Intraoperative prediction of postanaesthesia care unit hypotension.

Background: Postoperative hypotension is associated with adverse outcomes, but intraoperative prediction of postanaesthesia care unit (PACU) hypotension is not routine in anaesthesiology workflow. Although machine learning models may support clinician prediction of PACU hypotension, clinician acceptance of prediction models is poorly understood.

Methods: We developed a clinically informed gradient boosting machine learning model using preoperative and intraoperative data from 88 446 surgical patients from 2015 to 2019.

Initial Clinical Impressions of the Critical Care of COVID-19 Patients in Seattle, New York City, and Chicago.

Since the first recognition of a cluster of novel respiratory viral infections in China in late December 2019, intensivists in the United States have watched with growing concern as infections with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus-now named coronavirus disease of 2019 (COVID-19)-have spread to hospitals in the United States. Because COVID-19 is extremely transmissible and can progress to a severe form of respiratory failure, the potential to overwhelm available critical care resources is high and critical care management of COVID-19 patients has been thrust into the spotlight. COVID-19 arrived in the United States in January and, as anticipated, has dramatically increased the usage of critical care resources.

High Dose, Prolonged Epsilon Aminocaproic Acid Infusion, and Recombinant Factor VII for Massive Postoperative Retroperitoneal Hemorrhage following Splenectomy.

The antifibrinolytic agent -aminocaproic acid is used to decrease procedural blood loss in a variety of high risk surgeries. The utility of recombinant factor VII administration in massive hemorrhage has also been reported in a variety of settings, though the impact in a surgical context remains unclear. We describe the case of a patient who underwent massive open splenectomy and developed diffuse retroperitoneal bleeding on postoperative day one.

Case report: vancomycin-induced thrombocytopenia in a burn patient.

Objective: Report an unusual cause of thrombocytopenia in a burn patient and provide a brief review of causes of thrombocytopenia in critically ill patients.

Methods: Case report format and selected review of PubMed search including the search terms thrombocytopenia, critical illness, and vancomycin.

Results: Reports of vancomycin-induced thrombocytopenia are uncommon.

Closed-loop strategies for patient care systems.

Military operations, mass casualty events, and remote work sites present unique challenges to providers of immediate medical care, who may lack the necessary skills for optimal clinical management. Moreover, the number of patients in these scenarios may overwhelm available health care resources. Recent applications of closed-loop control (CLC) techniques to critical care medicine may offer possible solutions for such environments.

Economic stress and misaligned incentives in critical care medicine in the United States.

Objectives: This review will provide an overview of issues with economic ramifications intrinsic to the management of intensive care resources and identify some of the external pressures that ultimately influence the provision of intensive care services.

Design: A review of the current literature was performed.

Results: Economic stress is a reality of the management of intensive care resources.

Considerations in the aeromedical evacuation of a critically ill blast victim: lessons learned.

Rationale for the decision to transport and assessment of available resources are integral components of the decision for aeromedical evacuation of critically ill patients. We present the case of a 20-year-old man who sustained significant trauma after his vehicle struck a land mine. This case reviews and emphasizes the factors to consider in arriving at the decision to transport as well as the accurate assessment of available equipment and personnel resources.

Recovery room delirium predicts postoperative delirium after hip-fracture repair.

Unlabelled: In this study, we sought to determine the incidence of recovery room delirium in elderly patients having hip-fracture repair under general anesthesia and to discover whether recovery room delirium is associated with continuing postoperative delirium. In this prospective study, patients undergoing hip-fracture repair were anesthetized using a standardized protocol. In addition, postoperative pain management was standardized in both the postoperative anesthesia care unit and in the hospital ward.