Does the Implementation of a Clinical Care Pathway Have an Impact on Early Intravenous Fluid Therapy of Acute Pancreatitis?: A Pilot Quality Improvement Study

OBJECTIVES: Early intravenous fluid (IVF) resuscitation is crucial in the management of acute pancreatitis; variation in IVF prescription practice had been demonstrated. This pilot study aims to assess whether the implementation of an Acute Pancreatitis Care Pathway (APCP) produces a change toward a more adequate IVF regimen in the first 24 hours. METHODS: Patients with confirmed diagnosis of acute pancreatitis, from July 2015 to February 2016 (group 1) and from September 2017 to March 2018 (group 2), were considered. The APCP was developed between March 2016 and August 2017. Median IVF rate, volume, and type infused in the first 24 hours, were compared between groups. Nonparametric data were analyzed with the Mann-Whitney U test, differences in frequencies with the McNemar test; significance was set at P < 0.05. RESULTS: Seventy-two patients were included, 36 in each group. In the first 24 hours, the median IVF rate was 177 mL/h vs 225 mL/h (P = 0.004); Ringer lactate infusion was 30% vs 77.8% (P = 0.0003). The median total IVF volume did not differ between groups. CONCLUSIONS: The implementation of the APCP has the potential to lead to a successful change in early IVF resuscitation practice.The article is available via Open Access. Click on the 'Additional link' above to access the full-text.Published version, accepted version (12 month embargo

International Study on Microcirculatory Shock Occurrence in Acutely Ill Patients

Objectives: Microcirculatory alterations are associated with adverse outcome in subsets of critically ill patients. the prevalence and significance of microcirculatory alterations in the general ICU population are unknown. We studied the prevalence of microcirculatory alterations in a heterogeneous ICU population and its predictive value in an integrative model of macro- and microcirculatory variables.Design: Multicenter observational point prevalence study.Setting: the Microcirculatory Shock Occurrence in Acutely ill Patients study was conducted in 36 ICUs worldwide.Patients: A heterogeneous ICU population consisting of 501 patients.Interventions: None.Measurements and Main Results: Demographic, hemodynamic, and laboratory data were collected in all ICU patients who were 18 years old or older. Sublingual Sidestream Dark Field imaging was performed to determine the prevalence of an abnormal capillary microvascular flow index ( 90 beats/min) (odds ratio, 2.71; 95% CI, 1.67-4.39; p < 0.001), mean arterial pressure (odds ratio, 0.979; 95% CI, 0.963-0.996; p = 0.013), vasopressor use (odds ratio, 1.84; 95% CI, 1.11-3.07; p = 0.019), and lactate level more than 1.5 mEq/L (odds ratio, 2.15; 95% CI, 1.28-3.62; p = 0.004) were independent risk factors for hospital mortality, but not abnormal microvascular flow index. in reference to microvascular flow index, a significant interaction was observed with tachycardia. in patients with tachycardia, the presence of an abnormal microvascular flow index was an independent, additive predictor for in-hospital mortality (odds ratio, 3.24; 95% CI, 1.30-8.06; p = 0.011). This was not true for nontachycardic patients nor for the total group of patients.Conclusions: in a heterogeneous ICU population, an abnormal microvascular flow index was present in 17% of patients. This was not associated with mortality. However, in patients with tachycardia, an abnormal microvascular flow index was independently associated with an increased risk of hospital death.Erasmus MC Univ Med Ctr, Dept Intens Care Adults, Rotterdam, NetherlandsMed Ctr Leeuwarden, Dept Intens Care, Leeuwarden, NetherlandsUniv Politecn Marche, Dept Biomed Sci & Publ Hlth, Ancona, ItalyServ Terapia Intens Sanatorio Otamendi & Miroli, Buenos Aires, DF, ArgentinaBeth Israel Deaconess Med Ctr, Dept Emergency Med, Boston, MA 02215 USABeth Israel Deaconess Med Ctr, Vasc Biol Res Ctr, Boston, MA 02215 USABarts & London Queen Marys Sch Med & Dent, London, EnglandUniversidade Federal de São Paulo, São Paulo, BrazilUniv Klinikum RWTH Aachen, Klin Anesthesiol, Aachen, GermanyKosuyolu Univ, K Kosuyolu High Specialty Educ & Res Hosp, Istanbul, TurkeyLithuanian Univ Hlth Sci, Dept Intens Care, Kaunas, LithuaniaCooper Univ Hosp, Sect Cardiol, Camden, NJ USAUniv Basel Hosp, Med Intens Care Unit, CH-4031 Basel, SwitzerlandSt Antonius Hosp, Dept Anesthesiol Intens Care & Pain Manag, Nieuwegein, NetherlandsOnze Lieve Vrouw Hosp, Dept Intens Care, Amsterdam, NetherlandsSt Louis Univ Hosp, Mercy Hosp St Louis, St Louis, MO USAUniv Plymouth, Peninsula Sch Med, Derriford Hosp, Plymouth PL4 8AA, Devon, EnglandHacettepe Univ, Intens Care Unit, Ankara, TurkeyUDELAR, Sch Med, Hosp Espanol ASSE, Intens Care Unit, Montevideo, UruguayNew Cross Hosp, Intens Care Unit, Wolverhampton, W Midlands, EnglandUniv Paris 07, Hop Lariboisiere, AP HP, Dept Anesthesiol Crit Care & SMUR, Paris, FranceCanberra Hosp, Intens Care Unit, Canberra, ACT, AustraliaRoyal Brisbane & Womens Hosp, Dept Intens Care Med, Brisbane, Qld, AustraliaIspat Hosp, Intens Care Unit, Rourkela, Orissa, IndiaUniv Pittsburgh, Pittsburgh, PA USAUniv Calif San Diego, Sch Med, San Diego, CA 92103 USAJoan XXIII Univ Hosp, Dept Crit Care, Tarragona, SpainPontificia Univ Catolica Chile, Fac Med, Escuela Med, Dept Med Intens, Santiago, ChileHosp San Martin, Intens Care Unit, La Plata, Buenos Aires, ArgentinaUniv Paris 11, Hop Bicetre, AP HP, Hop Univ Paris Sud,Dept Anesthesie Reanimat, Paris, FranceGelre Ziekenhuizen, Intens Care Unit, Apeldoorn, NetherlandsRoyal Marsden Hosp, Intens Care Unit, London SW3 6JJ, EnglandRoyal Devon & Exeter Hosp, Intens Care Unit, Exeter EX2 5DW, Devon, EnglandSanta Maria Angeli Hosp, Intens Care Unit, Pordenone, ItalyUniv Jena, Univ Klinikum Jena, Dept Internal Med 1, Jena, GermanyRoyal Free Hosp, Intens Care Unit, London NW3 2QG, EnglandDipartimento Anestesia Rianimaz & Terapia Intens, Treviso, ItalyUniv Amsterdam, Acad Med Ctr, Dept Cardiol, NL-1105 AZ Amsterdam, NetherlandsUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc

Private Equity funds and their performance in the post-crisis period

The work covers the topic of private equity funds performance and attempt to identify the impact of macroeconomic conditions on the entire industry. The recent central banks' actions put a question about the impact of changes in interest rates on the private equity funds performance. With the sample of 100 observations provided by Cambridge Associates, we identified the significant negative effect of prevailing low interest rates on the growth of private equity funds performance. We further attempt to answer the question, whether private equity funds operating in post-crisis years has on average higher growth rate, however, we could not provide the answer as we failed to reject the null, neutral effect hypothesis. Additionally, with a sample of 3092 observations provided by Bloomberg, we found that the effect of cheap debt has increased on average in the postcrisis period, predicting that the private equity performance can suffer once the interest rates rises enough