Prone Positioning in Cardiac Surgery: For Many, But Not for Everyone.

Prone positioning is a therapeutic maneuver to improve arterial oxygenation in patients with acute lung injury that is not implemented in most centers performing adult cardiac surgery. The aim of this study was to review our experience with prone positioning to assess the effects of this maneuver in patients with postoperative acute respiratory failure. From 2010-2014, 127 adult patients with postoperative acute respiratory failure were treated with prone positioning in addition to specific therapy.

Retrospective analysis of autologous blood use in bimaxillary repositioning osteotomy surgery: a quality improvement study.

Background: Multiple studies have considered the necessity of preoperative autologous blood donation before bimaxillary orthognathic osteotomies. In the context of a quality improvement project, this topic was also investigated in our institution. Furthermore, the transfusion practice was analyzed and the correlations between patient, operative variables, and blood loss were studied.

Corrected incidences of co-morbidities - a statistical approach for risk-assessment in anesthesia using an AIMS.

Objective: In anesthesia and intensive care logistic regression analysis are often used to generate predictive models for risk assessment. Strictly seen only independent variables should be represented in such prognostic models. Using anesthesia-information-management-systems a lot of (depending) information is stored in a database during the preoperative ward round.

Summative software evaluation of a therapeutic guideline assistance system for empiric antimicrobial therapy in ICU.

Objective: While developing the patient data management system ICUData in close cooperation with the software company (IMESO GmbH, Hüttenberg, Germany), a therapeutic guideline assistance system for empiric antimicrobial therapy in ICU (called "Antibiotic Wizard") could be introduced and integrated into the existing software. After its introduction into clinical routine, the first version was to be tested, checked for usability and compared to other software products with the help of the IsoMetrics(s) inventory (based on the EN ISO 9241-10 for computer-assisted workflows).

Methods: Half a year after introducing the "Antibiotic Wizard" in the ICUs, 40 physicians from different specialties at different levels of training were surveyed in order to detect deficiencies in the use of the program.

Performance and customization of 4 prognostic models for postoperative onset of nausea and vomiting in ear, nose, and throat surgery.

Objective: To evaluate the performance of 4 published prognostic models for postoperative onset of nausea and vomiting (PONV) by means of discrimination and calibration and the possible impact of customization on these models.

Design: Prospective, observational study.

Setting: Tertiary care university hospital.

Computers in anesthesia and intensive care: lack of evidence that the central unit serves as reservoir of pathogens.

Objective: Computers are becoming increasingly visible in operating rooms (OR) and intensive care units (ICU) for use in bedside documentation. Recently, they have been suspected as possibly acting as reservoirs for microorganisms and vehicles for the transfer of pathogens to patients, causing nosocomial infections. The purpose of this study was to examine the microbiological (bacteriological and mycological) contamination of the central unit of computers used in an OR, a surgical and a pediatric ICU of a tertiary teaching hospital.

Impact of inadequate surgical antibiotic prophylaxis on perioperative outcome and length of stay on ICU in general and trauma surgery. Analysis using automated data collection.

Within surgical departments, a large amount of antibiotics is used for perioperative prophylaxis. Despite the existence of several guidelines and recommendations for administering antibiotic prophylaxis, mistakes still do occur and have an unknown impact on outcome severity. Based on the electronic anaesthesia records of 4304 patients undergoing defined surgical procedures requiring perioperative antibiotic prophylaxis, a matched pairs approach was used to evaluate the impact of inadequate antibiotic prophylaxis on hospital mortality and prolonged length of stay on intensive care.

Excessive alcohol consumption and perioperative outcome.

Background: Excessive alcohol consumption is a well-recognized factor contributing to premature morbidity and mortality.

Methods: This retrospective, matched cohort study was designed to assess the attributable effects of excessive alcohol consumption on outcome in patients undergoing noncardiac surgery. All data of 28,065 patients operated at a tertiary care university hospital were recorded with a computerized anesthesia record-keeping system.

Review of antibiotic drug use in a surgical ICU: management with a patient data management system for additional outcome analysis in patients staying more than 24 hours.

Background: A number of developments have been made in computerized patient data management systems (PDMSs), making them of interest to medical and nursing staff as a means of improving patient care.

Objectives: The aim of this study was to assess the capability of a PDMS to record and provide drug-administration data and to investigate whether the PDMS may be used as a means of support for clinical audits and quality control. Furthermore, we assessed whether antibiotic therapy as a surrogate for infections correlates with hospital mortality in patients staying >24 hours in a surgical intensive care unit (SICU).

Laryngeal mask airway versus endotracheal tube for outpatient surgery: analysis of anesthesia-controlled time.

Study Objective: To show that efficiency of operating room times can be improved significantly using rapid changes between operative procedures.

Design: Randomized, prospective clinical study.

Setting: Tertiary care university hospital, elective peripheral trauma-related orthopedic surgery.

Computer keyboard and mouse as a reservoir of pathogens in an intensive care unit.

Objective: User interfaces of patient data management systems (PDMS) in intensive care units (ICU), like computer keyboard and mouse, may serve as reservoirs for the transmission of microorganisms. Pathogens may be transferred via the hands of personnel to the patient causing nosocomial infections. The purpose of this study was to examine the microbial contamination of computer user interfaces with potentially pathogenic microorganisms, compared with other fomites in a surgical intensive care unit of a tertiary teaching hospital.

Automatic calculation of the nine equivalents of nursing manpower use score (NEMS) using a patient data management system.

Objective: The most recent approach to estimate nursing resources consumption has led to the generation of the Nine Equivalents of Nursing Manpower use Score (NEMS). The objective of this prospective study was to establish a completely automatically generated calculation of the NEMS using a patient data management system (PDMS) database and to validate this approach by comparing the results with those of the conventional manual method.

Design: Prospective study.

Increased body mass index and peri-operative risk in patients undergoing non-cardiac surgery.

Background: Increased BMI is a well known risk factor for morbidity and mortality in hospitalized nonsurgical patients. However, the published evidence for a comparable effect in surgical patients is scarce.

Methods: This retrospective study was designed to assess the attributable effects of increased BMI (>30 kg/m2) on outcome (hospital mortality, admission to the intensive care unit (ICU), and incidence of intraoperative cardiovascular events (CVE)) in patients undergoing non-cardiac surgery by a computerized anesthesia record-keeping system.

The incidence and prediction of automatically detected intraoperative cardiovascular events in noncardiac surgery.

Unlabelled: The objective of this study was to evaluate prognostic models for quality assurance purposes in predicting automatically detected intraoperative cardiovascular events (CVE) in 58458 patients undergoing noncardiac surgery. To this end, we assessed the performance of two established models for risk assessment in anesthesia, the Revised Cardiac Risk Index (RCRI) and the ASA physical status classification. We then developed two new models.

Intra-operative tachycardia and peri-operative outcome.

Background: Intra-operative tachycardia is a common adverse event, often recorded as an indicator for process quality in quality assurance projects in anaesthesia.

Methods: This retrospective study is based on data sets of 28,065 patients recorded with a computerised anaesthesia record-keeping system from 23 February 1999 to 31 December 2000 at a tertiary care university hospital. Cases were defined as patients with intra-operative tachycardia; references were automatically selected according to matching variables (high-risk surgery, severe congestive heart failure, severe coronary artery disease, significant carotid artery stenosis and/or history of stroke, renal failure, diabetes mellitus and urgency of surgery) in a stepwise fashion.

Computerize anesthesia record keeping in thoracic surgery--suitability of electronic anesthesia records in evaluating predictors for hypoxemia during one-lung ventilation.

Objective: The aim of this retrospective study was to assess the suitability of routine data gathered with a computerized anesthesia record keeping system in investigating predictors for intraoperative hypoxemia (SpO2 < 90%) during one-lung ventilation (OLV) in pulmonary surgery.

Methods: Over a four-year period data of 705 patients undergoing thoracic surgery (pneumonectomy: 78; lobectomy: 292; minor pulmonary resections: 335) were recorded online using an automated anesthesia record-keeping system. Twenty-six patient-related, surgery-related and anesthesia-related variables were studied for a possible association with the occurrence of intraoperative hypoxemia during OLV.

Differing incidences of relevant hypotension with combined spinal-epidural anesthesia and spinal anesthesia.

Unlabelled: In this investigation we assessed whether patients receiving spinal anesthesia (SPA) as part of combined spinal-epidural anesthesia (CSE) more often experience relevant hypotension than patients receiving SPA alone. From January 1, 1997, until August 5, 2000, electronic anesthesia records from 1596 patients having received SPA and 1023 patients having received CSE for elective surgery were collected by using a computerized anesthesia record-keeping system. Relevant hypotension was defined as a decrease of mean arterial blood pressure of more than 30% within a 10-min interval and a therapeutic action of the attending anesthesiologist within 20 min after onset.

A data model for managing drug therapy within a patient data management system for intensive care units.

The major intent of this article was to describe the design principles of the drug-therapy documentation module of the Patient Data Management System (PDMS) ICUData, in routine use at the intensive care unit (ICU) of the Department of Anesthesiology and Intensive Care Medicine at the University Hospital of Giessen, Germany, since February 1999. The new drug management system has been in routine use since March 2000. Until 8 January 2001, 1140 patients have been documented using this approach.

Automatic calculation of a modified APACHE II score using a patient data management system (PDMS).

Objective: To investigate a fully automated and modified APACHE II score calculation exclusively based on routine data supplied by patient data management system, the ICUData, and to assess the predictive performance of this score using analysis of discrimination and calibration at an operative ICU.

Method: SQL scripts (calculation programs) were developed to calculate the scores of 524 patients who stayed at the ICU between April 1st, 1999 and March 31st, 2000. The calculation programs considered unavailable data as 'not pathological'.

The incidence and risk factors for hypotension after spinal anesthesia induction: an analysis with automated data collection.

Unlabelled: We sought to identify factors that are associated with hypotension after the induction of spinal anesthesia (SpA) by using an anesthesia information management system. Hypotension was defined as a decrease of mean arterial blood pressure of more than 30% within a 10-min interval, and relevance was defined as a therapeutic intervention with fluids or pressors within 20 min. From January 1, 1997, to August 5, 2000, data sets from 3315 patients receiving SpA were recorded on-line by using the automatic anesthesia record keeping system NarkoData.

Discriminative power on mortality of a modified Sequential Organ Failure Assessment score for complete automatic computation in an operative intensive care unit.

Objective: To evaluate the discriminative power on mortality of a modified Sequential Organ Failure Assessment (SOFA) score and derived measures (maximum SOFA, total maximum SOFA, and delta SOFA) for complete automatic computation in an operative intensive care unit (ICU).

Design: Retrospective study.

Setting: Operative ICU of the Department of Anesthesiology and Intensive Care Medicine.