Pub Date : 2025-07-05DOI: 10.1016/j.mpaic.2025.05.012
Dhaneesha Navin Sannasgala Senaratne, Michael Serpell
Electricity is a dangerous tool. When used carefully it can substantially improve safety, outcomes and efficiency within the operating theatre; but if used without due caution it can cause significant harm or death. Understanding the principles and practicalities of electrical supply, equipment design and safety mechanisms helps us identify and mitigate the risks to ourselves, our colleagues and our patients. Specific medical devices that apply current directly to the body for therapeutic effect (e.g. surgical diathermy, defibrillators) can be the most dangerous; if appropriate practices are not followed then the risk of electrical injury is high. In this article we cover the principles and knowledge required to ensure basic electrical safety within the operating theatre.
{"title":"Electricity and the operating theatre: hazards and uses","authors":"Dhaneesha Navin Sannasgala Senaratne, Michael Serpell","doi":"10.1016/j.mpaic.2025.05.012","DOIUrl":"10.1016/j.mpaic.2025.05.012","url":null,"abstract":"<div><div>Electricity is a dangerous tool. When used carefully it can substantially improve safety, outcomes and efficiency within the operating theatre; but if used without due caution it can cause significant harm or death. Understanding the principles and practicalities of electrical supply, equipment design and safety mechanisms helps us identify and mitigate the risks to ourselves, our colleagues and our patients. Specific medical devices that apply current directly to the body for therapeutic effect (e.g. surgical diathermy, defibrillators) can be the most dangerous; if appropriate practices are not followed then the risk of electrical injury is high. In this article we cover the principles and knowledge required to ensure basic electrical safety within the operating theatre.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 8","pages":"Pages 459-466"},"PeriodicalIF":0.3,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144723689","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}
Pub Date : 2025-07-05DOI: 10.1016/j.mpaic.2025.05.004
Daniel Edelman, David. J. Brewster
Airway management practices in the intensive care unit (ICU) are still evolving, evidenced by an increasing proliferation of guidelines/algorithms in recent years as well ongoing studies focusing on equipment choices such as videolaryngoscopes. Specific considerations relate to the out-of-theatre environment and the physiological state in this patient population. Airway management in ICU is ultimately a multifaceted process spanning team training, simulation, preassessment, preparation, positioning of the patient, equipment decisions and guidelines/algorithm adherence including those covering the management of coronavirus disease (COVID-19). Emergency front-of-neck access (FONA) should be taught to all staff and standardized equipment made available. This updated article highlights the growing evidence supporting the use of videolaryngoscopy in the critical care setting as well as the use of checklists, and highlights the factors a multidisciplinary team must navigate when approaching airway management in the ICU.
{"title":"Airway management in the intensive care unit","authors":"Daniel Edelman, David. J. Brewster","doi":"10.1016/j.mpaic.2025.05.004","DOIUrl":"10.1016/j.mpaic.2025.05.004","url":null,"abstract":"<div><div>Airway management practices in the intensive care unit (ICU) are still evolving, evidenced by an increasing proliferation of guidelines/algorithms in recent years as well ongoing studies focusing on equipment choices such as videolaryngoscopes. Specific considerations relate to the out-of-theatre environment and the physiological state in this patient population. Airway management in ICU is ultimately a multifaceted process spanning team training, simulation, preassessment, preparation, positioning of the patient, equipment decisions and guidelines/algorithm adherence including those covering the management of coronavirus disease (COVID-19). Emergency front-of-neck access (FONA) should be taught to all staff and standardized equipment made available. This updated article highlights the growing evidence supporting the use of videolaryngoscopy in the critical care setting as well as the use of checklists, and highlights the factors a multidisciplinary team must navigate when approaching airway management in the ICU.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 8","pages":"Pages 472-476"},"PeriodicalIF":0.3,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144723691","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}
Pub Date : 2025-07-05DOI: 10.1016/j.mpaic.2025.05.013
Sjoerd HW van Bree, Shady Amer
Community-acquired pneumonia (CAP) is a condition characterized by inflammatory changes in the respiratory system caused by non-hospital pathogens. The symptoms and signs of a lower respiratory tract infection range from cough, dyspnoea, pleuritic chest pain, sputum with mucopurulent components, to systemic features such as myalgia, and fever. Patients in their older years are more likely to present with confusion or worsening pre-existing conditions and may lack fever. Severe CAP is a pneumonia that requires supportive therapy within intensive care settings, and is still associated with a high mortality and significantly morbidity, specifically amongst the elderly population with multiple comorbidities. Despite the improvement in supportive care by new modalities, such as high-flow nasal oxygen therapy, severe CAP remains one of the most common reasons for admission to a critical care facility. Correct diagnosis, risk stratification and early initiation of antibiotic treatment are key factors determining outcomes of patients with severe CAP. New developments will concentrate on diagnostics such as point of care microbiological tests and adjuvant non-antibiotic immunomodulating treatment strategies. Neither coronavirus disease (COVID-19) pneumonia nor pneumonia in immunocompromised patients are within the scope of this article.
{"title":"Community-acquired pneumonia","authors":"Sjoerd HW van Bree, Shady Amer","doi":"10.1016/j.mpaic.2025.05.013","DOIUrl":"10.1016/j.mpaic.2025.05.013","url":null,"abstract":"<div><div>Community-acquired pneumonia (CAP) is a condition characterized by inflammatory changes in the respiratory system caused by non-hospital pathogens. The symptoms and signs of a lower respiratory tract infection range from cough, dyspnoea, pleuritic chest pain, sputum with mucopurulent components, to systemic features such as myalgia, and fever. Patients in their older years are more likely to present with confusion or worsening pre-existing conditions and may lack fever. Severe CAP is a pneumonia that requires supportive therapy within intensive care settings, and is still associated with a high mortality and significantly morbidity, specifically amongst the elderly population with multiple comorbidities. Despite the improvement in supportive care by new modalities, such as high-flow nasal oxygen therapy, severe CAP remains one of the most common reasons for admission to a critical care facility. Correct diagnosis, risk stratification and early initiation of antibiotic treatment are key factors determining outcomes of patients with severe CAP. New developments will concentrate on diagnostics such as point of care microbiological tests and adjuvant non-antibiotic immunomodulating treatment strategies. Neither coronavirus disease (COVID-19) pneumonia nor pneumonia in immunocompromised patients are within the scope of this article.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 8","pages":"Pages 491-497"},"PeriodicalIF":0.3,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144723693","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}
Pub Date : 2025-07-05DOI: 10.1016/j.mpaic.2025.05.015
Emma Watson, Andy Lamb
This article describes and provides discussion about key equipment used by the UK Defence Medical Services (DMS) for field anaesthesia and critical care medicine. Field equipment must be both clinically effective and suitable for operation in a field environment, often resulting in a compromise. Field equipment must be robust, portable, simple to maintain, and require minimal consumables or parts.
{"title":"Field anaesthesia and critical care equipment used by the British military","authors":"Emma Watson, Andy Lamb","doi":"10.1016/j.mpaic.2025.05.015","DOIUrl":"10.1016/j.mpaic.2025.05.015","url":null,"abstract":"<div><div>This article describes and provides discussion about key equipment used by the UK Defence Medical Services (DMS) for field anaesthesia and critical care medicine. Field equipment must be both clinically effective and suitable for operation in a field environment, often resulting in a compromise. Field equipment must be robust, portable, simple to maintain, and require minimal consumables or parts.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 8","pages":"Pages 528-531"},"PeriodicalIF":0.3,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144723785","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}
Pub Date : 2025-07-05DOI: 10.1016/j.mpaic.2025.05.006
Michael G. Gardner, Michael Serpell
Healthcare-associated infections continue to place a significant burden on healthcare organizations with anaesthetic and intensive care practice contributing to this burden. Knowledge and understanding of methods to mitigate transmission is key to reducing its impact. Decontamination is the process where reusable medical devices are rendered safe for reuse through cleaning and then either disinfection or sterilization. Cleaning is the physical process of removing foreign matter from an object. Disinfection removes most, but not all microorganisms whilst sterilization eliminates all viable microorganisms. Single-use medical items are sterilized during manufacture and avoid the requirement for further decontamination altogether by being disposable.
{"title":"Disinfection, sterilization and single use","authors":"Michael G. Gardner, Michael Serpell","doi":"10.1016/j.mpaic.2025.05.006","DOIUrl":"10.1016/j.mpaic.2025.05.006","url":null,"abstract":"<div><div>Healthcare-associated infections continue to place a significant burden on healthcare organizations with anaesthetic and intensive care practice contributing to this burden. Knowledge and understanding of methods to mitigate transmission is key to reducing its impact. Decontamination is the process where reusable medical devices are rendered safe for reuse through cleaning and then either disinfection or sterilization. Cleaning is the physical process of removing foreign matter from an object. Disinfection removes most, but not all microorganisms whilst sterilization eliminates all viable microorganisms. Single-use medical items are sterilized during manufacture and avoid the requirement for further decontamination altogether by being disposable.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 8","pages":"Pages 455-458"},"PeriodicalIF":0.3,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144721429","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}
Pub Date : 2025-07-05DOI: 10.1016/j.mpaic.2025.05.008
Craig Johnston, Paul Nixon
The prevalence of asthma and chronic obstructive pulmonary disease is increasing worldwide. Patients who require intensive care management for acute exacerbations of these conditions represent a particular challenge. The requirement for invasive mechanical ventilation is associated with many pitfalls, as evidenced by the higher mortality rate of patients undergoing this intervention. This article describes the initial management, as well as escalating respiratory support and advanced pharmacological therapies, and the current evidence supporting these. In particular, the concept of dynamic hyperinflation is addressed as well as ventilation strategies that should be employed to prevent the development of complications.
{"title":"Asthma and chronic obstructive pulmonary disease in the intensive care unit","authors":"Craig Johnston, Paul Nixon","doi":"10.1016/j.mpaic.2025.05.008","DOIUrl":"10.1016/j.mpaic.2025.05.008","url":null,"abstract":"<div><div>The prevalence of asthma and chronic obstructive pulmonary disease is increasing worldwide. Patients who require intensive care management for acute exacerbations of these conditions represent a particular challenge. The requirement for invasive mechanical ventilation is associated with many pitfalls, as evidenced by the higher mortality rate of patients undergoing this intervention. This article describes the initial management, as well as escalating respiratory support and advanced pharmacological therapies, and the current evidence supporting these. In particular, the concept of dynamic hyperinflation is addressed as well as ventilation strategies that should be employed to prevent the development of complications.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 8","pages":"Pages 507-514"},"PeriodicalIF":0.3,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144723686","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}
Pub Date : 2025-07-05DOI: 10.1016/j.mpaic.2025.05.010
Tapan Parikh aka Parmar, David Pilcher
Acute respiratory distress syndrome (ARDS) is a heterogeneous lung disease that is triggered by pulmonary and non-pulmonary pathologies. It predominantly causes hypoxaemic respiratory failure and can lead to significant morbidity and mortality. Although ARDS re-mains underdiagnosed, 24% of mechanically ventilated patients in intensive care units and 33% of coronavirus disease (COVID-19) patients admitted to the hospital are reported to have ARDS. Despite recent advances in treatment, mortality remains at more than 30% for all ARDS patients and 43% for severe ARDS.
The pathophysiology is complex and involves acute pulmonary and systemic inflammation, alveolar oedema, and de-recruitment which lead to ventilation-perfusion mismatch, reduced lung compliance and hypoxaemia. Similarities in the pathophysiology of COVID-19 ARDS outnumber differences from non-COVID-19 ARDS. Inhomogeneous distribution of transpulmonary pressure variation throughout the lungs in ARDS increases the risk of patient self-inflicted lung injury and ventilator-associated lung injury.
Stratifying ARDS patients as per new proposed global definition may ensure broader patient inclusion and support future research especially in under resource countries. Treating the underlying cause, lung-protective ventilation and supportive care are the mainstays of clinical management. Multiple rescue therapies, novel treatments, and methods of facilitating individualized ventilation especially based on phenotypes have been described but many require further validation; and appropriate patient selection is warranted.
{"title":"Acute respiratory distress syndrome","authors":"Tapan Parikh aka Parmar, David Pilcher","doi":"10.1016/j.mpaic.2025.05.010","DOIUrl":"10.1016/j.mpaic.2025.05.010","url":null,"abstract":"<div><div>Acute respiratory distress syndrome (ARDS) is a heterogeneous lung disease that is triggered by pulmonary and non-pulmonary pathologies. It predominantly causes hypoxaemic respiratory failure and can lead to significant morbidity and mortality. Although ARDS re-mains underdiagnosed, 24% of mechanically ventilated patients in intensive care units and 33% of coronavirus disease (COVID-19) patients admitted to the hospital are reported to have ARDS. Despite recent advances in treatment, mortality remains at more than 30% for all ARDS patients and 43% for severe ARDS.</div><div>The pathophysiology is complex and involves acute pulmonary and systemic inflammation, alveolar oedema, and de-recruitment which lead to ventilation-perfusion mismatch, reduced lung compliance and hypoxaemia. Similarities in the pathophysiology of COVID-19 ARDS outnumber differences from non-COVID-19 ARDS. Inhomogeneous distribution of transpulmonary pressure variation throughout the lungs in ARDS increases the risk of patient self-inflicted lung injury and ventilator-associated lung injury.</div><div>Stratifying ARDS patients as per new proposed global definition may ensure broader patient inclusion and support future research especially in under resource countries. Treating the underlying cause, lung-protective ventilation and supportive care are the mainstays of clinical management. Multiple rescue therapies, novel treatments, and methods of facilitating individualized ventilation especially based on phenotypes have been described but many require further validation; and appropriate patient selection is warranted.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 8","pages":"Pages 515-522"},"PeriodicalIF":0.3,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144723687","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}
Pub Date : 2025-07-05DOI: 10.1016/j.mpaic.2025.05.009
Carmen Leung, Yiu Chung Lau
Risk assessment is crucial in perioperative care planning to optimize outcomes. Various risk assessment tools have been developed to predict the general risk of surgery and specific system-based risks. Guidelines recommend using these tools to stratify risk of perioperative complications. Cardiac biomarkers may supplement risk assessment for high-risk patients. Investigations including cardiopulmonary exercise testing and pulmonary function tests are reserved for high-risk patients and procedures. Frailty is an independent predictor of adverse outcomes and should be screened routinely preoperatively in elderly patients. Each risk prediction tool has its own limitations and there is a lack of evidence to suggest one over another. Further research on these tools and artificial intelligence could improve subsequent clinical decision-making.
{"title":"Risk assessment in anaesthesia for adult non-cardiac surgery","authors":"Carmen Leung, Yiu Chung Lau","doi":"10.1016/j.mpaic.2025.05.009","DOIUrl":"10.1016/j.mpaic.2025.05.009","url":null,"abstract":"<div><div>Risk assessment is crucial in perioperative care planning to optimize outcomes. Various risk assessment tools have been developed to predict the general risk of surgery and specific system-based risks. Guidelines recommend using these tools to stratify risk of perioperative complications. Cardiac biomarkers may supplement risk assessment for high-risk patients. Investigations including cardiopulmonary exercise testing and pulmonary function tests are reserved for high-risk patients and procedures. Frailty is an independent predictor of adverse outcomes and should be screened routinely preoperatively in elderly patients. Each risk prediction tool has its own limitations and there is a lack of evidence to suggest one over another. Further research on these tools and artificial intelligence could improve subsequent clinical decision-making.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 8","pages":"Pages 467-471"},"PeriodicalIF":0.3,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144723690","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}
Pub Date : 2025-06-12DOI: 10.1016/j.mpaic.2025.04.007
Reya Vinay Shah, Cleodie Swire, Rhiann Marie O'Shaughnessy, Fu Liang Ng
The autonomic nervous system comprises sympathetic and parasympathetic systems. Together, they modulate a variety of physiological functions in order to maintain homeostasis. Many commonly used medicines have direct or indirect effects upon this system and understanding of autonomic pharmacology is vital to use these medicines safely and effectively in clinical practice.
{"title":"Drugs affecting the autonomic nervous system","authors":"Reya Vinay Shah, Cleodie Swire, Rhiann Marie O'Shaughnessy, Fu Liang Ng","doi":"10.1016/j.mpaic.2025.04.007","DOIUrl":"10.1016/j.mpaic.2025.04.007","url":null,"abstract":"<div><div>The autonomic nervous system comprises sympathetic and parasympathetic systems. Together, they modulate a variety of physiological functions in order to maintain homeostasis. Many commonly used medicines have direct or indirect effects upon this system and understanding of autonomic pharmacology is vital to use these medicines safely and effectively in clinical practice.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 7","pages":"Pages 446-451"},"PeriodicalIF":0.2,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491166","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}
Pub Date : 2025-06-06DOI: 10.1016/j.mpaic.2025.04.003
Brigid Bassam
Pain management in palliative care is both an art and a science. Essential to good pain control is an understanding not only of the pathophysiology of the origin of the pain, but also the impact that the pain is having, as the palliative patient may have to live with the symptoms of disease for months or even years. Interventions can then be targeted and at various times, may include a range of pharmacological treatments, psychological or spiritual support and possibly the involvement of other specialties to alleviate a particular problem.
{"title":"Pain management in palliative care: art or science","authors":"Brigid Bassam","doi":"10.1016/j.mpaic.2025.04.003","DOIUrl":"10.1016/j.mpaic.2025.04.003","url":null,"abstract":"<div><div>Pain management in palliative care is both an art and a science. Essential to good pain control is an understanding not only of the pathophysiology of the origin of the pain, but also the impact that the pain is having, as the palliative patient may have to live with the symptoms of disease for months or even years. Interventions can then be targeted and at various times, may include a range of pharmacological treatments, psychological or spiritual support and possibly the involvement of other specialties to alleviate a particular problem.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 7","pages":"Pages 400-405"},"PeriodicalIF":0.2,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491161","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}
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