Current practice of hemodynamic monitoring with PiCCO in a single general surgical ICU in a university hospital - a short report

AbstractObjectivesOpioids are the most potent analgesics in the treatment of postoperative pain. Respiratory depression is, however, a serious side effect. The aims of this study were to evaluate current practice and routines for post-operative administration of opioids in a Norwegian university hospital and to evaluate whether the clinical safeguards adequately protected patients’ safety regarding risk of respiratory depression.MethodsThe study had a retrospective cross-sectional design and included 200 patients, treated with opioids postoperatively. The patients were treated in a post-anesthesia care unit (PACU) before transferal to a surgical ward. Relevant data such as opioid dosages, routes of administration, sedation and respiratory function, routines for patient monitoring, and numbers of patients with opioid induced respiratory depression was collected.ResultsTwo patients (1%) developed respiratory depression that needed naloxone to reverse the effect, and 32 patients (16%) had a respiratory rate (RR) <10/min, which may have been caused by opioids. In the PACU, the patient’s RR was evaluated on a routine base, but after transferal to a surgical ward RR documented in only 7% of the patients.ConclusionsThe lack of routines for patient monitoring, especially RR, represented a risk of not detecting opioid induced respiratory depression.

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Supervised Immediate Postoperative Mobilization After Elective Colorectal Surgery: A Feasibility Study

World Journal of Surgery ◽

10.1007/s00268-021-06347-2 ◽

2021 ◽

Author(s):

Rose-Marie W. Thörn ◽

Jan Stepniewski ◽

Hans Hjelmqvist ◽

Anette Forsberg ◽

Rebecca Ahlstrand ◽

...

Keyword(s):

Colorectal Surgery ◽

Feasibility Study ◽

Early Mobilization ◽

University Hospital ◽

Serious Adverse Events ◽

Elective Colorectal Surgery ◽

Post Surgery ◽

Surgical Icu ◽

Patient Refusal ◽

Four Levels

Abstract Background Early mobilization is a significant part of the ERAS® Society guidelines, in which patients are recommended to spend 2 h out of bed on the day of surgery. However, it is not yet known how early patients can safely be mobilized after completion of colorectal surgery. The aim of this study was to evaluate the feasibility, and safety of providing almost immediate structured supervised mobilization starting 30 min post-surgery at the postoperative anesthesia care unit (PACU), and to describe reactions to this approach. Methods This feasibility study includes 42 patients aged ≥18 years who received elective colorectal surgery at Örebro University Hospital. They underwent a structured mobilization performed by a specialized physiotherapist using a modified Surgical ICU Optimal Mobilization Score (SOMS). SOMS determines the level of mobilization at four levels from no activity to ambulating. Mobilization was considered successful at SOMS ≥ 2, corresponding to sitting on the edge of the bed as a proxy of sitting in a chair due to lack of space. Results In all, 71% (n = 30) of the patients reached their highest level of mobilization between the second and third hour of arrival in the PACU. Before discharge to the ward, 43% (n = 18) could stand at the edge of the bed and 38% (n = 16) could ambulate. Symptoms that delayed advancement of mobilization were pain, somnolence, hypotension, nausea, and patient refusal. No serious adverse events occurred. Conclusions Supervised mobilization is feasible and can safely be initiated in the immediate postoperative care after colorectal surgery. Trial registration Clinical trials.gov identifier: NTC03357497.

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Untreated Stroke as Collateral Damage of COVID-19: “Time Is Brain” Versus “Stay at Home”

The Neurohospitalist ◽

10.1177/1941874420929199 ◽

2020 ◽

Vol 10 (4) ◽

pp. 291-292

Author(s):

David Z. Rose ◽

W. Scott Burgin ◽

Swetha Renati

Keyword(s):

Stroke Volume ◽

University Hospital ◽

Medical Emergency ◽

Short Report ◽

Collateral Damage ◽

Stroke Patients ◽

Call To Action ◽

Atypical Presentations ◽

Overall Mortality ◽

At Home

For decades, neurologists have been advocating that anyone with acute focal deficits report immediately to the closest hospital’s emergency room. Major advancements in the hyperacute diagnosis and treatment of stroke have justified our call-to-action slogan of “Time is Brain”—faster therapy leads to superior outcomes. However, this mantra has been recently usurped by the catchphrase “Stay at Home” during the coronavirus disease 2019 (COVID-19) pandemic. Fewer patients are presenting to hospitals with acute stroke; our census is down. Presumably the etiology of this phenomenon is either strict “social distancing” that some people may misperceive to exclude even emergent situations, or fears of contracting the virus while hospitalized. In this Short Report, we describe the year-over-year drop in stroke volume (ischemic and hemorrhagic both) coinciding with a paradoxical rise in acute reperfusion therapies at our university hospital. These data imply that stroke patients with mild/moderate symptoms are most likely staying home, and not receiving urgent therapies, and correspondingly, only the most severely disabled stroke patients are ultimately seeking and receiving help. We must remind our patients and the general public that our services are essential and available, as stroke still remains a medical emergency, and carries a likely higher overall mortality risk than COVID-19. As neurologists, we also must be vigilant for the atypical presentations and varied etiologies of stroke associated with COVID-19 as well.

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