Hyperosmolar therapies for neurological deterioration in mild and moderate traumatic brain injury: towards new research.

The scoping review by Nicolò Marchesini and colleagues about the use of hyperosmolar therapies (HTs) in patients with traumatic brain injury (TBI) points out a significant gap in scientific literature regarding this topic. Although there are few high-quality recommendations, it is important to provide care under certain physiologic parameters. Through this letter we comment on the importance of guidelines to administer and monitor the use of HTs in the Neuro-ICU.

Length of preoperative hospital stay is the dominating risk factor for surgical site infection in neurosurgery: A cohort data-driven analysis.

Background: The number of days of preoperative hospital stay (PHS) is a modifiable variable that has shown contradictory surgical site infection (SSI) risk factor results in neurosurgery. We sought to pinpoint the day of PHS length related with a marked increase of risk of SSI. Methods: From a tertiary teaching hospital, January 2015-December 2017, prospectively collected nonpercutaneous neurosurgery procedures with standard antibiotic prophylaxis and 1-year follow-up were evaluated. SSI risk factors were assessed through multiple logistic regression models with different thresholds of PHS. Results: A total of 1012 procedures were included in the study. Incidence of SSI was 4.4%. The median PHS was higher in those with SSI than in those without (1 day, interquartile range [IQR]: 7 vs. 0 days, IQR: 1, respectively, P = 0.002). By the amount of six days of PHS, this exposure risk past the threshold of significance for impact on wound infection (OR 2.8; CI 1.23-6.39, P = 0.014). Operative time past 4 h (OR 2.11; CI 1.12-3.98; P = 0.021), and in some models, previous surgery at same admission were also identified by multivariate analysis as increasing postoperative SSI risk. Conclusion: The gradual increase of the SSI OR associated with longer PHS days was the highest risk factor of SSI in our cohort of patients. Studies directed to reduce this complication should consider the PHS.

A comparison of King Vision video laryngoscopy and direct laryngoscopy as performed by residents: a randomized controlled trial.

STUDY OBJECTIVE: For more than 40 years, direct laryngoscopy (DL) has been used to assure the airway during endotracheal intubation. The King Vision video laryngoscope is one of the latest devices introduced for endotracheal intubation. We hypothesize that, relative to direct laryngoscopy, it improves the intubation success rate with fewer intubation attempts and no difference in intubation time or complications. DESIGN: This randomized controlled clinical trial included. SETTING: The operating room and postanesthesia care unit of an academic hospital. PATIENTS: Eighty-eight patients with American Society of Anesthesiologists status I to II and aged ≥18 years who were scheduled for elective surgery under general anesthesia and had no predictors of difficult airway. Patients were randomized (44 per group) to undergo intubation using either DL or King Vision video laryngoscopy (KVVL) performed by first year residents in anesthesia and intensive care. MEASUREMENTS: During endotracheal intubation by residents, measurements were success rate, number of attempts, time to intubation, visualization of the glottis, and presence of complications. MAIN RESULTS: Both groups had a 100% success rate. A greater frequency of grade 1 laryngoscopy was reported with KVVL (86.4%) relative to DL (59.1%) (P < .05). There were no differences in time to intubation or the number of attempts between the groups (P = .75 and P = .91, respectively). Complications after intubation were low and included oral trauma, esophageal intubation, and sore throat. CONCLUSIONS: The use of KVVL by residents with less than 1 year of training (considered nonexperts) significantly improves visualization of the glottis in patients without predictors of difficult airway. The incidence of complications was too low to draw conclusions.