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Article ; Online: Association between self-reported METs and other perioperative cardiorespiratory fitness assessment tools in abdominal surgery-a prospective cross-sectional correlation study.

Czajka, Szymon / Krzych, Łukasz J

2024 Volume 14, Issue 1, Page(s) 7826

Abstract: Cardiovascular complications represent a significant proportion of adverse events during the perioperative period, necessitating accurate preoperative risk assessment. This study aimed to investigate the association between well-established risk ... ...

Abstract	Cardiovascular complications represent a significant proportion of adverse events during the perioperative period, necessitating accurate preoperative risk assessment. This study aimed to investigate the association between well-established risk assessment tools and self-reported preoperative physical performance, quantified by metabolic equivalent (MET) equivalents, in high-risk patients scheduled for elective abdominal surgery. A prospective cross-sectional correlation study was conducted, involving 184 patients admitted to a Gastrointestinal Surgery Department. Various risk assessment tools, including the Revised Cardiac Risk Index (RCRI), Surgical Mortality Probability Model (S-MPM), American University of Beirut (AUB)-HAS2 Cardiovascular Risk Index, and Surgical Risk Calculator (NSQIP-MICA), were utilized to evaluate perioperative risk. Patients self-reported their physical performance using the MET-REPAIR questionnaire. The findings demonstrated weak or negligible correlations between the risk assessment tools and self-reported MET equivalents (Spearman's ρ = - 0.1 to - 0.3). However, a statistically significant relationship was observed between the ability to ascend two flights of stairs and the risk assessment scores. Good correlations were identified among ASA-PS, S-MPM, NSQIP-MICA, and AUB-HAS2 scores (Spearman's ρ = 0.3-0.8). Although risk assessment tools exhibited limited correlation with self-reported MET equivalents, simple questions regarding physical fitness, such as the ability to climb stairs, showed better associations. A comprehensive preoperative risk assessment should incorporate both objective and subjective measures to enhance accuracy. Further research with larger cohorts is needed to validate these findings and develop a comprehensive screening tool for high-risk patients undergoing elective abdominal surgery.
MeSH term(s)	Humans ; United States ; Self Report ; Prospective Studies ; Cardiorespiratory Fitness ; Cross-Sectional Studies ; Correlation of Data ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Risk Factors ; Risk Assessment ; Retrospective Studies
Language	English
Publishing date	2024-04-03
Publishing country	England
Document type	Journal Article
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-024-56887-5
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Is Frailty a Good Predictor of Postoperative Complications in Elective Abdominal Surgery?-A Single-Center, Prospective, Observational Study.

Czajka, Szymon / Taborek, Maria / Krzych, Łukasz J

Journal of personalized medicine

2023 Volume 13, Issue 5

Abstract: Background: Despite the common occurrence of postoperative complications in patients with frailty syndrome, the nature and severity of this relationship remains unclear. We aimed to assess the association of frailty with possible postoperative ... ...

Abstract	Background: Despite the common occurrence of postoperative complications in patients with frailty syndrome, the nature and severity of this relationship remains unclear. We aimed to assess the association of frailty with possible postoperative complications after elective, abdominal surgery in participants of a single-centre prospective study in relation to other risk classification methods. Methods: Frailty was assessed preoperatively using the Edmonton Frail Scale (EFS), Modified Frailty Index (mFI) and Clinical Frailty Scale (CFS). Perioperative risk was assessed using the American Society of Anesthesiology Physical Status (ASA PS), Operative Severity Score (OSS) and Surgical Mortality Probability Model (S-MPM). Results: The frailty scores failed to predict in-hospital complications. The values of AUCs for in-hospital complications ranged between 0.5 and 0.6 and were statistically nonsignificant. The perioperative risk measuring system performance in ROC analysis was satisfactory with AUC ranging from 0.63 for OSS to 0.65 for S-MPM ( Conclusions: The analysed frailty rating scales proved to be poor predictors of postoperative complications in the studied population. Scales assessing perioperative risk performed better. Further studies are needed to obtain optimal predictive tools in senior patients undergoing surgery.
Language	English
Publishing date	2023-05-21
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662248-8
ISSN	2075-4426
ISSN	2075-4426
DOI	10.3390/jpm13050869
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Article ; Online: Post-induction hypotension and intraoperative hypotension as potential separate risk factors for the adverse outcome: a cohort study.

Czajka, Szymon / Putowski, Zbigniew / Krzych, Łukasz J

Journal of anesthesia

2023 Volume 37, Issue 3, Page(s) 442–450

Abstract: Purpose: Intraoperative hypotension (IOH) is associated with organ hypoperfusion. There are different underlying causes of IOH depending on the phase of surgery. Post-induction hypotension (PIH) and early-intraoperative hypotension tend to be frequently ...

Abstract	Purpose: Intraoperative hypotension (IOH) is associated with organ hypoperfusion. There are different underlying causes of IOH depending on the phase of surgery. Post-induction hypotension (PIH) and early-intraoperative hypotension tend to be frequently differentiated. We aimed to explore further different phases of IOH and verify whether they are differently associated with postoperative complications. Methods: Patients undergoing abdominal surgery between October 2018 and July 2019 in a university hospital were screened. Post-induction hypotension was defined as MAP ≤ 65 mmHg between the induction of anaesthesia and the onset of surgery. Hypotension during surgery (IOH) was defined as MAP ≤ 65 mmHg occurring between the onset of surgery and its completion. Acute kidney injury, stroke or transient ischaemic attack, delirium, and myocardial infarction were considered as the outcome. Results: We enrolled 508 patients (219 males, median age 62 years). 158 subjects (31.1%) met PIH, 171 (33.7%) met IOH criteria, and 67 (13.2%) patients experienced both. PIH time accounted for 22.8% of the total hypotension time and 29.7% of the IOH time. The IOH time accounted for 5.17% of the total intraoperative time, while PIH for 8.91% of the pre-incision time. Female sex, lower height, body mass and lower pre-induction BP (SBP and MAP) were found to be associated with the incidence of PIH. The negative outcome was observed in 38 (7.5%) patients. Intraoperative MAP ≤ 65 mmHg, longer duration of the procedure (≥ 230 min), chronic arterial hypertension and age were associated with the presence of the outcome (p < 0.01 each). Conclusions: The presence of IOH defined as MAP ≤ 65 mmHg is relevant to post-operative organ complications, the presence of PIH does not appear to be of such significance. Because cumulative duration of PIH and IOH differs significantly, especially in long-lasting procedures, direct comparison of the influence of PIH and IOH on outcome separately may be biased and should be taken into account in data interpretation. Further research is needed to deeply investigate this phenomenon.
MeSH term(s)	Male ; Humans ; Female ; Middle Aged ; Cohort Studies ; Intraoperative Complications/epidemiology ; Intraoperative Complications/etiology ; Hypotension/etiology ; Hypotension/complications ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Risk Factors ; Retrospective Studies
Language	English
Publishing date	2023-04-21
Publishing country	Japan
Document type	Journal Article
ZDB-ID	1107821-2
ISSN	1438-8359 ; 0913-8668
ISSN (online)	1438-8359
ISSN	0913-8668
DOI	10.1007/s00540-023-03191-7
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Article ; Online: Effect of lidocaine on intraoperative blood pressure variability in patients undergoing major vascular surgery.

Gajniak, Dariusz / Mendrala, Konrad / König-Widuch, Gabriela / Parzonka, Szymon / Gierek, Danuta / Krzych, Łukasz J

BMC anesthesiology

2024 Volume 24, Issue 1, Page(s) 170

Abstract: Background: Dynamic fluctuations of arterial blood pressure known as blood pressure variability (BPV) may have short and long-term undesirable consequences. During surgical procedures blood pressure is usually measured in equal intervals allowing to ... ...

Abstract	Background: Dynamic fluctuations of arterial blood pressure known as blood pressure variability (BPV) may have short and long-term undesirable consequences. During surgical procedures blood pressure is usually measured in equal intervals allowing to assess its intraoperative variability, which significance for peri and post-operative period is still under debate. Lidocaine has positive cardiovascular effects, which may go beyond its antiarrhythmic activity. The aim of the study was to verify whether the use of intravenous lidocaine may affect intraoperative BPV in patients undergoing major vascular procedures. Methods: We performed a post-hoc analysis of the data collected during the previous randomized clinical trial by Gajniak et al. In the original study patients undergoing elective abdominal aorta and/or iliac arteries open surgery were randomized into two groups to receive intravenous infusion of 1% lidocaine or placebo at the same infusion rate based on ideal body weight, in concomitance with general anesthesia. We analyzed systolic (SBP), diastolic (DBP) and mean arterial blood (MAP) pressure recorded in 5-minute intervals (from the first measurement before induction of general anaesthesia until the last after emergence from anaesthesia). Blood pressure variability was then calculated for SBP and MAP, and expressed as: standard deviation (SD), coefficient of variation (CV), average real variability (ARV) and coefficient of hemodynamic stability (C10%), and compared between both groups. Results: All calculated indexes were comparable between groups. In the lidocaine and placebo groups systolic blood pressure SD, CV, AVR and C10% were 20.17 vs. 19.28, 16.40 vs. 15.64, 14.74 vs. 14.08 and 0.45 vs. 0.45 respectively. No differences were observed regarding type of surgery, operating and anaesthetic time, administration of vasoactive agents and intravenous fluids, including blood products. Conclusion: In high-risk vascular surgery performed under general anesthesia, lidocaine infusion had no effect on arterial blood pressure variability. Trial registration: ClinicalTrials.gov; NCT04691726 post-hoc analysis; date of registration 31/12/2020.
MeSH term(s)	Humans ; Lidocaine/administration & dosage ; Lidocaine/pharmacology ; Male ; Female ; Blood Pressure/drug effects ; Aged ; Anesthetics, Local/administration & dosage ; Anesthetics, Local/pharmacology ; Vascular Surgical Procedures/methods ; Middle Aged ; Double-Blind Method ; Infusions, Intravenous ; Anesthesia, General/methods ; Monitoring, Intraoperative/methods
Chemical Substances	Lidocaine (98PI200987) ; Anesthetics, Local
Language	English
Publishing date	2024-05-07
Publishing country	England
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	2091252-3
ISSN	1471-2253 ; 1471-2253
ISSN (online)	1471-2253
ISSN	1471-2253
DOI	10.1186/s12871-024-02550-5
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Article: Appropriateness of Allogeneic Red Blood Cell Transfusions in Non-Bleeding Patients in a Large Teaching Hospital: A Retrospective Study.

Czempik, Piotr F / Wilczek, Dawid / Herzyk, Jan / Krzych, Łukasz J

Journal of clinical medicine

2023 Volume 12, Issue 4

Abstract: In hemodynamically stable patients, both anemia and red blood cell (RBC) transfusion may be detrimental to patients; hence, a decision regarding RBC transfusion should be based on thorough risk-benefit assessment. According to hematology and transfusion ... ...

Abstract	In hemodynamically stable patients, both anemia and red blood cell (RBC) transfusion may be detrimental to patients; hence, a decision regarding RBC transfusion should be based on thorough risk-benefit assessment. According to hematology and transfusion medicine organizations, RBC transfusion is indicated when recommended hemoglobin (Hb) triggers are met, and symptoms of anemia are present. The aim of our study was to examine the appropriateness of RBC transfusions in non-bleeding patients at our institution. We performed a retrospective analysis of all RBC transfusions performed between January 2022 and July 2022. The appropriateness of RBC transfusion was based on the most recent Association for the Advancement of Blood and Biotherapies (AABB) guidelines and some additional criteria. The overall incidence of RBC transfusions at our institution was 10.2 per 1000 patient-days. There were 216 (26.1%) RBC units appropriately transfused and 612 (73.9%) RBC units that were transfused with no clear indications. The incidence of appropriate and inappropriate RBC transfusions were 2.6 and 7.5 per 1000 patient-days, respectively. The most frequent clinical situations when RBC transfusion was classified as appropriate were: Hb < 70 g/L plus cognitive problems/headache/dizziness (10.1%), Hb < 60 g/L (5.4%), and Hb < 70 g/L plus dyspnea despite oxygen therapy (4.3%). The most frequent causes of inappropriate RBC transfusions were: no Hb determination pre-RBC transfusion (n = 317) and, among these, RBC transfused as a second unit in a single-transfusion episode (n = 260); absence of anemia sings/symptoms pre-transfusion (n = 179); and Hb concentration ≥80 g/L (n = 80). Although the incidence of RBC transfusions in non-bleeding inpatients in our study was generally low, the majority of RBC transfusions were performed outside recommended indications. Red blood cell transfusions were evaluated as inappropriate mainly due to multiple-unit transfusion episodes, absence of anemia signs and/or symptoms pre- transfusion, and liberal transfusion triggers. There is still the need to educate physicians on appropriate indications for RBC transfusion in non-bleeding patients.
Language	English
Publishing date	2023-02-06
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm12041293
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Article ; Online: Successful Use of Methylene Blue in Catecholamine-Resistant Septic Shock: A Case Report and Short Literature Review.

Pluta, Michał P / Putowski, Zbigniew / Czempik, Piotr F / Krzych, Łukasz J

International journal of molecular sciences

2023 Volume 24, Issue 13

Abstract: Despite efforts to improve treatment outcomes, mortality in septic shock remains high. In some patients, despite the use of several adrenergic drugs, features of refractory vasoplegic shock with progressive multiorgan failure are observed. We present a ... ...

Abstract	Despite efforts to improve treatment outcomes, mortality in septic shock remains high. In some patients, despite the use of several adrenergic drugs, features of refractory vasoplegic shock with progressive multiorgan failure are observed. We present a case report of the successful reversal of vasoplegic shock following the use of methylene blue, a selective inhibitor of the inducible form of nitric oxide synthase, which prevents vasodilation in response to inflammatory cytokines. We also briefly review the literature.
MeSH term(s)	Humans ; Catecholamines ; Methylene Blue/therapeutic use ; Nitric Oxide Synthase ; Shock/drug therapy ; Shock, Septic/drug therapy
Chemical Substances	Catecholamines ; Methylene Blue (T42P99266K) ; Nitric Oxide Synthase (EC 1.14.13.39)
Language	English
Publishing date	2023-06-28
Publishing country	Switzerland
Document type	Case Reports ; Journal Article ; Review
ZDB-ID	2019364-6
ISSN	1422-0067 ; 1422-0067 ; 1661-6596
ISSN (online)	1422-0067
ISSN	1422-0067 ; 1661-6596
DOI	10.3390/ijms241310772
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Article: Sonographic Images of Hepatic Portal Venous Gas in a Patient with Gastrointestinal Ischemia.

Czempik, Piotr F / Bożek, Oskar / Krzych, Łukasz J

Diagnostics (Basel, Switzerland)

2022 Volume 12, Issue 9

Abstract: Hepatic portal venous gas (HPVG) detected by ultrasound (US) following liver transplantation or in suppurative cholangitis was described previously. To our knowledge, there have been no descriptions of HPVG detected by US in acute mesenteric ischemia. ... ...

Abstract	Hepatic portal venous gas (HPVG) detected by ultrasound (US) following liver transplantation or in suppurative cholangitis was described previously. To our knowledge, there have been no descriptions of HPVG detected by US in acute mesenteric ischemia. Here we present diagnostic images of a 52-year-old female who was admitted to the intensive care unit (ICU) following successful embolization of a ruptured saccular aneurysm of the right vertebral artery. During their stay in the ICU, the patient developed hypotension with low systemic vascular resistance and hypovolemia. Based on physical examination of the abdomen and laboratory results, preliminary diagnosis of intra-abdominal sepsis was made. Early abdominal US was performed to find the source of sepsis. The preliminary diagnosis of stomach/small intestine ischemia was made by ultrasonic detection of HPVG. Other less likely diagnoses were pneumobilia due to cholangitis, hepatic micro-abscesses, and punctuate calcifications. The diagnosis was confirmed by multi-phase abdominal computed tomography. The explorative laparotomy revealed necrosis of the stomach, small intestine, and liver. Due to the severity of necrosis, surgical treatment was abandoned. Provided sonographic images show HPVG as an ominous sign of small intestine and stomach ischemia. Early liver US should be performed whenever intra-abdominal pathology is suspected.
Language	English
Publishing date	2022-08-23
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662336-5
ISSN	2075-4418
ISSN	2075-4418
DOI	10.3390/diagnostics12092034
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Article: Physiologic approach to red blood cell transfusion in non-bleeding critically ill patients.

Czempik, Piotr F / Pluta, Michał P / Krzych, Łukasz J

Archives of medical science : AMS

2022 Volume 18, Issue 5, Page(s) 1423–1425

Language	English
Publishing date	2022-08-30
Publishing country	Poland
Document type	Journal Article
ZDB-ID	2203781-0
ISSN	1734-1922
ISSN	1734-1922
DOI	10.5114/aoms/152217
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Article: Hemoglobin Determination Using Pulse Co-Oximetry and Reduced-Volume Blood Gas Analysis in the Critically Ill: A Prospective Cohort Study.

Czempik, Piotr F / Pluta, Michał P / Krzych, Łukasz J

Diagnostics (Basel, Switzerland)

2022 Volume 12, Issue 12

Abstract: Hospital-acquired anemia is common in patients hospitalized in the intensive care unit (ICU). A major source of iatrogenic blood loss in the ICU is the withdrawal of blood for laboratory testing. The aim of our study was to analyze the feasibility and ... ...

Abstract	Hospital-acquired anemia is common in patients hospitalized in the intensive care unit (ICU). A major source of iatrogenic blood loss in the ICU is the withdrawal of blood for laboratory testing. The aim of our study was to analyze the feasibility and accuracy of non-invasive spot-check pulse co-oximetry (SpHb), and a reduced-volume blood gas analysis (ABG Hb) for the determination of Hb concentration in critically ill patients. Comparisons between Hb determined with test devices and the gold standard—complete blood count (CBC)—were performed using Bland−Altman analysis and concordance correlation coefficient (CCC). The limits of agreement between SpHb and CBC Hb were −2.0 [95%CI −2.3−(−1.7)] to 3.6 (95%CI 3.3−3.9) g/dL. The limits of agreement between ABG Hb and CBC Hb were −0.6 [95%CI −0.7−(−0.4)] to 2.0 (95%CI 1.9−2.2) g/dL. Spearman’s coefficient and CCC between ABG Hb and CBC Hb were 0.96 (95%CI 0.95−0.97, p < 0.001) and 0.91 (95%CI 0.88−0.92), respectively. Non-invasive spot-check Hb co-oximetry is not sufficiently accurate for the monitoring of hemoglobin concentration in critically ill patients. Reduced volume arterial blood gas analysis has acceptable accuracy and could replace complete blood count for the monitoring of Hb concentration in critically ill patients, leading to a significant reduction in blood volume lost for anemia diagnostics.
Language	English
Publishing date	2022-11-22
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662336-5
ISSN	2075-4418
ISSN	2075-4418
DOI	10.3390/diagnostics12122908
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Article ; Online: The impact of intraoperative blood pressure variability on the risk of postoperative adverse outcomes in non-cardiac surgery: a systematic review.

Putowski, Zbigniew / Czok, Marcelina / Krzych, Łukasz J

Journal of anesthesia

2022 Volume 36, Issue 2, Page(s) 316–322

Abstract: Hemodynamic stability during surgery seems to account for positive postoperative outcomes in patients. However, little is known about the impact of intraoperative blood pressure variability (IBPV) on the postoperative complications. The aim was to ... ...

Abstract	Hemodynamic stability during surgery seems to account for positive postoperative outcomes in patients. However, little is known about the impact of intraoperative blood pressure variability (IBPV) on the postoperative complications. The aim was to investigate whether IBPV is associated with the development of postoperative complications and what is the nature of this association. We conducted a systematic search in PubMed, Medical Subject Headings, Embase, Web of Science, SCOPUS, clinicaltrials.gov, and Cochrane Library on the 8th of April, 2021. We included studies that only focused on adults who underwent primarily elective, non-cardiac surgery in which intraoperative blood pressure variation was measured and analyzed in regard to postoperative, non-surgical complications. We identified 11 papers. The studies varied in terms of applied definitions of blood pressure variation, of which standard deviation and average real variability were the most commonly applied definitions. Among the studies, the most consistent analyzed outcome was a 30-day mortality. The studies presented highly heterogeneous results, even after taking into account only the studies of best quality. Both higher and lower IBPV were reported to be associated for postoperative complications. Based on a limited number of studies, IBPV does not seem to be a reliable indicator in predicting postoperative complications. Existing premises suggest that either higher or lower IBPV could contribute to postoperative complications. Taking into account the heterogeneity and quality of the studies, the conclusions may not be definitive.
MeSH term(s)	Adult ; Blood Pressure ; Elective Surgical Procedures ; Humans ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Period
Language	English
Publishing date	2022-01-13
Publishing country	Japan
Document type	Journal Article ; Review ; Systematic Review
ZDB-ID	1107821-2
ISSN	1438-8359 ; 0913-8668
ISSN (online)	1438-8359
ISSN	0913-8668
DOI	10.1007/s00540-022-03035-w
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