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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. Methods: We conducted a single-center, randomized, controlled, outcome assessor--blinded clinical trial in adult patients, American Society of Anesthesiologists physical status classification 3 to 4 or undergoing high-risk surgery. Patients, whose serum albumin concentration dropped <30 g/L were randomly assigned to goal-directed albumin substitution maintaining serum concentration >30 g/L or to standard care until discharge from the postanesthesia intermediate care unit. Standard of care allowed albumin substitution in hemodynamic instable patients with serum concentration <20 g/L, only. Primary outcome was the incidence of postoperative complications ≥2 according to the Clavien-Dindo Classification in at least 1 of 9 domains (pulmonary, infectious, cardiovascular, neurological, renal, gastrointestinal, wound, pain, and hematological) until postoperative day 15. Results: Of 2509 included patients, 600 (23.9%) developed serum albumin concentrations <30 g/L. Human albumin 60 g (40--80 g) was substituted to 299 (99.7%) patients in the intervention group and to 54 (18.0%) in the standard care group. At least 1 postoperative complication classified as Clavien-Dindo Classification ≥ 2 occurred in 254 of 300 patients (84.7%) in the intervention group and in 262 of 300 (87.3%) in the standard treatment group (risk difference -2.7%, 95% CI, -8.3% to 2.9%). Conclusion: Maintaining serum albumin concentration of > 30 g/L perioperatively cannot generally be recommended in high-risk noncardiac surgery patients. [ABSTRACT FROM AUTHOR]

The article discusses a study which examined the dose of neostigmine and sugammadex for the reversal of a shallow residual neuromuscular block from a train-of-four (TOF) ratio of 0.5 to a ratio of 0.9 or higher in an average of 2 minutes. Recovery from neuromuscular block induced by rocuronium was assessed in the per-protocol population. The best fit modeling of the dose-response relationship revealed that 0.22 milligrams/kilogram (mg/kg) sugammadex accelerates recovery.

Purpose of Review: To examine the benefits of early mobilization and summarize the results of most recent clinical studies examining early mobilization in critically ill patients followed by a presentation of recent developments in the field., Recent Findings: Early mobilization of ICU patients, defined as mobilization within 72 h of ICU admission, is still uncommon. In medical and surgical critically ill patients, mobilization is well tolerated even in intubated patients. In neurocritical care, evidence to support early mobilization is either lacking (aneurysmal subarachnoid hemorrhage), or the results are inconsistent (e.g. stroke). Successful implementation of early mobilization requires a cultural change; preferably based on an interprofessional approach with clearly defined responsibilities and including a mobilization scoring system. Although the evidence for the majority of the technical tools is still limited, the use of a bed cycle ergometer and a treadmill with strap system has been promising in smaller trials., Summary: Early mobilization is well tolerated and feasible, resulting in improved outcomes in surgical and medical ICU patients. Implementation of early mobilization can be challenging and may need a cultural change anchored in an interprofessional approach and integrated in a patient-centered bundle. Scoring systems should be integrated to define daily goals and used to verify patients' achievements or identify barriers immediately.

Rationale and Objectives: To evaluate a newly developed algorithm for metal artifact reduction (MAR) in Computed Tomography (CT)., Methods: A projection interpolation algorithm for MAR with threshold-based metal segmentation was developed. First, the algorithm was tested with a simulated hip phantom. On demand, the presence of metallic inserts was simulated, representing total hip endoprostheses. Second, CT data of 20 patient with total hip endoprosthesis were reconstructed with and without application of the MAR algorithm. Image quality was independently assessed by 2 experienced radiologists using a qualitative score. The results of the in vitro study were evaluated with the Student's t test. Results of the in vivo study were analyzed using a repeated-measure analysis of variance., Results: Applying the MAR algorithm the phantom study showed no significant difference between images with and without simulated metal contributions. The patient study revealed improved image quality using the MAR algorithm. Results were statistically significant for fat (P=0.0097), vessels (P=0.0091), and bone (P=0.0005). Improvement of the image quality for muscle was not statistically significant (P=0.0287)., Conclusions: A new algorithm for metal artifact reduction was successfully introduced into clinical routine. The algorithm led to a robust reduction of metal artifacts. The MAR algorithm may serve for an improvement in image quality in patients with metallic implants.