Frailty and long-term outcomes in patients admitted to intensive care after surgery: a retrospective multicentre cohort study DOI Creative Commons
Ryo Ueno, Rachel Chan, Ryan Ruiyang Ling

et al.

Research Square (Research Square), Journal Year: 2024, Volume and Issue: unknown

Published: Aug. 26, 2024

Abstract Purpose As the global population ages and older patients undergo surgery, understanding association between frailty post-operative outcomes is crucial to informed decision-making patient care. There a lack of research assessing long-term in admitted intensive care units (ICUs) post-operatively. Methods We conducted multicentre retrospective cohort study using Australian New Zealand Intensive Care Society Adult Patient Database, linked with National Death Index. Adults aged ≥ 16 years 175 ICUs Australia January 1st, 2018, March 31st, 2022, following surgery were included. Frailty was assessed Clinical Scale (CFS), CFS 5 considered frail. The primary outcome survival time up four after ICU admission. Mixed-effects Cox regression models used for adjusted analyses. Results Of 222,509 included, 14.1% Patients had shorter overall (median: vs 21 months) lower rates at one, two, three, compared without frailty. After adjusting confounders, associated death (HR: 2.30, 95%-CI: 2.24–2.37). This consistent across sensitivity analyses subgroups, including elective vs. emergency age groups, various surgical categories. more pronounced younger (< 65 years), those undergoing treatment limitations. Conclusions In this study, worse amongst patients. trend concordant all subgroups.

Language: Английский

Perspectives on the Role of Thoracic Fascial Blocks in Cardiac Anaesthesia: Will They Represent a New Era? DOI Open Access
Giuseppe Sepolvere,

Daniele Marianello,

Cristina Santonocito

et al.

Journal of Clinical Medicine, Journal Year: 2025, Volume and Issue: 14(3), P. 973 - 973

Published: Feb. 3, 2025

Cardiac surgery is continuously evolving, with increasing skills required by the cardiac anaesthesiologist. Following advent of intraoperative echocardiography, we are witnessing a potential new revolution for A era has indeed started implementation thoracic fascial blocks (TFBs) in field surgery. TFBs provide several advantages context multimodal analgesia, improved pain control and reduction side effects related to large doses opioids. We envisage that likely become pivotal concept enhanced recovery after describe main anterior and/or antero-lateral chest wall, their peculiar use In particular, discuss indications tips tricks enhance clinical results following blocks: (1) Pecto-Intercostal Plane (superficial deep); (2) Rectus Sheath; (3) Interpectoral Pectoserratus Plane; (4) Serratus Anterior (5) Erector Spinae Plane. Nonetheless, scientific evidence anaesthesia not robust yet, mostly based on small-sized single-centre studies, making it difficult achieve high quality evidence. Further, remains unclear which patients may benefit most from these techniques.

Language: Английский

Citations

0
Enhanced Recovery after Cardiac Surgery: A Narrative Review DOI Creative Commons

Amarja Nagre,

Guriqbal Singh

Journal of the Practice of Cardiovascular Sciences, Journal Year: 2025, Volume and Issue: 11(1), P. 1 - 7

Published: Jan. 1, 2025

Abstract Enhanced recovery after cardiac surgery (ERACS) is an evidence-based multidisciplinary, patient-centered, and protocolized program with a primary objective of minimizing the physiological disturbances stress response associated surgery, expediting patient undergoing efficient use healthcare resources. ERACS includes preoperative optimization, liberal fasting guidelines such as consumption carbohydrate drink before goal-directed fluid therapy, minimally invasive fast-tracking extubation, lung protective ventilation, multimodal opioid sparing analgesia, optimum temperature management, avoidance postoperative nausea vomiting, primordial removal catheters, early mobilization. The implementation strategies requires coordinated robust team efforts involving surgeons, anesthesiologists, hospital staff. This structured approach to perioperative care abbreviates stay improves clinical outcomes.

Language: Английский

Citations

0
Role of dietitians in optimizing medical nutrition therapy in cardiac surgery patients: A secondary analysis of an international multicenter observational study DOI Creative Commons
Ellen Dresen, Danielle E. Bear, Ashley DePriest

et al.

Journal of Parenteral and Enteral Nutrition, Journal Year: 2025, Volume and Issue: unknown

Published: April 6, 2025

Abstract Background Better understanding the impact of dietetic services on nutrition practices seems required as it may represent an opportunity for optimization in post–cardiac surgery patients. The present study aims to evaluate and compare clinical outcomes intensive care unit (ICU) patients with without services. Methods This is a secondary analysis multinational prospective observational ( n = 237) >72 h surgical ICU stay describing up 12 days after admission. Results Dietetic were available 61.5% (8 13) ICUs (1.0 ± 0.5 full‐time equivalents/10 beds). Enteral was initiated <48 from admission 49.6% 59.1% at sites vs services, respectively. Parenteral started within 118.3 56.5 131.5 69.2 Energy target (23.7 4.8 24.6 kcal/kg body weight/day) actual supply (10.5 6.7 10.3 6.2 did not differ between groups. Protein targets (1.4 0.4 1.1 1.3 g/kg protein provision (0.6 0.3 higher Conclusion Improvements medical therapy cardiac are needed Appropriately staffed essential members team be crucial transfer knowledge adequate strategies into practice.

Language: Английский

Citations

0
Frailty and long-term survival of non-cancer patients admitted to intensive care after surgery: a retrospective multicentre cohort study DOI
Ryo Ueno,

Rachel Chan,

Ryan Ruiyang Ling

et al.

British Journal of Anaesthesia, Journal Year: 2025, Volume and Issue: unknown

Published: April 1, 2025

Language: Английский

Citations

0
Frailty and long-term outcomes in patients admitted to intensive care after surgery: a retrospective multicentre cohort study DOI Creative Commons
Ryo Ueno, Rachel Chan, Ryan Ruiyang Ling

et al.

Research Square (Research Square), Journal Year: 2024, Volume and Issue: unknown

Published: Aug. 26, 2024

Abstract Purpose As the global population ages and older patients undergo surgery, understanding association between frailty post-operative outcomes is crucial to informed decision-making patient care. There a lack of research assessing long-term in admitted intensive care units (ICUs) post-operatively. Methods We conducted multicentre retrospective cohort study using Australian New Zealand Intensive Care Society Adult Patient Database, linked with National Death Index. Adults aged ≥ 16 years 175 ICUs Australia January 1st, 2018, March 31st, 2022, following surgery were included. Frailty was assessed Clinical Scale (CFS), CFS 5 considered frail. The primary outcome survival time up four after ICU admission. Mixed-effects Cox regression models used for adjusted analyses. Results Of 222,509 included, 14.1% Patients had shorter overall (median: vs 21 months) lower rates at one, two, three, compared without frailty. After adjusting confounders, associated death (HR: 2.30, 95%-CI: 2.24–2.37). This consistent across sensitivity analyses subgroups, including elective vs. emergency age groups, various surgical categories. more pronounced younger (< 65 years), those undergoing treatment limitations. Conclusions In this study, worse amongst patients. trend concordant all subgroups.

Language: Английский

Citations

0