Canadian Journal of Anesthesia/Journal canadien d anesthésie

Mitra, Anish R.; Griesdale, Donald E. G.; Haljan, Gregory; O’Donoghue, Ashley; Stevens, Jennifer P.

doi: 10.1007/s12630-020-01775-5pmid: 32748188

PurposeHigh acuity units (HAU) are hospital units that provide patients with more acute care and closer monitoring than a general hospital ward but are not as resource intensive as an intensive care unit (ICU). Nevertheless, the impact of opening a HAU on ICU patient outcomes remains poorly defined. We investigated how the creation of a HAU impacted patient outcomes in the ICU.MethodsThis historical cohort study compared ICU patient in-hospital mortality, ICU length of stay (LOS), and hospital LOS before and after the creation of a HAU in a tertiary-care hospital with a medical/surgical ICU between 1 January 2013 and 31 December 2017.ResultsData from 4,380 patients (984 in the pre-HAU group and 3,396 in the post-HAU group) were analyzed. In this cohort of ICU patients, 360 (37%) died in the pre-HAU group before the creation of a HAU, and 1,074 (32%) died in the post-HAU group after the creation of a HAU. The creation of a HAU was associated with lower relative risk of in-hospital mortality (adjusted risk ratio, 0.80; 95% confidence interval [CI], 0.72 to 0.89; P < 0.001). The creation of a HAU was also associated with reduced ICU and hospital LOS with a 12% increase in the rate of ICU discharge (adjusted sub-distribution hazard ratio [SHR], 1.12; 95% CI, 1.02 to 1.23; P = 0.02) and a 26% increase in the rate of hospital discharge (adjusted SHR, 1.26; 95% CI, 1.14 to 1.39; P < 0.001), when accounting for the competing risk of death.ConclusionsThese data support the hypothesis that the creation of a HAU may be associated with reduced in-hospital mortality, ICU LOS, and hospital LOS for ICU patients.

Bowes, Duncan E.; Gamble, Jonathan J.; Bajwa, Jagmeet S.

doi: 10.1007/s12630-020-01776-4pmid: 32761316

PurposeThe harms caused by excessive perioperative intravenous (IV) fluid administration are both well recognized and avoidable. The purpose of this study was to compare the incidence of excess intraoperative fluid administration in pediatric dental surgery patients when either an automated pump-delivery device or a manual gravity-drip device is used.MethodsWe randomly assigned American Society of Anesthesiologists physical status I and II pediatric dental surgery patients to receive IV fluid via either a manual gravity-drip or automated pump-delivery device. Prior to each case, the attending anesthesiologist determined the target volume of maintenance IV fluid to be administered based on patient weight, estimated fluid deficits, and expected case length. The intraoperative IV fluid delivered was determined at the end of the case by the change in the IV bag weight. The primary outcome was the proportion of procedures that delivered ≥ 10% of the target IV fluid volume.Results:We recruited 105 children aged two to 12 yr (n = 49 in the automated pump-delivery device; n = 53 in the manual gravity-drip device). The proportion of excessive fluid administration was 8/49 (16%) in the automated pump-delivery device group compared with 33/53 (62%) in the gravity-drip group (relative risk of excessive fluid administration, 0.26; 95% confidence interval, 0.13 to 0.51; P < 0.001).ConclusionIntraoperative fluid administration using an automated pump-delivery device decreased the incidence of excessive IV fluid administration in pediatric dental surgery patients.Trial registrationwww.clinicaltrials.gov (NCT03312452); registered 17 October 2017.

Hancock, Jennifer; Witter, Tobias; Comber, Scott; Daley, Patricia; Thompson, Kim; Candow, Stewart; Follett, Gisele; Somers, Walter; Collins, Corry; White, Janet; Kits, Olga

doi: 10.1007/s12630-020-01789-z

Healey, Andrew; Hartwick, Michael; Downar, James; Keenan, Sean; Lalani, Jehan; Mohr, Jim; Appleby, Amber; Spring, Jenna; Delaney, Jesse W.; Wilson, Lindsay C.; Shemie, Sam; ,

doi: 10.1007/s12630-020-01774-6pmid: 32918249

BackgroundDonation after circulatory determination of death (DCD) is responsible for the largest increase in deceased donation over the past decade. When the Canadian DCD guideline was published in 2006, it included recommendations to create standard policies and procedures for withdrawal of life-sustaining measures (WLSM) as well as quality assurance frameworks for this practice. In 2016, the Canadian Critical Care Society produced a guideline for WLSM that requires modifications to facilitate implementation when DCD is part of the end-of-life care plan.MethodsA pan-Canadian multidisciplinary collaborative was convened to examine the existing guideline framework and to create tools to put the existing guideline into practice in centres that practice DCD.ResultsA set of guiding principles for implementation of the guideline in DCD practice were produced using an iterative, consensus-based approach followed by development of four implementation tools and three quality assurance and audit tools.ConclusionsThe tools developed will aid DCD centres in fulsomely adapting the Canadian Critical Care Society Withdrawal of Life-Sustaining Measures guideline.

Hare, Gregory M. T.; Cazorla-Bak, Melina P.; Ku, S. F. Michelle; Chin, Kyle; Mistry, Nikhil; Sklar, Michael C.; Pavenski, Katerina; Alli, Ahmad; Van Rensburg, Adriaan; Friedrich, Jan O.; Baker, Andrew J.; Mazer, C. David

Subedi, Asish

doi: 10.1007/s12630-020-01773-7pmid: 32734443

Shorten, George D.

doi: 10.1007/s12630-020-01784-4pmid: 32770312

Hung, Orlando; Lehmann, Christian; Coonan, Thomas; Murphy, Michael; Stewart, Ronald

doi: 10.1007/s12630-020-01785-3pmid: 32779004

Kamble, Vaibhav A.; Orser, Beverley A.; Wilson, C. Ruth

doi: 10.1007/s12630-020-01728-ypmid: 32533460

Stapleton, Kallie; Jefkins, Matthew; Grant, Christopher; Boyd, J. Gordon

doi: 10.1007/s12630-020-01741-1pmid: 32557196