Background: Perioperative fluid management in children has been a major topic for debate. Objectives: Our aim is to review the current evidence on perioperative fluid management in children including: type of fluid, administration rates, preoperative fluid intake and monitoring techniques. Design: Narrative review. Method: Following the PRISMA-S guidelines we performed a search (2010-March 2022) in databases Medline (through PubMed) and Cochrane Library. 4297 citations were found and screened by two independent researchers. After screening, 64 articles were withheld for our review. Results: The perioperative administration of isotonic fluids is safer than hypotonic solutions, concerning the development of hyponatremia. A balanced isotonic solution with 1-2,5% glucose should be used as perioperative maintenance IV fluid in children (1 month to 18 years). Colloids can be used in children when inadequate effect in volume correction is achieved with crystalloids. The preferred synthetic colloid for children is a third generation HES in a balanced solution. To date, most clinicians use the “4-2-1 rule” for calculating fluid rate. This may not be the optimal fluid rate, as little research has been done. Preoperative fasting for clear fluids should be limited to 1 hour, children should even be encouraged to drink up until 1 hour before induction. Respiratory variation of aortic blood flow peak velocity (ΔVpeak) with echocardiography is currently the most reliable technique for evaluating fluid responsiveness in children.
{"title":"Perioperative fluid management in children: an updated review","authors":"M. Beels, S. Stevens, V. Saldien","doi":"10.56126/73.3.03","DOIUrl":"https://doi.org/10.56126/73.3.03","url":null,"abstract":"Background: Perioperative fluid management in children has been a major topic for debate.\u0000\u0000Objectives: Our aim is to review the current evidence on perioperative fluid management in children including: type of fluid, administration rates, preoperative fluid intake and monitoring techniques.\u0000\u0000Design: Narrative review.\u0000\u0000Method: Following the PRISMA-S guidelines we performed a search (2010-March 2022) in databases Medline (through PubMed) and Cochrane Library. 4297 citations were found and screened by two independent researchers. After screening, 64 articles were withheld for our review.\u0000\u0000Results: The perioperative administration of isotonic fluids is safer than hypotonic solutions, concerning the development of hyponatremia. A balanced isotonic solution with 1-2,5% glucose should be used as perioperative maintenance IV fluid in children (1 month to 18 years). Colloids can be used in children when inadequate effect in volume correction is achieved with crystalloids. The preferred synthetic colloid for children is a third generation HES in a balanced solution. To date, most clinicians use the “4-2-1 rule” for calculating fluid rate. This may not be the optimal fluid rate, as little research has been done. Preoperative fasting for clear fluids should be limited to 1 hour, children should even be encouraged to drink up until 1 hour before induction. Respiratory variation of aortic blood flow peak velocity (ΔVpeak) with echocardiography is currently the most reliable technique for evaluating fluid responsiveness in children.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42705128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Cognitive aids (CAs) are clinical tools guiding clinical decision-making during critical events in the operating room. They may counteract the adverse effects of stress on the non-technical skills of the attending clinician(s). Although most clinicians acknowledge the importance of CAs, their uptake in clinical practice seems to be lagging behind. This situation has led us to investigate which features of CAs may enhance their uptake. Therefore, in this systematic review we explored the optimums regarding the 1) timing to consult the CA, 2) person consulting the CA, 3) location of the CA in the operating room, 4) CA design (paper vs. electronic), 5) CA lay-out, 6) reader of the CA and 7) if the use of CAs in the form of decision support tools lead to improved outcome. Methods: Seven PICO-questions guided our literature search in 4 biomedical databases (MEDLINE, Embase, Web of Science and Google Scholar). We selected English-language randomized controlled trials (RCTs), observational studies and expert opinions discussing the use of cognitive aids during life-threatening events in the operating theatre. Articles discussing non-urgent or non-operating room settings were excluded. The quality of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: We found 7 RCTs, 14 observational studies and 6 expert opinions. All trials were conducted in a simulation environment. The person who should trigger the use of a cognitive aid and the optimal timing of its initiation, could not be defined by the current literature. The ideal location of the cognitive aids remains also unclear. A favorable lay-out of an aid should be well-structured, standardized and easily readable. In addition, several potentially beneficial design features are described. RCT’s could not demonstrate a possible superiority of either electronic or paper-based aids. Both have their advantages and disadvantages. Furthermore, electronic decision support tools are potentially associated with an enhanced performance of the clinician. Likewise, the presence of a reader was associated with an improved performance of key steps in the management of a critical event. However, it remains unclear who should fulfill this role. Conclusion: Several features of the design or utilization of CAs may play a role in enhancing the uptake of CAs in clinical practice during the management of a critical event in the operating room. However, robust evidence supporting the use of a certain feature over another is lacking.
背景：认知辅助设备（CA）是指导手术室关键事件临床决策的临床工具。它们可以抵消压力对主治临床医生非技术技能的不利影响。尽管大多数临床医生都承认CA的重要性，但它们在临床实践中的应用似乎落后了。这种情况促使我们研究CA的哪些特征可以增强其吸收。因此，在本系统综述中，我们探讨了以下方面的最佳情况：1）咨询CA的时间，2）咨询CA人员，3）CA在手术室的位置，4）CA设计（纸质与电子版），5）CA布局，6）CA读者，7）以决策支持工具的形式使用CA是否能改善结果。方法：7个PICO问题指导我们在4个生物医学数据库（MEDLINE、Embase、Web of Science和Google Scholar）中进行文献检索。我们选择了英语随机对照试验（RCT）、观察性研究和专家意见，讨论了在手术室发生危及生命事件时使用认知辅助工具的问题。讨论非紧急或非手术室设置的文章被排除在外。证据的质量通过建议评估、发展和评估分级（GRADE）进行评估。结果：我们发现了7项随机对照试验、14项观察性研究和6项专家意见。所有试验都是在模拟环境中进行的。目前的文献无法定义应该触发使用认知辅助工具的人及其启动的最佳时机。认知辅助设备的理想位置也不清楚。援助的有利布局应结构良好、标准化且易于阅读。此外，还介绍了几个潜在的有益设计特征。RCT无法证明电子或纸质辅助工具的可能优势。两者各有优缺点。此外，电子决策支持工具可能与临床医生的增强性能相关联。同样，阅读器的存在与关键事件管理中关键步骤的改进性能有关。然而，目前尚不清楚谁应该履行这一职责。结论：在手术室处理重大事件的临床实践中，CA的设计或使用的几个特点可能在提高CA的吸收方面发挥作用。然而，缺乏有力的证据支持使用某个功能而不是另一个功能。
{"title":"The use of cognitive aids in the operating room: a systematic review","authors":"A. Claeys, R. Van den Eynde, S. Rex","doi":"10.56126/73.3.18","DOIUrl":"https://doi.org/10.56126/73.3.18","url":null,"abstract":"Background: Cognitive aids (CAs) are clinical tools guiding clinical decision-making during critical events in the operating room. They may counteract the adverse effects of stress on the non-technical skills of the attending clinician(s). Although most clinicians acknowledge the importance of CAs, their uptake in clinical practice seems to be lagging behind. This situation has led us to investigate which features of CAs may enhance their uptake. Therefore, in this systematic review we explored the optimums regarding the 1) timing to consult the CA, 2) person consulting the CA, 3) location of the CA in the operating room, 4) CA design (paper vs. electronic), 5) CA lay-out, 6) reader of the CA and 7) if the use of CAs in the form of decision support tools lead to improved outcome.\u0000\u0000Methods: Seven PICO-questions guided our literature search in 4 biomedical databases (MEDLINE, Embase, Web of Science and Google Scholar). We selected English-language randomized controlled trials (RCTs), observational studies and expert opinions discussing the use of cognitive aids during life-threatening events in the operating theatre. Articles discussing non-urgent or non-operating room settings were excluded. The quality of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation (GRADE).\u0000\u0000Results: We found 7 RCTs, 14 observational studies and 6 expert opinions. All trials were conducted in a simulation environment. The person who should trigger the use of a cognitive aid and the optimal timing of its initiation, could not be defined by the current literature. The ideal location of the cognitive aids remains also unclear.\u0000\u0000A favorable lay-out of an aid should be well-structured, standardized and easily readable. In addition, several potentially beneficial design features are described.\u0000RCT’s could not demonstrate a possible superiority of either electronic or paper-based aids. Both have their advantages and disadvantages. Furthermore, electronic decision support tools are potentially associated with an enhanced performance of the clinician. Likewise, the presence of a reader was associated with an improved performance of key steps in the management of a critical event. However, it remains unclear who should fulfill this role.\u0000\u0000Conclusion: Several features of the design or utilization of CAs may play a role in enhancing the uptake of CAs in clinical practice during the management of a critical event in the operating room. However, robust evidence supporting the use of a certain feature over another is lacking.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48629462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lieselot Geerts, Hugo Carvalho, Eliza Jarahyan, J. Mulier
Introduction: Opioid induced respiratory depression (OIRD) is a preventable aetiology of postoperative respiratory depression with 85% of the episodes taking place in the first 24 postoperative hours. Due to altered respiratory functional metrics and frequently coexisting comorbidities, obese patients are at a particularly higher risk for such complications. The present study aimed to assess if an opioid-free anesthesia (OFA) was associated with a reduced immediate postoperative OIRD when compared to Opiod-based anesthesia (OA). Methods: Obese patients presenting for bariatric surgery were consecutively included in a non-randomized fashion. Lung protective ventilation strategies applied in both groups. In the OA group, Sufentanil was used for intraoperative analgesia in a liberal fashion. In the OFA group, patients received a pre-induction dexmedetomidine loading, followed by a lidocaine, ketamine and dexmedetomidine bolus immediately before induction, further maintained throughout the intraoperative period. Plethysmographic saturations were obtained before induction as well as after extubation and in the Post-anesthesia care unit (PACU). Opioid requirement and Postoperative Nausea and Vomiting incidence were similarly registered. Results: Thirty-four patients were included in the OFA group, and 30 in the OA group. No significant anthropometric and comorbidity differences were found between both groups. OFA patients had significantly lower pre-induction saturations after dexmedetomidine loading. No difference was found for post-extubation saturations as well as well as pre-PACU discharge. The need for supplemental oxygen at the PACU was higher in the OA group. Opioid requirement and cumulative consumption (MEDs) were significantly higher with OA. Conclusion: OFA was not associated with significant postoperative saturation changes but led to a lower need of postoperative supplemental oxygen therapy. OA led to higher opioid rescue need. No fatal respiratory complications were registered in both groups in the immediate postoperative period.
{"title":"Impact of opioid free Anaesthesia versus opioid Anaesthesia on the immediate postoperative oxygenation after bariatric surgery: a prospective observational study","authors":"Lieselot Geerts, Hugo Carvalho, Eliza Jarahyan, J. Mulier","doi":"10.56126/73.3.15","DOIUrl":"https://doi.org/10.56126/73.3.15","url":null,"abstract":"Introduction: Opioid induced respiratory depression (OIRD) is a preventable aetiology of postoperative respiratory depression with 85% of the episodes taking place in the first 24 postoperative hours. Due to altered respiratory functional metrics and frequently coexisting comorbidities, obese patients are at a particularly higher risk for such complications. The present study aimed to assess if an opioid-free anesthesia (OFA) was associated with a reduced immediate postoperative OIRD when compared to Opiod-based anesthesia (OA).\u0000\u0000Methods: Obese patients presenting for bariatric surgery were consecutively included in a non-randomized fashion. Lung protective ventilation strategies applied in both groups. In the OA group, Sufentanil was used for intraoperative analgesia in a liberal fashion. In the OFA group, patients received a pre-induction dexmedetomidine loading, followed by a lidocaine, ketamine and dexmedetomidine bolus immediately before induction, further maintained throughout the intraoperative period. Plethysmographic saturations were obtained before induction as well as after extubation and in the Post-anesthesia care unit (PACU). Opioid requirement and Postoperative Nausea and Vomiting incidence were similarly registered.\u0000\u0000Results: Thirty-four patients were included in the OFA group, and 30 in the OA group. No significant anthropometric and comorbidity differences were found between both groups. OFA patients had significantly lower pre-induction saturations after dexmedetomidine loading. No difference was found for post-extubation saturations as well as well as pre-PACU discharge. The need for supplemental oxygen at the PACU was higher in the OA group. Opioid requirement and cumulative consumption (MEDs) were significantly higher with OA. Conclusion: OFA was not associated with significant postoperative saturation changes but led to a lower need of postoperative supplemental oxygen therapy. OA led to higher opioid rescue need. No fatal respiratory complications were registered in both groups in the immediate postoperative period.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41783210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Franquet, J. Pierart, A. Defresne, S. Joachim, V. Fraipont
Acute respiratory distress syndrome remains an uncommon condition during pregnancy. In patients with severe acute respiratory distress syndrome, when oxygenation or ventilation cannot be supported sufficiently using best practice conventional mechanical ventilation and additional therapies, veno-venous extracorporeal membrane oxygenation may be considered. In the past two decades, there has been increasing adoption of this technique to support adult patients with refractory acute respiratory distress syndrome. However, its use for the management of pregnant women is rare and remains a challenge. This narrative review addresses acute respiratory distress syndrome and its management during pregnancy, and then focuses on indications, contraindications, challenges, potential complications, and outcomes of the use of veno-venous extracorporeal membrane oxygenation for acute respiratory distress syndrome in the pregnant patient.
{"title":"Veno-venous Extracorporeal Membrane Oxygenation for pregnant women with Acute Respiratory Distress Syndrome: a narrative review","authors":"N. Franquet, J. Pierart, A. Defresne, S. Joachim, V. Fraipont","doi":"10.56126/73.3.17","DOIUrl":"https://doi.org/10.56126/73.3.17","url":null,"abstract":"Acute respiratory distress syndrome remains an uncommon condition during pregnancy. In patients with severe acute respiratory distress syndrome, when oxygenation or ventilation cannot be supported sufficiently using best practice conventional mechanical ventilation and additional therapies, veno-venous extracorporeal membrane oxygenation may be considered. In the past two decades, there has been increasing adoption of this technique to support adult patients with refractory acute respiratory distress syndrome. However, its use for the management of pregnant women is rare and remains a challenge. This narrative review addresses acute respiratory distress syndrome and its management during pregnancy, and then focuses on indications, contraindications, challenges, potential complications, and outcomes of the use of veno-venous extracorporeal membrane oxygenation for acute respiratory distress syndrome in the pregnant patient.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46344442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Gribomont, B. le Polain de Waroux, F. Veyckemans, B. Ki, Y. Kabré, R. Neighbour, P. Baele
A previously unpublished pediatric anesthesia circuit is presented here. It was invented and constructed by Dr Bernard-François Gribomont (hence called BFG circuit) around 1965 as a response to the important pediatric case load in the university hospital of Lovanium, near Leopoldville (now Kinshasa, DRC). The original objective was to find a simple solution that would enable the manual ventilation (assisted or controlled) of young children during ENT surgery, remaining very close to the child to reduce dead space while at the same time keeping far enough away from the surgeon in order to avoid obstructing their work. It includes a short coaxial single piece circuit devoid of any mechanical valve connected to an in-line fresh gas ventilation bag; it does not fit into any existing Mapleson category. Hence, the authors propose to classify it in a new Mapleson G class. Its main advantages are conceptual simplicity, inherent safety, very low dead space accounting for minimal rebreathing and thus reduced fresh gas flow, small size and weight, and ease of use even during prolonged manual ventilation in small children. Its main drawback is difficult scavenging of expired gases. For logistical reasons it was abandoned in the nineties but could be of renewed interest in low-income countries.
{"title":"Historical vignette – The Mapleson G, an original pediatric anesthesia circuit","authors":"B. Gribomont, B. le Polain de Waroux, F. Veyckemans, B. Ki, Y. Kabré, R. Neighbour, P. Baele","doi":"10.56126/73.3.22","DOIUrl":"https://doi.org/10.56126/73.3.22","url":null,"abstract":"A previously unpublished pediatric anesthesia circuit is presented here. It was invented and constructed by Dr Bernard-François Gribomont (hence called BFG circuit) around 1965 as a response to the important pediatric case load in the university hospital of Lovanium, near Leopoldville (now Kinshasa, DRC). The original objective was to find a simple solution that would enable the manual ventilation (assisted or controlled) of young children during ENT surgery, remaining very close to the child to reduce dead space while at the same time keeping far enough away from the surgeon in order to avoid obstructing their work.\u0000\u0000It includes a short coaxial single piece circuit devoid of any mechanical valve connected to an in-line fresh gas ventilation bag; it does not fit into any existing Mapleson category. Hence, the authors propose to classify it in a new Mapleson G class. Its main advantages are conceptual simplicity, inherent safety, very low dead space accounting for minimal rebreathing and thus reduced fresh gas flow, small size and weight, and ease of use even during prolonged manual ventilation in small children. Its main drawback is difficult scavenging of expired gases. For logistical reasons it was abandoned in the nineties but could be of renewed interest in low-income countries.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47339723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fabrizio De Biasi, Carlotta Olivei Maddalena, A. Vergallo, G. Fiore, R. Balagna, Paolo Donato, Loris Cristofoli, P. Caironi, F. Marinangeli
Background: The factors that may contribute to learners’ perception about the usefulness of Anaesthesia Crisis Resource Management (ACRM) key points are little known. Objectives: We investigated the link between demographic factors and the effect of an ACRM simulation training on anaesthesiologists’ perceived value of ACRM key points. Design: A prospective pre- and post-test survey from December 2017 to December 2019 of 111 anaesthesiologists involved into a combined ACRM-ACLS course in a simulation centre. Methods: Before and after the course participants were asked to indicate which were, in their opinion, the 5 ACRM key points most relevant for managing an anaesthetic emergency. No taxonomy tool of the 15 ACRM key points was used for teaching purposes. Main outcome measures: Pre-/post-course differences in participants’ subjective choices were connected by logistic regression analysis with demographic factors which included age, gender, years of work as anaesthesiologist, the amount of updating exposure, and familiarity with ACRM. Results: In median participants (47 M/64 F) had an age of 42 years (IQR 34-55 years), and 10 years working experience as anaesthesiologists (IQR 4-20 years). Around 20% of them had never heard of ACRM prior to this course. Communication was selected by up to 75% of participants without pre-/post-course differences. Although the other 4 ACRM points remained heterogeneously selected even after the course, we observed post-course vs pre-course increase in the selection rate of the ACRM points that address leadership, correct distribution of workload and utilization of all available resources. Among participants’ characteristics, the lack of familiarity with ACRM was the only significant predictor of the number of pre- to post-course changes in ACRM key points selection (OR=3.03, CI 95% 1.04 -9.09; p=0.0418). Conclusions: The familiarity with ACRM should be considered when planning ACRM training, especially in cases where the ACRM training is not yet part of a formal education in anaesthesia.
{"title":"Factors influencing anesthesiologistsperceived usefulness of ACRM (Anaesthesia Crisis Resources Management) key points after a combined ACLS (AHA)-ACRM similation training","authors":"Fabrizio De Biasi, Carlotta Olivei Maddalena, A. Vergallo, G. Fiore, R. Balagna, Paolo Donato, Loris Cristofoli, P. Caironi, F. Marinangeli","doi":"10.56126/73.2.09","DOIUrl":"https://doi.org/10.56126/73.2.09","url":null,"abstract":"Background: The factors that may contribute to learners’ perception about the usefulness of Anaesthesia Crisis Resource Management (ACRM) key points are little known.\u0000\u0000Objectives: We investigated the link between demographic factors and the effect of an ACRM simulation training on anaesthesiologists’ perceived value of ACRM key points.\u0000\u0000Design: A prospective pre- and post-test survey from December 2017 to December 2019 of 111 anaesthesiologists involved into a combined ACRM-ACLS course in a simulation centre.\u0000\u0000Methods: Before and after the course participants were asked to indicate which were, in their opinion, the 5 ACRM key points most relevant for managing an anaesthetic emergency. No taxonomy tool of the 15 ACRM key points was used for teaching purposes.\u0000\u0000Main outcome measures: Pre-/post-course differences in participants’ subjective choices were connected by logistic regression analysis with demographic factors which included age, gender, years of work as anaesthesiologist, the amount of updating exposure, and familiarity with ACRM.\u0000\u0000Results: In median participants (47 M/64 F) had an age of 42 years (IQR 34-55 years), and 10 years working experience as anaesthesiologists (IQR 4-20 years). Around 20% of them had never heard of ACRM prior to this course. Communication was selected by up to 75% of participants without pre-/post-course differences. Although the other 4 ACRM points remained heterogeneously selected even after the course, we observed post-course vs pre-course increase in the selection rate of the ACRM points that address leadership, correct distribution of workload and utilization of all available resources. Among participants’ characteristics, the lack of familiarity with ACRM was the only significant predictor of the number of pre- to post-course changes in ACRM key points selection (OR=3.03, CI 95% 1.04 -9.09; p=0.0418).\u0000\u0000Conclusions: The familiarity with ACRM should be considered when planning ACRM training, especially in cases where the ACRM training is not yet part of a formal education in anaesthesia.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44587827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vasoplegic syndrome is an important clinical entity characterized by profound arterial hypotension refractory to vasopressor therapy. The underlying pathophysiology is characterized by a complex and multifactorial dysregulation of both vasodilatory and vasoconstrictive mechanisms. During the last decades, there is growing interest in using methylene blue as an adjunct therapy to treat vasodilatory shock. The present review evaluates the safety and efficacy of methylene blue in cardiac and transplant surgery, severe sepsis and septic shock, severe burn injury, paediatric intensive care, and intoxications. Although most of the currently available evidence reports a benefit in haemodynamic parameters and a decrease in vasopressor requirements following the administration of methylene blue, study designs are heterogeneous, and the overall level of evidence is low. Moreover, a clear and consistent benefit in morbidity and mortality is lacking. Large prospective randomized controlled trials are needed to evaluate the exact role and timing of methylene blue in the treatment of vasopressor refractory vasoplegia.
{"title":"The role of methylene blue in the management of vasoplegic syndrome: a narrative review","authors":"J. Cottyn, E. Roussel, S. Rex, L. Al Tmimi","doi":"10.56126/73.2.11","DOIUrl":"https://doi.org/10.56126/73.2.11","url":null,"abstract":"Vasoplegic syndrome is an important clinical entity characterized by profound arterial hypotension refractory to vasopressor therapy. The underlying pathophysiology is characterized by a complex and multifactorial dysregulation of both vasodilatory and vasoconstrictive mechanisms. During the last decades, there is growing interest in using methylene blue as an adjunct therapy to treat vasodilatory shock. The present review evaluates the safety and efficacy of methylene blue in cardiac and transplant surgery, severe sepsis and septic shock, severe burn injury, paediatric intensive care, and intoxications. Although most of the currently available evidence reports a benefit in haemodynamic parameters and a decrease in vasopressor requirements following the administration of methylene blue, study designs are heterogeneous, and the overall level of evidence is low. Moreover, a clear and consistent benefit in morbidity and mortality is lacking. Large prospective randomized controlled trials are needed to evaluate the exact role and timing of methylene blue in the treatment of vasopressor refractory vasoplegia.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41611537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K., V. Loon, R., Rossaint, a., Saraçoğlu, n., MaRczin, s., Rex
Background: Inhaled nitric oxide (iNO) is a well-established off-label treatment of acute hypoxic respiratory failure and pulmonary hypertension, but high drug cost and lack of consistent proof of clinical benefit have led to restrictive expert recommendations regarding its use. Objectives: To evaluate the current practice of the use of iNO in different hospital settings at an international society level. Design & Setting: Web-based survey distributed via email to ESAIC and EACTAIC members. Methods: Survey responses are depicted as absolute frequencies and percentages that were analysed using Microsoft Excel. Results: One third of the respondents had institutional guidelines for the use of iNO. Pulmonary arterial hypertension, right ventricular failure, persistent pulmonary hypertension of the newborn and adult respiratory distress syndrome were the main indications for treatment with iNO. Prophylactic use of iNO during heart and lung transplantation or VAD implantation surgery was reported by 12-34%. The most frequently reported doses were 10-20 ppm and 20-40 ppm as initial and maximum treatment doses, respectively. Echocardiography was the most universally used form of advanced hemodynamic monitoring during treatment with iNO, followed by pulmonary artery catheterization. Half of the respondents had a fixed strategy to prevent rebound pulmonary hypertension during weaning from iNO, using phosphodiesterase inhibitors, prostacyclins or calcium channel antagonists. Conclusion: In line with the available evidence and expert recommendations, iNO remains a rescue treatment reserved for the most severe cases in highly specialized centres. The observations made in this survey should inspire future research to help better define the role of iNO, also in the setting of an ARDS-pandemic and the emergence of alternative selective pulmonary vasodilators.
{"title":"Multicenter international survey on the clinical use of inhaled nitric oxide in the perioperative setting and critically ill patients Survey on inhaled nitric oxide","authors":"K., V. Loon, R., Rossaint, a., Saraçoğlu, n., MaRczin, s., Rex","doi":"10.56126/73.2.10","DOIUrl":"https://doi.org/10.56126/73.2.10","url":null,"abstract":"Background: Inhaled nitric oxide (iNO) is a well-established off-label treatment of acute hypoxic respiratory failure and pulmonary hypertension, but high drug cost and lack of consistent proof of clinical benefit have led to restrictive expert recommendations regarding its use.\u0000\u0000Objectives: To evaluate the current practice of the use of iNO in different hospital settings at an international society level.\u0000\u0000Design & Setting: Web-based survey distributed via email to ESAIC and EACTAIC members.\u0000\u0000Methods: Survey responses are depicted as absolute frequencies and percentages that were analysed using Microsoft Excel.\u0000\u0000Results: One third of the respondents had institutional guidelines for the use of iNO. Pulmonary arterial hypertension, right ventricular failure, persistent pulmonary hypertension of the newborn and adult respiratory distress syndrome were the main indications for treatment with iNO. Prophylactic use of iNO during heart and lung transplantation or VAD implantation surgery was reported by 12-34%. The most frequently reported doses were 10-20 ppm and 20-40 ppm as initial and maximum treatment doses, respectively. Echocardiography was the most universally used form of advanced hemodynamic monitoring during treatment with iNO, followed by pulmonary artery catheterization. Half of the respondents had a fixed strategy to prevent rebound pulmonary hypertension during weaning from iNO, using phosphodiesterase inhibitors, prostacyclins or calcium channel antagonists.\u0000\u0000Conclusion: In line with the available evidence and expert recommendations, iNO remains a rescue treatment reserved for the most severe cases in highly specialized centres. The observations made in this survey should inspire future research to help better define the role of iNO, also in the setting of an ARDS-pandemic and the emergence of alternative selective pulmonary vasodilators.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41967958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Houthuys, A. Schrijvers, D. Van Beersel, W. Botermans, L. Al Tmimi
Background: Cardiac surgery with cardiopulmonary bypass (CPB) is associated with a significant risk for neurological complications. Reported incidence and risk factors for these complications vary significantly. Identifying risk factors could lead to preventive strategies to reduce complications and improve patient’s outcome. Objective: The study aims to assess the overall incidence and risk factors for severe early postoperative neurological complications after elective on-pump cardiac surgery. We specifically analyzed the incidence of stroke, global cerebral ischemia (GCI) and epilepsy in these patients. Methods: After getting approval from the Ethics Committee Research UZ/KU Leuven, on 14/12/2021 (s65871), we retrospectively evaluated data of 1080 adult patients after cardiac surgery with CPB between 06/2019 and 06/2021 at the University Hospitals Leuven. After exclusion of emergency procedures and patients who died before neurological evaluation, 977 patients remained for primary analysis. All data were collected from the electronic patient’s file. Primary objective was to identify the incidence of stroke, GCI and epilepsy. We defined stroke and GCI according to the American Stroke Association. Secondary endpoints were identifying independent risk-factors and assessing the impact of early neurological complications on mortality. Statistical analysis was performed using econometric and statistical modeling with python. We performed univariate logistic regression with Bonferonni correction and multivariable logistic regression with backwards elimination approach and p-value set to be <0.05. Results: The overall incidence of defined neurological complications after elective on-pump cardiac surgery at our institution was 3.17% (n=31) (stroke 2.35% (n=23), epilepsy 0.61% (n=6) and GCI 0.31% (n=3)). No statistically significant risk factors for these complications were found. In secondary analysis, patients with stroke and GCI had a higher risk of in-hospital mortality (Fisher’s exact test resulted in odds ratio 7.23 with p=0.005 and odds ratio 65.17 with p=0.003 respectively) Diabetes mellitus, preoperative atrial fibrillation, and endocarditis were also significantly related to in-hospital mortality. Conclusions: The incidence of early neurological complications after elective on-pump cardiac surgery at our institution was comparable to that reported in earlier studies. No independent risk factors for these neurological complications were found. The occurrence of stroke and GCI significantly increased in-hospital mortality which emphasizes the importance of these complications, with possible mortality benefit of early recognition and management of stroke.
{"title":"The incidence of early neurological complications after on-pump cardiac surgery: a retrospective study","authors":"J. Houthuys, A. Schrijvers, D. Van Beersel, W. Botermans, L. Al Tmimi","doi":"10.56126/73.2.08","DOIUrl":"https://doi.org/10.56126/73.2.08","url":null,"abstract":"Background: Cardiac surgery with cardiopulmonary bypass (CPB) is associated with a significant risk for neurological complications. Reported incidence and risk factors for these complications vary significantly. Identifying risk factors could lead to preventive strategies to reduce complications and improve patient’s outcome.\u0000\u0000Objective: The study aims to assess the overall incidence and risk factors for severe early postoperative neurological complications after elective on-pump cardiac surgery. We specifically analyzed the incidence of stroke, global cerebral ischemia (GCI) and epilepsy in these patients.\u0000\u0000Methods: After getting approval from the Ethics Committee Research UZ/KU Leuven, on 14/12/2021 (s65871), we retrospectively evaluated data of 1080 adult patients after cardiac surgery with CPB between 06/2019 and 06/2021 at the University Hospitals Leuven. After exclusion of emergency procedures and patients who died before neurological evaluation, 977 patients remained for primary analysis. All data were collected from the electronic patient’s file. Primary objective was to identify the incidence of stroke, GCI and epilepsy. We defined stroke and GCI according to the American Stroke Association. Secondary endpoints were identifying independent risk-factors and assessing the impact of early neurological complications on mortality. Statistical analysis was performed using econometric and statistical modeling with python. We performed univariate logistic regression with Bonferonni correction and multivariable logistic regression with backwards elimination approach and p-value set to be <0.05.\u0000\u0000Results: The overall incidence of defined neurological complications after elective on-pump cardiac surgery at our institution was 3.17% (n=31) (stroke 2.35% (n=23), epilepsy 0.61% (n=6) and GCI 0.31% (n=3)). No statistically significant risk factors for these complications were found. In secondary analysis, patients with stroke and GCI had a higher risk of in-hospital mortality (Fisher’s exact test resulted in odds ratio 7.23 with p=0.005 and odds ratio 65.17 with p=0.003 respectively) Diabetes mellitus, preoperative atrial fibrillation, and endocarditis were also significantly related to in-hospital mortality.\u0000\u0000Conclusions: The incidence of early neurological complications after elective on-pump cardiac surgery at our institution was comparable to that reported in earlier studies. No independent risk factors for these neurological complications were found. The occurrence of stroke and GCI significantly increased in-hospital mortality which emphasizes the importance of these complications, with possible mortality benefit of early recognition and management of stroke.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44133571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abnormal postpartum hemorrhage is a common problem, complicating 3-5% of vaginal and operative deliveries. In a majority of cases (98%) uterine atony, retained placenta or genital tract lacerations are responsible for excessive blood loss. However, occasionally, serious coagulopathy may occur early after delivery or in specific circumstances such as with placental abruption. Also, when bleeding is caused by uterine atony, retained placenta or vaginal lacerations, a dilutional coagulopathy may develop. Hence correcting coagulation abnormalities is often required. Crucial to manage postpartum coagulopathy is the use of tranexamic acid to reduce hyperfibrinolysis. In the present narrative review, we will discuss the use of tranexamic acid for the prevention and management of major postpartum hemorrhage by reviewing the available literature.
{"title":"The role of tranexamic acid in obstetric hemorrhage: a narrative review","authors":"M. Van Houwe, E. Roofthooft, M. Van de Velde","doi":"10.56126/73.2.12","DOIUrl":"https://doi.org/10.56126/73.2.12","url":null,"abstract":"Abnormal postpartum hemorrhage is a common problem, complicating 3-5% of vaginal and operative deliveries. In a majority of cases (98%) uterine atony, retained placenta or genital tract lacerations are responsible for excessive blood loss. However, occasionally, serious coagulopathy may occur early after delivery or in specific circumstances such as with placental abruption. Also, when bleeding is caused by uterine atony, retained placenta or vaginal lacerations, a dilutional coagulopathy may develop. Hence correcting coagulation abnormalities is often required. Crucial to manage postpartum coagulopathy is the use of tranexamic acid to reduce hyperfibrinolysis. In the present narrative review, we will discuss the use of tranexamic acid for the prevention and management of major postpartum hemorrhage by reviewing the available literature.","PeriodicalId":7024,"journal":{"name":"Acta anaesthesiologica Belgica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47693309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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