Anaesthesia Critical Care & Pain Medicine最新文献

{"title":"Landiolol for atrial fibrillation after cardiac surgery: from prevention to treatment.","authors":"Nicolas Mongardon, Bertrand Rozec, Marc-Olivier Fischer","doi":"10.1016/j.accpm.2026.101859","DOIUrl":"https://doi.org/10.1016/j.accpm.2026.101859","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101859"},"PeriodicalIF":4.7,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857481","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":"Clinical sedation assessment versus EEG-based monitoring during deep sedation in VV-ECMO patients: a prospective blinded observational study.","authors":"Tereza Bartošová, Jan Bláha, Petr Kopecký, Quynh Giang Nguyenová, Katarína Kapráľová, Jakub Petrus, Natália Žišková, Michal Lipš","doi":"10.1016/j.accpm.2026.101858","DOIUrl":"https://doi.org/10.1016/j.accpm.2026.101858","url":null,"abstract":"<p><strong>Background: </strong>Severe ARDS patients on VV-ECMO often require deep sedation, where behavioural assessments may fail to quantify cortical suppression. We evaluated this suppression burden and its relation to routine sedation assessment using blinded EEG.</p><p><strong>Methods: </strong>In this prospective observational study, adult VV-ECMO patients with severe ARDS underwent 24 -h blinded Conox EEG monitoring. Burst suppression ratio (BSR) and Quantium Consciousness Index (qCON) were paired with hourly Richmond Agitation-Sedation Scale (RASS) assessments (target -4). Linear mixed-effects models with patient as a random effect tested whether hourly RASS predicted BSR and qCON.</p><p><strong>Results: </strong>Twenty patients yielded 467 paired RASS-EEG observations. Burst suppression occurred in all patients. Median time-weighted average BSR was 7.3% (IQR 2.1-30.8), maximum BSR was 27.9% (IQR 6.2-71.2), and median time with BSR ≥ 5% was 37.7% (IQR 12.5-96.9). A 1-point RASS increase was associated with a 3.31% decrease in BSR (95% CI - 5.60 to -1.01; p =  0.005). At RASS -4, BSR was ≥5% in 64.5% and ≥10% in 51.7% of observations. Lower qCON values were associated with greater burst suppression burden, with BSR approaching zero above qCON ≈40.</p><p><strong>Conclusions: </strong>Processed EEG revealed a substantial burden of burst suppression during deep VV-ECMO sedation despite uniform behavioural targets. Within this deep sedation range, RASS had limited resolution for quantifying cortical suppression.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101858"},"PeriodicalIF":4.7,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844722","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":"Authors reply.","authors":"Romain Miguel Montanes, Theo Poufarin, Laure Elkrief","doi":"10.1016/j.accpm.2026.101857","DOIUrl":"https://doi.org/10.1016/j.accpm.2026.101857","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101857"},"PeriodicalIF":4.7,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844685","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":"Electrical Impedance Tomography- Based PEEP in Obese Patients Undergoing Laparoscopic Surgery: Comment","authors":"Brionna Sandridge Bulgarelli,&nbsp;Sophie Kupiec-Weglinski,&nbsp;Nancy M. Boulos","doi":"10.1016/j.accpm.2025.101730","DOIUrl":"10.1016/j.accpm.2025.101730","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"45 3","pages":"Article 101730"},"PeriodicalIF":4.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145696529","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":"Probe insertion is not an airway strategy endpoint.","authors":"Sacha Rozencwajg, Maxime Théo Aparicio","doi":"10.1016/j.accpm.2026.101856","DOIUrl":"https://doi.org/10.1016/j.accpm.2026.101856","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101856"},"PeriodicalIF":4.7,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786387","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":"General anesthesia with intubation and emergency endoscopy outcomes in patients with upper gastrointestinal bleeding: an inverse probability of treatment weighting study.","authors":"Elettra Merola, Maria Pina Dore","doi":"10.1016/j.accpm.2026.101855","DOIUrl":"https://doi.org/10.1016/j.accpm.2026.101855","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101855"},"PeriodicalIF":4.7,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786370","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":"The Echo Chamber of Command: Structural Isolation, Professional Agency, and Leadership in Anesthesiology.","authors":"Rodrigo Poves-Álvarez, Mario Lorenzo-López, Beatriz Martínez-Rafael, Gema Rodríguez Cerón, Esther Gómez-Sánchez, Eduardo Tamayo","doi":"10.1016/j.accpm.2026.101854","DOIUrl":"https://doi.org/10.1016/j.accpm.2026.101854","url":null,"abstract":"<p><p>In the operating room's symphony of shared clinical purpose, the anesthesia Department Chief transitions to a different form of structural silence: the \"echo chamber of command,\" where ontological responsibility, political, ethical, and human, can be experienced as profoundly solitary. This phenomenological essay explores the \"glass wall\": a transparent yet potentially impenetrable barrier enabling mutual surveillance but sometimes limiting genuine relational exchange, which may, under sustained strain, contribute to defensive detachment, cynicism, or burnout. In many European public hospital contexts, chiefs navigate a structural \"pincer movement\" between administrative fiscal pressures and clinical demands for resources, positioning them as boundary-spanning stewards of public funds with significant moral responsibility. In certain settings, this structural configuration may contribute to leadership reluctance. Younger generations reassess the balance between professional responsibility, autonomy, and work-life integration. Solutions encompass leadership training from residency (organizational psychology, negotiation); external peer forums, such as structured \"Leadership M&M\" (reflective sessions conceptually modeled on traditional Morbidity and Mortality conferences), which have been shown in peer-reflection models to reduce burnout; and genuine autonomy, transforming chiefs from foremen to architects. Empirical data suggest that leader burnout may negatively influence team performance and departmental outcomes. Institutions must shatter the echo chamber: recognize chiefs as strategic bridges, invest in human-centric empowerment beyond metrics. High-performing anesthesia services, central to hospital productivity, depend on leaders who are clinically grounded, organizationally empowered, and professionally connected. Perioperative resilience, therefore, rests on the integration of technical standards, structural clarity, and human sustainability.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101854"},"PeriodicalIF":4.7,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786505","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":"Acute Kidney Injury Complications and Kidney Replacement Therapy as Mediators of Mortality in Critically Ill Patients.","authors":"Vitor Dantas Macedo, André Libório Santos, Alexandre Braga Libório","doi":"10.1016/j.accpm.2026.101849","DOIUrl":"https://doi.org/10.1016/j.accpm.2026.101849","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) is associated with increased mortality in critically ill patients. This study aimed to evaluate the association between AKI and 28-day mortality, with a focus on measurable AKI-related complications (serum bicarbonate, blood urea nitrogen-BUN, potassium and fluid balance) as potential mediators.</p><p><strong>Methods: </strong>We extracted data for critically ill patients admitted between 2008 and 2019 from the MIMIC-IV database whose ICU length of stay exceeded 48 hours. Causal inference methods were employed to evaluate the association between AKI and 28-day mortality through marginal structural Cox models. We used the survival mediational g-formula to estimate the extent to which mortality in severe AKI (stage 2/3) could be reduced by shifting complication variables to match those of patients without severe AKI.</p><p><strong>Results: </strong>Among 28,549 patients, 70.2% experienced severe AKI for at least one day. Marginal structural Cox models demonstrated that severe AKI was independently associated with a higher hazard of death within 28 days. Mediation analysis revealed that serum bicarbonate concentration and fluid balance explained 33.2% and 7.4%, respectively, of the increased mortality observed in patients with severe AKI (P < 0.001). Furthermore, kidney replacement therapy (KRT) was associated with a 17.6% reduction in mortality attributable to AKI (P < 0.001). Serum potassium and BUN levels were not significant mediators of mortality related to severe AKI.</p><p><strong>Conclusions: </strong>Serum bicarbonate levels and fluid balance mediate approximately 40% of the mortality risk attributable to AKI. KRT is beneficial for AKI-associated mortality. Despite controversial results regarding the benefit of bicarbonate administration in AKI, the focus should remain on how managing metabolic acidosis-possibly beyond simple bicarbonate replacement-in combination with improved fluid balance management can enhance outcomes in critically ill patients with AKI.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101849"},"PeriodicalIF":4.7,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700520","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":"Performance of M-mode and Color Doppler Ultrasound for Confirming Epidural Catheter Placement in Laboring women: A Prospective Cohort Study.","authors":"Lauranne Ossé, Brebion Myriam, Samuel Dahan, Repessé Xavier, Hishaam Saumtally, Gilles Orliaguet, Lionel Bouvet, Hawa Keita","doi":"10.1016/j.accpm.2026.101850","DOIUrl":"https://doi.org/10.1016/j.accpm.2026.101850","url":null,"abstract":"<p><strong>Background: </strong>Correct epidural catheter (EC) placement is essential for effective epidural analgesia (EA) during labour, yet confirmation remains indirect. B-mode ultrasound facilitates EA placement but does not reliably visualise the EC. Alternative modalities such as M-mode and colour Doppler (cD) ultrasonography may improve EC localisation, though evidence in obstetrics remains limited. This study evaluated the feasibility of detecting the EC within the epidural space (ES) using M-mode, with secondary objectives of comparing the diagnostic performance of both modes.</p><p><strong>Methods: </strong>We conducted a prospective single-centre observational study including 100 parturients requesting EA. After EC insertion, parasagittal oblique and transverse ultrasound views were obtained. For EC location, M-mode detected a granular pattern at the catheter depth in the ES after saline injection, while cD detected saline flow as colour aliasing. EA effectiveness was assessed 20 minutes post-insertion.</p><p><strong>Results: </strong>M-mode localised the EC in 48% of cases, all with effective EA (sensitivity 49%, specificity 100%, positive predictive value (PPV) 100%, negative predictive value (NPV) 4%). Using cD, the EC was visualised in 76% of cases (sensitivity 78%, specificity and PPV 100%, NPV 8%) with faster detection (p < 0.001). Considering either modality increased sensitivity to 87%, with specificity and PPV 100% and NPV 13%. Among 15 cases undetected by either mode, EA failed in two, requiring catheter repositioning.</p><p><strong>Conclusion: </strong>cD is more sensitive and faster than M-mode for EC localisation in obstetrics. Neither technique alone suffices for systematic screening, but a combined approach markedly improves detection. Absence of EC visualisation could not be interpreted as incorrect placement.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101850"},"PeriodicalIF":4.7,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700533","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":"Monitored Anaesthesia Care Versus General Anaesthesia for Endoscopic Upper Gastrointestinal Ultrasonography: A Retrospective Cohort study.","authors":"Muhib Haidari, Amelie Delaporte, Theodora Wingert, Kenneth Lin, Arthur Chebishian, Janice Boktor, Aline Toukhtarian, Alexander Soussani, Tristan Grogan, Alireza Sedarat, Alexandre Joosten","doi":"10.1016/j.accpm.2026.101848","DOIUrl":"https://doi.org/10.1016/j.accpm.2026.101848","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101848"},"PeriodicalIF":4.7,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147647125","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}