Most patients with a perioperative MI will not experience ischemic symptoms. Data suggest that routine monitoring of troponin levels in at-risk patients is needed after surgery to detect most MIs, which have an equally poor prognosis regardless of whether they are symptomatic or asymptomatic.

Among patients undergoing noncardiac surgery, peak postoperative hsTnT during the first 3 days after surgery was significantly associated with 30-day mortality. Elevated postoperative hsTnT without an ischemic feature was also associated with 30-day mortality.

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Among adults undergoing noncardiac surgery, MINS is common and associated with substantial mortality.

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Background Awake prone positioning (awake-PP) in non-intubated coronavirus disease 2019 (COVID-19) patients could avoid endotracheal intubation, reduce the use of critical care resources, and improve survival. We aimed to examine whether the combination of high-flow nasal oxygen therapy (HFNO) with awake-PP prevents the need for intubation when compared to HFNO alone. Methods Prospective, multicenter, adjusted observational cohort study in consecutive COVID-19 patients with acute respiratory failure (ARF) receiving respiratory support with HFNO from 12 March to 9 June 2020. Patients were classified as HFNO with or without awake-PP. Logistic models were fitted to predict treatment at baseline using the following variables: age, sex, obesity, non-respiratory Sequential Organ Failure Assessment score, APACHE-II, C-reactive protein, days from symptoms onset to HFNO initiation, respiratory rate, and peripheral oxyhemoglobin saturation. We compared data on demographics, vital signs, laboratory markers, need for invasive mechanical ventilation, days to intubation, ICU length of stay, and ICU mortality between HFNO patients with and without awake-PP. Results A total of 1076 patients with COVID-19 ARF were admitted, of which 199 patients received HFNO and were analyzed. Fifty-five (27.6%) were pronated during HFNO; 60 (41%) and 22 (40%) patients from the HFNO and HFNO + awake-PP groups were intubated. The use of awake-PP as an adjunctive therapy to HFNO did not reduce the risk of intubation [RR 0.87 (95% CI 0.53–1.43), p = 0.60]. Patients treated with HFNO + awake-PP showed a trend for delay in intubation compared to HFNO alone [median 1 (interquartile range, IQR 1.0–2.5) vs 2 IQR 1.0–3.0] days (p = 0.055), but awake-PP did not affect 28-day mortality [RR 1.04 (95% CI 0.40–2.72), p = 0.92]. Conclusion In patients with COVID-19 ARF treated with HFNO, the use of awake-PP did not reduce the need for intubation or affect mortality.

orldwide, 100 million patients aged 45 years and older undergo inpatient noncardiac surgery each year. 1,2 Although surgery has the potential to improve and prolong quality and duration of life, it is also associated with complications and mortality. During the last several decades, advances in perioperative care have included less invasive surgery, improved anesthetic techniques, enhanced intraoperative monitoring and more rapid mobilization after surgery. 2 At the same time, the age and the number of comorbidities of patients undergoing surgery have increased substantially. 3,4 Hence, in the current context, the frequency and timing of mortality is uncertain, as is the relation between perioperative complications to mortality. In a large prospective study (The Vascular Events in Noncardiac Surgery Patients Cohort Evaluation [VISION] Study), we systematically followed patients who underwent noncardiac surgery and documented perioperative complications and death. Our a priori objectives included establishing the frequency and timing of death after noncardiac surgery, and the association between perioperative complications and postsurgical death. Methods Study design, population and data We previously reported details of the study design and methods. 5,6 VISION was an international, prospective cohort study. Patients were included if they were aged 45 years or older, had undergone noncardiac surgery, had received general or regional anesthesia and remained in hospital for at least 1 night after surgery. Patients were recruited at 28 centres in 14 countries in

NCT 02168751; EudraCT 2011-002294-29.