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Abstract Background Previous studies addressing teaching and learning in point-of-care ultrasound have primarily focussed on image interpretation and not on the technical quality of the images. We hypothesized that a limited intervention of 10 supervised examinations would improve the technical skills in Focus Assessed Transthoracic Echocardiography (FATE) and that physicians with no experience in FATE would quickly adopt technical skills allowing for image quality suitable for interpretation. Methods Twenty-one physicians with no previous training in FATE or echocardiography (Novices) participated in the study and a reference group of three examiners with more than 10 years of experience in echocardiography (Experts) was included. Novices received an initial theoretical and practical introduction (2 hours), after which baseline examinations were performed on two healthy volunteers. Subsequently all physicians were scheduled to a separate intervention day comprising ten supervised FATE examinations. For effect measurement a second examination (evaluation) of the same two healthy volunteers from the baseline examination was performed. Results At baseline 86% of images obtained by novices were suitable for interpretation, on evaluation this was 93% (p = 0.005). 100% of images obtained by experts were suitable for interpretation. Mean global image rating on baseline examinations was 70.2 (CI 68.0-72.4) and mean global image rating after intervention was 75.0 (CI 72.9-77.0), p = 0.0002. In comparison, mean global image rating in the expert group was 89.8 (CI 88.8-90.9). Conclusions Improvement of technical skills in FATE can be achieved with a limited intervention and upon completion of intervention 93% of images achieved are suitable for clinical interpretation.

Background: Intravenous therapies are essential for hospitalised patients. The rapid dissemination of portable ultrasound machines has eased ultrasound‐guided intravenous access and facilitated increased use of long peripheral venous catheters (LPCs). This study aimed to evaluate the clinical performance and complications of LPCs. Methods: Retrospective, observational single‐site study. Data from all consecutively inserted LPCs during a period of 18 months was evaluated. The primary endpoint was the all‐cause incidence rate of catheter removal. Secondary endpoints included specific reasons for the catheter removal and the associations between predefined characteristics of the patients, the infusions and the catheters with catheter failure. Results: During the period, 751 PVCs were inserted in 457 patients. The reasons for catheter removal were recorded in 563 cases. The overall incidence rate of catheter removal was 95.8/1000 catheter days (95% CI 88.4–103.8). The median dwell time was 8 days (IQR 5–14), and the total dwell time was 6136 days. Catheter failure occurred in 283 (50.3%) cases, of which the most common cause was phlebitis (n = 101, 17.9%). In multivariable analyses, the use of the cephalic vein was significantly associated with both all‐cause catheter failure (p <.001) and catheter failure due to phlebitis (p <.001). In multivariable analyses, vancomycin infusion was not significantly associated with all‐cause catheter failure (HR 1.15 (0.55–2.42), p =.71) or catheter failure due to phlebitis (HR 1.49 (0.49–4.53), p =.49). Conclusion: The overall incidence rate of catheter removal was 95.8/1000 catheter days, and the most common causes of catheter failure were phlebitis, infiltration and unintended catheter removal. The use of the cephalic vein was significantly associated with catheter failure in multivariable analyses. We did not find an association between vancomycin infusion and catheter failure in multivariable analyses. [ABSTRACT FROM AUTHOR]

Objective: Peri-operative myocardial injury (PMI) is common after non-cardiac surgery. Myocardial injury after non-cardiac surgery (MINS) describes patients with PMI who do not fulfil the definition of myocardial infarction. Existing guidelines recommend measuring peri-operative cardiac troponin levels in at-risk patients undergoing intermediate- or high-risk surgery to identify asymptomatic myocardial injury. The association between peri-operative cardiac troponins and a cumulative post-operative morbidity score, has not yet been described. This study aims to describe the association between peri-operative cardiac troponins, MINS, and cumulative post-operative complications at thirty days after vascular surgery. Design: A retrospective secondary analysis of an observational, single-center, cohort study. Method. All patients admitted for elective vascular surgery between September 2022 and November 2023 were included. High-sensitivity cardiac troponin I (hs-TnI) was obtained pre-operatively and on each of the first three post-operative days. MINS was defined as an absolute peak post-operative increase to more than the 99th percentile upper reference limit (47 ng/L) above pre-operative hs-TnI values. Post-operative complications were graded according to the Clavien-Dindo classification and summarized weighted by severity using the Comprehensive Complication Index (CCI). Outcomes were defined as the association between pre- and post-operative hs-TnI, and CCI. Due to an extremely skewed distribution, CCI was divided into CCI ≤ 26 and CCI >26. CCI >26 corresponds to a cumulated minimal complication burden equivalent to a Clavien-Dindo 3a complication. Multivariable logistic analyses were adjusted for age, smoking, any heart disease (valvular, coronary artery disease or left ventricular failure), renal dysfunction, smoking status, and surgery type. Results: 200 patients vascular surgery patients were included. 31 and 81 patients underwent open and percutaneous central vascular surgery, respectively, and 88 patients underwent open peripheral surgery. 9 patients were excluded from analysis due to missing hs-TnI values. 195 complications occurred in 97 patients [50.8%] of which 41 patients [42.3%] had a CCI >26. 11 patients [12.1%] developed MINS (median of increase 123 ng L-1 [88.5-2152]) of which 5 patients [45%] had a CCI >26. In univariable analyses, neither pre-operative, peak post-operative, nor the difference between the two (delta TnI) was significantly associated with a CCI >26 (odds ratio [OR]=1.008 ((95% confidence interval [CI]: 0.999-1.020), P=0.126), OR=1.000 ((95% CI: 0.999-1.000), P=0.109), OR=1.000 ((95% CI: 0.999-1.000), P=0.118)). There were no significant associations between pre-operative, peak post-operative, or delta TnI, and a CCI >26 in multivariable analyses (OR=1.007 ((95% CI: 0.998-1.020), P=0.205), OR=1.000 ((95% CI: 0.999-1.001), P= 0.251), OR=1.000 ((95% CI: 1.000-1.001), P=0.269)). Univariable analyses showed no significant associations between pre-operative or delta TnI and a CCI >26 among MINS patients (OR=1.022 ((95 % CI: 0.983-1.118), P= 0.404), OR=1.000 ((95% CI: 1.000-1.001), P= 0.390)) or non-MINS patients (OR=1.006 ((95% CI: 0.997-1.018), P= 0.187), OR=0.994 ((95% CI: 0.980-1.005), P= 0.281)). Pre-operative, post-operative, and delta hs-TnI were not associated with severe post-operative complications at thirty days in uni- and multivariable analyses. Larger studies are warranted to further evaluate this association in a larger sample size as our findings are possibly due to a type II error. [ABSTRACT FROM AUTHOR]

Fluid therapy is closely linked to patient outcome, but defining the correct fluid regime for the individual patient is exceedingly difficult. Giving patients too little fluid reduces forward organ oxygen delivery, whereas fluid excess builds up congestion in the systemic venous circulation. Venous congestion is claimed to be quantifiable with local organ venous Doppler profiles. This study aims to evaluate Doppler ultrasound indices of venous congestion as prognostic indicators for fluid responsiveness. This is an ongoing prospective clinical interventional study including 40 participants scheduled for elective cardiac surgery with planned insertion of a pulmonary artery catheter. The study protocol is initiated one hour after surgery in hemodynamic steady state. Ultrasound imaging of blood flow profiles from the renal, hepatic and portal veins are obtained. Subsequently, a fluid bolus of 7 ml/kg (ideal body weight) Ringer's acetate solution is administered over 15 minutes. Cardiac output is measured using bolus thermodilution immediately before and after fluid administration. The hepatic, portal and renal venous Doppler profiles are categorized based on the observed flow pattern in coherence with the VExUS grading system. Each venous Doppler profile corresponding to the three sample sites is stratified into three scores: normal (1 point), mild abnormality (2 points) and severe abnormality (3 points). The scores from each sample site and the cumulative score are evaluated for prediction of fluid responsiveness, defined as a >15% volume expansion induced increase in cardiac output. As of March 21st 2024, 25 out of 40 participants have been included in the study. Out of the 25 participants, 12 are identified as fluid responders based on their increase in cardiac output after receiving a fluid bolus. For venous Doppler ultrasound, the highest diagnostic accuracy is found for a cumulative score of 6 or under (0.58 (95% CI: 0.37, 0.78)) with a corresponding sensitivity of 1.00 (95% CI: 0.72, 1.00), specificity of 0.23 (95% CI: 0.05, 0.54), positive predictive value of 0.52 (95% CI: 0.30, 0.74) and negative predictive value of 1.00 (95% CI: 0.29, 1.00). For the renal Doppler profile, the highest diagnostic accuracy is observed at a score of 2 or under (0.52 (95% CI: 0.31, 0.72)) with a sensitivity of 0.92 (95% CI: 0.62, 1.00) and specificity of 0.15 (95% CI: 0.02, 0.45). For the hepatic Doppler profile, the highest diagnostic accuracy is observed at a score of 2 or under (0.54 (95% CI: 0.33, 0.74)) with a sensitivity of 0.73 (95% CI: 0.39, 0.94) and specificity of 0.38 (95% CI: 0.14, 0.68). For the portal Doppler profile, the highest diagnostic accuracy is observed at a score of 1 (0.56 (95% CI: 0.35, 0.76)) with a sensitivity of 0.58 (95% CI: 0.28, 0.85) and specificity of 0.54 (95% CI: 0.25, 0.81). Preliminary findings suggest that utilizing a modified Trendelenburg maneuver to predict fluid responsiveness are poor to moderate. The final results and conclusions will be presented at the congress [ABSTRACT FROM AUTHOR]

Perioperative hypotension is common and associated with major postoperative complications such as myocardial injury, renal injury, and death. However, the optimal blood pressure threshold remains unclear. This study aimed to describe the associations between intra- and postoperative blood pressures and postoperative outcomes, and how this association may be modified by the individual patients' preoperative night-time blood pressure. Design: A prospective, observational, single-centre study. Method: All patients admitted for elective vascular surgery between September 2022 and November 2023 were included. Preoperative resting blood pressure was measured the last day before surgery. Intraoperative and postoperative hypotension was expressed as time below a threshold of 65 mmHg. Outcomes was the association between intra- and postoperative times <65 mmHg and the Comprehensive Complication Index (CCI), and how this association was modified by preoperative night-time blood pressures. CCI sums up all postoperative complications weighted by severity. Due to an extremely skewed distribution, CCI was divided into CCI < 27 and CCI >26. CCI >26 corresponds to a cumulated minimal complication burden equivalent to a Clavien-Dindo 3A complication. Results: Open and percutaneous central vascular surgery was performed in 31 and 81 patients, respectively, and 88 peripheral surgeries were performed. Complications occurred in 98 patients of which 42 patients had an accumulated CCI > 26. In univariable analyses, the CCI > 26 group was associated with intraoperative time < 65 mmHg (OR 1.013 (95% CI 1.005-1.022), P<0.001), and postoperative time < 65 mmHg (OR 1.003 (95% CI 1.003-1.006), P=0.007). There was no significant interaction between intra/postoperative times < 65 mmHg and preoperative resting blood pressure (all P<0.14). In multivariable analyses including preoperative renal dysfunction, any heart disease (valve or left ventricle failure), smoking and surgery type, intraoperative time < 65 mmHg (OR 1.014 (95% CI 1.004-1.021), P=0.004) and postoperative time < 65mmHg (OR 1.004 (95% CI 1.001-1.006), P=0.005) remained significantly associated with severe complications. Intra- and postoperative times with MAP < 65 mmHg were significantly associated with severe complications in uni- and multivariable analyses. Preoperative resting blood pressure was not an effect-modifier. [ABSTRACT FROM AUTHOR]

Evidence in perioperative care is insufficient. There is an urgent need for large perioperative research programmes, including pragmatic randomised trials, testing daily clinical treatments and unanswered question, thereby providing solid evidence for effects of interventions given to a large and growing number of patients undergoing surgery and anaesthesia. This may be achieved through large collaborations. Collaboration for Evidence‐based Practice and Research in Anaesthesia (CEPRA) is a novel collaborative research network founded to pursue evidence‐based answers to major clinical questions in perioperative medicine. The aims of CEPRA are to (1) improve clinical treatment and outcomes and optimise the use of resources for patients undergoing anaesthesia and perioperative care, and (2) disseminate results and inform caretakers, patients and relatives, and policymakers of evidence‐based treatments in anaesthesia and perioperative medicine. CEPRA is inclusive in its concept. We aim to extend our collaboration with all relevant clinical collaborators and patient associations and representatives. Although initiated in Denmark, CEPRA seeks to develop an international network infrastructure, for example, with other Nordic countries. The work of CEPRA will follow the highest methodological standards. The organisation aims to structure and optimise any element of the research collaboration to reduce economic costs and harness benefits from well‐functioning research infrastructure. This includes successive continuation of trials, harmonisation of outcomes, and alignment of data management systems. This paper presents the initiation and visions of the CEPRA network. CEPRA aims to be inclusive, patient‐focused, methodologically sound, and to optimise all aspects of research logistics. This will translate into faster research conduct, reliable results, and accelerated clinical implementation of results, thereby benefiting millions of patients whilst being cost and labour‐saving. [ABSTRACT FROM AUTHOR]

Fluid therapy has a substantial impact on patient outcomes, but determining the optimal fluid regime for each individual patient is challenging. Passive leg raise is a validated method for predicting fluid responsiveness, but the method is rarely used in clinical practice due to its cumbersome execution. The modified Trendelenburg maneuver is more easily performed and increases preload, thereby simulating fluid administration. However, its validation is still pending. This study aims to evaluate the modified Trendelenburg maneuver as a predictive indicator for fluid responsiveness. This ongoing prospective clinical interventional study will include 40 participants. Patients scheduled for elective cardiac surgery with planned insertion of a pulmonary artery catheter are eligible for inclusion. The study protocol is initiated once hemodynamic stability is achieved, around one hour after surgery. Two interventions are performed. First, patients are subjected to a modified Trendelenburg maneuver: tilting the patient in the prone position from a 12° anti-Trendelenburg position to a 12° Trendelenburg position. Second, patients are repositioned to the 12° anti-Trendelenburg position and receive a fluid bolus of Ringer's acetate solution (7 mL/kg ideal body weight), administered over 15 minutes. Cardiac output (CO) is measured before and after the two interventions using the bolus thermodilution method. The analysis of the change in CO following the modified Trendelenburg maneuver is conducted in comparison to a >15% increase in CO after fluid administration, which defines fluid responsiveness. The optimal diagnostic threshold for fluid responsiveness using the modified Trendelenburg maneuver is obtained by the Youden index. As of March 27th, 2024, 28 out of 40 participants have been included in the study. Out of the 28 participants, 15 are identified as fluid responders based on their increase in cardiac output after receiving a fluid bolus. The area under the receiver operating curve for the change in CO following the modified Trendelenburg maneuver is 0.67 (95% CI: 0.46, 0.88) with an optimal diagnostic threshold of 34%. With the optimal diagnostic threshold of 34% or higher, the modified Trendelenburg maneuver was prognostic of fluid responsiveness with a sensitivity of 0.60 (95% CI: 0.32, 0.84), a specificity of 0.85 (95% CI: 0.55, 0.98), a positive predictive value of 0.82 (95% CI: 0.48, 0.98), a negative predictive value of 0.65 (95% CI: 0.38, 0.86) and a diagnostic accuracy of 0.71 (95% CI: 0.51, 0.87). Preliminary findings suggest that utilizing a modified Trendelenburg maneuver to predict fluid responsiveness are poor to moderate. The final results and conclusions will be presented at the congress. [ABSTRACT FROM AUTHOR]