Trends in Anaesthesia and Critical Care最新文献

Development of postoperative laryngeal edema in patients undergoing craniotomy for elective intracranial tumor excision: A prospective, observational, preliminary study 为选择性颅内肿瘤切除术而接受开颅手术的患者术后出现喉水肿的情况：一项前瞻性、观察性初步研究

IF 1.4 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care

Pub Date : 2024-10-01 DOI: 10.1016/j.tacc.2024.101496

Sivakumar R , Charu Mahajan , Niraj Kumar , Rajendra Singh Chouhan , Bijaya Laxmi

Background

Intracranial tumor surgeries require different head and surgical positions as well as large fluid administration, which can cause laryngeal edema (LE) and increased morbidity. But there are no studies regarding its incidence in this patient population. As these patients often receive steroids for reducing peri-tumoral edema, which can also reduce LE, we hypothesized that incidence of LE in patients undergoing intracranial tumor resection in various positions might not be high. Thus, this prospective, observational study aimed to find LE incidence, as assessed by cuff leak test (CLT) in these patients.

Methods

American Society of Anesthesiologists- Physical Status I/II, patients (18–60 yrs) undergoing elective intracranial tumor resection were included after atraumatic tracheal intubation under standard general anesthetic technique. Cuff leak volume (CLV) was measured in supine position before start of surgery (CLV_b) and completion (CLV_c) of surgery. CLV <110 ml was considered to indicate LE. Important parameters were noted and patients were followed till discharge from the hospital.

Results

Seventy-three patients with male preponderance (58.9 %) participated in study. Number of patients operated in supine, lateral, prone and sitting positions were 34, 16, 14 and 09, respectively. CLV decreased significantly in lateral and supine positions (p <0.01). Only, 02(2.74 %) patients had CLVc <110 ml; both were male patients operated in supine position with head rotation. Anesthetic duration and intraoperative fluid administration were comparable across surgical positions. No postextubation stridor was seen in any patient.

Conclusion

We found that optimal intraoperative care of patients undergoing excision of intracranial tumors resulted in a low postoperative LE incidence (2.74 %) as detected by CLT at completion of surgery. However larger studies are required to further elaborate this issue.

背景颅内肿瘤手术需要不同的头部和手术体位以及大量输液，这可能会导致喉头水肿（LE）并增加发病率。但目前还没有关于喉水肿在这类患者中发生率的研究。由于这些患者通常会接受类固醇治疗以减轻瘤周水肿，而类固醇也能减轻喉水肿，因此我们推测在接受各种体位的颅内肿瘤切除术的患者中，喉水肿的发生率可能并不高。这项前瞻性观察研究旨在通过袖带渗漏试验（CLT）评估这些患者的颅内肿瘤切除术的颅内肿瘤渗漏发生率。方法纳入美国麻醉医师协会体格状态 I/II 级、在标准全身麻醉技术下进行创伤性气管插管后接受择期颅内肿瘤切除术的患者（18-60 岁）。在手术开始前（CLVb）和手术完成后（CLVc），以仰卧位测量袖带漏气量（CLV）。CLV<110毫升被认为表示LE。研究人员记录了重要参数，并对患者进行了随访，直到他们出院。仰卧位、侧卧位、俯卧位和坐位手术的患者人数分别为 34 人、16 人、14 人和 09 人。CLV在侧卧位和仰卧位时明显下降（p <0.01）。只有 02 名（2.74 %）患者的 CLVc 为 110 毫升，这两名患者均为男性，在仰卧位并旋转头部的情况下进行手术。不同手术体位的麻醉时间和术中输液量相当。结论我们发现，对接受颅内肿瘤切除术的患者进行最佳术中护理可降低术后LE的发生率（2.74%），这是在手术完成时通过CLT检测到的。不过，还需要更大规模的研究来进一步阐述这一问题。

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引用次数: 0

Challenges of scientific societies activities: Anesthesia and intensive care medicine. A scoping review 科学协会活动的挑战：麻醉与重症监护医学。范围审查

IF 1.4 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care

Pub Date : 2024-10-01 DOI: 10.1016/j.tacc.2024.101498

Luca Marino , Lucilla Scarpellini , Else-Marie Ringvold , Federico Bilotta

Scientific societies are historically established institutions. Historical duties and future challenges include: Improvement of patient and healthcare providers safety, enhancement of practice sustainability, boost of under-represented-minorities inclusion, promotion of innovation in technology and techniques.

This review is focused on evidence of tasks and roles of anesthesia and intensive care societies.

Google, Medline, Pubmed were utilized to find relevant studies.

The findings from the 39 included studies were categorized into the subsections: Established tasks, expanding roles, methodological hints to promote participation. The analysis of established task enhances the key role of scientific societies in education and research as foundations of high professionality skills. The expanding roles consider a large and heterogeneous list of topics: underrepresented minorities, patient and healthcare providers' safety, sustainability, technology innovation, ethical issues. The methodological hints to promote participation of effective strategies to endorse wider sharing.

Anesthesia and intensive care scientific societies have recognized functions that can be involved in the future expanding clinical and professional challenges. Both technical and non-technical skills are in the realm of the tasks of the scientific societies and the promotion of a broader participation will offer new opportunities for active collaborations.

科学学会是历史悠久的机构。其历史职责和未来挑战包括本综述重点关注麻醉和重症监护学会的任务和作用的证据，利用 Google、Medline 和 Pubmed 查找相关研究：纳入的 39 项研究结果被分为以下几个小部分：既定任务、扩展角色、促进参与的方法提示。对既定任务的分析加强了科学协会在教育和研究中作为高专业技能基础的关键作用。扩展角色考虑了大量不同的主题：代表性不足的少数群体、患者和医疗服务提供者的安全、可持续性、技术创新、伦理问题。麻醉和重症监护科学协会已经认识到可以参与应对未来不断扩大的临床和专业挑战的职能。技术和非技术技能都属于科学协会的任务范围，促进更广泛的参与将为积极合作提供新的机遇。

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引用次数: 0

Optimizing patient safety: Unveiling the significance of cuff pressure in anaesthesia 优化患者安全：揭示袖带压力在麻醉中的重要性

IF 1.4 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care

Pub Date : 2024-10-01 DOI: 10.1016/j.tacc.2024.101493

Maria Valentim, João Barbosa, Mariana Almeida, Sara Alves, Helena Salgado

Background

Inadequate pressure in the endotracheal tube (ETT) cuff can lead to compromised ventilation or airway injury. Accurate assessment of ETT cuff pressure is essential and should be performed using a manometer, with an optimal target range of 20–30 cmH₂O.

Aim

In this study, we aimed to audit ETT cuff pressures in the operating theatre of our institution, utilizing a manometer from VBM Medizintechnik GmbH™.

Methods

Following approval from the ethics committee, we conducted an audit from January 2023 to November 2023. A convenience sample was utilized, including adult patients who were intubated in our operating rooms (ORs) during either the morning or afternoon shifts at the time of the audit.

Results

A total of 49 patients were evaluated. Our findings revealed that 78 % of the patients had cuff pressures outside the recommended target range, with recorded pressures ranging from 18 cmH₂O to 120 cmH₂O, and a mean pressure of 63 cmH₂O. Nitrous oxide was not used in any of the cases. Cuff inflation was performed using different syringe volumes: a 5 mL syringe was used in one case, a 10 mL syringe in 20 cases, and a 20 mL syringe in 28 cases, with a mean inflation volume of 9 mL. Statistical analysis indicated no significant difference in ETT cuff pressure related to the type of syringe used or the size of the endotracheal tube. Additionally, no correlation was found between the volume of air used for cuff inflation and the resulting ETT cuff pressure.

Conclusion

Our audit revealed that only 22 % of the patients had cuff pressures within the recommended limits, highlighting a significant need for increased awareness and education. As maintaining appropriate cuff pressure is a standard of care, systematic implementation of reliable cuff pressure monitoring is strongly recommended.

背景气管导管（ETT）袖带压力不足会导致通气功能受损或气道损伤。准确评估 ETT 袖带压力至关重要，应使用压力计进行评估，最佳目标范围为 20-30 cmH2O.Aim在本研究中，我们使用 VBM Medizintechnik GmbH™ 公司生产的压力计对本机构手术室的 ETT 袖带压力进行了审核。我们采用的是方便抽样法，抽样对象包括审核时在我们手术室（OR）上下午班插管的成年患者。我们的结果显示，78% 的患者的袖带压力超出了推荐的目标范围，记录的压力范围为 18 cmH2O 至 120 cmH2O，平均压力为 63 cmH2O。所有病例均未使用一氧化二氮。使用不同容量的注射器进行袖带充气：1 例使用 5 mL 注射器，20 例使用 10 mL 注射器，28 例使用 20 mL 注射器，平均充气量为 9 mL。统计分析表明，ETT 袖套压力的差异与使用的注射器类型或气管导管的大小没有明显关系。结论我们的审计结果表明，只有 22% 的患者的充气罩囊压力在建议范围内，这表明有必要加强宣传和教育。由于保持适当的充气罩囊压是一项护理标准，因此强烈建议系统地实施可靠的充气罩囊压监测。

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引用次数: 0

Vasoactive drugs for the management of maternal arterial hypotension after spinal anesthesia for cesarean section. An updated integrative narrative review 剖腹产脊髓麻醉后用于控制产妇动脉低血压的血管活性药物。最新综合叙述性综述

IF 1.4 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care

Pub Date : 2024-10-01 DOI: 10.1016/j.tacc.2024.101491

Martín Astete B , Lorena Basso V , Héctor J. Lacassie

Spinal neuraxial anesthesia remains the technique of choice due to its large number of maternal-fetal advantages over general anesthesia. However, its adverse effects, such as hypotension, nausea and vomiting continue to represent an important source of morbimortality and a challenge for anesthesiologists. Currently, there are different strategies for its prevention and management, vasoactive drugs being one of the mainstay treatments. In recent years different pharmacological alternatives and administration schemes have emerged in hopes of finding the ideal one and ending this dilemma. The objective of this integrative narrative review is to provide an update on vasoactive drugs used in cesarean section with the latest available evidence. To date, norepinephrine seems to achieve hemodynamic stability with a lower rate of maternal-fetal complications in patients without other associated complications.

与全身麻醉相比，脊髓神经麻醉在母胎方面有很多优势，因此仍然是首选技术。然而，其不良反应，如低血压、恶心和呕吐，仍然是导致死亡的一个重要原因，也是麻醉师面临的一个挑战。目前，有不同的策略来预防和处理这种不良反应，其中血管活性药物是主要的治疗方法之一。近年来，出现了不同的药物替代品和给药方案，希望能找到理想的方案，结束这一困境。本综述旨在提供剖宫产术中使用的血管活性药物的最新证据。迄今为止，去甲肾上腺素似乎能达到稳定血流动力学的效果，在无其他相关并发症的患者中，母胎并发症发生率较低。

引用次数: 0

Direct laryngoscopy versus videolaryngoscopy for neonatal tracheal intubation: An updated systematic review and meta-analysis 新生儿气管插管的直接喉镜检查与视频喉镜检查：最新系统回顾和荟萃分析

IF 1.4 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care

Pub Date : 2024-10-01 DOI: 10.1016/j.tacc.2024.101494

Carlos Henrique de Oliveira Ferreira , Bruno FM. Wegner , Gustavo RM. Wegner , João Victor de Oliveira Ramos , Gabrielle de Lacerda Dantas Henrique , Henrique Santana Cumming , Naieli Machado Andrade , Heidi Cordeiro , Tatiana Souza do Nascimento

Introduction

The potential benefits and risks of Videolaryngoscopy (VL) over Direct Laryngoscopy (DL) in neonates undergoing tracheal intubation are unclear.

Methods

We performed a systematic review and meta-analysis of randomized clinical trial (RCT) data comparing VL to DL in neonate patients following tracheal intubation, regarding the success rate of the first intubation attempt, mean number of intubation attempts, time to intubate, oxygen desaturation, bradycardia, airway trauma or bleeding and cardiopulmonary resuscitation.

Results

Seven studies comprising 897 patients undergoing tracheal intubation were included. Of the participants studied, 450 (50,2 %) used VL and 447 (49,8 %) utilized DL. Overall, VL was associated with a higher first intubation success rate (RR: 1.18; p = 0.02; I² = 67 %) and fewer episodes of oxygen desaturation <90 % (RR: 0.84; p = 0.008; I² = 0 %). No differences were found in mean attempts to intubate (MD: 0.25; p = 0.188; I² = 99 %), time to intubate (MD: 1.327; p = 0.81; I² = 97 %), airway trauma or bleeding (RR: 0.69; p = 0.372; I² = 16 %), bradycardia <100 bpm (RR: 1.05; p = 0.81; I² = 0 %), and cardiopulmonary resuscitation (RR: 0.61; p = 0.447; I² = 74 %). Sub Analyses of first attempt intubation success rate in the intensive care unit (ICU) (RR: 1.48; p = 0.003; I² = 35 %) showed an advantage for VL. However, in bradycardia <60 bpm (RR: 0.89; p = 0.769; I² = 0 %) and oxygen desaturation <80 % (RR: 0.85; p = 0.066; I² = 0 %), VL and DL were equivalent.

Conclusion

Despite the equivalence in some outcomes, in general, VL was superior to DL. This superiority was seen most clearly in the success rate of the first intubation and in the reduction in episodes of hypoxemia.

引言在接受气管插管的新生儿中，视频喉镜（VL）与直接喉镜（DL）相比的潜在益处和风险尚不清楚。方法我们对随机临床试验（RCT）数据进行了系统回顾和荟萃分析，比较了新生儿气管插管后 VL 和 DL 的首次插管成功率、平均插管次数、插管时间、氧饱和度降低、心动过缓、气道创伤或出血以及心肺复苏。其中 450 人（50.2%）使用了 VL，447 人（49.8%）使用了 DL。总体而言，VL 与较高的首次插管成功率（RR：1.18；p = 0.02；I2 = 67 %）和较少的氧饱和度下降（RR：0.84；p = 0.008；I2 = 0 %）相关。在平均插管尝试次数（MD：0.25；p = 0.188；I2 = 99 %）、插管时间（MD：1.327；p = 0.81；I2 = 97 %）、气道创伤或出血（RR：0.69；P = 0.372；I2 = 16 %）、心动过缓 <100 bpm（RR：1.05；P = 0.81；I2 = 0 %）和心肺复苏（RR：0.61；P = 0.447；I2 = 74 %）。对重症监护室（ICU）首次尝试插管成功率（RR：1.48；p = 0.003；I2 = 35 %）的子分析表明，VL 具有优势。然而，在心动过缓 <60 bpm (RR: 0.89; p = 0.769; I2 = 0 %) 和氧饱和度 <80 % (RR: 0.85; p = 0.066; I2 = 0 %)方面，VL 和 DL 相当。结论尽管在某些结果上两者相当，但总的来说，VL 优于 DL，这种优越性最明显地体现在首次插管成功率和低氧血症发作次数的减少上。

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引用次数: 0

The advantages of “closed” type management in intensive care units 重症监护室 "封闭式 "管理的优势

IF 1.4 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care

Pub Date : 2024-10-01 DOI: 10.1016/j.tacc.2024.101487

Mehdi Nematbakhsh

Background

The intensive care units (ICUs) are responsible for treating the most complex and sensitive patients in the clinic, and it often is stated that the types of management in intensive care units are associated with patient's clinical outcomes. Among the types of management in ICUs, two types are more common and more important— the “open” type and “closed” type —while each type of management has its own supportive and critics. In recent years, efforts have been made to defend each type of management in ICUs based on patients' vital indicators, such as mortality rate and length of stay in the ICU. Therefore, an important question arises regarding which type of ICU management is suitable for meeting treatment goals.

Method

The literature review was obtained using information sources such as Web of Sciences, PubMed, PMC, Google Scholar and Scopus. All articles that were published until 2024 were considered, and the English original or review publications evaluating “open” and “closed” types of ICUs management were selected. Finally, an overview was provided on patient's mortality rate and length of stay in “open” and “closed” types of ICUs.

Conclusion

Most of the findings support a “closed” type of ICU with trained intensivist supervision. However, to achieve a standard “closed” type of ICU under the supervision of trained intensivists, the necessary conditions must be performed. These necessary conditions were discussed, and a model was presented.

背景重症监护病房（ICU）负责治疗临床上最复杂、最敏感的病人，人们常说重症监护病房的管理类型与病人的临床预后有关。在重症监护室的管理类型中，有两种类型更为常见，也更为重要--"开放式 "和 "封闭式"，而每种管理类型都有其支持者和批评者。近年来，人们根据患者的死亡率和在重症监护室的住院时间等生命指标，努力为重症监护室的每一种管理方式辩护。因此，出现了一个重要问题，即哪种重症监护室管理方式适合实现治疗目标。方法通过 Web of Sciences、PubMed、PMC、Google Scholar 和 Scopus 等信息来源获取文献综述。考虑了 2024 年之前发表的所有文章，选择了评价 "开放式 "和 "封闭式 "重症监护室管理的英文原版或综述性出版物。最后，综述了 "开放式 "和 "封闭式 "重症监护病房的患者死亡率和住院时间。然而，要在训练有素的重症监护医师监督下建立标准的 "封闭式 "重症监护病房，必须具备必要的条件。对这些必要条件进行了讨论，并提出了一个模型。

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引用次数: 0

Evaluation of changes in Mallampati grading in patients undergoing elective urological procedures in prone and lithotomy positions- A prospective observational study 评估俯卧位和截石位接受泌尿外科择期手术患者的马兰帕蒂分级变化--一项前瞻性观察研究

IF 1.4 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care

Pub Date : 2024-10-01 DOI: 10.1016/j.tacc.2024.101492

Sharmila Chaganti, Nirmala Jonnavithula, Indira Gurajala, Harshini Muthyala, Hareesh Peetha

Intubation often results in airway edema, which can lead to reintubation following planned extubation in the post-anesthesia care unit. In urological procedures like percutaneous nephrolithotomy (PCNL) and ureteroscopic lithotripsy (URSL), the use of irrigation fluids may exacerbate these airway changes. This study aims to assess alterations in Mallampati grading in patients undergoing elective urological procedures, particularly in prone and lithotomy positions.

This prospective observational study was conducted at a tertiary care hospital from May 2021 to September 2021. Sixty patients with ASA I and II classifications scheduled for elective PCNL in the prone position and URSL in the lithotomy position, with 30 patients in each group, were enrolled. We assessed the Modified Mallampati Grading (MPG) before the procedure and at postoperative intervals of 4 h, 8 h, 12 h, 24 h, and 48 h, noting any changes and the time required to return to the baseline. We also recorded the number of irrigation fluids used, intravenous (IV) fluids administered, surgery duration, and estimated blood loss to explore potential associations.

MPG changed by at least one class in 36.6 % of patients in the prone position and 20 % of patients in the lithotomy position. Furthermore, MPG changed by two classes in 20 % of patients in the prone position and 3.3 % of patients in the lithotomy position. The absorption of irrigation fluids was identified as a potential cause of airway edema, with a significant p-value of 0.0001, leading to worsening of the MPG. Fortunately, in most patients, the changes in MPG returned to baseline values within 24 h.

In conclusion, our study confirms that Mallampati grading may experience at least a one-class increase in both prone and lithotomy positions in most patients, and it typically reverts to baseline in about 24 h for most patients. These airway changes should be considered when re-intubating patients in the postoperative period.

插管通常会导致气道水肿，这可能会导致在麻醉后护理病房按计划拔管后再次插管。在经皮肾镜碎石术（PCNL）和输尿管镜碎石术（URSL）等泌尿科手术中，使用冲洗液可能会加剧这些气道变化。这项前瞻性观察研究于 2021 年 5 月至 2021 年 9 月在一家三级甲等医院进行。60名ASA分级为I级和II级的患者参加了研究，他们计划在俯卧位接受PCNL手术，在碎石位接受URSL手术，每组30人。我们在术前和术后 4 小时、8 小时、12 小时、24 小时和 48 小时评估了改良马兰帕蒂分级（MPG），记录了任何变化以及恢复到基线所需的时间。我们还记录了所用冲洗液的数量、静脉输液（IV）用量、手术持续时间和估计失血量，以探讨可能存在的关联。36.6% 的俯卧位患者和 20% 的平卧位患者的 MPG 至少变化了一个等级。此外，有 20% 的俯卧位患者和 3.3% 的碎石位患者的 MPG 变化了两个等级。灌洗液的吸收被认为是气道水肿的潜在原因，其显著性P值为0.0001，导致MPG恶化。总之，我们的研究证实，大多数患者的马兰帕蒂分级在俯卧位和碎石位时至少会增加一个等级，而且大多数患者的马兰帕蒂分级通常会在 24 小时内恢复到基线值。术后为患者重新插管时应考虑这些气道变化。

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引用次数: 0

“Distribution of pulmonary ventilation in the lateral decubitus position of healthy adults under Non-Invasive Mechanical Ventilation: a pilot study” "无创机械通气下健康成人侧卧位的肺通气分布：一项试点研究

IF 1.4 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care

Pub Date : 2024-10-01 DOI: 10.1016/j.tacc.2024.101499

Konstantinos Grigoriadis , Anna Grigoriadou , Frantzeska Frantzeskaki , Ioannis Efstathiou , Iraklis Tsangaris

Objective

In the lateral decubitus position, the largest percentage of pulmonary ventilation in non-sedated subjects is distributed mainly in the dependent lung.

Methods

We aimed to investigate, via impedance tomography, the distribution of pulmonary ventilation in the lateral position under the effect of different Continuous Positive Airway Pressure (CPAP) levels (0, 5, 10 cm H₂O) in healthy subjects. The volunteers were noninvasively ventilated in both lateral positions and supine positions at the beginning and end of the process.

Results

A statistically significant difference between the percentage distribution of lung ventilation in different CPAP levels in the right and left lateral decubitus body positions was observed.

Conclusion

We concluded that in the lateral position, as positive pressure increases, ventilation of the dependent lung increases, while, conversely, pulmonary ventilation of the non-dependent lung decreases.

方法我们旨在通过阻抗断层扫描研究在不同持续气道正压（CPAP）水平（0、5、10 cm H2O）作用下，健康受试者侧卧位肺通气量的分布情况。结果在左右侧卧位时，不同 CPAP 水平下的肺通气量分布百分比差异有统计学意义。结论我们得出结论：在侧卧位时，随着正压的增加，依赖肺的通气量增加，反之，非依赖肺的肺通气量减少。

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引用次数: 0

Is pre-extubation fasting in ICU justified? Insights from a prospective observational study using gastric ultrasound ICU 拔管前禁食是否合理？使用胃超声进行前瞻性观察研究的启示

IF 1.4 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care

Pub Date : 2024-10-01 DOI: 10.1016/j.tacc.2024.101497

Mohd Saif Khan , Barun Ram , Amit Kumar , Kamel Bousselmi , Priyesh Kumar , Dumini Soren , Priyanka Shrivastava , Naveen Kumar

Background

In order to mitigate the risk of aspiration pneumonia, it is common practice to recommend fasting for critically ill patients who are undergoing elective tracheal extubation. This clinical investigation seeks to question and reassess this standard fasting protocol.

Aims & objectives

This study aimed to determine the role of gastric ultrasound in critically ill patients before a planned tracheal extubation. Main objectives of this study were to assess prevalence of at-risk stomach (full stomach) and the rates of safe extubation in fasted and non-fasted patients.

Methods

Gastric ultrasound was performed on 60 critically ill patients prior to tracheal extubation to assess cross-sectional area (CSA) and calculate gastric volume. Patients with a volume exceeding 1.5 mL/kg or thick fluid were classified as ‘at-risk’ for aspiration (full stomach). All patients were monitored for aspiration pneumonitis during the 24 h following extubation.

Results

The overall prevalence of at-risk stomachs (full stomach) was 40 %, showing no difference between fasted and non-fasted groups (50 % vs. 30 %; p = 0.114). Calculated gastric volumes were also similar across both groups (0.95 ± 0.58 vs. 0.86 ± 0.48 mL/kg; p = 0.574). The safe extubation rate did not significantly differ between fasted and non-fasted groups (86.7 % vs. 93.3 %; p = 0.39). Ongoing opioid use was identified as an independent predictor of at-risk stomach (adjusted odds ratio, 5.54; p = 0.016).

Conclusions

The prevalence of at-risk stomach (full stomach) was high in our cohort. Pre-extubation fasting did not decrease gastric volumes, as assessed by ultrasound, while ongoing opioid use was an independent predictor of an ‘at-risk’ stomach.

背景为了降低吸入性肺炎的风险，通常的做法是建议接受择期气管插管的重症患者禁食。本临床调查旨在质疑和重新评估这一标准禁食方案。本研究旨在确定胃超声在计划气管插管前对重症患者的作用。方法：在气管插管前对 60 名重症患者进行胃部超声检查，以评估横截面积（CSA）并计算胃容量。胃容量超过 1.5 mL/kg 或胃液粘稠的患者被归类为吸入 "高危 "患者（全胃）。所有患者在拔管后的 24 小时内均接受了吸入性肺炎的监测。结果高危胃部（满胃）的总体发病率为 40%，禁食组和非禁食组之间没有差异（50% 对 30%；P = 0.114）。两组的计算胃容量也相似（0.95 ± 0.58 vs. 0.86 ± 0.48 mL/kg；p = 0.574）。禁食组和非禁食组的安全拔管率没有明显差异（86.7% vs. 93.3%；p = 0.39）。持续使用阿片类药物被认为是胃部危险的独立预测因素（调整后的几率比为 5.54；P = 0.016）。根据超声波评估，拔管前禁食不会减少胃容量，而持续使用阿片类药物是 "危险 "胃的独立预测因素。

{"title":"Is pre-extubation fasting in ICU justified? Insights from a prospective observational study using gastric ultrasound","authors":"Mohd Saif Khan , Barun Ram , Amit Kumar , Kamel Bousselmi , Priyesh Kumar , Dumini Soren , Priyanka Shrivastava , Naveen Kumar","doi":"10.1016/j.tacc.2024.101497","DOIUrl":"10.1016/j.tacc.2024.101497","url":null,"abstract":"<div><h3>Background</h3><div>In order to mitigate the risk of aspiration pneumonia, it is common practice to recommend fasting for critically ill patients who are undergoing elective tracheal extubation. This clinical investigation seeks to question and reassess this standard fasting protocol.</div></div><div><h3>Aims & objectives</h3><div>This study aimed to determine the role of gastric ultrasound in critically ill patients before a planned tracheal extubation. Main objectives of this study were to assess prevalence of at-risk stomach (full stomach) and the rates of safe extubation in fasted and non-fasted patients.</div></div><div><h3>Methods</h3><div>Gastric ultrasound was performed on 60 critically ill patients prior to tracheal extubation to assess cross-sectional area (CSA) and calculate gastric volume. Patients with a volume exceeding 1.5 mL/kg or thick fluid were classified as ‘at-risk’ for aspiration (full stomach). All patients were monitored for aspiration pneumonitis during the 24 h following extubation.</div></div><div><h3>Results</h3><div>The overall prevalence of at-risk stomachs (full stomach) was 40 %, showing no difference between fasted and non-fasted groups (50 % vs. 30 %; p = 0.114). Calculated gastric volumes were also similar across both groups (0.95 ± 0.58 vs. 0.86 ± 0.48 mL/kg; p = 0.574). The safe extubation rate did not significantly differ between fasted and non-fasted groups (86.7 % vs. 93.3 %; p = 0.39). Ongoing opioid use was identified as an independent predictor of at-risk stomach (adjusted odds ratio, 5.54; p = 0.016).</div></div><div><h3>Conclusions</h3><div>The prevalence of at-risk stomach (full stomach) was high in our cohort. Pre-extubation fasting did not decrease gastric volumes, as assessed by ultrasound, while ongoing opioid use was an independent predictor of an ‘at-risk’ stomach.</div></div>","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"58 ","pages":"Article 101497"},"PeriodicalIF":1.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142653276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A knife to the neck; An airway challenge for the Anesthesiologist: A case report 刀架在脖子上；麻醉师面临的气道挑战：病例报告

IF 1.4 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care

Pub Date : 2024-10-01 DOI: 10.1016/j.tacc.2024.101490

Roaa Suleiman , Ayten Saracoglu , Redouane Mecharnia , Bushra M. Abdallah , Layla J.M. Kily , Loubna Zabat , Sana Saleem , Kemal Tolga Saracoglu

Penetrating neck injuries are potentially life-threatening emergencies that can pose significant airway difficulties. There is a lack of evidence regarding the best practice for airway management in these patients. We aimed to describe a multistep approach to airway management in a 36-year-old patient with a 3 cm deep penetrating neck stab wound. A combined technique of videolaryngoscope and fiberoptic scope was utilized to secure the airway, considering the patient's stability and cooperation. In conclusion, D blade-assisted tracheal intubation following rapid sequence induction can be considered as a safe alternative to awake intubation with a high success rate in selected patients with penetrating neck injuries.

颈部穿透性损伤是一种可能危及生命的急症，会造成严重的气道困难。关于这类患者气道管理的最佳实践，目前还缺乏证据。我们旨在介绍一种多步骤气道管理方法，该方法适用于一名颈部有 3 厘米深穿透性刀伤的 36 岁患者。考虑到患者的稳定性和合作性，我们采用了视频喉镜和光纤镜联合技术来固定气道。总之，在快速序列诱导后进行 D 型刀片辅助气管插管可被视为清醒插管的一种安全替代方法，在选定的颈部贯穿伤患者中成功率很高。

引用次数: 0