Category: Peri-operative Medicine

A collection of TBL summaries relevant to Peri-operative Medicine

Shared Decision Making in Resuscitation Decisions

A Randomized Trial of Shared Decision-Making in Code Status Discussions Becker. NEJM Evidence 2025; doi:10.1056/EVIDoa2400422 Clinical Question In hospitalized adults requiring code status discussions, does a shared decision-making approach (including a checklist and decision aid) compared to usual care increase the proportion of patients choosing a DNR status? Background In-hospital cardiac arrest outcomes are poor (<20% survival; ~40% with neurologic […]

Fluid – Hospital Wide Lactated Ringer’s versus Normal Saline

A Crossover Trial of Hospital-Wide Lactated Ringer’s Solution versus Normal Saline L McIntyre. NEJM 2025; DOI: 10.1056/NEJMoa2416761 Clinical Question In hospitalised patients, does the use of Lactated Ringers (LR) vs Normal Saline (NS) lower the incidence of death or readmission to the hospital within 90 days after the index admission? Background Fluid choice (balanced solutions vs NS) has been widely […]

TIGHT K: Potassium Supplementation and Prevention of Atrial Fibrillation After Cardiac Surgery

14 October 2024 George Walker Intensive Care Medicine, Peri-operative Medicine Leave a comment

Potassium Supplementation and Prevention of Atrial Fibrillation After Cardiac Surgery: The TIGHT K Randomized Clinical Trial O’Brien. JAMA 2024; 332:979 – 988. doi:10.1001/jama.2024.17888 Clinical Question In adult patients undergoing coronary artery bypass surgery (CABG) is supplementing potassium when serum concentration is ≤ 3.5 mEq/L non-inferior to supplementation when serum concentration is ≤ 4.5 mEq/L to reduce the frequency of new […]

ENRICH: Early Minimally Invasive Removal of ICH

15 July 2024 Generic Contributor Intensive Care Medicine, Peri-operative Medicine Leave a comment

In patients with spontaneous intracranial haemorrhage (ICH), does the use of early minimally invasive surgery + standard management compared to standard management alone, result in better functional outcomes at 180 days?

PROTECTION – Amino Acids for Kidney Protection

7 July 2024 Celia Bradford Intensive Care Medicine, Peri-operative Medicine Leave a comment

In adult patients scheduled for cardiac surgery with cardiopulmonary bypass does infusion of a balanced solution of amino acids, commencing at the time of surgery, compared with balanced crystalloid alone (Ringer’s Lactate) reduce the incidence of acute kidney injury (AKI)?

Early and Empirical High-Dose Cryoprecipitate for Hemorrhage After Traumatic Injury

18 October 2023 Celia Bradford Emergency Medicine, Intensive Care Medicine, Peri-operative Medicine, Summaries Leave a comment

In patients with trauma and critical bleeding who require activation of a major haemorrhage protocol, does the empiric administration of 3 pools of cryoprecipitate (6g fibrinogen) within 90 minutes of randomisation (and no more than 3 hours after injury) improve survival, compared to standard care?

Supplemental Parental Nutrition and Abdominal Surgery

15 July 2022 George Walker Intensive Care Medicine, Peri-operative Medicine, Summaries Leave a comment

In patients undergoing major abdominal surgery who are at high nutritional risk and have poor tolerance to enteral nutrition (EN) does the early use of supplemental parental nutrition (E-SPN), compared with late supplemental parental nutrition (L-SPN), reduce the risk of nosocomial infection?

PALACS

31 December 2021 Celia Bradford Intensive Care Medicine, Peri-operative Medicine Leave a comment

Posterior left pericardiotomy for the prevention of atrial fibrillation after cardiac surgery Mario Gaudino, The Lancet Dec 4 2021; 398: 2075–83 https://doi.org/10.1016/S0140-6736(21)02490-9 Clinical Question In selected patients undergoing cardiac surgery, does posterior left pericardiotomy compared with usual care, reduce the incidence of postoperative atrial fibrillation? Background Atrial fibrillation is common following cardiac surgery with approximately one-third of patients developing […]

CONTROLING

17 December 2021 George Walker Intensive Care Medicine, Peri-operative Medicine Leave a comment

Individualised versus conventional glucose control in critically-ill patients: the CONTROLING study—a randomized clinical trial Bohé. Intensive Care Medicine 2021. https://doi.org/10.1007/s00134-021-06526-8 Clinical Question In critically unwell adults does targeting individualised glycaemic control compared to glycaemia < 180 mg/dL improve 90 day mortality? Background Hyperglycaemia has been shown to result in worse outcomes in the critically ill, especially in non-diabetic patients In […]

TRAAP2

14 May 2021 George Walker Peri-operative Medicine Leave a comment

In patients undergoing caesarean section (CS) does the administration of tranexamic acid (TXA) when compared to placebo result in a lower incidence of calculated estimated blood loss of red blood cell transfusion by day 2?

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