Pub Date : 2024-10-01DOI: 10.1016/j.bjao.2024.100329
Joshua Burns, Soumen Sen, Katy O’Rourke
{"title":"Introduction of a Generic Professional Capabilities (GPC) hub to help trainees evidence GPC competencies in the 2021 curriculum","authors":"Joshua Burns, Soumen Sen, Katy O’Rourke","doi":"10.1016/j.bjao.2024.100329","DOIUrl":"10.1016/j.bjao.2024.100329","url":null,"abstract":"","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"12 ","pages":"Article 100329"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142416195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-24DOI: 10.1016/j.bjao.2024.100309
Jibba Amraoui , Gilles Leclerc , Marta Jarlier , Jesus Diaz , Ridvan Guler , Clément Demoly , Catherine Verin , Sophie Rey Dit Guzer , Patrick Chalbos , Aurore Moussion , Christophe Taoum , Mathias Neron , Laurent Philibert
Background
Non-pharmaceutical approaches can help manage preoperative anxiety, but few studies have evaluated psychoeducational programmes, especially for cancer surgery. We assessed the feasibility of the COHErence Cardiaque (COHEC) programme where cardiac coherence and medical hypnosis are combined to manage preoperative anxiety in patients undergoing breast or gynaecological cancer surgical interventions (BGCSI).
Methods
Patients undergoing BGCSI were enrolled and followed a daily home programme with cardiac coherence and medical hypnosis sessions, starting 7 days before the procedure. The primary endpoint was optimal patient adherence (i.e. completion of ≥14 sessions). Secondary endpoints were anxiety levels, measured using the Visual Analogue Scale (VAS) and the Amsterdam Preoperative Anxiety and Information Scale (APAIS), satisfaction (EVAN-G), and quality of postoperative recovery (QoR-15).
Results
In total, 53 patients [mean age: 55 (34–82) yr] were included; 83.7% had breast cancer and 15.1% had gynaecological cancer. Optimal adherence was achieved by 64.2% (95% confidence interval: 49.8–76.9%) of the intention-to-treat population. Among the 43 patients who completed at least one session, exploratory analysis showed that anxiety on the day before (P=0.02) and the morning of the intervention (P=0.04) was decreased in patients with severe anxiety at baseline (VAS ≥70). The median VAS satisfaction score for the programme was 10 (4–10). Overall, 94% of patients were willing to include the COHEC programme in their daily routine.
Conclusions
The implementation of a psychoeducational programme combining cardiac coherence and medical hypnosis is feasible and might potentially help patients undergoing BGCSI to manage preoperative anxiety. A randomised trial is underway to assess the efficacy of the COHEC programme.
{"title":"Cardiac coherence and medical hypnosis: a feasibility study of a new combined approach for managing preoperative anxiety in patients with breast or gynaecological cancer","authors":"Jibba Amraoui , Gilles Leclerc , Marta Jarlier , Jesus Diaz , Ridvan Guler , Clément Demoly , Catherine Verin , Sophie Rey Dit Guzer , Patrick Chalbos , Aurore Moussion , Christophe Taoum , Mathias Neron , Laurent Philibert","doi":"10.1016/j.bjao.2024.100309","DOIUrl":"10.1016/j.bjao.2024.100309","url":null,"abstract":"<div><h3>Background</h3><div>Non-pharmaceutical approaches can help manage preoperative anxiety, but few studies have evaluated psychoeducational programmes, especially for cancer surgery. We assessed the feasibility of the COHErence Cardiaque (COHEC) programme where cardiac coherence and medical hypnosis are combined to manage preoperative anxiety in patients undergoing breast or gynaecological cancer surgical interventions (BGCSI).</div></div><div><h3>Methods</h3><div>Patients undergoing BGCSI were enrolled and followed a daily home programme with cardiac coherence and medical hypnosis sessions, starting 7 days before the procedure. The primary endpoint was optimal patient adherence (i.e. completion of ≥14 sessions). Secondary endpoints were anxiety levels, measured using the Visual Analogue Scale (VAS) and the Amsterdam Preoperative Anxiety and Information Scale (APAIS), satisfaction (EVAN-G), and quality of postoperative recovery (QoR-15).</div></div><div><h3>Results</h3><div>In total, 53 patients [mean age: 55 (34–82) yr] were included; 83.7% had breast cancer and 15.1% had gynaecological cancer. Optimal adherence was achieved by 64.2% (95% confidence interval: 49.8–76.9%) of the intention-to-treat population. Among the 43 patients who completed at least one session, exploratory analysis showed that anxiety on the day before (<em>P</em>=0.02) and the morning of the intervention (<em>P</em>=0.04) was decreased in patients with severe anxiety at baseline (VAS ≥70). The median VAS satisfaction score for the programme was 10 (4–10). Overall, 94% of patients were willing to include the COHEC programme in their daily routine.</div></div><div><h3>Conclusions</h3><div>The implementation of a psychoeducational programme combining cardiac coherence and medical hypnosis is feasible and might potentially help patients undergoing BGCSI to manage preoperative anxiety. A randomised trial is underway to assess the efficacy of the COHEC programme.</div></div><div><h3>Clinical trial registration</h3><div>NCT03981731.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"12 ","pages":"Article 100309"},"PeriodicalIF":0.0,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772609624000534/pdfft?md5=435cc270567e1a90f8b237a71511b068&pid=1-s2.0-S2772609624000534-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142314118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-23DOI: 10.1016/j.bjao.2024.100310
Gabor Erdoes , Susan M. Goobie , Thorsten Haas , Andreas Koster , Jerrold H. Levy , Marie E. Steiner
Neonates, infants, and children undergoing major surgery or with trauma can develop severe coagulopathy perioperatively. Neonates and infants are at highest risk because their haemostatic system is not fully developed and underlying inherited bleeding disorders may not have been diagnosed before surgery. Historically, laboratory coagulation measurements have been used to diagnose and monitor coagulopathies. Contemporary dynamic monitoring strategies are evolving. Viscoelastic testing is increasingly being used to monitor coagulopathy, particularly in procedures with a high risk of bleeding. However, there is a lack of valid age-specific reference values for diagnosis and trigger or target values for appropriate therapeutic management. A promising screening tool of primary haemostasis that may be used to diagnose quantitative and qualitative platelet abnormalities is the in vitro closure time by platelet function analyser. Targeted individualised treatment strategies for haemostatic bleeding arising from inherited or acquired bleeding disorders may include measures such as tranexamic acid, administration of plasma, derived or recombinant factors such as fibrinogen concentrate, or allogeneic blood component transfusions (plasma, platelets, or cryoprecipitate).
Herein we review current recommended perioperative guidelines, monitoring strategies, and treatment modalities for the paediatric patient with a coagulopathy. In the absence of data from adequately powered prospective studies, it is recommended that expert consensus be considered until additional research and validation of goal-directed perioperative bleeding management in paediatric patients is available.
{"title":"Perioperative considerations in the paediatric patient with congenital and acquired coagulopathy","authors":"Gabor Erdoes , Susan M. Goobie , Thorsten Haas , Andreas Koster , Jerrold H. Levy , Marie E. Steiner","doi":"10.1016/j.bjao.2024.100310","DOIUrl":"10.1016/j.bjao.2024.100310","url":null,"abstract":"<div><div>Neonates, infants, and children undergoing major surgery or with trauma can develop severe coagulopathy perioperatively. Neonates and infants are at highest risk because their haemostatic system is not fully developed and underlying inherited bleeding disorders may not have been diagnosed before surgery. Historically, laboratory coagulation measurements have been used to diagnose and monitor coagulopathies. Contemporary dynamic monitoring strategies are evolving. Viscoelastic testing is increasingly being used to monitor coagulopathy, particularly in procedures with a high risk of bleeding. However, there is a lack of valid age-specific reference values for diagnosis and trigger or target values for appropriate therapeutic management. A promising screening tool of primary haemostasis that may be used to diagnose quantitative and qualitative platelet abnormalities is the <em>in vitro</em> closure time by platelet function analyser. Targeted individualised treatment strategies for haemostatic bleeding arising from inherited or acquired bleeding disorders may include measures such as tranexamic acid, administration of plasma, derived or recombinant factors such as fibrinogen concentrate, or allogeneic blood component transfusions (plasma, platelets, or cryoprecipitate).</div><div>Herein we review current recommended perioperative guidelines, monitoring strategies, and treatment modalities for the paediatric patient with a coagulopathy. In the absence of data from adequately powered prospective studies, it is recommended that expert consensus be considered until additional research and validation of goal-directed perioperative bleeding management in paediatric patients is available.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"12 ","pages":"Article 100310"},"PeriodicalIF":0.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772609624000546/pdfft?md5=1d06f4a239ed2b5ef6bd68b13267da73&pid=1-s2.0-S2772609624000546-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142310935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-21DOI: 10.1016/j.bjao.2024.100344
Vanessa Marchesini , Sebastian Corlette , Suzette Sheppard , Andrew Davidson , David Tingay
Background
Prolonged mechanical ventilation can create heterogeneous ventilation patterns, which increase the risk of lung injury in infants. However, little is understood about the risk of brief exposure to mechanical ventilation during anaesthesia. The aim of this prospective observational study was to describe the regional pattern of lung ventilation during general anaesthesia in healthy neonates and infants, using electrical impedance tomography.
Methods
Twenty infants (age 3 days to 12 months), without known lung disease and receiving general anaesthesia with endotracheal intubation for supine positioned surgery, were included in the study. Anaesthesia and ventilation management was at the discretion of the treating clinician. Standardised lung imaging using electrical impedance tomography was made at six time points during anaesthesia from induction to post-extubation. At each time point, the gravity-dependent and right–left lung centre of ventilation was calculated.
Results
Tidal ventilation favoured the dorsal lung regions at induction, with a median (inter-quartile range) centre of ventilation (CoV) of 58.2 (53.9–59.3)%. After intubation, there was a redistribution of ventilation to the ventral lung, with the greatest change occurring early in surgery: CoV of 53.8 (52.3–55.2)%. After extubation, CoV returned to pre-intubation values: 56.5 (54.7–58)%. Across all time points, the pattern of ventilation favoured the right lung.
Conclusions
General anaesthesia creates heterogenous patterns of ventilation similar to those reported during prolonged mechanical ventilation. This potentially poses a risk for lung injury that may not be recognised clinically. These results suggest the need to better understand the impact of general anaesthesia on the developing lung.
Clinical trial registration
Australian New Zealand Clinical Trials Registry (ACTRN 12616000818437, 22 June 2016).
{"title":"Evaluation of lung homogeneity in neonates and small infants during general anaesthesia using electrical impedance tomography: a prospective observational study","authors":"Vanessa Marchesini , Sebastian Corlette , Suzette Sheppard , Andrew Davidson , David Tingay","doi":"10.1016/j.bjao.2024.100344","DOIUrl":"10.1016/j.bjao.2024.100344","url":null,"abstract":"<div><h3>Background</h3><p>Prolonged mechanical ventilation can create heterogeneous ventilation patterns, which increase the risk of lung injury in infants. However, little is understood about the risk of brief exposure to mechanical ventilation during anaesthesia. The aim of this prospective observational study was to describe the regional pattern of lung ventilation during general anaesthesia in healthy neonates and infants, using electrical impedance tomography.</p></div><div><h3>Methods</h3><p>Twenty infants (age 3 days to 12 months), without known lung disease and receiving general anaesthesia with endotracheal intubation for supine positioned surgery, were included in the study. Anaesthesia and ventilation management was at the discretion of the treating clinician. Standardised lung imaging using electrical impedance tomography was made at six time points during anaesthesia from induction to post-extubation. At each time point, the gravity-dependent and right–left lung centre of ventilation was calculated.</p></div><div><h3>Results</h3><p>Tidal ventilation favoured the dorsal lung regions at induction, with a median (inter-quartile range) centre of ventilation (CoV) of 58.2 (53.9–59.3)%. After intubation, there was a redistribution of ventilation to the ventral lung, with the greatest change occurring early in surgery: CoV of 53.8 (52.3–55.2)%. After extubation, CoV returned to pre-intubation values: 56.5 (54.7–58)%. Across all time points, the pattern of ventilation favoured the right lung.</p></div><div><h3>Conclusions</h3><p>General anaesthesia creates heterogenous patterns of ventilation similar to those reported during prolonged mechanical ventilation. This potentially poses a risk for lung injury that may not be recognised clinically. These results suggest the need to better understand the impact of general anaesthesia on the developing lung.</p></div><div><h3>Clinical trial registration</h3><p>Australian New Zealand Clinical Trials Registry (ACTRN 12616000818437, 22 June 2016).</p></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"12 ","pages":"Article 100344"},"PeriodicalIF":0.0,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772609624000881/pdfft?md5=c0680283a94d462b976090bbbaf78733&pid=1-s2.0-S2772609624000881-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142272422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-20DOI: 10.1016/j.bjao.2024.100308
Nils Vlaeminck , Marie-Line van der Poorten , Vera Saldien , Vito Sabato , Didier G. Ebo
{"title":"Paediatric perioperative hypersensitivity: the performance of the current consensus formula and the effect of uneventful anaesthesia on serum tryptase. Reply to BJA Open 2024; 9: 100254","authors":"Nils Vlaeminck , Marie-Line van der Poorten , Vera Saldien , Vito Sabato , Didier G. Ebo","doi":"10.1016/j.bjao.2024.100308","DOIUrl":"10.1016/j.bjao.2024.100308","url":null,"abstract":"","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"12 ","pages":"Article 100308"},"PeriodicalIF":0.0,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772609624000522/pdfft?md5=c4654bf9de9875d669e57f92c03b2feb&pid=1-s2.0-S2772609624000522-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142272423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-20DOI: 10.1016/j.bjao.2024.100311
Beth MacLean, Jayne Lim, Toby Richards
{"title":"An update on iron therapy as an intervention to reduce blood transfusion for patients undergoing hip fracture surgery","authors":"Beth MacLean, Jayne Lim, Toby Richards","doi":"10.1016/j.bjao.2024.100311","DOIUrl":"10.1016/j.bjao.2024.100311","url":null,"abstract":"","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"12 ","pages":"Article 100311"},"PeriodicalIF":0.0,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772609624000558/pdfft?md5=305ae27cefa154f392c56e8fb38e60ac&pid=1-s2.0-S2772609624000558-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142272424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.bjao.2024.100305
Bart Billet , Lisa Goudman , Philippe Rigoard , Maxime Billot , Manuel Roulaud , Sören Verstraete , Werner Nagels , Maarten Moens
<div><h3>Background</h3><p>In recent years, there has been a growing interest in the use of neuromodulation as an alternative treatment option for chronic pain. Neuromodulation techniques, such as spinal cord stimulation (SCS), dorsal root ganglion (DRG) stimulation, deep brain stimulation (DBS), and peripheral nerve stimulation, have shown promising results in the management of various chronic pain conditions and involve targeted modulation of neural activity to alleviate pain and restore functional capacity. The autonomic nervous system (ANS) plays a crucial role in the regulation of various bodily functions including pain perception. However, the effects of neuromodulation on the ANS in the context of chronic pain remain poorly understood. This systematic review aimed to comprehensively assess the existing literature about the effects of neuromodulation on the ANS in chronic pain settings.</p></div><div><h3>Methods</h3><p>Searches were conducted using four electronic databases (PubMed, EMBASE, SCOPUS, and Web of Science). The study protocol was registered before initiation of the review process. The Office of Health Assessment and Translation (OHAT) Risk of Bias tool was used to evaluate risk of bias.</p></div><div><h3>Results</h3><p>A total of 43 studies were included, of which only one was an animal study. Several studies have reported more than one outcome parameter in the same population of chronic pain patients. Cardiovascular parameters were the most frequently used outcomes. More specifically, 18 outcome parameters were revealed to evaluate the function of the ANS, namely heart rate variability (<em>n</em>=17), arterial blood pressure (<em>n</em>=15), tissue oxygenation/perfusion (<em>n</em>=5), blood markers (<em>n</em>=6), multiunit postganglionic sympathetic nerve activity (<em>n</em>=4), skin temperature (<em>n</em>=3), skin conductance (<em>n</em>=3), cephalic autonomic symptoms (<em>n</em>=2), ventilatory frequency (<em>n</em>=2), vasomotor tone (<em>n</em>=1), baroreflex sensitivity (<em>n</em>=1), sympathetic innervation of the heart, neural activity of intrinsic cardiac neurons (<em>n</em>=1), vascular conductance (<em>n</em>=1), arterial diameter (<em>n</em>=1), blood pulse volume (<em>n</em>=1), and vagal efficiency (<em>n</em>=1). Most studies evaluated SCS (62.79%), followed by DBS (18.6%), peripheral nerve stimulation (9.3%), DRG stimulation (4.65%), and vagus nerve stimulation (4.65%). Overall, inconsistent results were revealed towards contribution of SCS, DBS, and peripheral nerve stimulation on ANS parameters. For DRG stimulation, included studies pointed towards a decrease in sympathetic activity.</p></div><div><h3>Conclusions</h3><p>There are indications that neuromodulation alters the ANS, supported by high or moderate confidence in the body of evidence, however, heterogeneity in ANS outcome measures drives towards inconclusive results. Further research is warranted to elucidate the indirect or direct mechanisms of
{"title":"Effect of neuromodulation for chronic pain on the autonomic nervous system: a systematic review","authors":"Bart Billet , Lisa Goudman , Philippe Rigoard , Maxime Billot , Manuel Roulaud , Sören Verstraete , Werner Nagels , Maarten Moens","doi":"10.1016/j.bjao.2024.100305","DOIUrl":"10.1016/j.bjao.2024.100305","url":null,"abstract":"<div><h3>Background</h3><p>In recent years, there has been a growing interest in the use of neuromodulation as an alternative treatment option for chronic pain. Neuromodulation techniques, such as spinal cord stimulation (SCS), dorsal root ganglion (DRG) stimulation, deep brain stimulation (DBS), and peripheral nerve stimulation, have shown promising results in the management of various chronic pain conditions and involve targeted modulation of neural activity to alleviate pain and restore functional capacity. The autonomic nervous system (ANS) plays a crucial role in the regulation of various bodily functions including pain perception. However, the effects of neuromodulation on the ANS in the context of chronic pain remain poorly understood. This systematic review aimed to comprehensively assess the existing literature about the effects of neuromodulation on the ANS in chronic pain settings.</p></div><div><h3>Methods</h3><p>Searches were conducted using four electronic databases (PubMed, EMBASE, SCOPUS, and Web of Science). The study protocol was registered before initiation of the review process. The Office of Health Assessment and Translation (OHAT) Risk of Bias tool was used to evaluate risk of bias.</p></div><div><h3>Results</h3><p>A total of 43 studies were included, of which only one was an animal study. Several studies have reported more than one outcome parameter in the same population of chronic pain patients. Cardiovascular parameters were the most frequently used outcomes. More specifically, 18 outcome parameters were revealed to evaluate the function of the ANS, namely heart rate variability (<em>n</em>=17), arterial blood pressure (<em>n</em>=15), tissue oxygenation/perfusion (<em>n</em>=5), blood markers (<em>n</em>=6), multiunit postganglionic sympathetic nerve activity (<em>n</em>=4), skin temperature (<em>n</em>=3), skin conductance (<em>n</em>=3), cephalic autonomic symptoms (<em>n</em>=2), ventilatory frequency (<em>n</em>=2), vasomotor tone (<em>n</em>=1), baroreflex sensitivity (<em>n</em>=1), sympathetic innervation of the heart, neural activity of intrinsic cardiac neurons (<em>n</em>=1), vascular conductance (<em>n</em>=1), arterial diameter (<em>n</em>=1), blood pulse volume (<em>n</em>=1), and vagal efficiency (<em>n</em>=1). Most studies evaluated SCS (62.79%), followed by DBS (18.6%), peripheral nerve stimulation (9.3%), DRG stimulation (4.65%), and vagus nerve stimulation (4.65%). Overall, inconsistent results were revealed towards contribution of SCS, DBS, and peripheral nerve stimulation on ANS parameters. For DRG stimulation, included studies pointed towards a decrease in sympathetic activity.</p></div><div><h3>Conclusions</h3><p>There are indications that neuromodulation alters the ANS, supported by high or moderate confidence in the body of evidence, however, heterogeneity in ANS outcome measures drives towards inconclusive results. Further research is warranted to elucidate the indirect or direct mechanisms of ","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"11 ","pages":"Article 100305"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772609624000492/pdfft?md5=20ae858320b29e303cd0fa605709276a&pid=1-s2.0-S2772609624000492-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142122324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-14DOI: 10.1016/j.bjao.2024.100302
Roberta Südy , John Diaper , Davide Bizzotto , Rafaelle Dellàca , Ferenc Petak , Walid Habre , Andre Dos Santos Rocha
Background
Introducing variability in tidal volume, ventilatory frequency, or both is beneficial during mechanical ventilation in acute respiratory distress syndrome (ARDS). We investigated whether applying cycle-by-cycle variability in the positive end-expiratory pressure (PEEP) exerts beneficial effect on lung function in a model of ARDS.
Methods
Rabbits with lung injury were randomly allocated to receive mechanical ventilation for 6 h by applying a pressure-controlled mode with constant PEEP of 7 cm H2O (PC group: n=6) or variable PEEP (VEEP) with a coefficient of variation of 21.4%, range 4–10 cm H2O (PC-VEEP group; n=6). Lung oxygenation index (Pao2/FiO2) after 6 h of ventilation (H6) was the primary outcome and respiratory mechanics, lung volume, intrapulmonary shunt, and lung inflammatory markers were secondary outcomes.
Results
After lung injury, both groups presented moderate-to-severe ARDS (Pao2/FiO2 <27 kPa). The Pao2/FiO2 was significantly higher in the PC-VEEP group than in the PC group at H6 (12.3 [sd 3.5] vs 19.2 [7.2] kPa, P=0.013) and a lower arterial partial pressure of CO2 at 1–3 h (P<0.02). The ventilation-induced increases in airway resistance and tissue elastance were prevented by PC-VEEP. There was no evidence for a difference in minute volume, driving pressure, end-tidal CO2, lung volumes, intrapulmonary shunt fraction, and cytokines between the ventilation modes.
Conclusions
Prolonged mechanical ventilation with cycle-by-cycle VEEP prevents deterioration in gas exchange and respiratory mechanics in a model of ARDS, suggesting the benefit of this novel ventilation strategy to optimise gas exchange without increasing driving pressure and lung overdistension.
背景在急性呼吸窘迫综合征（ARDS）的机械通气过程中引入潮气量、通气频率或两者的可变性是有益的。我们研究了在 ARDS 模型中逐个周期改变呼气末正压（PEEP）是否会对肺功能产生有益影响。方法将肺损伤的兔子随机分配到压力控制模式下接受机械通气 6 小时，PEEP 恒定为 7 cm H2O（PC 组：n=6）或变异系数为 21.4%、范围为 4-10 cm H2O 的可变 PEEP（VEEP）（PC-VEEP 组；n=6）。通气 6 小时（H6）后的肺氧合指数（Pao2/FiO2）为主要结果，呼吸力学、肺容积、肺内分流和肺部炎症指标为次要结果。在 H6 时，PC-VEEP 组的 Pao2/FiO2 明显高于 PC 组（12.3 [sd 3.5] vs 19.2 [7.2] kPa，P=0.013），且在 1-3 h 时动脉二氧化碳分压较低（P<0.02）。PC-VEEP 阻止了通气引起的气道阻力和组织弹性的增加。结论在 ARDS 模型中，通过逐周期 VEEP 延长机械通气可防止气体交换和呼吸力学的恶化，这表明这种新型通气策略可在不增加驱动压力和肺过度张力的情况下优化气体交换。
{"title":"Variable positive end-expiratory pressure in an experimental model of acute respiratory distress syndrome: an advanced ventilation modality","authors":"Roberta Südy , John Diaper , Davide Bizzotto , Rafaelle Dellàca , Ferenc Petak , Walid Habre , Andre Dos Santos Rocha","doi":"10.1016/j.bjao.2024.100302","DOIUrl":"10.1016/j.bjao.2024.100302","url":null,"abstract":"<div><h3>Background</h3><p>Introducing variability in tidal volume, ventilatory frequency, or both is beneficial during mechanical ventilation in acute respiratory distress syndrome (ARDS). We investigated whether applying cycle-by-cycle variability in the positive end-expiratory pressure (PEEP) exerts beneficial effect on lung function in a model of ARDS.</p></div><div><h3>Methods</h3><p>Rabbits with lung injury were randomly allocated to receive mechanical ventilation for 6 h by applying a pressure-controlled mode with constant PEEP of 7 cm H<sub>2</sub>O (PC group: <em>n</em>=6) or variable PEEP (VEEP) with a coefficient of variation of 21.4%, range 4–10 cm H<sub>2</sub>O (PC-VEEP group; <em>n</em>=6). Lung oxygenation index (<em>P</em>a<span>o</span><sub>2</sub>/FiO<sub>2</sub>) after 6 h of ventilation (H6) was the primary outcome and respiratory mechanics, lung volume, intrapulmonary shunt, and lung inflammatory markers were secondary outcomes.</p></div><div><h3>Results</h3><p>After lung injury, both groups presented moderate-to-severe ARDS (<em>P</em>a<span>o</span><sub>2</sub>/FiO<sub>2</sub> <27 kPa). The <em>P</em>a<span>o</span><sub>2</sub>/FiO<sub>2</sub> was significantly higher in the PC-VEEP group than in the PC group at H6 (12.3 [<span>sd</span> 3.5] <em>vs</em> 19.2 [7.2] kPa, <em>P</em>=0.013) and a lower arterial partial pressure of CO<sub>2</sub> at 1–3 h (<em>P</em><0.02). The ventilation-induced increases in airway resistance and tissue elastance were prevented by PC-VEEP. There was no evidence for a difference in minute volume, driving pressure, end-tidal CO<sub>2</sub>, lung volumes, intrapulmonary shunt fraction, and cytokines between the ventilation modes.</p></div><div><h3>Conclusions</h3><p>Prolonged mechanical ventilation with cycle-by-cycle VEEP prevents deterioration in gas exchange and respiratory mechanics in a model of ARDS, suggesting the benefit of this novel ventilation strategy to optimise gas exchange without increasing driving pressure and lung overdistension.</p></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"11 ","pages":"Article 100302"},"PeriodicalIF":0.0,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772609624000467/pdfft?md5=bb75ea3ad3c8a7e3b54a06862b85ba1d&pid=1-s2.0-S2772609624000467-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141985402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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