Brazilian Journal of Anesthesiology最新文献

{"title":"End-tidal carbon dioxide-guided extracorporeal cardiopulmonary resuscitation improves neurological prognosis in patients: a single-center retrospective cohort study","authors":"Xiaozu Liao,&nbsp;Chen Gu,&nbsp;Zhou Cheng,&nbsp;Kepeng Liu,&nbsp;Qing Yin,&nbsp;Binfei Li","doi":"10.1016/j.bjane.2025.844588","DOIUrl":"10.1016/j.bjane.2025.844588","url":null,"abstract":"<div><h3>Background</h3><div>Extracorporeal Cardiopulmonary Resuscitation (ECPR) is an effective intervention for restoring adequate circulatory perfusion after cardiac arrest. Ensuring high-quality Cardiopulmonary Resuscitation (CPR) before initiating Extracorporeal Membrane Oxygenation (ECMO) is critical to mitigate tissue hypoxia and ischemia. This study aimed to evaluate the effect of End-Tidal Carbon Dioxide (ETCO₂) Goal-Directed CPR (GDCPR) on neurological function before ECMO using a retrospective case-control analysis.</div></div><div><h3>Methods</h3><div>The medical records of all patients who received ECPR treated at Zhongshan City People's Hospital were collected between January 2020 and March 2023. In this retrospective cohort study, the patients were divided into Conventional CPR (CCPR) and ETCO₂-GDCPR groups based on whether ETCO₂ was used as a guide for CPR.</div></div><div><h3>Results</h3><div>A total of 71 patients were included, of whom 46 comprised the CCPR group and 25 comprised the GDCPR group. Approximately 37% of patients who received ECPR had good cerebral function at discharge, with a higher rate in the GDCPR group (52%) compared with the CCPR group (28%) (p = 0.047). Multivariate analysis showed that the Highest Interleukin-6 (H-IL6) levels after ECMO (Odds Ratio [OR = 1.001], 95% Confidence Interval [95% CI 1.000–1.003], p = 0.005) was a risk factor for neurological function at discharge. The other risk factors for poor prognosis in patients who received ECPR included pre-ECMO CPR protocols (OR = 10.74, 95% CI 1.90–60.48, p = 0.007) and IL6 levels after ECMO (OR = 1.002, 95% CI 1.001–1.003, p = 0.005). ECMO duration (OR = 0.83, 95% CI 0.74–0.94, p = 0.002) was identified as a protective factor. Patients with short ECMO duration have a poor prognosis. The area under the curve for ECMO duration was 0.86 (0.77–0.94, p &lt; 0.01), while that for H-IL6 was 0.19 (0.09–0.29, p &lt; 0.01).</div></div><div><h3>Conclusion</h3><div>ETCO₂-guided ECPR is associated with improved neurological prognosis and patient outcomes. Therefore, monitoring ETCO₂ levels should be considered a crucial component of evaluating resuscitation efficacy during CPR.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 3","pages":"Article 844588"},"PeriodicalIF":1.7,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of hypotension prediction index software in patients undergoing orthotopic liver transplantation: retrospective observational study","authors":"Jacek B. Cywinski ,&nbsp;Yufei Li ,&nbsp;Lusine Israelyan ,&nbsp;Roshni Sreedharan ,&nbsp;Silvia Perez-Protto ,&nbsp;Kamal Maheshwari","doi":"10.1016/j.bjane.2025.844589","DOIUrl":"10.1016/j.bjane.2025.844589","url":null,"abstract":"<div><h3>Background</h3><div>Extreme hemodynamic changes, especially intraoperative hypotension (IOH), are common and often prolonged during Liver Transplant (LT) surgery and during initial hours of recovery. Hypotension Prediction Index (HPI) software is one of the tools which can help in proactive hemodynamic management. The accuracy of the advanced hemodynamic parameters such as Cardiac Output (CO) and Systemic Vascular Resistance (SVR) obtained from HPI software and prediction performance of the HPI in LT surgery remains unknown.</div></div><div><h3>Methods</h3><div>This was a retrospective observational study conducted in a tertiary academic center with a large liver transplant program. We enrolled 23 adult LT patients who received both Pulmonary Artery Catheter (PAC) and HPI software monitoring. Primarily, we evaluated agreement between PAC and HPI software measured CO and SVR. A priori, we defined a relative difference of less than 20% between measurements as an adequate agreement for a pair of measurements and estimated the Lin's Concordance Correlation Coefficient and Bland-Altman Limits of Agreement (LOA). Clinically acceptable LOA was defined as ± 1 L.min^-1 for CO and ± 200 dynes s.cm^-5 for SVR. Secondary outcome was the ability of the HPI to predict future hypotension, defined as Mean Arterial Pressure (MAP) less than 65 mmHg lasting at least one minute. We estimated sensitivity, positive predictive value, and time from alert to hypotensive events for HPI software.</div></div><div><h3>Results</h3><div>Overall, 125 pairs of CO and 122 pairs of SVR records were obtained from 23 patients. Based on our predefined criteria, only 42% (95% CI 30%, 55%) of CO records and 53% (95% CI 28%, 72%) of SVR records from HPI software were considered to agree with those from PAC. Across all patients, there were a total of 1860 HPI alerts (HPI ≥ 85) and 642 hypotensive events (MAP &lt; 65 mmHg). Out of the 642 hypotensive events, 618 events were predicted by HPI alert with sensitivity of 0.96 (95% CI: 0.95). Many times, the HPI value remained above alert level and was followed by multiple hypotensive events. Thus, to evaluate PPV and time to hypotension metric, we considered only the first HPI alert followed by a hypotensive event (“true alerts”). The “true alert” was the first alert when there were several alerts before a hypotension. There were 614 “true alerts” and the PPV for HPI was 0.33 (95% CI 0.31, 0.35). The median time from HPI alert to hypotension was 3.3 [Q1, Q3: 1, 9.3] mins.</div></div><div><h3>Conclusion</h3><div>There was poor agreement between the pulmonary artery catheter and HPI software calculated advanced hemodynamic parameters (CO and SVR), in the patients undergoing LT surgery. HPI software had high sensitivity but poor specificity for hypotension prediction, resulting in a high burden of false alarms.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 3","pages":"Article 844589"},"PeriodicalIF":1.7,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges in surgical and perioperative care for Brazil's aging population","authors":"Andre P. Schmidt ,&nbsp;Federico Bilotta","doi":"10.1016/j.bjane.2025.844586","DOIUrl":"10.1016/j.bjane.2025.844586","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 2","pages":"Article 844586"},"PeriodicalIF":1.7,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11761882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The pulmonary artery catheter in modern anesthesiology and intensive care: indications, benefits, and limitations","authors":"Andre P. Schmidt ,&nbsp;Clovis T. Bevilacqua Filho ,&nbsp;Eduarda S. Martinelli ,&nbsp;Virgínia C. de Moura","doi":"10.1016/j.bjane.2025.844587","DOIUrl":"10.1016/j.bjane.2025.844587","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 2","pages":"Article 844587"},"PeriodicalIF":1.7,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender representation in anesthesiology research: a historical perspective from the Brazilian Journal of Anesthesiology","authors":"Stefania Lacerda Garcia ,&nbsp;Claudia Marquez Simões ,&nbsp;Maria José Carvalho Carmona ,&nbsp;Liana Maria Tôrres de Araújo Azi","doi":"10.1016/j.bjane.2024.844584","DOIUrl":"10.1016/j.bjane.2024.844584","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 2","pages":"Article 844584"},"PeriodicalIF":1.7,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of methylene blue in adult patients with septic shock: a systematic review and meta-analysis","authors":"Ka Ting Ng ,&nbsp;Pei En Kwok ,&nbsp;Wei En Lim ,&nbsp;Wan Yi Teoh ,&nbsp;Mohd Shahnaz Hasan ,&nbsp;Mohd Fitry Zainal Abidin","doi":"10.1016/j.bjane.2024.844580","DOIUrl":"10.1016/j.bjane.2024.844580","url":null,"abstract":"<div><h3>Objectives</h3><div>Methylene blue exerts its vasopressor properties by inhibiting nitric oxide-mediated vasodilation. Recent studies have advocated the use of methylene blue as a rescue therapy for patients with septic shock. The primary aim was to investigate the effect of methylene blue on the mean arterial pressure among adult patients with septic shock.</div></div><div><h3>Methods</h3><div>Databases of MEDLINE, EMBASE, and CENTRAL were searched from their inception date until October 2023. Randomized Clinical Trials (RCT) comparing methylene blue and placebo in adults with septic shock were included.</div></div><div><h3>Results</h3><div>Our systematic review included 5 studies (n = 257) for data analysis. As compared to the placebo, our pooled analysis showed that methylene blue significantly increased mean arterial pressure (MD: 1.34 mmHg, 95% CI 0.15 to 2.53, p = 0.03, level of evidence: very low). Patients who were given methylene blue were associated with statistically lower mortality rate (OR = 0.49, 95% CI 0.27 to 0.88, p = 0.02, level of evidence: low), reduced serum lactate levels (MD: -0.76 mmoL.L^-1, 95% CI -1.22 to -0.31, p = 0.0009, level of evidence: low), reduced length of hospital stay (MD: -1.94 days, 95% CI -3.79 to -0.08, p = 0.04, level of evidence: low), and increased PaO₂/FiO₂ (MD: 34.78, 95% CI 8.94 to 60.61, p = 0.008, level of evidence: low).</div></div><div><h3>Conclusions</h3><div>This meta-analysis demonstrated that methylene blue administration was associated with an increased in mean arterial pressure and PaO₂/FiO₂ ratio, along with a reduction in mortality rates, serum lactate levels, and length of hospital stay. However, substantial degree of heterogeneity and inadequate number of studies with low level of evidence warrant future adequately powered RCTs to affirm our results.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 1","pages":"Article 844580"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11754512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142775187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shaping the future of anesthesia research: celebrating progress and embracing new challenges","authors":"Andre P. Schmidt","doi":"10.1016/j.bjane.2024.844582","DOIUrl":"10.1016/j.bjane.2024.844582","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 1","pages":"Article 844582"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11717656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of patient- and family-centered care interventions on intensive care unit outcomes: a meta-analysis of randomized controlled trials","authors":"Yangjin LV ,&nbsp;Peng Li ,&nbsp;Ronghui Li ,&nbsp;Ting Zhang ,&nbsp;Kaifang Cai","doi":"10.1016/j.bjane.2024.844577","DOIUrl":"10.1016/j.bjane.2024.844577","url":null,"abstract":"<div><h3>Background</h3><div>Patient and Family-Centered Care (PFCC) interventions are increasingly recognized as a viable approach to address various mental health issues among patients in Intensive Care Units (ICUs). Therefore, this review aims to estimate the effect of Patient and Family-Centered Care Interventions on specific outcomes in adult patients admitted to Intensive Care Units (ICUs).</div></div><div><h3>Methods</h3><div>We systematically searched four major databases for parallel arm Randomized Controlled Trials (RCTs). The PRISMA framework was used to report our review. We included studies involving adult patients (&gt; 18-years) admitted to ICUs and examined the effects of any type of Patient and Family-Centered Care intervention (PFCC) on outcomes such as depression, anxiety, delirium, and length of hospital stay. Data extraction was performed independently by two authors in Medline, Google Scholar, and ScienceDirect, from inception to July 2024. Random effects model was used to pool the data.</div></div><div><h3>Results</h3><div>A total of 11 studies were included in our systematic review and meta-analysis, with a combined sample size of 3352 patients (PFCC group, n = 1681; usual care group, n = 1671). A random-effects model revealed a significant reduction in delirium prevalence in the PFCC group, with a pooled Risk Ratio (RR) of 0.54 (95% CI 0.36 to 0.81). However, no statistical significance was found for other outcomes such as depression, length of ICU stay, and anxiety. It is important to note that all the included studies were assessed to have either a high or unclear risk of bias.</div></div><div><h3>Conclusion</h3><div>PFCC interventions may significantly reduce delirium rates among ICU patients; however, their effects on other outcomes, such as depression, anxiety, and length of stay, were not statistically significant.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 1","pages":"Article 844577"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11714723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oscillatory ventilation enhances oxygenation and reduces inflammation in an animal model of acute respiratory distress syndrome: an experimental study","authors":"Luiz Alberto Forgiarini Junior ,&nbsp;Luiz Felipe Forgiarini ,&nbsp;Arthur de Oliveira Paludo ,&nbsp;Rodrigo Mariano ,&nbsp;Mikael Marcelo de Moraes ,&nbsp;Elaine Aparecida Felix ,&nbsp;Cristiano Feijó Andrade","doi":"10.1016/j.bjane.2024.844576","DOIUrl":"10.1016/j.bjane.2024.844576","url":null,"abstract":"<div><h3>Background</h3><div>This study aims to compare the use of variable mechanical ventilation with conventional mechanical ventilation in a porcine model of ARDS induced by oleic acid.</div></div><div><h3>Methods</h3><div>The animals were divided into two groups (n = 6), Conventional Ventilation (CO) and variable ventilation with Bi-Oscillatory PEEP (BiPEEP). ARDS was induced using intravenous oleic acid (0.15 mL.kg⁻¹). After, the animals were evaluated during 180 minutes and, measurements were taken every 30 minutes until the end of the observation period. The animals in the CO group were then ventilated under controlled pressure (Tidal Volume target at 6 mL.kg⁻¹) and 5 cm H₂O PEEP. Variable ventilation was characterized by the oscillation of PEEP from 5 to 10 cm H₂O every 4 respiratory cycles. Ventilatory, hemodynamic parameters, oxidative stress, antioxidant enzymes, Interleukin 8 (IL8) and 17-a (IL17a) were evaluated. Histological samples were collected from the upper and the lower portion of the left lungs and analyzed separately.</div></div><div><h3>Results</h3><div>BiPEEP improved lung compliance and PaO₂ in comparison to control (p &lt; 0.05). The levels of oxidative stress and antioxidant enzymes showed no significant difference. There was no difference in IL17a between groups. IL8 was significantly increased in the lung base of CO group in relation to BiPEEP group and it was reduced in the apex of BiPEEP group in comparsion to CO group. The BiPEEP group showed less changes in histopathological patterns.</div></div><div><h3>Conclusion</h3><div>Variable ventilation with bi-oscillatory level of PEEP demonstrated a potential ventilatory strategy for lung protection in an experimental model of ARDS.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 1","pages":"Article 844576"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11731209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The hidden cost of hypotension: redefining hemodynamic management to improve patient outcomes","authors":"Eric B. Lineburger ,&nbsp;Deepak K. Tempe ,&nbsp;Luiz Guilherme V. da Costa ,&nbsp;G. Burkhard Mackensen ,&nbsp;Fabio V. Papa ,&nbsp;Carlos Galhardo Jr. ,&nbsp;Mohamed R. El Tahan ,&nbsp;Marcello F. Salgado-Filho ,&nbsp;Rodrigo Diaz ,&nbsp;André P. Schmidt","doi":"10.1016/j.bjane.2024.844581","DOIUrl":"10.1016/j.bjane.2024.844581","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 1","pages":"Article 844581"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11733040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}