Pub Date : 2024-09-13DOI: 10.1016/j.accpm.2024.101423
Xuefei Li , Yi Xu , Zaili Wang , Weiwei Wang , Qiansu Luo , Qianglin Yi , Hai Yu
Background
The effect of different mechanical ventilation modes on pulmonary outcome after abdominal surgery remains unclear. We evaluated the effects of three common ventilation modes on postoperative pulmonary complications (PPCs) among intermediate- to high-risk patients undergoing abdominal surgery.
Methods
This randomized clinical trial enrolled adult patients at intermediate or high risk of PPCs who were scheduled for abdominal surgery. Participants were randomized to receive one of three modes of mechanical ventilation modes: volume-controlled ventilation (VCV), pressure-controlled ventilation (PCV), and pressure-control with volume-guaranteed ventilation (PCV-VG). Lung-protective ventilation strategy was implemented in all groups. The primary outcome was the incidence of a composite of pulmonary complications within the first 7 postoperative days. Pulmonary complications within 30 postoperative days, the severity grade of PPCs, and other secondary outcomes were also analyzed.
Results
A total of 1365 patients were randomized and 1349 were analyzed. The primary outcome occurred in 98 (21.8%) in the VCV group, 95 (22.1%) in the PCV group, and 101 (22.5%) in the PCV-VG group (P = 0.865). Additionally, there were no statistically significant differences among the three groups in terms of the incidence of pulmonary complications within postoperative 30 days, severity grade of PPCs, and other secondary outcomes.
Conclusion
In intermediate- to high-risk patients undergoing abdominal surgery, the choice of ventilation mode did not affect the risk of PPCs.
Trial Registration
Chinese Clinical Trial Registry, entry ChiCTR1900025880.
{"title":"Effect of ventilation mode on postoperative pulmonary complications among intermediate- to high-risk patients undergoing abdominal surgery: A randomized controlled trial","authors":"Xuefei Li , Yi Xu , Zaili Wang , Weiwei Wang , Qiansu Luo , Qianglin Yi , Hai Yu","doi":"10.1016/j.accpm.2024.101423","DOIUrl":"10.1016/j.accpm.2024.101423","url":null,"abstract":"<div><h3>Background</h3><div>The effect of different mechanical ventilation modes on pulmonary outcome after abdominal surgery remains unclear. We evaluated the effects of three common ventilation modes on postoperative pulmonary complications (PPCs) among intermediate- to high-risk patients undergoing abdominal surgery.</div></div><div><h3>Methods</h3><div>This randomized clinical trial enrolled adult patients at intermediate or high risk of PPCs who were scheduled for abdominal surgery. Participants were randomized to receive one of three modes of mechanical ventilation modes: volume-controlled ventilation (VCV), pressure-controlled ventilation (PCV), and pressure-control with volume-guaranteed ventilation (PCV-VG). Lung-protective ventilation strategy was implemented in all groups. The primary outcome was the incidence of a composite of pulmonary complications within the first 7 postoperative days. Pulmonary complications within 30 postoperative days, the severity grade of PPCs, and other secondary outcomes were also analyzed.</div></div><div><h3>Results</h3><div>A total of 1365 patients were randomized and 1349 were analyzed. The primary outcome occurred in 98 (21.8%) in the VCV group, 95 (22.1%) in the PCV group, and 101 (22.5%) in the PCV-VG group (<em>P</em> = 0.865). Additionally, there were no statistically significant differences among the three groups in terms of the incidence of pulmonary complications within postoperative 30 days, severity grade of PPCs, and other secondary outcomes.</div></div><div><h3>Conclusion</h3><div>In intermediate- to high-risk patients undergoing abdominal surgery, the choice of ventilation mode did not affect the risk of PPCs.</div></div><div><h3>Trial Registration</h3><div>Chinese Clinical Trial Registry, entry ChiCTR1900025880.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 6","pages":"Article 101423"},"PeriodicalIF":3.7,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299131","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 : 2024-07-30DOI: 10.1016/j.accpm.2024.101409
Audrey Jarrassier , Nicolas Py , Gaël de Rocquigny , Mathieu Raux , Sigismond Lasocki , Clément Dubost , Emmanuel Bordier , Nicolas Libert , Thomas Leclerc , Éric Meaudre , Pierre Pasquier
Background
The war in Ukraine provides purposefully anesthesiologists and intensivists with important data for improving the management of trauma patients. This scoping review aims to investigate the specific management of war-related trauma patients, during the war in Ukraine, through an objective and comprehensive analysis.
Methods
A comprehensive search of the Embase, Medline, and Open Grey databases from 2014 to February 2024 yielded studies focusing on anesthesia and surgery. These studies were assessed by PRISMA and STROBE criteria and needed to discuss anesthesiology and surgical procedures.
Results
Of the 519 studies identified, 21 were included, with a low overall level of evidence. The studies covered 11,622 patients and 2470 surgical procedures. Most patients were Ukrainian men, 25–63 years old, who had sustained severe injuries from high-energy weapons, such as multiple rocket systems and combat drones. These injuries included major abdominal, facial, and extremity traumas. The surgical procedures varied from initial debridement to complex reconstructions. Anesthesia management faced significant challenges, including resource scarcity and the need for quick adaptability. Evacuations of casualties were lengthy, complex, and often involved rail transportation. Hemorrhage control with tourniquets was critical but associated with many complications. The very frequent presence of multi-resistant organisms required dedicated preventive measures and appropriated treatments. The need for qualified human resources underscored the importance of civilian-military cooperation.
Conclusion
This scoping review provides original and relevant insights on the lessons learned from the ongoing war in Ukraine, which could be useful for anesthesiologists and intensivists.
{"title":"Lessons learned from the war in Ukraine for the anesthesiologist and intensivist: A scoping review","authors":"Audrey Jarrassier , Nicolas Py , Gaël de Rocquigny , Mathieu Raux , Sigismond Lasocki , Clément Dubost , Emmanuel Bordier , Nicolas Libert , Thomas Leclerc , Éric Meaudre , Pierre Pasquier","doi":"10.1016/j.accpm.2024.101409","DOIUrl":"10.1016/j.accpm.2024.101409","url":null,"abstract":"<div><h3>Background</h3><div>The war in Ukraine provides purposefully anesthesiologists and intensivists with important data for improving the management of trauma patients. This scoping review aims to investigate the specific management of war-related trauma patients, during the war in Ukraine, through an objective and comprehensive analysis.</div></div><div><h3>Methods</h3><div>A comprehensive search of the Embase, Medline, and Open Grey databases from 2014 to February 2024 yielded studies focusing on anesthesia and surgery. These studies were assessed by PRISMA and STROBE criteria and needed to discuss anesthesiology and surgical procedures.</div></div><div><h3>Results</h3><div>Of the 519 studies identified, 21 were included, with a low overall level of evidence. The studies covered 11,622 patients and 2470 surgical procedures. Most patients were Ukrainian men, 25–63 years old, who had sustained severe injuries from high-energy weapons, such as multiple rocket systems and combat drones. These injuries included major abdominal, facial, and extremity traumas. The surgical procedures varied from initial debridement to complex reconstructions. Anesthesia management faced significant challenges, including resource scarcity and the need for quick adaptability. Evacuations of casualties were lengthy, complex, and often involved rail transportation. Hemorrhage control with tourniquets was critical but associated with many complications. The very frequent presence of multi-resistant organisms required dedicated preventive measures and appropriated treatments. The need for qualified human resources underscored the importance of civilian-military cooperation.</div></div><div><h3>Conclusion</h3><div>This scoping review provides original and relevant insights on the lessons learned from the ongoing war in Ukraine, which could be useful for anesthesiologists and intensivists.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 5","pages":"Article 101409"},"PeriodicalIF":3.7,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876426","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 : 2024-07-30DOI: 10.1016/j.accpm.2024.101411
Jérémie Guillemin , Benjamin Rieu , Olivier Huet , Léonie Villeret , Stéphanie Pons , Anne Bignon , Quentin de Roux , Raphaël Cinotti , Vincent Legros , Gaëtan Plantefeve , Claire Dayhot-Fizelier , Edris Omar , Cyril Cadoz , Fanny Bounes , Cécile Caplin , Karim Toumert , Thibault Martinez , Damien Bouvier , Maxime Coutrot , Thomas Godet , Florian Blanchard
Background
We aimed to determine the epidemiology and outcomes of unplanned extubation (UE), both accidental and self-extubation, in ICU.
Methods
A multicentre prospective cohort study was conducted in 47 French ICUs. The number of mechanical ventilation (MV) days, and planned and unplanned extubation were recorded in each center over a minimum period of three consecutive months to evaluate UE incidence. Patient characteristics, UE environmental factors, and outcomes were compared based on the UE mechanism (accidental or self-extubation). Self-extubation outcomes were compared with planned extubation using a propensity-matched population. Finally, risk factors for extubation failure (re-intubation before day 7) were determined following self-extubation.
Results
During the 12-month inclusion period, we found a pooled UE incidence of 1.0 per 100 MV days. UE accounted for 9% of all endotracheal removals. Of the 605 UE, 88% were self-extubation and 12% were accidental-extubations. The latter had a worse prognosis than self-extubation (34% vs. 8% ICU-mortality, p < 0.001). Self-extubation did not increase mortality compared with planned extubation (8% vs. 11%, p = 0.075). Regardless of the type of extubation, planned or unplanned, extubation failure was independently associated with a poor outcome. Cancer, higher respiratory rate, lower PaO2/FiO2 at the time of extubation, weaning process not-ongoing, and immediate post-extubation respiratory failure were independent predictors of failed self-extubation.
Conclusion
Unplanned extubation, mostly represented by self-extubation, is common in ICU and accounts for 9% of all endotracheal extubations. While accidental extubations are a serious and infrequent adverse event, self-extubation does not increase mortality compared to planned extubation.
{"title":"Prospective multi-center evaluation of the incidence of unplanned extubation and its outcomes in French intensive care units. The Safe-ICU study","authors":"Jérémie Guillemin , Benjamin Rieu , Olivier Huet , Léonie Villeret , Stéphanie Pons , Anne Bignon , Quentin de Roux , Raphaël Cinotti , Vincent Legros , Gaëtan Plantefeve , Claire Dayhot-Fizelier , Edris Omar , Cyril Cadoz , Fanny Bounes , Cécile Caplin , Karim Toumert , Thibault Martinez , Damien Bouvier , Maxime Coutrot , Thomas Godet , Florian Blanchard","doi":"10.1016/j.accpm.2024.101411","DOIUrl":"10.1016/j.accpm.2024.101411","url":null,"abstract":"<div><h3>Background</h3><div>We aimed to determine the epidemiology and outcomes of unplanned extubation (UE), both accidental and self-extubation, in ICU.</div></div><div><h3>Methods</h3><div>A multicentre prospective cohort study was conducted in 47 French ICUs. The number of mechanical ventilation (MV) days, and planned and unplanned extubation were recorded in each center over a minimum period of three consecutive months to evaluate UE incidence. Patient characteristics, UE environmental factors, and outcomes were compared based on the UE mechanism (accidental or self-extubation). Self-extubation outcomes were compared with planned extubation using a propensity-matched population. Finally, risk factors for extubation failure (re-intubation before day 7) were determined following self-extubation.</div></div><div><h3>Results</h3><div>During the 12-month inclusion period, we found a pooled UE incidence of 1.0 per 100 MV days. UE accounted for 9% of all endotracheal removals. Of the 605 UE, 88% were self-extubation and 12% were accidental-extubations. The latter had a worse prognosis than self-extubation (34% <em>vs.</em> 8% ICU-mortality, <em>p</em> < 0.001). Self-extubation did not increase mortality compared with planned extubation (8% <em>vs.</em> 11%, <em>p</em> = 0.075). Regardless of the type of extubation, planned or unplanned, extubation failure was independently associated with a poor outcome. Cancer, higher respiratory rate, lower PaO<sub>2</sub>/FiO<sub>2</sub> at the time of extubation, weaning process not-ongoing, and immediate post-extubation respiratory failure were independent predictors of failed self-extubation.</div></div><div><h3>Conclusion</h3><div>Unplanned extubation, mostly represented by self-extubation, is common in ICU and accounts for 9% of all endotracheal extubations. While accidental extubations are a serious and infrequent adverse event, self-extubation does not increase mortality compared to planned extubation.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 5","pages":"Article 101411"},"PeriodicalIF":3.7,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876430","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 : 2024-07-30DOI: 10.1016/j.accpm.2024.101410
Antony George Attokaran , Kyle C White , Ra'eesa Doola , Philippa McIlroy , Siva Senthuran , Stephen Luke , Peter Garrett , Alexis Tabah , Kiran Shekar , Felicity Edwards , Hayden White , James PA McCullough , Rod Hurford , Pierre Clement , Kevin B Laupland , Mahesh Ramanan
Introduction
Hypophosphatemia is common in critically ill patients. We have described the epidemiology of hypophosphatemia in patients admitted to the Intensive Care Units.
Methods
A multicentre, retrospective cohort study of 12 ICUs in Queensland, Australia from January 1st, 2015, to December 31st, 2021. Exclusions included readmissions, renal replacement therapy, end-stage renal disease, and palliative intent admissions and transfers from other ICUs. Patients were classified into four groups based on the severity of the first episode of low serum phosphate (PO4): “None” (PO4: ≥0.81 mmol/L, “Mild” (PO4: ≥0.50 & <0.81 mmol/L) “Moderate” (PO4: ≥0.30 & <0.50 mmol/L) and “Severe” (PO4: <0.30 mmol/L). A mixed-effect logistic regression model, including hospital as a random effect, was developed to examine factors associated with 90-day case fatality.
Results
Of the 89,776 patients admitted, 68,699 patients were included in this study, with 23,485 (34.2%) having hypophosphatemia with onset mostly on Day 2 of ICU admission and correcting to normal 3 days after hypophosphatemia was identified. There was substantial variation among participating ICUs in phosphate replacement; the threshold, and the route by which it was replaced. Day-90 case fatality increased with severity of hypophosphatemia (None: 3974 (8.8%), Mild: 2306 (11%), Moderate: 377 (14%); Severe: 108 (21%) (p < 0.001)). Multivariable regression analysis showed that compared to those without hypophosphatemia, patients with moderate (odds ratio (OR) 1.24; 95% confidence intervals (CI) 1.07–1.44; p = 0.004) or severe (OR 1.49; 95% CI 1.13–1.97; p = 0.005) hypophosphatemia had increased risk of 90-day case fatality.
Conclusion
Hypophosphatemia was common, and mostly occurred on day 2 with early correction of serum phosphate. Phosphate replacement practices were variable among ICUs. Moderate and severe hypophosphatemia was associated with increased 90-day case fatality.
{"title":"Epidemiology of hypophosphatemia in critical illness: A multicentre, retrospective cohort study","authors":"Antony George Attokaran , Kyle C White , Ra'eesa Doola , Philippa McIlroy , Siva Senthuran , Stephen Luke , Peter Garrett , Alexis Tabah , Kiran Shekar , Felicity Edwards , Hayden White , James PA McCullough , Rod Hurford , Pierre Clement , Kevin B Laupland , Mahesh Ramanan","doi":"10.1016/j.accpm.2024.101410","DOIUrl":"10.1016/j.accpm.2024.101410","url":null,"abstract":"<div><h3>Introduction</h3><div>Hypophosphatemia is common in critically ill patients. We have described the epidemiology of hypophosphatemia in patients admitted to the Intensive Care Units.</div></div><div><h3>Methods</h3><div>A multicentre, retrospective cohort study of 12 ICUs in Queensland, Australia from January 1st, 2015, to December 31st, 2021. Exclusions included readmissions, renal replacement therapy, end-stage renal disease, and palliative intent admissions and transfers from other ICUs. Patients were classified into four groups based on the severity of the first episode of low serum phosphate (PO<sub>4</sub>): “None” (PO4: ≥0.81 mmol/L, “Mild” (PO4: ≥0.50 & <0.81 mmol/L) “Moderate” (PO4: ≥0.30 & <0.50 mmol/L) and “Severe” (PO4: <0.30 mmol/L). A mixed-effect logistic regression model, including hospital as a random effect, was developed to examine factors associated with 90-day case fatality.</div></div><div><h3>Results</h3><div>Of the 89,776 patients admitted, 68,699 patients were included in this study, with 23,485 (34.2%) having hypophosphatemia with onset mostly on Day 2 of ICU admission and correcting to normal 3 days after hypophosphatemia was identified. There was substantial variation among participating ICUs in phosphate replacement; the threshold, and the route by which it was replaced. Day-90 case fatality increased with severity of hypophosphatemia (None: 3974 (8.8%), Mild: 2306 (11%), Moderate: 377 (14%); Severe: 108 (21%) (<em>p</em> < 0.001)). Multivariable regression analysis showed that compared to those without hypophosphatemia, patients with moderate (odds ratio (OR) 1.24; 95% confidence intervals (CI) 1.07–1.44; <em>p</em> = 0.004) or severe (OR 1.49; 95% CI 1.13–1.97; <em>p</em> = 0.005) hypophosphatemia had increased risk of 90-day case fatality.</div></div><div><h3>Conclusion</h3><div>Hypophosphatemia was common, and mostly occurred on day 2 with early correction of serum phosphate. Phosphate replacement practices were variable among ICUs. Moderate and severe hypophosphatemia was associated with increased 90-day case fatality.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 5","pages":"Article 101410"},"PeriodicalIF":3.7,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876381","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 : 2024-07-10DOI: 10.1016/j.accpm.2024.101405
Background
Perioperative renal and myocardial protection primarily depends on preoperative prediction tools, along with intraoperative optimization of cardiac output (CO) and mean arterial pressure (MAP). We hypothesise that monitoring the intraoperative global afterload angle (GALA), a proxy of ventricular afterload derived from the velocity pressure (VP) loop, could better predict changes in postoperative biomarkers than the recommended traditional MAP and CO.
Method
This retrospective monocentric study included patients programmed for neurosurgery with continuous VP loop monitoring. Patients with hemodynamic instability were excluded. Those presenting a 1-day post-surgery increase in creatinine, B-type natriuretic peptide, or troponin Ic us were labelled Bio+, Bio− otherwise. Demographics, intra-operative data, and comorbidities were considered as covariates. The study aimed to determine if intraoperative GALA monitoring could predict early postoperative biomarker disruption.
Result
From November 2018 to November 2020, 86 patients were analysed (Bio+/Bio− = 47/39). Bio+ patients were significantly older (62 [54−69] vs. 42 [34−57] years, p < 0.0001), More often hypertensive (25% vs. 9%, p = 0.009), and more frequently treated with antihypertensive drugs (31.9% vs. 7.7%, p = 0.013). GALA was significantly larger in Bio+ patients (40 [31−56] vs. 23 [19–29] °, p < 0.0001), while CO, MAP, and cumulative time spent <65mmHg were similar between groups. GALA exhibited strong predictive performances for postoperative biological deterioration (AUC = 0.88 [0.80−0.95]), significantly outperforming MAP (MAP AUC = 0.55 [0.43−0.68], p < 0.0001).
Conclusion
GALA under general anaesthesia prove more effective in detecting patients at risk of early cardiac or renal biological deterioration, compared to classical hemodynamic parameters.
背景：围手术期的肾脏和心肌保护主要取决于术前预测工具以及术中对心排血量（CO）和平均动脉压（MAP）的优化。我们假设，与推荐的传统 MAP 和 CO 相比，监测术中全局后负荷角（GALA）（由速度压力（VP）环路得出的心室后负荷替代指标）能更好地预测术后生物标志物的变化：这项回顾性单中心研究纳入了计划进行神经外科手术并接受连续 VP 环路监测的患者。排除了血流动力学不稳定的患者。术后 1 天血肌酐、B 型利钠肽或肌钙蛋白 Ic 升高的患者标记为 Bio+，否则标记为 Bio-。人口统计学、术中数据和合并症被视为协变量。该研究旨在确定术中GALA监测能否预测术后早期生物标志物紊乱：从2018年11月到2020年11月，共分析了86名患者（Bio+/Bio- = 47/39）。Bio + 患者年龄明显偏大（62[54-69] 岁对 42[34-57] 岁，P 结论：与传统的血液动力学参数相比，全身麻醉下的 GALA 被证明能更有效地检测出有早期心脏或肾脏生物学恶化风险的患者。
{"title":"Association of velocity-pressure loop-derived values recorded during neurosurgical procedures with postoperative organ failure biomarkers: a retrospective single-center study","authors":"","doi":"10.1016/j.accpm.2024.101405","DOIUrl":"10.1016/j.accpm.2024.101405","url":null,"abstract":"<div><h3>Background</h3><div>Perioperative renal and myocardial protection primarily depends on preoperative prediction tools, along with intraoperative optimization of cardiac output (CO) and mean arterial pressure (MAP). We hypothesise that monitoring the intraoperative global afterload angle (GALA), a proxy of ventricular afterload derived from the velocity pressure (VP) loop, could better predict changes in postoperative biomarkers than the recommended traditional MAP and CO.</div></div><div><h3>Method</h3><div>This retrospective monocentric study included patients programmed for neurosurgery with continuous VP loop monitoring. Patients with hemodynamic instability were excluded. Those presenting a 1-day post-surgery increase in creatinine, B-type natriuretic peptide, or troponin Ic us were labelled Bio+, Bio− otherwise. Demographics, intra-operative data, and comorbidities were considered as covariates. The study aimed to determine if intraoperative GALA monitoring could predict early postoperative biomarker disruption.</div></div><div><h3>Result</h3><div>From November 2018 to November 2020, 86 patients were analysed (Bio+/Bio− = 47/39). Bio+ patients were significantly older (62 [54−69] vs. 42 [34−57] years, <em>p</em> < 0.0001), More often hypertensive (25% vs. 9%, <em>p</em> = 0.009), and more frequently treated with antihypertensive drugs (31.9% vs. 7.7%, <em>p</em> = 0.013). GALA was significantly larger in Bio+ patients (40 [31−56] vs. 23 [19–29] °, <em>p</em> < 0.0001), while CO, MAP, and cumulative time spent <65mmHg were similar between groups. GALA exhibited strong predictive performances for postoperative biological deterioration (AUC = 0.88 [0.80−0.95]), significantly outperforming MAP (MAP AUC = 0.55 [0.43−0.68], <em>p</em> < 0.0001).</div></div><div><h3>Conclusion</h3><div>GALA under general anaesthesia prove more effective in detecting patients at risk of early cardiac or renal biological deterioration, compared to classical hemodynamic parameters.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 5","pages":"Article 101405"},"PeriodicalIF":3.7,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141601980","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 : 2024-07-09DOI: 10.1016/j.accpm.2024.101406
{"title":"Dexmedetomidine, more than just an anaesthetic aid? An overview of latest evidence","authors":"","doi":"10.1016/j.accpm.2024.101406","DOIUrl":"10.1016/j.accpm.2024.101406","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 5","pages":"Article 101406"},"PeriodicalIF":3.7,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141591796","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 : 2024-07-09DOI: 10.1016/j.accpm.2024.101404
The French National Authority for Health (HAS) recently issued guidelines for patient blood management (PBM) in surgical procedures. These recommendations are based on three usual pillars of PBM: optimizing red cell mass, minimizing blood loss and optimizing anemia tolerance. In the preoperative period, these guidelines recommend detecting anemia and iron deficiency and taking corrective measures well in advance of surgery, when possible, in case of surgery with moderate to high bleeding risk or known preoperative anemia. In the intraoperative period, the use of tranexamic acid and some surgical techniques are recommended to limit bleeding in case of high bleeding risk or in case of hemorrhage, and the use of cell salvage is recommended in some surgeries with a major risk of transfusion. In the postoperative period, the limitation of blood samples is recommended but the monitoring of postoperative anemia must be carried out and may lead to corrective measures (intravenous iron in particular) or more precise diagnostic assessment of this anemia. A “restrictive” transfusion threshold considering comorbidities and, most importantly, the tolerance of the patient is recommended postoperatively. The implementation of a strategy and a program for patient blood management is recommended throughout the perioperative period in healthcare establishments in order to reduce blood transfusion and length of stay. This article presents an English translation of the HAS recommendations and a summary of the rationale underlying these recommendations.
法国国家卫生局（HAS）最近发布了外科手术患者血液管理（PBM）指南。这些建议基于 PBM 的三大支柱：优化红细胞质量、减少失血量和优化贫血耐受性。在术前阶段，这些指南建议检测贫血和缺铁情况，并尽可能在手术前采取纠正措施，以防手术有中度至高度出血风险或已知术前贫血。在术中，如果出血风险较高或出现大出血，建议使用氨甲环酸和一些外科技术来限制出血；在一些有较大输血风险的手术中，建议使用细胞挽救术。在术后，建议限制血液样本，但必须对术后贫血进行监测，这可能会导致采取纠正措施（尤其是静脉注射铁剂）或对这种贫血进行更精确的诊断评估。考虑到合并症，最重要的是考虑到患者的耐受性，建议术后采用 "限制性 "输血阈值。建议医疗机构在整个围手术期实施患者血液管理策略和计划，以减少输血和缩短住院时间。本文介绍了 HAS 建议的英文译文以及这些建议的基本原理。
{"title":"Perioperative Patient Blood Management (excluding obstetrics): Guidelines from the French National Authority for Health","authors":"","doi":"10.1016/j.accpm.2024.101404","DOIUrl":"10.1016/j.accpm.2024.101404","url":null,"abstract":"<div><div>The French National Authority for Health (HAS) recently issued guidelines for patient blood management (PBM) in surgical procedures. These recommendations are based on three usual pillars of PBM: optimizing red cell mass, minimizing blood loss and optimizing anemia tolerance. In the preoperative period, these guidelines recommend detecting anemia and iron deficiency and taking corrective measures well in advance of surgery, when possible, in case of surgery with moderate to high bleeding risk or known preoperative anemia. In the intraoperative period, the use of tranexamic acid and some surgical techniques are recommended to limit bleeding in case of high bleeding risk or in case of hemorrhage, and the use of cell salvage is recommended in some surgeries with a major risk of transfusion. In the postoperative period, the limitation of blood samples is recommended but the monitoring of postoperative anemia must be carried out and may lead to corrective measures (intravenous iron in particular) or more precise diagnostic assessment of this anemia. A “restrictive” transfusion threshold considering comorbidities and, most importantly, the tolerance of the patient is recommended postoperatively. The implementation of a strategy and a program for patient blood management is recommended throughout the perioperative period in healthcare establishments in order to reduce blood transfusion and length of stay. This article presents an English translation of the HAS recommendations and a summary of the rationale underlying these recommendations.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 5","pages":"Article 101404"},"PeriodicalIF":3.7,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141591797","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 : 2024-07-06DOI: 10.1016/j.accpm.2024.101403
{"title":"Use of beta-blockers in major surgery and critical care: The right use may be in the details","authors":"","doi":"10.1016/j.accpm.2024.101403","DOIUrl":"10.1016/j.accpm.2024.101403","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 5","pages":"Article 101403"},"PeriodicalIF":3.7,"publicationDate":"2024-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141555766","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 : 2024-07-02DOI: 10.1016/j.accpm.2024.101402
Background
Tracheal intubation in ICU is associated with high incidence of difficult intubations. The study aimed to investigate whether the “universal” use of a hyperangulated videolaryngoscope would increase the frequency of “easy intubation” in ICU patients compared to direct laryngoscopy.
Methods
A prospective before-after study was conducted. The pre-interventional period (36 months) involved tracheal intubations using direct laryngoscopy as the first intubation option. In the interventional period (18 months) a hyperangulated videolaryngoscope was the first intubation option. The primary outcome was the percentage of patients with “easy intubation” defined as intubation on the first attempt and easy laryngoscopy (modified Cormack-Lehane glottic view of I-IIa). Secondary outcomes included difficult laryngoscopy, operator technical difficulty, and complications.
Results
We enrolled 407 patients, 273 in non-interventional period, and 134 in interventional period. Tracheal intubation in the interventional period was associated with higher incidence of “easy intubation” (92.5%) compared with the non-interventional period (75.8%); P < 0.001)). Glottic visualization improved in the interventional period, with a reduced incidence of difficult laryngoscopy (1.5% vs. 22.5%; P < 0.001). The proportion of first-success rate intubation was 92.5% in the interventional period, and 87.8% in the non-interventional period (P = 0.147). Moderate and severe technical difficulty of intubation reported decreased in the interventional period (6% vs. 17.6%; P < 0.001). There was no significant difference between both periods in the incidence of complications.
Conclusion
“Universal” use of hyperangulated videolaryngoscopy for tracheal intubation in patients admitted in ICU improves the percentage of easy intubation compared to direct laryngoscopy.
{"title":"Impact of universal use of a hyperangulated videolaryngoscope as the first option for all intubations in the ICU: A prospective before-after study","authors":"","doi":"10.1016/j.accpm.2024.101402","DOIUrl":"10.1016/j.accpm.2024.101402","url":null,"abstract":"<div><h3>Background</h3><div>Tracheal intubation in ICU is associated with high incidence of difficult intubations. The study aimed to investigate whether the “universal” use of a hyperangulated videolaryngoscope would increase the frequency of “easy intubation” in ICU patients compared to direct laryngoscopy.</div></div><div><h3>Methods</h3><div>A prospective before-after study was conducted. The pre-interventional period (36 months) involved tracheal intubations using direct laryngoscopy as the first intubation option. In the interventional period (18 months) a hyperangulated videolaryngoscope was the first intubation option. The primary outcome was the percentage of patients with “easy intubation” defined as intubation on the first attempt and easy laryngoscopy (modified Cormack-Lehane glottic view of I-IIa). Secondary outcomes included difficult laryngoscopy, operator technical difficulty, and complications.</div></div><div><h3>Results</h3><div>We enrolled 407 patients, 273 in non-interventional period, and 134 in interventional period. Tracheal intubation in the interventional period was associated with higher incidence of “easy intubation” (92.5%) compared with the non-interventional period (75.8%); <em>P</em> < 0.001)). Glottic visualization improved in the interventional period, with a reduced incidence of difficult laryngoscopy (1.5% <em>vs.</em> 22.5%; <em>P</em> < 0.001). The proportion of first-success rate intubation was 92.5% in the interventional period, and 87.8% in the non-interventional period (<em>P</em> = 0.147). Moderate and severe technical difficulty of intubation reported decreased in the interventional period (6% <em>vs.</em> 17.6%; <em>P</em> < 0.001). There was no significant difference between both periods in the incidence of complications.</div></div><div><h3>Conclusion</h3><div>“Universal” use of hyperangulated videolaryngoscopy for tracheal intubation in patients admitted in ICU improves the percentage of <em>easy intubation</em> compared to direct laryngoscopy.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 5","pages":"Article 101402"},"PeriodicalIF":3.7,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141535758","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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