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Abstract Background Adult cardiac surgery is often complicated by elevated blood losses that account for elevated transfusion requirements. Perioperative bleeding and transfusion of blood products are major risk factors for morbidity and mortality. Timely diagnostic and goal-directed therapies aim at the reduction of bleeding and need for allogeneic transfusions. Methods Single-centre, prospective, randomized trial assessing blood loss and transfusion requirements of 26 adult patients undergoing elective cardiac surgery at high risk for perioperative bleeding. Primary endpoint was blood loss at 24 h postoperatively. Random assignment to intra- and postoperative haemostatic management following either an algorithm based on conventional coagulation assays (conventional group: platelet count, aPTT, PT, fibrinogen) or based on point-of-care (PoC-group) monitoring, i.e. activated rotational thromboelastometry (ROTEM®) combined with multiple aggregometry (Multiplate®). Differences between groups were analysed using nonparametric tests for independent samples. Results The study was terminated after interim analysis (n = 26). Chest tube drainage volume was 360 ml (IQR 229-599 ml) in the conventional group, and 380 ml (IQR 310-590 ml) in the PoC-group (p = 0.767) after 24 h. Basic patient characteristics, results of PoC coagulation assays, and transfusion requirements of red blood cells and fresh frozen plasma did not differ between groups. Coagulation results were comparable. Platelets were transfused in the PoC group only. Conclusion Blood loss via chest tube drainage and transfusion amounts were not different comparing PoC- and central lab-driven transfusion algorithms in subjects that underwent high-risk cardiac surgery. Routine PoC coagulation diagnostics do not seem to be beneficial when actual blood loss is low. High risk procedures might not suffice as a sole risk factor for increased blood loss. Trial registration NCT01402739, Date of registration July 26, 2011.

Summary A survey was conducted among 2,000 Germans at the mainline platforms of the two largest train stations in Berlin: Bahnhof Zoo and Ostbahnhof. These German citizens were surveyed concerning coronary risk factors, symptom complexes, angina pectoris, and acute myocardial infarction. An additional 400 Germans were questioned for gender-specific differences in cardiovascular disease. Our findings revealed a balanced relationship between male and female survey participants, and between the two German areas of origin (i. e., former West and East Germany). The share of those with college or university degrees was 37%, and 10% of the participants came from medical professions. Those surveyed indicated that 21% had, either themselves or among family members, directly experienced symptoms of angina pectoris or suffered myocardial infarction. The survey disclosed considerable deficiencies of information: only 2% of those surveyed were able to answer all questions posed correctly. There was no difference in this respect between the genders, or between Germans from former West and East Germany. Young Germans (<25) are significantly less well informed than are older (> 60). The results of this survey are alarming. They clearly reveal that the great majority of the population is unable, in the event of cardiac emergency, to take advantage of the unique possibilities in Germany that are offered by its infrastructure of cardiac medical centers and its tightly meshed network of facilities for left-ventricular catheterization and cardiac surgery. This ignorance exists despite the fact that German taxpayers, with their billions of investments, have created some of the best facilities for such treatment in the world. Ongoing programs of public education are therefore urgently necessary to ensure satisfactory post-infarction utilization of already existing medical capacities. A total of 77% of those surveyed expressed the need and a desire for more information, and 70% placed the blame for these deficiencies on publichealth politicians and their lack of commitment. [ABSTRACT FROM AUTHOR]

Noise is a proven cause of wakefulness and qualitative sleep disturbance in critically ill patients. A sound pressure level reduction can improve sleep quality, but there are no studies showing the feasibility of such a noise reduction in the intensive care unit (ICU) setting. Considering all available evidence, we redesigned two ICU rooms with the aim of investigating the physiological and clinical impact of a healing environment, including a noise reduction and day-night variations of sound level. Within an experimental design, we recorded 96 h of sound-pressure levels in standard ICU rooms and the modified ICU rooms. In addition, we performed a sound source observation by human observers. Our results show that we reduced A-weighted equivalent sound pressure levels and maximum sound pressure levels with our architectural interventions. During night-time, the modification led to a significant decrease in 50 dB threshold overruns from 65.5% to 39.9% (door side) and from 50% to 10.5% (window side). Sound peaks of more than 60 decibels were significantly reduced from 62.0% to 26.7% (door side) and 59.3% to 30.3% (window side). Time-series analysis of linear trends revealed a significantly more distinct day-night pattern in the modified rooms with lower sound levels during night-times. Observed sound sources during night revealed four times as many talking events in the standard room compared to the modified room. In summary, we show that it is feasible to reduce sound pressure levels using architectural modifications. [ABSTRACT FROM AUTHOR]

: Background Delirium is often seen in the recovery room and is a predictor for postoperative delirium on the ward. However, monitoring to detect delirium in the recovery room as a basic prerequisite for early intervention is rarely used. The aim of this study was to identify a valid and easy-to-use test for early screening of delirium in the recovery room. : Methods One hundred and fifty-four adult patients admitted to the recovery room during regular working hours were included. A screening assessment for delirium was performed in the recovery room by a trained research team at the time when the patient was judged to be ‘ready for discharge’. Delirium monitoring was performed with the Confusion Assessment Method (CAM), the Delirium Detection Score (DDS), and the Nursing Delirium Screening Scale (Nu-DESC). The Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV criteria were used as the gold standard. : Results Delirium in the recovery room was seen in 21 patients (14%) with the DSM-IV criteria, in 11 patients (7%) with the CAM, in four patients (3%) with the DDS, and in 37 patients (24%) with the Nu-DESC. Sensitivity and specificity were 0.43 and 0.98 for the CAM, 0.14 and 0.99 for the DDS, and 0.95 and 0.87 for the Nu-DESC, respectively. : Conclusions All scores used were very specific, but the CAM and the DDS were less sensitive compared with the gold standard. Overall, the Nu-DESC was the most sensitive test in the recovery room to detect delirium. [ABSTRACT FROM AUTHOR]