Revista Espanola de Anestesiologia y Reanimacion最新文献_第2页

Terapia hemodinámica guiada por objetivos intraoperatoria focalizada en parámetros de presión arterial y flujo mediante técnicas no calibradas de contorno del pulso: metaanálisis de ensayos controlados aleatorizados

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Revista Espanola de Anestesiologia y Reanimacion Pub Date : 2025-03-01 DOI: 10.1016/j.redar.2024.501653

J. Ripollés-Melchor , A.V. Espinosa , P. Fernández-Valdes-Bango , R. Navarro-Pérez , A. Abad-Motos , J.V. Lorente , M.J. Colomina , A. Abad-Gurumeta , M.I. Monge-García

{"title":"Terapia hemodinámica guiada por objetivos intraoperatoria focalizada en parámetros de presión arterial y flujo mediante técnicas no calibradas de contorno del pulso: metaanálisis de ensayos controlados aleatorizados","authors":"J. Ripollés-Melchor , A.V. Espinosa , P. Fernández-Valdes-Bango , R. Navarro-Pérez , A. Abad-Motos , J.V. Lorente , M.J. Colomina , A. Abad-Gurumeta , M.I. Monge-García","doi":"10.1016/j.redar.2024.501653","DOIUrl":"10.1016/j.redar.2024.501653","url":null,"abstract":"<div><h3>Background</h3><div>Goal-directed haemodynamic therapy (GDHT) aims to optimize haemodynamic variables. However, its effectiveness in reducing postoperative complications in major abdominal surgery, particularly when targeting both arterial pressure and flow variables, remains unclear. This meta-analysis addresses this by evaluating GDHT using uncalibrated pulse contour (uPC) methods.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and meta-analysis of randomized controlled trials (RCT) in adult patients undergoing major abdominal surgery who received GDHT using uncalibrated pulse contour (uPC) methods for cardiac output monitoring, with predefined targets for both blood flow and blood pressure. The primary outcome was postoperative complications; secondary outcomes included postoperative acute kidney injury (AKI), hospital length of stay (EH), intraoperative fluid administration and mortality.</div></div><div><h3>Results</h3><div>Initial search retrieved 860 reports, with 12 RCTs (1367 patients) meeting the inclusion criteria. Our meta-analysis showed a significant reduction in postoperative complications (RR: 0.78; 95%CI: 0.68-0.90), AKI (RR: 0.7; 95%CI: 0.51-0.97), and hospital LOS (SMD: −0.30; 95%CI: −0.54 to −0.06) with uPC-guided GDHT. No significant differences were observed in intraoperative fluid volume and mortality.</div></div><div><h3>Conclusions</h3><div>Implementing GDHT in major abdominal surgery with predefined arterial pressure and blood flow targets significantly reduces postoperative morbidity and hospital EH without increasing intraoperative fluid administration.</div></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"72 3","pages":"Article 501653"},"PeriodicalIF":0.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511999","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

Impacto medioambiental de los anestésicos volátiles en un hospital docente de alta complejidad de 2019 a 2022: análisis cuantitativo

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Revista Espanola de Anestesiologia y Reanimacion Pub Date : 2025-02-01 DOI: 10.1016/j.redar.2024.501659

A.M. Obando Rondón , C.A. Triana-Schöonewolff , J.D. Guerra Toro , J.F. Parada-Márquez , N.A. Avila Ardila , A.F. Zuluaga Zuluaga , M.C. Cardona-Lozano

{"title":"Impacto medioambiental de los anestésicos volátiles en un hospital docente de alta complejidad de 2019 a 2022: análisis cuantitativo","authors":"A.M. Obando Rondón , C.A. Triana-Schöonewolff , J.D. Guerra Toro , J.F. Parada-Márquez , N.A. Avila Ardila , A.F. Zuluaga Zuluaga , M.C. Cardona-Lozano","doi":"10.1016/j.redar.2024.501659","DOIUrl":"10.1016/j.redar.2024.501659","url":null,"abstract":"<div><h3>Background</h3><div>The healthcare sector emits 5% of greenhouse gases worldwide, inhaled anesthetic agents have contributed to this effect for years. Other countries measured and limited their use, leading to positive environmental changes. There is a lack of data on Colombia. This project aims to evaluate the environmental impact of desflurane, isoflurane, and sevoflurane between 2019 and 2022 in a hospital in Bogota.</div></div><div><h3>Methods</h3><div>A retrospective exploration of inhaled anesthetic agents use was conducted using our hospital's pharmacy inventory between 2019 and 2022. Oracle software tools were used, along with the amount of anesthetics dispensed by the pharmacy. The CO<sub>2</sub> equivalent was calculated in kilograms using the global warming potential at 20 and 100 years.</div></div><div><h3>Results</h3><div>A total of 743kg of inhaled anesthetic agents was administered between 2019 and 2022. Sevoflurane accounted for 265.7kg, desflurane for 473.9kg, while isoflurane was used in smaller quantities. There was a change in the trend between 2019/2020 and 2021/2022, with an increase of 69.3kg in sevoflurane use and a decrease of 86.2kg in desflurane use. The CO<sub>2</sub> emissions from desflurane decreased from 190.7 to 131.9t over 20 years and from 711 to 492t over 100 years.</div></div><div><h3>Conclusions</h3><div>The use of sevoflurane increased by 70%, whereas that of desflurane decreased by 31%. CO<sub>2</sub> emissions were reduced by 557t in 20 years and 210t in 100 years. The environmental impact of sevoflurane is 97% lower than desflurane in our OR's.</div></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"72 2","pages":"Article 501659"},"PeriodicalIF":0.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143167727","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

Uso de vancomicina y lesión renal aguda en pacientes críticos con sepsis o shock séptico: cohorte observacional retrospectiva

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Revista Espanola de Anestesiologia y Reanimacion Pub Date : 2025-02-01 DOI: 10.1016/j.redar.2024.501657

D. González-Delgado , M. Vives , P. Monedero , A. Aldaz

{"title":"Uso de vancomicina y lesión renal aguda en pacientes críticos con sepsis o shock séptico: cohorte observacional retrospectiva","authors":"D. González-Delgado , M. Vives , P. Monedero , A. Aldaz","doi":"10.1016/j.redar.2024.501657","DOIUrl":"10.1016/j.redar.2024.501657","url":null,"abstract":"<div><h3>Introduction</h3><div>The independent association of vancomycin with Acute Kidney Injury (AKI) in the critically ill patient with sepsis or septic Shock is controversial.</div><div>The aim of this study was to evaluate the incidence of AKI in a cohort of patients with sepsis or septic Shock with an adequate and strict monitoring of vancomycin, guided by the area under the concentration-time curve in relation to the minimum inhibitory concentration (AUC/MIC ratio).</div></div><div><h3>Material and methods</h3><div>Retrospective cohort study on 106 patients admitted to the ICU with a diagnosis of sepsis or septic shock with vancomycin treatment, consecutively from January 2017 to December 2019.</div><div>AKI was defined according to Kidney Disease Improving Global Outcomes criteria. Risk factors associated with AKI were determined by multivariable logistic regression analysis.</div></div><div><h3>Results</h3><div>In our cohort, 28 patients out of 106 (26%) developed AKI. ICU and 30-day mortality were 18% and 22%, respectively. After multivariable logistic regression adjusted analysis, chronic liver disease was associated with AKI.</div></div><div><h3>Conclusion</h3><div>In our retrospective cohort study on critical patients with sepsis and septic shock, treated with vancomycin adjusting the dose guided by a pharmacokinetic/pharmacodynamic monitoring to achieve the target AUC<sub>0-24</sub>/CMI ratio, the incidence of AKI was 26%.</div></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"72 2","pages":"Article 501657"},"PeriodicalIF":0.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143167729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Estudio de cohortes para evaluar el patrón de prescripción analgésica en pacientes adultos intervenidos en cirugía mayor ambulatoria

IF 0.9

Revista Espanola de Anestesiologia y Reanimacion Pub Date : 2025-02-01 DOI: 10.1016/j.redar.2024.501664

L. Velasco , A. Calle , J. Coronel , A. Gallo , A. Reyes , M. Portas , L. Bermejo , A. Giménez , A. Ribed , M. Zaballos

{"title":"Estudio de cohortes para evaluar el patrón de prescripción analgésica en pacientes adultos intervenidos en cirugía mayor ambulatoria","authors":"L. Velasco , A. Calle , J. Coronel , A. Gallo , A. Reyes , M. Portas , L. Bermejo , A. Giménez , A. Ribed , M. Zaballos","doi":"10.1016/j.redar.2024.501664","DOIUrl":"10.1016/j.redar.2024.501664","url":null,"abstract":"<div><h3>Introduction</h3><div>Postoperative pain in ambulatory surgery (AS) continues to be a recurrent problem despite anesthetic and surgical advances. Analgesic prescription and follow-up by patients at home may be a determining factor. Our objective was to evaluate analgesic prescription and its impact on the intensity of postoperative pain at 24h and 7days in an AS unit.</div></div><div><h3>Methods</h3><div>Retrospective cohort study of patients undergoing AS. Anthropometric data, ASA classification, surgery, anesthesia, analgesic prescription and postoperative pain. A telephone call was made by nurses to evaluate the DAP at 24h and one week after surgery.</div></div><div><h3>Results</h3><div>A total of 875 patients, 62% women, aged 50±17 years, were studied. Orthopedic (45.4%); head and neck (19.5%); general (10.6%); vascular (11.9%); plastic (2.4%) and gynecological (10.2%) surgery was performed. Multimodal analgesia was prescribed: 83.7%, combination of nonsteroidal anti-inflammatory drug (NSAID) +paracetamol +metamizole: 70.79%; opioid +paracetamol or NSAID or in monotherapy: 13.1%; monotherapy with paracetamol (15%) or NSAID (1.15%). Some 62.45% were prescribed «if pain» and 61.87% had rescue analgesia. At 24h the median (IQR) of pain on the self-assessing verbal scale was 3 (2 to 5) and at one week 2 (0 to 4). The presence of moderate-severe pain was 46% at 24h and 31% at one week after surgery.</div></div><div><h3>Conclusions</h3><div>Our results show great variability in analgesic prescription with insufficient control of postoperative pain in ambulatory surgery. Although the multimodal analgesic strategy has been widely used, opioid prescription has been insufficient in surgeries associated with moderate to severe pain.</div></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"72 2","pages":"Article 501664"},"PeriodicalIF":0.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143167734","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

Detección de hemorragia oculta utilizando un nuevo protocolo denominado UFOH: Ultrasound For Occult Hemorrhage-hemorragia oculta detectada por ecografía

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Revista Espanola de Anestesiologia y Reanimacion Pub Date : 2025-02-01 DOI: 10.1016/j.redar.2024.501660

D. González-Delgado , A. Hernández Martínez , J. Mercadal Mercadal , G. Romero-González , D.N. Wijeysundera , M. Vives Santacana , en nombre de The Spanish Critical Care Ultrasound Network Group

{"title":"Detección de hemorragia oculta utilizando un nuevo protocolo denominado UFOH: Ultrasound For Occult Hemorrhage-hemorragia oculta detectada por ecografía","authors":"D. González-Delgado , A. Hernández Martínez , J. Mercadal Mercadal , G. Romero-González , D.N. Wijeysundera , M. Vives Santacana , en nombre de The Spanish Critical Care Ultrasound Network Group","doi":"10.1016/j.redar.2024.501660","DOIUrl":"10.1016/j.redar.2024.501660","url":null,"abstract":"<div><div>Point-of-care abdominal ultrasound has emerged as a powerful tool for clinicians and is becoming a routine bedside tool to rapidly diagnose, manage hemodynamics, monitor fluid status, and guide procedures in emergency and critical care. Extended Focused Assessment with Sonography for Trauma is commonly used to detect free intraperitoneal blood in the trauma setting and may also be an option in non-trauma patients. However, it has significant limitations for detecting gastrointestinal or retroperitoneal bleeding. To date, there is no ultrasound protocol described for the diagnosis of occult bleeding in the retroperitoneal space. We describe a new ultrasound protocol called Ultrasound For Occult Hemorrhage for a fast diagnosis of occult hemorrhage. This protocol is a novel ultrasound-guided approach designed to detect occult bleeding in various clinical settings, including emergency department, intensive care and perioperative environment.</div></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"72 2","pages":"Article 501660"},"PeriodicalIF":0.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143167736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Soporte circulatorio mecánico prolongado en shock cardiogénico secundario a acromegalia. Reporte de caso

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Revista Espanola de Anestesiologia y Reanimacion Pub Date : 2025-02-01 DOI: 10.1016/j.redar.2024.05.002

L.A. Salazar-Rojas , D.I. García-Gómez , R.E. Gonzalez-Vesga , C. Colmenares-Mejia

引用次数: 0

Trombectomía mecánica en el tromboembolismo pulmonar agudo: normalización de patrones de hipertensión pulmonar

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Revista Espanola de Anestesiologia y Reanimacion Pub Date : 2025-02-01 DOI: 10.1016/j.redar.2024.04.005

A. Peral Santos , J.F. Muñoz Moreno , G. Hernández Gozalves , A.M. Sobrino López

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Técnica de Seldinger: si hay resistencia, más vale maña que fuerza

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Revista Espanola de Anestesiologia y Reanimacion Pub Date : 2025-02-01 DOI: 10.1016/j.redar.2024.04.002

M. López-Baamonde, A. Capdevila, E. Lacoba, M. Magaldi

引用次数: 0

Estudio clínico sobre la utilidad predictiva de CPAP de alto flujo en el destete de la ventilación mecánica en pacientes pediátricos críticos quirúrgicos

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Revista Espanola de Anestesiologia y Reanimacion Pub Date : 2025-02-01 DOI: 10.1016/j.redar.2024.501658

S. Cabezudo Ballesteros, P. Sanabria Carretero, L. Castro Parga, A. Martín Vega, L. López García, F. Reinoso Barbero

{"title":"Estudio clínico sobre la utilidad predictiva de CPAP de alto flujo en el destete de la ventilación mecánica en pacientes pediátricos críticos quirúrgicos","authors":"S. Cabezudo Ballesteros, P. Sanabria Carretero, L. Castro Parga, A. Martín Vega, L. López García, F. Reinoso Barbero","doi":"10.1016/j.redar.2024.501658","DOIUrl":"10.1016/j.redar.2024.501658","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Weaning paediatric patients from mechanical ventilation (MV) often results in extubation failure (EF) (14%-22%) and 2% of patients will require tracheostomy (2%).</div></div><div><h3>Methods</h3><div>We performed an observational study in 115 critically ill patients in whom a novel high-flow CPAP (CPAP-ANRI) system was connected to the tracheal tube during ventilation (CPAP+TI). After extubation, the same system was connected to various interfaces.</div></div><div><h3>Results</h3><div>Mean (±SD) age was 31±49 months, PRISM-III score was 2.9±2.4, and duration of intermittent positive pressure ventilation with tracheal intubation (IPPV+TI) was 6±5.6 days followed by CPAP+TI for 1.4±1.7 days. The initial rate of EF was 10.4% for either haemodynamic (n=4) or respiratory (n=8) reasons, although the final rate of EF requiring tracheostomy was only 0.8%. After progressing from IPPV+TI to CPAP+TI, PO<sub>2</sub>/FiO<sub>2</sub> values in successfully extubated patients immediately increased by 27% (<em>P</em><.0003) vs only 13% (<em>P</em>>.3) in patients presenting EF. Switching to CPAP+TI increased the percentage of patients with pO<sub>2</sub>/FiO<sub>2</sub> >200, particularly in patients with heart disease, in whom >30% increase in pO<sub>2</sub>/FiO<sub>2</sub> over baseline had a positive predictive value for successful extubation (AUC=0.708; <em>P</em>.056).</div></div><div><h3>Conclusions</h3><div>The CPAP-ANRI device is a simple respiratory aid that is highly effective in optimizing cardiopulmonary interaction to facilitate weaning from MV and identifying most cases in which extubation is likely to be successful.</div></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"72 2","pages":"Article 501658"},"PeriodicalIF":0.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143167728","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}

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Parada cardiorrespiratoria durante la cirugía de trasplante hepático: implicación del beta-bloqueo perioperatorio en el paciente cirrótico

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Revista Espanola de Anestesiologia y Reanimacion Pub Date : 2025-02-01 DOI: 10.1016/j.redar.2024.06.004

R.C. Vela Pascual, J.M. Pérez Peña, A. Elvira Rodríguez, M. Power Esteban, C. Jimeno Fernández, J.A. Varela Cabo

引用次数: 0