bluuebunny/crossref_metadata_2025_split huggingface dataset:
Challenges of Anesthetic Monitoring in Low- and Middle-Income Countries: Availability of Equipment in Major Referral Hospitals in Kenya
Authors: Atandi Bryan Ogoti , Chokwe Thomas Muinga , Sulemanji Demet Sargin 
Published: February 2023

BACKGROUND:
Anesthetic monitoring within standards defined by various professional anesthesia organizations has been shown to reduce perioperative mortality. Given the scarce resources for anesthesia and surgery in low- to middle-income countries, we sought to determine the availability of recommended monitoring devices in major referral hospitals in Kenya.

METHODS:
We purposely selected the 16 major referral hospitals in Kenya. A cross-sectional survey was conducted in 103 operating theaters, 96 postanesthesia care unit (PACU) beds, and 16 areas where procedural sedation was routinely administered. A checklist questionnaire based on the Association of Anaesthetists of Great Britain and Ireland (AAGBI) guidelines of 2015 was used to determine the availability of basic and functional monitoring devices.

RESULTS:
We determined that only 1 of 16 (6.25%) hospitals had all the monitoring devices recommended by the AAGBI. Automated noninvasive blood pressure (NIBP) monitoring and pulse oximetry were present in all operating theaters. Continuous electrocardiography (ECG) was available in 102 of 103 (99%) operating theaters, skin temperature monitoring probes in 73 of 103 (70.9%), and capnography in 49 (47.6%). A nerve stimulator was accessible in 5 of 16 (31.25%) hospitals. There were functional patient monitors in all operating theaters (100%). One of the regional referral hospitals did not have a PACU. We encountered 9 of 96 (9.4%) PACU beds without any monitoring devices. Pulse oximetry was the most common device (84.4%) in the PACU beds equipped with monitoring. In 5 of 16 (31.25%) procedural sedation areas, pulse oximetry was the only monitoring device, whereas there were no devices in 2 of 16 (12.5%) areas. Portable multiparameter devices used for patient transport were present in 5 of 16 (31.25%) hospitals.

CONCLUSIONS:
The availability of recommended monitoring devices in major referral hospitals in Kenya is inadequate. Thus, there are challenges to anesthetic monitoring in these hospitals, and perioperative patient safety is jeopardized. We recommend the universal provision of basic monitoring devices and suggest the use of the data collected in this study to affect policy change and safe anesthesia practice in our country.
Activated 4-Factor Prothrombin Complex Concentrate as a Hemostatic Adjunct for Neonatal Cardiac Surgery: A Propensity Score-Matched Cohort Study
Authors: Navaratnam Manchula , Mendoza Julianne M. , Zhang Shiqi , Boothroyd Derek , Maeda Katsuhide , Kamra Komal , Williams Glyn D. 
Published: February 2023

BACKGROUND:
Prothrombin complex concentrates are an emerging “off-label” therapy to augment hemostasis after cardiopulmonary bypass (CPB), but data supporting their use for neonatal cardiac surgery are limited.

METHODS:
We retrospectively reviewed neonates undergoing open heart surgery with first-time sternotomy between May 2014 and December 2018 from a hospital electronic health record database. Neonates who received activated 4-factor prothrombin complex concentrate (a4FPCC) after CPB were propensity score matched (PSM) to neonates who did not receive a4FPCC (control group). The primary efficacy outcome was total volume (mL/kg) of blood products transfused after CPB, including the first 24 hours on the cardiovascular intensive care unit (CVICU). The primary safety outcome was the incidence of 7- and 30-day postoperative thromboembolism. Secondary outcomes included 24 hours postoperative chest tube output, time to extubation, duration of CVICU stay, duration of hospital stay, 30-day mortality, and incidence of acute kidney injury on postoperative day 3. We used linear regression modeling on PSM data for the primary efficacy outcome. For the primary safety outcome, we tested for differences using McNemar test on PSM data. For secondary outcomes, we used linear regression, Fisher exact test, or survival analyses as appropriate, with false discovery rate-adjusted P values.

RESULTS:
A total of 165 neonates were included in the final data analysis: 86 in the control group and 79 in the a4FPCC group. After PSM, there were 43 patients in the control group and 43 in the a4FPCC group. We found a statistically significant difference in mean total blood products transfused for the a4FPCC group (47.5 mL/kg) compared with the control group (63.7 mL/kg) for PSM patients (adjusted difference, 15.3; 95% CI, 29.4–1.3; P = .032). We did not find a statistically significant difference in 7- or 30-day thromboembolic rate, postoperative chest tube output, time to extubation, incidence of postoperative acute kidney injury (AKI), or 30-day mortality between the groups. The a4FPCC group had a significantly longer length of intensive care unit stay (32.9 vs 13.3 days; adjusted P = .049) and hospital stay (44.6 vs 24.1 days; adjusted P = .049) compared with the control group.

CONCLUSIONS:
We found that the use of a4FPCC as a hemostatic adjunct for post-CPB bleeding in neonatal cardiac surgery was associated with a decrease in mean total blood products transfused after CPB without an increased rate of 7- or 30-day postoperative thromboembolism. Our findings suggest that a4FPCCs can be considered as part of a hemostasis pathway for refractory bleeding in neonatal cardiac surgery.
Understanding the Intricacies of Delivering Compassionate Care in the Intensive Care Unit and What Hinders It: A Qualitative Study of Members of 2 Critical Care Societies
Authors: Siddiqui Shahla , Mohamed Enas , Johansson Anna , Rock Laura , Hartog Christiane , Subramaniam Balachundhar 
Published: February 2023

BACKGROUND:
Patient-centered care is increasing in importance especially in the post-coronavirus disease 2019 (COVID-19) pandemic era. We sought to understand factors affecting compassionate care faced by intensivists in the intensive care unit (ICU).

METHODS:
Using survey methodology incorporating 3 real-life case vignettes, responses were elicited to difficult ethical and moral dilemmas in the ICU setting. Members of 2 critical care societies in the United States and Europe were included in the survey.

RESULTS:
Responses from 323 intensivists (32% out of 1000 members who opened the initial email invitation) around the world were analyzed thematically. Conflicts between patient choices and suggested medical care, institutional/work constraints restricting compassionate care and leading to burnout, and personal variables influencing compassionate care were the themes that emerged from our investigation. The results demonstrate that intensivists have compassion for their patients and want to provide patient-centered care, but also experience stress due to their limited ability to improve their patients’ conditions.

CONCLUSIONS:
Compassionate attitudes can be hindered by an underlying worry about the decision made by the patient and their family, a lack of confidence in making hard moral decisions, and the burdens of burnout.
Burnout Among Chinese Anesthesiologists After the COVID-19 Pandemic Peak: A National Survey
Authors: Che Lu , Ma Shuang , Zhang Yue Lun , Huang Yuguang 
Published: February 2023

BACKGROUND:
Evidence has shown that large-scale pandemics can have prolonged psychological impacts on health care professionals. The current study aimed to evaluate the prevalence of burnout after the coronavirus disease 2019 (COVID-19) epidemic peak and to explore the prolonged impact of COVID-19 on burnout among Chinese anesthesiologists.

METHODS:
From August 2021 to October 2021, a nationwide cross-sectional survey was conducted. Burnout was measured using the Maslach Burnout Inventory-Human Service Survey. Basic demographic information, exposure to COVID-19, and perceived institutional support were documented. Validated tools measuring mental health status, including anxiety, depression, post-traumatic stress disorder (PTSD) and resilience, were also used to provide additional information on psychological distress.

RESULTS:
Of the 8850 anesthesiologists from the 218 institutions who were invited to participate, 6331 (74.93%) completed the surveys and were included in the analysis. A total of 52.7% (95% confidence interval [CI], 51.5–53.9) met the criteria for burnout. Depression, anxiety, and PTSD were positively associated with burnout. After pooled multivariate analysis adjusting for potential confounding factors, among the COVID-19 exposure parameters, redeployment outside normal professional boundaries remained associated with an increased risk of burnout (odds ratio, 0.84; 95% CI, 0.72–0.92; P = .039). Higher perceived institutional support and resilience could act as protective factors against burnout.

CONCLUSIONS:
The impact of the COVID-19 epidemic on the psychological well-being of anesthesiologists still exists more than 1 year after the outbreak. Building better institutional support and cultivating stronger resilience may be helpful future intervention measures.
Maternal Cardiovascular Morbidity Events Following Preeclampsia: A Retrospective Cohort Study
Authors: Meng Marie-Louise , Frere Zachary , Fuller Matthew , Li Yi-Ju , Habib Ashraf S. , Federspiel Jerome J. , Wheeler Sarahn M. , Gilner Jennifer B. , Shah Svati H. , Ohnuma Tetsu , Raghunathan Karthik , Krishnamoorthy Vijay 
Published: February 2023

BACKGROUND:
Patients with preeclampsia are at high risk for long-term cardiovascular events, yet the short-term, acute cardiovascular complications that follow preeclampsia are understudied. The objective of this study was to compare the short-term, acute maternal cardiovascular morbidity events after delivery among patients with a diagnosis of preeclampsia versus those without this diagnosis.

METHODS:
In this retrospective cohort study, the Premier inpatient database was used to examine a cohort of obstetric patients older than 18 years, who delivered from January 1, 2016, to September 30, 2020. A diagnosis of preeclampsia and preeclampsia with severe features during delivery hospitalization were the exposures of interest. The primary outcome was a composite of maternal cardiovascular morbidity events during delivery hospital admission. The secondary outcome was the occurrence of maternal cardiovascular morbidity events during a readmission within 90 days of delivery hospitalization.

RESULTS:
In total, 4,488,759 patients met inclusion criteria, of which 158,114 (3.5%) were diagnosed with preeclampsia without severe features, and 117,940 (2.6%) with preeclampsia with severe features. Adjusted odds of maternal cardiovascular morbidity events were higher in patients with preeclampsia and in those with preeclampsia with severe features compared with those without preeclampsia during delivery hospitalization (adjusted odds ratio [OR] [95% confidence interval {CI}] 1.87 [1.78–1.97] and 4.74 [4.44–5.05], respectively) and within 90 days (adjusted OR [95% CI] 2.01 [1.83–2.21] and 2.32 [2.10–2.57], respectively).

CONCLUSIONS:
Patients with both preeclampsia and preeclampsia with severe features have higher rates of maternal cardiovascular morbidity events than those without preeclampsia. Future studies are necessary to examine which patients with preeclampsia are at highest risk for cardiovascular complications.
Benefit of Flow-Controlled Over Pressure-Regulated Volume Control Mode During One-Lung Ventilation: A Randomized Experimental Crossover Study
Authors: Schranc Álmos , Diaper John , Südy Roberta , Fodor Gergely H. , Habre Walid , Albu Gergely 
Published: February 2023

BACKGROUND:
Application of a ventilation modality that ensures adequate gas exchange during one-lung ventilation (OLV) without inducing lung injury is of paramount importance. Due to its beneficial effects on respiratory mechanics and gas exchange, flow-controlled ventilation (FCV) may be considered as a protective alternative mode of traditional pressure- or volume-controlled ventilation during OLV. We investigated whether this new modality provides benefits compared with conventional ventilation modality for OLV.

METHODS:
Ten pigs were anaesthetized and randomly assigned in a crossover design to be ventilated with FCV or pressure-regulated volume control (PRVC) ventilation. Arterial partial pressure of oxygen (Pao
2), carbon dioxide (Paco
2), ventilation and hemodynamical parameters, and lung aeration measured by electrical impedance tomography were assessed at baseline and 1 hour after the application of each modality during OLV using an endobronchial blocker.

RESULTS:
Compared to PRVC, FCV resulted in increased Pao
2 (153.7 ± 12.7 vs 169.9 ± 15.0 mm Hg; P = .002) and decreased Paco
2 (53.0 ± 11.0 vs 43.2 ± 6.0 mm Hg; P < .001) during OLV, with lower respiratory elastance (103.7 ± 9.5 vs 77.2 ± 10.5 cm H2O/L; P < .001) and peak inspiratory pressure values (27.4 ± 1.9 vs 22.0 ± 2.3 cm H2O; P < .001). No differences in lung aeration or hemodynamics could be detected between the 2 ventilation modalities.

CONCLUSIONS:
The application of FCV in OLV led to improvement in gas exchange and respiratory elastance with lower ventilatory pressures. Our findings suggest that FCV may offer an optimal, protective ventilation modality for OLV.
Minimizing Lung Injury During Laparoscopy in Head-Down Tilt: A Physiological Cohort Study
Authors: De Meyer Gregory R. A. , Morrison Stuart G. , Saldien Vera , Jorens Philippe G. , Schepens Tom 
Published: February 2023

BACKGROUND:
Increased intra-abdominal pressure during laparoscopy induces atelectasis. Positive end-expiratory pressure (PEEP) can alleviate atelectasis but may cause hyperinflation. Cyclic opening of collapsed alveoli and hyperinflation can lead to ventilator-induced lung injury and postoperative pulmonary complications. We aimed to study the effect of PEEP on atelectasis, lung stress, and hyperinflation during laparoscopy in the head-down (Trendelenburg) position.

METHODS:
An open-label, repeated-measures, interventional, physiological cohort trial was designed. All participants were recruited from a single tertiary Belgian university hospital. Twenty-three nonobese patients scheduled for laparoscopy in the Trendelenburg position were recruited.
We applied a decremental PEEP protocol: 15 (high), 10 and 5 (low) cm H2O. Atelectasis was studied with the lung ultrasound score, the end-expiratory transpulmonary pressure, the arterial oxygen partial pressure to fraction of inspired oxygen concentration (Pa
o
2/Fio
2) ratio, and the dynamic respiratory system compliance. Global hyperinflation was evaluated by dead space volume, and regional ventilation was evaluated by lung ultrasound. Lung stress was estimated using the transpulmonary driving pressure and dynamic compliance. Data are reported as medians (25th–75th percentile).

RESULTS:
At 15, 10, and 5 cm H2O PEEP, the respective measurements were: lung ultrasound scores (%) 11 (0–22), 27 (11–39), and 53 (42–61) (P < .001); end-expiratory transpulmonary pressures (cm H2O) 0.9 (–0.6 to 1.7), –0.3 (–2.0 to 0.7), and −1.9 (–4.6 to −0.9) (P < .001); Pa
o
2/Fio
2 ratios (mm Hg) 471 (435–538), 458 (410–537), and 431 (358–492) (P < .001); dynamic respiratory system compliances (mL/cm H2O) 32 (26–36), 30 (25–34), and 27 (22–30) (P < .001); driving pressures (cm H2O) 8.2 (7.5–9.5), 9.3 (8.5–11.1), and 11.0 (10.3–12.2) (P < .001); and alveolar dead space ventilation fractions (%) 10 (9–12), 10 (9–12), and 9 (8–12) (P = .23). The lung ultrasound score was similar between apical and basal lung regions at each PEEP level (P = .76, .37, and .76, respectively).

CONCLUSIONS:
Higher PEEP levels during laparoscopy in the head-down position facilitate lung-protective ventilation. Atelectasis and lung stress are reduced in the absence of global alveolar hyperinflation.
Complications of Pediatric Midline Catheters: A Prospective Observational Pilot Study
Authors: Östlund Åsa , Fläring Urban , Norberg Åke , Kaiser Sylvie , Frisk Tony , Larsson Peter , Andersson Andreas 
Published: February 2023

BACKGROUND:
Midline catheters are peripheral intravenous (IV) catheters in which the tip of the catheter does not reach the central circulation. In children, the use of midline catheters could lead to decreased complications from central venous catheters. To validate the safety of midline catheter use in children, we aimed to describe the complications and dwell time of pediatric midline catheters. The primary outcome was the incidence of catheter-related venous thromboembolism (VTE).

METHODS:
We conducted an observational, prospective study including consecutive patients at a tertiary multidisciplinary pediatric hospital. One hundred pediatric midline catheters were followed for thrombotic, infectious, and mechanical complications. After catheter removal, Doppler ultrasonography was performed to detect asymptomatic VTE.

RESULTS:
The mean age was 6.0 years (standard deviation [SD], 4.7), and median catheter dwell time was 6 (4–8) days. Most midline catheters were inserted in arm veins, most commonly in the basilic vein (56%). Catheter-related VTE was diagnosed in 30 (30%; 95% confidence interval [CI], 21%–40%) cases, corresponding to an incidence rate of 39 (95% CI, 26–55) cases per 1000 catheter days. Eight of 14 saphenous vein catheters were complicated by VTE compared to 22 of 86 arm vein catheters, suggesting an imbalance in favor of arm vein insertion site. Two patients needed anticoagulation therapy due to catheter-related VTE. Thirty (30%) catheters were removed unintentionally or due to complications, 22 of these needed additional IV access to complete the intended therapy. No catheter-related bloodstream infection (95% CI, 0%–4%) occurred. Mechanical complications occurred in 33 (33%; 95% CI, 24%–43%) midline catheters.

CONCLUSIONS:
In children, thrombotic and mechanical complications of midline catheters are common, but only few VTEs are severe enough to warrant anticoagulation therapy. Systemic infectious complications are rare. Seventy-eight percent of patients did not need additional venous access to complete short-term IV therapy. Considering the rate of clinically relevant complications and the catheter dwell time, pediatric midline catheters could be an alternative to central venous access for short-term (5–10 days) IV therapy.
Incidence of Interstitial Alveolar Syndrome on Point-of-Care Lung Ultrasonography in Pre-eclamptic Women With Severe Features: A Prospective Observational Study
Authors: Yagani Seshagiribabu , Jain Kajal , Bhatia Nidhi , Singla Karan , Bagga Rashmi , Bahl Ajay 
Published: February 2023

BACKGROUND:
Lung interstitial edema is a clinically silent pathology that develops before overt pulmonary edema among pre-eclamptic women with severe features. Point-of-care lung ultrasonography (LUS) has been suggested as an accessible bedside tool that may identify lung interstitial edema before developing clinical signs and symptoms. Thus, we planned to use bedside LUS as a diagnostic tool in admitted pre-eclamptic women with severe features, with the aim of identifying alveolar-interstitial fluid, seen as B-lines. Our primary objective was to assess the incidence of interstitial alveolar syndrome on lung ultrasonography.

METHODS:
We conducted a prospective, single-center, observational study on parturients with pre-eclampsia with severe features over a period of 15 months. LUS in 4 intercostal spaces (ICS) was performed on all eligible patients. The number of single or confluent B-lines in each space was recorded by an independent observer. A scoring system was used to grade the lung fluid content based on the number of single and confluent B-lines per ICS, with scores ranging from 0 to 32 (low, 0–10; moderate, 11–20; and high, 21+). The incidence of B-lines at admission and before and after delivery was calculated. In addition, bedside 2D echocardiography was performed to assess left ventricular systolic and diastolic function. Any correlation between presence of B-lines on LUS and blood pressure, clinical symptoms, or echocardiography findings was assessed.

RESULTS:
Seventy patients were enrolled in the study. On LUS, B-lines were seen in 64.3% patients at admission (45/70 vs 25/70 without B-lines; P = .02), 65.7% patients before delivery (46/70 vs 24/70 without B-lines; P = .01), and 58.6% patients 24 hours postpartum (41/70 versus 29/70 without B-lines; P = .15). Nearly all patients (94.3%) exhibited low to moderate severity of pulmonary fluid burden at admission. Echocardiography revealed diastolic dysfunction in 47.1% (n = 33/70) patients with associated B-lines in the majority (n = 32/33). The total B-line score and E/e’ ratio among patients with diastolic dysfunction was found to be strongly correlated (r = 0.848; P < .001). All pre-eclamptic women with presence of breathlessness (11/11; 100%) and facial puffiness (16/16; 100%) on admission had B-lines on LUS.

CONCLUSIONS:
We conclude that ultrasonographic pulmonary interstitial syndrome is present in more than half of the women with pre-eclampsia with severe features and correlates with diastolic dysfunction, high blood pressure records, and acute-onset breathlessness.
Performance of the SEDLine Monitor: Age Dependency and Time Delay
Authors: Obert David P. , Schneider Frederick , Schneider Gerhard , von Dincklage Falk , Sepulveda Pablo , García Paul S. , Kratzer Stephan , Kreuzer Matthias 
Published: February 2023

BACKGROUND:
Devices monitoring the hypnotic component of general anesthesia can help to guide anesthetic management. The main purposes of these devices are the titration of anesthesia dose. While anesthesia at low doses can result in awareness with intraoperative memory formation, excessive administration of anesthetics may be associated with an increased risk of postoperative neurocognitive disorder. We have previously shown for various indices that they are significantly influenced by the patient’s age and that the monitors have a significant time delay. Here, we evaluated the influence of patient’s age and time delay on the patient state index (PSI) of the SEDLine monitor.

METHODS:
To analyze the influence of the patient’s age, we replayed 2 minutes of electroencephalography (EEG) of 141 patients (19–88 years, ASA I–IV) undergoing general anesthesia maintained with desflurane, sevoflurane, or propofol to the SEDLine monitor. We extracted the PSI as well as the spectral edge frequency (SEF) and performed a linear regression analysis. For evaluation of the time delay, we replayed 5 minutes of EEG of stable episodes of adequate anesthesia (PSI between 25 and 50) or light sedation/wake (PSI >70) in different orders to the SEDLine to simulate sudden changes between the states. Time delays were defined as the required time span of the monitor to reach the stable target index.

RESULTS:
PSI and SEF increased significantly with the patient’s age. These findings did not depend on the administered anesthetic. The evaluation of the correlation between SEF and PSI showed a strong correlation with Spearman’s correlation coefficient of ρ = 0.86 (0.82; 0.89). The time delays depended on the type of transition. We found a median time delay of 54 (Min: 46; Max: 61) seconds for the important transition between adequate anesthesia and awake and 55 (Min: 50; Max: 67) seconds in the other direction.

CONCLUSIONS:
With our analyses, we show that the indices presented on the SEDLine display, the PSI and the SEF, increase with age for patients under general anesthesia. Additionally, a delay of the PSI to react to sudden neurophysiologic changes due to dose of the maintenance anesthetic is of a time course that is clinically significant. These factors should be considered when navigating anesthesia relying on only the proprietary index for the SEDLine monitor.