Pub Date : 2025-02-05DOI: 10.1016/j.bjane.2025.844596
Luciana C. Stefani , Liana M.T.A. Azi , Andre P. Schmidt
{"title":"Transforming perioperative care in Brazil: challenges and opportunities for improving outcomes","authors":"Luciana C. Stefani , Liana M.T.A. Azi , Andre P. Schmidt","doi":"10.1016/j.bjane.2025.844596","DOIUrl":"10.1016/j.bjane.2025.844596","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 2","pages":"Article 844596"},"PeriodicalIF":1.7,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143375056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-26DOI: 10.1016/j.bjane.2025.844595
Simone Chaves Fagondes , Carmem Lúcia Oliveira da Silva , Anneliese Hoffmann , Rita de Cássia Guedes de Azevedo Barbosa , Daiane Falkembach , Ângela Beatriz John
Growing evidence of the benefits of home ventilatory support in patients with chronic respiratory failure along with technological advances in ventilators have enabled their use in overly complex situations, shaping a new scenario for physicians. This has further given rise to new challenges related to their incorporation into current medical practice. However, this evolution needs to be coupled with knowledge and skills of physicians who are willing to prescribe Home Mechanical Ventilation (HMV), in order to prevent them from making inappropriate choices or adjustments that may ultimately have ethical and legal implications. This article aims to provide guidance and information to support the indication for HMV and the ventilation modalities to be implemented, review basic ventilation concepts, including the ventilator modes most commonly used in patients outside the hospital setting, list the brands and models available in the Brazilian market, provide the means for obtaining equipment for HMV, and finally, describe the requirements for selection of equipment, taking into account the individual characteristics of the patient to ensure safe perioperative care and earlier dehospitalization.
{"title":"Home mechanical ventilation: a narrative review and a proposal of practical approach","authors":"Simone Chaves Fagondes , Carmem Lúcia Oliveira da Silva , Anneliese Hoffmann , Rita de Cássia Guedes de Azevedo Barbosa , Daiane Falkembach , Ângela Beatriz John","doi":"10.1016/j.bjane.2025.844595","DOIUrl":"10.1016/j.bjane.2025.844595","url":null,"abstract":"<div><div>Growing evidence of the benefits of home ventilatory support in patients with chronic respiratory failure along with technological advances in ventilators have enabled their use in overly complex situations, shaping a new scenario for physicians. This has further given rise to new challenges related to their incorporation into current medical practice. However, this evolution needs to be coupled with knowledge and skills of physicians who are willing to prescribe Home Mechanical Ventilation (HMV), in order to prevent them from making inappropriate choices or adjustments that may ultimately have ethical and legal implications. This article aims to provide guidance and information to support the indication for HMV and the ventilation modalities to be implemented, review basic ventilation concepts, including the ventilator modes most commonly used in patients outside the hospital setting, list the brands and models available in the Brazilian market, provide the means for obtaining equipment for HMV, and finally, describe the requirements for selection of equipment, taking into account the individual characteristics of the patient to ensure safe perioperative care and earlier dehospitalization.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 3","pages":"Article 844595"},"PeriodicalIF":1.7,"publicationDate":"2025-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Extracorporeal Cardiopulmonary Resuscitation (ECPR) is an effective intervention for restoring adequate circulatory perfusion after cardiac arrest. Ensuring high-quality Cardiopulmonary Resuscitation (CPR) before initiating Extracorporeal Membrane Oxygenation (ECMO) is critical to mitigate tissue hypoxia and ischemia. This study aimed to evaluate the effect of End-Tidal Carbon Dioxide (ETCO2) Goal-Directed CPR (GDCPR) on neurological function before ECMO using a retrospective case-control analysis.
Methods
The medical records of all patients who received ECPR treated at Zhongshan City People's Hospital were collected between January 2020 and March 2023. In this retrospective cohort study, the patients were divided into Conventional CPR (CCPR) and ETCO2-GDCPR groups based on whether ETCO2 was used as a guide for CPR.
Results
A total of 71 patients were included, of whom 46 comprised the CCPR group and 25 comprised the GDCPR group. Approximately 37% of patients who received ECPR had good cerebral function at discharge, with a higher rate in the GDCPR group (52%) compared with the CCPR group (28%) (p = 0.047). Multivariate analysis showed that the Highest Interleukin-6 (H-IL6) levels after ECMO (Odds Ratio [OR = 1.001], 95% Confidence Interval [95% CI 1.000–1.003], p = 0.005) was a risk factor for neurological function at discharge. The other risk factors for poor prognosis in patients who received ECPR included pre-ECMO CPR protocols (OR = 10.74, 95% CI 1.90–60.48, p = 0.007) and IL6 levels after ECMO (OR = 1.002, 95% CI 1.001–1.003, p = 0.005). ECMO duration (OR = 0.83, 95% CI 0.74–0.94, p = 0.002) was identified as a protective factor. Patients with short ECMO duration have a poor prognosis. The area under the curve for ECMO duration was 0.86 (0.77–0.94, p < 0.01), while that for H-IL6 was 0.19 (0.09–0.29, p < 0.01).
Conclusion
ETCO2-guided ECPR is associated with improved neurological prognosis and patient outcomes. Therefore, monitoring ETCO2 levels should be considered a crucial component of evaluating resuscitation efficacy during CPR.
{"title":"End-tidal carbon dioxide-guided extracorporeal cardiopulmonary resuscitation improves neurological prognosis in patients: a single-center retrospective cohort study","authors":"Xiaozu Liao, Chen Gu, Zhou Cheng, Kepeng Liu, Qing Yin, Binfei Li","doi":"10.1016/j.bjane.2025.844588","DOIUrl":"10.1016/j.bjane.2025.844588","url":null,"abstract":"<div><h3>Background</h3><div>Extracorporeal Cardiopulmonary Resuscitation (ECPR) is an effective intervention for restoring adequate circulatory perfusion after cardiac arrest. Ensuring high-quality Cardiopulmonary Resuscitation (CPR) before initiating Extracorporeal Membrane Oxygenation (ECMO) is critical to mitigate tissue hypoxia and ischemia. This study aimed to evaluate the effect of End-Tidal Carbon Dioxide (ETCO<sub>2</sub>) Goal-Directed CPR (GDCPR) on neurological function before ECMO using a retrospective case-control analysis.</div></div><div><h3>Methods</h3><div>The medical records of all patients who received ECPR treated at Zhongshan City People's Hospital were collected between January 2020 and March 2023. In this retrospective cohort study, the patients were divided into Conventional CPR (CCPR) and ETCO<sub>2</sub>-GDCPR groups based on whether ETCO<sub>2</sub> was used as a guide for CPR.</div></div><div><h3>Results</h3><div>A total of 71 patients were included, of whom 46 comprised the CCPR group and 25 comprised the GDCPR group. Approximately 37% of patients who received ECPR had good cerebral function at discharge, with a higher rate in the GDCPR group (52%) compared with the CCPR group (28%) (p = 0.047). Multivariate analysis showed that the Highest Interleukin-6 (H-IL6) levels after ECMO (Odds Ratio [OR = 1.001], 95% Confidence Interval [95% CI 1.000–1.003], p = 0.005) was a risk factor for neurological function at discharge. The other risk factors for poor prognosis in patients who received ECPR included pre-ECMO CPR protocols (OR = 10.74, 95% CI 1.90–60.48, p = 0.007) and IL6 levels after ECMO (OR = 1.002, 95% CI 1.001–1.003, p = 0.005). ECMO duration (OR = 0.83, 95% CI 0.74–0.94, p = 0.002) was identified as a protective factor. Patients with short ECMO duration have a poor prognosis. The area under the curve for ECMO duration was 0.86 (0.77–0.94, p < 0.01), while that for H-IL6 was 0.19 (0.09–0.29, p < 0.01).</div></div><div><h3>Conclusion</h3><div>ETCO<sub>2</sub>-guided ECPR is associated with improved neurological prognosis and patient outcomes. Therefore, monitoring ETCO<sub>2</sub> levels should be considered a crucial component of evaluating resuscitation efficacy during CPR.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 3","pages":"Article 844588"},"PeriodicalIF":1.7,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-22DOI: 10.1016/j.bjane.2025.844589
Jacek B. Cywinski , Yufei Li , Lusine Israelyan , Roshni Sreedharan , Silvia Perez-Protto , Kamal Maheshwari
Background
Extreme hemodynamic changes, especially intraoperative hypotension (IOH), are common and often prolonged during Liver Transplant (LT) surgery and during initial hours of recovery. Hypotension Prediction Index (HPI) software is one of the tools which can help in proactive hemodynamic management. The accuracy of the advanced hemodynamic parameters such as Cardiac Output (CO) and Systemic Vascular Resistance (SVR) obtained from HPI software and prediction performance of the HPI in LT surgery remains unknown.
Methods
This was a retrospective observational study conducted in a tertiary academic center with a large liver transplant program. We enrolled 23 adult LT patients who received both Pulmonary Artery Catheter (PAC) and HPI software monitoring. Primarily, we evaluated agreement between PAC and HPI software measured CO and SVR. A priori, we defined a relative difference of less than 20% between measurements as an adequate agreement for a pair of measurements and estimated the Lin's Concordance Correlation Coefficient and Bland-Altman Limits of Agreement (LOA). Clinically acceptable LOA was defined as ± 1 L.min-1 for CO and ± 200 dynes s.cm-5 for SVR. Secondary outcome was the ability of the HPI to predict future hypotension, defined as Mean Arterial Pressure (MAP) less than 65 mmHg lasting at least one minute. We estimated sensitivity, positive predictive value, and time from alert to hypotensive events for HPI software.
Results
Overall, 125 pairs of CO and 122 pairs of SVR records were obtained from 23 patients. Based on our predefined criteria, only 42% (95% CI 30%, 55%) of CO records and 53% (95% CI 28%, 72%) of SVR records from HPI software were considered to agree with those from PAC. Across all patients, there were a total of 1860 HPI alerts (HPI ≥ 85) and 642 hypotensive events (MAP < 65 mmHg). Out of the 642 hypotensive events, 618 events were predicted by HPI alert with sensitivity of 0.96 (95% CI: 0.95). Many times, the HPI value remained above alert level and was followed by multiple hypotensive events. Thus, to evaluate PPV and time to hypotension metric, we considered only the first HPI alert followed by a hypotensive event (“true alerts”). The “true alert” was the first alert when there were several alerts before a hypotension. There were 614 “true alerts” and the PPV for HPI was 0.33 (95% CI 0.31, 0.35). The median time from HPI alert to hypotension was 3.3 [Q1, Q3: 1, 9.3] mins.
Conclusion
There was poor agreement between the pulmonary artery catheter and HPI software calculated advanced hemodynamic parameters (CO and SVR), in the patients undergoing LT surgery. HPI software had high sensitivity but poor specificity for hypotension prediction, resulting in a high burden of false alarms.
{"title":"Evaluation of hypotension prediction index software in patients undergoing orthotopic liver transplantation: retrospective observational study","authors":"Jacek B. Cywinski , Yufei Li , Lusine Israelyan , Roshni Sreedharan , Silvia Perez-Protto , Kamal Maheshwari","doi":"10.1016/j.bjane.2025.844589","DOIUrl":"10.1016/j.bjane.2025.844589","url":null,"abstract":"<div><h3>Background</h3><div>Extreme hemodynamic changes, especially intraoperative hypotension (IOH), are common and often prolonged during Liver Transplant (LT) surgery and during initial hours of recovery. Hypotension Prediction Index (HPI) software is one of the tools which can help in proactive hemodynamic management. The accuracy of the advanced hemodynamic parameters such as Cardiac Output (CO) and Systemic Vascular Resistance (SVR) obtained from HPI software and prediction performance of the HPI in LT surgery remains unknown.</div></div><div><h3>Methods</h3><div>This was a retrospective observational study conducted in a tertiary academic center with a large liver transplant program. We enrolled 23 adult LT patients who received both Pulmonary Artery Catheter (PAC) and HPI software monitoring. Primarily, we evaluated agreement between PAC and HPI software measured CO and SVR. A priori, we defined a relative difference of less than 20% between measurements as an adequate agreement for a pair of measurements and estimated the Lin's Concordance Correlation Coefficient and Bland-Altman Limits of Agreement (LOA). Clinically acceptable LOA was defined as ± 1 L.min<sup>-1</sup> for CO and ± 200 dynes s.cm<sup>-5</sup> for SVR. Secondary outcome was the ability of the HPI to predict future hypotension, defined as Mean Arterial Pressure (MAP) less than 65 mmHg lasting at least one minute. We estimated sensitivity, positive predictive value, and time from alert to hypotensive events for HPI software.</div></div><div><h3>Results</h3><div>Overall, 125 pairs of CO and 122 pairs of SVR records were obtained from 23 patients. Based on our predefined criteria, only 42% (95% CI 30%, 55%) of CO records and 53% (95% CI 28%, 72%) of SVR records from HPI software were considered to agree with those from PAC. Across all patients, there were a total of 1860 HPI alerts (HPI ≥ 85) and 642 hypotensive events (MAP < 65 mmHg). Out of the 642 hypotensive events, 618 events were predicted by HPI alert with sensitivity of 0.96 (95% CI: 0.95). Many times, the HPI value remained above alert level and was followed by multiple hypotensive events. Thus, to evaluate PPV and time to hypotension metric, we considered only the first HPI alert followed by a hypotensive event (“true alerts”). The “true alert” was the first alert when there were several alerts before a hypotension. There were 614 “true alerts” and the PPV for HPI was 0.33 (95% CI 0.31, 0.35). The median time from HPI alert to hypotension was 3.3 [Q1, Q3: 1, 9.3] mins.</div></div><div><h3>Conclusion</h3><div>There was poor agreement between the pulmonary artery catheter and HPI software calculated advanced hemodynamic parameters (CO and SVR), in the patients undergoing LT surgery. HPI software had high sensitivity but poor specificity for hypotension prediction, resulting in a high burden of false alarms.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 3","pages":"Article 844589"},"PeriodicalIF":1.7,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-14DOI: 10.1016/j.bjane.2025.844586
Andre P. Schmidt , Federico Bilotta
{"title":"Challenges in surgical and perioperative care for Brazil's aging population","authors":"Andre P. Schmidt , Federico Bilotta","doi":"10.1016/j.bjane.2025.844586","DOIUrl":"10.1016/j.bjane.2025.844586","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 2","pages":"Article 844586"},"PeriodicalIF":1.7,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11761882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-14DOI: 10.1016/j.bjane.2025.844587
Andre P. Schmidt , Clovis T. Bevilacqua Filho , Eduarda S. Martinelli , Virgínia C. de Moura
{"title":"The pulmonary artery catheter in modern anesthesiology and intensive care: indications, benefits, and limitations","authors":"Andre P. Schmidt , Clovis T. Bevilacqua Filho , Eduarda S. Martinelli , Virgínia C. de Moura","doi":"10.1016/j.bjane.2025.844587","DOIUrl":"10.1016/j.bjane.2025.844587","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 2","pages":"Article 844587"},"PeriodicalIF":1.7,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-03DOI: 10.1016/j.bjane.2024.844584
Stefania Lacerda Garcia , Claudia Marquez Simões , Maria José Carvalho Carmona , Liana Maria Tôrres de Araújo Azi
{"title":"Gender representation in anesthesiology research: a historical perspective from the Brazilian Journal of Anesthesiology","authors":"Stefania Lacerda Garcia , Claudia Marquez Simões , Maria José Carvalho Carmona , Liana Maria Tôrres de Araújo Azi","doi":"10.1016/j.bjane.2024.844584","DOIUrl":"10.1016/j.bjane.2024.844584","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 2","pages":"Article 844584"},"PeriodicalIF":1.7,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.bjane.2024.844580
Ka Ting Ng , Pei En Kwok , Wei En Lim , Wan Yi Teoh , Mohd Shahnaz Hasan , Mohd Fitry Zainal Abidin
Objectives
Methylene blue exerts its vasopressor properties by inhibiting nitric oxide-mediated vasodilation. Recent studies have advocated the use of methylene blue as a rescue therapy for patients with septic shock. The primary aim was to investigate the effect of methylene blue on the mean arterial pressure among adult patients with septic shock.
Methods
Databases of MEDLINE, EMBASE, and CENTRAL were searched from their inception date until October 2023. Randomized Clinical Trials (RCT) comparing methylene blue and placebo in adults with septic shock were included.
Results
Our systematic review included 5 studies (n = 257) for data analysis. As compared to the placebo, our pooled analysis showed that methylene blue significantly increased mean arterial pressure (MD: 1.34 mmHg, 95% CI 0.15 to 2.53, p = 0.03, level of evidence: very low). Patients who were given methylene blue were associated with statistically lower mortality rate (OR = 0.49, 95% CI 0.27 to 0.88, p = 0.02, level of evidence: low), reduced serum lactate levels (MD: -0.76 mmoL.L-1, 95% CI -1.22 to -0.31, p = 0.0009, level of evidence: low), reduced length of hospital stay (MD: -1.94 days, 95% CI -3.79 to -0.08, p = 0.04, level of evidence: low), and increased PaO2/FiO2 (MD: 34.78, 95% CI 8.94 to 60.61, p = 0.008, level of evidence: low).
Conclusions
This meta-analysis demonstrated that methylene blue administration was associated with an increased in mean arterial pressure and PaO2/FiO2 ratio, along with a reduction in mortality rates, serum lactate levels, and length of hospital stay. However, substantial degree of heterogeneity and inadequate number of studies with low level of evidence warrant future adequately powered RCTs to affirm our results.
目的：亚甲基蓝通过抑制一氧化氮介导的血管舒张发挥其血管加压特性。最近的研究提倡使用亚甲基蓝作为脓毒性休克患者的抢救治疗。主要目的是研究亚甲基蓝对脓毒性休克成年患者平均动脉压的影响。方法：检索MEDLINE、EMBASE和CENTRAL数据库，检索时间为建站日期至2023年10月。随机临床试验（RCT）比较亚甲基蓝和安慰剂在成人感染性休克。结果：我们的系统综述纳入了5项研究（n = 257）进行数据分析。与安慰剂相比，我们的合并分析显示亚甲基蓝显著增加了平均动脉压（MD: 1.34 mmHg, 95% CI 0.15至2.53,p = 0.03，证据水平非常低）。给予亚甲基蓝的患者死亡率降低（OR = 0.49,95% CI 0.27 ~ 0.88, p = 0.02，证据水平低），血清乳酸水平降低（MD: -0.76 mmoL）。L-1, 95% CI -1.22 ~ -0.31, p = 0.0009，证据水平低)，住院时间缩短（MD: -1.94天，95% CI -3.79 ~ -0.08, p = 0.04，证据水平低），PaO2/FiO2增加（MD: 34.78, 95% CI 8.94 ~ 60.61, p = 0.008，证据水平低）。结论：该荟萃分析表明，亚甲蓝给药与平均动脉压和PaO2/FiO2比值升高相关，同时降低死亡率、血清乳酸水平和住院时间。然而，大量的异质性和低水平证据的研究数量不足，需要未来足够有力的随机对照试验来证实我们的结果。
{"title":"The use of methylene blue in adult patients with septic shock: a systematic review and meta-analysis","authors":"Ka Ting Ng , Pei En Kwok , Wei En Lim , Wan Yi Teoh , Mohd Shahnaz Hasan , Mohd Fitry Zainal Abidin","doi":"10.1016/j.bjane.2024.844580","DOIUrl":"10.1016/j.bjane.2024.844580","url":null,"abstract":"<div><h3>Objectives</h3><div>Methylene blue exerts its vasopressor properties by inhibiting nitric oxide-mediated vasodilation. Recent studies have advocated the use of methylene blue as a rescue therapy for patients with septic shock. The primary aim was to investigate the effect of methylene blue on the mean arterial pressure among adult patients with septic shock.</div></div><div><h3>Methods</h3><div>Databases of MEDLINE, EMBASE, and CENTRAL were searched from their inception date until October 2023. Randomized Clinical Trials (RCT) comparing methylene blue and placebo in adults with septic shock were included.</div></div><div><h3>Results</h3><div>Our systematic review included 5 studies (n = 257) for data analysis. As compared to the placebo, our pooled analysis showed that methylene blue significantly increased mean arterial pressure (MD: 1.34 mmHg, 95% CI 0.15 to 2.53, p = 0.03, level of evidence: very low). Patients who were given methylene blue were associated with statistically lower mortality rate (OR = 0.49, 95% CI 0.27 to 0.88, p = 0.02, level of evidence: low), reduced serum lactate levels (MD: -0.76 mmoL.L<sup>-1</sup>, 95% CI -1.22 to -0.31, p = 0.0009, level of evidence: low), reduced length of hospital stay (MD: -1.94 days, 95% CI -3.79 to -0.08, p = 0.04, level of evidence: low), and increased PaO<sub>2</sub>/FiO<sub>2</sub> (MD: 34.78, 95% CI 8.94 to 60.61, p = 0.008, level of evidence: low).</div></div><div><h3>Conclusions</h3><div>This meta-analysis demonstrated that methylene blue administration was associated with an increased in mean arterial pressure and PaO<sub>2</sub>/FiO<sub>2</sub> ratio, along with a reduction in mortality rates, serum lactate levels, and length of hospital stay. However, substantial degree of heterogeneity and inadequate number of studies with low level of evidence warrant future adequately powered RCTs to affirm our results.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 1","pages":"Article 844580"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11754512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142775187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.bjane.2024.844582
Andre P. Schmidt
{"title":"Shaping the future of anesthesia research: celebrating progress and embracing new challenges","authors":"Andre P. Schmidt","doi":"10.1016/j.bjane.2024.844582","DOIUrl":"10.1016/j.bjane.2024.844582","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 1","pages":"Article 844582"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11717656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.bjane.2024.844577
Yangjin LV , Peng Li , Ronghui Li , Ting Zhang , Kaifang Cai
Background
Patient and Family-Centered Care (PFCC) interventions are increasingly recognized as a viable approach to address various mental health issues among patients in Intensive Care Units (ICUs). Therefore, this review aims to estimate the effect of Patient and Family-Centered Care Interventions on specific outcomes in adult patients admitted to Intensive Care Units (ICUs).
Methods
We systematically searched four major databases for parallel arm Randomized Controlled Trials (RCTs). The PRISMA framework was used to report our review. We included studies involving adult patients (> 18-years) admitted to ICUs and examined the effects of any type of Patient and Family-Centered Care intervention (PFCC) on outcomes such as depression, anxiety, delirium, and length of hospital stay. Data extraction was performed independently by two authors in Medline, Google Scholar, and ScienceDirect, from inception to July 2024. Random effects model was used to pool the data.
Results
A total of 11 studies were included in our systematic review and meta-analysis, with a combined sample size of 3352 patients (PFCC group, n = 1681; usual care group, n = 1671). A random-effects model revealed a significant reduction in delirium prevalence in the PFCC group, with a pooled Risk Ratio (RR) of 0.54 (95% CI 0.36 to 0.81). However, no statistical significance was found for other outcomes such as depression, length of ICU stay, and anxiety. It is important to note that all the included studies were assessed to have either a high or unclear risk of bias.
Conclusion
PFCC interventions may significantly reduce delirium rates among ICU patients; however, their effects on other outcomes, such as depression, anxiety, and length of stay, were not statistically significant.
背景：以患者和家庭为中心的护理（PFCC）干预措施越来越被认为是解决重症监护病房（icu）患者各种心理健康问题的可行方法。因此，本综述旨在评估以患者和家庭为中心的护理干预对入住重症监护病房（icu）的成年患者特定结局的影响。方法：我们系统地检索了四个主要数据库的平行组随机对照试验（RCTs）。使用PRISMA框架报告我们的审查。我们纳入了icu收治的成年患者（18岁）的研究，并检查了任何类型的以患者和家庭为中心的护理干预（PFCC）对抑郁、焦虑、谵妄和住院时间等结果的影响。数据提取由Medline，谷歌Scholar和ScienceDirect的两位作者独立完成，从成立到2024年7月。采用随机效应模型对数据进行汇总。结果：我们的系统评价和荟萃分析共纳入了11项研究，总样本量为3352例患者(PFCC组，n = 1681；常规护理组，n = 1671)。随机效应模型显示PFCC组谵妄患病率显著降低，合并风险比（RR）为0.54 （95% CI 0.36 ~ 0.81）。然而，其他结果如抑郁、ICU住院时间和焦虑没有统计学意义。值得注意的是，所有纳入的研究都被评估为具有高偏倚风险或不明确的偏倚风险。结论：PFCC干预可显著降低ICU患者谵妄发生率；然而，它们对其他结果的影响，如抑郁、焦虑和住院时间，在统计上并不显著。
{"title":"The impact of patient- and family-centered care interventions on intensive care unit outcomes: a meta-analysis of randomized controlled trials","authors":"Yangjin LV , Peng Li , Ronghui Li , Ting Zhang , Kaifang Cai","doi":"10.1016/j.bjane.2024.844577","DOIUrl":"10.1016/j.bjane.2024.844577","url":null,"abstract":"<div><h3>Background</h3><div>Patient and Family-Centered Care (PFCC) interventions are increasingly recognized as a viable approach to address various mental health issues among patients in Intensive Care Units (ICUs). Therefore, this review aims to estimate the effect of Patient and Family-Centered Care Interventions on specific outcomes in adult patients admitted to Intensive Care Units (ICUs).</div></div><div><h3>Methods</h3><div>We systematically searched four major databases for parallel arm Randomized Controlled Trials (RCTs). The PRISMA framework was used to report our review. We included studies involving adult patients (> 18-years) admitted to ICUs and examined the effects of any type of Patient and Family-Centered Care intervention (PFCC) on outcomes such as depression, anxiety, delirium, and length of hospital stay. Data extraction was performed independently by two authors in Medline, Google Scholar, and ScienceDirect, from inception to July 2024. Random effects model was used to pool the data.</div></div><div><h3>Results</h3><div>A total of 11 studies were included in our systematic review and meta-analysis, with a combined sample size of 3352 patients (PFCC group, n = 1681; usual care group, n = 1671). A random-effects model revealed a significant reduction in delirium prevalence in the PFCC group, with a pooled Risk Ratio (RR) of 0.54 (95% CI 0.36 to 0.81). However, no statistical significance was found for other outcomes such as depression, length of ICU stay, and anxiety. It is important to note that all the included studies were assessed to have either a high or unclear risk of bias.</div></div><div><h3>Conclusion</h3><div>PFCC interventions may significantly reduce delirium rates among ICU patients; however, their effects on other outcomes, such as depression, anxiety, and length of stay, were not statistically significant.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 1","pages":"Article 844577"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11714723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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