Pub Date : 2024-11-14DOI: 10.1016/j.accpm.2024.101450
Chin Wen Tan, Dgp Luther, Hon Sen Tan, Nabilah Rahman, Mihir Gandhi, Rehena Sultana, Alex Tiong Heng Sia, Ban Leong Sng
{"title":"The association between neuraxial labor analgesia and subacute pain after childbirth: a randomized controlled trial.","authors":"Chin Wen Tan, Dgp Luther, Hon Sen Tan, Nabilah Rahman, Mihir Gandhi, Rehena Sultana, Alex Tiong Heng Sia, Ban Leong Sng","doi":"10.1016/j.accpm.2024.101450","DOIUrl":"https://doi.org/10.1016/j.accpm.2024.101450","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101450"},"PeriodicalIF":3.7,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-22DOI: 10.1016/j.accpm.2024.101446
Anne Godier, Dominique Lasne, Gilles Pernod, Normand Blais, Fanny Bonhomme, Fanny Bounes, Alex Bourguignon, Ariel Cohen, Emmanuel de Maistre, Pierre Fontana, Jean-Philippe Galanaud, Delphine Garrigue Huet, Alexandre Godon, Isabelle Gouin-Thibault, Samia Jebara, Silvy Laporte, Thomas Lecompte, Dan Longrois, Jerrold H Levy, Grégoire Le Gal, Yves Gruel, Alexandre Mansour, Anne-Céline Martin, Mikael Mazighi, Pierre-Emmanuel Morange, Serge Motte, François Mullier, Philippe Nguyen, Nadia Rosencher, Stéphanie Roullet, Pierre-Marie Roy, Jean-François Schved, Marie-Antoinette Sevestre, Pierre Sié, Sophie Susen, Charles Tacquard, André Vincentelli, Paul Zufferey, Patrick Mismetti, Pierre Albaladejo
Background: Any surgical procedure carries a risk for venous thromboembolism (VTE), albeit variable. Improvements in medical and surgical practices and the shortening of care pathways due to the development of day surgery and enhanced recovery after surgery, have reduced the perioperative risk for VTE.
Objective: A collaborative working group of experts in perioperative haemostasis updated in 2024 the recommendations for the Prevention of perioperative venous thromboembolism published in 2011.
Methods: The addressed questions were defined by 40 experts (GIHP, SFAR, SFTH and SFMV) and formulated in a PICO format. They performed the literature review and formulated recommendations according to the Grading of GRADE system. Recommendations were then validated by a vote determining the strength of each recommendation. Of note, these recommendations do not cover all surgical specialties. Especially, thromboprophylaxis in cardiac surgery, neurosurgery and obstetrics is not addressed.
Results: 78 recommendations were formalized into 17 sections, including patient-related VTE risk factors, types of surgery, extreme body weight, renal impairment, mechanical prophylaxis, distal deep vein thrombosis; 27 were found to have a high level of evidence (GRADE 1) and 41 a low level of evidence (GRADE 2) and 10 were expert opinion. All had strong agreement among the experts.
Conclusions: These guidelines help to weigh the perioperative risk for VTE (which includes the risk associated to surgery and the patient-related risk) against the adverse effects of thromboprophylaxis, either pharmacological or mechanical. This includes particularly the bleeding risk induced by antithrombotic drugs as well as costs.
{"title":"Prevention of perioperative venous thromboembolism: 2024 guidelines from the French Working Group on Perioperative Haemostasis (GIHP) developed in collaboration with the French Society of Anaesthesia and Intensive Care Medicine (SFAR), the French Society of Thrombosis and Haemostasis (SFTH) and the French Society of Vascular Medicine (SFMV) and endorsed by the French Society of Digestive Surgery (SFCD), the French Society of Pharmacology and Therapeutics (SFPT) and INNOVTE (Investigation Network On Venous ThromboEmbolism) network.","authors":"Anne Godier, Dominique Lasne, Gilles Pernod, Normand Blais, Fanny Bonhomme, Fanny Bounes, Alex Bourguignon, Ariel Cohen, Emmanuel de Maistre, Pierre Fontana, Jean-Philippe Galanaud, Delphine Garrigue Huet, Alexandre Godon, Isabelle Gouin-Thibault, Samia Jebara, Silvy Laporte, Thomas Lecompte, Dan Longrois, Jerrold H Levy, Grégoire Le Gal, Yves Gruel, Alexandre Mansour, Anne-Céline Martin, Mikael Mazighi, Pierre-Emmanuel Morange, Serge Motte, François Mullier, Philippe Nguyen, Nadia Rosencher, Stéphanie Roullet, Pierre-Marie Roy, Jean-François Schved, Marie-Antoinette Sevestre, Pierre Sié, Sophie Susen, Charles Tacquard, André Vincentelli, Paul Zufferey, Patrick Mismetti, Pierre Albaladejo","doi":"10.1016/j.accpm.2024.101446","DOIUrl":"https://doi.org/10.1016/j.accpm.2024.101446","url":null,"abstract":"<p><strong>Background: </strong>Any surgical procedure carries a risk for venous thromboembolism (VTE), albeit variable. Improvements in medical and surgical practices and the shortening of care pathways due to the development of day surgery and enhanced recovery after surgery, have reduced the perioperative risk for VTE.</p><p><strong>Objective: </strong>A collaborative working group of experts in perioperative haemostasis updated in 2024 the recommendations for the Prevention of perioperative venous thromboembolism published in 2011.</p><p><strong>Methods: </strong>The addressed questions were defined by 40 experts (GIHP, SFAR, SFTH and SFMV) and formulated in a PICO format. They performed the literature review and formulated recommendations according to the Grading of GRADE system. Recommendations were then validated by a vote determining the strength of each recommendation. Of note, these recommendations do not cover all surgical specialties. Especially, thromboprophylaxis in cardiac surgery, neurosurgery and obstetrics is not addressed.</p><p><strong>Results: </strong>78 recommendations were formalized into 17 sections, including patient-related VTE risk factors, types of surgery, extreme body weight, renal impairment, mechanical prophylaxis, distal deep vein thrombosis; 27 were found to have a high level of evidence (GRADE 1) and 41 a low level of evidence (GRADE 2) and 10 were expert opinion. All had strong agreement among the experts.</p><p><strong>Conclusions: </strong>These guidelines help to weigh the perioperative risk for VTE (which includes the risk associated to surgery and the patient-related risk) against the adverse effects of thromboprophylaxis, either pharmacological or mechanical. This includes particularly the bleeding risk induced by antithrombotic drugs as well as costs.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101446"},"PeriodicalIF":3.7,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142511034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-16DOI: 10.1016/j.accpm.2024.101445
Chang-Hoon Koo , Soowon Lee , Subin Yim , Yu Kyung Bae , Insun Park , Ah-Young Oh
Background
Some anaesthetists wonder whether confirming a train-of-four ratio (TOFR) ≥0.9 is necessary when using sugammadex to antagonise neuromuscular blockade (NMB). In this study, we aimed to determine whether using sugammadex at the recommended dose under neuromuscular monitoring (NMM) would ensure complete recovery, even without further NMM.
Methods
This prospective observational study included 51 patients who underwent robot-assisted surgery under general anaesthesia between March and May 2023. At the end of surgery, sugammadex was administered (2 mg/kg for a train-of-four (TOF) count ≥1 and 4 mg/kg for a TOF count = 0 and a post-tetanic count ≥1). NMM was discontinued, and subsequent recovery was completed at the discretion of the attending anaesthetist. TOFR was measured twice immediately upon admission to the post-anaesthesia care unit (PACU). The primary outcome was the incidence of a non-normalised TOFR (nTOFR) <0.9 upon arrival in PACU. The secondary outcomes were the incidences of a nTOFR <0.7 or 1.0, symptoms/signs of residual NMB (diplopia, dyspnoea, and desaturation) and recovery profiles in PACU.
Results
The incidence of a nTOFR <0.9 upon arrival in PACU was 5.9% (3/51 patients). No patient had a nTOFR <0.7, and 47.1% (24 patients) had a nTOFR <1.0, but no patients showed clinical symptoms/signs of residual NMB.
Conclusions
When the recommended dose of sugammadex was administered under qualitative NMM, residual NMB at the time of PACU arrival occurred frequently, indicating that quantitative NMM is necessary to ensure adequate recovery.
{"title":"Is quantitative neuromuscular monitoring mandatory after administration of the recommended dose of sugammadex? A prospective observational study","authors":"Chang-Hoon Koo , Soowon Lee , Subin Yim , Yu Kyung Bae , Insun Park , Ah-Young Oh","doi":"10.1016/j.accpm.2024.101445","DOIUrl":"10.1016/j.accpm.2024.101445","url":null,"abstract":"<div><h3>Background</h3><div>Some anaesthetists wonder whether confirming a train-of-four ratio (TOFR) ≥0.9 is necessary when using sugammadex to antagonise neuromuscular blockade (NMB). In this study, we aimed to determine whether using sugammadex at the recommended dose under neuromuscular monitoring (NMM) would ensure complete recovery, even without further NMM.</div></div><div><h3>Methods</h3><div>This prospective observational study included 51 patients who underwent robot-assisted surgery under general anaesthesia between March and May 2023. At the end of surgery, sugammadex was administered (2 mg/kg for a train-of-four (TOF) count ≥1 and 4 mg/kg for a TOF count = 0 and a post-tetanic count ≥1). NMM was discontinued, and subsequent recovery was completed at the discretion of the attending anaesthetist. TOFR was measured twice immediately upon admission to the post-anaesthesia care unit (PACU). The primary outcome was the incidence of a non-normalised TOFR (nTOFR) <0.9 upon arrival in PACU. The secondary outcomes were the incidences of a nTOFR <0.7 or 1.0, symptoms/signs of residual NMB (diplopia, dyspnoea, and desaturation) and recovery profiles in PACU.</div></div><div><h3>Results</h3><div>The incidence of a nTOFR <0.9 upon arrival in PACU was 5.9% (3/51 patients). No patient had a nTOFR <0.7, and 47.1% (24 patients) had a nTOFR <1.0, but no patients showed clinical symptoms/signs of residual NMB.</div></div><div><h3>Conclusions</h3><div>When the recommended dose of sugammadex was administered under qualitative NMM, residual NMB at the time of PACU arrival occurred frequently, indicating that quantitative NMM is necessary to ensure adequate recovery.</div></div><div><h3>Registration</h3><div>ClinicalTrials, NCT 05760560.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 6","pages":"Article 101445"},"PeriodicalIF":3.7,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-16DOI: 10.1016/j.accpm.2024.101444
Umar Akram , Zain Ali Nadeem , Haider Ashfaq , Eeshal Fatima , Hamza Ashraf , Muhammad Ahmed Raza , Shahzaib Ahmed , Arsalan Nadeem , Sana Rehman , Muhammad Hassan Ahmad
Background
Video-assisted thoracoscopic surgery (VATS) reduces postoperative discomfort and expedites recovery compared to open thoracotomy. Effective postoperative pain management is crucial to enhance recovery and reduce complications. Ketamine, an NMDA receptor antagonist, has shown promise, though its efficacy in VATS remains uncertain. This meta-analysis aims to evaluate the efficacy and safety of ketamine in reducing acute pain in VATS patients.
Methods
A comprehensive search of MEDLINE (PubMed), CENTRAL, Embase, Science Direct, Scopus, and clinicaltrials.gov was conducted. Eligible studies were randomized controlled trials (RCTs) comparing intraoperative intravenous ketamine with normal saline in VATS patients and reporting postoperative pain scores. Statistical analyses were performed using R version 4.3.3. Cochrane risk of bias (RoB2) tool was used to assess the quality of included studies.
Results
A total of 10 RCTs with 1151 participants were included. Ketamine was associated with a significant reduction in postoperative pain at 12 (MD −0.65, p = 0.04) and 48 h (MD −0.55 points, p < 0.01) post-surgery. No significant difference was observed in pain scores within the first 3 h, at 6 and 12 h, 24-h postoperative opioid consumption, urine output, surgery duration, rescue analgesia, mean arterial pressure, infusion volume, heart rate, extubation time, and blood loss. The certainty of evidence ranged from moderate to low across the outcomes.
Conclusions
Intraoperative intravenous ketamine effectively reduces acute postoperative pain in VATS patients but does not significantly impact opioid consumption, hemodynamic parameters, and adverse events. Large-scale studies are needed to confirm these findings and explore ketamine’s potential benefits for chronic pain management.
{"title":"Intraoperative ketamine and pain after video-assisted thoracoscopic surgery (VATS): A systematic review and meta-analysis","authors":"Umar Akram , Zain Ali Nadeem , Haider Ashfaq , Eeshal Fatima , Hamza Ashraf , Muhammad Ahmed Raza , Shahzaib Ahmed , Arsalan Nadeem , Sana Rehman , Muhammad Hassan Ahmad","doi":"10.1016/j.accpm.2024.101444","DOIUrl":"10.1016/j.accpm.2024.101444","url":null,"abstract":"<div><h3>Background</h3><div>Video-assisted thoracoscopic surgery (VATS) reduces postoperative discomfort and expedites recovery compared to open thoracotomy. Effective postoperative pain management is crucial to enhance recovery and reduce complications. Ketamine, an NMDA receptor antagonist, has shown promise, though its efficacy in VATS remains uncertain. This meta-analysis aims to evaluate the efficacy and safety of ketamine in reducing acute pain in VATS patients.</div></div><div><h3>Methods</h3><div>A comprehensive search of MEDLINE (PubMed), CENTRAL, Embase, Science Direct, Scopus, and clinicaltrials.gov was conducted. Eligible studies were randomized controlled trials (RCTs) comparing intraoperative intravenous ketamine with normal saline in VATS patients and reporting postoperative pain scores. Statistical analyses were performed using R version 4.3.3. Cochrane risk of bias (RoB2) tool was used to assess the quality of included studies.</div></div><div><h3>Results</h3><div>A total of 10 RCTs with 1151 participants were included. Ketamine was associated with a significant reduction in postoperative pain at 12 (MD −0.65, p = 0.04) and 48 h (MD −0.55 points, p < 0.01) post-surgery. No significant difference was observed in pain scores within the first 3 h, at 6 and 12 h, 24-h postoperative opioid consumption, urine output, surgery duration, rescue analgesia, mean arterial pressure, infusion volume, heart rate, extubation time, and blood loss. The certainty of evidence ranged from moderate to low across the outcomes.</div></div><div><h3>Conclusions</h3><div>Intraoperative intravenous ketamine effectively reduces acute postoperative pain in VATS patients but does not significantly impact opioid consumption, hemodynamic parameters, and adverse events. Large-scale studies are needed to confirm these findings and explore ketamine’s potential benefits for chronic pain management.</div></div><div><h3>Registration</h3><div>PROSPERO (CRD42024527858).</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 6","pages":"Article 101444"},"PeriodicalIF":3.7,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-12DOI: 10.1016/j.accpm.2024.101442
Aurélie Gouel-Chéron , Ludovic Meuret , Hélène Beloeil , Raphaël Cinotti , Maxime Léger , the SFAR research network
{"title":"Motivations and barriers to clinical research participation among anaesthesiology and intensive care staff in France","authors":"Aurélie Gouel-Chéron , Ludovic Meuret , Hélène Beloeil , Raphaël Cinotti , Maxime Léger , the SFAR research network","doi":"10.1016/j.accpm.2024.101442","DOIUrl":"10.1016/j.accpm.2024.101442","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 6","pages":"Article 101442"},"PeriodicalIF":3.7,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-11DOI: 10.1016/j.accpm.2024.101437
Morgan Le Guen , Ahed Zeidan , Paul Thourel
{"title":"Incidence and clinical impact of aspiration during cesarean delivery: A multi-center retrospective study","authors":"Morgan Le Guen , Ahed Zeidan , Paul Thourel","doi":"10.1016/j.accpm.2024.101437","DOIUrl":"10.1016/j.accpm.2024.101437","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 6","pages":"Article 101437"},"PeriodicalIF":3.7,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-11DOI: 10.1016/j.accpm.2024.101439
Luigi Vetrugno , Andrea Cortegiani
{"title":"Incidence of unplanned extubation in French intensive care units: are we ready for a SAFE-ICU plan!","authors":"Luigi Vetrugno , Andrea Cortegiani","doi":"10.1016/j.accpm.2024.101439","DOIUrl":"10.1016/j.accpm.2024.101439","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 6","pages":"Article 101439"},"PeriodicalIF":3.7,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-11DOI: 10.1016/j.accpm.2024.101438
Catarina Fernandes , Luciano Pereira
Background
Hypocalcemia, measured through ionized calcium, is a common derangement in critically ill patients. Hypocalcemia is corrected as a routine procedure in intensive care units; however, no clear guidelines exist for its management.
Objectives
This narrative review aims to provide an overview of hypocalcemia in critical care settings. This includes its association with important clinical outcomes and the assessment of the need for its correction in critically ill patients in general and in two subgroups: those with trauma and sepsis.
Methods
An extensive article search on hypocalcemia in critically ill patients was performed using PubMed, Web of Science, Cochrane Library, and Google Scholar.
Findings
Several studies showed an association between hypocalcemia and high mortality and disease severity in critically ill patients. However, the scientific evidence concerning its correction remains conflicting. Most studies showed that calcium supplementation did not improve clinical outcomes, such as mortality, and in some cases, ionized calcium levels normalized without supplementation. Patients with trauma and sepsis are subgroups, with special characteristics that should be considered when treating hypocalcemia.
Conclusions
We concluded that hypocalcemia is associated with several important clinical outcomes. Treating severe hypocalcemia is generally recommended, whereas treating moderate or mild hypocalcemia can lead to higher mortality and organ dysfunction, outweighing the potential clinical benefits, particularly in patients with sepsis. Hence, multicenter clinical trials are needed to assess the efficacy and safety of hypocalcemia treatment in these patients.
背景：低钙血症（通过离子钙测量）是重症患者常见的失调。低钙血症的纠正是重症监护病房的常规程序，但目前尚无明确的管理指南：本综述旨在概述重症监护环境中的低钙血症。这包括低钙血症与重要临床结果的关联，以及对一般重症患者和两个亚组（创伤患者和败血症患者）纠正低钙血症需求的评估：方法：使用 PubMed、Web of Science、Cochrane Library 和 Google Scholar 对重症患者低钙血症的相关文章进行了广泛搜索：几项研究表明，低钙血症与危重病人的高死亡率和疾病严重程度有关。然而，有关纠正低钙血症的科学证据仍然相互矛盾。大多数研究表明，补充钙剂并不能改善死亡率等临床结果，在某些情况下，不补充钙剂也能使离子钙水平恢复正常。创伤和败血症患者属于亚组，在治疗低钙血症时应考虑其特殊性：我们得出的结论是，低钙血症与几种重要的临床结果有关。一般建议治疗重度低钙血症，而治疗中度或轻度低钙血症会导致更高的死亡率和器官功能障碍，得不偿失，尤其是对败血症患者而言。因此，需要进行多中心临床试验，以评估这些患者低钙血症治疗的有效性和安全性。
{"title":"Hypocalcemia in critical care settings, from its clinical relevance to its treatment: A narrative review","authors":"Catarina Fernandes , Luciano Pereira","doi":"10.1016/j.accpm.2024.101438","DOIUrl":"10.1016/j.accpm.2024.101438","url":null,"abstract":"<div><h3>Background</h3><div>Hypocalcemia, measured through ionized calcium, is a common derangement in critically ill patients. Hypocalcemia is corrected as a routine procedure in intensive care units; however, no clear guidelines exist for its management.</div></div><div><h3>Objectives</h3><div>This narrative review aims to provide an overview of hypocalcemia in critical care settings. This includes its association with important clinical outcomes and the assessment of the need for its correction in critically ill patients in general and in two subgroups: those with trauma and sepsis.</div></div><div><h3>Methods</h3><div>An extensive article search on hypocalcemia in critically ill patients was performed using PubMed, Web of Science, Cochrane Library, and Google Scholar.</div></div><div><h3>Findings</h3><div>Several studies showed an association between hypocalcemia and high mortality and disease severity in critically ill patients. However, the scientific evidence concerning its correction remains conflicting. Most studies showed that calcium supplementation did not improve clinical outcomes, such as mortality, and in some cases, ionized calcium levels normalized without supplementation. Patients with trauma and sepsis are subgroups, with special characteristics that should be considered when treating hypocalcemia.</div></div><div><h3>Conclusions</h3><div>We concluded that hypocalcemia is associated with several important clinical outcomes. Treating severe hypocalcemia is generally recommended, whereas treating moderate or mild hypocalcemia can lead to higher mortality and organ dysfunction, outweighing the potential clinical benefits, particularly in patients with sepsis. Hence, multicenter clinical trials are needed to assess the efficacy and safety of hypocalcemia treatment in these patients.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 6","pages":"Article 101438"},"PeriodicalIF":3.7,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-11DOI: 10.1016/j.accpm.2024.101441
Jiayue Xu , Qiao He , Mingqi Wang , Zichen Wang , Wenkai Wu , Li Lingling , Wen Wang , Xin Sun
Background
Sedation strategies have not been well established for patients being treated with invasive mechanical ventilation (MV). This study aimed to compare the potential effects of alternative sedation strategies – including early deep-to-light sedation (DTLS), continuous deep sedation (CDS) and continuous light sedation (CLS, the currently recommended strategy) – on ventilator, intensive care unit (ICU) or hospital mortality.
Methods
A cohort study was conducted using two large validated ICU databases, including the Registry of Healthcare-associated Infections in ICUs in China (ICU-HAI) and the Medical Information Mart for Intensive Care (MIMIC). Patients who received MV for more than 3 days with one of three sedation strategies were included. Multivariable survival analyses with inverse probability-weighted competing risk models were conducted separately for ICU-HAI and MIMIC cohorts. Adjusted estimates were pooled using fixed-effects models.
Results
In total, 6700 patients (2627 ICU-HAI, 4073 MIMIC) were included in the cohort study, of whom 2689 received CLS, 2079 CDS and 1932 DTLS. Compared to CLS, DTLS was associated with lower ICU mortality (9.3% vs. 11.0%; pooled adjusted HR 0.78, 95% CI 0.66−0.94) and hospital mortality (16.0% vs. 14.1%; 0.86, CI 0.74–1.00); and CDS was associated with higher ventilator mortality (32.8% vs. 7.0%; 4.65, 3.91–5.53), ICU mortality (40.6% vs. 11.0%; 3.39, 2.95–3.90) and hospital mortality (46.8% vs. 14.1%; 3.27, 2.89–3.71) than CLS. All HRs were qualitatively consistent in both cohorts.
Conclusions
Compared to the continuous light sedation, early deep-to-light sedation strategy was associated with improved patient outcomes, and continuous deep sedation was confirmed with poorer patient outcomes.
{"title":"Early deep-to-light sedation versus continuous light sedation for ICU patients with mechanical ventilation: A cohort study","authors":"Jiayue Xu , Qiao He , Mingqi Wang , Zichen Wang , Wenkai Wu , Li Lingling , Wen Wang , Xin Sun","doi":"10.1016/j.accpm.2024.101441","DOIUrl":"10.1016/j.accpm.2024.101441","url":null,"abstract":"<div><h3>Background</h3><div>Sedation strategies have not been well established for patients being treated with invasive mechanical ventilation (MV). This study aimed to compare the potential effects of alternative sedation strategies – including early deep-to-light sedation (DTLS), continuous deep sedation (CDS) and continuous light sedation (CLS, the currently recommended strategy) – on ventilator, intensive care unit (ICU) or hospital mortality.</div></div><div><h3>Methods</h3><div>A cohort study was conducted using two large validated ICU databases, including the Registry of Healthcare-associated Infections in ICUs in China (ICU-HAI) and the Medical Information Mart for Intensive Care (MIMIC). Patients who received MV for more than 3 days with one of three sedation strategies were included. Multivariable survival analyses with inverse probability-weighted competing risk models were conducted separately for ICU-HAI and MIMIC cohorts. Adjusted estimates were pooled using fixed-effects models.</div></div><div><h3>Results</h3><div>In total, 6700 patients (2627 ICU-HAI, 4073 MIMIC) were included in the cohort study, of whom 2689 received CLS, 2079 CDS and 1932 DTLS. Compared to CLS, DTLS was associated with lower ICU mortality (9.3% <em>vs.</em> 11.0%; pooled adjusted HR 0.78, 95% CI 0.66−0.94) and hospital mortality (16.0% <em>vs.</em> 14.1%; 0.86, CI 0.74–1.00); and CDS was associated with higher ventilator mortality (32.8% <em>vs.</em> 7.0%; 4.65, 3.91–5.53), ICU mortality (40.6% <em>vs.</em> 11.0%; 3.39, 2.95–3.90) and hospital mortality (46.8% <em>vs.</em> 14.1%; 3.27, 2.89–3.71) than CLS. All HRs were qualitatively consistent in both cohorts.</div></div><div><h3>Conclusions</h3><div>Compared to the continuous light sedation, early deep-to-light sedation strategy was associated with improved patient outcomes, and continuous deep sedation was confirmed with poorer patient outcomes.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 6","pages":"Article 101441"},"PeriodicalIF":3.7,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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