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Healthcare
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Anesthesiology and Critical Care
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Anesthesiology and Critical Care

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Critical Care".

Deadline for manuscript submissions: 30 April 2024 | Viewed by 15279

Special Issue Editor

Dr. Krzysztof Laudanski

E-Mail Website
Guest Editor
Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA 19104, USA
Interests: critical care; anesthesiology

Special Issue Information

Dear Colleagues,

Anesthesiology as a medical specialty is uniquely positioned in healthcare delivery. For patients, anesthesia is critical in determining the outcome, satisfaction, and recovery from surgery and various procedures. The traditional paradigm of anesthesia limited to the hospital operating has dramatically evolved as more and more significant procedures are being carried out in outpatient facilities. Increased emphasis on perioperative outcome provides anesthesia services with the opportunity to expand into preoperative testing and conditioning to postoperative rehabilitation in or the potential expansion of anesthesia to maximize the benefit of stressful surgery. In healthcare systems, anesthesiology is critical to delivering uninterrupted healthcare delivery and providing care for most sick patients in intensive care. Finally, anesthesia-generated revenue is a key component in operating any healthcare system.

In this Special Issue of Healthcare, we invite original research, reviews, case reports, and implementation studies to demonstrate delivering anesthesiology services in the context of healthcare operations. We encourage both novel and forward-thinking concepts and well-grounded methodologically sound studies illustrating the value of anesthesia.

Dr. Krzysztof Laudanski
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • anesthesiology
  • critical care

Published Papers (6 papers)

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Research

9 pages, 1538 KiB  
Article
uNGAL Predictive Value for Serum Creatinine Decrease in Critically Ill Children
by Cristina Gavrilovici, Cristian Petru Duşa, Cosmin Teodor Mihai, Elena-Lia Spoială, Iuliana Magdalena Stârcea, Codruta Olimpiada Iliescu-Halitchi, Irina Nicoleta Zetu, Lavinia Bodescu-Amancei Ionescu, Roxana Alexandra Bogos, Elena Hanganu and Vasile Lucian Boiculese
Healthcare 2022, 10(8), 1575; https://doi.org/10.3390/healthcare10081575 - 19 Aug 2022
Cited by 1 | Viewed by 1280
Abstract
Acute kidney injury (AKI) occurs frequently in critically ill children, having an incidence of up to 26.9% and is associated with high morbidity and mortality in pediatric intensive care units (PICU). Currently, the decrease in the glomerular filtration rate is calculated using the [...] Read more.
Acute kidney injury (AKI) occurs frequently in critically ill children, having an incidence of up to 26.9% and is associated with high morbidity and mortality in pediatric intensive care units (PICU). Currently, the decrease in the glomerular filtration rate is calculated using the serum creatinine levels. Nevertheless, there may be a 48 h delay between the renal injury and measurable increase in creatinine. Urinary neutrophil gelatinase-associated lipocalin (uNGAL) has been validated in relation to cardiopulmonary bypass in children, being able to detect AKI before the functional change proven by the rise in serum creatinine. Our aim was to study the utility of using uNGAL in the management of critical pediatric patients admitted to our hospital in a six month period, more specifically, its capacity to predict AKI development, alone and in the association with the renal angina index (RAI). Twenty-eight critically ill children aged from 1 day to 15 years have been included. We found that an increase in uNGAL in day 1 of admission in the PICU was significantly correlated with a decrease in creatinine clearance but not anymore in day 3. However, in our sample uNGAL did not show a significant predictability for AKI development nor the supplementary incorporation of RAI into the prediction model. Therefore, apart from cardiac surgery, the efficacy and utility or uNGAL in the management of critically ill children is still questionable. For the best prediction, we will need to incorporate not only the RAI or other PICU scores, but other biomarkers such as KIM-1, urinary cystatin, and IL 18 in larger samples. Full article
(This article belongs to the Special Issue Anesthesiology and Critical Care)
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12 pages, 668 KiB  
Article
The Impact of Delayed Symptomatic Treatment Implementation in the Intensive Care Unit
by Lesley Meng, Krzysztof Laudanski, Mariana Restrepo, Ann Huffenberger and Christian Terwiesch
Healthcare 2022, 10(1), 35; https://doi.org/10.3390/healthcare10010035 - 25 Dec 2021
Cited by 2 | Viewed by 3445
Abstract
We estimated the harm related to medication delivery delays across 12,474 medication administration instances in an intensive care unit using retrospective data in a large urban academic medical center between 2012 and 2015. We leveraged an instrumental variables (IV) approach that addresses unobserved [...] Read more.
We estimated the harm related to medication delivery delays across 12,474 medication administration instances in an intensive care unit using retrospective data in a large urban academic medical center between 2012 and 2015. We leveraged an instrumental variables (IV) approach that addresses unobserved confounds in this setting. We focused on nurse shift changes as disruptors of timely medication (vasodilators, antipyretics, and bronchodilators) delivery to estimate the impact of delay. The average delay around a nurse shift change was 60.8 min (p < 0.001) for antipyretics, 39.5 min (p < 0.001) for bronchodilators, and 57.1 min (p < 0.001) for vasodilators. This delay can increase the odds of developing a fever by 32.94%, tachypnea by 79.5%, and hypertension by 134%, respectively. Compared to estimates generated by a naïve regression approach, our IV estimates tend to be higher, suggesting the existence of a bias from providers prioritizing more critical patients. Full article
(This article belongs to the Special Issue Anesthesiology and Critical Care)
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8 pages, 212 KiB  
Article
The Impact of Endoscopy Sedation Information Sheets on the Level of Concern Regarding Possible Awareness in Patients Undergoing Endoscopy Sedation
by Zi Ping Tong, Lincoln Gan Lim, Alison Pighills, Matthew Hiskens and Danny Bartlett
Healthcare 2022, 10(1), 34; https://doi.org/10.3390/healthcare10010034 - 24 Dec 2021
Cited by 1 | Viewed by 1657
Abstract
Sedation encompasses a continuum from complete unconsciousness to drowsiness and anxiolysis where some awareness might be expected. Most patients undergoing endoscopy sedation expect to be completely unconscious during the procedure and thus have unmet expectations regarding their state of consciousness. This study aimed [...] Read more.
Sedation encompasses a continuum from complete unconsciousness to drowsiness and anxiolysis where some awareness might be expected. Most patients undergoing endoscopy sedation expect to be completely unconscious during the procedure and thus have unmet expectations regarding their state of consciousness. This study aimed to evaluate whether endoscopy sedation information sheets reduce the level of concern regarding possible awareness during endoscopy sedation at a major regional hospital. Our findings were that 28.8% of patients who received the endoscopy sedation information sheet (n = 82) were concerned about awareness during the procedure, compared to 36.5% of patients in the control group (n = 105). However, the difference was not statistically significant. We also found that the incidence of awareness was higher (13.9%) in the intervention group compared to 8.8% in the control group but, again, not statistically different. This study allowed us to elucidate the level of concern regarding possible awareness during sedation and the incidence of awareness during endoscopy sedation. This will enable future work investigating the role of endoscopy sedation information methods involving written and video material in assisting pre-procedure patient counselling. Full article
(This article belongs to the Special Issue Anesthesiology and Critical Care)
10 pages, 1542 KiB  
Article
Cognitive Aid for Anesthetic Preparation in An Emergency Situation: A Simulation-Based Study
by Emmanuel Rineau, Anna Collard, Lorine Jean, Sarah Guérin, Louise Maunoury, Ludovic Martin, Sigismond Lasocki and Maxime Léger
Healthcare 2021, 9(12), 1646; https://doi.org/10.3390/healthcare9121646 - 27 Nov 2021
Cited by 1 | Viewed by 4406
Abstract
When anesthesia checklists and preparations are performed urgently, omissions may occur and be deleterious to the patient. The aim of this study was to evaluate in simulation the interest of a cognitive aid to effectively prepare an anesthetic room for an emergency. In [...] Read more.
When anesthesia checklists and preparations are performed urgently, omissions may occur and be deleterious to the patient. The aim of this study was to evaluate in simulation the interest of a cognitive aid to effectively prepare an anesthetic room for an emergency. In a prospective single-center simulation-based study, 32 anesthesia residents had to prepare an anesthetic room in an emergency scenario, without cognitive aid in the first phase. Three months later (phase 2), they were randomly assigned to receive a cognitive aid (aid group) or no additional aid (control) and were involved in the same scenario. The primary outcome was the validation rate of each essential item in the first 5 min in phase 2. Eight items were significantly more frequently completed in the first 5 min in the aid group in phase 2 (vs. phase 1), compared with two only in the control group. However, there were no significant differences in the overall number of completed items between the two groups, as both groups completed significantly more items in phase 2, either in the first 5 min (19 (14–23) vs. 13 (9–15) in phase 1 for all residents, p < 0.001) or without time limit. Preparation times were reduced in phase 2 in both groups. In conclusion, the use of a cognitive aid allowed anesthesia residents to complete some safety items of a simulated urgent anesthesia preparation more frequently. In addition, despite daily clinical experience, a single simulation session improved anesthesia preparation and reduced the preparation time with or without cognitive aid. Full article
(This article belongs to the Special Issue Anesthesiology and Critical Care)
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11 pages, 266 KiB  
Article
The Practices of Anaesthesiologists in the Management of Patients with Sickle Cell Disease: Empirical Evidence from Cameroon
by Dominique Djomo Tamchom, Aristide Kuitchet, Raymond Ndikontar, Serge Nga Nomo, Hermine Fouda and Luc Van Obbergh
Healthcare 2021, 9(12), 1617; https://doi.org/10.3390/healthcare9121617 - 23 Nov 2021
Viewed by 1435
Abstract
Patients with sickle cell disease are more likely to undergo surgery during their lifetime, especially given the numerous complications they may develop. There is a paucity of data concerning the management of patients with sickle cell disease by anaesthesiologists, especially in Africa. This [...] Read more.
Patients with sickle cell disease are more likely to undergo surgery during their lifetime, especially given the numerous complications they may develop. There is a paucity of data concerning the management of patients with sickle cell disease by anaesthesiologists, especially in Africa. This study aimed to describe the practices of anaesthesiologists in Cameroon concerning the perioperative management of patients with sickle cell disease. A cross-sectional study was carried out over four months and involved 35 out 47 anaesthesiologists working in hospitals across the country, who were invited to fill a data collection form after giving their informed consent. The data were analysed using descriptive statistics and a binary logistic regression model. Among the 35 anaesthesiologists included in the study, most (29 (82.9%)) had managed patients with sickle cell disease for both emergency and elective surgical procedures. Most of them had never asked for a haematology consultation before surgery. Most participants (26 (74.3%)) admitted to having carried out simple blood transfusions, while 4 (11.4%) carried out exchange transfusions. The haemoglobin thresholds for transfusion varied from one practitioner to another, between <6 g/dL and <9 g/dL. Only 6 (17.1%) anaesthesiologists had a treatment guideline for the management of patients with sickle cell disease in the hospitals where they practiced. Only 9 (25.7%) prescribed a search for irregular agglutinins. The percentage of haemoglobin S before surgery was always available for 5 (14.3%) of the participants. The coefficient (0.06) of the occurrence of a haematology consultation before surgery had a significant influence on the probability of management of post-operative complications (coefficient 0.06, 10% level of probability). This study highlights the fact that practices in the perioperative management of patients with sickle cell disease in Cameroon vary greatly from one anaesthesiologist to another. We disclosed major differences in the current recommendations, which support the fact that even in Sub-Saharan countries, guidelines applicable to the local settings should be published. Full article
(This article belongs to the Special Issue Anesthesiology and Critical Care)
15 pages, 3067 KiB  
Article
Examination of Electrolyte Replacements in the ICU Utilizing MIMIC-III Dataset Demonstrates Redundant Replacement Patterns
by Mousa Ghannam, Parasteh Malihi and Krzysztof Laudanski
Healthcare 2021, 9(10), 1373; https://doi.org/10.3390/healthcare9101373 - 14 Oct 2021
Cited by 1 | Viewed by 2287
Abstract
Electrolyte repletion in the ICU is one of the most ubiquitous tasks in critical care, involving significant resources while having an unclear risk/benefit ratio. Prior data indicate most replacements are administered while electrolytes are within or above reference ranges with little effect on [...] Read more.
Electrolyte repletion in the ICU is one of the most ubiquitous tasks in critical care, involving significant resources while having an unclear risk/benefit ratio. Prior data indicate most replacements are administered while electrolytes are within or above reference ranges with little effect on serum post-replacement levels and potential harm. ICU electrolyte replacement patterns were analyzed using the MIMIC-III database to determine the threshold governing replacement decisions and their efficiency. The data of serum values for potassium, magnesium, and phosphate before and after repletion events were evaluated. Thresholds for when repletion was administered and temporal patterns in the repletion behaviors of ICU healthcare providers were identified. Most electrolyte replacements happened when levels were below or within reference ranges. Of the lab orders placed, a minuscule number of them were followed by repletion. Electrolyte repletion resulted in negligible (phosphate), small (potassium), and modest (magnesium) post-replacement changes in electrolyte serum levels. The repletion pattern followed hospital routine work and was anchored around shift changes. A subset of providers conducting over-repletion in the absence of clinical indication was also identified. This pattern of behavior found in this study supports previous studies and may allude to a universal pattern of over-repletion in the ICU setting. Full article
(This article belongs to the Special Issue Anesthesiology and Critical Care)
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