Background The Clinical Frailty Scale (CFS) is frequently used to measure frailty in critically ill adults. There is wide variation in the approach to analysing the relationship between the CFS score and mortality after admission to the ICU. This study aimed to evaluate the influence of modelling approach on the association between the CFS score and short-term mortality and quantify the prognostic value of frailty in this context. Methods We analysed data from two multicentre prospective cohort studies which enrolled intensive care unit patients ≥ 80 years old in 26 countries. The primary outcome was mortality within 30-days from admission to the ICU. Logistic regression models for both ICU and 30-day mortality included the CFS score as either a categorical, continuous or dichotomous variable and were adjusted for patient’s age, sex, reason for admission to the ICU, and admission Sequential Organ Failure Assessment score. Results The median age in the sample of 7487 consecutive patients was 84 years (IQR 81–87). The highest fraction of new prognostic information from frailty in the context of 30-day mortality was observed when the CFS score was treated as either a categorical variable using all original levels of frailty or a nonlinear continuous variable and was equal to 9% using these modelling approaches (p < 0.001). The relationship between the CFS score and mortality was nonlinear (p < 0.01). Conclusion Knowledge about a patient’s frailty status adds a substantial amount of new prognostic information at the moment of admission to the ICU. Arbitrary simplification of the CFS score into fewer groups than originally intended leads to a loss of information and should be avoided. Trial registration NCT03134807 (VIP1), NCT03370692 (VIP2)

Background Sepsis is one of the most frequent reasons for acute intensive care unit (ICU) admission of very old patients and mortality rates are high. However, the impact of pre-existing physical and cognitive function on long-term outcome of ICU patients ≥ 80 years old (very old intensive care patients (VIPs)) with sepsis is unclear. Objective To investigate both the short- and long-term mortality of VIPs admitted with sepsis and assess the relation of mortality with pre-existing physical and cognitive function. Design Prospective cohort study. Setting 241 ICUs from 22 European countries in a six-month period between May 2018 and May 2019. Subjects Acutely admitted ICU patients aged ≥80 years with sequential organ failure assessment (SOFA) score ≥ 2. Methods Sepsis was defined according to the sepsis 3.0 criteria. Patients with sepsis as an admission diagnosis were compared with other acutely admitted patients. In addition to patients’ characteristics, disease severity, information about comorbidity and polypharmacy and pre-existing physical and cognitive function were collected. Results Out of 3,596 acutely admitted VIPs with SOFA score ≥ 2, a group of 532 patients with sepsis were compared to other admissions. Predictors for 6-month mortality were age (per 5 years): Hazard ratio (HR, 1.16 (95% confidence interval (CI), 1.09–1.25, P &lt; 0.0001), SOFA (per one-point): HR, 1.16 (95% CI, 1.14–1.17, P &lt; 0.0001) and frailty (CFS &gt; 4): HR, 1.34 (95% CI, 1.18–1.51, P &lt; 0.0001). Conclusions There is substantial long-term mortality in VIPs admitted with sepsis. Frailty, age and disease severity were identified as predictors of long-term mortality in VIPs admitted with sepsis.

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K Ke ey y w wo or rd ds s: : immunonutrition, acute pancreatitis, perioperative therapy, sepsis. S Sł ło ow wa a k kl lu uc cz zo ow we e: : immunożywienie, ostre zapalenie trzustki, terapia okołooperacyjna, sepsa.

Chronic obstructive pulmonary disease (COPD) is the 3rd leading cause of death worldwide and 7th in the classification of years of life lost or lived with disability. Indeed, COPD prevalence is still increasing. Moreover, chronic respiratory failure in advanced COPD is one of the most common indications for palliative care. The deterioration of general health, including respiratory failure, raises many doubts as to the need for hospitalization, prognosis and medical interventions. The decision to start palliative care provision in COPD patients is based on poor prognosis, but it is not clear when it should be started. Proper and specialized palliative care in this patient population can limit hospital, Intensive Care Unit (ICU), and emergency admissions. A case of a patient with advanced COPD receiving palliative care and the treatment in the ICU is presented. Due to pneumonia with permanent respiratory hypercapnia, the patient was hospitalized and qualified to tracheostomy and invasive ventilation. In bronchofiberoscopy granulation tissue narrowing the airways below the tracheotomy tube, confirmed by the CT scan. The patient was qualified for rigid bronchofiberoscopy to widen the trachea. Antibiotic therapy with multidirectional pharmacological treatment was provided at the ICU. The patient was discharged home in a fairly good general condition, on his breathing with passive oxygen therapy, periodically requiring assisted mechanical ventilation, without carbon dioxide retention, and with effective cough reflexes. Mechanical causes of respiratory failure in ventilated advanced COPD patients should be considered. Short-time-intensive therapy treatment may improve the general condition of ventilated advanced COPD patients.

Hypersensitivity reactions are an important aspect of perioperative care and are a crucial interdisciplinary issue in anaesthesiological practice, as well as allergological and laboratory diagnostics. This phenomenon was observed as early as the 1980s and 1990s in Western European countries, and knowledge on this subject has grown significantly over time. Although hypersensitivity reactions are not frequent events (the incidence of perioperative hypersensitivity reactions ranges from 1:386 to 1:13 000 procedures, with higher frequency − 1 per 6500 general anaesthesias with neuromuscular blocking agents administrations), their courses are unfortunately serious and life-threatening. It should also be noted that there is no information regarding the occurrence of perioperative hypersensitivity reactions in many countries. Hence, global assessment of the problem is underestimated. The primary source of actual knowledge comes from epidemiological studies, which indicate an increasing frequency of hypersensitivity reaction occurrence and changes in aetiological factors. The first report from France (1984 to 1989) described two main causes – neuromuscular blocking agents and hypnotic agents. The following years confirmed an increase in perioperative hypersensitivity reactions associated with latex and antibiotics. The most recent data from the National Audit Project 6 indicated increased participation of antibiotics, chlorhexidine, and contrast agents. The results of epidemiological analyses are the basis of medical management guidelines and practice modification. Thanks to the activity of many organisations monitoring the intensity and nature of perioperative hypersensitivity reactions, guidelines for diagnostics and management have been developed. This article presents the results of numerous studies, including the first and the most recent, from various geographical regions. The clinical significance, pathogenesis mechanisms are also discussed. This publication also presents important directions for further scientific and epidemiological research on perioperative hypersensitivity reactions. Key messages The incidence of perioperative hypersensitivity reactions ranges from 1:386 to 1:13 000 procedures, with higher frequency – 1 per 6500 general anaesthesias with neuromuscular blocking agents administrations. Reactions may occur during the first episode of anaesthesia, most frequently in the induction of general anaesthesia, and much less frequently during postoperative follow-up. The first reports of perioperative hypersensitivity reaction come from the 1990s, and knowledge on this subject has grown significantly over time. In many countries, multidisciplinary teams and organisations have been established to identify, monitor the occurrence of this phenomenon, and have set the directions of medical activities and have changed the rules and recommendations. There is no information about t...

Background: The first case of COVID-19 (Coronavirus Disease 2019) in Poland was reported on March 4th, 2020 and resulted in cancellation of bariatric procedures during the lockdown in Poland. The lockdown caused difficult access to all means of medical care. The study was conducted show the impact of SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus) pandemic on bariatric patients’ status in one of Polish regions. Methods: The survey was designed and distributed to bariatric patients. The questionnaire was divided into two parts: demographic characteristics of participants and part concerned the impact of the pandemic on bariatric patients. Results: 116 bariatric patients participated in the survey. 109 of them (94%) reported at least one accompanying disease. The mean value of the willingness to perform the bariatric procedure among women it was 8.8 (±2.2 SD) and men 8.5 (±2.3 SD). The mean value of the impact of SARS-CoV-2 pandemic on the willingness to perform the bariatric in the group of women was 3.0 (±3.0 SD) and in the group of men - 3.2 (±3.0 SD). Statistical analysis shows that there is no statistically significant difference between those date. Conclusions: Despite the pandemic and higher risk of mortality and complications after COVID-19 infection, bariatric patients declare the high level of willingness to perform the bariatric procedure and the impact of SARS-CoV-2 pandemic does not play an important role in a process of deciding to undergo the bariatric procedure. Delay of surgery can significantly increase the disease load in these patients, so cancelling or postponing treatment is not advisable.

Postoperative pain is a complex and multifactorial symptom that requires a well thought approach using different treatments to achieve the optimal outcome after surgery. Contemporary anaesthesiology, looking for an alternative to analgesia with the use of opioids, more often turns to the protocols of low-opioid and opioid free treatment and pain control. By replacing opioids with non-opioid analgesics, koanalgetics, as well as using local and regional anesthetic techniques, we limit or avoid adverse effects of opioids while maintaining a satisfactory level of analgesia for the patient. Methods of general anesthesia without or with the minimum amount of opioid drugs are of particular importance in bariatric surgery due to a reduction in the incidence of post-operative respiratory depression and excessive sedation. They also allow to achieve and maintain cardiovascular stability in the intraoperative and postoperative period, prevent the occurrence of opioid-induced hyperalgesia (the so-called opioid paradox), and improve the comfort of patients in the post-operative period due to the lower incidence of post-operative nausea and vomiting and constipation. The particular significance of regional and local analgesia techniques, which supplement general anesthesia and reduce the need for analgesics in the perioperative period, is emphasized. This analysis presents the theoretical foundations of multimodal analgesia and existing scientific evidence confirming its benefits in improving pain control after surgery.