In Reply : Early Moderate Hyperoxemia does not Predict Outcome After Aneurysmal Subarachnoid Hemorrhage

Non peer reviewe

Covid-19 på intensivvårdsavdelningar i Finland

English summary. Covid-19-pandemin

Randomized, Double-Blind Trial of the Effect of Fluid Composition on Electrolyte, Acid-Base, and Fluid Homeostasis in Patients Early After Subarachnoid Hemorrhage

Background: Hyper- and hyponatremia are frequently observed in patients after subarachnoidal hemorrhage, and are potentially related to worse outcome. We hypothesized that the fluid regimen in these patients is associated with distinct changes in serum electrolytes, acid-base disturbances, and fluid balance. Methods: Thirty-six consecutive patients with SAH were randomized double-blinded to either normal saline and hydroxyethyl starch dissolved in normal saline (Voluven®; saline) or balanced crystalloid and colloid solutions (Ringerfundin® and Tetraspan®; balanced, n=18, each) for 48h. Laboratory samples and fluid balance were evaluated at baseline and at 24 and 48h. Results: Age [57±13years (mean±SD; saline) vs. 56±12years (balanced)], SAPS II (38±16 vs. 34±17), Hunt and Hess [3 (1-4) (median, range) vs. 2 (1-4)], and Fischer scores [3.5 (1-4) vs. 3.5 (1-4)] were similar. Serum sodium, chloride, and osmolality increased in saline only (p≤0.010, time-group interaction). More patients in saline had Cl >108mmol/L [16 (89%) vs. 8 (44%); p=0.006], serum osmolality >300mosmol/L [10 (56%) vs. 2 (11%); p=0.012], a base excess 1,500mL during the first 24h [11 (61%) vs. 5 (28%); p=0.046]. Hyponatremia and hypo-osmolality were not more frequent in the balanced group. Conclusions: Treatment with saline-based fluids resulted in a greater number of patients with hyperchloremia, hyperosmolality, and positive fluid balance >1,500mL early after SAH, while administration of balanced solutions did not cause more frequent hyponatremia or hypo-osmolality. These results should be confirmed in larger studie

Physicians' perceptions of intensive care patients' 1-year prognoses compared to realistic prognoses

Background: It is unknown whether physicians treating critically ill patients have realistic perceptions of their patients' prognoses. Methods: We sent a survey by email to Finnish anesthesiologists to investigate their ability to estimate the probability of 1-year survival of intensive care unit (ICU) patients based on data available at the beginning of intensive care. We presented 12 fictional but real-life-based patient cases and asked the respondent to estimate the probability of 1-year survival in each case by choosing one of the alternatives 5%, 10%–90% in 10% intervals and 95%. We compared the physicians' estimates to registry data-based realistic prognoses of comparable patients treated in the ICU. Based on the difference between the estimate and the realistic prognosis, we categorized the estimates into three groups: (1) difference less than 10 percentage points, (2) difference between 10 and 20 percentage points, and (3) difference over 20 percentage points. Results: We received 210 responses (totally 2520 estimates). Of the respondents, 43 (20.5%) were specialists working mainly in the ICU, 81 (38.6%) were specialists working occasionally in the ICU, 47 (22.4%) were specialists not working in the ICU, and 39 (18.6%) were doctors in training. The difference between the estimate and the realistic prognosis was less than 10 percentage points for 1083 (43.0%) estimates, between 10 and 20 percentage points for 645 (25.6%) estimates, and over 20 percentage points for 792 (31.4%) estimates, out of which 612 (24.3% of all estimates) underestimated and 180 (7.1%) overestimated the likelihood of survival. The median error (the median of the differences between the estimate and the realistic prognosis) for all estimates was −8.8 [interquartile range (IQR), −20.0 to −0.2], which means that the most typical response underestimated the likelihood of survival by 9 percentage points. Based on the 12 estimates, we calculated the median error for each respondent. The median (IQR) of these median errors was −8.6 (−12.6 to −5.0) for specialists working mainly in the ICU, −8.1 (−13.0 to −5.2) for specialists working occasionally in the ICU, −9.7 (−17.7 to −6.3) for specialists not working in the ICU, and −9.1 (−14.5 to −5.1) for doctors in training (p =.29). Conclusion: Finnish anesthesiologists commonly misestimate the long-term prognoses of ICU patients, more often underestimating than overestimating the likelihood of 1-year survival. More education about critically ill patients' prognoses and better prediction tools are needed.Peer reviewe

Onko ylipainehappihoito vaikuttavaa?

Kommentti Mika Valtosen kirjoitukseen Finnanest 48(3):230-237, 201

Koronaviruspandemiaan liittynyt tehohoidon tarve ja hoitotulokset Suomessa kevään ja kesän 2020 aikana

Vertaisarvioitu.COVID-19-pandemia aiheutti merkittävää tehohoidon tarvetta keväällä 2020. Tilannekuvaa kokoamaan perustettiin tehohoidon koordinoiva toimisto, joka raportoi viranomaisille ajantasaista tietoa potilas- ja paikkamääristä koko maassa. Suurin tehohoidon kuormitus kohdistui HUS:n sairaaloihin. Teho-osastoilla hoidettiin yhteensä 227:ää COVID-19-potilasta, ja erillisiä tehohoitojaksoja kirjattiin 293. Suomessa COVID-19-potilaiden tehohoitokuolleisuus oli vähäistä, vain 15 %. Ikä ja krooniset sairaudet lisäsivät kuolleisuutta. Tehohoitojaksot olivat tavanomaisia tehohoitojaksoja pidempiä (14 vrk vs 3 vrk), ja 67 % potilaista tarvitsi hengityslaitehoitoa. Epidemian vaikeimmassa vaiheessa huhtikuun puolivälissä tehohoitokapasiteettia oli jo kasvatettu voimakkaasti, ja sen täyttöaste jäi alle puoleen.Peer reviewe