Pub Date : 2024-03-11DOI: 10.1016/j.accpm.2024.101369
Xueying Tan , Jieying Tan
{"title":"Comment on Effect of continuous infusion of hypertonic saline solution on survival of patients with brain injury: a systematic review and meta-analysis","authors":"Xueying Tan , Jieying Tan","doi":"10.1016/j.accpm.2024.101369","DOIUrl":"10.1016/j.accpm.2024.101369","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 3","pages":"Article 101369"},"PeriodicalIF":5.5,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140102680","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 : 2024-03-08DOI: 10.1016/j.accpm.2024.101364
Lu Wang , Xudong Ma , Yehan Qiu , Yujie Chen , Sifa Gao , Huaiwu He , Longxiang Su , Shabai Dai , Yanhong Guo , Wenhu Wang , Guangliang Shan , Yaoda Hu , Dawei Liu , Zhi Yin , Chang Yin , Xiang Zhou , on behalf of China National Critical Care Quality Control Centre Group (China-NCCQC)
Background
Hospitals with higher septic shock case volume demonstrated lower hospital mortality. We conducted this study to investigate whether this phenomenon was only caused by the increase in the number of admissions or the need to improve the medical care capacity in septic shock at the same time.
Methods
Seven-hundred and eighty-seven hospitals from China collected in a survey from January 1, 2021 to December 31, 2021. Medical care capacity for septic shock was explored by patients with septic shock in intensive care units (ICU) divided into beds, intensivists, and nurses respectively.
Main results
The proportion of ICU patients with septic shock was negatively associated with the patient mortality of septic shock (Estimate [95%CI], −0.2532 [-0.5038, -0.0026]) (p-value 0.048). The ratios of patients with septic shock to beds, intensivists, and nurses were negatively associated with mortality of septic shock (Estimate [95%CI], −0.370 [−0.591, −0.150], −0.136 [−0.241, −0.031], and −0.774 [−1.158, −0.389]) (p-value 0.001, 0.011 and < 0.001). Severe pneumonia, the most common infection that caused a septic shock, correlated positively with its mortality (Estimate [95%CI], 0.1002 [0.0617, 0.1387]) (p-value < 0.001).
Conclusions
Hospitals with higher medical care capacity for septic shock were associated with lower hospital mortality.
{"title":"Association of medical care capacity and the patient mortality of septic shock: a cross-sectional study","authors":"Lu Wang , Xudong Ma , Yehan Qiu , Yujie Chen , Sifa Gao , Huaiwu He , Longxiang Su , Shabai Dai , Yanhong Guo , Wenhu Wang , Guangliang Shan , Yaoda Hu , Dawei Liu , Zhi Yin , Chang Yin , Xiang Zhou , on behalf of China National Critical Care Quality Control Centre Group (China-NCCQC)","doi":"10.1016/j.accpm.2024.101364","DOIUrl":"10.1016/j.accpm.2024.101364","url":null,"abstract":"<div><h3>Background</h3><p>Hospitals with higher septic shock case volume demonstrated lower hospital mortality. We conducted this study to investigate whether this phenomenon was only caused by the increase in the number of admissions or the need to improve the medical care capacity in septic shock at the same time.</p></div><div><h3>Methods</h3><p>Seven-hundred and eighty-seven hospitals from China collected in a survey from January 1, 2021 to December 31, 2021. Medical care capacity for septic shock was explored by patients with septic shock in intensive care units (ICU) divided into beds, intensivists, and nurses respectively.</p></div><div><h3>Main results</h3><p>The proportion of ICU patients with septic shock was negatively associated with the patient mortality of septic shock (Estimate [95%CI], −0.2532 [-0.5038, -0.0026]) (<em>p</em>-value 0.048). The ratios of patients with septic shock to beds, intensivists, and nurses were negatively associated with mortality of septic shock (Estimate [95%CI], −0.370 [−0.591, −0.150], −0.136 [−0.241, −0.031], and −0.774 [−1.158, −0.389]) (<em>p</em>-value 0.001, 0.011 and < 0.001). Severe pneumonia, the most common infection that caused a septic shock, correlated positively with its mortality (Estimate [95%CI], 0.1002 [0.0617, 0.1387]) (<em>p</em>-value < 0.001).</p></div><div><h3>Conclusions</h3><p>Hospitals with higher medical care capacity for septic shock were associated with lower hospital mortality.</p></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 3","pages":"Article 101364"},"PeriodicalIF":5.5,"publicationDate":"2024-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140068826","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 : 2024-03-08DOI: 10.1016/j.accpm.2024.101370
Pierre-Gregoire Guinot , Dan Longrois , Stefan Andrei , Maxime Nguyen , Belaid Bouhemad , CodOrea study group
Background
In the intensive care unit (ICU) patients, fluid overload and congestion are associated with worse outcomes. Because of the heterogeneity of ICU patients, we hypothesized that there may exist different endotypes of congestion. The aim of this study was to identify endotypes of congestion and their association with outcomes.
Methods
We conducted an unsupervised hierarchical clustering analysis on 145 patients admitted to ICU to identify endotypes. We measured several parameters related to clinical context, volume status, filling pressure, and venous congestion. These parameters included NT-proBNP, central venous pressure (CVP), the mitral E/e' ratio, the systolic/diastolic ratio of hepatic veins' flow velocity, the mean diameter of the inferior vena cava (IVC) and its variations, stroke volume changes following passive leg raising, the portal vein pulsatility index, and the venous renal impedance index.
Results
Three distinct endotypes were identified: (1) “hemodynamic congestion” endotype (n = 75) with moderate alterations of ventricular function, increased CVP and left filling pressure values, and moderate fluid overload; (2) “volume overload congestion” endotype (n = 50); with normal cardiac function and filling pressure despite high positive fluid balance (fluid overload); (3) “systemic congestion” endotype (n = 20) with severe alterations of left and right ventricular functions, increased CVP and left ventricular filling pressure values. These endotypes vary significantly in ICU admission reasons, acute kidney injury rates, mortality, and length of ICU/hospital stay.
Conclusions
Our analysis revealed three unique congestion endotypes in ICU patients, each with distinct pathophysiological features and outcomes. These endotypes are identifiable through key ultrasonographic characteristics at the bedside.
{"title":"Exploring congestion endotypes and their distinct clinical outcomes among ICU patients: A post-hoc analysis","authors":"Pierre-Gregoire Guinot , Dan Longrois , Stefan Andrei , Maxime Nguyen , Belaid Bouhemad , CodOrea study group","doi":"10.1016/j.accpm.2024.101370","DOIUrl":"10.1016/j.accpm.2024.101370","url":null,"abstract":"<div><h3>Background</h3><p>In the intensive care unit (ICU) patients, fluid overload and congestion are associated with worse outcomes. Because of the heterogeneity of ICU patients, we hypothesized that there may exist different endotypes of congestion. The aim of this study was to identify endotypes of congestion and their association with outcomes.</p></div><div><h3>Methods</h3><p>We conducted an unsupervised hierarchical clustering analysis on 145 patients admitted to ICU to identify endotypes. We measured several parameters related to clinical context, volume status, filling pressure, and venous congestion. These parameters included NT-proBNP, central venous pressure (CVP), the mitral E/e' ratio, the systolic/diastolic ratio of hepatic veins' flow velocity, the mean diameter of the inferior vena cava (IVC) and its variations, stroke volume changes following passive leg raising, the portal vein pulsatility index, and the venous renal impedance index.</p></div><div><h3>Results</h3><p>Three distinct endotypes were identified: (1) “hemodynamic congestion” endotype (n = 75) with moderate alterations of ventricular function, increased CVP and left filling pressure values, and moderate fluid overload; (2) “volume overload congestion” endotype (n = 50); with normal cardiac function and filling pressure despite high positive fluid balance (fluid overload); (3) “systemic congestion” endotype (n = 20) with severe alterations of left and right ventricular functions, increased CVP and left ventricular filling pressure values. These endotypes vary significantly in ICU admission reasons, acute kidney injury rates, mortality, and length of ICU/hospital stay.</p></div><div><h3>Conclusions</h3><p>Our analysis revealed three unique congestion endotypes in ICU patients, each with distinct pathophysiological features and outcomes. These endotypes are identifiable through key ultrasonographic characteristics at the bedside.</p></div><div><h3>Clinical trial gov</h3><p>NCT04680728.</p></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 3","pages":"Article 101370"},"PeriodicalIF":5.5,"publicationDate":"2024-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140094900","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 : 2024-03-07DOI: 10.1016/j.accpm.2024.101367
Vladimir L. Cousin , Raphael Joye , Tornike Sologashvili , Julie Wacker , Angelo Polito
{"title":"Nosocomial infections after cardiac surgery in children from low- to middle- income countries operated in West-Switzerland","authors":"Vladimir L. Cousin , Raphael Joye , Tornike Sologashvili , Julie Wacker , Angelo Polito","doi":"10.1016/j.accpm.2024.101367","DOIUrl":"10.1016/j.accpm.2024.101367","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 3","pages":"Article 101367"},"PeriodicalIF":5.5,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140068827","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 : 2024-03-07DOI: 10.1016/j.accpm.2024.101368
Jiwon Han , Ah-Young Oh , Jung-Won Hwang , Sun Woo Nam
Background
Deep neuromuscular blockade (NMB) has benefits in various surgical procedures, however, precise quantitative neuromuscular monitoring is crucial for its proper maintenance and recovery. Neuromuscular blocking agent dosage relies on actual body weight (ABW), but this varies among individuals. Therefore, this study hypothesizes that there is a correlation between the rocuronium requirement for deep NMB and muscle mass ratio measured by bioelectric impedance analysis.
Methods
Ninety adult female patients undergoing laparoscopic operation were enrolled in this study. Muscle and fat masses were assessed using a body composition analyser. Deep NMB, defined as a post-tetanic count of 1–2, was maintained through the continuous infusion of rocuronium. The primary outcome involves determining the correlation between the rocuronium dose required for deep NMB and the muscle mass ratio. Conversely, secondary outcomes included assessing the relationship between the rocuronium dose for deep NMB and fat mass ratio, and ABW. Additionally, we investigated their relationship with rocuronium onset time and profound blockade duration.
Results
No relationship was observed between the muscle mass ratio and rocuronium dose required for maintaining deep NMB (r = 0.059 [95% CI = 0.153–0.267], p = 0.586). Fat mass ratio and ABW showed no correlation with the rocuronium dose, whereas rocuronium onset time was positively correlated with muscle mass ratio (r = 0.327) and negatively correlated with fat mass ratio (r = −0.302), respectively. Profound blockade duration showed no correlation with any of the assessed variables.
Conclusions
No correlation was detected between muscle mass ratio and the rocuronium dose required to achieve deep NMB.
{"title":"Relationship between muscle mass ratio and rocuronium dose required for maintaining deep neuromuscular blockade: A prospective observational study","authors":"Jiwon Han , Ah-Young Oh , Jung-Won Hwang , Sun Woo Nam","doi":"10.1016/j.accpm.2024.101368","DOIUrl":"10.1016/j.accpm.2024.101368","url":null,"abstract":"<div><h3>Background</h3><p>Deep neuromuscular blockade (NMB) has benefits in various surgical procedures, however, precise quantitative neuromuscular monitoring is crucial for its proper maintenance and recovery. Neuromuscular blocking agent dosage relies on actual body weight (ABW), but this varies among individuals. Therefore, this study hypothesizes that there is a correlation between the rocuronium requirement for deep NMB and muscle mass ratio measured by bioelectric impedance analysis.</p></div><div><h3>Methods</h3><p>Ninety adult female patients undergoing laparoscopic operation were enrolled in this study. Muscle and fat masses were assessed using a body composition analyser. Deep NMB, defined as a post-tetanic count of 1–2, was maintained through the continuous infusion of rocuronium. The primary outcome involves determining the correlation between the rocuronium dose required for deep NMB and the muscle mass ratio. Conversely, secondary outcomes included assessing the relationship between the rocuronium dose for deep NMB and fat mass ratio, and ABW. Additionally, we investigated their relationship with rocuronium onset time and profound blockade duration.</p></div><div><h3>Results</h3><p>No relationship was observed between the muscle mass ratio and rocuronium dose required for maintaining deep NMB (r = 0.059 [95% CI = 0.153–0.267], <em>p</em> = 0.586). Fat mass ratio and ABW showed no correlation with the rocuronium dose, whereas rocuronium onset time was positively correlated with muscle mass ratio (r = 0.327) and negatively correlated with fat mass ratio (r = −0.302), respectively. Profound blockade duration showed no correlation with any of the assessed variables.</p></div><div><h3>Conclusions</h3><p>No correlation was detected between muscle mass ratio and the rocuronium dose required to achieve deep NMB.</p></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 3","pages":"Article 101368"},"PeriodicalIF":5.5,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140068828","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 : 2024-03-07DOI: 10.1016/j.accpm.2024.101365
Britta S. von Ungern-Sternberg , Aine Sommerfield , David Sommerfield , Thomas Engelhardt , Graham Wilson
{"title":"The effect of the COVID-19 pandemic on paediatric anaesthesia research as evidenced by the contrasting recruitment experiences of centres in Australia and Scotland","authors":"Britta S. von Ungern-Sternberg , Aine Sommerfield , David Sommerfield , Thomas Engelhardt , Graham Wilson","doi":"10.1016/j.accpm.2024.101365","DOIUrl":"10.1016/j.accpm.2024.101365","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 3","pages":"Article 101365"},"PeriodicalIF":5.5,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140068830","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}
Ventilator-associated events (VAE) is a tier implemented for surveillance by the CDC in the USA. Implementation usefulness for clinical decisions is unknown.
Methods
We conducted a secondary analysis from a prospective, multicentre, international study, to assess the impact on outcomes of using tiers with shorter follow-up (VAE24), lower oxygenation requirements (light-VAE) or both (light VAE24).
Results
A cohort of 261 adults with 2706 ventilator-days were included. The median (IQR) duration of mechanical ventilation (MV) was 9 days (5–21), and the median (IQR) length of stay in the intensive care unit (ICU) was 14 days (8–26). A VAE tier was associated with a trend to increase from 32% to 44% in the ICU mortality rates. VAE Incidence was 24 per 1,000 ventilator-days, being increased when reduced the oxygenation settings requirement (35 per 1,000 ventilator-days), follow-up (41 per 1,000 ventilator-days) or both (55 per 1,000 ventilator-days). A VAE tier was associated with 13 extra (21 vs. 8) days of ventilation, 11 (23 vs. 12) ICU days and 7 (31 vs. 14) hospitalization days, outperforming the modified tiers’ performance.
Conclusions
The modification of ventilator settings (consistent with ventilator-associated events) was associated with worse outcomes among adults with prolonged mechanical ventilation. Monitoring ventilator-associated events at the bedside represents a new tool for quality improvement.
{"title":"Ventilator-associated events in adults: A secondary analysis assessing the impact of monitoring ventilator settings on outcomes","authors":"Sergio Ramírez-Estrada , Yolanda Peña-López , Marta Serrano-Megías , Jordi Rello","doi":"10.1016/j.accpm.2024.101363","DOIUrl":"10.1016/j.accpm.2024.101363","url":null,"abstract":"<div><h3>Background</h3><p>Ventilator-associated events (VAE) is a tier implemented for surveillance by the CDC in the USA. Implementation usefulness for clinical decisions is unknown.</p></div><div><h3>Methods</h3><p>We conducted a secondary analysis from a prospective, multicentre, international study, to assess the impact on outcomes of using tiers with shorter follow-up (VAE24), lower oxygenation requirements (light-VAE) or both (light VAE24).</p></div><div><h3>Results</h3><p>A cohort of 261 adults with 2706 ventilator-days were included. The median (IQR) duration of mechanical ventilation (MV) was 9 days (5–21), and the median (IQR) length of stay in the intensive care unit (ICU) was 14 days (8–26). A VAE tier was associated with a trend to increase from 32% to 44% in the ICU mortality rates. VAE Incidence was 24 per 1,000 ventilator-days, being increased when reduced the oxygenation settings requirement (35 per 1,000 ventilator-days), follow-up (41 per 1,000 ventilator-days) or both (55 per 1,000 ventilator-days). A VAE tier was associated with 13 extra (21 <em>vs</em>. 8) days of ventilation, 11 (23 <em>vs.</em> 12) ICU days and 7 (31 <em>vs.</em> 14) hospitalization days, outperforming the modified tiers’ performance.</p></div><div><h3>Conclusions</h3><p>The modification of ventilator settings (consistent with ventilator-associated events) was associated with worse outcomes among adults with prolonged mechanical ventilation. Monitoring ventilator-associated events at the bedside represents a new tool for quality improvement.</p></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 3","pages":"Article 101363"},"PeriodicalIF":5.5,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140023071","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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