Background: Neonates and infants requiring anaesthesia are at risk of physiological instability and complications, but triggers for peri-anaesthetic interventions and associations with subsequent outcome are unknown. Methods: This prospective, observational study recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. The primary aim was to identify thresholds of pre-determined physiological variables that triggered a medical intervention. The secondary aims were to evaluate morbidities, mortality at 30 and 90 days, or both, and associations with critical events. Results: Infants (n¼5609) born at mean (standard deviation [SD]) 36.2 (4.4) weeks postmenstrual age (35.7% preterm) underwent 6542 procedures within 63 (48) days of birth. Critical event(s) requiring intervention occurred in 35.2% of cases, mainly hypotension (>30% decrease in blood pressure) or reduced oxygenation (SpO 2 <85%). Postmenstrual age influenced the incidence and thresholds for intervention. Risk of critical events was increased by prior neonatal medical conditions, congenital anomalies, or both (relative risk [RR]¼1.16; 95% confidence interval [CI], 1.04e1.28
Background: Neonates and infants are susceptible to hypoxaemia in the perioperative period. The aim of this study was to analyse interventions related to anaesthesia tracheal intubations in this European cohort and identify their clinical consequences. Methods: We performed a secondary analysis of tracheal intubations of the European multicentre observational trial (NEonate and Children audiT of Anaesthesia pRactice IN Europe [NECTARINE]) in neonates and small infants with difficult tracheal intubation. The primary endpoint was the incidence of difficult intubation and the related complications. The secondary endpoints were the risk factors for severe hypoxaemia attributed to difficult airway management, and 30 and 90 day outcomes. Results: Tracheal intubation was planned in 4683 procedures. Difficult tracheal intubation, defined as two failed attempts of direct laryngoscopy, occurred in 266 children (271 procedures) with an incidence (95% confidence interval [CI]) of 5.8% (95% CI, 5.1e6.5). Bradycardia occurred in 8% of the cases with difficult intubation, whereas a significant decrease in oxygen saturation (SpO 2 <90% for 60 s) was reported in 40%. No associated risk factors could be identified among comorbidities, surgical, or anaesthesia management. Using propensity scoring to adjust for confounders, difficult anaesthesia tracheal intubation did not lead to an increase in 30 and 90 day morbidity or mortality. Conclusions:The results of the present study demonstrate a high incidence of difficult tracheal intubation in children less than 60 weeks post-conceptual age commonly resulting in severe hypoxaemia. Reassuringly, the morbidity and mortality at 30 and 90 days was not increased by the occurrence of a difficult intubation event. Clinical trial registration: NCT02350348.
Background and objectives: Organ shortage is considered to be a major limitation for increasing transplantation rates. Brain-dead donors (DBDs) are an important source of organs, but up to 50% of potential DBDs might not be identified. An active brain-dead donor search could potentially increase a deceased donor pool. The aim of this study was to evaluate the effectiveness of an active potential DBD identification program and to evaluate one year impact on the potential organ donor pool in Lithuania‘s biggest medical institution. Materials and Methods: An organ donor coordinator service was established and active DBD search strategy was implemented in the hospital of LSMU Kauno Klinikos, and retrospective data analysis was performed between December 2016 and December 2017. Collected data was compared to the available data of the previous year in the same center and to the donation dynamics of the whole country. Results: A total of 6734 patients were treated in all intensive care units (ICU), and 234 (3.5%) of them were identified as possible donors. No increase in potential donor’s number was observed in study year (n = 34) compared to remote year (n = 37). No significant difference in potential donor’s demographic data, cause of death, family refusals and medical contraindication rates. Cerebral angiography (CA) repeated in 20% of potential donors in order to confirm brain death diagnosis. More potential donors for whom CA was repeated had decompressive craniectomy done (66.7% vs. 33.3%, p = 0.018). Decompressive craniectomy statistically significantly increases the rate of repeated CA (OR 12.7; 95% CI, 1.42–113.37; p = 0.023). Active search strategy increased length of hospital stay of potential donors comparing to previous year (3.97 ± 4.73 vs. 2.51 ± 2.63, p = 0.003). An optimal time of the first four days of hospitalization to identify a potential donor was observed during our study (OR 10.42; 95% CI, 4.29–25.34; p = 0.001). Conclusions: We were not able to demonstrate active donor identification strategy superiority over the passive strategy during a short one year period; nevertheless, valuable knowledge was gained in brain death diagnostics, new terminology was implemented, and the stability of actual donor numbers was observed in the experimental donor center in the light of decreasing national results. Long-term strategy is required to achieve sustainable results in organ donation.
Raktažodžiai: organų donoras, donorystė dėl negrįžta-mai nutrūkusios kraujotakos, potencialus donoras, mirčių analizė, donorinis centras. SantraukaOrganų transplantacija yra efektyviausias ir ekonomiškai naudingiausias, o kai kuriais atvejais ir vienintelis gydymo būdas esant terminaliniam vidaus organų funkcijos nepakankamumui. Pagrindinė kliūtis transplantacijai -donorinių organų trūkumas. Pasaulinėje praktikoje geriausi rezultatai pasiekiami, kai kartu taikomi skirtingi donorystės modeliai: gyvoji donorytė, donorystė po smegenų mirties ir donorystė dėl negrįžtamai nutrūkusios kraujotakos (DNNK). Nuo 2016 m. sausio 1d., pakeitus įstatyminę bazę, Lietuvoje atsirado galimybė ruošti DNNK, tačiau kokia galima šio modelio įtaka organų donorų skaičiui šalyje nėra žinoma. Siekiant pamatuoto ir tvaraus DNNK programos diegimo LSMUL KK atlikta visų suaugusių pacientų mirčių, 2015 m. registruotų Kauno klinikose ir Valstybinės teismo medicinos tarnybos (VTMT) Kauno skyriaus registre, analizė ir identifikuoti potencialūs DNNK. Analizės metu naudoti visuotinai priimti potencialaus DNNK demografiniai, ligos anamnezės ir su mirties procesu susiję laiko kriterijai. Dėl Lietuvoje galiojančių įsta-tymų įtraukti tik nekontroliuojami DNNK. Nustatyta, kad iš 2356 mirusiųjų potencialaus DNNK kriterijus atitiko 56 mirusieji, taip padidindami potencialių organų donorų skaičių LSMUL KK donoriniame centre 119,5 %. Remiantis atlikta analize galima teigti, kad sėkmingai įdiegus nekontroliuojamos DNNK modelį Kauno klinikų donoriniame centre galima tikėtis žen-klaus donorinių organų padidėjimo. DNNK -donoras dėl negrįžtamai nutrūkusios kraujotakos, ŽIV -žmogaus imunodeficito virusas, CD -cukrinis diabetas, IFN -inkstų funkcijos nepakankamumas, CNS -centrinė nervų sistema. PD -potencialūs donorai, SM -smegenų mirtis, DNNK -donorai dėl negrįžtamai nutrūkusios kraujotakos. DNNK -donorai dėl negrįžtamai nutrūkusios kraujotakos, SPS -skubios pagalbos skyrius, ITS -intensyviosios terapijos skyrius. ĮvadasOrganų transplantacija pagerina gyvenimo kokybę, pailgina gyvenimo trukmę ir yra ekonomiškai naudingiausias gydymo būdas pacientams, sergantiems paskutinės stadijos inkstų nepakankamumu (1-4). Esant kepenų ar plaučių terminaliniam nepakankamumui tai gali būti vienintelis gydymo būdas (5-7). Pagrindinė kliūtis organų transplantacijai -donorinių organų trūkumas (2, 4). Pasaulinė sveikatos organizacija (PSO) skatina maksimaliai išnaudoti kiekvienos šalies organų donorystės galimybes siekiant užtikrinti donorinių organų poreikio patenkinimą. Tai atlikti optimizuojant vidinius resursus ir ypatingas pastangas skiriant negyvosios donorystės skatinimui, nes tokiu būdu kovojama su organų prekyba iš trečiųjų šalių (8, 9). Lietuvoje, kaip ir kitose išsivysčiusiose Vakarų šalyse, stebimos organų donorų po smegenų mirties mažėjimo tendencijos, sąlygotos mažėjančio eismo įvykių skaičiaus su letaliomis baigtimis, gerėjančių neurokritinių ligonių gydymo rezultatų (10-12). Organų trū-kumo problemai spręsti įvairios šalys naudoja skirtingas strategijas ir donoryst...
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