Anaesthesia Critical Care & Pain Medicine最新文献

Objective: To provide guidelines for guidelines on adult patient intubation in emergency settings outside the operating room and intensive care unit.

Design: A consensus committee of 24 experts from the French Society of Anaesthesia and Intensive Care Medicine (Société Française d'Anesthésie et de Réanimation, SFAR) and the French Society of Emergency Medicine (Société Française de Médecine d'Urgence, SFMU) was convened. A formal conflict-of-interest (COI) policy was developed at the beginning of the process and enforced throughout. The entire guideline construction process was conducted independently of any industrial funding (i.e., pharmaceutical, medical devices). The authors were required to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide the assessment of the quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised.

Methods: The aim of these expert panel guidelines is to evaluate adult patient intubation in emergency settings outside the operating room and intensive care unit. The experts studied questions within 5 domains. Each question was formulated according to the PICO (Patients Intervention Comparison Outcome) model, and the evidence profiles were produced. An extensive literature review and recommendations were carried out and analysed according to the GRADE® methodology.

Results: The experts' synthesis and the application of the GRADE® method yielded 32 recommendations for adult patient intubation in emergency settings outside the operating room and intensive care unit. Among the formalised recommendations, 5 have high levels of evidence (GRADE 1), and 12 have low levels of evidence (GRADE 2). For 15 recommendations, the GRADE method could not be applied, resulting in expert opinions. 4 questions did not find any response in the literature. After 4 rounds of scoring and amendment, strong agreement was reached for all the recommendations.

Conclusions: There was strong agreement among experts for 36 recommendations to improve practices for adult patient intubation in emergency settings outside the operating room and intensive care unit.

Background: The incidence of postoperative pulmonary complications (PPCs⁵) following abdominal surgery varies across surgical specialties. It remains unclear to what extent the incidence of PPCs is attributable to known patient-related factors and anaesthesia duration, rather than to differences inherent to the surgical specialty itself.

Methods: Post-hoc analysis of an observational study describing postoperative outcomes in patients undergoing urological, gastrointestinal, and gynaecological abdominal surgery. The primary endpoint was a composite measure of PPCs. Secondary endpoints included the individual incidence of each PPC. Propensity score weighting was used to create a cohort with similar patient characteristics and anaesthesia duration.

Results: The cohort consisted of 3306 patients across 146 centres in 29 countries-367 underwent urological surgery, 2100 underwent gastrointestinal surgery, and 839 underwent gynaecological surgery. Risk scores for PPCs were highest in urological surgical patients, followed by gastrointestinal and gynaecological surgical patients. PPCs also occurred most often after urological surgery (17.7%), followed by gastrointestinal (14.9%) and gynaecological surgery (9.8%) (p < 0.001). After weighting, these differences in incidence disappeared, with comparable rates across the three groups (urological surgery 15.7%, gastrointestinal 14.5%, gynaecological 12.2%; p = 0.340). Apart from unplanned supplementary oxygen, all PPCs were most frequent after gastrointestinal surgery and least common following gynaecological surgery.

Conclusions: In this worldwide cohort of patients undergoing abdominal surgery, the incidence of PPCs varied across urological, gastrointestinal, and gynaecological surgery; the differences in incidence may be more strongly influenced by patient-related factors and anaesthesia duration than by the characteristics of the surgical specialty itself. Gastrointestinal surgeries showed the highest rates of severe PPCs.