Anaesthesiology intensive therapy最新文献

Introduction: The Air-Q Self Pressurized Airway Device with Blocker (SP Blocker) was compared to the Proseal Laryngeal Mask Airway (PLMA) during positive pressure ventilation regarding the primary outcome (oropharyngeal leak pressure [OLP]), secondary outcomes (peak inspiratory pressure [PIP], inspired tidal volume [ITV], expired tidal volume [ETV], leak volume [LV] and leak fraction [LF]), insertion time, ventilation score, fiber-optic glottis view score, and postoperative laryngopharyngeal parameters (LPM).

Material and methods: Adult healthy female patients scheduled for elective gynecological laparotomies under general anesthesia using controlled mechanical ventilation were recruited to a prospective randomized comparative clinical trial. Exclusion criteria were body mass index (BMI) ≥ 35 kg m -2 , El-Ganzouri score ≥ 5, upper airway problems, hiatus hernia or pregnancy. Patients were classified into an SP Blocker group ( n = 75) and a PLMA group ( n = 75). Primary and secondary outcomes were assessed initially and at fixed time points after successful insertion of devices.

Results: Initially after successful device insertion: the SP Blocker group showed statistically significant higher mean OLP (cmH 2 O) (29.46 ± 2.11 vs. 28.06 ± 1.83 respectively; 95% CI: -2.037 to -0.76, P < 0.0001), lower mean PIP (cmH 2 O) (15.49 ± 0.61 vs. 17.78 ± 1.04 respectively; 95% CI: 2.02 to 2.56, P < 0.0001), higher mean ITV (mL) (411 ± 30 vs. 403 ± 15 respectively; 95% CI: -15.65 to -0.347, P = 0.041), higher mean ETV (mL) (389 ± 12 vs. 354 ± 11 respectively; 95% CI: -38.72 to -31.29, P < 0.0001), lower mean LV (mL) (22 ± 18 vs. 49 ± 10 respectively; 95% CI: 22.3 to 31.7, P < 0.0001) and lower mean LF (%) (5 ± 2.04 vs. 12 ± 6.8 respectively; 95% CI: 5.38 to 8.62, P < 0.0001) than the PLMA group. Mean insertion time (seconds) was shorter in the SP Blocker group than the PLMA group (16.39 ± 2.81 vs. 18.63 ± 3.44 respectively; 95% CI: 1.23 to 3.25, P < 0.0001). The SP Blocker group offered a better fiber-optic glottis view score than the PLMA group without differences concerning ventilation score and LPM.

Conclusions: SP Blocker provided as safe anesthesia during controlled mechanical ventilation as PLMA.

Brain ultrasonography has emerged as a valuable diagnostic and monitoring tool in intensive care, complementing other point-of-care techniques. Transcranial colour-coded duplex (TCCD) offers a rapid, non-invasive, repeatable, and cost-effective bedside me-thod that has gained significant interest among intensivists. TCCD enables visualisation of the circle of Willis and adjacent cerebral arteries, supporting its use in various critical scenarios, including vasospasm following subarachnoid haemorrhage, elevated intracranial pressure, hydrocephalus, acute ischaemic stroke, cerebral circulatory arrest, and certain intracranial haematomas. This manuscript aims to equip intensivists with foundational knowledge to integrate TCCD effectively into their diagnostic arsenal, covering essential Doppler physics, transcranial insonation techniques, and clinical applications of TCCD within intensive care settings.

Introduction: Although nutritional treatment is an established pillar of multidisciplinary care provided in critical illness, there are many concerns regarding this issue in severe COVID-19. This observational, retrospective, multicentre study aimed to analyse the approach to nutritional treatment among selected intensive care units (ICUs) in Poland.

Material and methods: The medical records of 129 patients hospitalized in five units due to respiratory failure following COVID-19 were analysed in terms of nutritional management on the eighth day of the ICU stay. The Harris-Benedict equation (HB), Mifflin St. Jeor equation (MsJ) and ESPEN formula (20 kcal kg -1 body weight) were used to estimate the energy target for each patient, and two ESPEN formulas determined the protein target (1 g kg -1 body weight and 1.3 g kg -1 body weight).

Results: Evaluation of nutritional therapy was performed in 129 subjects. The fulfilment of caloric requirement considering the HB, MsJ and ESPEN formula was 66%, 66.7% and 62.5%, respectively. Two clinical centres managed to provide 70% or more of daily caloric requirements. According to the ESPEN formula, the implementation of the protein target was 70%; however, one of the investigated units provided a median of 157% of the protein demand. The nutritional management varied in the preferred route of nutrition administration. Neither method nor grade of nutrition supply influenced biochemical parameters on the 8th day of ICU stay.

Conclusions: Significant differences in nutritional treatment of critically ill COVID-19 patients in Polish ICUs were noted, which underlines the importance of setting up clear guidelines regarding this issue.

Introduction: Critical neurological conditions require urgent assessment and treatment. The quality of care and treatment provided during the transportation is important and related to the outcome of critically ill patients. We aimed to assess the quality of interhospital transportation of neurocritical patients in the largest neurosurgical cluster in Lithuania and identify possible outcome prediction variables.

Material and methods: A retrospective cohort study was conducted. We analysed the data from 106 neurocritical patients who were transported to the Hospital of Lithuanian University of Health Sciences Kaunas Clinics Neurosurgery Clinic in 2018. We collected the needed data from patients' medical history, referrals, and transfer sheets. In our research, we evaluated the quality of referrals and the quality of filling protocols.

Results: The transportation protocols showed that during the transferrals diuresis, end-tidal carbon dioxide (ETCO2), pupil size, and reaction to light were not routinely measured in any of the patients, as opposed to other vital signs. We found that less than half of referrals (42%) were informative and suitable for sending the patient to another hospital. Results showed that the first systolic arterial blood pressure (sABP) measured at Neuro-ICU is associated with patient outcomes. Higher sABP was seen in the group of patients with negative outcomes (death, continued need for care).

Conclusions: This study demonstrated that monitoring of vital signs and neurological parameters as well as the quality of referrals were found to be the weakest links in the neurocritical patient transfer.

Purpose: Mivacurium is a short-acting, non-depolarising neuromuscular blocking agent that provides adequate vocal cord myorelaxation during transoral laser microsurgery. This study aimed to determine the optimal dose of mivacurium by comparing the infusion rate delivered via a closed-loop target-controlled infusion system.

Methods: A prospective, randomized clinical trial was conducted on 60 patients undergoing laser-assisted laryngeal microsurgery for vocal cord tumours. All patients received an induction mivacurium dose of 0.2 mg kg -1 and were randomized to 3 groups, namely C1, C2 and C3, each receiving infusion rates of 6 μg kg -1 min -1 , 7 μg kg -1 min -1 , 8 μg kg -1 min -1 , respectively. Neuromuscular monitoring and pharmacodynamic para-meters of mivacurium were recorded.

Results: No cases of airway spasms, blood pressure or heart rate fluctuations were observed. Three patients had skin redness at the injection site. The onset time, no- response time, and recovery index (RI) of mivacurium did not differ significantly among the groups. However, additional mivacurium doses were needed for 15 patients in C1, 10 patients in C2, and 3 patients in C3 ( P 5.68 min was correlated with reduced mivacurium supplementation, and it was associated with no-response time and total mivacurium dose. The recovery index of all patients was also positively correlated with total mivacurium dosage ( p < 0.0001, r = 0.7838).

Conclusions: A mivacurium infusion rate of 8 μg kg -1 min -1 offered the most favourable surgical field condition with no involuntary vocal cord movements, less need for supplementary doses, and fewer adverse reactions in laser-assisted laryngeal microsurgery.

The current literature indicates that routine evaluation of preoperative anxiety, its determinants, and patient-specific concerns is universally advocated. This aligns with the increasingly acknowledged importance of prehabilitation - a comprehensive process preparing patients for surgery. A crucial component of prehabilitation is assessing patients' mental health. Recommendations for psychological evaluations in prehabilitation encompass, inter alia, determining the severity of anxiety. This work builds on a 2019 article, which presented scales for preoperative anxiety assessment: the State Trait Anxiety Inventory (STAI), the Hospital Anxiety and Depression Scale (HADS), the Amsterdam Preoperative Anxiety and Information Scale (APAIS), and the Visual Analogue Scale (VAS). This article extends the possibilities of preoperative anxiety assessment by introducing four additional methods: the Surgical Fear Questionnaire (SFQ), the Anxiety Specific to Surgery Questionnaire (ASSQ), the Surgical Anxiety Questionnaire (SAQ), and Anesthesia- and Surgery-dependent Preoperative Anxiety (ASPA). The authors provide comprehensive details on these instruments, including scoring, interpretation, availability, and usefulness both in scientific research and clinical practice. The authors also provide the data on the availability of Polish versions of the presented methods and preliminary data on the reliability of SFQ in patients awaiting cardiac surgery. This review seems relevant for professionals in multiple disciplines, including anesthesiology, surgery, clinical psychology, nursing, primary care and notably prehabilitation. It emphasizes the necessity of individualizing anxiety assessment and acknowledging patient subjectivity, which the presented methods facilitate through a thorough evaluation of specific patient concerns. The literature review also identifies concerns and future research avenues in this area. The importance of qualitative studies and those evaluating prehabilitation intervention is emphasized.