Journal of Clinical Anesthesia最新文献

Defining standards of care for AI and clinicians alike: Regarding ChatGPT in labor analgesia management 为人工智能和临床医生定义护理标准：关于分娩镇痛管理中的 ChatGPT。

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2024-11-12 DOI: 10.1016/j.jclinane.2024.111673

Alejandro Fuentes , Rene de la Fuente , Fernando R. Altermatt

引用次数: 0

Continuous vital sign monitoring on surgical wards: The COSMOS pilot 外科病房的连续生命体征监测：COSMOS 试验。

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2024-11-11 DOI: 10.1016/j.jclinane.2024.111661

Nikola Anusic MD , Alper Gulluoglu MD , Elyad Ekrami MD , Edward J. Mascha PhD , Shuyi Li MS , René Coffeng , Alparslan Turan MD , Amber Clemens BSN RN , Christine Perez RN , John W. Beard MD , Daniel I. Sessler MD

Study objectives

Alerts for vital sign abnormalities seek to identify meaningful patient instability while limiting alarm fatigue. Optimal vital sign alarm settings for postoperative patients remain unknown, as is whether alerts lead to effective clinical responses reducing vital sign disturbances. We conducted a 2-phase pilot study to identify thresholds and delays and test the hypothesis that alerts from continuous monitoring reduce the duration of vital sign abnormalities.

Design

Two-phase pilot.

Patients

250 adults having major non-cardiac surgery.

Setting

Surgical wards.

Intervention

All patients had routine vital sign monitoring by nurses at 4-h intervals. We initially continuously recorded clinician-blinded saturation, heart rate, and respiratory rate in 100 patients. In the second phase, we randomized 150 patients to blinded versus unblinded continuous vital sign monitoring. In unblinded patients, nurses were verbally alerted to abnormal vital signs.

Measurements

In the first phase, we modeled expected alarm counts using 6082 h of continuous oxygen saturation, heart rate, and respiratory rate data. Thresholds and delays targeting ∼3 alarms per patient per day were selected for phase two. Primary analysis assessed the effect of unblinded monitoring across a 5-component primary composite of cumulative durations of vital sign abnormalities. Secondary outcomes included fraction of alerts deemed meaningful by nurses and number of clinical interventions.

Results

In phase one, we identified alarm settings that yielded an average of 2.3 alerts per patient per day. In phase two, the average relative effect ratio of geometric duration means for vital signs exceeding thresholds was 0.75 [95 % CI: 0.51, 1.1], P = 0.17. Sixty alarms (82 %) were deemed useful in unblinded patients, leading to 60 % more interventions in unblinded patients.

Conclusions

We were able to select continuous saturation, heart rate, and respiratory rate thresholds that generated about 2 alerts per patient per day, nearly all of which were considered useful by nurses. Unblinded monitoring and nursing alerts led to interventions (mostly increasing oxygen delivery) that non-significantly reduced vital sign abnormalities by 25 %.

ClinicalTrials.gov registration: NCT05280574.

研究目的：生命体征异常警报旨在识别有意义的患者不稳定性，同时限制警报疲劳。术后患者的最佳生命体征警报设置以及警报是否会导致有效的临床反应以减少生命体征紊乱仍是未知数。我们进行了一项分两个阶段的试点研究，以确定阈值和延迟，并检验连续监测发出的警报能缩短生命体征异常持续时间的假设：设计：两阶段试验：250名接受非心脏大手术的成人：干预措施所有患者均由护士每 4 小时进行一次常规生命体征监测。最初，我们连续记录了 100 名患者的饱和度、心率和呼吸频率，并由临床医生对其进行盲测。在第二阶段，我们将 150 名患者随机分组，分别接受盲法和非盲法连续生命体征监测。在非盲患者中，护士会对异常生命体征进行口头提醒：在第一阶段，我们利用 6082 小时的连续血氧饱和度、心率和呼吸频率数据对预期警报次数进行了建模。第二阶段选择了阈值和延迟，目标是每名患者每天发出 3 次警报。主要分析评估了非盲监测对生命体征异常累积持续时间的 5 个主要复合要素的影响。次要结果包括护士认为有意义的警报比例和临床干预次数：结果：在第一阶段，我们确定了平均每位患者每天发出 2.3 次警报的警报设置。在第二阶段，生命体征超过阈值的几何持续时间平均相对效应比为 0.75 [95 % CI: 0.51, 1.1]，P = 0.17。有 60 次警报（82%）在非盲法患者中被认为是有用的，从而使非盲法患者的干预次数增加了 60%：我们能够选择连续饱和度、心率和呼吸频率阈值，每天为每位患者发出约 2 次警报，护士认为几乎所有警报都有用。非盲监测和护理警报导致了干预措施（主要是增加供氧量），使生命体征异常非显著性地减少了 25%：NCT05280574。

{"title":"Continuous vital sign monitoring on surgical wards: The COSMOS pilot","authors":"Nikola Anusic MD , Alper Gulluoglu MD , Elyad Ekrami MD , Edward J. Mascha PhD , Shuyi Li MS , René Coffeng , Alparslan Turan MD , Amber Clemens BSN RN , Christine Perez RN , John W. Beard MD , Daniel I. Sessler MD","doi":"10.1016/j.jclinane.2024.111661","DOIUrl":"10.1016/j.jclinane.2024.111661","url":null,"abstract":"<div><h3>Study objectives</h3><div>Alerts for vital sign abnormalities seek to identify meaningful patient instability while limiting alarm fatigue. Optimal vital sign alarm settings for postoperative patients remain unknown, as is whether alerts lead to effective clinical responses reducing vital sign disturbances. We conducted a 2-phase pilot study to identify thresholds and delays and test the hypothesis that alerts from continuous monitoring reduce the duration of vital sign abnormalities.</div></div><div><h3>Design</h3><div>Two-phase pilot.</div></div><div><h3>Patients</h3><div>250 adults having major non-cardiac surgery.</div></div><div><h3>Setting</h3><div>Surgical wards.</div></div><div><h3>Intervention</h3><div>All patients had routine vital sign monitoring by nurses at 4-h intervals. We initially continuously recorded clinician-blinded saturation, heart rate, and respiratory rate in 100 patients. In the second phase, we randomized 150 patients to blinded versus unblinded continuous vital sign monitoring. In unblinded patients, nurses were verbally alerted to abnormal vital signs.</div></div><div><h3>Measurements</h3><div>In the first phase, we modeled expected alarm counts using 6082 h of continuous oxygen saturation, heart rate, and respiratory rate data. Thresholds and delays targeting ∼3 alarms per patient per day were selected for phase two. Primary analysis assessed the effect of unblinded monitoring across a 5-component primary composite of cumulative durations of vital sign abnormalities. Secondary outcomes included fraction of alerts deemed meaningful by nurses and number of clinical interventions.</div></div><div><h3>Results</h3><div>In phase one, we identified alarm settings that yielded an average of 2.3 alerts per patient per day. In phase two, the average relative effect ratio of geometric duration means for vital signs exceeding thresholds was 0.75 [95 % CI: 0.51, 1.1], <em>P</em> = 0.17. Sixty alarms (82 %) were deemed useful in unblinded patients, leading to 60 % more interventions in unblinded patients.</div></div><div><h3>Conclusions</h3><div>We were able to select continuous saturation, heart rate, and respiratory rate thresholds that generated about 2 alerts per patient per day, nearly all of which were considered useful by nurses. Unblinded monitoring and nursing alerts led to interventions (mostly increasing oxygen delivery) that non-significantly reduced vital sign abnormalities by 25 %.</div><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> registration: <span><span>NCT05280574</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111661"},"PeriodicalIF":5.0,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Continuation versus discontinuation of renin-angiotensin aldosterone system inhibitors before non-cardiac surgery: A systematic review and meta-analysis 非心脏手术前继续使用与停用肾素-血管紧张素醛固酮系统抑制剂：系统回顾和荟萃分析。

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2024-11-11 DOI: 10.1016/j.jclinane.2024.111679

Mushood Ahmed , Eeshal Fatima , Aimen Shafiq , Areeba Ahsan , Eeshal Zulfiqar , Fouad Masood , Raheel Ahmed , Farah Yasmin , Muhammad Sohaib Asghar

Background

A large number of patients undergoing noncardiac surgeries are on long-term use of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs). The current guidelines regarding the continuation or discontinuation of renin-angiotensin-aldosterone system inhibitors (RAAS) inhibitors before noncardiac surgery are conflicting. This meta-analysis aims to evaluate whether continuing or withholding RAAS inhibitors before noncardiac surgery influences perioperative mortality and complications.

Methods

A thorough literature search was performed across PubMed/MEDLINE, Embase, and the Cochrane Library from their inception up to August 30, 2024 to identify eligible randomized controlled trials (RCTs) and cohort studies. Clinical outcomes were evaluated using a random-effects model to pool odds ratios (ORs) with 95 % confidence intervals (CIs).

Results

The analysis included 16 studies with a total of 59,105 patients on RAAS inhibitors before noncardiac surgery. Withholding RAAS inhibitors was associated with a significantly lower incidence of intraoperative hypotension (OR = 0.49; 95 % CI = 0.29 to 0.83) and acute kidney injury (AKI) (OR = 0.88; 95 % CI = 0.82 to 0.95) than continuing the therapy. However, there was no statistically significant difference in reducing mortality (OR = 1.10; 95 % CI = 0.86 to 1.40), major adverse cardiovascular events (MACE) (OR = 1.27; 95 % CI = 0.75 to 2.16), myocardial infarction (OR = 0.83; 95 % CI = 0.27 to 2.59) or stroke events (OR = 0.70; 95 % CI = 0.36 to 1.36) between the two groups.

Conclusion

Withholding RAAS inhibitors before noncardiac surgery reduces intraoperative hypotension and AKI with nonsignificant effects on mortality and MACE.

背景：大量接受非心脏手术的患者长期服用血管紧张素转换酶抑制剂（ACEi）或血管紧张素受体阻滞剂（ARB）。目前关于非心脏手术前继续使用或停用肾素-血管紧张素-醛固酮系统抑制剂（RAAS）的指南存在冲突。本荟萃分析旨在评估在非心脏手术前继续使用或停用 RAAS 抑制剂是否会影响围手术期死亡率和并发症：方法：我们在 PubMed/MEDLINE、Embase 和 Cochrane 图书馆中进行了全面的文献检索，以确定符合条件的随机对照试验 (RCT) 和队列研究。采用随机效应模型对临床结果进行评估，以得出带有 95% 置信区间 (CI) 的赔率比 (OR)：分析包括16项研究，共有59105名患者在非心脏手术前服用了RAAS抑制剂。与继续使用 RAAS 抑制剂相比，停用 RAAS 抑制剂可显著降低术中低血压（OR = 0.49；95 % CI = 0.29 至 0.83）和急性肾损伤（AKI）（OR = 0.88；95 % CI = 0.82 至 0.95）的发生率。然而，在降低死亡率（OR = 1.10；95 % CI = 0.86 至 1.40）、主要不良心血管事件（MACE）（OR = 1.27；95 % CI = 0.75 至 2.16）、心肌梗死（OR = 0.83；95 % CI = 0.27 至 2.59）或中风事件（OR = 0.70；95 % CI = 0.36 至 1.36）方面，两组之间没有统计学意义上的显著差异：结论：非心脏手术前停用 RAAS 抑制剂可降低术中低血压和 AKI，但对死亡率和 MACE 的影响不大。

{"title":"Continuation versus discontinuation of renin-angiotensin aldosterone system inhibitors before non-cardiac surgery: A systematic review and meta-analysis","authors":"Mushood Ahmed , Eeshal Fatima , Aimen Shafiq , Areeba Ahsan , Eeshal Zulfiqar , Fouad Masood , Raheel Ahmed , Farah Yasmin , Muhammad Sohaib Asghar","doi":"10.1016/j.jclinane.2024.111679","DOIUrl":"10.1016/j.jclinane.2024.111679","url":null,"abstract":"<div><h3>Background</h3><div>A large number of patients undergoing noncardiac surgeries are on long-term use of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs). The current guidelines regarding the continuation or discontinuation of renin-angiotensin-aldosterone system inhibitors (RAAS) inhibitors before noncardiac surgery are conflicting. This meta-analysis aims to evaluate whether continuing or withholding RAAS inhibitors before noncardiac surgery influences perioperative mortality and complications.</div></div><div><h3>Methods</h3><div>A thorough literature search was performed across PubMed/MEDLINE, Embase, and the Cochrane Library from their inception up to August 30, 2024 to identify eligible randomized controlled trials (RCTs) and cohort studies. Clinical outcomes were evaluated using a random-effects model to pool odds ratios (ORs) with 95 % confidence intervals (CIs).</div></div><div><h3>Results</h3><div>The analysis included 16 studies with a total of 59,105 patients on RAAS inhibitors before noncardiac surgery. Withholding RAAS inhibitors was associated with a significantly lower incidence of intraoperative hypotension (OR = 0.49; 95 % CI = 0.29 to 0.83) and acute kidney injury (AKI) (OR = 0.88; 95 % CI = 0.82 to 0.95) than continuing the therapy. However, there was no statistically significant difference in reducing mortality (OR = 1.10; 95 % CI = 0.86 to 1.40), major adverse cardiovascular events (MACE) (OR = 1.27; 95 % CI = 0.75 to 2.16), myocardial infarction (OR = 0.83; 95 % CI = 0.27 to 2.59) or stroke events (OR = 0.70; 95 % CI = 0.36 to 1.36) between the two groups.</div></div><div><h3>Conclusion</h3><div>Withholding RAAS inhibitors before noncardiac surgery reduces intraoperative hypotension and AKI with nonsignificant effects on mortality and MACE.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111679"},"PeriodicalIF":5.0,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Evaluating prevalence and trajectory of functional disability in older surgical patients: An observational cohort study 评估老年手术患者功能障碍的发生率和轨迹：一项观察性队列研究。

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2024-11-10 DOI: 10.1016/j.jclinane.2024.111681

Ellene Yan HBSc , Nina Butris MSc , Yasmin Alhamdah MSc , Paras Kapoor MSc , Leif Erik Lovblom PhD , Jean Wong MD , Sazzadul Islam MSc , Aparna Saripella MSc , David F. Tang-Wai MD CM , Linda Mah MD MHSc , Shabbir M.H. Alibhai MD MSc , David He MD PhD , Frances Chung MD

Study objectives

To (1) estimate the prevalence and trajectory of functional disability exceeding patient-acceptable and clinically significant levels in older surgical patients preoperatively and at 30, 90, and 180 days postoperatively, (2) identify risk factors associated with postoperative functional disability, and (3) compare adverse clinical outcomes between participants with and without functional disability.

Design

Multicenter prospective study.

Setting

Remote preoperative and postoperative assessments.

Patients

307 older patients aged ≥65 years undergoing non-cardiac surgery.

Measurements

Functional disability was assessed using the 12-item World Health Organization Disability Assessment Schedule 2.0 on an online survey, with a score ≥ 16 % exceeding a patient-acceptable symptom state and ≥ 35 % indicating significant, or at least moderate, severity.

Main results

We found that 133 (43 %) patients exhibited preoperative functional disability exceeding a patient-acceptable level, with 42 (14 %) experiencing clinically significant, or at least moderate, functional disability. The Functional Disability group showed greater improvement in function than the No-disability group. Specifically, over 60 % of participants in the Functional Disability group showed significant improvement at 90 and 180 days postoperatively, with 40 % being disability-free. However, 12 % of the Functional Disability group and 9 % of the No-disability group experienced a clinically important worsening in functional disability at 180 days postoperatively. Preoperative functional disability and depression were associated with nearly 6- and 4-fold higher odds of functional disability at 180 days, respectively.

Conclusions

Patients with preoperative functional disability experienced greater postoperative improvement in functional disability than the No-disability group. Preoperative evaluation of functional disability informs perioperative care and recovery for patients and clinicians.

研究目标：目的：（1）估计老年手术患者术前、术后30天、90天和180天时功能障碍超过患者可接受和临床意义水平的发生率和轨迹；（2）确定与术后功能障碍相关的风险因素；（3）比较有功能障碍和无功能障碍参与者的不良临床结局：设计：多中心前瞻性研究：远程术前和术后评估：307名年龄≥65岁接受非心脏手术的老年患者：主要结果：我们发现，133 名（43%）患者在术后出现了严重的功能障碍：我们发现，133 例（43%）患者术前的功能障碍程度超过了患者可接受的水平，其中 42 例（14%）患者的功能障碍程度有临床意义，或至少为中度。与无残疾组相比，功能残疾组的功能改善幅度更大。具体来说，超过 60% 的功能障碍组参与者在术后 90 天和 180 天有明显改善，其中 40% 的人无残疾。然而，12%的功能障碍组和 9%的无残疾组患者在术后 180 天出现了临床意义上的功能障碍恶化。术前功能障碍和抑郁分别与180天后功能障碍几率增加近6倍和4倍有关：结论：与无功能障碍组相比，术前有功能障碍的患者术后功能障碍的改善程度更大。术前功能障碍评估为患者和临床医生的围手术期护理和康复提供了参考。

{"title":"Evaluating prevalence and trajectory of functional disability in older surgical patients: An observational cohort study","authors":"Ellene Yan HBSc , Nina Butris MSc , Yasmin Alhamdah MSc , Paras Kapoor MSc , Leif Erik Lovblom PhD , Jean Wong MD , Sazzadul Islam MSc , Aparna Saripella MSc , David F. Tang-Wai MD CM , Linda Mah MD MHSc , Shabbir M.H. Alibhai MD MSc , David He MD PhD , Frances Chung MD","doi":"10.1016/j.jclinane.2024.111681","DOIUrl":"10.1016/j.jclinane.2024.111681","url":null,"abstract":"<div><h3>Study objectives</h3><div>To (1) estimate the prevalence and trajectory of functional disability exceeding patient-acceptable and clinically significant levels in older surgical patients preoperatively and at 30, 90, and 180 days postoperatively, (2) identify risk factors associated with postoperative functional disability, and (3) compare adverse clinical outcomes between participants with and without functional disability.</div></div><div><h3>Design</h3><div>Multicenter prospective study.</div></div><div><h3>Setting</h3><div>Remote preoperative and postoperative assessments.</div></div><div><h3>Patients</h3><div>307 older patients aged ≥65 years undergoing non-cardiac surgery.</div></div><div><h3>Measurements</h3><div>Functional disability was assessed using the 12-item World Health Organization Disability Assessment Schedule 2.0 on an online survey, with a score ≥ 16 % exceeding a patient-acceptable symptom state and ≥ 35 % indicating significant, or at least moderate, severity.</div></div><div><h3>Main results</h3><div>We found that 133 (43 %) patients exhibited preoperative functional disability exceeding a patient-acceptable level, with 42 (14 %) experiencing clinically significant, or at least moderate, functional disability. The Functional Disability group showed greater improvement in function than the No-disability group. Specifically, over 60 % of participants in the Functional Disability group showed significant improvement at 90 and 180 days postoperatively, with 40 % being disability-free. However, 12 % of the Functional Disability group and 9 % of the No-disability group experienced a clinically important worsening in functional disability at 180 days postoperatively. Preoperative functional disability and depression were associated with nearly 6- and 4-fold higher odds of functional disability at 180 days, respectively.</div></div><div><h3>Conclusions</h3><div>Patients with preoperative functional disability experienced greater postoperative improvement in functional disability than the No-disability group. Preoperative evaluation of functional disability informs perioperative care and recovery for patients and clinicians.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111681"},"PeriodicalIF":5.0,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Effects of Desflurane versus sevoflurane on graft outcome of patients with cirrhosis receiving steatotic liver graft in deceased donor liver transplantation 地氟醚与七氟醚对接受脂肪肝肝移植的肝硬化患者移植结果的影响

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2024-11-09 DOI: 10.1016/j.jclinane.2024.111674

Insun Park , Eun-Ki Min , Bon-Nyeo Koo , Jae Hyon Park , Deok Gie Kim , Dong Jin Joo , Jae Geun Lee

Study objective

This study aimed to analyze the effects of two volatile anesthetic agents, desflurane and sevoflurane, on graft outcomes in patients undergoing deceased donor liver transplantation (DDLT) for cirrhosis, with a specific focus on fatty grafts.

Design

A retrospective observational study.

Setting

A tertiary hospital (Severance Hospital, Korea).

Patients

This study included 151 patients with liver cirrhosis who underwent DDLT for cirrhosis between January 2006 and December 2022.

Interventions

Patients were grouped according to maintenance anesthesia received (desflurane or sevoflurane), the model for end-stage liver disease (MELD) score, and macrovesicular steatosis (MVS) of the liver graft.

Measurements

Survival curves were constructed from the date of surgery to graft failure or death. After propensity score matching (PSM), Cox regression analysis was used to compare hazards ratios (HR) for 5-year graft and overall survival. Subgroup analyses were performed for the MELD score and MVS of the liver graft. Incidences of 1-month acute rejection and early allograft dysfunction (EAD) were also compared between the two groups.

Main results

Among 151 eligible patients, 49 patients remained in each group after PSM, with 14 (28.6 %) graft failures and deaths occurring in each group. In matched analysis, sevoflurane showed poorer 5-year graft and overall survival compared to desflurane in recipients of graft with ≥10 % MVS, and this trend was significant in patients with MELD score of ≥35. In Cox regression model, compared to desflurane sevoflurane showed a propensity score-matched HR of 5.8 (95 % CI, 1.13–30.50 for both 5-year graft and overall survival. Additionally, sevoflurane showed an increased risk of 1-month acute rejection; however, no difference was observed for EAD.

Conclusions

Sevoflurane as a maintenance agent during DDLT in recipients with high MELD scores and fatty grafts may be associated with poorer outcomes compared to desflurane.

研究目的本研究旨在分析地氟醚和七氟醚这两种挥发性麻醉剂对肝硬化死亡供体肝移植（DDLT）患者移植物预后的影响，尤其关注脂肪移植物：设计：回顾性观察研究：患者：151名肝硬化患者：本研究纳入了2006年1月至2022年12月期间接受DDLT治疗的151例肝硬化患者：根据接受的维持麻醉（地氟醚或七氟醚）、终末期肝病模型（MELD）评分和肝脏移植物大泡性脂肪变性（MVS）对患者进行分组：测量：构建了从手术日期到移植失败或死亡的生存曲线。经过倾向评分匹配（PSM）后，采用Cox回归分析比较5年移植物和总生存率的危险比（HR）。根据肝脏移植物的 MELD 评分和 MVS 进行了分组分析。还比较了两组患者 1 个月急性排斥反应和早期异体移植功能障碍（EAD）的发生率：主要结果：在 151 名符合条件的患者中，每组有 49 名患者在 PSM 后继续接受治疗，每组均有 14 例（28.6%）移植失败和死亡。在匹配分析中，与地氟醚相比，七氟醚在MVS≥10%的移植物受者中显示出更差的5年移植物和总生存率，这一趋势在MELD评分≥35分的患者中显著。在 Cox 回归模型中，与地氟醚相比，七氟醚在 5 年移植物存活率和总存活率方面的倾向评分匹配 HR 为 5.8（95 % CI，1.13-30.50）。此外，七氟醚增加了1个月急性排斥反应的风险；但在EAD方面未观察到差异：结论：与地氟烷相比，七氟烷作为 MELD 评分高和脂肪移植物受者 DDLT 期间的维持用药可能会导致较差的预后。

{"title":"Effects of Desflurane versus sevoflurane on graft outcome of patients with cirrhosis receiving steatotic liver graft in deceased donor liver transplantation","authors":"Insun Park , Eun-Ki Min , Bon-Nyeo Koo , Jae Hyon Park , Deok Gie Kim , Dong Jin Joo , Jae Geun Lee","doi":"10.1016/j.jclinane.2024.111674","DOIUrl":"10.1016/j.jclinane.2024.111674","url":null,"abstract":"<div><h3>Study objective</h3><div>This study aimed to analyze the effects of two volatile anesthetic agents, desflurane and sevoflurane, on graft outcomes in patients undergoing deceased donor liver transplantation (DDLT) for cirrhosis, with a specific focus on fatty grafts.</div></div><div><h3>Design</h3><div>A retrospective observational study.</div></div><div><h3>Setting</h3><div>A tertiary hospital (Severance Hospital, Korea).</div></div><div><h3>Patients</h3><div>This study included 151 patients with liver cirrhosis who underwent DDLT for cirrhosis between January 2006 and December 2022.</div></div><div><h3>Interventions</h3><div>Patients were grouped according to maintenance anesthesia received (desflurane or sevoflurane), the model for end-stage liver disease (MELD) score, and macrovesicular steatosis (MVS) of the liver graft.</div></div><div><h3>Measurements</h3><div>Survival curves were constructed from the date of surgery to graft failure or death. After propensity score matching (PSM), Cox regression analysis was used to compare hazards ratios (HR) for 5-year graft and overall survival. Subgroup analyses were performed for the MELD score and MVS of the liver graft. Incidences of 1-month acute rejection and early allograft dysfunction (EAD) were also compared between the two groups.</div></div><div><h3>Main results</h3><div>Among 151 eligible patients, 49 patients remained in each group after PSM, with 14 (28.6 %) graft failures and deaths occurring in each group. In matched analysis, sevoflurane showed poorer 5-year graft and overall survival compared to desflurane in recipients of graft with ≥10 % MVS, and this trend was significant in patients with MELD score of ≥35. In Cox regression model, compared to desflurane sevoflurane showed a propensity score-matched HR of 5.8 (95 % CI, 1.13–30.50 for both 5-year graft and overall survival. Additionally, sevoflurane showed an increased risk of 1-month acute rejection; however, no difference was observed for EAD.</div></div><div><h3>Conclusions</h3><div>Sevoflurane as a maintenance agent during DDLT in recipients with high MELD scores and fatty grafts may be associated with poorer outcomes compared to desflurane.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111674"},"PeriodicalIF":5.0,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Efficacy and safety of remimazolam versus dexmedetomidine for patients undergoing flexible fiberoptic bronchoscopy: A randomized, clinical trial 对接受柔性纤维支气管镜检查的患者使用雷马唑仑与右美托咪定的有效性和安全性：随机临床试验。

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2024-11-07 DOI: 10.1016/j.jclinane.2024.111677

Laiying Zhou , Jingcheng Zou , Xue Li , Xiaozhuo Zuo , Mengting Gu , Kai Sun , Wen Fan , Yuanyuan Yao , Min Yan

Study objective

Remimazolam's benefits for patients undergoing painless flexible fiberoptic bronchoscopy remain uncertain. We aimed to compare the efficacy and safety of remimazolam and dexmedetomidine in flexible fiberoptic bronchoscopy (FFB).

Design

Randomized controlled trial.

Setting

University hospital.

Patients

Between April 2021 and September 2022, patients undergoing painless flexible fiberoptic bronchoscopy were recruited.

Interventions

The patients were randomly assigned with a 1:1 ratio to remimazolam-remifentanil group (RR group) or dexmedetomidine-remifentanil group (DR group).

Measurements

The primary outcome was the procedure interruption rate during bronchoscopy. Secondary outcomes were hemodynamic changes, resuscitation time, rescue medication usage rate and dose, satisfaction scores of patients and bronchoscopists, operation-related complications, and adverse events.

Main results

A total of 363 patients were included for final analysis. The interruption rates of bronchoscopy were 8.2 % in the RR group and 39.2 % in the DR group (P < 0.05). The rescue medication usage rate (4.4 % vs. 38.7 %, P < 0.05) and dose (1.51 ± 8.15 mg vs. 13.17 ± 18.86 mg, P < 0.05) were lower in the RR group compared with the DR group. The incidence of oxygen desaturation was significantly lower in the RR group than in the DR group (14.3 % vs. 44.2 %, P < 0.05). Hemodynamic changes in patients in the DR group were significant, with longer recovery time and lower satisfaction scores for both inpatients and bronchoscopists (P < 0.05), compared with the RR group. However, there were no significant differences between groups in terms of operation-related complications (P > 0.05) except for postoperative dizziness, which was more common in the DR group (P < 0.05).

Conclusions

Remimazolam is effective and safe in painless flexible fiberoptic bronchoscopy. It allows a lower procedure interruption rate and incidence of oxygen desaturation, providing better hemodynamic stability compared to dexmedetomidine.

研究目的雷马唑仑对接受无痛柔性纤维支气管镜检查患者的益处仍不确定。我们旨在比较雷马唑仑和右美托咪定在柔性纤维支气管镜检查（FFB）中的疗效和安全性：设计：随机对照试验：患者2021年4月至2022年9月期间，招募接受无痛柔性纤维支气管镜检查的患者：患者按1:1的比例随机分配到雷马唑仑-瑞芬太尼组（RR组）或右美托咪定-瑞芬太尼组（DR组）：主要结果是支气管镜检查过程中的手术中断率。次要结果为血流动力学变化、复苏时间、抢救药物使用率和剂量、患者和支气管镜医师的满意度评分、手术相关并发症和不良事件：最终分析共纳入了363名患者。RR组和DR组的支气管镜检查中断率分别为8.2%和39.2%（P 0.05），但术后头晕在DR组更为常见（P 结论：雷米唑仑是一种有效的支气管镜治疗药物：雷马唑仑在无痛柔性纤维支气管镜检查中既有效又安全。与右美托咪定相比，它能降低手术中断率和氧饱和度降低率，提供更好的血流动力学稳定性。

{"title":"Efficacy and safety of remimazolam versus dexmedetomidine for patients undergoing flexible fiberoptic bronchoscopy: A randomized, clinical trial","authors":"Laiying Zhou , Jingcheng Zou , Xue Li , Xiaozhuo Zuo , Mengting Gu , Kai Sun , Wen Fan , Yuanyuan Yao , Min Yan","doi":"10.1016/j.jclinane.2024.111677","DOIUrl":"10.1016/j.jclinane.2024.111677","url":null,"abstract":"<div><h3>Study objective</h3><div>Remimazolam's benefits for patients undergoing painless flexible fiberoptic bronchoscopy remain uncertain. We aimed to compare the efficacy and safety of remimazolam and dexmedetomidine in flexible fiberoptic bronchoscopy (FFB).</div></div><div><h3>Design</h3><div>Randomized controlled trial.</div></div><div><h3>Setting</h3><div>University hospital.</div></div><div><h3>Patients</h3><div>Between April 2021 and September 2022, patients undergoing painless flexible fiberoptic bronchoscopy were recruited.</div></div><div><h3>Interventions</h3><div>The patients were randomly assigned with a 1:1 ratio to remimazolam-remifentanil group (RR group) or dexmedetomidine-remifentanil group (DR group).</div></div><div><h3>Measurements</h3><div>The primary outcome was the procedure interruption rate during bronchoscopy. Secondary outcomes were hemodynamic changes, resuscitation time, rescue medication usage rate and dose, satisfaction scores of patients and bronchoscopists, operation-related complications, and adverse events.</div></div><div><h3>Main results</h3><div>A total of 363 patients were included for final analysis. The interruption rates of bronchoscopy were 8.2 % in the RR group and 39.2 % in the DR group (<em>P</em> < 0.05). The rescue medication usage rate (4.4 % vs. 38.7 %, <em>P</em> < 0.05) and dose (1.51 ± 8.15 mg vs. 13.17 ± 18.86 mg, <em>P</em> < 0.05) were lower in the RR group compared with the DR group. The incidence of oxygen desaturation was significantly lower in the RR group than in the DR group (14.3 % vs. 44.2 %, <em>P</em> < 0.05). Hemodynamic changes in patients in the DR group were significant, with longer recovery time and lower satisfaction scores for both inpatients and bronchoscopists (<em>P</em> < 0.05), compared with the RR group. However, there were no significant differences between groups in terms of operation-related complications (<em>P</em> > 0.05) except for postoperative dizziness, which was more common in the DR group (<em>P</em> < 0.05).</div></div><div><h3>Conclusions</h3><div>Remimazolam is effective and safe in painless flexible fiberoptic bronchoscopy. It allows a lower procedure interruption rate and incidence of oxygen desaturation, providing better hemodynamic stability compared to dexmedetomidine.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111677"},"PeriodicalIF":5.0,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The effects of thoracic epidural blockade on ventilation-perfusion matching during one-lung ventilation: An exploratory study 单肺通气时胸腔硬膜外阻滞对通气-灌注匹配的影响：一项探索性研究。

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2024-11-06 DOI: 10.1016/j.jclinane.2024.111678

Yuxian Wang BS , Yilin Wei BS , Guannan Chen M.D., Ph.D , Zhiyao Wang M.D., Ph.D , Yu Fan MS , Jie Wang MS , Yuanjun Yang BS , Di Zhou M.D., Ph.D , Ming Zhong M.D., Ph.D

Objective

Electrical impedance tomography (EIT) enables continuous image acquisition, facilitating real-time measurements of ventilation and perfusion at the clinical bedside. Experimental and clinical studies on controversial effects of thoracic epidural blockade (TEB) with local anesthetics on ventilation-perfusion(V/Q) matching and hypoxia during one lung ventilation (OLV) are rare. The aim of this study was to use EIT to investigate the effects of TEB combined with general anesthesia on pulmonary perfusion distribution and V/Q matching during one-lung ventilation.

Design

Single-centered, prospective, unblinded, randomized, parallel-group clinical trial.

Setting

Surgical suite of a university-affiliated teaching hospital.

Patients

Thirty patients prepared for thoracic surgery were randomly assigned to either the control group or the TEB group, which received a combination of thoracic epidural blockade and general anesthesia.

Measurements

EIT measurements and blood gas analysis were conducted in the lateral position during two-lung ventilation(T₀), 15 min after OLV(T₁), and 15 min after administration of 0.25 % ropivacaine or 0.9 % saline via epidural delivery during OLV(T₂). Hemodynamic and respiratory parameters were recorded, and Dead Space%, Shunt%, and V/Q Match% were calculated based on blood gas analysis and EIT images.

Results

Mean arterial pressure (p < 0.05) significantly decreased 15 min after TEB, while there were no significant changes in heart rate among the 30 patients (p = 0.547). OLV resulted in a significant decrease in arterial oxygen partial pressure/inspired oxygen fraction (PaO₂/FiO₂) from T₀ to T₁ in both groups. The PaO₂/FiO₂ in the TEB group was significantly lower after epidural administration of the local anesthetic (p < 0.05). Shunt- ABG (%) was significantly higher in the TEB group compared to the control group at T₂ (p < 0.05). TEB increased non-ventilated perfusion distribution(p < 0.05), and Shunt-EIT % (p < 0.05) and reduced Matched Region % (p < 0.05), while Dead Space-EIT % remained (p = 0.499).

Conclusions

Based on the contrast-enhanced EIT evaluation of pulmonary perfusion and ventilation, TEB appears to induce a V/Q mismatch in patients undergoing OLV in the lateral position for thoracic surgery.

Trial registration: ClinicalTrials.gov, NCT04730089. Registration on January 25th, 2021.

目的：电阻抗断层扫描（EIT）可实现连续图像采集，便于在临床床旁对通气和灌注进行实时测量。关于使用局麻药进行胸腔硬膜外阻滞（TEB）对通气-灌注（V/Q）匹配和单肺通气（OLV）时缺氧的争议性影响的实验和临床研究并不多见。本研究旨在使用 EIT 调查 TEB 联合全身麻醉对单肺通气时肺部灌注分布和 V/Q 匹配的影响：单中心、前瞻性、非盲、随机、平行组临床试验：地点：一所大学附属教学医院的手术室：30名准备接受胸腔手术的患者被随机分配到对照组或TEB组，TEB组接受胸腔硬膜外阻滞和全身麻醉：在双肺通气（T0）、OLV（T1）后 15 分钟以及 OLV（T2）期间通过硬膜外给药给予 0.25 % 罗哌卡因或 0.9 % 生理盐水（T2）后 15 分钟，分别在侧卧位进行 EIT 测量和血气分析。记录血流动力学和呼吸参数，并根据血气分析和 EIT 图像计算死腔率、分流率和 V/Q 匹配率：两组患者从 T0 到 T1 的平均动脉压（p 2/FiO2）。硬膜外注射局麻药后，TEB 组的 PaO2/FiO2 明显降低（p 2）：根据对比增强 EIT 对肺灌注和通气的评估，TEB 似乎会诱发胸外科手术侧卧位 OLV 患者的 V/Q 失配：试验注册：ClinicalTrials.gov，NCT04730089。注册日期：2021 年 1 月 25 日。

{"title":"The effects of thoracic epidural blockade on ventilation-perfusion matching during one-lung ventilation: An exploratory study","authors":"Yuxian Wang BS , Yilin Wei BS , Guannan Chen M.D., Ph.D , Zhiyao Wang M.D., Ph.D , Yu Fan MS , Jie Wang MS , Yuanjun Yang BS , Di Zhou M.D., Ph.D , Ming Zhong M.D., Ph.D","doi":"10.1016/j.jclinane.2024.111678","DOIUrl":"10.1016/j.jclinane.2024.111678","url":null,"abstract":"<div><h3>Objective</h3><div>Electrical impedance tomography (EIT) enables continuous image acquisition, facilitating real-time measurements of ventilation and perfusion at the clinical bedside. Experimental and clinical studies on controversial effects of thoracic epidural blockade (TEB) with local anesthetics on ventilation-perfusion(V/Q) matching and hypoxia during one lung ventilation (OLV) are rare. The aim of this study was to use EIT to investigate the effects of TEB combined with general anesthesia on pulmonary perfusion distribution and V/Q matching during one-lung ventilation.</div></div><div><h3>Design</h3><div>Single-centered, prospective, unblinded, randomized, parallel-group clinical trial.</div></div><div><h3>Setting</h3><div>Surgical suite of a university-affiliated teaching hospital.</div></div><div><h3>Patients</h3><div>Thirty patients prepared for thoracic surgery were randomly assigned to either the control group or the TEB group, which received a combination of thoracic epidural blockade and general anesthesia.</div></div><div><h3>Measurements</h3><div>EIT measurements and blood gas analysis were conducted in the lateral position during two-lung ventilation(T<sub>0</sub>), 15 min after OLV(T<sub>1</sub>), and 15 min after administration of 0.25 % ropivacaine or 0.9 % saline via epidural delivery during OLV(T<sub>2</sub>). Hemodynamic and respiratory parameters were recorded, and Dead Space%, Shunt%, and V/Q Match% were calculated based on blood gas analysis and EIT images.</div></div><div><h3>Results</h3><div>Mean arterial pressure (<em>p</em> < 0.05) significantly decreased 15 min after TEB, while there were no significant changes in heart rate among the 30 patients (<em>p</em> = 0.547). OLV resulted in a significant decrease in arterial oxygen partial pressure/inspired oxygen fraction (PaO<sub>2</sub>/FiO<sub>2</sub>) from T<sub>0</sub> to T<sub>1</sub> in both groups. The PaO<sub>2</sub>/FiO<sub>2</sub> in the TEB group was significantly lower after epidural administration of the local anesthetic (<em>p</em> < 0.05). Shunt- ABG (%) was significantly higher in the TEB group compared to the control group at T<sub>2</sub> (<em>p</em> < 0.05). TEB increased non-ventilated perfusion distribution(p < 0.05), and Shunt-EIT % (p < 0.05) and reduced Matched Region % (p < 0.05), while Dead Space-EIT % remained (<em>p</em> = 0.499).</div></div><div><h3>Conclusions</h3><div>Based on the contrast-enhanced EIT evaluation of pulmonary perfusion and ventilation, TEB appears to induce a V/Q mismatch in patients undergoing OLV in the lateral position for thoracic surgery.</div><div>Trial registration: <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>, <span><span>NCT04730089</span><svg><path></path></svg></span>. Registration on January 25th, 2021.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111678"},"PeriodicalIF":5.0,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Effect of inspiratory oxygen fraction during driving pressure-guided ventilation strategy on pulmonary complications following open abdominal surgery: A randomized controlled trial 驱动压力引导通气策略中吸气氧分压对开腹手术后肺部并发症的影响：随机对照试验

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2024-11-06 DOI: 10.1016/j.jclinane.2024.111676

Yu-Tong Zhang , Yang Han , Hui-Jia Zhuang , Ai-Min Feng , Liang Jin , Xue-Fei Li , Hong Yu , Hai Yu

Study objective

The aim of the present study was to determine the effect of 30 % fraction of inspired oxygen (FIO₂) compared with 80 % FIO₂ in the context of driving pressure-guided ventilation strategy on pulmonary complications following open abdominal surgery.

Design

A single-center, prospective, randomized controlled trial.

Setting

Tertiary university hospital in China.

Patients

514 adult patients, ASA I-III and scheduled for major open abdominal surgery under general anesthesia.

Interventions

Patients were randomly assigned to receive either 30 % or 80 % FIO₂ during the intraoperative period. All patients received driving pressure-guided ventilation strategy, including low tidal volume and individualized PEEP set at lowest driving pressure.

Measurements

The primary outcome was the incidence of a composite of pulmonary complications within the 7 days postoperatively. The severity of pulmonary complications, extrapulmonary complications, and other secondary outcomes were also assessed.

Main results

Of 1553 patients assessed for eligibility, 514 patients were randomly assigned and analyzed with intention-to-treat principle. Patients receiving 30 % FIO₂ had a significantly lower incidence of postoperative pulmonary complications (PPCs) compared to those receiving 80 % FIO₂ (46.3 %vs. 64.6 %; RR, 0.72; 95 % CI, 0.61–0.84; P < 0.001). The severity score of PPCs was significantly reduced in the 30 % FIO₂ group compared with that in the 80 % FIO₂ group within the 7 postoperative days (P < 0.001). Dynamic compliance was significantly greater in 30 % FIO₂ group at the end of surgery (56 [48–66] vs. 53 [46–62], P = 0.027). More patients in the 80 % FIO₂ group developed oxygen desaturation (SpO₂ < 94 %) on air intake during PACU stay (18.5 %vs. 30.4 %; RR, 0.61; 95 % CI, 0.44–0.84; P = 0.002; 30 % FIO₂ group vs.80 % FIO₂ group).

Conclusions

In patients undergoing open abdominal surgery, using a 30 % FIO₂, compared with 80 % FIO₂, in context of driving pressure-guided ventilation strategy, intraoperatively reduced the incidence and severity of pulmonary complications within the first 7 postoperative days.

研究目的本研究旨在确定在压力引导通气策略下，30%的吸入氧饱和度（FIO2）与80%的吸入氧饱和度（FIO2）相比，对开腹手术后肺部并发症的影响。干预措施患者被随机分配到术中接受 30% 或 80% 的 FIO2。所有患者均接受驱动压力引导的通气策略，包括低潮气量和以最低驱动压力设定的个性化 PEEP。主要结果在1553名通过资格评估的患者中，514名患者被随机分配，并按照意向治疗原则进行分析。与接受80% FIO2治疗的患者相比，接受30% FIO2治疗的患者术后肺部并发症（PPCs）发生率明显较低（46.3%对64.6%；RR，0.72；95% CI，0.61-0.84；P< 0.001）。与 80% FIO2 组相比，30% FIO2 组在术后 7 天内的 PPC 严重程度评分明显降低（P <0.001）。手术结束时，30% FIO2 组的动态顺应性明显更高（56 [48-66] 对 53 [46-62]，P = 0.027）。在 PACU 住院期间，80% FIO2 组中有更多患者在吸入空气时出现氧饱和度降低（SpO2 < 94 %）（18.5 % vs. 30.4 %; RR, 0.61; 95 % CI, 0.44-0.84; P = 0.002; 30 % FIO2 组 vs. 80 % FIO2 组）。结论在腹部开腹手术患者中，与 80% FIO2 相比，在压力引导通气策略的驱动下，术中使用 30% FIO2 可降低术后 7 天内肺部并发症的发生率和严重程度。

{"title":"Effect of inspiratory oxygen fraction during driving pressure-guided ventilation strategy on pulmonary complications following open abdominal surgery: A randomized controlled trial","authors":"Yu-Tong Zhang , Yang Han , Hui-Jia Zhuang , Ai-Min Feng , Liang Jin , Xue-Fei Li , Hong Yu , Hai Yu","doi":"10.1016/j.jclinane.2024.111676","DOIUrl":"10.1016/j.jclinane.2024.111676","url":null,"abstract":"<div><h3>Study objective</h3><div>The aim of the present study was to determine the effect of 30 % fraction of inspired oxygen (FIO<sub>2</sub>) compared with 80 % FIO<sub>2</sub> in the context of driving pressure-guided ventilation strategy on pulmonary complications following open abdominal surgery.</div></div><div><h3>Design</h3><div>A single-center, prospective, randomized controlled trial.</div></div><div><h3>Setting</h3><div>Tertiary university hospital in China.</div></div><div><h3>Patients</h3><div>514 adult patients, ASA I-III and scheduled for major open abdominal surgery under general anesthesia.</div></div><div><h3>Interventions</h3><div>Patients were randomly assigned to receive either 30 % or 80 % FIO<sub>2</sub> during the intraoperative period. All patients received driving pressure-guided ventilation strategy, including low tidal volume and individualized PEEP set at lowest driving pressure.</div></div><div><h3>Measurements</h3><div>The primary outcome was the incidence of a composite of pulmonary complications within the 7 days postoperatively. The severity of pulmonary complications, extrapulmonary complications, and other secondary outcomes were also assessed.</div></div><div><h3>Main results</h3><div>Of 1553 patients assessed for eligibility, 514 patients were randomly assigned and analyzed with intention-to-treat principle. Patients receiving 30 % FIO<sub>2</sub> had a significantly lower incidence of postoperative pulmonary complications (PPCs) compared to those receiving 80 % FIO<sub>2</sub> (46.3 %<em>vs.</em> 64.6 %; RR, 0.72; 95 % CI, 0.61–0.84; <em>P</em> < 0.001). The severity score of PPCs was significantly reduced in the 30 % FIO<sub>2</sub> group compared with that in the 80 % FIO<sub>2</sub> group within the 7 postoperative days (<em>P</em> < 0.001). Dynamic compliance was significantly greater in 30 % FIO<sub>2</sub> group at the end of surgery (56 [48–66] <em>vs.</em> 53 [46–62], <em>P</em> = 0.027). More patients in the 80 % FIO<sub>2</sub> group developed oxygen desaturation (SpO<sub>2</sub> < 94 %) on air intake during PACU stay (18.5 %<em>vs.</em> 30.4 %; RR, 0.61; 95 % CI, 0.44–0.84; <em>P</em> = 0.002; 30 % FIO<sub>2</sub> group <em>vs.</em>80 % FIO<sub>2</sub> group).</div></div><div><h3>Conclusions</h3><div>In patients undergoing open abdominal surgery, using a 30 % FIO<sub>2</sub>, compared with 80 % FIO<sub>2</sub>, in context of driving pressure-guided ventilation strategy, intraoperatively reduced the incidence and severity of pulmonary complications within the first 7 postoperative days.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111676"},"PeriodicalIF":5.0,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Can the lung ultrasound score predict pulmonary complications after non-thoracic surgery in patients with blunt thoracic trauma: A single-center observational study 肺部超声评分能否预测胸部钝伤患者非胸部手术后的肺部并发症？单中心观察研究

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2024-11-05 DOI: 10.1016/j.jclinane.2024.111675

Jianhong Hao , Peng Pang , Xiaobing Liu , Wen Chi , Zhenguo Luo , Wenbo Cai , Li Zhang

Study objective

Patients with blunt thoracic trauma have a high risk of developing postoperative pulmonary complications (PPCs). In this study, we aimed to identify the risk factors for PPCs after non-thoracic surgery in patients with blunt thoracic trauma and investigate the efficacy of perioperative lung ultrasound scores in predicting PPC occurrence.

Design

Prospective observational study.

Setting

A Chinese tertiary orthopedic hospital.

Participants

This observational study included 369 patients with blunt thoracic trauma who underwent surgery for pelvic and upper or lower extremity fractures.

Interventions

Lung ultrasonography was performed pre- and postoperatively.

Measurements

Patients were followed up for 1 week to assess PPCs and assigned to the PPC or non-PPC groups. We identified risk factors for PPCs using univariate and multivariate logistic regression analyses. The predictive value of these risk factors was evaluated using receiver operating characteristic (ROC) curves.

Main results

PPCs incidence was 36.58 %. The two groups differed significantly in Injury Severity Scores, American Society of Anesthesiologists (ASA) classification, chronic obstructive pulmonary disease, hydrothorax, preoperative hypoxemia, lung ultrasound score, preoperative hemoglobin level, intraoperative infusion volume, and Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) scores (P < 0.05). Independent risk factors for PPCs included ASA classification III, higher postoperative lung ultrasound scores, preoperative anemia, higher intraoperative infusion volume, and higher ARISCAT scores. ROC curve analysis revealed that postoperative lung ultrasound score (area under the curve [AUC]: 0.810, cutoff: 10), preoperative hemoglobin level (AUC: 0.627, cutoff: 97), intraoperative infusion volume (AUC: 0.701, cutoff: 886.51 mL/h) and ARISCAT score (AUC: 0.718, cutoff: 33) predicted postoperative outcomes effectively.

Conclusions

Postoperative lung ultrasound scores reliably predicted pulmonary complications after non-thoracic surgery in patients with blunt thoracic trauma. ASA classification III, preoperative anemia, excessive intraoperative fluid infusion, higher ARISCAT, and postoperative lung ultrasound scores were significant risk factors associated with PPCs.

Trial registration: Clinical Trial Number: 1900023408. Registered on May 26, 2019.

研究目的胸部钝挫伤患者术后发生肺部并发症（PPCs）的风险很高。本研究旨在确定钝性胸部创伤患者非胸部手术后发生 PPCs 的风险因素，并探讨围手术期肺超声评分对预测 PPC 发生的有效性。干预措施术前和术后均进行肺部超声检查。我们使用单变量和多变量逻辑回归分析确定了 PPC 的风险因素。主要结果PPCs发生率为36.58%。两组患者在损伤严重程度评分、美国麻醉医师协会（ASA）分类、慢性阻塞性肺病、胸水、术前低氧血症、肺部超声评分、术前血红蛋白水平、术中输液量和加泰罗尼亚地区手术患者呼吸风险评估（ARISCAT）评分方面存在明显差异（P < 0.05）。PPCs 的独立危险因素包括 ASA 分级 III、术后肺部超声评分较高、术前贫血、术中输液量较高和 ARISCAT 评分较高。ROC 曲线分析显示，术后肺部超声评分（曲线下面积 [AUC]：0.810，临界值：10）、术前血红蛋白水平（AUC：0.627，临界值：97）、术中输液量（AUC：0.701，临界值：886.51 mL/h）和 ARISCAT 评分（AUC：0.718，临界值：33）可有效预测术后结果。ASA分级III、术前贫血、术中输液过多、ARISCAT和术后肺部超声评分较高是与PPCs相关的重要风险因素：临床试验编号：1900023408。注册时间：2019年5月26日。

{"title":"Can the lung ultrasound score predict pulmonary complications after non-thoracic surgery in patients with blunt thoracic trauma: A single-center observational study","authors":"Jianhong Hao , Peng Pang , Xiaobing Liu , Wen Chi , Zhenguo Luo , Wenbo Cai , Li Zhang","doi":"10.1016/j.jclinane.2024.111675","DOIUrl":"10.1016/j.jclinane.2024.111675","url":null,"abstract":"<div><h3>Study objective</h3><div>Patients with blunt thoracic trauma have a high risk of developing postoperative pulmonary complications (PPCs). In this study, we aimed to identify the risk factors for PPCs after non-thoracic surgery in patients with blunt thoracic trauma and investigate the efficacy of perioperative lung ultrasound scores in predicting PPC occurrence.</div></div><div><h3>Design</h3><div>Prospective observational study.</div></div><div><h3>Setting</h3><div>A Chinese tertiary orthopedic hospital.</div></div><div><h3>Participants</h3><div>This observational study included 369 patients with blunt thoracic trauma who underwent surgery for pelvic and upper or lower extremity fractures.</div></div><div><h3>Interventions</h3><div>Lung ultrasonography was performed pre- and postoperatively.</div></div><div><h3>Measurements</h3><div>Patients were followed up for 1 week to assess PPCs and assigned to the PPC or non-PPC groups. We identified risk factors for PPCs using univariate and multivariate logistic regression analyses. The predictive value of these risk factors was evaluated using receiver operating characteristic (ROC) curves.</div></div><div><h3>Main results</h3><div>PPCs incidence was 36.58 %. The two groups differed significantly in Injury Severity Scores, American Society of Anesthesiologists (ASA) classification, chronic obstructive pulmonary disease, hydrothorax, preoperative hypoxemia, lung ultrasound score, preoperative hemoglobin level, intraoperative infusion volume, and Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) scores (<em>P</em> < 0.05). Independent risk factors for PPCs included ASA classification III, higher postoperative lung ultrasound scores, preoperative anemia, higher intraoperative infusion volume, and higher ARISCAT scores. ROC curve analysis revealed that postoperative lung ultrasound score (area under the curve [AUC]: 0.810, cutoff: 10), preoperative hemoglobin level (AUC: 0.627, cutoff: 97), intraoperative infusion volume (AUC: 0.701, cutoff: 886.51 mL/h) and ARISCAT score (AUC: 0.718, cutoff: 33) predicted postoperative outcomes effectively.</div></div><div><h3>Conclusions</h3><div>Postoperative lung ultrasound scores reliably predicted pulmonary complications after non-thoracic surgery in patients with blunt thoracic trauma. ASA classification III, preoperative anemia, excessive intraoperative fluid infusion, higher ARISCAT, and postoperative lung ultrasound scores were significant risk factors associated with PPCs.</div><div><em>Trial registration:</em> Clinical Trial Number: 1900023408. Registered on May 26, 2019.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111675"},"PeriodicalIF":5.0,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142586906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Effect of perioperative rehabilitation exercise on postoperative outcomes in patients aged ≥65 years undergoing gastrointestinal surgery: A multicenter randomized controlled trial 围手术期康复锻炼对接受胃肠道手术的≥65 岁患者术后效果的影响：多中心随机对照试验。

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2024-11-02 DOI: 10.1016/j.jclinane.2024.111670

Xuecai Lv MD , Aisheng Hou MD , Shiyi Han MD , Jiangbei Cao MD, PhD , Jingsheng Lou MD, PhD , Hao Li MD, PhD , Su Min MD, PhD , Hongyu Tan MD, PhD , Shuo Li MD, PhD , Feng Lv MD, PhD , Zhikang Zhou BD , Menglin Chi BD , Hong Zhang MD, PhD , Yanhong Liu MD, PhD , Weidong Mi MD, PhD

Study objectives

This study aimed to assess the effect of perioperative rehabilitation exercise, initiated shortly after hospital admission, on postoperative outcomes in elderly patients.

Design

A prospective, multicenter, randomized, controlled, open-label, and assessor-blinded clinical trial.

Setting

Hospital wards.

Patients

Elderly patients (≥65 years, n = 160) scheduled for gastrointestinal surgery between June 2021 and November 2022 were enrolled and randomly assigned to the intervention or control group.

Interventions

Patients were divided into two groups base on whether they had received a specific type of exercise program initiated after hospital admission and continued until 30 days after surgery.

Measurements

The primary outcome was the Comprehensive Complications Index (CCI) measured at 30 days after surgery. Secondary outcomes were the rate of complications, number of complications, patient satisfaction, hospital readmission, postoperative length of stay, gastrointestinal function recovery, postoperative quality of life and psychological status. Intention-to-treat (ITT) and per-protocol (PP) analyses were conducted.

Main results

ITT analysis showed a significantly lower 30-day CCI in the intervention group (β: -6.31; 95 % Confidence Interval [CI], −11.26 to −1.37, P = 0.013). Compared to controls, the intervention group had a decreased rate of hospital readmission (Odds Ratio: 0.00; 95 % CI, 0.00 to 0.32, P = 0.022), less number of complications (β: -0.57; 95 % CI, −1.03 to −0.11, P = 0.016), as well as lower rate of postoperative anxiety (β: -0.74; 95 % CI, −1.42 to −0.06, P = 0.033) and depression scores (β: -1.13; 95 % CI, −0.97 to −1.30, P = 0.008). Additionally, the intervention group reported higher satisfaction (β: 0.98; 95 % CI, 0.33 to 1.64, P = 0.004) and Euro quality of life-Visual Analogue Scale scores (β: 8.88; 95 % CI, 2.48 to 15.28, P = 0.007). Similar results were found in the PP analysis.

Conclusion

Perioperative rehabilitation exercise has a positive impact on postoperative complications, quality of life and psychological well-being in elderly patients undergoing gastrointestinal surgery, even when implemented after hospital admission.

研究目的本研究旨在评估入院后不久开始的围手术期康复锻炼对老年患者术后效果的影响：前瞻性、多中心、随机对照、开放标签和评估者盲法临床试验：患者患者：2021年6月至2022年11月期间计划接受胃肠道手术的老年患者（≥65岁，n = 160）：干预措施：根据患者是否在入院后接受了特定类型的锻炼计划并持续到术后 30 天，将患者分为两组：主要结果是术后30天的综合并发症指数（CCI）。次要结果为并发症发生率、并发症数量、患者满意度、再入院率、术后住院时间、胃肠功能恢复情况、术后生活质量和心理状态。进行了意向治疗（ITT）和按协议（PP）分析：ITT分析显示，干预组的30天CCI明显降低（β：-6.31；95%置信区间[CI]，-11.26至-1.37，P = 0.013）。与对照组相比，干预组的再入院率降低（Odds Ratio：0.00；95 % CI，0.00 至 0.32，P = 0.022），并发症数量减少（β：-0.57；95 % CI，-1.03至-0.11，P = 0.016），术后焦虑率较低（β：-0.74；95 % CI，-1.42至-0.06，P = 0.033），抑郁评分较低（β：-1.13；95 % CI，-0.97至-1.30，P = 0.008）。此外，干预组的满意度更高（β：0.98；95 % CI，0.33 至 1.64，P = 0.004），欧洲生活质量-视觉模拟量表评分更高（β：8.88；95 % CI，2.48 至 15.28，P = 0.007）。结论：围手术期康复锻炼对患者的康复有积极作用：围手术期康复锻炼对接受胃肠道手术的老年患者的术后并发症、生活质量和心理健康有积极影响，即使是在入院后实施。

{"title":"Effect of perioperative rehabilitation exercise on postoperative outcomes in patients aged ≥65 years undergoing gastrointestinal surgery: A multicenter randomized controlled trial","authors":"Xuecai Lv MD , Aisheng Hou MD , Shiyi Han MD , Jiangbei Cao MD, PhD , Jingsheng Lou MD, PhD , Hao Li MD, PhD , Su Min MD, PhD , Hongyu Tan MD, PhD , Shuo Li MD, PhD , Feng Lv MD, PhD , Zhikang Zhou BD , Menglin Chi BD , Hong Zhang MD, PhD , Yanhong Liu MD, PhD , Weidong Mi MD, PhD","doi":"10.1016/j.jclinane.2024.111670","DOIUrl":"10.1016/j.jclinane.2024.111670","url":null,"abstract":"<div><h3>Study objectives</h3><div>This study aimed to assess the effect of perioperative rehabilitation exercise, initiated shortly after hospital admission, on postoperative outcomes in elderly patients.</div></div><div><h3>Design</h3><div>A prospective, multicenter, randomized, controlled, open-label, and assessor-blinded clinical trial.</div></div><div><h3>Setting</h3><div>Hospital wards.</div></div><div><h3>Patients</h3><div>Elderly patients (≥65 years, <em>n</em> = 160) scheduled for gastrointestinal surgery between June 2021 and November 2022 were enrolled and randomly assigned to the intervention or control group.</div></div><div><h3>Interventions</h3><div>Patients were divided into two groups base on whether they had received a specific type of exercise program initiated after hospital admission and continued until 30 days after surgery.</div></div><div><h3>Measurements</h3><div>The primary outcome was the Comprehensive Complications Index (CCI) measured at 30 days after surgery. Secondary outcomes were the rate of complications, number of complications, patient satisfaction, hospital readmission, postoperative length of stay, gastrointestinal function recovery, postoperative quality of life and psychological status. Intention-to-treat (ITT) and per-protocol (P<img>P) analyses were conducted.</div></div><div><h3>Main results</h3><div>ITT analysis showed a significantly lower 30-day CCI in the intervention group (β: -6.31; 95 % Confidence Interval [CI], −11.26 to −1.37, <em>P</em> = 0.013). Compared to controls, the intervention group had a decreased rate of hospital readmission (Odds Ratio: 0.00; 95 % CI, 0.00 to 0.32, <em>P</em> = 0.022), less number of complications (β: -0.57; 95 % CI, −1.03 to −0.11, <em>P</em> = 0.016), as well as lower rate of postoperative anxiety (β: -0.74; 95 % CI, −1.42 to −0.06, <em>P</em> = 0.033) and depression scores (β: -1.13; 95 % CI, −0.97 to −1.30, <em>P</em> = 0.008). Additionally, the intervention group reported higher satisfaction (β: 0.98; 95 % CI, 0.33 to 1.64, <em>P</em> = 0.004) and Euro quality of life-Visual Analogue Scale scores (β: 8.88; 95 % CI, 2.48 to 15.28, <em>P</em> = 0.007). Similar results were found in the P<img>P analysis.</div></div><div><h3>Conclusion</h3><div>Perioperative rehabilitation exercise has a positive impact on postoperative complications, quality of life and psychological well-being in elderly patients undergoing gastrointestinal surgery, even when implemented after hospital admission.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111670"},"PeriodicalIF":5.0,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0