European Journal of Anaesthesiology最新文献

{"title":"Mean arterial pressure versus cardiac index for haemodynamic management and myocardial injury after hepatopancreatic surgery: A randomised controlled trial.","authors":"Taner Abdullah,Hürü Ceren Gökduman,İşbara Alp Enişte,İlyas Kudaş,Achmet Ali,Erdem Kınacı,İlgin Özden,Funda Gümüş Özcan","doi":"10.1097/eja.0000000000002059","DOIUrl":"https://doi.org/10.1097/eja.0000000000002059","url":null,"abstract":"BACKGROUNDMyocardial injury after noncardiac surgery (MINS) frequently complicates the peri-operative period and is associated with increased mortality.OBJECTIVESWe hypothesised that cardiac index (CI) based haemodynamic management reduces peri-operative high-sensitive troponin-T (hsTnT) elevation and MINS incidence in patients undergoing hepatic/pancreatic surgery compared to mean arterial pressure.DESIGNA randomised controlled study.SETTINGA single-centre study conducted in a university-affiliated tertiary hospital between June 2022 and March 2023.PATIENTSNinety-one patients, who were ≥ 65 years old or ≥ 45 years old with a history of at least one cardiac risk factor were randomised to either mean arterial pressure (MAP) based (n = 45) or CI-based (n = 46) management groups, and completed the study.INTERVENTIONSIn group-MAP, patients received fluid boluses and/or a noradrenaline infusion to maintain MAP above the predefined threshold. In group-CI, patients received fluid boluses and/or dobutamine infusion to keep CI above the predefined threshold. When a low MAP was observed despite a normal CI, a noradrenaline infusion was started.MAIN OUTCOME MEASURESThe primary outcome was peri-operative hsTnT elevation. The secondary outcomes were MINS incidence and 90-day mortality.RESULTSThe median absolute troponin elevation was 4.3 ng l-1 (95% CI 3.4 to 6) for the CI-based group, and 9.4 ng l-1 (95% CI 7.7 to 12.7) for the MAP-based group (median difference: 5.1 ng l-1, 95% CI 3 to 7; P < 0.001). MINS occurred in 8 (17.4%) patients in the CI-based group and 17 (37.8%) patients in the MAP-based group (relative risk: 0.46, 95% CI: 0.22 to 0.96; P = 0.029). Two patients in group-MAP died from cardiovascular-related causes. One patient in group-CI and two in group-MAP died from sepsis-related complications (for all-cause mortality: χ2 = 1.98, P = 0.16). MAP-AUC and CI-AUC values of the CI- and MAP-based groups were 147 vs. 179 min × mmHg (P = 0.85) and 8.4 vs. 43.2 l m-2 min-1 × min (P < 0.001), respectively.CONCLUSIONSCI-based haemodynamic management assures sufficient flow and consequently is associated with peri-operative hsTnT elevation and the incidence of MINS compared to MAP.TRIAL REGISTRATIONClinicaltrials.gov identifier: NCT05391087.","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142226506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of remimazolam on intra-operative hypotension: Systematic review and meta-analysis of randomised controlled trials.","authors":"Ting-Yu He,Rui-Peng Zhong,Wei-Bo Zhong,Gui-Ming Huang,Xiao-Cheng Liu","doi":"10.1097/eja.0000000000002057","DOIUrl":"https://doi.org/10.1097/eja.0000000000002057","url":null,"abstract":"BACKGROUNDHypotension is common during anaesthesia. Increasing number of studies have reported that remimazolam may be associated with lower incidence of intra-operative hypotension compared with other anaesthetics. However, the results remain controversial.OBJECTIVEThis study aimed to evaluate the influence of remimazolam on intra-operative hypotension and its related outcomes (hypoxaemia, bradycardia and time to awake).DESIGNA systematic review of randomised controlled trials (RCTs) with meta-analyses.DATA SOURCESPubMed, Cocharane and Embase databases were searched to identify eligible RCTs published up to June 2024.ELIGIBILITY CRITERIARCTs published in English were eligible for inclusion. The study patients were 18 years or older who were administered with remimazolam and other positive control agents in either the pre-operative or intra-operative period. The incidence of intra-operative hypotension was identified in these studies.RESULTSThis study evaluated 34 trials including 4847 individuals. Basing on moderate-certainty evidence, we found that remimazolam administration reduced the incidence of intra-operative hypotension [risk ratio (RR) = 0.48, 95% confidence interval (95% CI): 0.41 to 0.57] and bradycardia (16 studies, n = 2869, RR = 0.40, 95% CI: 0.29 to 0.54). No difference was observed in the incidence of hypoxaemia (RR = 0.70, 95% CI: 0.48 to 1.01) and time to awake (MD = -0.91, 95% CI: -2.42 to 0.60). The remarkable association between remimazolam and hypotension remained robust and significant, regardless of general anaesthesia or procedural sedation (P < 0.01, I2 = 82%). No significant difference was found between different control drugs (P = 0.97, I2 = 82%).CONCLUSIONModerate-quality evidence shows that remimazolam administration to patients undergoing general anaesthesia or procedural sedation decreases the incidence of intra-operative hypotension and bradycardia.","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142207647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-operative triAge proCedure to streaMline elective surgicAl patieNts (PACMAN) improves efficiency by selecting patients eligible for phone consultation: A retrospective cohort study.","authors":"Manuela Di Biase,Babette van der Zwaard,Fenne Aarts,Barbe Pieters","doi":"10.1097/eja.0000000000002055","DOIUrl":"https://doi.org/10.1097/eja.0000000000002055","url":null,"abstract":"BACKGROUNDPre-operative screening is a high volume task consuming time and resource. Streamlining patient flow by gathering information in advance reduces costs, optimises resources and diminishes patient burden whilst maintaining safety of care.OBJECTIVETo evaluate whether 'Pre-operative triAge proCedure to streaMline elective surgicAl patieNts' (PACMAN) is able to improve pre-operative screening by selecting patients eligible for evaluation by telephone.DESIGNA single-centre, retrospective, observational cohort analysis.SETTINGA tertiary medical teaching hospital in 's-Hertogenbosch, The Netherlands.PATIENTS AND METHODSAdults scheduled for clinical interventions under procedural sedation and all types of elective medium or low risk surgery with anaesthetic guidance were eligible. Patients answered a questionnaire to calculate the PACMAN score. This score combined with risk factors related to surgery determines suitability for phone consultation (PhC) or the need for an in-person consultation (in-PC).INTERVENTIONEvaluation of standard care.MAIN OUTCOME MEASURESPrimary outcome was the reduction in number of in-PCs. Secondary outcomes included reliability of PACMAN, peri-operative patient outcomes and cost-effectiveness.RESULTSOf 965 patients triaged by PACMAN, 705 (73.1%) were identified as suitable for a PhC. Of those, 688 (97.6%) were classified American Society of Anesthesiologists Physical Status (ASA-PS) I to II or III with stable comorbidities. Of the 260 in-PC patients, 47.4% were classified ASA-PS III with unstable comorbidities or ASA-PS IV. The overall incidence of unanticipated adverse peri-operative events was 1.3%. Finally, implementation of PACMAN led to a 20% increase in pre-operative department efficiency due to better deployment of personnel and resources.CONCLUSIONImplementation of PACMAN resulted in a 73.1% reduction in pre-operative in-PCs at our hospital. Given the increasing pressure on healthcare systems globally, we suggest developing further optimisation and integration of smart triage solutions into the pre-operative process.TRIAL REGISTRATIONClinicalTrials.gov Identifier: NCT06148701.","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142207646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic value of lung ultrasound, clinical examination, and colourflow Doppler compared with fiberoptic bronchoscopy to predict appropriate lung exclusion in thoracic surgery: A cohort study.","authors":"Pierre-Henri Moury, Quentin Jegousso, Maxime Durost, Jérôme Nicolas, Pierre Albaladejo","doi":"10.1097/EJA.0000000000002056","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002056","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142119309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of goal-directed analgesia using the analgesia nociception index in children undergoing surgery for moyamoya disease: A randomised controlled trial.","authors":"Jung-Bin Park, Pyoyoon Kang, Sang-Hwan Ji, Young-Eun Jang, Ji-Hyun Lee, Jin-Tae Kim, Hee-Soo Kim, Eun-Hee Kim","doi":"10.1097/EJA.0000000000002013","DOIUrl":"10.1097/EJA.0000000000002013","url":null,"abstract":"<p><strong>Background: </strong>The potential benefits of Analgesia Nociception Index guided intra-operative analgesia on intra-operative opioid consumption remains to be demonstrated in paediatric anaesthesia.</p><p><strong>Objectives: </strong>This study aimed to explore the effects of Analgesia Nociception Index guided analgesia on sufentanil consumption during anaesthesia and postoperative pain scores in paediatric patients with moyamoya disease.</p><p><strong>Design: </strong>A prospective randomised controlled study.</p><p><strong>Setting: </strong>Seoul National University Children's Hospital, Seoul, Republic of Korea.</p><p><strong>Patients: </strong>A total of 40 children scheduled for encephaloduroarteriosynangiosis.</p><p><strong>Main outcome measures: </strong>The primary outcome was total intra-operative sufentanil consumption, and the secondary outcomes included postoperative pain scores and incidence of opioid-related adverse events.</p><p><strong>Results: </strong>The Analgesia Nociception Index group showed lower intra-operative sufentanil consumption (in μg kg -1  h -1 ) compared with the Standard group (0.30 ± 0.12 and 0.39 ± 0.17, respectively; mean difference, -0.09; 95% confidence interval, -0.19 to 0.00; P  = 0.049). Postoperatively, compared with the Standard group, the Analgesia Nociception Index group reported lower median pain scores at 18 and 24 h and maximum pain within 24 h (1 [0 to 2] vs. 3 [2 to 5]; P  = 0.004, 1 [0 to 2] vs. 3 [1 to 4]; P  = 0.041, and 4 [3 to 5] vs. 5 [4 to 7]; P  = 0.045, respectively), with fewer patients experiencing nausea (3 [15%] vs. 10 [50%], P  = 0.043).</p><p><strong>Conclusion: </strong>The Analgesia Nociception Index guided analgesic protocol can reduce intra-operative sufentanil consumption and postoperative pain within 24 h with fewer nausea symptoms in paediatric patients with moyamoya disease who undergo encephaloduroarteriosynangiosis.</p><p><strong>Trial registration number: </strong>NCT05672212.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141237367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of nitric oxide delivery via cardiopulmonary bypass circuit on postoperative oxygenation in adults undergoing cardiac surgery (NOCARD trial): a randomised controlled trial.","authors":"Karam Azem, Denis Novakovsky, Boris Krasulya, Shai Fein, Daniel Iluz-Freundlich, Julia Uhanova, Evgeniya Kornilov, Leonid A Eidelman, Shani Kaptzon, Dan Gorfil, Dan Aravot, Yaron Barac, Roussana Aranbitski","doi":"10.1097/EJA.0000000000002022","DOIUrl":"10.1097/EJA.0000000000002022","url":null,"abstract":"<p><strong>Background: </strong>Cardiac surgery involving cardiopulmonary bypass induces a significant systemic inflammatory response, contributing to various postoperative complications, including pulmonary dysfunction, myocardial and kidney injuries.</p><p><strong>Objective: </strong>To investigate the effect of Nitric Oxide delivery via the cardiopulmonary bypass circuit on various postoperative outcomes.</p><p><strong>Design: </strong>A prospective, single-centre, double-blinded, randomised controlled trial.</p><p><strong>Setting: </strong>Rabin Medical Centre, Beilinson Hospital, Israel.</p><p><strong>Patients: </strong>Adult patients scheduled for elective cardiac surgery were randomly allocated to one of the study groups.</p><p><strong>Interventions: </strong>For the treatment group, 40 ppm of nitric oxide was delivered via the cardiopulmonary bypass circuit. For the control group, nitric oxide was not delivered.</p><p><strong>Outcome measures: </strong>The primary outcome was the incidence of hypoxaemia, defined as a p a O2 /FiO 2 ratio less than 300 within 24 h postoperatively. The secondary outcomes were the incidences of low cardiac output syndrome and acute kidney injury within 72 h postoperatively.</p><p><strong>Results: </strong>Ninety-eight patients were included in the final analysis, with 47 patients allocated to the control group and 51 to the Nitric Oxide group. The Nitric Oxide group exhibited significantly lower hypoxaemia rates at admission to the cardiothoracic intensive care unit (47.1 vs. 68.1%), P  = 0.043. This effect, however, varied in patients with or without baseline hypoxaemia. Patients with baseline hypoxaemia who received nitric oxide exhibited significantly lower hypoxaemia rates (61.1 vs. 93.8%), P  = 0.042, and higher p a O2 /FiO 2 ratios at all time points, F (1,30) = 6.08, P  = 0.019. Conversely, this benefit was not observed in patients without baseline hypoxaemia. No significant differences were observed in the incidence of low cardiac output syndrome or acute kidney injury. No substantial safety concerns were noted, and toxic methaemoglobin levels were not observed.</p><p><strong>Conclusions: </strong>Patients with baseline hypoxaemia undergoing cardiac surgery and receiving nitric oxide exhibited lower hypoxaemia rates and higher p a O2 /FiO 2 ratios. No significant differences were found regarding postoperative pulmonary complications and overall outcomes.</p><p><strong>Trial registration: </strong>NCT04807413.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141733765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oxygen reserve index versus conventional peripheral oxygen saturation for prevention of hypoxaemia: A randomised controlled trial.","authors":"Eun-Hee Kim, Jung-Bin Park, Pyoyoon Kang, Sang-Hwan Ji, Young-Eun Jang, Ji-Hyun Lee, Hee-Soo Kim, Jin-Tae Kim","doi":"10.1097/EJA.0000000000002018","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002018","url":null,"abstract":"<p><strong>Background: </strong>Hypoxaemia occurs frequently during paediatric laryngeal microsurgery.</p><p><strong>Objective: </strong>The oxygen reserve index is a noninvasive and continuous parameter to assess PaO2 levels in the range of 100 to 200 mmHg. It ranges from 0 to 1.0. We investigated whether monitoring the oxygen reserve index can reduce the incidence of SpO2 90% or less.</p><p><strong>Design: </strong>Randomised controlled trial.</p><p><strong>Setting: </strong>A tertiary care paediatric hospital.</p><p><strong>Participants: </strong>Paediatric patients aged 18 years or less scheduled to undergo laryngeal microsurgery.</p><p><strong>Intervention: </strong>The patients were randomly allocated to the oxygen reserve index or control groups, and stratified based on the presence of a tracheostomy tube. Rescue intervention was performed when the oxygen reserve index was 0.2 or less and the SpO2 was 94% or less in the oxygen reserve index and control groups, respectively.</p><p><strong>Main outcome measure: </strong>The primary outcome was the incidence of SpO2 90% or less during the surgery.</p><p><strong>Results: </strong>Data from 88 patients were analysed. The incidence of SpO2 ≤ 90% did not differ between the oxygen reserve index and control groups [P = 0.114; 11/44, 25% vs. 18/44, 40.9%; relative risk: 1.27; and 95% confidence interval (CI): 0.94 to 1.72]. Among the 128 rescue interventions, SpO2 ≤ 90% event developed in 18 out of 75 events (24%) and 42 out of 53 events (79.2%) in the oxygen reserve index and control groups, respectively (P < 0.001; difference: 55.2%; and 95% CI 38.5 to 67.2%). The number of SpO2 ≤ 90% events per patient in the oxygen reserve index group (median 0, maximum 3) was less than that in the control group (median 0, maximum 8, P = 0.031).</p><p><strong>Conclusion: </strong>Additional monitoring of the oxygen reserve index, with a target value of greater than 0.2 during paediatric airway surgery, alongside peripheral oxygen saturation, did not reduce the incidence of SpO2 ≤ 90%.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141859413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early supraglottic airway versus facemask ventilation before tracheal intubation to facilitate ventilation in high-risk patients: A prospective randomised trial.","authors":"J Ross Renew, Eslam A Fouda, Dylan M Mordecai, Ashley N Huxhold, Ilana I Logvinov, Michael G Heckman, Klaus D Torp","doi":"10.1097/EJA.0000000000002030","DOIUrl":"10.1097/EJA.0000000000002030","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141476241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors affecting adherence to recommendations on pre-operative cardiac testing: A cohort study.","authors":"Alexandra Stroda, Tanja Sulot, Sebastian Roth, René M'Pembele, Eckhard Mauermann, Daniela Ionescu, Wojciech Szczeklik, Stefan De Hert, Miodrag Filipovic, Beatrice Beck Schimmer, Savino Spadaro, Purificación Matute, Sanem Cakar Turhan, Judith van Waes, Filipa Lagarto, Kassiani Theodoraki, Anil Gupta, Hans-Jörg Gillmann, Luca Guzzetti, Katarzyna Kotfis, Jan Larmann, Dan Corneci, Simon J Howell, Giovanna Lurati Buse","doi":"10.1097/EJA.0000000000002039","DOIUrl":"10.1097/EJA.0000000000002039","url":null,"abstract":"<p><strong>Background: </strong>Cardiac risk evaluation prior to noncardiac surgery is fundamental to tailor peri-operative management to patient's estimated risk. Data on the degree of adherence to guidelines in patients at cardiovascular risk in Europe and factors influencing adherence are underexplored.</p><p><strong>Objectives: </strong>The aim of this analysis was to describe the degree of adherence to [2014 European Society of Cardiology (ESC)/European Society of Anaesthesiology (ESA) guidelines] recommendations on rest echocardiography [transthoracic echocardiography (TTE)] and to stress imaging prior to noncardiac surgery in a large European sample and to assess factors potentially affecting adherence.</p><p><strong>Design: </strong>Secondary analysis of a multicentre, international, prospective cohort study (MET-REPAIR).</p><p><strong>Setting: </strong>Twenty-five European centres of all levels of care that enrolled patients between 2017 and 2020.</p><p><strong>Patients: </strong>With elevated cardiovascular risk undergoing in-hospital elective, noncardiac surgery.</p><p><strong>Main outcome measures: </strong>(Non)adherence to each pre-operative TTE and stress imaging recommendations classified as guideline-adherent, overuse and underuse. We performed descriptive analysis. To explore the impact of patients' sex, age, geographical region, and hospital teaching status, we conducted multivariate multinominal regression analysis.</p><p><strong>Results: </strong>Out of 15 983 patients, 15 529 were analysed (61% men, mean age 72 ± 8 years). Overuse (conduction in spite of class III) and underuse (nonconduction in spite of class I recommendation) for pre-operative TTE amounted to 16.6% (2542/15 344) and 6.6% (1015/15 344), respectively. Stress imaging overuse and underuse amounted to 1.7% (241/14 202) and 0.4% (52/14 202) respectively. Male sex, some age categories and some geographical regions were significantly associated with TTE overuse. Male sex and some regions were also associated with TTE underuse. Age and regions were associated with overuse of stress imaging. Male sex, age, and some regions were associated with stress imaging underuse.</p><p><strong>Conclusion: </strong>Adherence to pre-operative stress imaging recommendation was high. In contrast, adherence to TTE recommendations was moderate. Both patients' and geographical factors affected adherence to joint ESC/ESA guidelines.</p><p><strong>Trial registration: </strong>NCT03016936.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141579281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognosis and assessment of the predictive value of severity scores in paediatric abdominal trauma: A French national cohort study.","authors":"Sidonie Hanna, Juliette Montmayeur, Estelle Vergnaud, Gilles Orliaguet","doi":"10.1097/EJA.0000000000002019","DOIUrl":"10.1097/EJA.0000000000002019","url":null,"abstract":"<p><strong>Background: </strong>Paediatric closed abdominal trauma is common, however, its severity and influence on survival are difficult to determine. No prognostic score integrating abdominal involvement exists to date in paediatrics.</p><p><strong>Objectives: </strong>To evaluate the severity and short-term and medium-term prognosis of closed abdominal trauma in children, and the performance of severity scores in predicting mortality.</p><p><strong>Design: </strong>Retrospective, cohort, observational study.</p><p><strong>Setting and participants: </strong>Patients aged 0 to 18 years presenting at the trauma room of a French paediatric Level I Trauma Centre over the period 2015 to 2019 with an isolated closed abdominal trauma or as part of a polytrauma.</p><p><strong>Main outcomes: </strong>Primary outcome was the six months mortality. Secondary outcomes were related complications and therapeutic interventions, and performance for predicting mortality of the scores listed. Paediatric Trauma Score (PTS), Revised Trauma Score (RTS), Shock Index Paediatric Age-adjusted (SIPA) score, Reverse shock index multiplied by Glasgow Coma Scale score (rSIG), Base Deficit, International Normalised Ratio, and Glasgow Coma Scale (BIG), Injury Severity Score (ISS) and Trauma Score and the Injury Severity (TRISS) score.</p><p><strong>Data collection: </strong>Data collected include clinical, biological and CT scan data at admission, first 24 h management and prognosis. The PTS, RTS, SIPA, rSIG, BIG and ISS scores were calculated and mortality was predicted according to BIG score and TRISS methodology.</p><p><strong>Results: </strong>Of 1145 patients, 149 met the inclusion criteria and 12 (8.1%) died. Of the 12 deceased patients, 11 (91.7%) presented with severe head injury, 11 (91.7%) had blood products transfusion and 7 received tranexamic acid. ROC curves analysis concluded that PTS, RTS, rSIG and BIG scores accurately predict mortality in paediatric closed abdominal trauma with AUCs at least 0.92. The BIG score offered the best predictive performance for predicting mortality at a threshold of 24.8 [sensitivity 90%, specificity 92%, negative-predictive value (NPV) 99%, area under the curve (AUC) 0.93].</p><p><strong>Conclusion: </strong>PEVALPED is the first French study to evaluate the prognosis of paediatric closed abdominal trauma. The use of PTS, rSIG and BIG scores are relevant from the acute phase and the pathophysiological interest and accuracy of the BIG score make it a powerful tool for predicting mortality of closed abdominal trauma in children.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141069742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}