Anaesthesia Critical Care & Pain Medicine最新文献

{"title":"Remimazolam for anesthesia in cardiac and noncardiac surgery. A narrative literature review and synthesis.","authors":"Jacopo D'Andria Ursoleo, Alice Bottussi, Gabor Erdoes, Jiapeng Huang, Fabrizio Monaco","doi":"10.1016/j.accpm.2025.101555","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101555","url":null,"abstract":"<p><p>Despite decades of advancements in anesthetic techniques, a novel hypnotic agent combining rapid onset and offset, hemodynamic stability, and predictable effects has remained elusive. The recent approval of remimazolam, a short-acting benzodiazepine, represents a potential breakthrough in fulfilling these criteria. Since its first approval, growing evidence highlights its benefits, including superior hemodynamic stability, rapid emergence from anesthesia, and minimal respiratory depression compared to widely used agents such as propofol. These attributes have been demonstrated across various surgical contexts and patient populations. However, existing studies have limitations that challenge the generalizability of such findings. This review evaluates the literature on remimazolam in both the cardiac and noncardiac perioperative surgical contexts. A systematic search of PubMed/MEDLINE, EMBASE, and Google Scholar databases identified studies published from 2020 to 2024, with an emphasis on randomized controlled trials and observational studies. By analyzing the limitations inherent in the retrieved studies, we aimed to provide practicing anesthesiologists with an overview of remimazolam's potential benefits and inherent challenges, while identifying current knowledge gaps that warrant future research.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101555"},"PeriodicalIF":3.7,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimization of antimicrobial therapy in critically ill patients, What Clinicians and Searchers Must Know.","authors":"Claire Roger, Despoina Koulenti, Emmanuel Novy, Jason Roberts, Claire Dahyot-Fizelier","doi":"10.1016/j.accpm.2025.101561","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101561","url":null,"abstract":"<p><p>Effective sepsis treatment requires not only the timely administration of appropriate antimicrobials but also precise dosing to maximize patient survival in intensive care units (ICUs). However, the pharmacokinetics (PK) and pharmacodynamics (PD) of antibiotics in critically ill patients differ significantly from those in the general population. Understanding these pathophysiological changes is essential for optimizing antibiotic therapy. In this context, adequate dosing refers to strategies that achieve therapeutic drug concentrations at the infection site, ensuring both clinical and microbiological effectiveness while minimizing the risk of antibiotic-related toxicity. Additionally, optimizing the mode of antibiotic administration-particularly for beta-lactams-through continuous infusion has shown benefits, including improved achievement of PK/PD targets, higher clinical cure rates, and better microbiological eradication. To ensure proper antimicrobial dosing, therapeutic drug monitoring (TDM) is the preferred approach. However, TDM is not universally available in all ICUs or for all antimicrobial agents. In its absence, clinicians must rely on factors such as the patient's clinical condition, the identified pathogen, the impact of organ dysfunction requiring extracorporeal therapies, and the physicochemical properties of antimicrobials to guide dosing decisions. The pharmacokinetics of antimicrobials can vary widely between critically ill patients and even within the same patient throughout their ICU stay, emphasizing the need for individualized dosing strategies and dynamic reassessments. This review aims to outline the key pathophysiological changes observed in critically ill patients and their influence on antimicrobial dosing decisions, while also providing practical considerations to help clinicians optimize antimicrobial therapy in this patient population. Finally, the outstanding challenges in delivering optimal antimicrobial therapy to critically ill patients will be explored, highlighting areas for future research.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101561"},"PeriodicalIF":3.7,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delphi study to develop a core outcome set for inpatient pain assessment after cesarean delivery.","authors":"S Ciechanowicz, B Carvalho, J Berger, P Duch, P Flood, R Ffrench-O'Carroll, H Sviggum, S Hakimi, D Jethava, M Mieszkowski, A Merriam, S Osmundson, U Ituk, J Wagner Kovacec, P Sultan","doi":"10.1016/j.accpm.2025.101556","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101556","url":null,"abstract":"<p><strong>Background: </strong>Studies of cesarean delivery pain report different outcomes, restricting data pooling. The study aimed to develop a core outcome set for inpatient postoperative pain assessment after cesarean delivery to use for research and clinical practice, using the Delphi consensus methodology.</p><p><strong>Methods: </strong>A scoping review identified 37 initial outcomes, with 2 additional outcomes developed from a focus group. These were rated in a two-round Delphi survey completed by the focus group consisting of authors of studies from the scoping review (n = 9), supplemented with other experts (n = 5) and patients with recent lived experience (n = 7). Scores were on a 1-5 Likert scale, 1-2 being 'critical for inclusion'; 3 being 'important but not critical', and 4-5 of 'limited importance/invalid'. Outcomes were included if recommended by ≥70% of stakeholders after voting. A third-round virtual meeting determined domains, and several further rounds of online surveys, the specific measures.</p><p><strong>Results: </strong>Round one included 14 experts and 7 patients. Round two included 12 experts and 4 patients (76% response). The virtual meeting was attended by 11 experts and 3 patients (67%), and the 4 online surveys were completed by 67%, 52%, 67%, and 76% of the focus group. The final domains included pain intensity: at rest, movement-evoked, and pain relief; pain interference; total consumption of opioids; and maternal adverse effects. 12 measures for domains were agreed upon.</p><p><strong>Conclusions: </strong>Getting out of a hospital bed was selected as the most relevant functional activity for movement-evoked pain after cesarean delivery. This core outcome set may be applied to future research and clinical practice.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101556"},"PeriodicalIF":3.7,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mortality of cancer patients with septic shock: A nation-based cohort analysis of 77,888 patients.","authors":"Antoine Bianchi, Yann Brousse, Ines Lakbar, Vanessa Pauly, Veronica Orleans, Guillaume Fond, Gary Duclos, Laurent Zieleskiewicz, Djamel Mokart, Laurent Boyer, Marc Leone","doi":"10.1016/j.accpm.2025.101557","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101557","url":null,"abstract":"<p><strong>Background: </strong>Septic shock and cancer occur routinely in intensive care unit patients. Our aim was to use the French national hospitalization database to overcome the limitations of the small cohorts used in previous studies that examined the 90-day mortality rate of patients with septic shock and either solid or hematological cancers.</p><p><strong>Methods: </strong>We performed a retrospective cohort study using data from the French national hospitalization database regarding adult patients with septic shock from 2017 to 2018. The primary outcomes were the hospital mortality rate at 90 days in patients with solid cancer and hematological cancer. Secondary outcomes were the risk factors associated with mortality in our cohort. Associations between 90-day mortality and cancer have been estimated by multivariable analysis.</p><p><strong>Results: </strong>Septic shock was found in 77,888 patients, including 19,329 patients with solid cancer, 6,498 with hematological cancer, and 52,061 noncancer patients. The 90-day mortality rate was 44.3 %, 53.7%, and 59.1% for noncancer patients, solid cancer patients and hematological cancer patients, respectively. An association was found between 90-day mortality and solid cancer (adjusted hazard ratio 1.55 [1.51-1.59]) or hematological cancer (1.59 [1.53-1.65]) as compared with noncancer patients. Risk factors for 90-day mortality included both hematological and solid cancers.</p><p><strong>Conclusions: </strong>In septic shock patients, solid cancer and hematological cancer were associated with increased 90-day mortality compared with noncancer patients. Future investigations are required to assess the interplay between cancer and septic shock.</p><p><strong>Registration: </strong>National Commission for Data Protection (CNIL) under number F20220318151239.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101557"},"PeriodicalIF":3.7,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal stability of inflammatory subphenotypes of acute respiratory distress syndrome: 28-day insights from the ICAR trial.","authors":"Laurent Renard Triché, Maxime Fosset, Matthieu Jabaudon, Emmanuel Futier, Bruno Lucas, Claire Latroche, Béla-Simon Paschold, Elias Baedorf-Kassis, Tarek Sharshar, Maximilian S Schaefer, Boris Jung, Aurélien Mazeraud, Joris Pensier","doi":"10.1016/j.accpm.2025.101559","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101559","url":null,"abstract":"<p><strong>Background: </strong>International guidelines have emphasized the necessity of evaluating the temporal stability of acute respiratory distress syndrome (ARDS) subphenotypes. This study aimed to assess the temporal stability of subphenotypes of ARDS over 28 days.</p><p><strong>Methods: </strong>A reanalysis of a randomized trial was conducted, including patients with COVID-19-related moderate-to-severe ARDS across 43 centers. A K-means clustering was conducted to identify subphenotypes at 7-day intervals from inclusion to day 28. A Bayesian discrete-time Markov model was constructed to assess the temporal stability of subphenotypes.</p><p><strong>Results: </strong>Two subphenotypes were identified among 146 patients. At inclusion, 121 (83%) patients were in the hypoinflammatory subphenotype and 25 (17%) in the hyperinflammatory subphenotype. The hyperinflammatory subphenotype was associated with higher rates of organ failure, higher plasma levels of cytokines, chemokines, adhesion molecules, and proangiogenic factors, and lower endothelial stability than the hypoinflammatory subphenotype. The hyperinflammatory subphenotype was associated with higher 28-day mortality (13/25, 52% vs. 30/121, 25%, p = 0.001) and fewer ventilatory-free-days through day 28 (p < 0.01) than the hypoinflammatory subphenotype. In the Bayesian Markov model, over 7-day intervals, patients in the hypoinflammatory subphenotype had a higher probability of remaining hypoinflammatory (70%) or being extubated (17%) than of progressing to the hyperinflammatory subphenotype (7%). Inversely, patients in the hyperinflammatory subphenotype had a higher probability of remaining in the hyperinflammatory subphenotype (52%) or dying (23%) than of transitioning to the hypoinflammatory subphenotype (20%) or being extubated (5%).</p><p><strong>Conclusions: </strong>Inflammatory subphenotypes were stable in COVID-19-related ARDS, with few transitions over 28 days. Monitoring these subphenotypes could be valuable for assessing patient trajectories and treatment responses.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101559"},"PeriodicalIF":3.7,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ROBotic-assisted Early Mobilization in Ventilated Surgical Critically ill Patients (ROBEM-I) - a randomized, controlled, outcome-assessor-blinded pilot study.","authors":"Marco Lorenz, Nadine Langer, Philipp Kloss, Mathilde Maechler, Annika Bald, Linus Warner, Kristina Fuest, Björn Weiß, Stefan J Schaller","doi":"10.1016/j.accpm.2025.101549","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101549","url":null,"abstract":"<p><strong>Background: </strong>A shortage of human resources is a key barrier to the early mobilization of mechanically ventilated ICU patients. Recent advancements in robotic mobilization systems offer promising solutions to this challenge.</p><p><strong>Objective(s): </strong>This study assessed the operability of an AI-assisted robotic mobilization system by a single healthcare provider, along with its safety, feasibility, and potential benefits for mechanically ventilated surgical ICU patients.</p><p><strong>Design: </strong>Randomized controlled pilot study.</p><p><strong>Setting: </strong>Five surgical ICUs at Charité - Universitätsmedizin Berlin, Germany, November 2020 to September 2022.</p><p><strong>Patients: </strong>Twenty critically ill patients requiring >24 hours of mechanical ventilation.</p><p><strong>Intervention(s): </strong>Twice-daily robotic-assisted mobilization sessions ≥ 20 minutes over five days, compared to the control group receiving standard care.</p><p><strong>Main outcome measures: </strong>Number of mobilization sessions conducted by a single person RESULTS: In the robotic-assisted group, no mobility sessions were conducted by a single person (0%)vs. 26 (96%) in the control group (p < 0.001). Significant secondary outcomes included a mobilization duration of 41 minutes/day [IQR 36-47] in the intervention group vs. 19 minutes/day [IQR 13-21] in the control group (p < 0.001) and higher mobilization frequency, with two units/day [IQR 2-2] in the intervention group vs. 0.9 units/day [IQR 0.7-1.0] in the control group (p < 0.001). Interleukin-6 levels decreased significantly by -4.65 pg/mL [IQR -13.00-3.83] in the intervention group vs. an increase of 3.70 pg/mL [IQR -1.30-28.88] in the control group (p = 0.049).</p><p><strong>Conclusions: </strong>Robotic-assisted mobilization in mechanically ventilated critically ill patients did not reduce required healthcare providers but increased the duration and frequency, and significantly reduced IL-6 levels compared to the standard group.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov, registration number NCT04423796.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101549"},"PeriodicalIF":3.7,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative ventilation support, what clinicians and searchers must know.","authors":"Joris Pensier, Manuel A Guerrero, Joana Berger-Estilita, Laura Borgstedt, Ahmed Mohamed Sabri Zaher, Samir Jaber, Audrey De Jong","doi":"10.1016/j.accpm.2025.101554","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101554","url":null,"abstract":"<p><p>Postoperative pulmonary complications (PPC) affect over 10% of surgical patients, especially after abdominal, thoracic, or cardiac surgery. Understanding PPC's pathophysiology and risk factors provides an effective framework for prevention strategies. Significant alterations of the respiratory function occur in all patients undergoing major surgery, especially if the surgical site is close to the diaphragm. The main changes observed are a reduction in lung volumes, with the development of restrictive patterns of respiratory mechanics, atelectasis, and diaphragmatic dysfunction. Hypoxemia often develops in patients after major surgery and may lead to acute respiratory failure (ARF). Postoperative ARF may require reintubation, which has been associated with mortality and healthcare-associated pneumonia. The Peri-Operative Positive Pressure (P.O.P) Ventilation concept includes multiple interventions ranging from positive pressure pre-oxygenation to intraoperative lung protective ventilation and tailored postoperative noninvasive respiratory support. Such strategies aim to mitigate the onset of ARF and prevent a reduction in lung volumes. Despite the inevitability of respiratory function alterations after surgery and anesthesia, perioperative interventions can significantly reduce complications. Positive pressure pre-oxygenation enhances the safety of the intubation procedure and prevents the decrease in lung volumes. Intraoperative lung-protective ventilation associating low to moderate tidal volumes based on predicted body weight, positive end-expiratory pressure, and careful recruitment maneuvers have been effective in decreasing PPC. The respective roles of noninvasive ventilation (NIV) and high-flow nasal oxygenation (HFNO) in preventing PPC remain to be clarified. Their efficacy in preventing the onset of ARF may depend on the ability to identify high-risk patients and tailor interventions accordingly. Current evidence supports curative NIV as the gold standard to treat postoperative ARF in comparison to conventional oxygen therapy or HFNO. As the understanding of the complex interplay between major surgery and respiratory function evolves, so must approaches to tailoring perioperative ventilation support.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101554"},"PeriodicalIF":3.7,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes and Predictors of Mortality in Patients with Severe COVID-19 and COPD admitted to ICU: A multicenter study.","authors":"Laia Fernández-Barat, Ana Motos, Joan Canseco-Ribas, Albert Gabarrús, Ruben López-Aladid, Alejandro Alvaro-Meca, Adrián Ceccato, Nadia García, Miquel Ferrer, Denise Battaglini, Sergio Ávarez-Napagao, Dario García-Gasulla, Ricard Ferrer, David de Gonzalo-Calvo, José Ángel Lorente, Rosario Menéndez, Oscar Peñuelas, Jordi Riera, Alejandro Rodríguez, Rosario Amaya Villar, José M Añón, Ana Balan Mariño, Carme Barberà, José Barberán, Aaron Blandino Ortiz, Maria Victoria Boado, Neus Bofill, Elena Bustamante-Munguira, Jesús Caballero, María Luisa Cantón-Bulnes, Cristina Carbajales Pérez, Nieves Carbonell, Mercedes Catalán-González, Maria Del Carmen de la Torre, Emili Díaz, Ángel Estella, Albert Figueras, Raul de Frutos, Nieves Franco, Cristóbal Galbán, Elena Gallego, José Luis García Garmendia, Jessica González, José M Gómez, Víctor D Gumucio-Sanguino, Arturo Huerta, Ruth Noemí Jorge García, Ana Loza-Vázquez, Judith Marin-Corral, María Cruz Martin Delgado, Amalia Martínez de la Gándara, Ignacio Martínez Varela, Guillermo M Albaiceta, Maite Nieto, Yhivian Peñasco, Leire Pérez-Bastida, Felipe Pérez-García, Juan Carlos Pozo-Laderas, Pilar Ricart, Víctor Sagredo, Ángel Sánchez-Miralles, Susana Sancho Chinesta, Lorenzo Socias, Jordi Solé-Violan, Fernando Suarez-Sipmann, Luis Tamayo Lomas, José Trenado, Alejandro Úbeda, Luis Jorge Valdivia, Pablo Vidal, Jesús Bermejo-Martin, Ferran Barbé, Antoni Torres","doi":"10.1016/j.accpm.2025.101558","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101558","url":null,"abstract":"<p><strong>Background: </strong>High mortality rates among patients with chronic obstructive pulmonary disease (COPD) admitted to intensive care units (ICUs) during the COVID-19 pandemic highlight the need for tailored clinical management strategies.</p><p><strong>Study design and methods: </strong>Epidemiological, clinical, and laboratory data were collected in REDCap for 6,512 patients hospitalized with COVID-19 across 55 Spanish ICUs. Patients were stratified into three groups: those with COPD, those with other chronic respiratory diseases (CRD), and those without respiratory comorbidities (No CRD). The primary outcome was to determine clinical predictors for 90-day mortality, focusing on the COPD group. A propensity score matching (PSM) method was applied to analyze the effects of respiratory support, biomarkers, and immunomarkers.</p><p><strong>Results: </strong>Patients with COPD (n = 328) exhibited a 50% mortality rate compared to 33% of those with other chronic respiratory diseases (CRD, n = 547), and those without respiratory comorbidities (No CRD, n = 5,124). Among COPD patients, 95% of whom had Acute Respiratory Distress Syndrome (ARDS) due to COVID-19, the use of a high-flow nasal cannula (HFNC) was associated with reduced 90-day mortality (hazard ratio: 0.54 (95% Confidence Interval [0.31 to 0.95]). At a molecular scale, lower IgG levels but higher viral load and TNF-alpha, Vascular Cell Adhesion Molecule-1 (VCAM-1), and Fas Cell Surface Death Receptor (Fas) were associated with mortality in the COPD group.</p><p><strong>Conclusions: </strong>In COPD patients with ARDS due to COVID-19, the use of HFNC was associated with a better prognosis. The dysregulation in biomarkers and immunomarkers in COPD patients and its association with mortality highlight the need for further targeted therapeutic strategies.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101558"},"PeriodicalIF":3.7,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-assisted mobilization in the ICU - Opportunities and challenges.","authors":"Zhigang Zhang, Sébastien Tanaka, Aurélien Mazeraud","doi":"10.1016/j.accpm.2025.101548","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101548","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101548"},"PeriodicalIF":3.7,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative pulmonary complications in emergency abdominal surgery. A prospective international cohort study.","authors":"Carlos Ferrando-Ortolá","doi":"10.1016/j.accpm.2025.101560","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101560","url":null,"abstract":"<p><strong>Background: </strong>Emergency abdominal surgery is a high-risk procedure often performed on high-risk patients. The incidence of Postoperative pulmonary complications (PPCs) in emergency abdominal surgery is not well established yet. Several factors, such as the ventilatory approach, may be associated with PPCs but data on patients undergoing emergency abdominal surgery is scarce. The primary aim of the study was to describe the incidence of PPCs during the first 7 postoperative days.</p><p><strong>Methods: </strong>Prospective international cohort study including all consecutive patients >18y/o undergoing emergency abdominal surgery. From April to June 2023 each hospital selected a single 7-day period for the recruitment with a 7-day follow-up. The PPCs included the following international standard definitions for the primary outcome: acute respiratory failure; pneumothorax; weaning failure; acute respiratory distress syndrome; pulmonary infection; atelectasis; pleural effusion; bronchospasm; aspiration pneumonitis; pulmonary thromboembolism; and pulmonary edema.</p><p><strong>Results: </strong>45 hospitals from 5 geographical areas participated in the study with 507 patients included in the final analysis. A total of 114(22.5%) patients developed PPCs and 38(7.5%) developed severe PPCs. The multivariate analysis showed that the independent risk factors for PPCs were: high ARISCAT score (Odds Ratio: 2.67; 95%CI 1.06-6.86), laparotomy (OR:2.29; 95%CI 1.06-5.01), and postoperative positive air-test (OR:2.05; 95%CI 1.02-4.24). Conversely, neuromuscular block reversal was associated with a reduced risk of PPCs (OR:0.36; 95%CI 0.16-0.82).</p><p><strong>Conclusion: </strong>Incidence of PPCs in patients undergoing emergency abdominal surgery is significant. Among the modifiable risk factors, a lack of neuromuscular block reversal and postoperative positive air test were associated with the increased incidence of PPCs.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101560"},"PeriodicalIF":3.7,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}