Transthoracic Echocardiography for Central Venous Catheter Tip Positioning in Children: An Observational Study Using Transesophageal Echocardiography as Reference Method.

Background: Children who need to have major surgery or are critically ill often require the insertion of a central venous catheter (CVC). To avoid serious complications, it is important to correctly position the CVC tip at the junction of the distal superior vena cava and the right atrium (cavoatrial junction). Transthoracic echocardiography (TTE) can be used to confirm the correct position of the CVC tip.

Wire-in-needle versus conventional syringe-on-needle technique for ultrasound-guided central venous catheter insertion in the internal jugular vein: the WIN randomized trial.

Purpose: There are different techniques for ultrasound-guided central venous catheter (CVC) insertion. When using the conventional syringe-on-needle technique, the syringe needs to be removed from the needle after venous puncture to pass the guidewire through the needle into the vein. When, alternatively, using the wire-in-needle technique, the needle is preloaded with the guidewire, and the guidewire-after venous puncture-is advanced into the vein under real-time ultrasound guidance.

Processed electroencephalography-guided general anesthesia and norepinephrine requirements: A randomized trial in patients having vascular surgery.

Study Objective: Processed electroencephalography (pEEG) may help clinicians optimize depth of general anesthesia. Avoiding excessive depth of anesthesia may reduce intraoperative hypotension and the need for vasopressors. We tested the hypothesis that pEEG-guided - compared to non-pEEG-guided - general anesthesia reduces the amount of norepinephrine needed to keep intraoperative mean arterial pressure above 65 mmHg in patients having vascular surgery.

Medical student´s motivational changes during the COVID-19 university lockdown: a mixed-method study.

Background: During the crucial stage of the COVID-19 pandemic, face-to-face undergraduate medical education was disrupted and replaced with online teaching activities. Based on its emphasized impact on several outcomes, a deeper insight into the pandemic related effects on medical students´ motivation is aspirational. Therefore, this study aimed to assess the motivational changes that took place during the pandemic in medical students and explored, how motivation of medical students is influenced.

The Urethral Perfusion Index During Off-Pump Coronary Artery Bypass Surgery: An Observational Study.

Objectives: The IKORUS system (Vygon, Écouen, France) allows continuous monitoring of the urethral perfusion index (uPI) using a photoplethysmographic sensor mounted near the base of the balloon of a dedicated urinary catheter. We aimed to test the hypothesis that the uPI decreases during off-pump coronary artery bypass (OPCAB) surgery and to investigate the relationship between the uPI and macrocirculatory variables.

Design: Prospective observational study.

Unloading, ablation, bridging and transplant: different indications and treatments using the Impella 5.5 as longer-term circulatory support in one patient-an interdisciplinary case report.

Background: In patients with cardiogenic shock the clinical treatment often involves temporary mechanical circulatory support for initial haemodynamic stabilization to enable further assessment of therapeutic strategies. The surgically implanted Impella 5.5 can be used for several indications like ventricular unloading, haemodynamic support during high-risk interventions, and as a bridge-to-transplant strategy.

National consensus on entrustable professional activities for competency-based training in anaesthesiology.

Entrustable Professional Activities (EPA) are specialty specific tasks or responsibilities, combining the clinical workplace and the long-demanded competency-based medical education. The first step to transform time-based into EPA-based training is to reach consensus on core EPAs that describe sufficiently the workplace. We aimed to present a nationally validated EPA-based curriculum for postgraduate training in anaesthesiology.

The impact of a standardized Enhanced Recovery After Surgery (ERAS) protocol in patients undergoing minimally invasive heart valve surgery.

Background: An enhanced recovery after surgery (ERAS) protocol is a multimodal and multi-professional strategy aiming to accelerate postoperative convalescence. Pre-, intra- and postoperative measures might furthermore reduce postoperative complications and hospital length of stay (LOS) in a cost-effective way. We hypothesized that our unique ERAS protocol leads to shorter stays on the intensive care unit (ICU) and a quicker discharge without compromising patient safety.

Can Different Admissions to Medical School Predict Performance of Non-Technical Skill Performance in Simulated Clinical Settings?

Non-technical skills (NTS) in medical care are essential to ensure patient safety. Focussing on applicants' NTS during medical school admission could be a promising approach to ensure that future physicians master NTS at a high level. Next to pre-university educational attainment, many selection tests have been developed worldwide to facilitate and standardise the selection process of medical students.

Preliminary Experience of Extracorporeal Cytokine Hemoadsorption during Left Ventricular Assist Device Implantation in Cardiogenic Shock Patients.

Background:  Systemic inflammation due to cardiogenic shock is associated with vasoplegia leading to organ hypoperfusion, right heart failure, and poor clinical outcome. Extracorporeal cytokine hemoadsorption emerged to attenuate excessive levels of inflammatory cytokines, potentially improving patient outcomes. Nevertheless, its prognostic impact during high-risk left ventricular assist device (LVAD) implantation remains unknown.

A new noninvasive finger sensor (NICCI system) for cardiac output monitoring: A method comparison study in patients after cardiac surgery.

Background: The new noninvasive finger sensor system NICCI (Getinge; Gothenburg, Sweden) allows continuous cardiac output monitoring. We aimed to investigate its cardiac output measurement performance.

Objectives: To investigate the NICCI system's cardiac output measurement performance.

Pulse Wave Analysis Using the Pressure Recording Analytical Method to Measure Cardiac Output in Pediatric Cardiac Surgery Patients: A Method Comparison Study Using Transesophageal Doppler Echocardiography as Reference Method.

Background: Cardiac output (CO) is a key determinant of oxygen delivery, but choosing the optimal method to obtain CO in pediatric patients remains challenging. The pressure recording analytical method (PRAM), implemented in the MostCareUp system (Vygon), is an invasive uncalibrated pulse wave analysis (PWA) method to measure CO. The objective of this study is to compare CO measured by PRAM (PRAM-CO; test method) with CO simultaneously measured by transesophageal Doppler echocardiography (TEE-CO; reference method) in pediatric patients.

The Relation Between Mean Arterial Pressure and Cardiac Index in Major Abdominal Surgery Patients: A Prospective Observational Cohort Study.

Background: Cardiac output is an important hemodynamic variable and determines oxygen delivery. In contrast to blood pressure, cardiac output is rarely measured even in high-risk surgical patients, suggesting that clinicians consider blood pressure to be a reasonable indicator of systemic blood flow. However, the relationship depends on constant vascular tone and volume, both of which routinely vary during anesthesia and surgery.

The effects of simulation-based education on medical students' motivation.

Objectives: To assess the effects of simulation-based education on medical students' motivation and to compare these effects with the motivational effects of a classical teaching approach (seminar).

Methods: In this cross-sectional study, motivational qualities of 164 3rd year medical students, who participated in four mandatory simulation-based training and two seminars of the department of anaesthesiology, were assessed. Comparative analysis was made to determine differences and changes of motivation towards participating in each teaching unit and each teaching format, using a one-way analysis of variance and unpaired t-tests.

Flipped learning enhances non-technical skill performance in simulation-based education: a randomised controlled trial.

Background: Many efforts of the past years aimed to build a safer health care system and hereby, non-technical skills (NTS) have been recognised to be responsible for over 70 % of preventable medical mishaps. In order to counteract those mishaps, several simulation-based trainings have been implemented in health care education to convey NTS. Still, the best and effective way to foster NTS in simulation-based training is not known.

Understanding how the motivational dimension of learning is influenced by clinical teaching in medical education: A prospective cohort study.

Introduction: Many changes of medical curricula have been conducted in the past years. Based on learning psychology, three dimensions of learning have to be covered, in order to create the best possible curricula: Cognitive, metacognitive and motivational. The metacognitive and cognitive dimension (what/how to teach) have always been considered and the motivational dimension has been neglected, although the importance and benefits of motivation in learning have been emphasized repeatedly.

Understanding Why All Types of Motivation Are Necessary in Advanced Anaesthesiology Training Levels and How They Influence Job Satisfaction: Translation of the Self-Determination Theory to Healthcare.

Studies applying the self-determination theory have shown that intrinsic motivation and autonomous regulation lead to job satisfaction and to better job performance. What has not been worked out clearly yet are the effects of extrinsic motivation and controlled regulation on affect, job performance and job satisfaction. However, it has been described that controlled regulation is often necessary for mundane tasks.

Economic impact of enhanced recovery after surgery protocol in minimally invasive cardiac surgery.

Background: ERAS (Enhanced Recovery After Surgery) is a multidisciplinary and integrative approach with the goal of optimizing the postoperative recovery. We aimed to analyze the economic impact of a newly established ERAS protocol in minimally invasive heart valve surgery at our institution.

Methods: ERAS protocol was implemented in 61 consecutive patients who were referred for elective minimally-invasive aortic or mitral valve surgery, between February 1, 2018 and March 31, 2019 (ERAS-group).

Correlation of medical students' situational motivation and performance of non-technical skills during simulation-based emergency training.

Background: Non-technical skills (NTS) are an indispensable element of emergency care and need to be prevalent alongside with good technical skills. Though, questions of how to teach (instructional design) and improve NTS effectively remain unresolved. One adjustment screw to enhance performance of NTS, which is detached from instructional designs and learning efforts might be motivation.

Development and validation of a postgraduate anaesthesiology core curriculum based on Entrustable Professional Activities: a Delphi study.

Postgraduate training curricula should not be based on time-spans or predefined numbers of performed procedures. One approach to link competencies to clinical tasks is the concept of Entrustable Professional Activities (EPA). The goal of this study was the definition, ranking and validation of EPAs for anaesthesiology postgraduate training and the creation of an anaesthesiologic core curriculum.