Changes of body position resulted in marked changes in CVP but not in HVPs. Head down or head up tilt to reduce venous pressures in the liver may therefore not be effective measures to reduce blood loss during liver surgery.

BackgroundIntensive care treat critically ill patients. When intensive care is not considered beneficial for the patient, decisions to withdraw or withhold treatments are made. We aimed to identify independent patient variables that increase the odds for receiving a decision to withdraw or withhold intensive care.MethodsRegistry study using data from the Swedish Intensive Care Registry (SIR) 2014‐2016. Age, condition at admission, including co‐morbidities (Simplified Acute Physiology Score version 3, SAPS 3), diagnosis, sex, and decisions on treatment limitations were extracted. Patient data were divided into a full care (FC) group, and a withhold or withdraw (WW) treatment group.ResultsOf all 97 095 cases, 47.1% were 61‐80 years old, 41.9% were women and 58.1% men. 14 996 (15.4%) were allocated to the WW group and 82 149 (84.6%) to the FC group. The WW group, compared with the FC group, was older (P < 0.001), had higher SAPS 3 (P < 0.001) and were predominantly female (P < 0.001). Compared to patients 16‐20 years old, patients >81 years old had 11 times higher odds of being allocated to the WW group. Higher SAPS 3 (continuous) increased the odds of being allocated to the WW group by odds ratio [OR] 1.085, (CI 1.084‐1.087). Female sex increased the odds of being allocated to the WW group by 18% (1.18; CI 1.13‐ 1.23).ConclusionOlder age, higher SAPS 3 at admission and female sex were found to be independent variables that increased the odds to receive a decision to withdraw or withhold intensive care.

BackgroundDelayed cerebral ischemia (DCI) is a major cause of impaired outcome after aneurysmal subarachnoidal hemorrhage (aSAH). In this observational cohort study we investigated whether changes in heart rate variability (HRV) that precede DCI could be detected.MethodsSixty‐four patients with aSAH were included. HRV data were collected for up to 10 days and analyzed offline. Correlation with clinical status and/or radiologic findings was investigated. A linear mixed model was used for the evaluation of HRV parameters over time in patients with and without DCI. Extended Glasgow outcome scale score was assessed after 1 year.ResultsIn 55 patients HRV data could be analyzed. Fifteen patients developed DCI. No changes in HRV parameters were observed 24 hours before onset of DCI. Mean of the HRV parameters in the first 48 hours did not correlate with the development of DCI. Low/high frequency (LF/HF) ratio increased more in patients developing DCI (β −0.07 (95% confidence interval, 0.12‐0.01); P = .012). Lower STDRR (standard deviation of RR intervals), RMSSD (root mean square of the successive differences between adjacent RR intervals), and total power (P = .003, P = .007 and P = .004 respectively) in the first 48 hours were seen in patients who died within 1 year.ConclusionImpaired HRV correlated with 1‐year mortality and LF/HF ratio increased more in patients developing DCI. Even though DCI could not be detected by the intermittent analysis of HRV used in this study, continuous HRV monitoring may have potential in the detection of DCI after aSAH using different methods of analysis.

Cardiac complications after SAH are associated with an increased risk of short-term death. Patients with electrocardiogram abnormalities and stress cardiomyopathy need appropriate follow-up for the identification of cardiac disease or risk factors for cardiovascular disease.