Rudolf Mörgeli

Long-term recovery In critical illness myopathy is complete, contrary to polyneuropathy.

Introduction: Muscle weakness in critically ill patients after discharge varies. It is not known whether the electrophysiological distinction between critical illness myopathy (CIM) and critical illness polyneuropathy (CIP) during the early part of a patients stay in the intensive care unit (ICU) predicts long‐term prognosis. Methods: This was a prospective cohort study of mechanically ventilated ICU patients undergoing conventional nerve conduction studies and direct muscle stimulation in addition to neurological examination during their ICU stay and 1 year after ICU discharge. Results: Twenty‐six patients (7 ICU controls, 8 CIM patients, and 11 CIM/CIP patients) were evaluated 1 year after discharge from the ICU. Eighty‐eight percent (n = 7) of CIM patients recovered within 1 year compared with 55% (n = 6) of CIM/CIP patients. Thirty‐six percent (n = 4) of CIM/CIP patients still needed assistance during their daily routine (P = 0.005). Conclusions: Early electrophysiological testing predicts long‐term outcome in ICU survivors. CIM has a significantly better prognosis than CIM/CIP. Muscle Nerve 50: 431–436, 2014

Peri- and postoperative cognitive and consecutive functional problems of elderly patients.

Purpose of reviewFrom an elderly patients perspective, acute and chronic cognitive disturbances are among the most harmful complications that can occur following surgery. For elderly patients, these complications often mean the end of an independent life. This article focuses on this serious aspect, which is increasingly prevalent in our aging society. Cognitive disturbances are associated with severe outcome impairments and increased mortality. This article aims to provide a current overview regarding the diagnosis, pathophysiology, prevention, and treatment of this severe social problem. Recent findingsThe current knowledge of risk factors, diagnosis, prevention, and treatment of postoperative delirium and postoperative cognitive dysfunction should help to raise awareness and improve the outcome of delirious patients, particularly in the elderly population. SummaryEspecially in elderly patients, postoperative delirium constitutes a common, severe complication. Early diagnosis and supportive treatment are essential to improve outcome. To date, no pharmacological treatment strategy was effective, so that further research about the underlying pathophysiology and the development of treatment strategies are urgently required.

Accuracy of a subcutaneous continuous glucose management system in critically ill patients

Continuous glucose management (CGM) has not yet been implemented to daily routine in the intensive care unit (ICU) setting. CGM systems aim to improve glycemic control, and consequently patient outcome.

Perioperative Management of Elderly Patients with Gastrointestinal Malignancies: The Contribution of Anesthesia

Introduction: Elderly patients suffering from gastrointestinal malignancies are particularly prone to perioperative complications. Elderly patients often present with reduced physiological reserves, and comorbidities can limit treatment options and promote complications. Surgeons and anesthesiologists must be aware of strategies required to deal with this vulnerable subgroup. Methods: We provide a brief review of current and emerging perioperative strategies for the treatment of elderly patients with gastrointestinal malignancies and frequent comorbidities. Results: Especially in combination with advanced age, the effects of malignancies can be devastating, bringing new health challenges, exacerbating preexisting conditions, and exerting severe psychological strain. An interdisciplinary assessment and process planning provide an ideal setting to identify and prevent potential complications, especially in regards to frailty and cardiovascular risk. In addition, important perioperative considerations are presented, such as malnutrition, fasting, intraoperative neuromonitoring, and hemodynamic control, as well as postoperative early mobilization, pain, and delirium management. Conclusion: The decisions and interventions made in the perioperative stage can positively influence many intra- and postoperative factors, significantly improving the chances of successful treatment of elderly cancer patients. Appropriate management can help prevent or mitigate complications, secure a quick recovery, and improve short- and long-term outcomes.

The Role of Intravenous Agents in Delirium

Delirium is a symptom complex resulting from brain dysfunction and is a frequent complication in the perioperative setting. Classification into three subtypes is common: the rare hyperactive, the hypoactive, and the mixed forms of delirium. Delirium is an outcome relevant complication, as it is associated with an increased length of hospital stay, higher mortality rate, as well as an impaired long-term cognitive trajectory.

Glycemic variability as a risk factor of intensive care unit-acquired weakness

Intensive care unit-acquired weakness (ICUAW) is a serious complication associated with loss of muscle mass and strength, metabolic disorders, organ failure, failure to wean, and increased mortality. ICUAW is diagnosed via MRC scores, and electrophysiological examinations (EP) can detect muscle excitability disorders associated with ICUAW (1). While uncontrolled hyperglycemia and/or insulin resistance has been linked to ICUAW (2), glucose variability, promoted by Krinsley et al as a crucial parameter independently linked to ICU mortality (3), has thus far been neglected in ICUAW studies. There is a lack of standardization in the assessment of glucose variability, and not all methods associate with mortality.