Canadian Journal of Anesthesia-Journal Canadien D Anesthesie最新文献

Purpose: Accurate hemodynamic monitoring is essential for personalized care in surgical and intensive care unit (ICU) settings, and radial artery catheters are the gold standard. Nevertheless, central-to-peripheral arterial blood pressure gradients (CPAPGs) have been reported in up to 77% of patients, potentially leading to misinformed clinical decisions. Identifying patients at risk of CPAPGs is crucial to adapt monitoring strategies. We aimed to identify the risk factors contributing to CPAPGs and assess their level of consensus in a systematic review of the literature.

Methods: For this systematic review, we searched MEDLINE/PubMed®, Embase, and Cochrane databases (CENTRAL and Database of Systematic Reviews) from inception to 15 July 2024. Studies on adult patients with simultaneous radial and central arterial pressure monitoring were included. We extracted and analyzed risk factors and assessed the consistency of the literature for each.

Results: From 741 retrieved articles, we included 55 studies (N = 5,598) evaluating the presence of CPAPGs during cardiopulmonary bypass, hepatic transplant, ICU stay, and other settings. Overall, 90 unique potential risk factors were evaluated, with 36 showing a statistically significant association with CPAPGs. Complex procedures and smaller radial artery diameter were the most consistent predictors, with both showing significant association with CPAPGs in the 3 studies evaluating them. Vasopressor usage showed statistical significance in half the studies evaluating it, and demographic factors, potentially associated with smaller radial artery diameter, such as older age, shorter stature, and female sex, were also statistically significant risk factors in some studies.

Conclusions: The present systematic review identified numerous risk factors for CPAPGs. In patients with multiple contributing factors, clinicians should consider using more central arterial cannulation to minimize the risk of inaccurate pressure measurements.

Study registration: PROSPERO ( CRD42024561474 ); first submitted 10 July 2024.

Purpose: Extreme weather events have been increasing in frequency and intensity globally. Surgical patients may be particularly susceptible to the impact of extreme weather on health outcomes and health care delivery. Our primary objective was to synthesize the available evidence on the association between extreme weather events and postoperative adverse outcomes within thirty days after surgery.

Methods: We performed a systematic review of the literature, searching MEDLINE on PubMed®, Embase, CINAHL, Web of Science, and the Cochrane Database of Systematic Reviews for English-language, full-text articles published prior to 30 May 2024. We included studies that involved surgical patients, exposure to an extreme weather event thirty days pre- or postoperatively, and had one or more adverse outcome within thirty days postoperatively. Screening and extraction were performed by two independent reviewers. We also performed thematic analysis to summarize the impact of extreme weather events on postoperative health care delivery.

Results: Our search identified 8,422 articles, of which 4 studies encompassing 117,804 surgical patients qualified for inclusion (3 on heatwave or extreme heat, and 1 on wildfire smoke). Retrospective studies linked temperatures > 40 °C to increased perioperative complications in trauma patients (1 study), temperatures > 30 °C to increased length of hospital stay in patients older than 60 yr (1 study), and wildfire smoke to respiratory complications in pediatric patients with prematurity or respiratory conditions (1 study). Health delivery domains that were affected were patients (3 studies), care processes and infrastructure (2 studies), and capacity (2 studies). The studies were limited by heterogenous definitions of exposure, confounding, and bias.

Conclusions: Our review revealed major research gaps in the impact of extreme weather events on postoperative outcomes and health care delivery. Existing literature is scant and limited by substantial methodologic issues, and further research is urgently required.

Study registration: PROSPERO ( CRD42023435273 ); first submitted 26 June 2023.

Purpose: Inequities for sexual- and gender-minoritized (SGM) populations in organ and tissue donation and transplantation (OTDT) have been identified. We aimed to understand the awareness and attitudes of community members who are SGM regarding current SGM-relevant policies, policy gaps, and policy alternatives in Canadian OTDT systems.

Methods: We conducted an online, cross-sectional, Canada-wide survey of members of the Two-Spirit, gay, bisexual, transgender, queer, intersex and more (2SGBTQI+) communities (June-September 2024). Questionnaire development adhered to current survey science recommendations. We present descriptive data as counts and proportions.

Results: We analyzed responses from a convenience sample of 2,276 participants from across Canada. Most participants self-identified as White cisgender gay men. Prior to questionnaire completion, only 17% (257/1,497) of participants were aware that men who have sex with men are considered "increased infectious risk donors" in OTDT and cannot donate tissues, and 20% (302/1,512) were aware that they may only donate organs if the benefit to the recipient is deemed to outweigh the risk. Of the respondents, 18% (270/1,535) did not realize that potential donors are screened on the basis of sex assigned at birth as opposed to self-identified gender identity. On average, 23% (1,406/6,084) of participants perceived these policies as nondiscriminatory. Of the respondents, 60% (1,865/3,115) supported gender-neutral, behavior-focused donor risk assessments that were data-driven. Most participants reported a willingness to donate organs (79%; 1,237/2,276) and tissues (72%; 1,123/2,276) after death.

Conclusions: People in Canada who self-identify as 2SGBTQI+ perceived current OTDT policies to be discriminatory and in need of equitable revision. Evidence-based behavioral and gender-neutral donor risk criteria were preferred over identity-based criteria. The majority of survey participants who identify as SGM were willing to donate organs and tissues despite current system inequities. Health Canada should revise current donor risk assessment criteria to ensure they are data-driven and optimize access and safety to OTDT in Canada.

Purpose: We sought to describe the clinical features and outcomes of adult patients with traumatic brain injury in Ontario.

Methods: We carried out a cohort study of adult patients admitted to an intensive care unit (April 2009 to March 2021) with a first episode of traumatic brain injury. To compare the long-term outcome trajectory after traumatic brain injury, we matched patients with traumatic brain injury 1:1 to patients who survived an intensive care unit admission with multisystem trauma but without traumatic brain injury. We measured in-hospital and long-term all-cause mortality; additional endpoints included 1) new psychiatric diagnosis, 2) epilepsy, 3) venous thromboembolic disease, and 4) sepsis. We estimated hazard ratios (HR) with 95% confidence intervals (CI).

Results: Overall, we included 13,283 adult patients with traumatic brain injury. The mean age was 54 yr; 72% of patients were male. The most common pre-existing comorbidities were hypertension (39%) and cardiovascular disease (19%). Median follow-up was 5 years; 17% of patients with traumatic brain injury died during their initial hospital stay, and 16% died during long-term follow-up. Sepsis after hospital discharge occurred in 14% of patients; additional outcomes included new psychiatric diagnosis (7%), epilepsy (4%), and venous thromboembolic disease (2%). Surviving traumatic brain injury was associated with a higher hazard of epilepsy (HR, 2.42; 95% CI, 1.99 to 2.95); the risk of other outcomes was similar or lower when compared with survivors without traumatic brain injury.

Conclusions: Patients with traumatic brain injury have a high risk of in-hospital death. Those who survive the initial hospitalization are at risk of long-term outcomes including new epilepsy.