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Pharmacology and clinical use of plasma expanders: a 2026 update 血浆扩张器的药理学和临床应用：2026年更新
IF 0.3
Anaesthesia and Intensive Care Medicine Pub Date : 2026-04-01 Epub Date: 2026-03-30 DOI: 10.1016/j.mpaic.2026.02.018
J Pedro Teixeira, Catherine C Wentowski, Nathan D Nielsen
{"title":"Pharmacology and clinical use of plasma expanders: a 2026 update","authors":"J Pedro Teixeira,&nbsp;Catherine C Wentowski,&nbsp;Nathan D Nielsen","doi":"10.1016/j.mpaic.2026.02.018","DOIUrl":"10.1016/j.mpaic.2026.02.018","url":null,"abstract":"<div><div>Plasma expanders are colloidal solutions that expand the circulating blood volume more than isotonic crystalloids. Though this physiologic effect is typically transient, colloids remain commonly though variably used in critical care and perioperative medicine worldwide. Our review of these agents begins by introducing the modified Starling model, which incorporates the fundamental physiologic role of the endothelial glycocalyx in transcapillary fluid movement. Next, we discuss each fluid's pharmacological properties and evidence base for use. Multiple trials suggest that albumin is a safe, albeit more expensive, alternative to crystalloids in intensive care, with secondary analyses suggesting harm in traumatic brain injury and possibly benefit in septic shock. Data to support the routine perioperative use of albumin are lacking, with recent trials in cardiac surgery showing no benefit or harm. Trials on hydroxyethyl starch in critical care demonstrate increased risk of kidney injury, coagulopathy, and possibly mortality. Recent trial data indicate that these harms may not equally apply to low-risk surgical patients, but, while an area of ongoing debate and study, no compelling evidence exists to support the routine perioperative use of hydroxyethyl starch. Finally, human trials on gelatins and dextrans are relatively scarce, making their use difficult to justify in most settings.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"27 4","pages":"Pages 227-234"},"PeriodicalIF":0.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147653117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Management of the patient with rib fractures 肋骨骨折患者的处理
IF 0.3
Anaesthesia and Intensive Care Medicine Pub Date : 2026-04-01 Epub Date: 2026-03-30 DOI: 10.1016/j.mpaic.2026.02.012
Arran Keir, Robert Hart
{"title":"Management of the patient with rib fractures","authors":"Arran Keir,&nbsp;Robert Hart","doi":"10.1016/j.mpaic.2026.02.012","DOIUrl":"10.1016/j.mpaic.2026.02.012","url":null,"abstract":"<div><div>Rib fractures commonly result from blunt chest wall trauma and are often associated with significant morbidity and mortality. Patients often develop a vicious cycle of pain, requirement for opioid analgesia, respiratory dysfunction, hypostatic pneumonia and ultimately respiratory failure. This is more common in those with high-risk features such as increasing age, respiratory co-morbidities and significant burden of injury. Poorly managed chest wall pain can lead to prolonged hospital stay, including critical care admission, invasive ventilation and increased likelihood of morbidity and death. Protocolized assessment and management is recommended to ensure high-risk patients are identified early and ensure that a holistic package of care including physiotherapy, incentive spirometry, multi-modal stepwise analgesia and laxatives are provided for all patients. Regional anaesthesia and surgical fixation should also be considered early for high-risk patients. A multidisciplinary approach is essential to maximize patient experience and outcome.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"27 4","pages":"Pages 196-201"},"PeriodicalIF":0.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147653124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The critical care management of major burns and inhalational injury 重大烧伤和吸入性损伤的重症监护管理
IF 0.3
Anaesthesia and Intensive Care Medicine Pub Date : 2026-04-01 Epub Date: 2026-03-30 DOI: 10.1016/j.mpaic.2026.02.013
Max Williamson, Alistair Baird
{"title":"The critical care management of major burns and inhalational injury","authors":"Max Williamson,&nbsp;Alistair Baird","doi":"10.1016/j.mpaic.2026.02.013","DOIUrl":"10.1016/j.mpaic.2026.02.013","url":null,"abstract":"<div><div>Burns, or tissue damage secondary to heat, high-voltage electricity or caustic chemical exposure, lead to an estimated 8,000 hospital admissions in the UK each year. Given the vast array of different causes and complications of these injuries, critically ill burns patients require multidisciplinary team input from the moment they arrive in hospital. From the perspective of the anaesthetist or the intensivist, burns patients present unique challenges in pre-hospital stabilization, operative management and in critical care. This narrative review will highlight key practice points in the recognition and management of critically ill patients with burns. The focus will be on adult patients, and where practices differ for children links for further reading will be provided. Thermal burns and scalds will be the focus of this review, although chemical and electrical burns will be discussed where practice differs. Whilst often falling under the care of burns units, frostbite injuries will not be discussed. We aim to review the complications arising from burns from critical care admission and to discharge, with a focus on the pathophysiology and management of inhalational injury.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"27 4","pages":"Pages 202-207"},"PeriodicalIF":0.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147653122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Management of major trauma 重大创伤的处理
IF 0.3
Anaesthesia and Intensive Care Medicine Pub Date : 2026-04-01 Epub Date: 2026-03-30 DOI: 10.1016/j.mpaic.2026.02.011
Roshan Saleh, Andrew McGuire, Fin O'Sullivan
{"title":"Management of major trauma","authors":"Roshan Saleh,&nbsp;Andrew McGuire,&nbsp;Fin O'Sullivan","doi":"10.1016/j.mpaic.2026.02.011","DOIUrl":"10.1016/j.mpaic.2026.02.011","url":null,"abstract":"<div><div>Major trauma remains a significant cause of mortality and morbidity, with a profound impact on both society and the individual. The last two decades have seen important changes in the structure of trauma care across the UK. The rollout of major trauma networks and multidisciplinary working has improved care to this cohort. In-hospital management of the trauma patient begins with the trauma team, comprising different roles, specialities, skills, and experience. The cohesion of this team under the coordination of a trauma team leader is essential for effective management. Clinical management focuses on a ‘CABCD’ approach (catastrophic haemorrhage, airway with cervical spine control, breathing, circulation, disability) to identify and manage life-threatening injuries. Onward management is governed by the patient's condition, but may include computerized tomography scanning, damage control surgery, and critical care admission. Eventually, patients should receive definitive surgical treatment and a robust rehabilitation plan. Trauma affecting the elderly population is an increasingly large portion of the trauma workload. This cohort suffer from inequities of care, while being exposed to higher risk of death and complications of injury. A comprehensive assessment and multi-specialist input is necessary to optimize this group's recovery potential.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"27 4","pages":"Pages 187-191"},"PeriodicalIF":0.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147652976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Spinal cord injury 脊髓损伤
IF 0.3
Anaesthesia and Intensive Care Medicine Pub Date : 2026-04-01 Epub Date: 2026-03-30 DOI: 10.1016/j.mpaic.2026.02.015
Mark Patek, Mark Stewart
{"title":"Spinal cord injury","authors":"Mark Patek,&nbsp;Mark Stewart","doi":"10.1016/j.mpaic.2026.02.015","DOIUrl":"10.1016/j.mpaic.2026.02.015","url":null,"abstract":"<div><div>In the UK, the annual incidence of acute spinal cord injury (SCI) is 19 new cases per million population, contributing to an estimated 50,000 people who are currently living with SCI. Trauma is the most common cause of SCI, predominantly from falls and road traffic accidents. Damage to the spinal cord occurs both at the time of injury (primary) and in its aftermath (secondary). Effectively treating and preventing secondary cord injury, and managing complications associated with SCI, can make a significant improvement to patient outcomes. Improving outcomes in this patient population mean more patients with established SCIs are presenting for routine operations. Anaesthetists should be aware of the unique challenges posed by these patients, both in the acute and chronic settings.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"27 4","pages":"Pages 212-217"},"PeriodicalIF":0.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147653119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Anaesthetic priorities in pre-hospital trauma care 院前创伤护理中麻醉的优先级
IF 0.3
Anaesthesia and Intensive Care Medicine Pub Date : 2026-04-01 Epub Date: 2026-03-30 DOI: 10.1016/j.mpaic.2026.02.009
Eoghan Smith, Chris Lochrin
{"title":"Anaesthetic priorities in pre-hospital trauma care","authors":"Eoghan Smith,&nbsp;Chris Lochrin","doi":"10.1016/j.mpaic.2026.02.009","DOIUrl":"10.1016/j.mpaic.2026.02.009","url":null,"abstract":"<div><div>This article explores the critical role of anaesthesia and advanced interventions in pre-hospital trauma care. It outlines a systematic, evidence-based approach for pre-hospital critical care teams, adapting the standard (C)ABCDE framework to address the unique challenges of the scene. The abstract highlights key clinical considerations, including the crucial management of catastrophic haemorrhage, the complexities of airway management in austere environments, and the importance of neuroprotective strategies for traumatic brain injury. It details pharmacological considerations for safe drug administration, with a focus on agents that maintain haemodynamic stability in unstable patients. The document also emphasizes the fundamental importance of non-technical skills, such as teamwork, communication, and situational awareness, in ensuring the safe and effective delivery of care. Ultimately, the article argues that a comprehensive and systematic approach is essential to bridge the gap between the scene of injury and definitive hospital care, thereby optimizing patient outcomes in major trauma.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"27 4","pages":"Pages 177-182"},"PeriodicalIF":0.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147652974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Self-assessment 自我评估
IF 0.3
Anaesthesia and Intensive Care Medicine Pub Date : 2026-04-01 Epub Date: 2026-03-30 DOI: 10.1016/j.mpaic.2026.03.013
Vijayanand Nadella
{"title":"Self-assessment","authors":"Vijayanand Nadella","doi":"10.1016/j.mpaic.2026.03.013","DOIUrl":"10.1016/j.mpaic.2026.03.013","url":null,"abstract":"","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"27 4","pages":"Pages 240-241"},"PeriodicalIF":0.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147653118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Management of shock in trauma 创伤休克的处理
IF 0.3
Anaesthesia and Intensive Care Medicine Pub Date : 2026-04-01 Epub Date: 2026-03-30 DOI: 10.1016/j.mpaic.2026.02.022
Hamish Reed-Embleton, Robert Hart
{"title":"Management of shock in trauma","authors":"Hamish Reed-Embleton,&nbsp;Robert Hart","doi":"10.1016/j.mpaic.2026.02.022","DOIUrl":"10.1016/j.mpaic.2026.02.022","url":null,"abstract":"<div><div>Shock is defined as a failure of the circulatory system resulting in a level of perfusion to tissues, which is inadequate to meet the oxygen demands of cellular metabolism. Haemorrhagic shock is most commonly associated with trauma. Haemorrhage is a leading cause of preventable death in trauma and over the past two decades there has been an increasing understanding of the pathophysiological processes that occur in major haemorrhage associated with trauma. This has been fundamental to the current approach to management of traumatic shock, known as damage-control resuscitation (DCR). DCR encompasses three key resuscitative strategies: permissive hypotension, haemostatic resuscitation (the use of blood products as primary resuscitative fluids) and damage-control surgery. The implementation of DCR alongside the creation of trauma networks has been revolutionary in the management of the shocked trauma patient.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"27 4","pages":"Pages 192-195"},"PeriodicalIF":0.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147653123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Drowning and immersion injury 溺水和浸没伤
IF 0.3
Anaesthesia and Intensive Care Medicine Pub Date : 2026-04-01 Epub Date: 2026-03-30 DOI: 10.1016/j.mpaic.2026.02.014
Sophie Robinson, Robert Hart, Charlotte R. Soulsby
{"title":"Drowning and immersion injury","authors":"Sophie Robinson,&nbsp;Robert Hart,&nbsp;Charlotte R. Soulsby","doi":"10.1016/j.mpaic.2026.02.014","DOIUrl":"10.1016/j.mpaic.2026.02.014","url":null,"abstract":"<div><div>Drowning is defined as respiratory impairment following submersion or immersion in liquid. It is recognized as a global public health crisis, and although death rates have declined, significant disparities remain, with the most socioeconomically deprived populations at greatest risk. Drowning is more common among males and individuals with pre-existing medical co-morbidities. It is a leading cause of death in younger people, often due to limited risk awareness, poor water safety skills, and lack of swimming ability. The drowning process is a continuum, characterized by the onset of hypoxia, hypercarbia, and hypothermia, which can lead to cardiac arrest. Irreversible brain injury secondary to cerebral hypoxia is the primary cause of morbidity and mortality. Following rescue, basic life support should be initiated, and rescue breaths may be delivered in the water. In cardiac arrest, non-shockable rhythms are most common, and emphasis is placed on rescue breaths before chest compressions. Critical care management is supportive, aiming to optimize oxygenation, maintain haemodynamic stability, and implement neuroprotective strategies. Active and passive rewarming measures are employed to prevent hypothermia. Although most drowning victims survive, outcomes depend on the duration of submersion and hypoxia, as well as factors such as age, water temperature, and the timeliness of early cardiopulmonary resuscitation.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"27 4","pages":"Pages 208-211"},"PeriodicalIF":0.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147653125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pain priorities in pre-hospital care 院前护理中疼痛的优先级
IF 0.3
Anaesthesia and Intensive Care Medicine Pub Date : 2026-04-01 Epub Date: 2026-03-30 DOI: 10.1016/j.mpaic.2026.02.010
Maximilian R Ralston, Martin Esposito, Richard J Price, Andrew J Cadamy
{"title":"Pain priorities in pre-hospital care","authors":"Maximilian R Ralston,&nbsp;Martin Esposito,&nbsp;Richard J Price,&nbsp;Andrew J Cadamy","doi":"10.1016/j.mpaic.2026.02.010","DOIUrl":"10.1016/j.mpaic.2026.02.010","url":null,"abstract":"<div><div>Acute pain is prevalent yet frequently undertreated in pre-hospital care. The pre-hospital setting is a dynamic environment, and achieving adequate analgesia is crucial to allow comprehensive assessment, extrication and transport of patients to hospital in a timely and humane manner. Patients may be cared for by a variety of providers throughout their clinical journey, which will influence the analgesia that is provided. Assessment of pain is crucial to its management, and this review summarizes the best practices, and common pitfalls, to pain assessment in pre-hospital care.</div><div>A multimodal approach, using pharmacological and non-pharmacological approaches, is ideal in achieving optimal analgesia whilst minimizing side-effects. However, this is not always practical, depending on the environment, patient, and skills of the team present, and more simple approaches may be required. The review discusses the various pharmacological and non-pharmacological strategies that may be of benefit in pre-hospital care, including the available routes of drug administration, and their benefits and challenges.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"27 4","pages":"Pages 183-186"},"PeriodicalIF":0.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147652975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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