Longitudinal Model Shifts of Machine Learning-Based Clinical Risk Prediction Models: Evaluation Study of Multiple Use Cases Across Different Hospitals.

Background: In recent years, machine learning (ML)-based models have been widely used in clinical domains to predict clinical risk events. However, in production, the performances of such models heavily rely on changes in the system and data. The dynamic nature of the system environment, characterized by continuous changes, has significant implications for prediction models, leading to performance degradation and reduced clinical efficacy.

Implementation of Evidence-Based International Recommendations Reduces Postoperative Delirium Rate in Patients Undergoing Cardiac Surgery or Interventions: A System-Based Quality Improvement Study.

Background: Delirium is a frequent and serious complication of cardiac procedures that can lead to serious long-term health restrictions. As primary prevention is more effective in reducing rate of delirium than the therapy itself, this study aimed to investigate the effect of a multidisciplinary delirium prevention bundle on the postoperative delirium rate in patients undergoing cardiac procedures.

Methods: In this system-based quality improvement study, a four-component delirium prevention bundle was implemented in patients undergoing cardiac procedures at a single high-volume center.

Evaluating gender bias in ML-based clinical risk prediction models: A study on multiple use cases at different hospitals.

Background: An inherent difference exists between male and female bodies, the historical under-representation of females in clinical trials widened this gap in existing healthcare data. The fairness of clinical decision-support tools is at risk when developed based on biased data. This paper aims to quantitatively assess the gender bias in risk prediction models.

Randomized feasibility trial for evaluating the impact of primary nursing on delirium duration during intensive care unit stay.

Objective: We tested the feasibility of a randomized controlled trial for comparing primary nursing with standard care.

Research Methodology: Elective cardiac surgical patients were eligible for inclusion. Patients with an intensive care unit stay of ≥ 3 days were followed up until intensive care unit discharge.

Self-reported exhaustion and a 4-item physical frailty index to predict the incidence of major complications after onco-geriatric surgery.

Background: The aim of this study was to analyze four pre-operative physical frailty indicators from a geriatric assessment (GA) independently and combined in a physical frailty index, in their ability to predict postoperative 30 d-complications.

Materials And Methods: In this secondary analysis of data from the published PERATECS study (ClinicalTrials.gov: NCT01278537), the predictive value of four physical frailty indicators from a defined GA battery was examined with univariable and multivariate logistic regression models in a sample of 493 onco-geriatric surgical patients.

Practical training concept for perfusionists at the heart and diabetes center Nordrhein-Westfalen.

Background: Increasing regulations and requirements of advisory bodies, in particular the Joint Federal Committee and the Medical Service of the health insurance funds, make it necessary to employ only demonstrably well-trained perfusionists. The minimum requirement for this staff is EBCP certification. Currently there is limited availability of such specialists on the German market.

European Pediatric Cardiac Anesthesia Fellowship Program: A First Proof of Concept.

The Pediatric Cardiac Anesthesia (PCA) fellowship is a demanding training program in Europe and the United States. Successful completion of the program requires years of training in anesthesiology, a thorough understanding of cardiovascular anatomy and physiology, and extensive experience in the perioperative management of neonates and children with heart disease. In the context of the first candidate to successfully complete the PCA program in Europe, this article presents excerpts from the design and structure of the European PCA program.

Intraoperative Blood Pressure Management and Its Effects on Postoperative Delirium After Cardiac Surgery: A Single-Center Retrospective Cohort Study.

Objectives: There is accumulating evidence that blood pressure management might be associated with end-organ dysfunction after cardiac surgery. This study aimed to investigate the impact of intraoperative hypotension (IOH) on adverse neurologic outcomes and mortality.

Design: A single-center retrospective cohort study.

How Would We Treat Our Own Cystic Fibrosis With Lung Transplantation?

Lung transplantation is the only therapy for patients with end-stage lung disease. In advanced lung diseases such as cystic fibrosis (CF), life expectancy increases, and it is important to recognize extrapulmonary comorbidities. Cardiovascular involvement, including pulmonary hypertension, right-heart failure, and myocardial dysfunction, are manifest in the late stages of CF disease.

PERSUADE Survey-PERioperative AnestheSia and Intensive Care Management of Left VentricUlar Assist DevicE Implantation in Europe and the United States.

Objective: To comprehensively assess relevant institutional variations in anesthesia and intensive care management during left ventricular assist device (LVAD) implantation.

Design: The authors used a prospective data analysis.

Setting: This was an online survey.

Peripheral cholinesterase activity is not correlated with postoperative delirium in urological surgery.

The value of biomarkers, such as acetylcholinesterase and butyrylcholinesterase, for guiding perioperative patients suffering from postoperative delirium and/or (possibly related) postoperative cognitive dysfunction is unclear. Only recently have different biomarkers are being explored to assess postoperative delirium's occurrence and/or course. The aim of this work is to investigate whether acetylcholinesterase and butyrylcholinesterase can help detect increased risks of the development and course of postoperative delirium in urological patients undergoing surgery.

Implementation of the Kidney Disease Improving Global Outcomes guidelines for the prevention of acute kidney injury after cardiac surgery: An international cohort survey.

Background: Increasing evidence from randomised controlled trials supports the implementation of a six-measure care bundle proposed by the Kidney Disease Improving Global Outcomes (KDIGO) guidelines in patients at high risk for acute kidney injury (AKI) to reduce its incidence after cardiac surgery.

Objective: To assess compliance with the KDIGO bundle in clinical practice.

Design: Prospective observational multinational study.

Patient-related effects of primary nursing : Protocol of a pilot randomized controlled trial.

Background: Since January 2022, a primary nursing system called process-responsible nursing (PP) has substituted the standard room care system in an intensive care unit (ICU) at our institution. The process of the development and implementation of PP is already being evaluated in a separate study as an actual analysis prior to implementation, as well as after 6 and 12 months.

Aim: This pilot randomized controlled trial (RCT) aims to test the feasibility of an RCT.

The Efficacy and Safety of a Low-Dose Tranexamic Acid Bolus-Only Protocol Compared with the Moderate-Dose Protocol in Valvular Heart Surgery.

In 873 propensity score-matched pairs of patients undergoing valvular heart surgery, we compared a "moderate dose" of tranexamic acid (TXA) protocol (group 1; median TXA dose: 24 mg/kg body weight) with a 1.5-g "bolus-only" protocol (group 2; median TXA dose: 19 mg/kg body weight). The number of transfused patients was higher in group 2 than in group 1 (74.

Transfusions and early outcomes in anaemic patients undergoing off- or on-pump coronary artery bypass grafting.

We retrospectively compared transfusion rates and early outcomes in 1621 consecutive patients with preoperative anaemia undergoing off-pump coronary artery bypass grafting (OPCAB) or on-pump coronary artery bypass grafting (ONCAB) surgery using a propensity score analysis with inverse probability of treatment weighting. Endpoints were transfusions, early morbidity, and mortality. Surgeries were performed by 45 dedicated OPCAB and/or ONCAB surgeons during the 10-year study period.

Association between post-operative delirium and use of volatile anesthetics in the elderly: A real-world big data approach.

Study Objective: Early post-operative delirium is a common perioperative complication in the post anesthesia care unit. To date it is unknown if a specific anesthetic regime can affect the incidence of delirium after surgery. Our objective was to examine the effect of volatile anesthetics on post-operative delirium.

Intraoperative Circulatory Support in Lung Transplantation: Current Trend and Its Evidence.

Lung transplantation has a high risk of haemodynamic complications in a highly vulnerable patient population. The effects on the cardiovascular system of the various underlying end-stage lung diseases also contribute to this risk. Following a literature review and based on our own experience, this review article summarises the current trends and their evidence for intraoperative circulatory support in lung transplantation.

Tranexamic Acid and the Risk of Delirium after Off-Pump Surgery.

We investigated whether in patients undergoing off-pump coronary artery bypass grafting surgery a single bolus of 1 g tranexamic acid (TXA) impacts the risk of postoperative delirium using the propensity score matching approach. In 2,757 pairs, the risk of delirium was 4.2% (TXA group) and 5.

Use of the CytoSorb® filter for elimination of residual therapeutic argatroban concentrations during heparinized cardiopulmonary bypass for heart transplantation.

Introduction: No antidote or established extracorporeal elimination strategy is available for argatroban. Hemadsorption facilitates elimination of smaller drugs.

Case Report: A 34-year-old patient underwent urgent heart transplantation.

Machine Learning-Based Prediction Models for Different Clinical Risks in Different Hospitals: Evaluation of Live Performance.

Background: Machine learning algorithms are currently used in a wide array of clinical domains to produce models that can predict clinical risk events. Most models are developed and evaluated with retrospective data, very few are evaluated in a clinical workflow, and even fewer report performances in different hospitals. In this study, we provide detailed evaluations of clinical risk prediction models in live clinical workflows for three different use cases in three different hospitals.

Early Use of Methylene Blue in Vasoplegic Syndrome: A 10-Year Propensity Score-Matched Cohort Study.

Background: Vasoplegic syndrome is associated with increased morbidity and mortality in patients undergoing cardiac surgery. This retrospective, single-center study aimed to evaluate the effect of early use of methylene blue (MB) on hemodynamics after an intraoperative diagnosis of vasoplegic syndrome (VS).

Methods: Over a 10-year period, all patients diagnosed with intraoperative VS (hypotension despite treatment with norepinephrine ≥0.