 30-day mortality (53% vs. 41%, OR 1.44, 95% CI 0.32-6.47, p = 0.62). CONCLUSION: In this explorative study, a perioperative high-dose selenium-supplementation did not show beneficial effects on organ dysfunctions and mortality rates in patients with PCCS receiving tMCS.
Subject(s)
Cardiac Surgical Procedures , Postoperative Complications , Selenium , Shock, Cardiogenic , Humans , Shock, Cardiogenic/mortality , Shock, Cardiogenic/therapy , Male , Female , Selenium/administration & dosage , Selenium/therapeutic use , Middle Aged , Aged , Postoperative Complications/mortality , Postoperative Complications/prevention & control , Heart-Assist Devices , Multiple Organ Failure/mortality , Multiple Organ Failure/prevention & control , Multiple Organ Failure/etiologyABSTRACT
BACKGROUND: The aim of this study was to analyze the cleaning and disinfection of operating rooms (ORs) status quo focusing on hygiene plans in German hospitals. METHODS: In 2016, a structured online survey was sent to infection prevention and control (IPC) specialists at the cost calculation hospitals of the Institute for the Hospital Remuneration System (InEK) and all university hospitals in Germany (n = 365). RESULTS: With a response rate of 27.4%, 78% stated that written hygiene plans were available. After cleaning and disinfecting an OR with a "septic" patient, 55% waited until surfaces were dry before reusing in accordance with national recommendations, 27% waited > 30 min. Additionally, 28% of hospitals had ORs only for "septic" patients. In 56% "septic" patients were only operated on at the end of the program. Postoperative monitoring of patients with bacteria with special IPC requirements took place in the post anesthesia care unit (PACU) (29%), operating room (OR) (52%), intensive care unit (ICU) (53%), and in the intermediate care unit (IMC) (19%). DISCUSSION AND CONCLUSIONS: Despite written hygiene plans in place the partly long duration of OR nonuse time following IPC measures, the consistent continued use of stratification for "septic" patients and the postoperative follow-up care of patients with colonizing/infecting bacteria with special IPC requirements in the OR and high care areas represent relevant potential for improvement.
Subject(s)
Cross Infection , Disinfection , Infection Control , Operating Rooms , Germany , Humans , Operating Rooms/standards , Operating Rooms/statistics & numerical data , Infection Control/methods , Disinfection/methods , Disinfection/standards , Cross Infection/prevention & control , Hospitals/statistics & numerical data , Surveys and QuestionnairesABSTRACT
BACKGROUND: The aim of this survey was to describe, on a patient basis, the current practice of sedation, pharmacologic and non-pharmacologic measures to promote sleep and facilitation of communication in critically ill patients oro-tracheally intubated or tracheostomized. METHODS: Cross-sectional online-survey evaluating sedation, sleep management and communication in oro-tracheally intubated (IP) or tracheostomized (TP) patients in intensive care units on a single point. RESULTS: Eighty-one intensive care units including 447 patients (IP: n = 320, TP: n = 127) participated. A score of ≤ -2 on the Richmond Agitation Sedation Scale (RASS) was prevalent in 58.2% (IP 70.7% vs. TP 26.8%). RASS -1/0 was present in 32.2% (IP 25.9% vs. TP 55.1%) of subjects. Propofol and alpha-2-agonist were the predominant sedatives used while benzodiazepines were applied in only 12.1% of patients. For sleep management, ear plugs and sleeping masks were rarely used (< 7%). In half of the participating intensive care units a technique for phonation was used in the tracheostomized patients. CONCLUSIONS: The overall rate of moderate and deep sedation appears high, particularly in oro-tracheally intubated patients. There is no uniform sleep management and ear plugs and sleeping masks are only rarely applied. The application of phonation techniques in tracheostomized patients during assisted breathing is low. More efforts should be directed towards improved guideline implementation. The enhancement of sleep promotion and communication techniques in non-verbal critically ill patients may be a focus of future guideline development.
Subject(s)
Conscious Sedation , Hypnotics and Sedatives , Humans , Conscious Sedation/methods , Cross-Sectional Studies , Critical Illness/therapy , Sleep , CommunicationABSTRACT
BACKGROUND AND OBJECTIVE: In this study medical students of the generations Y and Z at the Georg-August University Göttingen were asked about their preferences in the workplace and the choice of an employer. MATERIAL AND METHODS: In 2016, the survey was sent to 2637 students at the University Medical Center Göttingen using an online questionnaire via EvaSys and was answered by 742 (response rate: 28.1%). RESULTS: Regardless of the generation, with 89.5% the respondents felt predominantly "well" and "not so well" prepared for the transition from university to professional life. The most common fears were a lot of work/little free time, lack of time in patient care, lack of experience, stress, excessive technical demands and poor familiarization. In both groups almost 60% obtained information about future employers via the hospital's website. It was important for the students to have a particularly good education and a structured induction/advanced training curriculum. CONCLUSION: The further development of a structured induction concept for young professionals, a binding and structured further training curriculum, the establishment or further development of a mentoring program, the further development of leadership skills and the design of an appealing and updated website are essential prerequisites for future success in the highly competitive skilled labor market.
Subject(s)
Leadership , Students, Medical , Curriculum , Hospitals , Humans , Surveys and QuestionnairesABSTRACT
Aim: In 2017, the Institute for Quality Assurance and Transparency in Healthcare (IQTIG) introduced a quality assurance system for the surveillance of surgical site infections (SSI) on behalf the Federal Joint Committee. The establishment of the new system was made in parallel to existing methods, such as the "Krankenhaus-Infektions-Surveillance-System" (KISS). The aim of this work was to perform a comparative analysis. Methods: All 2,233 cases at the University Medical Center Goettingen requiring an assessment of the presence of SSI as part of the IQTIG procedure in 2018 and 2019 were evaluated retrospectively according to the KISS protocol. Results: In total, 2,050 patients were included in the comparative evaluation. Overall, 1,779 (79.7%) had a surgical anamnesis (surgery during the stay or in the past), and 1,716 (83.7%) showed identical results for both surveillance strategies. Different results were found for 334 patients (16.3%), with 160 of these (7.8%) positive for SSI according to IQTIG and 174 (8.5%) positive for KISS. Risk factors were identified for a discordant assessment between the methods. Conclusion: The congruence of the two strategies was consistently high over the study period. There is evidence that the efficiency of the documentation algorithm can be increased without the loss of documentation of SSI, while preserving the precision of the documentation through training.
ABSTRACT
AIM: To evaluate the prevalence and cause of severe hypokalaemia in patients administered for cardiopulmonary resuscitation (CPR) for non-traumatic cardiac arrest. METHODS: We conducted a retrospective database review in the setting of a University hospital on 281 consecutive adult patients admitted to emergency admission, cardiac catheterization laboratory or intensive care units for resuscitation from non-traumatic cardiac arrest. The first available potassium value was evaluated. RESULTS: The mean potassium level was 3.9 ± 0.9 mmol/l and thus within the reference range of 3.5-5.0 mmol/l, but the overall prevalence of hypokalaemia was high (31.0%). Moderate rather than severe hypokalaemia was typically observed, with 95% of patients exhibiting potassium levels above 2.7 mmol/l. Among those six patients with extreme hypokalaemia defined as a potassium levels below the 2.5 percentile, two adult females were identified to suffer from previously untreated body scheme disorder with furosemide abuse (potassium 1.1 and 1.4 mmol/l). Another patient (potassium 2.1 mmol/l) suffered from poorly controlled bulimia nervosa and acute diarrhoea due to GI infection and one (potassium 2.4 mmol/l) from untreated bulimic anorexia. CONCLUSIONS: In contrast to moderately reduced potassium which is a frequent finding in adult patients at the time of admission for non-traumatic cardiac arrest, severe hypokalaemia is uncommon. The high prevalence of patients with body dysmorphophobic eating disorders in this group underscores accidental self-induced hypokalaemia may evolve as an important differential diagnosis in cardiac arrest in young female patients.
Subject(s)
Body Dysmorphic Disorders/complications , Cardiopulmonary Resuscitation/methods , Heart Arrest/therapy , Hypokalemia/blood , Potassium/blood , Adult , Body Dysmorphic Disorders/blood , Body Dysmorphic Disorders/therapy , Female , Follow-Up Studies , Heart Arrest/blood , Heart Arrest/etiology , Humans , Hypokalemia/complications , Hypokalemia/therapy , Male , Middle Aged , Retrospective Studies , Young AdultABSTRACT
INTRODUCTION: The purpose of this study was to assess the relation between glycaemic control and the severity of sepsis in a cohort of patients treated with intensive insulin therapy (IIT). METHODS: In a prospective, observational study, all patients in the intensive care unit (ICU) (n = 191) with sepsis, severe sepsis or septic shock were treated with IIT (target blood glucose (BG) level 80 to 140 mg/dl instead of strict normoglycaemia). BG values were analysed by calculating mean values, rate of BG values within different ranges, rate of patients experiencing BG values within different levels and standard deviation (SD) of BG values as an index of glycaemic variability. RESULTS: The number of patients with hypoglycaemia and hyperglycaemia was highly dependent on the severity of sepsis (critical hypoglycaemia < or = 40 mg/dl: sepsis: 2.1%, severe sepsis: 6.0%, septic shock: 11.5%, p = 0.1497; hyperglycaemia: >140 mg/dl: sepsis: 76.6%, severe sepsis: 88.0%, septic shock: 100%, p = 0.0006; >179 mg/dl: sepsis: 55.3%, severe sepsis: 73.5%, septic shock: 88.5%, p = 0.0005; >240 mg/dl: sepsis: 17.0%, severe sepsis: 48.2%, septic shock: 45.9%, p = 0.0011). Multivariate analyses showed a significant association of SD levels with critical hypoglycaemia especially for patients in septic shock (p = 0.0197). In addition, SD levels above 20 mg/dl were associated with a significantly higher mortality rate relative to those with SD levels below 20 mg/dl (24% versus 2.5%, p = 0.0195). CONCLUSIONS: Patients with severe sepsis and septic shock who were given IIT had a high risk of hypoglycaemia and hyperglycaemia. Among these patients even with a higher target BG level, IIT mandates an increased awareness of the occurrence of critical hypoglycaemia, which is related to the severity of the septic episode.