Pub Date : 2024-02-12DOI: 10.1016/j.accpm.2024.101352
Ophélie Hurtado , Tristan T. Timbrook , Benjamin Hommel
{"title":"Systematic review and meta-analysis on Staphylococcus aureus methicillin resistance detection performance and discrepancy analysis with the BIOFIRE® FILMARRAY® Pneumonia Panel","authors":"Ophélie Hurtado , Tristan T. Timbrook , Benjamin Hommel","doi":"10.1016/j.accpm.2024.101352","DOIUrl":"10.1016/j.accpm.2024.101352","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 2","pages":"Article 101352"},"PeriodicalIF":5.5,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139736488","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 : 2024-02-12DOI: 10.1016/j.accpm.2024.101353
Cécile Poulain , Yoann Launey , Marwan Bouras , Karim Lakhal , Laura Dargelos , Lise Crémet , Sophie-Anne Gibaud , Stéphane Corvec , Philippe Seguin , Bertrand Rozec , Karim Asehnoune , Fanny Feuillet , Antoine Roquilly
Background
We aimed to determine whether implementing antimicrobial stewardship based on multiplex bacterial PCR examination of respiratory fluid can enhance outcomes of critically ill patients with hospital-acquired pneumonia (HAP).
Methods
We conducted a quality improvement study in two hospitals in France. Adult patients requiring invasive mechanical ventilation with a diagnosis of HAP were included. In the pre-intervention period (August 2019 to April 2020), antimicrobial therapy followed European guidelines. In the «intervention» phase (June 2020 to October 2021), treatment followed a multiplex PCR-guided protocol. The primary endpoint was a composite endpoint made of mortality on day 28, clinical cure between days 7 and 10, and duration of invasive mechanical ventilation on day 28. The primary outcome was analyzed with a DOOR strategy.
Results
A total of 443 patients were included in 3 ICUs from 2 hospitals (220 pre-intervention; 223 intervention). No difference in the ranking of the primary composite outcome was found (DOOR: 50.3%; 95%CI, 49.9%–50.8%). The number of invasive mechanical ventilation-free days at day 28 was 10.0 [0.0; 19.0] in the baseline period and 9.0 [0.0; 20.0] days during the intervention period (p = 0.95). The time-to-efficient antimicrobial treatment was 0.43 ± 1.29 days before versus 0.55 ± 1.13 days after the intervention (p = 0.56).
Conclusion
Implementation of Rapid Multiplex PCR to guide empirical antimicrobial therapy for critically ill patients with HAP was not associated with better outcomes. However, adherence to stewardship was low, and the study may have had limited power to detect a clinically important difference.
{"title":"Clinical evaluation of the BioFire Respiratory Pathogen Panel for the guidance of empirical antimicrobial therapy in critically ill patients with hospital-acquired pneumonia: A multicenter, quality improvement project","authors":"Cécile Poulain , Yoann Launey , Marwan Bouras , Karim Lakhal , Laura Dargelos , Lise Crémet , Sophie-Anne Gibaud , Stéphane Corvec , Philippe Seguin , Bertrand Rozec , Karim Asehnoune , Fanny Feuillet , Antoine Roquilly","doi":"10.1016/j.accpm.2024.101353","DOIUrl":"10.1016/j.accpm.2024.101353","url":null,"abstract":"<div><h3>Background</h3><p>We aimed to determine whether implementing antimicrobial stewardship based on multiplex bacterial PCR examination of respiratory fluid can enhance outcomes of critically ill patients with hospital-acquired pneumonia (HAP).</p></div><div><h3>Methods</h3><p>We conducted a quality improvement study in two hospitals in France. Adult patients requiring invasive mechanical ventilation with a diagnosis of HAP were included. In the pre-intervention period (August 2019 to April 2020), antimicrobial therapy followed European guidelines. In the «intervention» phase (June 2020 to October 2021), treatment followed a multiplex PCR-guided protocol. The primary endpoint was a composite endpoint made of mortality on day 28, clinical cure between days 7 and 10, and duration of invasive mechanical ventilation on day 28. The primary outcome was analyzed with a DOOR strategy.</p></div><div><h3>Results</h3><p>A total of 443 patients were included in 3 ICUs from 2 hospitals (220 pre-intervention; 223 intervention). No difference in the ranking of the primary composite outcome was found (DOOR: 50.3%; 95%CI, 49.9%–50.8%). The number of invasive mechanical ventilation-free days at day 28 was 10.0 [0.0; 19.0] in the baseline period and 9.0 [0.0; 20.0] days during the intervention period (p = 0.95). The time-to-efficient antimicrobial treatment was 0.43 ± 1.29 days before <em>versus</em> 0.55 ± 1.13 days after the intervention (<em>p</em> = 0.56).</p></div><div><h3>Conclusion</h3><p>Implementation of Rapid Multiplex PCR to guide empirical antimicrobial therapy for critically ill patients with HAP was not associated with better outcomes. However, adherence to stewardship was low, and the study may have had limited power to detect a clinically important difference.</p></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 2","pages":"Article 101353"},"PeriodicalIF":5.5,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139736487","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 : 2024-01-24DOI: 10.1016/j.accpm.2024.101349
Nicolas Chéron , Luc de Chaisemartin , Simon Aubert , Felix Laborier , Philippe Montravers , Catherine Neukirch , Aurélie Gouel-Chéron
Background
The first line of prevention of surgical site infection relies on the timely administration of antibiotic prophylaxis. First- and second-generation cephalosporins are the most recommended antibiotics in elective surgery. The incidence of cefazolin allergy has increased worldwide over the years. The sensitization mechanism of cefazolin is currently unknown, and data supporting cross-reactivity between penicillins and cephalosporins are lacking. Sensitization could occur through previous exposure either to cefazolin or to structurally related chemical agents. The objective of this study was to evaluate sensitization agents towards cefazolin.
Methods
The OpenBabel chemoinformatics toolbox was used to search for similarities between cefazolin and other molecules in an extensive drug database. Using the pholcodine-rocuronium similarity score as a threshold, we selected drugs with the most similar structure to that of cefazolin. Exposure to those drugs and cefazolin was assessed in a cohort of patients with skin test-proven cefazolin allergy at a specialized allergy centre via a self-administered anonymous questionnaire.
Results
Using the pholcodine-rocuronium similarity score as a threshold (score≥0.7), 42 molecules were found to be similar to cefazolin (all cephalosporins). Only 8 were marketed in France. None of the 14 cefazolin-allergic patients who answered the questionnaire (65% female, median age 56 years) reported exposure to any identified antibiotics. In contrast, 11 (78%) had at least one previous surgery requiring cefazolin before the index case.
Conclusion
Direct previous cefazolin exposure was identified in 78% of cefazolin-allergic patients. Cefazolin started to take a central place in antibiotic prophylaxis after 2010, when cefamandole usage decreased drastically. Changes in antibiotic prophylaxis over the past 14 years in France could have been the turning point for the increased incidence of cefazolin allergy.
{"title":"Are changes in antibiotic prophylaxis recommendations responsible for an increased risk of cefazolin allergy?","authors":"Nicolas Chéron , Luc de Chaisemartin , Simon Aubert , Felix Laborier , Philippe Montravers , Catherine Neukirch , Aurélie Gouel-Chéron","doi":"10.1016/j.accpm.2024.101349","DOIUrl":"10.1016/j.accpm.2024.101349","url":null,"abstract":"<div><h3>Background</h3><p>The first line of prevention of surgical site infection relies on the timely administration of antibiotic prophylaxis. First- and second-generation cephalosporins are the most recommended antibiotics in elective surgery. The incidence of cefazolin allergy has increased worldwide over the years. The sensitization mechanism of cefazolin is currently unknown, and data supporting cross-reactivity between penicillins and cephalosporins are lacking. Sensitization could occur through previous exposure either to cefazolin or to structurally related chemical agents. The objective of this study was to evaluate sensitization agents towards cefazolin.</p></div><div><h3>Methods</h3><p>The OpenBabel chemoinformatics toolbox was used to search for similarities between cefazolin and other molecules in an extensive drug database. Using the pholcodine-rocuronium similarity score as a threshold, we selected drugs with the most similar structure to that of cefazolin. Exposure to those drugs and cefazolin was assessed in a cohort of patients with skin test-proven cefazolin allergy at a specialized allergy centre via a self-administered anonymous questionnaire.</p></div><div><h3>Results</h3><p>Using the pholcodine-rocuronium similarity score as a threshold (score≥0.7), 42 molecules were found to be similar to cefazolin (all cephalosporins). Only 8 were marketed in France. None of the 14 cefazolin-allergic patients who answered the questionnaire (65% female, median age 56 years) reported exposure to any identified antibiotics. In contrast, 11 (78%) had at least one previous surgery requiring cefazolin before the index case.</p></div><div><h3>Conclusion</h3><p>Direct previous cefazolin exposure was identified in 78% of cefazolin-allergic patients. Cefazolin started to take a central place in antibiotic prophylaxis after 2010, when cefamandole usage decreased drastically. Changes in antibiotic prophylaxis over the past 14 years in France could have been the turning point for the increased incidence of cefazolin allergy.</p></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 2","pages":"Article 101349"},"PeriodicalIF":5.5,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139553937","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 : 2024-01-24DOI: 10.1016/j.accpm.2024.101348
Steve Primmaz, Tommaso Rochat Negro, Noémie Suh, Christophe Le Terrier, Hannah Wozniak, Jérôme Pugin, Karim Bendjelid
Background
Pulmonary embolism (PE) in critically ill patients with acute respiratory distress syndrome (ARDS) caused by COVID-19 is a major complication which might impact survival. We aimed to determine the prevalence of PE and assess its impact of PE on clinical outcomes in intubated patients with ARDS due to COVID-19.
Methods
All intubated patients with ARDS due to COVID-19 admitted to the intensive care unit (ICU) of Geneva University Hospitals between March 9, 2020, and May 31, 2022, were included. A retrospective analysis was conducted on the occurrence of PE and its association with clinical outcomes. The primary outcome was ventilator-free days during the first 28 days after ICU admission. Linear regressions were performed to investigate the association between PE and outcomes.
Results
Among the 370 intubated patients with ARDS related to COVID-19, 58 (15.7%) presented with PE. Patients with PE had significantly fewer ventilator-free days than patients without PE (median (IQR) of 3 (0−11) days versus 12 (0−19) days; p < 0.001). Mortality did not differ significantly between groups (12/58 [20.7%] of patients with PE versus 71/312 [22.8%] of patients without PE; p = 0.72). Duration of IMV, and ICU and hospital LOS were significantly longer among patients with PE. The need for ECMO support was similar among both groups.
Conclusions
The occurrence of PE in patients with ARDS due to COVID-19 had a significant impact on clinical outcomes. They had fewer ventilator-free days, longer duration of IMV, and longer ICU and hospital lengths of stay. However, pulmonary embolism was not associated with higher mortality.
Ethics approval
Ethical committee of Geneva (BASEC #: 2020-00917).
背景COVID-19导致的急性呼吸窘迫综合征（ARDS）重症患者肺栓塞（PE）是一种可能影响生存的主要并发症。方法纳入 2020 年 3 月 9 日至 2022 年 5 月 31 日期间日内瓦大学医院重症监护室（ICU）收治的所有 COVID-19 引起的 ARDS 插管患者。对PE的发生及其与临床结果的关系进行了回顾性分析。主要结果是入住 ICU 后前 28 天内无呼吸机天数。结果在与COVID-19相关的370例ARDS插管患者中，有58例（15.7%）出现PE。与无 PE 患者相比，有 PE 患者的无呼吸机天数明显较少（中位数（IQR）为 3（0-11）天，而无 PE 患者为 12（0-19）天；P< 0.001）。两组患者的死亡率无明显差异（12/58 PE 患者[20.7%]对 71/312 PE 患者[22.8%]；P = 0.72）。PE患者的IMV持续时间、重症监护室和住院时间明显更长。结论COVID-19导致的ARDS患者发生PE对临床结果有重大影响。他们的无呼吸机天数较少，IMV持续时间较长，ICU和住院时间较长。然而，肺栓塞与死亡率升高并无关联。
{"title":"Pulmonary embolism impacts clinical outcomes of intubated patients with acute respiratory distress syndrome related to COVID-19","authors":"Steve Primmaz, Tommaso Rochat Negro, Noémie Suh, Christophe Le Terrier, Hannah Wozniak, Jérôme Pugin, Karim Bendjelid","doi":"10.1016/j.accpm.2024.101348","DOIUrl":"10.1016/j.accpm.2024.101348","url":null,"abstract":"<div><h3>Background</h3><p>Pulmonary embolism (PE) in critically ill patients with acute respiratory distress syndrome (ARDS) caused by COVID-19 is a major complication which might impact survival. We aimed to determine the prevalence of PE and assess its impact of PE on clinical outcomes in intubated patients with ARDS due to COVID-19.</p></div><div><h3>Methods</h3><p>All intubated patients with ARDS due to COVID-19 admitted to the intensive care unit (ICU) of Geneva University Hospitals between March 9, 2020, and May 31, 2022, were included. A retrospective analysis was conducted on the occurrence of PE and its association with clinical outcomes. The primary outcome was ventilator-free days during the first 28 days after ICU admission. Linear regressions were performed to investigate the association between PE and outcomes.</p></div><div><h3>Results</h3><p>Among the 370 intubated patients with ARDS related to COVID-19, 58 (15.7%) presented with PE. Patients with PE had significantly fewer ventilator-free days than patients without PE (median (IQR) of 3 (0−11) days <em>versus</em> 12 (0−19) days; <em>p</em> < 0.001). Mortality did not differ significantly between groups (12/58 [20.7%] of patients with PE <em>versus</em> 71/312 [22.8%] of patients without PE; <em>p</em> = 0.72). Duration of IMV, and ICU and hospital LOS were significantly longer among patients with PE. The need for ECMO support was similar among both groups.</p></div><div><h3>Conclusions</h3><p>The occurrence of PE in patients with ARDS due to COVID-19 had a significant impact on clinical outcomes. They had fewer ventilator-free days, longer duration of IMV, and longer ICU and hospital lengths of stay. However, pulmonary embolism was not associated with higher mortality.</p></div><div><h3>Ethics approval</h3><p>Ethical committee of Geneva (BASEC #: 2020-00917).</p></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 2","pages":"Article 101348"},"PeriodicalIF":5.5,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352556824000067/pdfft?md5=834929409185c9facaac6ff76e98ccbd&pid=1-s2.0-S2352556824000067-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139554225","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 : 2024-01-24DOI: 10.1016/j.accpm.2024.101347
Yair Binyamin , Sharon Orbach-Zinger , Alexander Ioscovich , Yair Yaish Reina , Yoav Bichovsky , Igor Gruzman , Alexander Zlotnik , Evgeny Brotfain
Background
The risk of aspiration during general anesthesia for cesarean delivery has long been thought to be increased due to factors such as increased intra-abdominal pressures and delayed gastric emptying in pregnant patients. However, recent studies have reported normal gastric emptying in pregnant patients, suggesting that the risk of aspiration may not be as high as previously believed.
Methods
We conducted a retrospective study of 48,609 cesarean deliveries, of which 22,690 (46.7%) were performed under general anesthesia at two large tertiary medical centers in Israel. The study aimed to examine the incidence of potentially severe aspiration during cesarean delivery, both under general and neuraxial anesthesia.
Results
Among the patients included in the study, three were admitted to the intensive care unit due to suspected pulmonary aspiration. Two of these cases occurred during induction of general anesthesia for emergency cesarean delivery associated with difficult intubation and one under deep sedation during spinal anesthesia. The incidence of aspiration during cesarean delivery during general anesthesia in our study was 1 in 11,345 patients, and the incidence of aspiration during neuraxial anesthesia was 1 in 25,929 patients. No deaths due to aspiration were reported during the study period.
Conclusions
Our findings provide another contemporary analysis of aspiration rates in obstetric patients, highlighting increased risks during the management of difficult airways during general anesthesia and deep sedation associated with neuraxial anesthesia.
{"title":"Incidence and clinical impact of aspiration during cesarean delivery: A multi-center retrospective study","authors":"Yair Binyamin , Sharon Orbach-Zinger , Alexander Ioscovich , Yair Yaish Reina , Yoav Bichovsky , Igor Gruzman , Alexander Zlotnik , Evgeny Brotfain","doi":"10.1016/j.accpm.2024.101347","DOIUrl":"10.1016/j.accpm.2024.101347","url":null,"abstract":"<div><h3>Background</h3><p>The risk of aspiration during general anesthesia for cesarean delivery has long been thought to be increased due to factors such as increased intra-abdominal pressures and delayed gastric emptying in pregnant patients. However, recent studies have reported normal gastric emptying in pregnant patients, suggesting that the risk of aspiration may not be as high as previously believed.</p></div><div><h3>Methods</h3><p>We conducted a retrospective study of 48,609 cesarean deliveries, of which 22,690 (46.7%) were performed under general anesthesia at two large tertiary medical centers in Israel. The study aimed to examine the incidence of potentially severe aspiration during cesarean delivery, both under general and neuraxial anesthesia.</p></div><div><h3>Results</h3><p>Among the patients included in the study, three were admitted to the intensive care unit due to suspected pulmonary aspiration. Two of these cases occurred during induction of general anesthesia for emergency cesarean delivery associated with difficult intubation and one under deep sedation during spinal anesthesia. The incidence of aspiration during cesarean delivery during general anesthesia in our study was 1 in 11,345 patients, and the incidence of aspiration during neuraxial anesthesia was 1 in 25,929 patients. No deaths due to aspiration were reported during the study period.</p></div><div><h3>Conclusions</h3><p>Our findings provide another contemporary analysis of aspiration rates in obstetric patients, highlighting increased risks during the management of difficult airways during general anesthesia and deep sedation associated with neuraxial anesthesia.</p></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 2","pages":"Article 101347"},"PeriodicalIF":5.5,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139554165","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 : 2024-01-24DOI: 10.1016/j.accpm.2024.101346
Manuel Taboada , Agustín Cariñena , Ana Estany-Gestal , Diego Iglesias-Álvarez , Sonia Veiras , Adrián Martínez , María Eiras , Manuela De Miguel , Salomé Selas , Amparo Martínez-Monzonis , Pedro Pereira , María Bastos-Fernández , Violeta González-Salvado , María Álvarez-Barrado , Esteban Ferreiroa , Valentín Caruezo , Jose Costa , Alberto Naveira , Pablo Otero , Belén Adrio , Teresa Seoane-Pillado
Background
Transesophageal echocardiogram probe insertion in intubated critically ill patients can be difficult, leading to complications, such as gastric bleeding or lesions in the oropharyngeal mucosa. We hypothesised that the use of a videolaryngoscope would facilitate the first attempt at insertion of the transesophageal echocardiogram probe and would decrease the incidence of complications compared to the conventional insertion technique.
Methods
In this clinical trial, patients were randomly assigned the insertion of a transesophageal echocardiogram probe using a videolaryngoscope or conventional technique. The primary outcome was the successful transesophageal echocardiogram probe insertion on the first attempt. The secondary outcomes included total success rate, number of insertion attempts, and incidence of pharyngeal complications.
Results
A total of 100 intubated critically ill patients were enrolled. The success rate of transesophageal echocardiogram probe insertion on the first attempt was higher in the videolaryngoscope group than in the conventional group (90% vs. 58%; absolute difference, 32%; 95% CI 16%–48%; p < 0.001). The overall success rate was higher in the videolaryngoscope group than in the conventional group (100% vs. 72%; absolute difference, 28%; 95% CI 16%–40%; p < 0.001). The incidence of pharyngeal mucosal injury was smaller in the videolaryngoscope group than in the conventional group (14% vs. 52%; absolute difference, 38%; 95% CI 21%–55%; p < 0.001).
Conclusions
Our study showed that in intubated critically ill patients required transesophageal echocardiogram, the use of videolaryngoscope resulted in higher successful insertion on the first attempt with lower rate of complications when compared with the conventional insertion technique.
Trial registration
ClinicalTrials.gov Identifier: NCT04980976.
背景在插管的重症患者中插入经食道超声心动图探头可能很困难，从而导致并发症，如胃出血或口咽粘膜病变。我们假设，与传统的插入技术相比，使用视频喉镜将有助于首次尝试插入经食道超声心动图探头，并能降低并发症的发生率。主要结果是首次成功插入经食道超声心动图探头。次要结果包括总成功率、插入次数和咽部并发症的发生率。首次插入经食道超声心动图探头的成功率，视频喉镜组高于传统组（90% 对 58%；绝对差异，32%；95% CI 16%-48%；P <；0.001）。视频喉镜组的总体成功率高于常规组（100% 对 72%；绝对差异为 28%；95% CI 为 16%-40%；p <；0.001）。视频喉镜组的咽部粘膜损伤发生率低于传统组（14% 对 52%；绝对差异，38%；95% CI 21%-55%；p <；0.001）。结论我们的研究表明，对于需要经食道超声心动图的插管重症患者，与传统插管技术相比，使用视频喉镜首次插管成功率更高，并发症发生率更低：NCT04980976。
{"title":"Videolaryngoscope versus conventional technique for insertion of a transesophageal echocardiography probe in intubated ICU patients (VIDLARECO trial): A randomized clinical trial","authors":"Manuel Taboada , Agustín Cariñena , Ana Estany-Gestal , Diego Iglesias-Álvarez , Sonia Veiras , Adrián Martínez , María Eiras , Manuela De Miguel , Salomé Selas , Amparo Martínez-Monzonis , Pedro Pereira , María Bastos-Fernández , Violeta González-Salvado , María Álvarez-Barrado , Esteban Ferreiroa , Valentín Caruezo , Jose Costa , Alberto Naveira , Pablo Otero , Belén Adrio , Teresa Seoane-Pillado","doi":"10.1016/j.accpm.2024.101346","DOIUrl":"10.1016/j.accpm.2024.101346","url":null,"abstract":"<div><h3>Background</h3><p>Transesophageal echocardiogram probe insertion in intubated critically ill patients can be difficult, leading to complications, such as gastric bleeding or lesions in the oropharyngeal mucosa. We hypothesised that the use of a videolaryngoscope would facilitate the first attempt at insertion of the transesophageal echocardiogram probe and would decrease the incidence of complications compared to the conventional insertion technique.</p></div><div><h3>Methods</h3><p>In this clinical trial, patients were randomly assigned the insertion of a transesophageal echocardiogram probe using a videolaryngoscope or conventional technique. The primary outcome was the successful transesophageal echocardiogram probe insertion on the first attempt. The secondary outcomes included total success rate, number of insertion attempts, and incidence of pharyngeal complications.</p></div><div><h3>Results</h3><p>A total of 100 intubated critically ill patients were enrolled. The success rate of transesophageal echocardiogram probe insertion on the first attempt was higher in the videolaryngoscope group than in the conventional group (90% <em>vs.</em> 58%; absolute difference, 32%; 95% CI 16%–48%; <em>p</em> < 0.001). The overall success rate was higher in the videolaryngoscope group than in the conventional group (100% <em>vs.</em> 72%; absolute difference, 28%; 95% CI 16%–40%; <em>p</em> < 0.001). The incidence of pharyngeal mucosal injury was smaller in the videolaryngoscope group than in the conventional group (14% <em>vs.</em> 52%; absolute difference, 38%; 95% CI 21%–55%; <em>p</em> < 0.001).</p></div><div><h3>Conclusions</h3><p>Our study showed that in intubated critically ill patients required transesophageal echocardiogram, the use of videolaryngoscope resulted in higher successful insertion on the first attempt with lower rate of complications when compared with the conventional insertion technique.</p></div><div><h3>Trial registration</h3><p>ClinicalTrials.gov Identifier: NCT04980976.</p></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 2","pages":"Article 101346"},"PeriodicalIF":5.5,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139554173","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 : 2024-01-23DOI: 10.1016/j.accpm.2024.101345
Pierre Bouzat, GITE Network
{"title":"Standardizing categorization of major trauma patients in France: A position paper from the GITE Network","authors":"Pierre Bouzat, GITE Network","doi":"10.1016/j.accpm.2024.101345","DOIUrl":"10.1016/j.accpm.2024.101345","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 2","pages":"Article 101345"},"PeriodicalIF":5.5,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139554166","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 : 2024-01-23DOI: 10.1016/j.accpm.2024.101344
Armelle Nicolas-Robin , Jean-Yves Lefrant
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