Anaesthesiology intensive therapy最新文献

Introduction: Hypovolaemia is presumed to be a common risk factor of postinduction hypotension (PIH), despite worldwide improvement in preoperative volume optimization. Correct assessment of fluid status in patients undergoing general anaesthesia remains a major challenge for anaesthesiologists. Bioimpedance analysis (BIA) is a sensitive method that allows objective assessment of patient fluid status as it can detect subclinical changes. The study's main purpose was to determine the correlation between the preoperative BIA assessed fluid status and PIH.

Material and methods: This was an observational single centre study that included patients undergoing elective surgery. We defined PIH as the blood pressure decrease occurring during the first 10 minutes after induction of anaesthesia and orotracheal intubation before surgical incision. We standardized BIA evaluation, patient pre anaesthetic and preoperative preparation, technique and monitoring of anaesthesia.

Results: Our study included 115 patients. The mean age of the population was 58.1 years and the median values for total and intracellular water were 35.1 L and 19.3 L, respectively. In the univariable and multivariable analysis, only total body and intracellular water were associated with different definitions of PIH. There was no correlation between any of the BIA-derived parameters of fluid status and the duration of PIH.

Conclusions: Our study shows that in elective surgery, bioimpedance could detect subtle, subclinical fluid parameters that are associated with PIH.

Introduction: The superior vena cava collapsibility index (SVC-CI) is a potential marker of fluid responsiveness (FR) in mechanically ventilated patients. Few studies reporting its diagnostic performance are currently available.

Material and methods: A systematic search, using the PRISMA approach, was performed using the Medline and EMBASE databases. Prospective studies evaluating the SVC-CI as a marker of FR in ventilated adult patients were included. A bivariate random-effect model was utilised to generate the summary receiver operating characteristic (SROC) curve. The area under the ROC curve (AUC), the sensitivity and specificity of the curve operating point were calculated.

Results: We included eight studies with a total of 857 patients, in whom SVC-CI was evaluated a total of 1083 times prior to the volume expansion trial. In 609 (56.23%) trial cases FR was present. The SROC curve demonstrated that the test's operating point has a sensitivity and specificity of 80.8% (95% CI: 66.3-90%) and 81.4% (95% CI: 76.4-85.5%), respectively. The model's AUC was equal to 0.848 (95% CI: 0.824-0.863) with P < 0.001. No significant inter-study heterogeneity was found (I 2 = 0%). A subgroup analysis revealed a significantly lower sensitivity of SVC-CI in patients with higher levels of positive end-expiratory pressure (PEEP) (> 5 cm H 2 O) (χ 2 = 7.753, df = 2, P = 0.0207). The study setting and type of intervention for volume expansion did not significantly change the performance of the test.

Conclusions: SVC-CI is a reliable predictor of FR for mechanically ventilated patients in intensive care units and operating rooms. A PEEP level exceeding 5 cm H 2 O may impair the sensitivity of the test.

Introduction: Neuraxial anaesthesia is a common choice for most hip and lower limb operations. Pain associated with positioning is often a deterrent, and the vast literature suggests different regional blocks and opioids for these patients. Patients with acetabular fractures may experience increased pain, and thus are more difficult to position for the neuraxial block. We conducted a randomized controlled pilot study to assess and compare the analgesic efficacy of ultrasound-guided suprainguinal fascia iliaca block (SFICB) versus systemic fentanyl to facilitate positioning for combined spinal epidural (CSE) anaesthesia in patients undergoing acetabular fracture surgery.

Material and methods: Twenty patients referred for surgical repair of acetabular fractures were randomly assigned to receive either ultrasound-guided SFICB (group B) or intravenous fentanyl (group F). Changes in visual analogue scale (VAS) scores in supine and sitting position, improvement in sitting angle (SA), positioning quality, rescue analgesic requirement, total opioid consumption, comfort VAS scores, and complications were noted to compare both groups.

Results: The post-intervention VAS score in the sitting position was significantly lower in group B than in group F (5.9 ± 2.1 vs. 3.5 ± 1.5, P = 0.01). Group B also had more significant improvement in SA (27.5° (20.75-36.5°), in comparison to group F (10 (5-18.75), P = 0.006). The positioning quality was better in group B, with 70% of patients achieving an optimal position compared to only 10% in group F ( P = 0.02).

Conclusions: Ultrasound-guided SFICB, as compared to systemic fentanyl, provided better analgesia and helped to achieve a better and more comfortable position to perform the neuraxial block.

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.

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.

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.