Mortality scoring in ITU

Chronic shortage of ITU beds makes decisions on admission difficult and responsible. The use of computer-based mortality scoring should help in decision-making and for this purpose, a number of different scoring systems have been created; in principle, they should be easy to use, adaptable to all populations of patients and suitable for predicting the risk of mortality during both ITU and hospital stay. Most of existing scales and scoring systems were included in this review. They are frequently used in ITUs and become a necessary tool to describe ITU populations and to explain differences in mortality. As there are several pitfalls related to the interpretation of the numbers supplied by the systems, they should be used with the knowledge on the severity scoring science. Moreover, the cost and significant workload limit the use of scoring systems; in many cases an extra person has to be employed for collection and analysis of data only.Chronic shortage of ITU beds makes decisions on admission difficult and responsible. The use of computer-based mortality scoring should help in decision-making and for this purpose, a number of different scoring systems have been created; in principle, they should be easy to use, adaptable to all populations of patients and suitable for predicting the risk of mortality during both ITU and hospital stay. Most of existing scales and scoring systems were included in this review. They are frequently used in ITUs and become a necessary tool to describe ITU populations and to explain differences in mortality. As there are several pitfalls related to the interpretation of the numbers supplied by the systems, they should be used with the knowledge on the severity scoring science. Moreover, the cost and significant workload limit the use of scoring systems; in many cases an extra person has to be employed for collection and analysis of data only

Usability of ultrasound assessment of gastric content. Case reports

The paper presents the use of ultrasound assessment of gastric content in anesthesiological practice. Factors influencing pulmonary aspiration of gastric content and the risk of a complication in the form of aspiration pneumonia are discussed. The examination was performed on two patients hospitalized in a state of emergency who required surgical intervention. The first patient, a 46-year-old male with a phlegmon of the foot, treated for type 2 diabetes, ischemic heart disease and renal insufficiency, required urgent incision of the phlegmon. The second patient, a 36-year-old male with a post-traumatic pericerebral hematoma, qualified for an urgent trepanation. Interviews with the patients and their medical documentation indicated that they had been fasting for the recommended six hours before the surgery. However, during a gastric ultrasound examination it was found that food was still present in the stomach, which caused a change in the anesthesiological procedure chosen. The authors present a method of performing gastric ultrasound examination, determining the nature of the food content present and estimating its volume.W pracy przedstawiono wykorzystanie ultrasonograficznej oceny zawartości żołądka w praktyce anestezjologicznej. Omówiono czynniki wpływające na aspirację treści żołądkowej do płuc oraz na ryzyko powikłania, jakim jest zachłystowe zapalenie płuc. Badanie przeprowadzono u dwójki pacjentów poddanych hospitalizacji w trybie nagłym, wymagających interwencji chirurgicznej. Pierwszy pacjent – 46-letni mężczyzna z ropowicą stopy, leczący się na cukrzycę typu II, chorobę niedokrwienną serca i niewydolność nerek – wymagał natychmiastowego nacięcia ropowicy. Drugi pacjent – 36-letni mężczyzna z pourazowym krwiakiem przymózgowym – kwalifikował się do pilnej trepanacji. Z wywiadów lekarskich i dokumentacji medycznej wynikało, że chorzy pozostawali na czczo zalecane sześć godzin przed zabiegiem operacyjnym. W badaniu ultrasonograficznym żołądka stwierdzono jednak zaleganie treści pokarmowej, co wpłynęło na zmianę postępowania anestezjologicznego. Autorzy przedstawiają sposób wykonania ultrasonografii żołądka, określenia charakteru zalegającej treści pokarmowej oraz oszacowania jej objętości

Prognozowanie śmiertelności na oddziałach intensywnej terapii na podstawie skali APACHE

The search for a tool enabling predicting morbidity and mortality among intensive care patients had been going on for years. 30 years ago it resulted in designing severity scoring systems which offer an objective quantification of illness severity of the patients admitted to ICU. APACHE (Acute Physiology and Chronic Health Evaluation Score). The most recently released version of APACHE IV, not only allow assessing patients on admission but also enable predicting risk of death during hospitalization. Severity scoring systems like APACHE IV is very useful but complicated and time consuming also. Their use without computer software is virtually impossible.The search for a tool enabling predicting morbidity and mortality among intensive care patients had been going on for years. 30 years ago it resulted in designing severity scoring systems which offer an objective quantification of illness severity of the patients admitted to ICU. APACHE (Acute Physiology and Chronic Health Evaluation Score). The most recently released version of APACHE IV, not only allow assessing patients on admission but also enable predicting risk of death during hospitalization. Severity scoring systems like APACHE IV is very useful but complicated and time consuming also. Their use without computer software is virtually impossible

Will transoesophageal echocardiography become a standard tool for anesthetists to assess haemodynamic status during non-cardiac surgeries? Case report and literature review

A 53-year-old male, with no history of cardiovascular diseases, underwent elective extended right hemihepatectomy for large metastatic tumor. Approximately 2 hours after the start of procedure sudden onset of severe hypotension associated with profound desaturation and significant fall in end-tidal carbon dioxide pressure was noted. Transoesophageal echocardiography was performed and massive air embolism was confirmed. Patient was turned into Trendelenburg position, inspired oxygen was increased to 100% and positive end-expiratiory pressure turned up to 10 cm H 2 0. Patient was further resuscitated with iv fluids, blood products and vasopressors under surveillance of transoesophageal echocardiography. In this report we present a case in which intraoperative use of transoesophageal echocardiography by trained anaesthetist helped to immediately identify the cause of sudden hypotension and hypoxaemia. Transoesophageal echocardiographywas also a valuable tool for direct monitoring of efficacy of instituted treatment.Pięćdziesięciotrzyletni mężczyzna bez chorób układu sercowo-naczyniowego w wywiadzie przeszedł planową operację rozszerzonej hemihepatektomii prawostronnej z powodu dużego guza przerzutowego. Mniej więcej dwie godziny po rozpoczęciu operacji wystąpił nagły epizod ciężkiej hipotensji z towarzyszącą głęboką desaturacją oraz istotnym spadkiem ciśnienia końcowo-wydechowego dwutlenku węgla. Wykonano echokardiografię przezprzełykową, która potwierdziła obecność dużego zatoru powietrznego. Pacjenta ułożono w pozycji Trendelenburga, zwiększono stężenie tlenu w mieszaninie oddechowej do 100% oraz dodatnie ciśnienie końcowo-wydechowe do 10 cm H2O. Następnie kontynuowano resuscytację pacjenta z zastosowaniem płynów dożylnych, preparatów krwiopochodnych oraz leków wazopresyjnych pod kontrolą echokardiografii przezprzełykowej. W niniejszej pracy przedstawiamy opis przypadku, w którym śródoperacyjne zastosowanie echokardiografii przezprzełykowej przez wyszkolonego anestezjologa pozwoliło na natychmiastowe zidentyfikowanie przyczyny nagłej hipotensji i hipoksemii. Metoda ta okazała się również przydatnym narzędziem umożliwiającym monitorowanie skuteczności zastosowanego leczenia

Perioperative bleeding in patients undergoing liver transplantation

Liver transplantation (LT) remains one of the most challenging surgical procedures. For many years uncontrolled bleeding and catastrophic haemorrhages were one of the major causes of perioperative mortality and morbidity. During the past fifty years or so, significant progress in surgical techniques and perioperative management has led to a marked change in transfusion practice over time, where up to 79.6% of LTs in experienced transplant centers are performed without any blood product transfusion. Despite this, perioperative bleeding and transfusion requirements remain potent predictors of patient’s mortality, as well as postoperative complications and graft survival. The major impact of blood product transfusion on LT recipient outcomes implies that all patients on waiting lists should be carefully screened for the presence of risk factors of perioperative bleeding. Although multiple predictors of transfusion requirements during LT have been identified, no predictive model validated across centers has been constructed. The most suitable strategies to reduce intraoperative blood loss in this group should be employed on a case-to-case basis. This paper aims to summarize the most up-to-date evidence in the management of haemostasis in LT recipients

SEGAE: An online serious game to learn agroecology

CONTEXT There is growing evidence that agroecology can reconcile the environmental, economic, and social pillars of agricultural sustainability. However, teaching and learning agroecology is challenging, especially since most agricultural graduate programs in Europe are not adapted to teach the diversity of its related practices. OBJECTIVE To improve agroecology learning, we built the online simulation game SEGAE. This article illustrates the game's relevance for learning agroecology. METHODS The game is based on a modeling framework that gamifies the implementation of agroecological practices in an integrated crop-livestock farm and assesses their impacts on sustainability. To do so, SEGAE is based on an output-oriented approach that represents impacts of practices on various indicators. These impacts are included in a matrix, which is associated with a dynamic graphical interface accessible to players. Two examples of game sessions were developed to illustrate the game's potential. RESULTS AND CONCLUSIONS In the first example, players can gain knowledge about agroecological practices by implementing practices that improve soil quality and assessing their impacts on sustainability. Results of this example place the farm's improved overall sustainability into perspective with its reduced food production potential. In the second example, players can improve their skills in transition management and acquire a systems approach by converting the farm to organic farming within five years. Results of this example prompt discussion of the steps needed to obtain organic certification and the coherence between crop and animal production needed to foster sustainability. SIGNIFICANCE SEGAE was designed to strengthen European training in agroecology, and active contributions from users would help to improve this tool, extend it to new farming systems and forge connections within the community of teachers working on agroecology

A dataset for sustainability assessment of agroecological practices in a crop-livestock farming system

This article presents data designed by European researchers who performed a literature review and interpreted the results to determine impact factors of many agroecological practices on a wide variety of sustainability indicators. The impact factors are represented in a matrix that connects practices to indicators. The indicators are related to environmental, economic and social sustainability of a typical European integrated crop-livestock farm. The data are included in the serious game SEGAE to learn agroecology, as described in “SEGAE: a serious game to learn agroecology” [1]. The data can be modified to adapt the game to other agricultural systems. Finally, the data can be re-used in research projects as a basis to assess impacts of agroecological practices