OBJECTIVES: Sleep disturbances may contribute to the development of delirium, prolonged ICU stay, and increased mortality. There is conflicting data on the effectiveness of earplugs and eye masks for sleep promotion in the ICU. This study evaluates the impact of earplugs and eye masks on sleep quality in postoperative surgical ICU patients at risk for frequent awakenings. DESIGN: Prospective randomized controlled trial. SETTING: Surgical ICU within the University of Texas Southwestern Medical Center. PATIENTS: Adult, female patients admitted to the surgical ICU requiring hourly postoperative assessments following breast free flap surgery between February 2018 and October 2019. INTERVENTIONS: Patients were randomized into an intervention group or a control group. The intervention group received earplugs and eye masks in addition to standard postoperative care, whereas the control group received standard postoperative care. MEASUREMENTS AND MAIN RESULTS: The primary outcome was overall sleep quality assessed via the Richards-Campbell Sleep Questionnaire. Secondary outcomes of patient satisfaction and rates of ICU delirium were assessed with a modified version of the Family Satisfaction in the ICU survey and the Confusion Assessment Method for the ICU. After a planned interim analysis, the study was stopped early because prespecified criteria for significance were attained. Compared with the control group’s average Richards-Campbell Sleep Questionnaire total score of 47.3 (95% CI, 40.8–53.8), the intervention group’s average Richards-Campbell Sleep Questionnaire total score was significantly higher at 64.5 (95% CI, 58.3–70.7; p = 0.0007). There were no significant between-group differences for Confusion Assessment Method for the ICU scores or modified Family Satisfaction in the ICU survey scores. CONCLUSIONS: These results suggest that earplugs and eye masks are effective in improving sleep quality in ICU patients undergoing frequent assessments. The results strengthen the evidence for nonpharmacologic sleep-promoting adjuncts in the ICU.

International audienceIntroduction : In order to evaluate whether cardiologists follow guidelines, we studied patients who were seen for a pre-operative cardiologic consultation prior to surgery. Methods This retrospective study took place in two surgical units (Vascular and Orthopaedic) in two different university hospitals in 2013. The patient eligibility criteria were: planned elective surgery, cardiologic consultation prior to anaesthesiology consultation and lack of any unstable cardiac condition. The primary endpoint was determination of appropriate use of preoperative cardiac stress exams (CSE). Results : The study included 238 patients who were seen by 131 different cardiologists. Of 238 patients, 60 had a CSE before surgery, but only 7/60 (12%) were deemed to be necessary. Seven out 15 (47%) patients with an indication for a CSE actually underwent said exam. Sixty-six % of patients (156/238) had a resting trans-thoracic echocardiography before surgery, while only 27/156 (17%) were considered of appropriate use. Among patients with known coronary arterial disease, 59/73 (81%) received a statin, 60/73 (82%) received an antiplatelet agent, and 38/73 (52%) received a beta-blocker. Among patients with planned arterial surgery, 86/137 (63 %) received a statin and 100/137 (73 %) patients received an antiplatelet agent. Of the 159 consultation reports that were examined, only 5 (3%) mentioned the Lee score and 117 (74%) were concluded with “no contraindication” or a similar phrase. Discussion In this study, we found that guidelines were generally not used when cardiologists evaluated patients for non-cardiac surgery. This is evidenced by the number of inappropriate exams performed, the lack of true perioperative risk stratification, and incomplete optimization of long-term treatment regimen

Aim: To evaluate the effect of implementation of a hysterectomy Enhanced Recovery After Surgery (ERAS) protocol on perioperative anesthetic medication costs. Patients & methods: Historical cohort study of 84 adult patients who underwent a hysterectomy. Forty-two patients who underwent surgery before protocol implementation comprised the pre-ERAS group. Forty-two patients who underwent surgery after protocol implementation comprised the post-ERAS group. Data on anesthetic medication costs and outcomes were analyzed. Results: Compared with the pre-ERAS group, the post-ERAS group’s total medication cost was significantly lower (median: 325.20 USD; interquartile range [IQR]: 256.12–430.65 USD vs median: 273.10 USD; IQR: 220.63–370.59 USD, median difference: -40.76, 95% CI: -130.39, 16.99, p = 0.047). Length of stay was significantly longer in pre-ERAS when compared with post-ERAS groups (median: 5.0 days; IQR: 4.0–7.0 days vs median: 3.0 days; IQR: 3.0–4.0 days, median difference: -2.0 days, 95% CI: -2.5581, -1.4419, p < 0.0001). Conclusion: ERAS protocols may reduce perioperative medication costs.

Results There was no evidence of increased quantities of muscle nuclear P65 or P50 binding DNA in patients compared with controls and the quantity of muscle nuclear AP-1 c-jun binding DNA was lower in patients than controls (336 (174,513) Introduction Quadriceps dysfunction is associated with reduced exercise tolerance and survival in COPD. Quadriceps dysfunction has been attributed to quadriceps fibre atrophy (FA) and oxidative to glycolytic (type I to II) fibre shift (FS) but the prevalence of FA and FS and their individual relationships with exercise capacity are not clear. Methods We measured lung function, physical activity, fat-free mass index (FFMI), quadriceps strength and endurance and exercise performance (6-min walk and incremental cycle ergometry) in 114 COPD patients and 30 healthy age-matched controls and measured mid-thigh muscle cross-sectional area (MTCSA) by CT in 30 patients and 10 controls. Each subject had a quadriceps biopsy and type I, IIa and IIx fibre proportions and CSA were determined by immunohistochemistry. FA and FS were defined using reference intervals for quadriceps fibre characteristics derived from the controls.