To determine whether changes in transcranial near‐infrared spectroscopy (NIRS) values reflect changes in cardiac index (CI) in adult cardiac surgical patients. Single‐center prospective post hoc ...analysis. University hospital. One hundred and twenty‐four adult patients undergoing cardiac surgery. In each patient, several CI measurements were taken, and NIRS values were collected simultaneously. We used a hierarchical linear regression model to assess the association between NIRS values and CI. We calculated a crude model with NIRS as the only factor included, and an adjusted model, where mean arterial pressure, end‐tidal CO2, and oxygen saturation were used as confounding factors. A total of 1301 pairs of NIRS and CI values were collected. The analysis of separate NIRS and CI pairs revealed a poor association, which was not statistically significant when adjusted with the chosen confounders. However, when the changes in NIRS from baseline or from the previous measurement were compared to those of CI, a clinically and statistically significant association between NIRS and CI was observed also in the adjusted model. Compared to the baseline and to the previous measurement, respectively, the regression coefficients with 95% confidence intervals were 0.048 (0.041–0.056) and 0.064 (0.055–0.073) in off‐pump coronary artery bypass patients and 0.022 (0.016–0.029) and 0.026 (0.020–0.033) in patients who underwent cardiopulmonary bypass. In an unselected cardiac surgical population, the changes in NIRS values reflect those in CI, especially in off‐pump coronary artery bypass patients. In this single‐center post hoc analysis of data from a prospectively collected database of cardiac surgery patients, paired measurements of cardiac output and NIRS revealed that while there was a no correlation between individual paired measurements, a small correlation was found in changes in the two measurements from baseline values. This highlights a potential to utilize changes in NIRS from baseline to suggest changes in cardiac output in cardiac surgical populations.
Abstract
Background
Low postoperative mixed venous oxygen saturation (SvO
2
) values have been linked to poor outcomes after cardiac surgery. The present study was designed to assess whether SvO
2
...values of < 60% at intensive care unit (ICU) admission and 4 h after admission are associated with increased mortality after cardiac surgery.
Methods
During the years 2007–2020, 7046 patients (74.4% male; median age, 68 years interquartile range, 60–74) underwent cardiac surgery at an academic medical center in Finland. All patients were monitored with a pulmonary artery catheter. SvO
2
values were obtained at ICU admission and 4 h later. Patients were divided into four groups for analyses: SvO
2
≥ 60% at ICU admission and 4 h later; SvO
2
≥ 60% at admission but < 60% at 4 h; SvO
2
< 60% at admission but ≥ 60% at 4 h; and SvO
2
< 60% at both ICU admission and 4 h later. Kaplan–Meier survival curves, Cox regression models, and receiver operating characteristic curve analysis were used to assess differences among groups in 30-day and 1-year mortality.
Results
In the overall cohort, 52.9% underwent coronary artery bypass grafting (CABG), 29.1% valvular surgery, 12.1% combined CABG and valvular procedures, 3.5% surgery of the ascending aorta or aortic dissection, and 2.4% other cardiac surgery. The 1-year crude mortality was 4.3%. The best outcomes were associated with SvO
2
≥ 60% at both ICU admission and 4 h later. Hazard ratios for 1-year mortality were highest among patients with SvO
2
< 60% at both ICU admission and 4 h later, regardless of surgical subgroup.
Conclusion
SvO
2
values < 60% at ICU admission and 4 h after admission are associated with increased 30-day and 1-year mortality after cardiac surgery. Goal-directed therapy protocols targeting SvO
2
≥ 60% may be beneficial. Prospective studies are needed to confirm these observational findings.
To determine whether central venous oxygen saturation (ScvO2) measurements could be used interchangeably with mixed venous oxygen saturation (SvO2) measurements in adult cardiac surgery patients.
A ...single-center prospective observational study.
A university hospital.
Eighty-five adult patients undergoing cardiac surgery.
The study authors compared the oxygen saturations in 590 pairs of venous blood samples drawn from the pulmonary artery catheter (PAC) at three different time points during surgery and four different time points in the intensive care unit. They compared samples obtained from the distal pulmonary artery line (SvO2) to those drawn from the proximal central venous line of the PAC (ScvO2) with the Bland-Altman test and the four-quadrant method.
The mean bias between SvO2 and ScvO2 was –1.9 (95% confidence interval CI, –2.3 to –1.5) and the limits of agreement (LOA) were –11.5 to 7.6 (95% CI, –12.5 to –10.7 and 6.8-8.5, respectively). The percentage error (PE) was 13.2%. Based on the four-quadrant plot, only 50% of the measurement pairs were in agreement, indicating deficient trending ability.
ScvO2 values showed acceptable accuracy as the mean bias was low. The precision was inadequate; although the PE was acceptable, the LOA were wide. Trending ability was inadequate. The authors cannot recommend the use of ScvO2 values interchangeably with SvO2 measurements in the management of adult cardiac surgery patients.
A pneumatic tourniquet is often used during ankle fracture surgery to reduce bleeding and enhance the visibility of the surgical field. Tourniquet use causes both mechanical and ischemic pain. The ...main purpose of this study was to evaluate the effect of tourniquet time on postoperative opioid consumption after ankle fracture surgery.
We retrospectively reviewed the files of 586 adult patients with surgically treated ankle fractures during the years 2014-2016. We evaluated post hoc the effect of tourniquet time on postoperative opioid consumption during the first 24 h after surgery. The patients were divided into quartiles by the tourniquet time (4-43 min; 44-58 min; 59-82 min; and ≥83 min). Multivariable linear regression analysis was used to evaluate the results.
Tourniquets were used in 486 patients. The use of a tourniquet was associated with an increase in the total postoperative opioid consumption by 5.1 mg (95 % CI 1.6-8.5; p=0.004) during the first 24 postoperative hours. The tourniquet time over 83 min was associated with an increase in the mean postoperative oxycodone consumption by 5.4 mg (95 % CI 1.2 to 9.7; p=0.012) compared to patients with tourniquet time of 4-43 min.
The use of a tourniquet and prolonged tourniquet time were associated with higher postoperative opioid consumption during the 24 h postoperative follow-up after surgical ankle fracture fixation. The need for ethical approval and informed consent was waived by the Institutional Review Board of Northern Ostrobothnia Health District because of the retrospective nature of the study.
The aim of the study was to determine if unresponsive mixed venous oxygen saturation (SvO
) values during early postoperative hours are associated with postoperative organ dysfunction.
A ...single-center retrospective observational study.
A university hospital.
A total of 6,282 adult patients requiring cardiac surgery who underwent surgery in a University Hospital from 2007 to 2020.
A pulmonary artery catheter was used to gather SvO
samples after surgery at admission to the intensive care unit (ICU) and 4 hours later. For the analysis, patients were divided into 4 groups according to their SvO
values. The rate of organ dysfunctions categorized according to the SOFA score was then studied among these subgroups.
The crude mortality rate for the cohort at 1 year was 4.3%. Multiple organ dysfunction syndrome (MODS) was present in 33.0% of patients in the early postoperative phase. During the 4-hour initial treatment period, 43% of the 931 patients with low SvO
on admission responded to goal-directed therapy to increase SvO
>60%; whereas, in 57% of the 931 patients, the low SvO
was sustained. According to the adjusted logistic regression analyses, the odds ratio for MODS (4.23 95% CI 3.41-5.25), renal- replacement therapy (4.97 95% CI 3.28-7.52), time on a ventilator (2.34 95% CI 2.17-2.52), and vasoactive-inotropic score >30 (3.62 95% CI 2.96-4.43) were the highest in the group with sustained low SvO
.
Patients with SvO
<60% at ICU admission and 4 hours later had the greatest risk of postoperative MODS. Responsiveness to a goal-directed therapy protocol targeting maintaining or increasing SvO
≥60% at and after ICU admission may be beneficial.
Background
Surgical treatment of ankle fracture is associated with significant pain and high postoperative opioid consumption. The anaesthesia method may affect early postoperative pain. The main ...objective of the study was to compare postoperative opioid consumption after ankle‐fracture surgery between patients treated with spinal anaesthesia and general anaesthesia.
Methods
We reviewed retrospectively the files of 586 adult patients with surgically treated ankle fracture in the years 2014 through 2016. The primary outcome was opioid consumption during the first 48 postoperative hours. Secondary outcomes were maximal pain scores, postoperative nausea and vomiting, the length of stay in the post‐anaesthesia care unit, and opioid use in different time periods up to 48 h postoperatively. Propensity score matching was used to mitigate confounding variables.
Results
Total opioid consumption 48 h postoperatively was significantly lower after spinal anaesthesia (propensity score‐matched population: effect size −13.7 milligrams; 95% CI −18.8 to −8.5; P < .001). The highest pain score on the numerical rating scale in the post‐anaesthesia care unit was significantly higher after general anaesthesia (propensity score‐matched population: effect size 3.7 points; 95% CI 3.2‐4.2; P < .001). A total of 60 patients had postoperative nausea and vomiting in the post‐anaesthesia care unit, 53 (88.3%) of whom had general anaesthesia (P = .001).
Conclusions
Patients with surgically treated ankle fracture whose operation was performed under general anaesthesia used significantly more opioids in the first 48 h postoperatively, predominantly in the post‐anaesthesia care unit, compared with patients given spinal anaesthesia.
The delay of percutaneous coronary intervention increases the risk of heart failure and mortality in STEMI. The aim of this study was to examine the time intervals of EMS and the factors associated ...with the time delay to angiography in patients with STEMI.
The present study was conducted in Northern Ostrobothnia, Finland in 2014–2016. All patients transported to the hospital by EMS who were diagnosed with STEMI and underwent a primary angiography within 24 h of arrival were included. Angiography was defined as delayed if it was performed over 120 min of the first medical contact (FMC).
310 patients met the inclusion criteria during the study period. Time from the FMC to angiography was less than 120 min in 231 patients (74.5%). In multivariate analysis, the factors associated with delayed angiography were the absence of chest pain (OR 2.46 (1.18–5.13),p = 0.016), dyspnea (OR 3.11 (1.54–6.28),p = 0.002), the treatment protocol violations by EMS (OR 2.41 (0.99–5.80),p = 0.050), treatment initiation at a primary health care center (OR 3.64 (1.39–9.48),p = 0.008), and the distance to hospital of over 100 km (OR 11.87 (6.14–22.93),p < 0.001).
In our study, treatment protocol violations, non-specific symptoms, and the distance to hospital of over 100 km were associated with primary angiography in patients with STEMI transported to the hospital by EMS.
The global epidemic of obesity and physical inactivity may have detrimental implications for young people's cognitive function and academic achievement. This prospective study investigated whether ...childhood motor function predicts later academic achievement via physical activity, fitness, and obesity. The study sample included 8,061 children from the Northern Finland Birth Cohort 1986, which contains data about parent-reported motor function at age 8 y and self-reported physical activity, predicted cardiorespiratory fitness (cycle ergometer test), obesity (body weight and height), and academic achievement (grades) at age 16 y. Structural equation models with unstandardized (B) and standardized (β) coefficients were used to test whether, and to what extent, physical activity, cardiorespiratory fitness, and obesity at age 16 mediated the association between childhood motor function and adolescents' academic achievement. Physical activity was associated with a higher grade-point average, and obesity was associated with a lower grade-point average in adolescence. Furthermore, compromised motor function in childhood had a negative indirect effect on adolescents' academic achievement via physical inactivity (B = -0.023, 95% confidence interval = -0.031, -0.015) and obesity (B = -0.025, 95% confidence interval = -0.039, -0.011), but not via cardiorespiratory fitness. These results suggest that physical activity and obesity may mediate the association between childhood motor function and adolescents' academic achievement. Compromised motor function in childhood may represent an important factor driving the effects of obesity and physical inactivity on academic underachievement.
Syllabification by hyphens (e.g., hy-phen-a-tion) is a standard procedure in early Finnish reading instruction. However, recent findings indicate that hyphenation slows down children's reading ...already during the first grade (Häikiö, Hyönä, & Bertram, 2015, 2016). In the present study, it was examined whether this slowdown is indicative of deeper processing and/or more strategic reading. To this end, 2nd grade children (N = 36) read short expository and narrative stories while their eye movements were registered. The presence of syllable boundary cue (SBC) was manipulated; for half of the stories, each word was hyphenated at syllable boundaries whereas the other half included no hyphenation. After each story, story comprehension (SC) was measured by three types of oral questions, namely free recall, cued recall, and true/false questions. With regard to reading behavior, SBC interacted with independently measured reading comprehension scores for both forward and regressive fixation times during first pass sentence reading. Hyphenation slowed down reading of good comprehenders to a larger extent than weaker comprehenders in comparison to nonhyphenated condition, especially for regressive fixation times. With respect to SC, cued recall scores were lower in the hyphenated than in the nonhyphenated condition. There was no effect of SBC in free recall or true/false questions. Hyphenation seems to promote phonological encoding even when readers might want to access words via orthographic codes, which are obscured by hyphenation, especially at the whole-word level. This more piecemeal reading style then makes it harder to integrate the pieces into a bigger whole, affecting not only reading speed but also reading comprehension.
Educational Impact and Implications Statement
Syllable structure is routinely marked with hyphens (e.g., syl-la-ble) in early Finnish reading instruction. The present study suggests that hyphens slow down 2nd grade children's reading and hinder their reading comprehension. These findings imply that the use of hyphenation in Finnish reading instruction needs to be reconsidered, especially as a one-style-fits-all approach.
The SARS-CoV-2 coronavirus disease (COVID-19) has had a major impact on health care services globally. Recent studies report that emergency departments have experienced a significant decline in the ...number of admitted patients in the early phase of the pandemic. To date, research regarding the influence of COVID-19 on emergency medical services (EMS) is limited. The present study investigates a change in the number and characteristics of EMS missions in the early phase of the pandemic.
All EMS missions in the Northern Ostrobothnia region, Finland (population 295 500) between 1 March to 30 June 2020 were screened and analyzed as the study group. A control group was composed from the EMS calls between the corresponding months in the years 2016-2019.
A total of 74 576 EMS missions were screened for the study. Within the first two months after the first COVID-19 cases in the study area, the decline in the number of EMS missions was 5.7% - 13% compared to the control group average. EMS time intervals (emergency call to dispatch, dispatch, en-route, on-scene and hospital handover) prolonged in the COVID-19 period. Dispatches concerning mental health problems increased most in the study period (+1.2%, p < 0.001). Only eleven confirmed COVID-19 infections were encountered by EMS in the study period.
Our findings suggest that the present COVID-19 pandemic and social restrictions lead to changes in the EMS usage. These preliminary findings emphasize the importance of developing new strategies and protocols in response to the oncoming pandemic waves.
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