Browsing by Author "Bine, Evita"

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    The Controlling Nutritional Status (CONUT) Score for Prediction of Microvascular Flap Complications in Reconstructive Surgery
    (2023-08) Rocans, Rihards P; Zarins, Janis; Bine, Evita; Deksnis, Renars; Citovica, Margarita; Donina, Simona; Mamaja, Biruta; Department of Anaesthesiology, Intensive Care and Clinical simulations; Institute of Microbiology and Virology
    Microvascular flap surgery is a widely acknowledged procedure for significant defect reconstruction. Multiple flap complication risk factors have been identified, yet there are limited data on laboratory biomarkers for the prediction of flap loss. The controlling nutritional status (CONUT) score has demonstrated good postoperative outcome assessment ability in diverse surgical populations. We aim to assess the predictive value of the CONUT score for complications in microvascular flap surgery. This prospective cohort study includes 72 adult patients undergoing elective microvascular flap surgery. Preoperative blood draws for analysis of full blood count, total plasma cholesterol, and albumin concentrations were collected on the day of surgery before crystalloid infusion. Postoperative data on flap complications and duration of hospitalization were obtained. The overall complication rate was 15.2%. True flap loss with vascular compromise occurred in 5.6%. No differences in flap complications were found between different areas of reconstruction, anatomical flap types, or indications for surgery. Obesity was more common in patients with flap complications (p = 0.01). The CONUT score had an AUC of 0.813 (0.659-0.967, p = 0.012) for predicting complications other than true flap loss due to vascular compromise. A CONUT score > 2 was indicated as optimal during cut-off analysis (p = 0.022). Patients with flap complications had a longer duration of hospitalization (13.55, 10.99-16.11 vs. 25.38, 14.82-35.93; p = 0.004). Our findings indicate that the CONUT score has considerable predictive value in microvascular flap surgery.
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    DIFFICULT AIRWAY PREDICTORS FOR ANTICIPATED OR UNANTICIPATED DIFFICULT AIRWAY IN PATIENTS WITH FIBREOPTIC INTUBATION : A RETROSPECTIVE OBSERVATIONAL STUDY
    (2024-12) Bērziņš, Arvīds; Bine, Evita; Kļučņiks, Andris; Vanags, Indulis; Ozoliņa, Agnese; Rīga Stradiņš University
    Airway management is a cornerstone of anaesthesia. The aim of the study was to identify difficult airway (DA) predictors for patients with fibreoptic intubation (FOI). This retrospective cohort study included 135 adult patients undergoing general anaesthesia with the use of FOI at Rîga East University Hospital from 1 January 2018 to 31 December 2022. For analysis, 135 patients were divided into two groups according to unanticipated (un-DA, n = 33) or anticipated DA: (a-DA, n = 102). Data were analysed using SPSS 26.0, p < 0.05. FOI was used only in 135 cases of 50,186 general anaesthesia cases over the study period. Of 135 FOI cases, 75 (55.6%) were males with a median age of 62 ± 19 years; 24.4% FOI was used in acute and 75.6% in elective surgeries. Those with a-DA had a higher Mallampati score, on average 3.2 vs. 2.1, p = 0.002. Unanticipated DA were reported statistically more frequently in acute admission cases compared to elective surgeries — 39.3% vs 10.8% of cases. Previously known tracheal pathologies such as dislocation (p = 0.001) and stenosis (p = 0.011) were statistically reliable factors for the anticipated DA. Comparing a-DA and un-DA groups for combinations of predictors (Mallampati score, admission and tracheal pathology) we found a sensitivity and specificity 70.3% and 68.7% to predict DA. Mallampati score, acute admission, and previously known tracheal pathology are reliable predictors of DA in patients undergoing FOI. Acute admission had the greatest impact on unanticipated DA.
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    The Impact of Different Ventilatory Strategies on Clinical Outcomes in Patients with COVID-19 Pneumonia
    (2022-05-11) Rocans, Rihards P; Ozoliņa, Agnese; Battaglini, Denise; Bine, Evita; Birnbaums, Janis V; Tsarevskaya, Anastasija; Udre, Sintija; Aleksejeva, Marija; Mamaja, Biruta; Pelosi, Paolo; Department of Anaesthesiology, Intensive Care and Clinical simulations
    Introduction: The aim was to investigate the impact of different ventilator strategies (non-invasive ventilation (NIV); invasive MV with tracheal tube (TT) and with tracheostomy (TS) on outcomes (mortality and intensive care unit (ICU) length of stay) in patients with COVID-19. We also assessed the impact of timing of percutaneous tracheostomy and other risk factors on mortality. Methods: The retrospective cohort included 868 patients with severe COVID-19. Demographics, MV parameters and duration, and ICU mortality were collected. Results: MV was provided in 530 (61.1%) patients, divided into three groups: NIV (n = 139), TT (n = 313), and TS (n = 78). Prevalence of tracheostomy was 14.7%, and ICU mortality was 90.4%, 60.2%, and 30.2% in TT, TS, and NIV groups, respectively (p < 0.001). Tracheostomy increased the chances of survival and being discharged from ICU (OR 6.3, p < 0.001) despite prolonging ICU stay compared to the TT group (22.2 days vs. 10.7 days, p < 0.001) without differences in survival rates between early and late tracheostomy. Patients who only received invasive MV had higher odds of survival compared to those receiving NIV in ICU prior to invasive MV (OR 2.7, p = 0.001). The odds of death increased with age (OR 1.032, p < 0.001), obesity (1.58, p = 0.041), chronic renal disease (1.57, p = 0.019), sepsis (2.8, p < 0.001), acute kidney injury (1.7, p = 0.049), multiple organ dysfunction (3.2, p < 0.001), and ARDS (3.3, p < 0.001). Conclusions: Percutaneous tracheostomy compared to MV via TT significantly increased survival and the rate of discharge from ICU, without differences between early or late tracheostomy.
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    Novel Challenges and Opportunities for Anesthesia and Perioperative Care in Microvascular Flap Surgery : A Narrative Review
    (2024-10-18) Ojuva, Aleksi Matias; Rocans, Rihards Peteris; Zariņš, Jānis; Bine, Evita; Mahauri, Insana; Doniņa, Simona; Mamaja, Biruta; Vanags, Indulis; Department of Anaesthesiology, Intensive Care and Clinical simulations; Institute of Microbiology and Virology
    Complex microvascular techniques and in-depth knowledge of blood rheology and microanastomosis function are required for success in microvascular flap surgery. Substantial progress has been achieved in preventing complications, but the rate of flap loss is still significant and can have significant adverse effects on the patient. Flap thrombosis, flap hematoma, and flap loss are the most frequent and severe major surgical complications. Advances in understanding the pathophysiology of different flap complications, the use of preoperative risk assessment and new treatment concepts could improve the perioperative care of microvascular flap surgery patients. Our aim was to outline novel avenues for best practice and provide an outlook for further research of anesthesia and perioperative care concepts in microvascular flap surgery
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    Von Willebrand Factor Antigen, Biomarkers of Inflammation, and Microvascular Flap Thrombosis in Reconstructive Surgery
    (2024-09-12) Rocans, Rihards Peteris; Zarins, Janis; Bine, Evita; Mahauri, Insana; Deksnis, Renars; Citovica, Margarita; Donina, Simona; Vanags, Indulis; Gravelsina, Sabine; Vilmane, Anda; Rasa-Dzelzkaleja, Santa; Mamaja, Biruta; Department of Anaesthesiology, Intensive Care and Clinical simulations; Institute of Microbiology and Virology
    Background: Microvascular flap surgery has become a routine option for defect correction. The role of von Willebrand factor antigen (VWF:Ag) in the pathophysiology of flap complications is not fully understood. We aim to investigate the predictive value of VWF:Ag for microvascular flap complications and explore the relationship between chronic inflammation and VWF:Ag. Methods: This prospective cohort study included 88 adult patients undergoing elective microvascular flap surgery. Preoperative blood draws were collected on the day of surgery before initiation of crystalloids. The plasma concentration of VWF:Ag as well as albumin, neutrophil-to-lymphocyte ratio (NLR), interleukin-6, and fibrinogen were determined. Results: The overall complication rate was 27.3%, and true flap loss occurred in 11.4%. VWF:Ag levels were higher in true flap loss when compared to patients without complications (217.94 IU/dL [137.27–298.45] vs. 114.14 [95.67–132.71], p = 0.001). Regression analysis revealed the association between VWF:Ag and true flap loss at the cutoff of 163.73 IU/dL (OR 70.22 [10.74–485.28], p = 0.043). Increased VWF:Ag concentrations were linked to increases in plasma fibrinogen (p < 0.001), C-reactive protein (p < 0.001), interleukin-6 (p = 0.032), and NLR (p = 0.019). Conclusions: Preoperative plasma VWF:Ag concentration is linked to biomarkers of inflammation and may be valuable in predicting complications in microvascular flap surgery.