Backgrounds: Early mobilization (EM) is vital for critically ill patients, yet various barriers hinder its implementation in daily critical care practice. This study aimed to explore the impact of multidisciplinary rounds (MDR) on the initiation of EM.
Methods: We conducted a retrospective, process-focused observational study in the medical/surgical intensive care unit (ICU) of a tertiary university medical center in Tokyo, Japan, including 301 patients who received physical therapy (PT) during their ICU stay. MDR implementation commenced in October 2016, followed by a year-long initiative to enhance awareness about the importance of EM. Patients admitted between April 2015 and September 2016 were categorized into the pre-MDR group (Phase 1, n = 110), while those admitted from October 2017 to March 2019 formed the post-MDR group (Phase 2, n = 191).
Results: EM practice was significantly increased in Phase 2, compared to Phase 1 (39.8% vs. 20.9%; p = 0.001), particularly among mechanically ventilated patients (33.8% vs. 9.3%; p < 0.001). The median time from ICU admission to PT initiation was significantly reduced in Phase 2 (3.0 vs. 6.0 days, p < 0.001). Additionally, PT consultations significantly increased from 9.2% to 16.5% (X2 = 27.75, p < 0.001). MDR was associated with an 84% higher likelihood of initiating EM (adjusted relative risk 1.84, 95% CI 1.30-2.61).
Conclusions: MDR played a pivotal role in enhancing the initiation of EM for ICU patients, highlighting its significance in overcoming barriers to EM.
{"title":"Enhancing early mobilization in critically ill patients through multidisciplinary rounds: A process-focused observational study.","authors":"Nobuhiro Shiota, Nobuyuki Nosaka, Nobutoshi Nawa, Takeo Fujiwara, Hidenobu Shigemitsu, Kenji Wakabayashi","doi":"10.1016/j.accpm.2025.101485","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101485","url":null,"abstract":"<p><strong>Backgrounds: </strong>Early mobilization (EM) is vital for critically ill patients, yet various barriers hinder its implementation in daily critical care practice. This study aimed to explore the impact of multidisciplinary rounds (MDR) on the initiation of EM.</p><p><strong>Methods: </strong>We conducted a retrospective, process-focused observational study in the medical/surgical intensive care unit (ICU) of a tertiary university medical center in Tokyo, Japan, including 301 patients who received physical therapy (PT) during their ICU stay. MDR implementation commenced in October 2016, followed by a year-long initiative to enhance awareness about the importance of EM. Patients admitted between April 2015 and September 2016 were categorized into the pre-MDR group (Phase 1, n = 110), while those admitted from October 2017 to March 2019 formed the post-MDR group (Phase 2, n = 191).</p><p><strong>Results: </strong>EM practice was significantly increased in Phase 2, compared to Phase 1 (39.8% vs. 20.9%; p = 0.001), particularly among mechanically ventilated patients (33.8% vs. 9.3%; p < 0.001). The median time from ICU admission to PT initiation was significantly reduced in Phase 2 (3.0 vs. 6.0 days, p < 0.001). Additionally, PT consultations significantly increased from 9.2% to 16.5% (X<sup>2</sup> = 27.75, p < 0.001). MDR was associated with an 84% higher likelihood of initiating EM (adjusted relative risk 1.84, 95% CI 1.30-2.61).</p><p><strong>Conclusions: </strong>MDR played a pivotal role in enhancing the initiation of EM for ICU patients, highlighting its significance in overcoming barriers to EM.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101485"},"PeriodicalIF":3.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075957","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 : 2025-01-30DOI: 10.1016/j.accpm.2025.101486
Diogo Lopes , João Pedro Bandovas , Beatriz Chumbinho , Catarina Espírito Santo , Mónica Sousa , Bernardo Ferreira , Luis Val-Flores , Nuno Germano , Rui Pereira , Filipe S. Cardoso , Luís Bento , Pedro Póvoa
Background
Pancreatic Stone Protein (PSP) seems to have higher accuracy for sepsis detection compared to other biomarkers. As PSP has never been studied in patients with liver failure (LF), our purpose was to assess its accuracy for diagnosis of infection and prognosis in this population.
Methods
We conducted a prospective pilot cohort study on patients with LF consecutively admitted to the Intensive Care Unit of a liver transplant center in 2021−2023. Ongoing overt infection was an exclusion criterion. Daily measurements of biomarkers were performed until discharge, death, or for 21 days. Analysis was performed by adjusting the baseline for the first infection episode (median on D3), which was the reference for those non-infected.
Results
Sixteen patients were included, 7 with acute and 9 with acute-on-chronic LF. Median age was 54 (interquartile range 42−64) years, half were female, with admission SOFA score of 10 (IQR 8−12). Hospital mortality was 43.8% (n = 7). An infection was observed in 8 patients, who presented non-significantly higher levels of PSP than non-infected ones during follow-up. Levels were higher in non-survivors than survivors (p < 0.05 from D4 on and since the day of infection considering only infected patients). Similarly, patients under renal replacement therapy had higher PSP levels than others (p < 0.05, D2 to D7 after admission).
Conclusion
This pilot study provides early insights into PSP kinetics, suggesting a potential role for prognosis in patients with LF. PSP rises in both ALF and ACLF to levels sustainably higher than those expected for healthy adults. Further research is needed to reassess its diagnostic accuracy for infection and redefine cut-offs in this population.
{"title":"Pancreatic Stone Protein in patients with liver failure: A prospective pilot cohort study","authors":"Diogo Lopes , João Pedro Bandovas , Beatriz Chumbinho , Catarina Espírito Santo , Mónica Sousa , Bernardo Ferreira , Luis Val-Flores , Nuno Germano , Rui Pereira , Filipe S. Cardoso , Luís Bento , Pedro Póvoa","doi":"10.1016/j.accpm.2025.101486","DOIUrl":"10.1016/j.accpm.2025.101486","url":null,"abstract":"<div><h3>Background</h3><div>Pancreatic Stone Protein (PSP) seems to have higher accuracy for sepsis detection compared to other biomarkers. As PSP has never been studied in patients with liver failure (LF), our purpose was to assess its accuracy for diagnosis of infection and prognosis in this population.</div></div><div><h3>Methods</h3><div>We conducted a prospective pilot cohort study on patients with LF consecutively admitted to the Intensive Care Unit of a liver transplant center in 2021−2023. Ongoing overt infection was an exclusion criterion. Daily measurements of biomarkers were performed until discharge, death, or for 21 days. Analysis was performed by adjusting the baseline for the first infection episode (median on D3), which was the reference for those non-infected.</div></div><div><h3>Results</h3><div>Sixteen patients were included, 7 with acute and 9 with acute-on-chronic LF. Median age was 54 (interquartile range 42−64) years, half were female, with admission SOFA score of 10 (IQR 8−12). Hospital mortality was 43.8% (n = 7). An infection was observed in 8 patients, who presented non-significantly higher levels of PSP than non-infected ones during follow-up. Levels were higher in non-survivors than survivors (<em>p</em> < 0.05 from D4 on and since the day of infection considering only infected patients). Similarly, patients under renal replacement therapy had higher PSP levels than others (<em>p</em> < 0.05, D2 to D7 after admission).</div></div><div><h3>Conclusion</h3><div>This pilot study provides early insights into PSP kinetics, suggesting a potential role for prognosis in patients with LF. PSP rises in both ALF and ACLF to levels sustainably higher than those expected for healthy adults. Further research is needed to reassess its diagnostic accuracy for infection and redefine cut-offs in this population.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 2","pages":"Article 101486"},"PeriodicalIF":3.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075974","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 : 2025-01-23DOI: 10.1016/j.accpm.2025.101484
Peiying Huang , Lichao Di , Sichen Cui , Xueji Wang , Tianyu Cao , Sufang Jiang , Lining Huang
Background
Research links gut microbiota to postoperative delirium (POD) through the gut-brain axis. However, changes in gut microbiota and fecal short-chain fatty acids (SCFAs) in POD patients during the perioperative period and their association with POD are unclear.
Methods
We conducted a nested case-control study among patients undergoing off-pump coronary artery bypass grafting, focusing on POD as the main outcome. POD patients were matched 1:1 with non-POD patients based on sociodemographic characteristics, health, and diet. Fecal samples were collected pre- and post-surgery to assess gut microbiota and SCFAs changes. Postoperative fecal samples were transplanted into antibiotic-treated mice to evaluate delirium-like behavior and neuroinflammation.
Results
Out of 120 patients, 60 were matched. Before surgery, gut microbiota in both groups was similar. After surgery, POD patients had lower alpha diversity and distinct microbiota compared to non-POD patients. LEfSe analysis showed POD was linked to increased opportunistic pathogens (Enterococcus) and decreased SCFAs producers (Bacteroides, Ruminococcus, etc.). SCFAs were significantly reduced in POD patients and negatively correlated with delirium severity and plasma inflammation. Mice receiving fecal transplants from POD patients exhibited delirium-like behavior and neuroinflammation.
Conclusions
Postoperative delirium is associated with gut microbiota dysbiosis, marked by an increase in opportunistic pathogens and a decrease in SCFA-producing genera.
Registration
Chinese Clinical Trial Registry ChiCTR2300070477.
{"title":"Postoperative delirium after cardiac surgery associated with perioperative gut microbiota dysbiosis: Evidence from human and antibiotic-treated mouse model","authors":"Peiying Huang , Lichao Di , Sichen Cui , Xueji Wang , Tianyu Cao , Sufang Jiang , Lining Huang","doi":"10.1016/j.accpm.2025.101484","DOIUrl":"10.1016/j.accpm.2025.101484","url":null,"abstract":"<div><h3>Background</h3><div>Research links gut microbiota to postoperative delirium (POD) through the gut-brain axis. However, changes in gut microbiota and fecal short-chain fatty acids (SCFAs) in POD patients during the perioperative period and their association with POD are unclear.</div></div><div><h3>Methods</h3><div>We conducted a nested case-control study among patients undergoing off-pump coronary artery bypass grafting, focusing on POD as the main outcome. POD patients were matched 1:1 with non-POD patients based on sociodemographic characteristics, health, and diet. Fecal samples were collected pre- and post-surgery to assess gut microbiota and SCFAs changes. Postoperative fecal samples were transplanted into antibiotic-treated mice to evaluate delirium-like behavior and neuroinflammation.</div></div><div><h3>Results</h3><div>Out of 120 patients, 60 were matched. Before surgery, gut microbiota in both groups was similar. After surgery, POD patients had lower alpha diversity and distinct microbiota compared to non-POD patients. LEfSe analysis showed POD was linked to increased opportunistic pathogens (<em>Enterococcus</em>) and decreased SCFAs producers <em>(Bacteroides, Ruminococcus</em>, etc.). SCFAs were significantly reduced in POD patients and negatively correlated with delirium severity and plasma inflammation. Mice receiving fecal transplants from POD patients exhibited delirium-like behavior and neuroinflammation.</div></div><div><h3>Conclusions</h3><div>Postoperative delirium is associated with gut microbiota dysbiosis, marked by an increase in opportunistic pathogens and a decrease in SCFA-producing genera.</div></div><div><h3>Registration</h3><div>Chinese Clinical Trial Registry ChiCTR2300070477.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 2","pages":"Article 101484"},"PeriodicalIF":3.7,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042641","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 : 2025-01-23DOI: 10.1016/j.accpm.2025.101483
Joe Zako , Nicolas Daccache , Louis Morisson , Philippe Richebé , Pascal Laferrière-Langlois
Background
Pharmacological sedation and analgesia are used to alleviate discomfort during awake medical procedures but can cause adverse effects like apnea and hypoxemia, increasing the need for airway management and prolonging recovery. Virtual reality (VR) has emerged as a non-pharmacological intervention to reduce the need for procedural sedatives and analgesics.
Methods
A systematic review and meta-analysis were conducted, assessing the impact of VR immersion on intraprocedural sedation and analgesia usage in adults (≥ 18 years). We searched MEDLINE (PubMed), Embase, Cochrane CENTRAL, and Web of Science from inception to August 1st, 2024. We included analytical studies utilizing VR immersion in the intervention arm, and reporting tailored dosages of intraprocedural sedatives (propofol, midazolam) and/or opioids. Statistical analyses used standardized mean differences (SMD), and heterogeneity was assessed with I2.
Results
Of 2714 identified papers, 11 (560 patients) were included. VR significantly reduced propofol usage (SMD = −1.70; 95% CI −3.10 to −0.31; P = 0.02; I2 = 92%) and midazolam usage (SMD = −0.29; 95% CI −0.57 to 0.00; P = 0.05; I2 = 0%). However, our analysis showed no reduction in opioid usage (SMD = −0.21; 95% CI −0.60 to 0.19; P = 0.31; I2 = 74%) in the VR group.
Conclusions
VR immersion effectively reduces the required dose of intraprocedural sedatives, but its impact on opioid consumption remains unclear, especially in the absence of regional or neuraxial anesthesia. Further research is needed to clarify these effects and optimize VR use in clinical practice.
Registration
This review’s protocol was prospectively registered on PROSPERO (CRD42024569462).
{"title":"Virtual reality for reduction of intraprocedural pharmacological sedation and analgesia in adult patients: A systematic review and meta-analysis","authors":"Joe Zako , Nicolas Daccache , Louis Morisson , Philippe Richebé , Pascal Laferrière-Langlois","doi":"10.1016/j.accpm.2025.101483","DOIUrl":"10.1016/j.accpm.2025.101483","url":null,"abstract":"<div><h3>Background</h3><div>Pharmacological sedation and analgesia are used to alleviate discomfort during awake medical procedures but can cause adverse effects like apnea and hypoxemia, increasing the need for airway management and prolonging recovery. Virtual reality (VR) has emerged as a non-pharmacological intervention to reduce the need for procedural sedatives and analgesics.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis were conducted, assessing the impact of VR immersion on intraprocedural sedation and analgesia usage in adults (≥ 18 years). We searched MEDLINE (PubMed), Embase, Cochrane CENTRAL, and Web of Science from inception to August 1st, 2024. We included analytical studies utilizing VR immersion in the intervention arm, and reporting tailored dosages of intraprocedural sedatives (propofol, midazolam) and/or opioids. Statistical analyses used standardized mean differences (SMD), and heterogeneity was assessed with I<sup>2</sup>.</div></div><div><h3>Results</h3><div>Of 2714 identified papers, 11 (560 patients) were included. VR significantly reduced propofol usage (SMD = −1.70; 95% CI −3.10 to −0.31; <em>P</em> = 0.02; I<sup>2</sup> = 92%) and midazolam usage (SMD = −0.29; 95% CI −0.57 to 0.00; <em>P</em> = 0.05; I<sup>2</sup> = 0%). However, our analysis showed no reduction in opioid usage (SMD = −0.21; 95% CI −0.60 to 0.19; <em>P</em> = 0.31; I<sup>2</sup> = 74%) in the VR group.</div></div><div><h3>Conclusions</h3><div>VR immersion effectively reduces the required dose of intraprocedural sedatives, but its impact on opioid consumption remains unclear, especially in the absence of regional or neuraxial anesthesia. Further research is needed to clarify these effects and optimize VR use in clinical practice.</div></div><div><h3>Registration</h3><div>This review’s protocol was prospectively registered on PROSPERO (CRD42024569462).</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 2","pages":"Article 101483"},"PeriodicalIF":3.7,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042576","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 : 2025-01-21DOI: 10.1016/j.accpm.2025.101482
Mina Adolf Helmy, Mahmoud Mansour, Lydia Magdy Milad, Esmat Mohammed Aboelregal, Marianne Magdy Youssef
{"title":"Change in femoral artery pulsatility index as a novel predictor of post-spinal anesthesia hypotension in adult patients undergoing infra-umbilical surgeries: A prospective observational study","authors":"Mina Adolf Helmy, Mahmoud Mansour, Lydia Magdy Milad, Esmat Mohammed Aboelregal, Marianne Magdy Youssef","doi":"10.1016/j.accpm.2025.101482","DOIUrl":"10.1016/j.accpm.2025.101482","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 2","pages":"Article 101482"},"PeriodicalIF":3.7,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030192","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 : 2025-01-21DOI: 10.1016/j.accpm.2025.101481
Benjamin Deniau , Ayu Asakage , Koji Takagi , Etienne Gayat , Alexandre Mebazaa , Amina Rakisheva
Acute Heart Failure (AHF) is a leading cause of death and represents the most frequent cause of unplanned hospital admission in patients older than 65 years. Since the past decade, several randomized clinical trials have highlighted the importance and pivotal role of certain therapeutics, including decongestion by the combination of loop diuretics, the need for rapid goal-directed medical therapies implementation before discharge, risk stratification, and early follow-up after discharge therapies. Cardiogenic shock, defined as sustained hypotension with tissue hypoperfusion due to low cardiac output and congestion, is the most severe form of AHF and mainly occurs after acute myocardial infarction, which can progress to multiple organ failure. Although its prevalence is relatively low, cardiogenic shock complicates 12% of acute myocardial infarction. After a brief summary of the epidemiology of AHF and cardiogenic shock, followed by key pathophysiological points, we detailed current treatments in AHF and cardiogenic shock what every anaesthesiologist and intensivist needs to know, based on the latest guidelines and randomized clinical trials published in recent years.
{"title":"Therapeutic novelties in acute heart failure and practical perspectives","authors":"Benjamin Deniau , Ayu Asakage , Koji Takagi , Etienne Gayat , Alexandre Mebazaa , Amina Rakisheva","doi":"10.1016/j.accpm.2025.101481","DOIUrl":"10.1016/j.accpm.2025.101481","url":null,"abstract":"<div><div>Acute Heart Failure (AHF) is a leading cause of death and represents the most frequent cause of unplanned hospital admission in patients older than 65 years. Since the past decade, several randomized clinical trials have highlighted the importance and pivotal role of certain therapeutics, including decongestion by the combination of loop diuretics, the need for rapid goal-directed medical therapies implementation before discharge, risk stratification, and early follow-up after discharge therapies. Cardiogenic shock, defined as sustained hypotension with tissue hypoperfusion due to low cardiac output and congestion, is the most severe form of AHF and mainly occurs after acute myocardial infarction, which can progress to multiple organ failure. Although its prevalence is relatively low, cardiogenic shock complicates 12% of acute myocardial infarction. After a brief summary of the epidemiology of AHF and cardiogenic shock, followed by key pathophysiological points, we detailed current treatments in AHF and cardiogenic shock what every anaesthesiologist and intensivist needs to know, based on the latest guidelines and randomized clinical trials published in recent years.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 2","pages":"Article 101481"},"PeriodicalIF":3.7,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030193","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 : 2025-01-20DOI: 10.1016/j.accpm.2025.101480
Liwei Wang , Yinyin Qu , Yuanli Dun , Xiaowen Wu , Yao Yao , Kun Zhang , Changyi Wu
Background
Quadratus lumborum block (QLB) has gained traction as a regional anesthesia technique to manage postoperative pain following laparoscopic surgery. However, the 90% minimum effective concentration (MEC90) of local anesthetics for posterior QLB remains undetermined.
Methods
We conducted a double-blind, comparative dose-finding study involving 54 women scheduled for elective laparoscopic myomectomy under general anesthesia. Each patient received a bilateral posterior QLB with 20 mL of ropivacaine on each side. The concentration administered varied for each patient and was determined based on the response of the previous participant. The initial concentration was set at 0.20%. Upon successful block, the subsequent patient was assigned to receive either the same (probability of 0.89) or a 0.05% lower concentration (probability of 0.11). In cases of block failure, the concentration was increased by 0.05% for the next patient. The trial concluded when 45 successful blocks were achieved, with block success defined as a pain score of three or fewer 30 minutes after arrival in the post-anesthesia care unit.
Results
The 90% minimum effective concentration (MEC90) of ropivacaine was 0.340% (95% CI 0.329 to 0.344%).
Conclusions
The optimal concentration of ropivacaine for posterior QLB to achieve satisfactory analgesia following laparoscopic myomectomy is a 20 mL volume of 0.340% ropivacaine per side.
Registration
Chinese Clinical Trial Registry ChiCTR2200055743.
{"title":"Preoperative posterior quadratus lumborum block: determining the minimum effective ropivacaine concentration in 90% of patients (MEC90) for postoperative analgesia after laparoscopic myomectomy","authors":"Liwei Wang , Yinyin Qu , Yuanli Dun , Xiaowen Wu , Yao Yao , Kun Zhang , Changyi Wu","doi":"10.1016/j.accpm.2025.101480","DOIUrl":"10.1016/j.accpm.2025.101480","url":null,"abstract":"<div><h3>Background</h3><div>Quadratus lumborum block (QLB) has gained traction as a regional anesthesia technique to manage postoperative pain following laparoscopic surgery. However, the 90% minimum effective concentration (MEC90) of local anesthetics for posterior QLB remains undetermined.</div></div><div><h3>Methods</h3><div>We conducted a double-blind, comparative dose-finding study involving 54 women scheduled for elective laparoscopic myomectomy under general anesthesia. Each patient received a bilateral posterior QLB with 20 mL of ropivacaine on each side. The concentration administered varied for each patient and was determined based on the response of the previous participant. The initial concentration was set at 0.20%. Upon successful block, the subsequent patient was assigned to receive either the same (probability of 0.89) or a 0.05% lower concentration (probability of 0.11). In cases of block failure, the concentration was increased by 0.05% for the next patient. The trial concluded when 45 successful blocks were achieved, with block success defined as a pain score of three or fewer 30 minutes after arrival in the post-anesthesia care unit.</div></div><div><h3>Results</h3><div>The 90% minimum effective concentration (MEC90) of ropivacaine was 0.340% (95% CI 0.329 to 0.344%).</div></div><div><h3>Conclusions</h3><div>The optimal concentration of ropivacaine for posterior QLB to achieve satisfactory analgesia following laparoscopic myomectomy is a 20 mL volume of 0.340% ropivacaine per side.</div></div><div><h3>Registration</h3><div>Chinese Clinical Trial Registry ChiCTR2200055743.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 2","pages":"Article 101480"},"PeriodicalIF":3.7,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025028","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 : 2025-01-01DOI: 10.1016/j.accpm.2024.101460
Charles-Hervé Vacheron , Marlene Bras , Arnaud Friggeri , Cyril Manzon , Emmanuel Vivier , Lyon Sud Nursing Research Group , Anaelle Caillet , Florent Wallet
Background
Nurse retention is a major concern in healthcare settings, especially among intensive care units (ICU), in which nurses are highly specialized. The objective was to describe the nurse courses after their entrance into the ICU, their motivation for leaving the ICU, and to identify the independent factors that influenced the nurse resignation from their units.
Methods
In 3 different centers, every ICU nurse working between 2013 and 2023 was telephonically contacted and was asked to describe their career and, when appropriate, the reasons that influenced their resignation from their units; they rated on a Likert scale of 14 factors that influenced their decision.
Results
Among the 405 nurses who worked in these ICUs between 2013 and 2023, 265 (65.0%) were included in the study, and 93 (35.1%) were still working in their unit. The median time of professional experience of the nurses in their ICU was 5.8 [5.0–7.0] years, and at 10 years, 26.3% [20.4–33.9] of the nurses remained in their unit, 23.8% [17.3–32.8] left the ICU but were still in-hospital nurses, and 22.4% [15.8–31.7] underwent specialization. A minority of nurses resigned and changed their careers (9.5% [5.3–17.0]). The main factors influencing the nurse’s resignation from their unit were belonging to Generation Y or Z (HR 1.89 [1.35;2.64]), experiencing symptoms of burnout (2.37 [1.63;3.46]), and pregnancy during the ICU (1.77 [1.41;2.23]). The COVID-19 period was inconsistently associated with nurse resignation depending on the center. The main motivations to leave the unit were organizational (variability of schedule, night shift), personal (willingness to change, personal event), and related to the ICU workload.
Conclusion
Nurse retention is an increasing concern, associated with the generational aspects and increased prevalence of burnout. Structural changes will have to be made to reduce the turnover.
{"title":"Factors influencing the turnover of nurses in French intensive care unit—A multicenter interview survey","authors":"Charles-Hervé Vacheron , Marlene Bras , Arnaud Friggeri , Cyril Manzon , Emmanuel Vivier , Lyon Sud Nursing Research Group , Anaelle Caillet , Florent Wallet","doi":"10.1016/j.accpm.2024.101460","DOIUrl":"10.1016/j.accpm.2024.101460","url":null,"abstract":"<div><h3>Background</h3><div>Nurse retention is a major concern in healthcare settings, especially among intensive care units (ICU), in which nurses are highly specialized. The objective was to describe the nurse courses after their entrance into the ICU, their motivation for leaving the ICU, and to identify the independent factors that influenced the nurse resignation from their units.</div></div><div><h3>Methods</h3><div>In 3 different centers, every ICU nurse working between 2013 and 2023 was telephonically contacted and was asked to describe their career and, when appropriate, the reasons that influenced their resignation from their units; they rated on a Likert scale of 14 factors that influenced their decision.</div></div><div><h3>Results</h3><div>Among the 405 nurses who worked in these ICUs between 2013 and 2023, 265 (65.0%) were included in the study, and 93 (35.1%) were still working in their unit. The median time of professional experience of the nurses in their ICU was 5.8 [5.0–7.0] years, and at 10 years, 26.3% [20.4–33.9] of the nurses remained in their unit, 23.8% [17.3–32.8] left the ICU but were still in-hospital nurses, and 22.4% [15.8–31.7] underwent specialization. A minority of nurses resigned and changed their careers (9.5% [5.3–17.0]). The main factors influencing the nurse’s resignation from their unit were belonging to Generation Y or Z (HR 1.89 [1.35;2.64]), experiencing symptoms of burnout (2.37 [1.63;3.46]), and pregnancy during the ICU (1.77 [1.41;2.23]). The COVID-19 period was inconsistently associated with nurse resignation depending on the center. The main motivations to leave the unit were organizational (variability of schedule, night shift), personal (willingness to change, personal event), and related to the ICU workload.</div></div><div><h3>Conclusion</h3><div>Nurse retention is an increasing concern, associated with the generational aspects and increased prevalence of burnout. Structural changes will have to be made to reduce the turnover.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 1","pages":"Article 101460"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878323","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 : 2025-01-01DOI: 10.1016/j.accpm.2024.101457
Vincent Legros , Yannick Hourmant , Louis Genty , Karim Asehnoune , Quentin De Roux , Lucie Picard , Jean-Denis Moyer , Fanny Bounes , Martin Cailloce , Anais Adolle , Alexandre Behouche , Benjamin Bergis , Jeremy Bourenne , Cyril Cadoz , Emilie Charbit , Jonathan Charbit , Baptiste Compagnon , Charlotte Florin , Nouchan Mellati , Marie Moisan , Arthur James
Background
Indications for Veno-venous (VV) or veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) after trauma rely on poor evidence. The main aims were to describe the population of trauma patients requiring either VV or VA ECMO and report their clinical management and outcomes.
Methods
An observational multicentre retrospective study was conducted in 17 Level 1 trauma centres in France between January 2010 and December 2021. All patients admitted for major trauma were screened for inclusion, and those receiving either VV ECMO or VA ECMO were included. The primary outcome was in-hospital mortality.
Results
Among the 52,851 patients screened, 179 were included, with 143 supported by VV ECMO (median [Q1-Q3] age 32 years [24–48]; men 83.5%; injury severity score [ISS] 33 [25–43] and 76 (53.6%) with a traumatic brain injury [TBI]) and 36 supported by VA ECMO (median age 39 years [25–55]; men 88.9%; ISS 36 [25–56] and 23 (63.9%) with a TBI). In the VV ECMO group, three indications for ECMO implementation were chest injuries (n = 68, 47.6%), ventilator-associated pneumonia (VAP; n = 57, 39.9%), and extra-respiratory acute respiratory distress syndrome (ARDS; n = 57, 39.9%). In the VV ECMO group, 45.8% (n = 65) died in the hospital, with 33 (48.5%) deaths following cannulation for chest injuries, 22 (39.3%) following cannulation for VAP, and 10 (55.6%) following cannulation for extrapulmonary ARDS. In the VA ECMO group, 75.0% (n = 27) died during their hospital stay.
Conclusions
In-hospital mortality of trauma patients requiring ECMO for refractory ARDS varied according to indications. The best prognosis was observed in the subgroup of pneumonia-induced ARDS patients.
{"title":"Extracorporeal membrane oxygenation in trauma patient in France: A retrospective nationwide registry","authors":"Vincent Legros , Yannick Hourmant , Louis Genty , Karim Asehnoune , Quentin De Roux , Lucie Picard , Jean-Denis Moyer , Fanny Bounes , Martin Cailloce , Anais Adolle , Alexandre Behouche , Benjamin Bergis , Jeremy Bourenne , Cyril Cadoz , Emilie Charbit , Jonathan Charbit , Baptiste Compagnon , Charlotte Florin , Nouchan Mellati , Marie Moisan , Arthur James","doi":"10.1016/j.accpm.2024.101457","DOIUrl":"10.1016/j.accpm.2024.101457","url":null,"abstract":"<div><h3>Background</h3><div>Indications for Veno-venous (VV) or veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) after trauma rely on poor evidence. The main aims were to describe the population of trauma patients requiring either VV or VA ECMO and report their clinical management and outcomes.</div></div><div><h3>Methods</h3><div>An observational multicentre retrospective study was conducted in 17 Level 1 trauma centres in France between January 2010 and December 2021. All patients admitted for major trauma were screened for inclusion, and those receiving either VV ECMO or VA ECMO were included. The primary outcome was in-hospital mortality.</div></div><div><h3>Results</h3><div>Among the 52,851 patients screened, 179 were included, with 143 supported by VV ECMO (median [Q1-Q3] age 32 years [24–48]; men 83.5%; injury severity score [ISS] 33 [25–43] and 76 (53.6%) with a traumatic brain injury [TBI]) and 36 supported by VA ECMO (median age 39 years [25–55]; men 88.9%; ISS 36 [25–56] and 23 (63.9%) with a TBI). In the VV ECMO group, three indications for ECMO implementation were chest injuries (<em>n</em> = 68, 47.6%), ventilator-associated pneumonia (VAP; <em>n</em> = 57, 39.9%), and extra-respiratory acute respiratory distress syndrome (ARDS; <em>n</em> = 57, 39.9%). In the VV ECMO group, 45.8% (n = 65) died in the hospital, with 33 (48.5%) deaths following cannulation for chest injuries, 22 (39.3%) following cannulation for VAP, and 10 (55.6%) following cannulation for extrapulmonary ARDS. In the VA ECMO group, 75.0% (<em>n</em> = 27) died during their hospital stay.</div></div><div><h3>Conclusions</h3><div>In-hospital mortality of trauma patients requiring ECMO for refractory ARDS varied according to indications. The best prognosis was observed in the subgroup of pneumonia-induced ARDS patients.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 1","pages":"Article 101457"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878363","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号