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Introduction: In Brazil, data show an important decrease in morbi-mortality of high-risk surgical patients over a 10-year high. The objective of this post-hoc study was to evaluate the mechanism explaining this trend in high-risk surgical patients admitted to Brazilian ICUs in two large Brazilian multicenter cohort studies performed 10 years apart. Methods: The patients included in the 2 cohorts studies published in 2008 and 2018 were compared after a (1:1) propensity score matching. Patients included were adults who underwent surgeries and admitted to the ICU afterwards. Results: After matching, 704 patients were analyzed. Compared to the 2018 cohort, 2008 cohort had more postoperative infections (OR 13.4; 95%CI 6.1–29.3) and cardiovascular complications (OR 1.5; 95%CI 1.0–2.2), as well as a lower survival ICU stay (HR = 2.39, 95% CI: 1.36–4.20) and hospital stay (HR = 1.64, 95% CI: 1.03–2.62). In addition, by verifying factors strongly associated with hospital mortality, it was found that the risk of death correlated with higher intraoperative fluid balance (OR = 1.03, 95% CI 1.01–1.06), higher creatinine (OR = 1.31, 95% CI 1.1–1.56), and intraoperative blood transfusion (OR = 2.32, 95% CI 1.35–4.0). By increasing the mean arterial pressure, according to the limits of sample values from 43 mmHg to 118 mmHg, the risk of death decreased (OR = 0.97, 95% CI 0.95–0.98). The 2008 cohort had higher fluid balance, postoperative creatinine, and volume of intraoperative blood transfused and lower mean blood pressure at ICU admission and temperature at the end of surgery. Conclusion: In this sample of ICUs in Brazil, high-risk surgical patients still have a high rate of complications, but with improvement over a period of 10 years. There were changes in the management of these patients over time. [ABSTRACT FROM AUTHOR]

Ketamine is unique among anesthetics and analgesics. The drug is a rapid-acting general anesthetic that produces an anesthetic state characterized by profound analgesia, preserved pharyngeal-laryngeal reflexes, normal or slightly enhanced skeletal muscle tone, cardiovascular and respiratory stimulation, and occasionally a transient and minimal respiratory depression. Research has demonstrated the efficacy of its use on anesthesia, pain, palliative care, and intensive care. Recently, it has been used for postoperative and chronic pain, as an adjunct in psychotherapy, as a treatment for depression and posttraumatic stress disorder, as a procedural sedative, and as a treatment for respiratory and/or neurologic clinical conditions. Despite being a safe and widely used drug, many physicians, such as intensivists and those practicing in emergency care, are not aware of the current clinical applications of ketamine. The objective of this narrative literature review is to present the theoretical and practical aspects of clinical applications of ketamine in intensive care unit and emergency department settings. [ABSTRACT FROM AUTHOR]

Background and objectives: Hypothermia occurs commonly during surgery and can cause postoperative complications. We aimed to describe the characteristics and outcomes of hypothermia in patients undergoing major surgeries. Methods: This prospective, observational, multicenter study of a nationally representative sample included all patients over 18 years of age admitted to an intensive care unit (ICU). Thirty ICUs were selected randomly at national level. The main outcome measure was the proportion of patients who developed postoperative hypothermia in the first 24 hours of ICU admission. Patients were divided into three groups based on temperature: <35°C, <36°C, and ≥36°C (no hypothermia). Patients' characteristics, postoperative complications, and risk factors were evaluated in all groups. To verify whether hypothermia was a strong risk factor for postoperative complications, a Kaplan–Meier curve was generated and adjusted using a Cox regression model. Results: In total, 738 patients had their temperatures measured. The percentage of patients with temperature <35°C (median [Q1-Q3], 34.7°C [34.3–34.9°C]) was 19.1% (95% confidence interval [CI] = 16.1–22.5) and that of patients with temperature <36°C (median [Q1-Q3], 35.4°C [35.0–35.8°C]) was 64% (95% CI = 58.3–70.0). The percentage of surgical complications was 38.9%. Patients with hypothermia were older, had undergone abdominal surgeries, had undergone procedures of longer duration, and had more comorbidities. A postoperative temperature ≤35°C was an independent risk for composite postoperative complications (hazard ratio = 1.523, 95% CI = 1.15–2.0), especially coagulation and infection. Conclusions: Inadvertent hypothermia was frequent among patients admitted to the ICU and occurred more likely after abdominal surgery, after a long procedure, in elderly patients, and in patients with a higher number of comorbidities. Low postoperative temperature was associated with postoperative complications. [ABSTRACT FROM AUTHOR]

Introduction: The health environment is an important reservoir for a multitude of microorganisms. Contact with environment surfaces contaminated with multidrugresistant organisms (MDROs) may be associated with healthcare-associated infections and higher hospital costs, morbidity, and mortality.(1) Objective: To perform a systematic review of clinical and microbiological outcomes associated with interventions based on use of sanitizers in hospital environment surfaces or medical devices. Methods: Published studies were identified through electronic literature search of PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and SCOPUS by three independent reviewers. All interventions based on use of sanitizers (in isolation or combined with other methods) and targeting the hospital environment or medical devices were included. No restrictions regarding patients and microorganisms were imposed. Bench studies, studies involving surface contamination with MDROs and animal studies were excluded. The quality of randomized controlled trials (RCTs) and non-randomized trials was assessed using the Cochrane Collaboration's tool and the Newcastle-Ottawa scale, respectively. Results: A total of 8,984 studies involving sanitizer interventions targeting the healthcare environment or medical devices were found. Of these, 26 were included in this review (Figure 1). Intervention effectiveness varied between studies. The five randomized studies which met the inclusion criteria involved the use of different sanitizers in disinfection: isopropyl alcohol swab, sodium hypochlorite (bleach), benzalkonium chloride swabs, quaternary ammonium disinfectant and UV-C light, bleach, and UV-C light, organosilane, hydrogen peroxide and silver vapor, and 65% ethyl alcohol. Environmental studies comprised two multicenter randomized trials and one single center randomized trial. All these studies assessed microbiological outcomes and only 6 included clinical outcomes. Studies focusing on medical device disinfection consisted of single center randomized trials and assessed microbiological outcomes. Selected studies involved the use of different chemical or physical-chemical cleaning and disinfection methods. Significant variation in cleaning and disinfection strategies in these settings reflect of lack of consensus on management of hospital rooms, medical devices and patients infected with MDROs. Conclusion: The efficacy of sanitizers was consistent across studies included in this systematic review. However, few RCTs were found, and most were limited to microbiological outcomes. More studies are urgently needed to evaluate the impact of environmental interventions on clinical outcomes. [ABSTRACT FROM AUTHOR]

Introduction: The environment is an important reservoir of microorganisms, especially multidrug-resistant (MR) organisms, which often tend to survive on surfaces (bed rails, door handles, computer keyboards) for extended periods of time. Evidence regarding the relationship between inadequate environmental hygiene practices and/or infrastructure and increased risk of healthcareassociated infections (HAIs) is unclear.(1,2) Objective: To identify hospital infrastructure patterns potentially associated with intensive care unit-acquired infections (ICU-AIs) using unsupervised machine learning techniques. Methods: Thirty-eight Brazilian hospitals located in different regions of the country were visited by healthcare professionals trained by the Research Group between November and December 2020. An instrument comprising 99 specifically designed questions and K-means clustering were used to examine potential relationships between items and presence of infection upon patient admission to respective intensive care units. The number of clusters was chosen according to the silhouette metric, as can be seen in figure 1. Results: Two groups (Group 0 and Group 1) were created after application of the K-means clustering algorithm. Findings revealed differences between hospital clusters, which may be related to the number of infections diagnosed upon admission. Intensive care unit-acquired infection rates were 28% higher in Group 0 relative to Group 1 hospitals (preliminary results; table 1). The three most distinguishing characteristics were: percentage of properly functioning liquid soap dispenser (58% and 100%, Group 0 and Group 1 respectively); percentage of alcohol solution dispensers in the unit (8% and 22%, Group 0 and Group 1 respectively); percentage of alcoholic solution availability in visible and readily accessible areas close to the point of care (10% and 60%, Group 0 and Group 1 respectively). Conclusion: Unsupervised machine learning methods (such as K-means) can be used to distinguish between hospitals according to infrastructure characteristics. Preliminary results suggest a relation between infrastructure and infection at admission. [ABSTRACT FROM AUTHOR]

Pulmonary aspiration of gastric residues during anesthesia is a potentially fatal complication for which no specific treatment is available. The primary way to prevent its occurrence in the context of elective surgeries is adherence to fasting protocols. However, some clinical conditions can prolong the gastric emptying time, and the risk of aspiration may exist despite adequate fasting. Recognizing the risk factors for gastroparesis allows the adoption of preventive methods and is the primary way to reduce morbidity and mortality from pulmonary aspiration. In this scenario, the anesthesiologist can investigate the gastric content by using ultrasound, adjust the anesthetic technique, and even postpone elective surgeries. Here, we describe incidental computed tomography finding of solid contents in the stomach of a patient without prior identification of the risk factors for gastroparesis. The patient underwent elective renal nodule ablation under general anesthesia after fasting for 9 hours. During the procedure, solid contents in the stomach were noted on computed tomography. Subsequently, it was discovered that the patient had been using semaglutide for 6 days and had not disclosed this information. Semaglutide use may represent a new and significant risk factor for anesthesia-related pulmonary aspiration. Until studies provide information on the appropriate perioperative management of patients using semaglutide, anesthesiologists need to adopt preventive measures to avoid aspiration. Awareness of this potential association and open communication among patients, physicians, and anesthesia teams are essential for enhancing patient safety. [ABSTRACT FROM AUTHOR]