Predictors of 30-Day In-Hospital Mortality in Patients Undergoing Urgent Abdominal Surgery Due to Acute Peritonitis Complicated with Sepsis.

BACKGROUND Sepsis is a life-threatening condition with high morbidity and mortality rate. Identifying early prediction factors of critical situations in intra-abdominal sepsis patients can help reduce mortality rates. This prospective study was carried out to evaluate the association of technically available factors with 30-day in-hospital mortality. MATERIAL AND METHODS There were 67 intra-abdominal sepsis patients included in the study; patients were observed for 30 days postoperatively. The data was processed using SPSS24.0 statistical analysis package. All tests that had a significance level of 0.05 were selected. RESULTS Septic shock in association with increase in age per year showed increase the odds of mortality and prognosed 30-days in hospital mortality correctly in 79% of cases. The observed OR was 12.24 (P<0.001). Multiple logistic regression model 2 for the 30-day mortality identified a combination of septic shock, age (≥70 years), time from peritonitis symptoms to surgery prognose mortality with accuracy of 82%. The most accurate model to prognose 30-day in-hospital mortality included the presents of septic shock, age, time from peritonitis symptoms to surgery, drop of MAP <65 mmHg) post-induction, the odds of mortality 8.86 (P=0.001). Severe hypotension post-induction was more frequent in patients who were not diagnosed with sepsis (P=0.035). CONCLUSIONS The present study revealed a simple indicator for the risk for death under diffuse peritonitis patients complicated with sepsis. Septic shock, increase in age per year, peritonitis symptoms lasting more than 30 hours, and severe hypotension post-induction had a negative prognostic value for mortality in patients with intra-abdominal sepsis, and might be a high risk for 30-day mortality.

Can the inferior vena cava collapsibility index be useful in predicting hypotension during spinal anaesthesia in a spontaneously breathing patient? A mini fluid challenge.

The study was performed at the Department of Orthopaedics and Traumatology of the Kauno Klinikos Hospital of Lithuanian University of Health Sciences. BACKGROUND: Intravascular fluids are empirically administered to prevent hypotension induced by spinal anaesthesia. Ultrasound measurements of the inferior vena cava (IVC) and the IVC collapsibility index (IVC-CI) is a non-invasive method to evaluate the intravascular volume status. The aim of the study was to identify the prognostic value of the IVC collapsibility index in spontaneously breathing patients to predict severe intraoperative hypotension. MATERIALS AND METHODS: Sixty patients undergoing elective knee arthroplasty under spinal anaesthesia were included in the prospective study. The diameters of IVCex, IVCin, and IVC-CI were measured before and 15 min after spinal anaesthesia when administration of 500 ml of normal saline using infusion pump was finished. The haemodynamic parameters (heart rate, systolic, diastolic, and mean blood pressures, breathing rate) were collected. RESULTS: Severe arterial hypotension was noticed in 18.3% of the patients. No statistically significant differences were detected between changes in IVCex, IVCin, and IVC-CI comparing hypotensive and non-hypotensive patients at the baseline and after the interventions (p > 0.005). According to receiver operating characteristic (ROC) analysis, IVC-CI is not effective in the prediction of severe hypotension during spinal anaesthesia in spontaneously breathing patients: the area under the ROC curve for IVC-CI was <0.7, p > 0.05. CONCLUSIONS: IVC-CI is not an effective predictor of severe hypotension after induction of spinal anaesthesia followed by normal saline administration in spontaneously breathing patients undergoing elective knee arthroplasty. More trials, including different patient subgroups, will be needed.

Measurements of Inferior Vena Cava Diameter for Prediction of Hypotension and Bradycardia during Spinal Anesthesia in Spontaneously Breathing Patients during Elective Knee Joint Replacement Surgery.

Background and objective: Hypotension and bradycardia are the most common hemodynamic disorders and side effects of spinal anesthesia (SA) on the cardiovascular system. SA-induced sympathetic denervation causes peripheral vasodilatation and redistribution of central blood volume that may lead to decreased venous return to the heart. The aim of the study was to evaluate the changes of inferior vena cava collapsibility index (IVC-CI) during SA in spontaneously breathing patients during elective knee joint replacement surgery to prognose manifestation of intraoperative hypotension and bradycardia. Materials and methods: 60 patients (American Society of Anesthesiologists (ASA) physical status I or II, no clinically significant cardiovascular pathology) of both sexes undergoing elective knee joint replacement surgery under SA were included in the prospective study. Inspiratory and expiratory inferior vena cava (IVCin, IVCex) diameters were measured using an ultrasound device in supine position before and immediately after SA, then 15 min, 30 min, and 45 min after SA was performed. The heart rate, along with systolic, diastolic, and mean arterial blood pressures were collected. The parameters were measured at the baseline and at the next four time points. Results: There were no significant changes in IVCin, IVCex, and IVC-CI compared to baseline and other time point measurements in hypotensive versus nonhypotensive and bradycardic versus nonbradycardic patients (p > 0.05). Changes in IVC diameter do not prognose hypotension and/or bradycardia during SA: the area under the curve (AUC) of the receiver operating characteristic (ROC) curve for IVC-CI at all measuring points was <0.7, p > 0.05. Conclusions: Reduction in IVC diameters and increase in IVC-CI do not predict hypotension and bradycardia during SA in spontaneously breathing patients undergoing elective knee joint replacement surgery.

Public Knowledge, Beliefs and Behavior on Antibiotic Use and Self-Medication in Lithuania.

Irrational antibiotic use has led society to antibiotic resistance-a serious health problem worldwide. This study aimed to assess public knowledge, beliefs, and behavior concerning antibiotic use and self-medication in Lithuania. The cross-sectional survey method was processed using a validated questionnaire in different regions of Lithuania. In total, 1005 adults completed the questionnaire and were included in the study. More than half of the respondents (61.1%) had poor knowledge of antibiotics. Almost half of the respondents incorrectly identified antibiotics as being effective either against viral (26.0%) or mixed (bacterial and viral) infections (21.7%). The respondents with lower educational qualifications (OR = 2.515; 95% CI 1.464-4.319; p = 0.001) and those from rural areas (OR = 1.765; 95% CI 1.041-2.991; p = 0.035) were significantly less knowledgeable of antibiotics. There was no significant difference between genders, different age groups, or different parenthood status. The determined level of self-medication with antibiotics was 31.0%. The men (OR = 1.650; 95% CI 1.120-2.430; p = 0.011), the respondents from rural areas (OR = 2.002; 95% CI 1.343-2.985; p = 0.001), and those without children (OR = 2.428; 95% CI 1.477-3.991; p < 0.001) were more likely to use antibiotics in self-medication. Lithuanian residents' knowledge of antibiotics is insufficient. More information about antibiotic use should be provided by physicians and pharmacists. Self-medication with antibiotics is a serious problem in Lithuania and requires considerable attention.