Intraoperative Hypotension and Its Association with Postoperative Acute Kidney Injury in Patients Undergoing Pancreaticoduodenectomy: A 5-Year, Single-Center, Retrospective Cohort Study.

BACKGROUND Intraoperative hypotension (IOH) is a common phenomenon in high-risk surgery and is often linked to postoperative acute kidney injury (AKI). Pancreaticoduodenectomy (PD), or Whipple's procedure, is a lengthy and complex surgical procedure to remove the head of the pancreas, gallbladder and bile duct, and the first part of the duodenum. This retrospective 5-year study from a single center in Poland included 303 patients who underwent PD and evaluated IOH as a factor associated with AKI. MATERIAL AND METHODS We analyzed perioperative data to assess how various IOH thresholds can predict AKI (according to KDIGO criteria). Several IOH definitions were applied, including absolute and relative thresholds, based on the mean arterial pressure (MAP). Statistically significant IOH thresholds were inserted into multivariable logistic regression models with previously established independent variables. RESULTS We included 303 patients over a 5-year period (2016-2021). There were 58 (19.1%) cases of postoperative AKI. MAP <55 mmHg and a maximal% drop from preinduction MAP were the only IOH definitions associated with AKI. Multivariable analysis revealed that max% drop from preinduction MAP (per 10%, OR=1.65; AUROC=0.70) was the IOH definition best suited for AKI prediction in patients undergoing PD. CONCLUSIONS In patients undergoing PD, it is important to prevent excessive blood pressure drops in regards to preinduction blood pressure values. In this cohort, relative IOH thresholds were better suited for prediction of AKI than the absolute IOH thresholds.

Mortality in critically ill COVID­19 patients with fungal infections: a comprehensive systematic review and meta­analysis.

INTRODUCTION: Patients with COVID­19 may develop concomitant viral, bacterial, or fungal infections. Such patients are at a higher risk of death, especially from a critical illness. Although much attention has been recently given to fungal infections that may have devastating consequences, data on this issue are scarce. OBJECTIVES: The aim of the study was to assess the impact and prevalence of fungal infections in critically ill patients with COVID 19. METHODS: We systematically searched for studies that focused on critically ill adults diagnosed with COVID­19 and a fungal coinfection. Mortality was our outcome of interest. The search was conducted within MEDLINE, Web of Science, clinicaltrials.gov, Embase, and Cochrane Library on January 8, 2022. RESULTS: We reviewed 38 papers covering 17 695 patients, 1182 (6.7%) of whom had an acquired fungal infection. The overall mortality in the papers retrieved for a systematic review (n = 38) varied from 29% to 100% (median [IQR], 56% [40%-77%]). In a meta­analysis (19 studies), the patients with a fungal infection were more likely to die than the controls (odds ratio [OR], 2.987; 95% CI, 2.369-3.767; P <0.001; I2 = 26.63%). Subgroup analyses showed that COVID­19-associated pulmonary aspergillosis (CAPA) increased mortality by 3 times (OR, 3.279; 95% CI, 2.692-3.994; P <0.001; I2 = 0%), and that COVID­19-associated candidiasis (CAC) increased mortality by 2 times (OR, 2.254; 95% CI, 1.322-3.843; I2 = 26.14%). CONCLUSIONS: In critically ill patients with COVID­ 19, CAPA is rather common and significantly increases mortality. The evidence regarding other fungal infections is weaker, with CAC occurring less frequently but also impacting mortality. Therefore, clinical awareness and screening are needed, followed by personalized antifungal therapy stewardship, which is strongly recommended in order to improve the patients' prognosis.

What Do We Know about Early Management of Sepsis and Septic Shock in Polish Hospitals? A Questionnaire Study.

BACKGROUND: Sepsis and septic shock are medical emergencies with a high risk of poor prognosis. We investigate the correspondence between Surviving Sepsis Campaign (SSC) guidelines and clinical practice in Poland, with special attention given to differences between ICU and non-ICU environments as well as regional variations within the country. METHODS: A web-based questionnaire study was performed on a random sample of 60 hospitals from the three most populated regions in Poland-Masovia, Silesia, and Greater Poland. A 19-item questionnaire was built based on the most recent edition of SSC guidelines. RESULTS: Sepsis diagnosis was primarily based on clinical evaluation (ICUs: 94%, non-ICUs: 62%; p = 0.02). There were significant differences between ICUs and non-ICUs regarding taking blood cultures for pathogen identification (2-times more frequent in ICUs) and having hospital-based operating procedures to adjust antimicrobial treatment to a clinical scenario (a difference of 17%). Modification of empiric antimicrobial treatment was required post-ICU admission in 70% of cases. ICUs differed from non-ICUs with regard to the methods of fluid responsiveness assessment and the types of catecholamines and fluids used to treat septic shock. The mean fluid load applied before the implementation of catecholamines was 25.8 ± 10.6 mL/kg. Norepinephrine was the first-line agent used to treat shock, and balanced crystalloids were preferred in both ICUs and non-ICUs. CONCLUSION: Compliance with SCC guidelines in Polish hospitals is insufficient, especially outside ICUs. There is a need for education among healthcare professionals to reach at least an acceptable level of knowledge and attitude in this field.