A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

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Neuromonitoring and Emergency EEG

Intraoperative and Intensive Care Unit (ICU) EEG monitoring is very useful in cases of possible brain damage, for example, during carotid endarterectomy, cardiac surgery and neurosurgery, or when subclinical seizures are suspected. Continuous EEG (cEEG) monitoring during surgery is a valid and sensitive instrument for recognizing and/or preventing perioperative ischemic insults or any epileptiform activity responsible for convulsive or nonconvulsive symptoms. Furthermore, it allows brain functions monitoring for anesthetic drug administration, to determine the depth of anesthesia and for adjusting drug levels to achieve a predefined neural effect, such as burst suppression. In ICU, cEEG monitoring is essential to identify electrical discharges that occur frequently in critically ill patients and that are often clinically undetected, but potentially harmful if the diagnosis and the treatment are delayed. In the last years, cEEG monitoring has become a widespread practice, especially because of the use of new digital equipments, which are extremely compact and easy to use, not requiring a constant connection to the power grid and thus avoiding artifacts. EEG tracings can be visualized in real-time or analyzed after acquisition, either online or offline, with qualitative and/or quantitative methods. Finally, it is worth remembering that EEGs can be recorded bedside from a peripheral recording unit and then sent to the central unit, so that neurophysiologists can examine the recordings from distance and process them without interfering with the patients’ management

N-3 fatty acids in patients with multiple cardiovascular risk factors

BACKGROUND: Trials have shown a beneficial effect of n-3 polyunsaturated fatty acids in patients with a previous myocardial infarction or heart failure. We evaluated the potential benefit of such therapy in patients with multiple cardiovascular risk factors or atherosclerotic vascular disease who had not had a myocardial infarction. METHODS: In this double-blind, placebo-controlled clinical trial, we enrolled a cohort of patients who were followed by a network of 860 general practitioners in Italy. Eligible patients were men and women with multiple cardiovascular risk factors or atherosclerotic vascular disease but not myocardial infarction. Patients were randomly assigned to n-3 fatty acids (1 g daily) or placebo (olive oil). The initially specified primary end point was the cumulative rate of death, nonfatal myocardial infarction, and nonfatal stroke. At 1 year, after the event rate was found to be lower than anticipated, the primary end point was revised as time to death from cardiovascular causes or admission to the hospital for cardiovascular causes. RESULTS: Of the 12,513 patients enrolled, 6244 were randomly assigned to n-3 fatty acids and 6269 to placebo. With a median of 5 years of follow-up, the primary end point occurred in 1478 of 12,505 patients included in the analysis (11.8%), of whom 733 of 6239 (11.7%) had received n-3 fatty acids and 745 of 6266 (11.9%) had received placebo (adjusted hazard ratio with n-3 fatty acids, 0.97; 95% confidence interval, 0.88 to 1.08; P=0.58). The same null results were observed for all the secondary end points. CONCLUSIONS: In a large general-practice cohort of patients with multiple cardiovascular risk factors, daily treatment with n-3 fatty acids did not reduce cardiovascular mortality and morbidity. Copyright © 2013 Massachusetts Medical Society