Preventing postoperative pulmonary complications by establishing a machine-learning assisted approach (PEPPERMINT): Study protocol for the creation of a risk prediction model.

Background: Postoperative pulmonary complications (POPC) are common after general anaesthesia and are a major cause of increased morbidity and mortality in surgical patients. However, prevention and treatment methods for POPC that are considered effective tie up human and technical resources. Therefore, the planned research project aims to create a prediction model that enables the reliable identification of high-risk patients immediately after surgery based on a tailored machine learning algorithm.

Improved pathogen identification in sepsis or septic shock by clinical metagenomic sequencing.

Objectives: Despite limited sensitivity and specificity, blood cultures (BCs) still represent the gold standard of diagnostic care in septic patients. We aimed to overcome current diagnostic limitations by unbiased next-generation sequencing (NGS) of circulating microbial cell-free DNA (mcfDNA) in plasma samples.

Methods: We performed a prospective, observational, non-interventional, multicenter study (Next GeneSiS-Trial) to compare positivity rates for NGS-based identification of causative pathogens with BCs in patients suffering from sepsis or septic shock.

Evidence from a Bayesian reanalysis of the iPROVE-OLV study: is it time to update our prior assumptions regarding neuromuscular block and reversal?

In a Bayesian secondary analysis of a subset of 698 patients in the iPROVE-OLV study, Mazzinari and colleagues report evidence of benefit for the use of neuromuscular monitoring and reversal under a range of prior assumptions (i.e. assumptions of probability of benefit or harm).

Precision of electromyography according to the calibration approach of neuromuscular monitoring: a randomised prospective agreement study.

Purpose: Anaesthesia providers often complain that quantitative neuromuscular monitoring does not accurately assess neuromuscular function, a problem that can be mitigated by appropriate calibration. However, there are only very limited recommendations for the calibration of quantitative neuromuscular monitoring in clinical routine. Therefore, this multicentre prospective agreement study compared the precision of electromyography using three different calibration approaches.

Reliability of pre-admission patient-reported outcome measures postoperatively assessed via proxies: a prospective, multicenter observational study.

Background: Pre-admission status obtained through patient-reported outcome measures is an essential metric in both clinical and research settings for prognostication and treatment decisions. It is frequently collected by proxies, although its reliability has yet to be thoroughly investigated. The objective was to determine the reliability of proxy assessments regarding pre-ICU admission status via patient-reported outcome measures and to explore the impact of the ICU setting on these assessments.

Developing novel drugs to reverse neuromuscular block: do we need them?

In the last 5 yr, rocuronium followed by reversal with sugammadex has become the most common combination of neuromuscular blocking drug and neuromuscular block antagonist in use during anaesthesia in the developed world. Despite a low incidence of side-effects from this drug combination, research continues on the development of new reversal agents. This includes development of new gamma cyclodextrins such as adamgammadex, and unrelated compounds such as calabadion 2 and Pillar[6]MaxQ, that not only sequestrate rocuronium, but also opioids such as fentanyl.

Unlocking opportunities to transform patient care: an expert insight on limitations and opportunities in patient monitoring.

Background: Current patient monitoring technologies are crucial for delivering personalised and timely care and are critical in achieving the best health outcomes while maintaining high care standards. However, these technologies also present several challenges affecting patients and healthcare professionals.

Information Overload: Healthcare providers often deal with excess data, making it challenging to identify the most critical patient information quickly.

Transforming in-clinic post-operative and intermediate care with cosinuss°.

Continuous, mobile patient monitoring plays a critical role in healthcare, particularly for post-surgery, intermediate care in clinics. The implementation of vital signs monitoring technology enables healthcare professionals to triage patients effectively by maintaining real-time awareness of their health status and allowing for prompt intervention when necessary. This technology supports early mobilization and facilitates the detection of potential complications such as post-surgical sepsis.

Skeletal Muscle Mass Loss Leads to Prolonged Mechanical Ventilation and Higher Tracheotomy Rates in Critically Ill Patients.

: Skeletal muscle mass depletion adversely affects critically ill patient outcomes. Standardized methods for assessing muscle mass in this population are limited, particularly regarding changes during ICU stays and their implications for risk stratification. : In this secondary analysis of our prospective data registry of surgical ICU patients, we used a single slice extracted from a computed tomography scan to determine the patient's direction of absolute change in skeletal muscle mass between two different time points (-14 d to +0 d and +5 d to +21 d) during his or her critical illness.

Guideline on positioning and early mobilisation in the critically ill by an expert panel.

A scientific panel was created consisting of 23 interdisciplinary and interprofessional experts in intensive care medicine, physiotherapy, nursing care, surgery, rehabilitative medicine, and pneumology delegated from scientific societies together with a patient representative and a delegate from the Association of the Scientific Medical Societies who advised methodological implementation. The guideline was created according to the German Association of the Scientific Medical Societies (AWMF), based on The Appraisal of Guidelines for Research and Evaluation (AGREE) II. The topics of (early) mobilisation, neuromuscular electrical stimulation, assist devices for mobilisation, and positioning, including prone positioning, were identified as areas to be addressed and assigned to specialist expert groups, taking conflicts of interest into account.

Implementation of a software-based decision support tool for guideline-appropriate preoperative evaluation: a prospective agreement study.

Background: Guideline adherence in the medical field leaves room for improvement. Digitalised decision support helps improve compliance. However, the complex nature of the guidelines makes implementation in clinical practice difficult.

Anaesthesiologists' guideline adherence in pre-operative evaluation: a retrospective observational study.

Background: Surveys suggest a low level of implementation of clinical guidelines, although they are intended to improve the quality of treatment and patient safety. Which guideline recommendations are not followed and why has yet to be analysed. In this study, we investigate the proportion of European and national guidelines followed in the area of pre-operative anaesthetic evaluation prior to non-cardiac surgery.

Genotype- and sex-specific changes in vital parameters during isoflurane anesthesia in a mouse model of Alzheimer's disease.

Background: The prevalence of neurodegenerative diseases is increasing as is life expectancy with Alzheimer's disease accounting for two-thirds of dementia cases globally. Whether general anesthesia and surgery worsen cognitive decline is still a matter of debate and most likely depending on the interplay of various influencing factors. In order to account for this complexity, Alzheimer's disease animal models have been developed.

Susceptibility of AutoML mortality prediction algorithms to model drift caused by the COVID pandemic.

Background: Concept drift and covariate shift lead to a degradation of machine learning (ML) models. The objective of our study was to characterize sudden data drift as caused by the COVID pandemic. Furthermore, we investigated the suitability of certain methods in model training to prevent model degradation caused by data drift.

Under-dosing and over-dosing of neuromuscular blocking drugs and reversal agents: beware of the risks.

The phenomena of residual curarisation and recurarisation after the use of long-acting non-depolarising neuromuscular blocking drugs such as tubocurarine and pancuronium were well recognised 60 years ago. But the incidence seemed to decline with the introduction of atracurium and vecuronium. However, recently there have been an increasing number of reports of residual and recurrent neuromuscular block.

Wearable in-ear pulse oximetry validly measures oxygen saturation between 70% and 100%: A prospective agreement study.

Objectives: Postoperative monitoring outside intensive and post-anaesthesia care units is seldom, partly due to lack of suitable and approved systems. We therefore aim to validate the oxygen saturation (SpO) and pulse rate measurement of the in-ear sensor c-med° alpha with a reference pulse oximeter.

Methods: This prospective agreement study was conducted in 12 healthy (ASA 1) adult (18-50 years) volunteers according to the EN ISO 80601-2-61.

Goal-directed Perioperative Albumin Substitution Versus Standard of Care to Reduce Postoperative Complications: A Randomized Clinical Trial (SuperAdd Trial).

Objective: To investigate whether goal-directed albumin substitution during surgery and postanesthesia care to maintain a serum albumin concentration >30 g/L can reduce postoperative complications.

Background: Hypoalbuminemia is associated with numerous postoperative complications. Since albumin has important physiological functions, substitution of patients with hypoalbuminemia is worth considering.

Effects of mobility dose on discharge disposition in critically ill stroke patients.

Background: Mobilization in the intensive care unit (ICU) has the potential to improve patient outcomes following acute stroke. The optimal duration and intensity of mobilization for patients with hemorrhagic or ischemic stroke in the ICU remain unclear.

Objective: To assess the effect of mobilization dose in the ICU on adverse discharge disposition in patients after stroke.

Enabling personalized perioperative risk prediction by using a machine-learning model based on preoperative data.

Preoperative risk assessment is essential for shared decision-making and adequate perioperative care. Common scores provide limited predictive quality and lack personalized information. The aim of this study was to create an interpretable machine-learning-based model to assess the patient's individual risk of postoperative mortality based on preoperative data to allow analysis of personal risk factors.

Corrigendum: The functional trajectory in frail compared with non-frail critically ill patients during the hospital stay.

[This corrects the article DOI: 10.3389/fmed.2021.

Successful treatment of out-of-hospital cardiac arrest is still based on quick activation of the chain of survival.

Background And Goal Of Study: Cardiopulmonary resuscitation (CPR) in prehospital care is a major reason for emergency medical service (EMS) dispatches. CPR outcome depends on various factors, such as bystander CPR and initial heart rhythm. Our aim was to investigate whether short-term outcomes such as the return of spontaneous circulation (ROSC) and hospital admission with spontaneous circulation differ depending on the location of the out-of-hospital cardiac arrest (OHCA).

Association of immature platelets with perioperative complications in neurosurgery.

Immature platelets are newly formed platelets with an increased prothrombotic potential. This study evaluates whether immature platelets are associated with relevant complications in neurosurgical patients. Data were obtained in the frame of a prospectively conducted observational study exploring the association between immature platelets and major cardiovascular events after surgery.

Insulin signaling in skeletal muscle during inflammation and/or immobilisation.

Background: The decline in the downstream signal transduction pathway of anabolic hormone, insulin, could play a key role in the muscle atrophy and insulin resistance observed in patients with intensive care unit acquired weakness (ICUAW). This study investigated the impact of immobilisation via surgical knee and ankle fixation and inflammation via Corynebacterium parvum injection, alone and in combination, as risk factors for altering insulin transduction and, therefore, their role in ICUAW.

Results: Muscle weight was significantly decreased due to immobilisation [estimated effect size (95% CI) - 0.