Pub Date : 2025-01-01Epub Date: 2024-10-18DOI: 10.1111/aas.14526
Katrine Tanggaard, Caroline Gronlund, Martin V Nielsen, Kirstine la Cour, Casper D Tvarnø, Jens Børglum, Mathias Maagaard, Ole Mathiesen
Background: The anterior quadratus lumborum (QL) block may be used for postoperative pain management for intra-abdominal surgeries, but the evidence is uncertain. We aimed to investigate the benefit and harm of the anterior QL block compared to placebo/no block for intra-abdominal surgery.
Methods: We searched Medline, Embase, and CENTRAL for randomized controlled trials investigating anterior QL block for postoperative pain management for adult patients undergoing any intra-abdominal surgery. The two co-primary outcomes were cumulative 24-h opioid consumption and serious adverse events. We performed meta-analysis, trial sequential analysis (TSA), assessed the risk of bias, and present the certainty of evidence with the Grading of Recommendations, Assessment, Development and Evaluation approach.
Results: Thirty-five trials randomizing 2418 patients were included in the meta-analyses. Anterior QL block may reduce cumulative 24-h intravenous opioid consumption compared to placebo/no block (MD -10.42 mg, 96.7% CI -14.83 to -6.01, TSA-adjusted CI -17.03 to -3.82, p < .01). Two trials reported on SAEs. Anterior QL block may have little to no effect on the number of serious adverse events compared to placebo (RR 1.49, 96.7% CI 0.19 to 11.47, p = .68), but the evidence is very uncertain. All trial results were assessed as being high risk of bias.
Conclusions: The anterior QL block may reduce cumulative 24-h opioid consumption. Reported serious adverse events were few and the anterior QL block may have little to no effect on the number of SAEs, but the evidence was very uncertain.
背景:腰前肌阻滞(QL)可用于腹腔内手术的术后疼痛治疗,但相关证据尚不确定。我们的目的是研究腹腔内手术中前QL阻滞与安慰剂/无阻滞相比的利弊:我们在 Medline、Embase 和 CENTRAL 中检索了对接受任何腹腔内手术的成年患者进行 QL 前阻滞术后疼痛治疗的随机对照试验。两个共同主要结果是 24 小时阿片类药物累积用量和严重不良事件。我们进行了荟萃分析、试验序列分析(TSA),评估了偏倚风险,并采用建议、评估、发展和评价分级法对证据的确定性进行了评估:荟萃分析共纳入了35项试验,随机抽取了2418名患者。与安慰剂/无阻滞相比,QL前阻滞可减少24小时阿片类药物的累积静脉用量(MD -10.42 mg,96.7% CI -14.83 to -6.01,TSA调整后CI -17.03 to -3.82,P 结论:QL前阻滞可减少24小时阿片类药物的累积静脉用量:QL前阻滞可减少24小时阿片类药物的累积用量。报告的严重不良事件很少,QL前阻滞可能对SAE的数量几乎没有影响,但证据非常不确定。
{"title":"Anterior quadratus lumborum blocks for postoperative pain treatment following intra-abdominal surgery: A systematic review with meta-analyses and trial sequential analyses.","authors":"Katrine Tanggaard, Caroline Gronlund, Martin V Nielsen, Kirstine la Cour, Casper D Tvarnø, Jens Børglum, Mathias Maagaard, Ole Mathiesen","doi":"10.1111/aas.14526","DOIUrl":"10.1111/aas.14526","url":null,"abstract":"<p><strong>Background: </strong>The anterior quadratus lumborum (QL) block may be used for postoperative pain management for intra-abdominal surgeries, but the evidence is uncertain. We aimed to investigate the benefit and harm of the anterior QL block compared to placebo/no block for intra-abdominal surgery.</p><p><strong>Methods: </strong>We searched Medline, Embase, and CENTRAL for randomized controlled trials investigating anterior QL block for postoperative pain management for adult patients undergoing any intra-abdominal surgery. The two co-primary outcomes were cumulative 24-h opioid consumption and serious adverse events. We performed meta-analysis, trial sequential analysis (TSA), assessed the risk of bias, and present the certainty of evidence with the Grading of Recommendations, Assessment, Development and Evaluation approach.</p><p><strong>Results: </strong>Thirty-five trials randomizing 2418 patients were included in the meta-analyses. Anterior QL block may reduce cumulative 24-h intravenous opioid consumption compared to placebo/no block (MD -10.42 mg, 96.7% CI -14.83 to -6.01, TSA-adjusted CI -17.03 to -3.82, p < .01). Two trials reported on SAEs. Anterior QL block may have little to no effect on the number of serious adverse events compared to placebo (RR 1.49, 96.7% CI 0.19 to 11.47, p = .68), but the evidence is very uncertain. All trial results were assessed as being high risk of bias.</p><p><strong>Conclusions: </strong>The anterior QL block may reduce cumulative 24-h opioid consumption. Reported serious adverse events were few and the anterior QL block may have little to no effect on the number of SAEs, but the evidence was very uncertain.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":" ","pages":"e14526"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142455396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Viscoelastic testing (VET) has been implemented in clinical care to diagnose and manage coagulation in patients with manifest or high risk of major bleeding. However, the breakdown of formed blood clots, that is, fibrinolysis, has been comparatively less studied. There is an increasing recognition that acute infections trigger a dysregulated immunothrombotic response, which has focused attention on viscoelastic testing to identify in particular fibrinolysis resistant states.
Methods: This scoping review on fibrinolysis assessment using viscoelastic testing will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Publications will be included in the review if they evaluate the fibrinolytic capacity of adult patients admitted to an intensive care unit (ICU) for acute infection (including SARS-CoV2) using VET assays that included a fibrinolytic agent. No date or language restrictions will be applied, and all study designs will be considered. A peer-reviewed search strategy will be employed in multiple electronic bibliographic databases and will also include the grey literature.
Results: The included studies will be reported by descriptive analyses and tabulated results.
Conclusion: This scoping review aims to map the research describing viscoelastic testing (VET) to assess fibrinolysis in acutely infected critically ill patients, with the goal of identifying diagnostic capabilities, any associations with patient outcomes, and the potential to guide clinical management.
导言:粘弹性测试(VET)已被应用于临床护理,以诊断和管理有明显大出血或大出血高风险患者的凝血功能。然而,对已形成血凝块的分解,即纤维蛋白溶解的研究相对较少。越来越多的人认识到,急性感染会引发失调的免疫性血栓反应,这使人们开始关注粘弹性测试,以特别识别纤溶耐药状态:本综述将根据《系统综述和荟萃分析的首选报告项目》(Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews,PRISMA-ScR)对使用粘弹性测试进行的纤溶评估进行范围界定。只要是使用含纤维蛋白溶解剂的 VET 检测方法对因急性感染(包括 SARS-CoV2)而入住重症监护室(ICU)的成人患者的纤维蛋白溶解能力进行评估的文献,都将被纳入综述。没有日期或语言限制,所有研究设计都将考虑在内。将在多个电子文献数据库中采用同行评审的检索策略,还将包括灰色文献:结果:纳入的研究将通过描述性分析和列表结果进行报告:本范围综述旨在绘制粘弹性测试(VET)研究图,以评估急性感染重症患者的纤维蛋白溶解情况,目的是确定诊断能力、与患者预后的关联以及指导临床管理的潜力。
{"title":"Viscoelastic testing of fibrinolytic capacity in acutely infected critically ill patients: Protocol for a scoping review.","authors":"Matthew Self, Lucy Coupland, Anders Aneman","doi":"10.1111/aas.14533","DOIUrl":"10.1111/aas.14533","url":null,"abstract":"<p><strong>Introduction: </strong>Viscoelastic testing (VET) has been implemented in clinical care to diagnose and manage coagulation in patients with manifest or high risk of major bleeding. However, the breakdown of formed blood clots, that is, fibrinolysis, has been comparatively less studied. There is an increasing recognition that acute infections trigger a dysregulated immunothrombotic response, which has focused attention on viscoelastic testing to identify in particular fibrinolysis resistant states.</p><p><strong>Methods: </strong>This scoping review on fibrinolysis assessment using viscoelastic testing will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Publications will be included in the review if they evaluate the fibrinolytic capacity of adult patients admitted to an intensive care unit (ICU) for acute infection (including SARS-CoV2) using VET assays that included a fibrinolytic agent. No date or language restrictions will be applied, and all study designs will be considered. A peer-reviewed search strategy will be employed in multiple electronic bibliographic databases and will also include the grey literature.</p><p><strong>Results: </strong>The included studies will be reported by descriptive analyses and tabulated results.</p><p><strong>Conclusion: </strong>This scoping review aims to map the research describing viscoelastic testing (VET) to assess fibrinolysis in acutely infected critically ill patients, with the goal of identifying diagnostic capabilities, any associations with patient outcomes, and the potential to guide clinical management.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 1","pages":"e14533"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142589416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-09-23DOI: 10.1111/aas.14520
Guillermo Lema
{"title":"Lack of correlation between biomarkers and acute kidney injury after pediatric cardiac surgery with cardiopulmonary bypass: Should be look for something else?","authors":"Guillermo Lema","doi":"10.1111/aas.14520","DOIUrl":"10.1111/aas.14520","url":null,"abstract":"","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":" ","pages":"1607"},"PeriodicalIF":1.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142306932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-09-26DOI: 10.1111/aas.14527
Per Kristian Hyldmo, Marius Rehn, Kristian Dahl Friesgaard, Leif Rognås, Lasse Raatiniemi, Jouni Kurola, Robert Larsen, Poul Kongstad, Mårten Sandberg, Vidar Magnusson, Gunn Elisabeth Vist
Background: Many prehospital emergency patients receive suboptimal treatment for their moderate to severe pain. Various factors may contribute. We aim to systematically review literature pertaining to prehospital emergency adult patients with acute pain and the pain-reducing effects, adverse events (AEs), and safety issues associated with inhaled analgetic agents compared with other prehospital analgesic agents.
Methods: As part of an initiative from the Scandinavian Society of Anaesthesia and Intensive Care Medicine, we conducted a systematic review (PROSPERO CRD42018114399), applying the PRISMA guidelines, Grading of Recommendations Assessment, Development, and Evaluation (GRADE), and Cochrane methods, searching the Cochrane Library, Epistemonikos, Centre for Reviews and Dissemination, PubMed, and EMBASE databases (updated March 2024). Inclusion criteria were the use of inhaled analgesic agents in adult patients with acute pain in the prehospital emergency care setting. All steps were performed by minimum of two individual researchers. The primary outcome was pain reduction; secondary outcomes were speed of onset, duration of effect, and relevant AEs.
Results: We included seven studies (56,535 patients in total) that compared inhaled agents (methoxyflurane [MF] and nitrous oxide [N2O]) to other drugs or placebo. Study designs were randomized controlled trial (1; n = 60), randomized non-blinded study (1; n = 343), and randomized open-label study (1; n = 270). The remaining were prospective or retrospective observational studies. The evidence according to GRADE was of low or very low quality. No combined meta-analysis was possible. N2O may reduce pain compared to placebo, but not compared to intravenous (IV) paracetamol, and may be less effective compared to morphine and MF. MF may reduce pain compared to paracetamol, ketoprofen, tramadol, and fentanyl. Both agents may be associated with marked but primarily mild AEs.
Conclusion: We found low-quality evidence suggesting that both MF and N2O are safe and may have a role in the management of pain in the prehospital setting. There is low-quality evidence to support MF as a short-acting single analgesic or as a bridge to IV access and the administration of other analgesics. There may be occupational health issues regarding the prehospital use of N2O.
{"title":"Inhaled analgesics for the treatment of prehospital acute pain-A systematic review.","authors":"Per Kristian Hyldmo, Marius Rehn, Kristian Dahl Friesgaard, Leif Rognås, Lasse Raatiniemi, Jouni Kurola, Robert Larsen, Poul Kongstad, Mårten Sandberg, Vidar Magnusson, Gunn Elisabeth Vist","doi":"10.1111/aas.14527","DOIUrl":"10.1111/aas.14527","url":null,"abstract":"<p><strong>Background: </strong>Many prehospital emergency patients receive suboptimal treatment for their moderate to severe pain. Various factors may contribute. We aim to systematically review literature pertaining to prehospital emergency adult patients with acute pain and the pain-reducing effects, adverse events (AEs), and safety issues associated with inhaled analgetic agents compared with other prehospital analgesic agents.</p><p><strong>Methods: </strong>As part of an initiative from the Scandinavian Society of Anaesthesia and Intensive Care Medicine, we conducted a systematic review (PROSPERO CRD42018114399), applying the PRISMA guidelines, Grading of Recommendations Assessment, Development, and Evaluation (GRADE), and Cochrane methods, searching the Cochrane Library, Epistemonikos, Centre for Reviews and Dissemination, PubMed, and EMBASE databases (updated March 2024). Inclusion criteria were the use of inhaled analgesic agents in adult patients with acute pain in the prehospital emergency care setting. All steps were performed by minimum of two individual researchers. The primary outcome was pain reduction; secondary outcomes were speed of onset, duration of effect, and relevant AEs.</p><p><strong>Results: </strong>We included seven studies (56,535 patients in total) that compared inhaled agents (methoxyflurane [MF] and nitrous oxide [N<sub>2</sub>O]) to other drugs or placebo. Study designs were randomized controlled trial (1; n = 60), randomized non-blinded study (1; n = 343), and randomized open-label study (1; n = 270). The remaining were prospective or retrospective observational studies. The evidence according to GRADE was of low or very low quality. No combined meta-analysis was possible. N<sub>2</sub>O may reduce pain compared to placebo, but not compared to intravenous (IV) paracetamol, and may be less effective compared to morphine and MF. MF may reduce pain compared to paracetamol, ketoprofen, tramadol, and fentanyl. Both agents may be associated with marked but primarily mild AEs.</p><p><strong>Conclusion: </strong>We found low-quality evidence suggesting that both MF and N<sub>2</sub>O are safe and may have a role in the management of pain in the prehospital setting. There is low-quality evidence to support MF as a short-acting single analgesic or as a bridge to IV access and the administration of other analgesics. There may be occupational health issues regarding the prehospital use of N<sub>2</sub>O.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":" ","pages":"1306-1318"},"PeriodicalIF":1.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142338978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-08-06DOI: 10.1111/aas.14508
Anders Peder Højer Karlsen, Pernille Bjersand Sunde, Markus Harboe Olsen, Jens Laigaard, Caroline Folkersen, Trang Xuan Minh Tran, Ida Houtved Rasmussen, Selma Kjartansdóttir, Atena Saito, Michael Asger Andersen, Mathias Maagaard, Nicholas Papadomanolakis-Pakis, Kim Dalhoff, Lone Nikolajsen, Troels Haxholdt Lunn, Christian Sylvest Meyhoff, Janus Christian Jakobsen, Ole Mathiesen
Background: Treatment with opioids is a mainstay in perioperative pain management. While the leading treatment paradigm has been procedure-specific pain management, efforts regarding personalized pain treatment are increasing. The OPI•AID project aims to develop personalized algorithms for perioperative pain management, taking demographic, surgical, and anaesthesiologic factors into account. We will undertake five parallel reviews to illuminate current evidence on different aspects of individual responses to perioperative opioid treatment.
Methods: Inclusion of adult populations in English-written studies. Review-specific searches are developed for the following databases: CENTRAL, MEDLINE, Embase, clinicaltrials.gov, and clinicaltrial.eu. Two authors will independently screen citations, extract data, and assess the risks of bias in each review (QUIPS, PROBAST and RoB2, as relevant).
Conclusion: These reviews will evaluate various aspects of perioperative opioid treatment, including individualized treatment strategies, selection of specific opioids, and individual patient responses. These will guide future development of a personalized perioperative opioid treatment algorithm (OPI•AID) that will be validated and tested clinically against standard of care.
{"title":"Opioids and personalized analgesia in the perioperative setting: A protocol for five systematic reviews.","authors":"Anders Peder Højer Karlsen, Pernille Bjersand Sunde, Markus Harboe Olsen, Jens Laigaard, Caroline Folkersen, Trang Xuan Minh Tran, Ida Houtved Rasmussen, Selma Kjartansdóttir, Atena Saito, Michael Asger Andersen, Mathias Maagaard, Nicholas Papadomanolakis-Pakis, Kim Dalhoff, Lone Nikolajsen, Troels Haxholdt Lunn, Christian Sylvest Meyhoff, Janus Christian Jakobsen, Ole Mathiesen","doi":"10.1111/aas.14508","DOIUrl":"10.1111/aas.14508","url":null,"abstract":"<p><strong>Background: </strong>Treatment with opioids is a mainstay in perioperative pain management. While the leading treatment paradigm has been procedure-specific pain management, efforts regarding personalized pain treatment are increasing. The OPI•AID project aims to develop personalized algorithms for perioperative pain management, taking demographic, surgical, and anaesthesiologic factors into account. We will undertake five parallel reviews to illuminate current evidence on different aspects of individual responses to perioperative opioid treatment.</p><p><strong>Methods: </strong>Inclusion of adult populations in English-written studies. Review-specific searches are developed for the following databases: CENTRAL, MEDLINE, Embase, clinicaltrials.gov, and clinicaltrial.eu. Two authors will independently screen citations, extract data, and assess the risks of bias in each review (QUIPS, PROBAST and RoB2, as relevant).</p><p><strong>Conclusion: </strong>These reviews will evaluate various aspects of perioperative opioid treatment, including individualized treatment strategies, selection of specific opioids, and individual patient responses. These will guide future development of a personalized perioperative opioid treatment algorithm (OPI•AID) that will be validated and tested clinically against standard of care.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":" ","pages":"1573-1580"},"PeriodicalIF":1.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141896442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-08-27DOI: 10.1111/aas.14516
Sine Wichmann, Dorthe Ørsnes Christensen, Claus Antonio Juel Jensen, Jette Bangsborg, Mette Kolpen, Morten Heiberg Bestle
Background: Early initiation of targeted antibiotic therapy is important to achieve the best patient outcomes in intubated patients with pneumonia in the intensive care unit (ICU). This study aimed to investigate the applicability of multiplex polymerase chain reaction (PCR) in an ICU by comparing the test results to the results of conventional microbiological methods to assess the possible impact on antibiotic therapy.
Method: This retrospective study investigated adult patients with pneumonia on mechanical ventilation in the ICU. Tracheal aspirates were collected within 24h after intubation and the initiation of mechanical ventilation. Samples were initially tested by conventional microbiological methods and subsequently re-evaluated with rapid multiplex PCR on stored samples. Concordance between the two methods was assessed. An intensivist and a microbiologist retrospectively reviewed the patients' electronic health records for relevant clinical details to evaluate the potential impact of multiplex PCR results on antibiotic therapy.
Results: In this study, 76 patients were enrolled and 55 (72.4%) tested positive for 95 pathogens using multiplex PCR, while conventional microbiological methods identified 40 pathogens in 32 (42.2%) patients. Concordance between the two methods was observed in 42 (55.3%) patients. Multiplex PCR detected 39 additional pathogens in 31 (40.7%) patients. Retrospective analysis indicated potential antibiotic de-escalation in 35 (46.1%) patients and escalation in 4 (5.3%) patients. Multiplex PCR significantly reduced the turnaround time for test results.
Conclusion: In ICU patients with suspected pneumonia, multiplex PCR identified a higher number of pathogens compared to CMM. A retrospective assessment indicates that the use of multiplex PCR could potentially have prompted the de-escalation of antibiotic therapy in nearly half of the patients. Therefore, multiplex PCR may serve as a supplement to CMM in guiding antibiotic stewardship.
{"title":"Antibiotic stewardship with multiplex PCR for pneumonia in intensive care patients: A retrospective study.","authors":"Sine Wichmann, Dorthe Ørsnes Christensen, Claus Antonio Juel Jensen, Jette Bangsborg, Mette Kolpen, Morten Heiberg Bestle","doi":"10.1111/aas.14516","DOIUrl":"10.1111/aas.14516","url":null,"abstract":"<p><strong>Background: </strong>Early initiation of targeted antibiotic therapy is important to achieve the best patient outcomes in intubated patients with pneumonia in the intensive care unit (ICU). This study aimed to investigate the applicability of multiplex polymerase chain reaction (PCR) in an ICU by comparing the test results to the results of conventional microbiological methods to assess the possible impact on antibiotic therapy.</p><p><strong>Method: </strong>This retrospective study investigated adult patients with pneumonia on mechanical ventilation in the ICU. Tracheal aspirates were collected within 24h after intubation and the initiation of mechanical ventilation. Samples were initially tested by conventional microbiological methods and subsequently re-evaluated with rapid multiplex PCR on stored samples. Concordance between the two methods was assessed. An intensivist and a microbiologist retrospectively reviewed the patients' electronic health records for relevant clinical details to evaluate the potential impact of multiplex PCR results on antibiotic therapy.</p><p><strong>Results: </strong>In this study, 76 patients were enrolled and 55 (72.4%) tested positive for 95 pathogens using multiplex PCR, while conventional microbiological methods identified 40 pathogens in 32 (42.2%) patients. Concordance between the two methods was observed in 42 (55.3%) patients. Multiplex PCR detected 39 additional pathogens in 31 (40.7%) patients. Retrospective analysis indicated potential antibiotic de-escalation in 35 (46.1%) patients and escalation in 4 (5.3%) patients. Multiplex PCR significantly reduced the turnaround time for test results.</p><p><strong>Conclusion: </strong>In ICU patients with suspected pneumonia, multiplex PCR identified a higher number of pathogens compared to CMM. A retrospective assessment indicates that the use of multiplex PCR could potentially have prompted the de-escalation of antibiotic therapy in nearly half of the patients. Therefore, multiplex PCR may serve as a supplement to CMM in guiding antibiotic stewardship.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":" ","pages":"1456-1462"},"PeriodicalIF":1.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142078771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-07-21DOI: 10.1111/aas.14497
Jeannie Callum, Zbignew Putowski, Waleed Alhazzani, Emilie Belley-Cote, Morten Hylander Møller, Nicola Curry, Zainab Al Duhailib, Mark Fung, Louise Giocobbo, Anders Granholm, Vernon Louw, Patrick Maybohm, Marcella Muller, Nathan Nielsen, Curtis Oleschuk, Sheharyar Raza, Elizabeth Scruth, Deborah Siegal, Simon J Stanworth, Alexander P J Vlaar, Micheline White, Simon Oczkowski
Background: This Intensive Care Medicine Rapid Practice Guideline (ICM-RPG) provides an evidence-based recommendation to address the question: in adult patients in intensive care units (ICUs), should we use small-volume or conventional blood collection tubes?
Methods: We included 23 panelists in 8 countries and assessed and managed financial and intellectual conflicts of interest. Methodological support was provided by the Guidelines in Intensive Care, Development, and Evaluation (GUIDE) group. We conducted a systematic review, including evidence from observational and randomized studies. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach, we evaluated the certainty of evidence and developed recommendations using the Evidence-to-Decision framework.
Results: We identified 8 studies (1 cluster and 2 patient-level randomized trials; 5 observational studies) comparing small-volume to conventional tubes. We had high certainty evidence that small-volume tubes reduce daily and cumulative blood sampling volume; and moderate certainty evidence that they reduce the risk of transfusion and mean number of red blood cell units transfused, but these estimates were limited by imprecision. We had high certainty that small-volume tubes have a similar rate of specimens with insufficient quantity. The panel considered that the desirable effects of small-volume tubes outweigh the undesirable effects, are less wasteful of resources, and are feasible, as demonstrated by successful implementation across multiple countries, although there are upfront implementation costs to validate small-volume tubes on laboratory instrumentation.
Conclusion: This ICM-RPG panel made a strong recommendation for the use of small-volume sample collection tubes in adult ICUs based on overall moderate certainty evidence.
{"title":"Small-volume blood sample collection tubes in adult intensive care units: A rapid practice guideline.","authors":"Jeannie Callum, Zbignew Putowski, Waleed Alhazzani, Emilie Belley-Cote, Morten Hylander Møller, Nicola Curry, Zainab Al Duhailib, Mark Fung, Louise Giocobbo, Anders Granholm, Vernon Louw, Patrick Maybohm, Marcella Muller, Nathan Nielsen, Curtis Oleschuk, Sheharyar Raza, Elizabeth Scruth, Deborah Siegal, Simon J Stanworth, Alexander P J Vlaar, Micheline White, Simon Oczkowski","doi":"10.1111/aas.14497","DOIUrl":"10.1111/aas.14497","url":null,"abstract":"<p><strong>Background: </strong>This Intensive Care Medicine Rapid Practice Guideline (ICM-RPG) provides an evidence-based recommendation to address the question: in adult patients in intensive care units (ICUs), should we use small-volume or conventional blood collection tubes?</p><p><strong>Methods: </strong>We included 23 panelists in 8 countries and assessed and managed financial and intellectual conflicts of interest. Methodological support was provided by the Guidelines in Intensive Care, Development, and Evaluation (GUIDE) group. We conducted a systematic review, including evidence from observational and randomized studies. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach, we evaluated the certainty of evidence and developed recommendations using the Evidence-to-Decision framework.</p><p><strong>Results: </strong>We identified 8 studies (1 cluster and 2 patient-level randomized trials; 5 observational studies) comparing small-volume to conventional tubes. We had high certainty evidence that small-volume tubes reduce daily and cumulative blood sampling volume; and moderate certainty evidence that they reduce the risk of transfusion and mean number of red blood cell units transfused, but these estimates were limited by imprecision. We had high certainty that small-volume tubes have a similar rate of specimens with insufficient quantity. The panel considered that the desirable effects of small-volume tubes outweigh the undesirable effects, are less wasteful of resources, and are feasible, as demonstrated by successful implementation across multiple countries, although there are upfront implementation costs to validate small-volume tubes on laboratory instrumentation.</p><p><strong>Conclusion: </strong>This ICM-RPG panel made a strong recommendation for the use of small-volume sample collection tubes in adult ICUs based on overall moderate certainty evidence.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":" ","pages":"1319-1326"},"PeriodicalIF":1.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141733224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-07-03DOI: 10.1111/aas.14491
Sine Wichmann, Rasmus Rønhøj, Karen L Ellekjær, Morten Hylander Møller, Morten H Bestle
Background: Hypernatremia is a common electrolyte disturbance in hospitalised patients associated with adverse outcomes. The aetiology is diverse but often related to fluid therapy and sodium-containing medicaments. We aim to outline the evidence base on hypernatremia in adult hospitalised patients.
Methods: We will conduct a scoping review and adhere to the preferred reporting items for systematic and meta-analysis extension for scoping reviews (PRISMA-ScR). We will systematically search the Cochrane Library, Medline, Pubmed, and Embase from inception with no limitations to language, and include all study designs. We will use the population, exposure, comparator, and outcome-based approach to define eligibility criteria. The population: adult hospitalised patients; exposure: hypernatremia; comparator: no hypernatremia or all types of treatments of hypernatremia; and outcomes: all reported outcomes. Two authors will independently screen and select studies followed by full-text assessment and data extraction in duplicate. All outcome measures will be reported, and descriptive analyses will be performed. The certainty of evidence will be assessed according to an adapted grading of recommendations assessment, development, and evaluation (GRADE) approach.
Discussion: This scoping review will provide an overview of the current evidence regarding the incidence of hypernatremia, treatment modalities, and outcomes reported for hospitalised adult patients with hypernatremia.
{"title":"Hypernatremia in hospitalised adult patients: A protocol for a scoping review.","authors":"Sine Wichmann, Rasmus Rønhøj, Karen L Ellekjær, Morten Hylander Møller, Morten H Bestle","doi":"10.1111/aas.14491","DOIUrl":"10.1111/aas.14491","url":null,"abstract":"<p><strong>Background: </strong>Hypernatremia is a common electrolyte disturbance in hospitalised patients associated with adverse outcomes. The aetiology is diverse but often related to fluid therapy and sodium-containing medicaments. We aim to outline the evidence base on hypernatremia in adult hospitalised patients.</p><p><strong>Methods: </strong>We will conduct a scoping review and adhere to the preferred reporting items for systematic and meta-analysis extension for scoping reviews (PRISMA-ScR). We will systematically search the Cochrane Library, Medline, Pubmed, and Embase from inception with no limitations to language, and include all study designs. We will use the population, exposure, comparator, and outcome-based approach to define eligibility criteria. The population: adult hospitalised patients; exposure: hypernatremia; comparator: no hypernatremia or all types of treatments of hypernatremia; and outcomes: all reported outcomes. Two authors will independently screen and select studies followed by full-text assessment and data extraction in duplicate. All outcome measures will be reported, and descriptive analyses will be performed. The certainty of evidence will be assessed according to an adapted grading of recommendations assessment, development, and evaluation (GRADE) approach.</p><p><strong>Discussion: </strong>This scoping review will provide an overview of the current evidence regarding the incidence of hypernatremia, treatment modalities, and outcomes reported for hospitalised adult patients with hypernatremia.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":" ","pages":"1541-1543"},"PeriodicalIF":1.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141496811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-07-08DOI: 10.1111/aas.14486
Charlotte Levy Hansen, Thordis Thomsen, Aske Tøgern, Ann Merete Møller, Morten Vester-Andersen, Søren Overgaard, Nicolai Bang Foss, Daniel Hägi-Pedersen
Background: Delirium is an acute and fluctuating disturbance in attention, awareness, and cognition, commonly observed in hospital settings, particularly among older adults, critically ill and surgical patients. Delirium poses significant challenges in patient care, leading to increased morbidity, mortality, prolonged hospital stays, and functional decline.
Aim: The aim of this review is to map existing evidence on delirium diagnostic tools suitable for use in patients treated surgically due to hip fracture, to inform clinical practice and enhance patient care protocols in the postoperative setting.
Method: We will conduct a scoping review on delirium diagnostic tools used for adult patients in the postoperative setting according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Eligibility criteria encompass all languages, publications dates, and study designs, with exception of case-reports. We will systematically search multiple databases and include unpublished trials, ensuring a comprehensive review based on a predefined protocol.
Results: Results will be presented descriptively, with supplementary tables and graphs. Studies will be grouped by design, surgical specialties, and diagnostic tools to identify potential variations.
Conclusion: This scoping review will provide an overview of existing delirium diagnostic tools used in the postoperative setting and highlight knowledge-gaps to support future research. Due to the large number of patients affected by postoperative delirium, evidence mapping is much needed to facilitate evidence-based practice.
背景:谵妄是一种急性、波动性的注意力、意识和认知障碍,常见于医院环境中,尤其是老年人、危重病人和手术病人。谵妄给患者护理带来了巨大挑战,导致发病率、死亡率、住院时间延长和功能衰退的增加。目的:本综述旨在绘制适用于因髋部骨折接受手术治疗的患者的谵妄诊断工具的现有证据图,为临床实践提供参考,并加强术后患者护理方案:我们将根据 "系统综述和荟萃分析首选报告项目"(Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews,PRISMA-ScR)对术后成年患者使用的谵妄诊断工具进行范围界定综述。资格标准包括所有语言、发表日期和研究设计,病例报告除外。我们将系统地搜索多个数据库,并纳入未发表的试验,确保根据预定方案进行全面综述:结果:结果将以描述性方式呈现,并配有补充表格和图表。研究将按设计、外科专科和诊断工具分组,以确定潜在的差异:本范围综述将概述术后环境中使用的现有谵妄诊断工具,并强调知识差距以支持未来的研究。由于受术后谵妄影响的患者人数众多,因此亟需证据图谱来促进循证实践。
{"title":"Delirium diagnostic tools in the postoperative setting: A scoping review protocol.","authors":"Charlotte Levy Hansen, Thordis Thomsen, Aske Tøgern, Ann Merete Møller, Morten Vester-Andersen, Søren Overgaard, Nicolai Bang Foss, Daniel Hägi-Pedersen","doi":"10.1111/aas.14486","DOIUrl":"10.1111/aas.14486","url":null,"abstract":"<p><strong>Background: </strong>Delirium is an acute and fluctuating disturbance in attention, awareness, and cognition, commonly observed in hospital settings, particularly among older adults, critically ill and surgical patients. Delirium poses significant challenges in patient care, leading to increased morbidity, mortality, prolonged hospital stays, and functional decline.</p><p><strong>Aim: </strong>The aim of this review is to map existing evidence on delirium diagnostic tools suitable for use in patients treated surgically due to hip fracture, to inform clinical practice and enhance patient care protocols in the postoperative setting.</p><p><strong>Method: </strong>We will conduct a scoping review on delirium diagnostic tools used for adult patients in the postoperative setting according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Eligibility criteria encompass all languages, publications dates, and study designs, with exception of case-reports. We will systematically search multiple databases and include unpublished trials, ensuring a comprehensive review based on a predefined protocol.</p><p><strong>Results: </strong>Results will be presented descriptively, with supplementary tables and graphs. Studies will be grouped by design, surgical specialties, and diagnostic tools to identify potential variations.</p><p><strong>Conclusion: </strong>This scoping review will provide an overview of existing delirium diagnostic tools used in the postoperative setting and highlight knowledge-gaps to support future research. Due to the large number of patients affected by postoperative delirium, evidence mapping is much needed to facilitate evidence-based practice.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":" ","pages":"1528-1531"},"PeriodicalIF":1.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141557722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-08-07DOI: 10.1111/aas.14503
D Østergaard, C Strøm, K Kjelstrup, C Escher, O D Thomas, T S Sigurdsson, R Rikalainen-Salmi, J T Korhonen
{"title":"Reflections on the status and future of continuous professional development: Scandinavian anesthesiologists' view.","authors":"D Østergaard, C Strøm, K Kjelstrup, C Escher, O D Thomas, T S Sigurdsson, R Rikalainen-Salmi, J T Korhonen","doi":"10.1111/aas.14503","DOIUrl":"10.1111/aas.14503","url":null,"abstract":"","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":" ","pages":"1517-1525"},"PeriodicalIF":1.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141896443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}