Anaesthesia Critical Care & Pain Medicine最新文献

Blood pressure (BP) measurement in both acute care and outpatient settings is essential, as conditions like hypertension and hypotension are common and often asymptomatic until organ damage occurs. These conditions significantly increase the risk of morbidity and mortality but can be effectively managed through early detection and treatment. For decades, cuff-based devices have dominated non-invasive BP monitoring; however, they are often bulky, inconvenient, and limited to intermittent measurements. In recent years, machine learning (ML) and artificial intelligence (AI)-based approaches for BP estimation from non-invasive physiological signals-such as electrocardiography (ECG) and photoplethysmography (PPG)-have generated considerable interest. These innovations promise to enable continuous, cuff-less BP monitoring, expanding the reach of BP assessment into wearable devices and facilitating more dynamic, patient-centered care. This review provides a comprehensive overview of the evolution of non-invasive BP measurement technologies, with particular emphasis on emerging AI-driven methods and trends shaping the development of continuous and wearable solutions. While these technologies offer new opportunities for continuous monitoring and patient engagement, this review focuses on their conceptual and technological development rather than detailed performance evaluation or clinical validation.

Introduction: Postoperative pain management typically relies on numerical (NRS) or analogue rating scales. However, exclusive focus on nociception may overlook broader aspects of patient experience, especially under regional anaesthesia (RA). This post hoc analysis of the COMFORT trial (NCT05234216) examined whether replacing the NRS with a comfort-focused scale affects patient-reported experience, opioid use, and related outcomes.

Methods: We analysed data from a cluster-randomised trial in 29 French centres. Adults undergoing elective non-cardiac surgery managed in the post-anaesthesia care unit (PACU) were included. The intervention (comfort scale) and comparator (pain NRS) were applied in the PACU. Patient-reported experience was measured with the EVAN-G/LR scales, self-completed on the ward/day-care unit ≥4 hours postoperatively. Participants were divided into RA and general anaesthesia subgroups.

Results: Of 885 randomised patients, 786 had evaluable EVAN data. After regional anaesthesia (RA; n = 305), comfort‑focused assessment was associated with higher EVAN Pain (median 88 [IQR 75-94] vs. 75 [69-88]; p = 0.034), Waiting (100 [75-100] vs. 75 [50-100]; p = 0.012), and Global Index (81 [72-91] vs. 77 [68-90]; p = 0.044). After general anaesthesia (GA; n=481), EVAN scores were similar between groups. Nefopam use was lower with the comfort approach in RA (7% vs. 18%; p = 0.005). Antiemetic use was lower with the comfort approach in GA.

Conclusion: Replacing the NRS with a comfort-focused approach did not improve global patient experience after surgery. In patients receiving regional anaesthesia, however, using a comfort scale was associated with better patient-reported experience in the EVAN "Pain" dimension, while no benefit was observed after general anaesthesia.

Background: Observational studies have shown patient-level variations in weaning practices. This study aimed to assess the individual opinions of French intensivists about the weaning process.

Methods: A national e-survey was conducted in ICUs in France in December 2023.

Results: Among 343 ICUs contacted, 487 physicians answered the questionnaire. The weaning process begins at the first attempt of stopping sedation for 50% of responders, at the time the patient begins to trigger the ventilator for 26%, and at the first spontaneous breathing trial (SBT) for 24%. Fifty-five percent of physicians evaluate the patient's ability to breathe without the ventilator after a gradual lowering of the level of ventilatory assistance, and 45% daily, whatever the level of assistance. SBTs are performed always or frequently for 96% of responders, with pressure support ventilation (PS) for 73%, and without positive end-expiratory pressure for 76%. The main objective of extubation is to reduce the duration of mechanical ventilation for 52% of responders, vs. to make the extubation a success for 48%. An impaired consciousness is a contraindication to extubation for 69% of responders, a negative cuff leak test for 66%, large fluid overload for 43%, sputum retention for 27%, weak cough for 23%, and swallowing disorders for 21%.

Conclusion: Our survey among French intensivists shows that the attempt to separate the patient from the ventilator is largely performed by SBTs. However, daily screening for readiness to SBT seems to be a minority. The level of consciousness is a key factor in the decision of extubation.

Background: Enhanced Recovery After Surgery (ERAS) protocols have been widely adopted in gastric cancer surgery, with consistent benefits in perioperative recovery. However, whether adherence to ERAS influences long-term oncologic outcomes remains unclear. This study aimed to evaluate the association between ERAS adherence and disease-free survival (DFS) following curative-intent gastrectomy.

Methods: This was a prespecified substudy of the POWER4 cohort, a prospective, multicentre investigation of perioperative care and outcomes in patients undergoing elective gastrectomy for gastric cancer. ERAS adherence was assessed using 22 predefined components and analysed as a binary (high vs. low), continuous (per 10-point increment), and quartile-based variable. The primary endpoint was DFS, defined as the time from surgery to recurrence or death. Kaplan-Meier estimates and multivariable Cox models were used to evaluate the association between ERAS adherence and DFS, adjusting for age, sex, ASA, BMI, nutritional risk, anaemia, chronic kidney disease, surgical approach, procedure type, operative time, and tumour stage.

Results: Among 368 patients with complete oncologic follow-up, the median follow-up was 1616 days. Kaplan-Meier curves suggested a trend toward improved DFS with higher ERAS adherence (log-rank p =  0.10 for binary comparison; p =  0.05 across quartiles). In multivariable Cox models, ERAS adherence was not significantly associated with DFS. Prognosis was independently predicted by tumour stage, chronic kidney disease, ASA ≥ III, and total gastrectomy.

Conclusion: In this multicentre cohort, ERAS adherence was not independently associated with long-term DFS after gastrectomy for gastric cancer. Long-term prognosis appeared primarily driven by tumour and patient-related factors rather than perioperative protocol adherence. The study was registered on Clinicaltrials.gov: NCT06790238.