Anaesthesia Critical Care & Pain Medicine最新文献

{"title":"Association between low income and ICU delirium among critically ill older patients: A retrospective cohort study in Japan","authors":"Toshinori Nishizawa ,&nbsp;Nobutoshi Nawa ,&nbsp;Atsushi Mizuno ,&nbsp;Takahiro Suzuki ,&nbsp;Hiroko Arioka ,&nbsp;Takeo Fujiwara","doi":"10.1016/j.accpm.2025.101523","DOIUrl":"10.1016/j.accpm.2025.101523","url":null,"abstract":"<div><h3>Background</h3><div>The social determinants of delirium have yet to be well-studied. We explored the association between low-income and intensive care unit (ICU) delirium among critically ill older patients in Japan, where universal healthcare coverage is provided.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study. Study patients included 2705 adults aged 70 years or older who were admitted to the ICU of St. Luke's International Hospital in Tokyo for a mean duration of 4.3 (SD = 6.0) days between March 2014 and April 2022. Patients classified in the low-income categories of the public health insurance system or receiving public assistance were designated as the low-income group. ICU delirium was assessed using the Confusion Assessment Method-ICU. The Cox proportional hazards model was used to estimate the associations between low income and delirium.</div></div><div><h3>Results</h3><div>508 patients (18.8%) were categorized as low-income. Delirium occurred in 1055 patients (39.0%) during ICU stay. After adjustment for age, sex, hearing or vision impairment, alcohol abuse, psychiatric disorders, cognitive impairment, cerebrovascular disease, and physical function, low-income showed a 1.20 times greater risk of ICU delirium (95%CI: 1.04−1.39, <em>p</em> = 0.014). After adjustment for potential mediators in addition to the confounding factors, low-income remained at 1.17 times greater risk of ICU delirium (95%CI: 1.01−1.36, <em>p</em> = 0.035).</div></div><div><h3>Conclusions</h3><div>In a Japanese ICU, low income was found to be an independent risk factor for ICU delirium. Future studies are needed to elucidate the mechanism of the association between low income and delirium in Japanese critically ill older patients.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 3","pages":"Article 101523"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143903373","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":"Life-sustaining treatment limitation decisions: What place for the opinion of patients’ relatives during decision-making meetings in French ICUs?","authors":"Camille Urien ,&nbsp;Marie-France Mamzer ,&nbsp;Mikhael Giabicani","doi":"10.1016/j.accpm.2025.101517","DOIUrl":"10.1016/j.accpm.2025.101517","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 3","pages":"Article 101517"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143895736","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":"Different mortality and transfer rates between teaching and nonteaching urban hospitals among patients presenting with Stevens-Johnson syndrome","authors":"SeungEun Lee,&nbsp;William Rienas,&nbsp;Renxi Li","doi":"10.1016/j.accpm.2025.101505","DOIUrl":"10.1016/j.accpm.2025.101505","url":null,"abstract":"<div><div>Stevens-Johnson Syndrome is a rare disorder of the skin and mucous membranes accompanied by systemic symptoms that are life threatening and require immediate intervention. We sought to determine if different hospital types, specifically urban nonteaching hospitals versus urban teaching hospitals, have different outcomes among patients presenting with Stevens-Johnson Syndrome during hospitalization. Patients presenting to urban teaching and urban nonteaching hospitals were compared. Compared to patients at urban nonteaching hospitals, patients at urban teaching hospitals had significantly increased risk of mortality, and urban nonteaching hospitals had higher rates of transferring patients to another hospital. Future research is needed to explore patient outcomes beyond the hospitalization period and in different hospital settings.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 3","pages":"Article 101505"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630957","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":"Lung resistance - but not compliance - impairs P0.1 and maximal inspiratory pressure measurements","authors":"Mickael Lescroart ,&nbsp;Florian Blanchard ,&nbsp;Jean-Michel Constantin ,&nbsp;Mathieu Specklin ,&nbsp;Alma Revol ,&nbsp;Hind Hani ,&nbsp;Bruno Levy ,&nbsp;Mathieu Koszutski ,&nbsp;Benjamin Pequignot","doi":"10.1016/j.accpm.2025.101501","DOIUrl":"10.1016/j.accpm.2025.101501","url":null,"abstract":"<div><h3>Introduction</h3><div>Bedside tools have been developed to assess inspiratory muscle function and inspiratory drive for patients under invasive mechanical ventilation. Occlusion maneuvers are currently considered but their pitfalls remain underexplored. We aimed to assess the impact of respiratory system compliance and resistance on P0.1 (addressing respiratory drive and inspiratory muscle function) and maximal inspiratory pressure (MIP, assessing global inspiratory muscle function) monitoring for fixed inspiratory muscle pressure (P_MUS) through an <em>in-silico</em> model.</div></div><div><h3>Methods</h3><div>The Active Servo Lung 5000 (ASL-5000) was used to reproduce respiratory conditions under fixed P_MUS of 5, 10 and 20 cmH₂O. From baseline, resistance and compliance challenges were performed. P0.1 and MIP were monitored on a ventilator (Dräger Evita Infinity V500).</div></div><div><h3>Results</h3><div>Resistance challenge impacted the monitoring of both P0.1 and MIP while compliance challenge barely modified P0.1 and MIP under all P_MUS settings. Statistical analysis confirmed significant correlations for increased Resistance and under-estimation of P0.1 and MIP (Spearman coefficient - 0.80, <em>p</em>-value &lt; 0.01), while reduced compliance had inconsistent effect on occlusion maneuver values. We found expiratory (rather than inspiratory) resistances impacted pressure monitoring.</div></div><div><h3>Discussion</h3><div>Lung Resistance - but not Compliance - impairs P0.1 and Maximal Inspiratory Pressure Measurements. Further clinical studies are mandatory to define pitfalls and limits of occlusion maneuver monitoring.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 3","pages":"Article 101501"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630960","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":"Use of norepinephrine for intraoperative hypotension in pediatric anesthesia: a French survey","authors":"Margot Milhiet ,&nbsp;Noemie De Martino ,&nbsp;Matthieu Laborier ,&nbsp;Nada Sabourdin ,&nbsp;Christophe Dadure ,&nbsp;Marco Caruselli ,&nbsp;Fabrice Michel ,&nbsp;RAP-ADARPEF group","doi":"10.1016/j.accpm.2025.101503","DOIUrl":"10.1016/j.accpm.2025.101503","url":null,"abstract":"<div><h3>Introduction</h3><div>Intraoperative hypotension (IOH) is a common complication in the operating room. Vasopressors are crucial in managing IOH but data on their use in children, particularly norepinephrine (NE), are limited. This study aimed to explore NE use in IOH management among French pediatric anesthesiologists.</div></div><div><h3>Materials and methods</h3><div>A survey was conducted using an online Google Forms® questionnaire, validated by experienced pediatric anesthesiologists and the ADARPEF board. Distributed via the ADARPEF Research Network, the survey covered demographics, IOH definitions, treatment approaches, and NE use.</div></div><div><h3>Results</h3><div>We received 205 responses (44.1%). IOH was defined as a percent of fall of preoperative arterial pressure for 63.9% of respondents and normogram or age-based formulae value for 33.6%. Cerebral NIRS and invasive arterial blood pressure were the most common tools for monitoring patients with high risk of IOH. For vasoplegia-induced IOH, the first-line treatment was fluid bolus (49.2%) or ephedrine (35.3%). NE was used as second line treatment by 26.2 % of respondents. For IOH due to blood loss, fluid bolus was the primary treatment followed by NE. NE was used monthly by 79.3% of respondents and weekly by 45.3%. Variations in dilution and dosage practices were noted, with 70.5% reporting the use of highly diluted NE. Side effects were reported by 86.1% of NE users.</div></div><div><h3>Conclusion</h3><div>The survey highlights significant variability to determine the threshold of IOH requiring treatment and vasopressors use. NE is widely used by pediatric anesthesiologists, but practices vary, indicating the need for standardised guidelines and further safety studies.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 3","pages":"Article 101503"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630962","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":"Traumatic cardiac arrest, what clinicians and researchers must know","authors":"Stanislas Abrard ,&nbsp;Dominique Savary ,&nbsp;Daniel Nevin ,&nbsp;Kenji Inaba ,&nbsp;Jean-Stéphane David","doi":"10.1016/j.accpm.2025.101507","DOIUrl":"10.1016/j.accpm.2025.101507","url":null,"abstract":"<div><div>Survival rates for trauma cardiac arrest (TCA) routinely range from 2 to 5% and have not improved in high-income countries over the past two decades, unlike those for medically induced cardiac arrests. This persisting low TCA survival rates have led to debates, about the value of resuscitating TCA patients, considering the significant risks and costs involved compared to the low chances of favorable outcomes. As well, TCA patients are frequently excluded from large randomized controlled trials on cardiac arrest management, with most research consisting of retrospective studies and clinical case series.</div><div>The causes of cardiac arrest following injury are diverse, and hypovolemia, particularly from hemorrhagic shock, is a significant cause of early death. Direct cardiac or large vessel injuries, such as myocardial contusions or tamponade, can also lead to TCA. While TCA from severe brain or spinal injuries are less frequent, survival rates in these cases can be slightly better if return of spontaneous circulation (ROSC) is achieved. The presence of bystander CPR, shockable initial rhythms, and rapid identification and treatment of reversible causes are associated with favorable outcomes. A few strategies should be applied systematically, such as early bleeding source control, oxygen supplementation, hypovolemia correction, and diagnosing and treating compressive pleural or pericardial effusions.</div><div>Emerging techniques are suggested for the management of refractory hemorrhagic shock and cardiac arrest, such as the REBOA (Resuscitative Balloon Occlusion of the Aorta), but further research is needed to determine the most effective approaches to prehospital and in-hospital TCA management.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 3","pages":"Article 101507"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651580","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":"A phase 2 open-label pilot study of Remimazolam for sedation in critically ill patients","authors":"Nicolas Grillot ,&nbsp;Mickaël Vourc’h ,&nbsp;Yannick Hourmant ,&nbsp;Marwan Bouras ,&nbsp;Bertrand Rozec ,&nbsp;Armine Rouhani ,&nbsp;Thomas Stoehr ,&nbsp;Alexandra Jobert ,&nbsp;Antoine Roquilly ,&nbsp;Raphaël Cinotti","doi":"10.1016/j.accpm.2025.101510","DOIUrl":"10.1016/j.accpm.2025.101510","url":null,"abstract":"<div><h3>Introduction</h3><div>Remimazolam is a novel benzodiazepine with an ultra-short half-life. It is a potentially interesting alternative for sedation in the Intensive Care Unit, but there is limited data regarding its use in critically ill patients.</div></div><div><h3>Methods</h3><div>Phase 2, investigator-initiated, single-center, non-randomized, open-label study. Patients with an expected duration of sedation ≥ 24 h were eligible and received a maximum 48-h infusion of Remimazolam, with a dose ranging from 0.1 to 1 mg/min.</div><div>The primary endpoint was a composite of the ability to reach a targeted sedation level without the use of another hypnotic drug and hemodynamic stability (no drop in mean arterial pressure ≤ 65 mmHg and no increase in norepinephrine dose ≥ 50% for more than 1 h), during the first 8 h after start. Secondary endpoints included the monitoring of Adverse Events (AE) and pharmacokinetics.</div></div><div><h3>Results</h3><div>30 patients were included with a median age of 60 [51–70] years, a SAPS II 38 [30–46], and a mortality rate of 23.3%. Fourteen (46.7%) patients met the primary endpoint. Ten (33.3%) patients received Remimazolam for 48 h and 4 (13.3%) patients received the highest dose. 54 AEs were reported in 23 patients and 11 were classified as Serious AEs in 8 patients. Ten AEs were related to Remimazolam. The pharmacokinetics analysis showed steady plasma levels throughout the infusion and rapid elimination after dosing discontinuation.</div></div><div><h3>Discussion</h3><div>Remimazolam could be useful for sedation in the ICU but deserves further investigation before routine use.</div></div><div><h3>Trial registration</h3><div>NCT04611425. Registered 2 November 2020.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 3","pages":"Article 101510"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774726","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":"Gender imbalance in critical care medicine journals","authors":"Cristina Santonocito ,&nbsp;Martina Maria Giambra ,&nbsp;Maria Grazia Lumia ,&nbsp;Filippo Sanfilippo ,&nbsp;Vittorio Del Fabbro ,&nbsp;Francesca Rubulotta ,&nbsp;Elena Giovanna Bignami ,&nbsp;Domenico Abelardo ,&nbsp;Jean-Yves Lefrant ,&nbsp;Jordi Rello","doi":"10.1016/j.accpm.2025.101504","DOIUrl":"10.1016/j.accpm.2025.101504","url":null,"abstract":"<div><h3>Introduction</h3><div>The present study aimed at assessing gender balance in the Editorial roles of Critical Care Medicine (CCM) journals.</div></div><div><h3>Methods</h3><div>A cross-sectional survey was performed for assessing the gender distribution in Editorial Board (EB) roles of journals indexed under Clarivate Journal Citation Reports and Scimago Journal &amp; Country Rank. The influences of editorial roles and of journal rank (separated in quartiles) on gender balance were also assessed.</div></div><div><h3>Results</h3><div>Among 99 screened CCM journals, 92 journals were included. There were 937 women among 4002 EB members (23.4%). We found a greater imbalance among Editors-in-Chief (females: n = 12/104, 11.5%) as compared to editorial roles with lower responsibilities (Senior Editors, n = 22/104, 21.2%, <em>p</em> = 0.04; Associate Editors, n = 208/739, 28.1%, <em>p</em> = 0.0002; EB members, n = 695/3055, 22.7%, <em>p</em> = 0.0038). In a post-hoc analysis conducted separating the journals according to their ranking quartiles (1–2 <em>vs.</em> 3–4), we found no influence of ranking on gender balance. When exploring the gender balance according to the journals’ impact factor, there was a majority of men as editors in all 4 quartiles across all EB roles.</div></div><div><h3>Conclusions</h3><div>We found a large gap in gender distribution across EB members’ roles in CCM journals, especially in the role of Editor-in-Chief, regardless of the journal ranking.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 3","pages":"Article 101504"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630958","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":"Conscious sedation for intracranial venous manometry and sinus stenting: 3 in 1 procedure","authors":"Rami El Ojaimi ,&nbsp;Luca Scarcia ,&nbsp;Dan Benhamou ,&nbsp;Christophe Quesnel ,&nbsp;Erwah Kalsoum","doi":"10.1016/j.accpm.2025.101514","DOIUrl":"10.1016/j.accpm.2025.101514","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 3","pages":"Article 101514"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143895735","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":"Association between arterial carbon dioxide tension and poor outcomes after cardiac arrest: A meta-analysis","authors":"Ru-Ting Xue ,&nbsp;Ran-Hong Sun ,&nbsp;Min Wang ,&nbsp;Hao Guo ,&nbsp;Jie Chang","doi":"10.1016/j.accpm.2025.101522","DOIUrl":"10.1016/j.accpm.2025.101522","url":null,"abstract":"<div><h3>Background</h3><div>Abnormal arterial carbon dioxide tension (PaCO₂) is a common finding after cardiac arrest (CA). Inconsistent results regarding the association between abnormal PaCO₂ and poor outcomes have been reported previously. We performed a meta-analysis to evaluate whether hypocapnia or hypercapnia is associated with an increased risk of hospital mortality and poor neurological outcomes in adult patients with CA.</div></div><div><h3>Methods</h3><div>PubMed, Embase, and the Cochrane Library databases were searched through October 2024 to determine studies investigating the association between PaCO₂ and the risk of hospital mortality and/or poor neurological outcomes in adult patients with CA. A random-effects model was used to calculate the pooled odds ratio (OR) with 95% confidence intervals (CIs) for cohort studies and relative risks (RRs) with 95% CIs for randomized controlled trials (RCTs).</div></div><div><h3>Results</h3><div>A total of 14 cohort studies and 3 RCTs comprising 72344 patients were included. Pooled analysis indicated that hypocapnia was associated with an increased risk of hospital mortality (nine cohort studies, OR 1.37; 95% CI, 1.18–1.59; <em>P</em> &lt; 0.0001) and poor neurological outcomes (five cohort studies, OR, 1.75; 95% CI, 1.04–2.96; <em>P</em> = 0.035). Within cohort studies, hypercapnia was associated with increased risk of hospital mortality (10 trials, OR 1.40; 95% CI, 1.13–1.73; <em>P</em> = 0.002), but not associated with poor neurological outcomes (six cohort studies, OR, 1.57; 95% CI, 0.87–2.83; <em>P</em> = 0.130). Within RCTs, mild hypercapnia was not associated with an increased risk of poor neurological outcomes after CA.</div></div><div><h3>Conclusions</h3><div>Current evidence indicated that hypocapnia was associated with an increased risk of hospital mortality and poor neurological outcomes after CA; however, hypercapnia was associated with an increased risk of hospital mortality but did not appear to be associated with increased poor neurological outcomes after CA.</div></div><div><h3>Systematic review protocol</h3><div>INPLASY 2024100120. Registered 28 October 2024.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 3","pages":"Article 101522"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143904497","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}