Anaesthesia Critical Care & Pain Medicine最新文献

{"title":"Trauma coagulopathy: Insights from the PROCOAG and CRYOSTAT-2 trials. Coagulation factors are not antibiotics","authors":"Tobias Gauss , Pierre Bouzat","doi":"10.1016/j.accpm.2024.101360","DOIUrl":"10.1016/j.accpm.2024.101360","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 3","pages":"Article 101360"},"PeriodicalIF":5.5,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139941055","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":"Dexmedetomidine and acute kidney injury after non-cardiac surgery: A meta-analysis with trial sequential analysis","authors":"Kai Zhuang ,&nbsp;Hao-tian Yang ,&nbsp;Yu-qin Long ,&nbsp;Hong Liu ,&nbsp;Fu-hai Ji ,&nbsp;Ke Peng","doi":"10.1016/j.accpm.2024.101359","DOIUrl":"10.1016/j.accpm.2024.101359","url":null,"abstract":"<div><h3>Background</h3><p>Acute kidney injury (AKI) is a common complication after surgery and is associated with detrimental outcomes. This systematic review and meta-analysis evaluated perioperative dexmedetomidine on AKI and renal function after non-cardiac surgery.</p></div><div><h3>Methods</h3><p>PubMed, Embase, and Cochrane Library databases were searched until August 2023 for randomised trials comparing dexmedetomidine with normal saline on AKI and renal function in adults undergoing non-cardiac surgery. The primary outcome was the incidence of AKI (according to Kidney Disease Improving Global Outcomes or Acute Kidney Injury Network criteria). Meta-analysis was performed using a random-effect model. We conducted sensitivity analysis, trial sequential analysis (TSA), and Grading of Recommendations Assessment, Development and Evaluation level of evidence.</p></div><div><h3>Results</h3><p>Twenty-three trials involving 2440 patients were included. Dexmedetomidine administration, as compared to normal saline, significantly reduced the incidence of AKI (7.4% <em>vs.</em> 13.2%; risk ratio = 0.57, 95% CI = 0.40–0.83, <em>P</em> =  0.003, <em>I²</em> = 0%; a high level of evidence); TSA and sensitivity analyses suggested the robustness of this outcome. For the renal function and inflammation parameters, dexmedetomidine decreased serum creatinine, blood urea nitrogen, cystatin C, tumour necrosis factor-α, and interleukin-6, and increased urine output and estimated glomerular filtration rate. Additionally, dexmedetomidine reduced postoperative nausea and vomiting and length of hospital stay. Dexmedetomidine was associated with an increased rate of bradycardia, but not hypotension.</p></div><div><h3>Conclusion</h3><p>Dexmedetomidine administration reduced the incidence of AKI and improved renal function after non-cardiac surgery. Based on a high level of evidence, dexmedetomidine is recommended as a component of perioperative renoprotection.</p></div><div><h3>Registration</h3><p>International Prospective Register of Systematic Reviews; Registration number: CRD42022299252.</p></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 3","pages":"Article 101359"},"PeriodicalIF":5.5,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139941054","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":"Effect of dexmedetomidine infusion on postoperative sleep disturbances in women with breast cancer: A monocentric randomized-controlled double-blind trial","authors":"Yushan Dong ,&nbsp;Maosan Wang ,&nbsp;Wenzhan Li ,&nbsp;Kai Zhao ,&nbsp;Xiaojie Cui ,&nbsp;Yanming Yang ,&nbsp;Xingyu Geng ,&nbsp;Yutian Pu ,&nbsp;Ziwei Hu ,&nbsp;Can Fang ,&nbsp;Gaochao Lv ,&nbsp;Su Liu ,&nbsp;Xiuxia Chen","doi":"10.1016/j.accpm.2024.101358","DOIUrl":"10.1016/j.accpm.2024.101358","url":null,"abstract":"<div><h3>Background</h3><p>Most women with breast cancer are prone to postoperative sleep disturbances (POSD). Little is known about the differences between sevoflurane and propofol combined with dexmedetomidine on POSD in the same context. We investigated the effect of intra-operative sevoflurane or propofol combined with intravenous dexmedetomidine on the incidence of POSD and postoperative sleep structures.</p></div><div><h3>Methods</h3><p>A monocentric, randomized-controlled, double-blind trial. Female patients undergoing radical surgery for breast cancer were randomly assigned to receive sevoflurane and placebo, sevoflurane and dexmedetomidine, propofol and placebo, or propofol and dexmedetomidine. Dexmedetomidine was administered at 1.0 μg kg⁻¹ infusion 15 min before induction, then infused at 0.4 μg kg⁻¹ h⁻¹ until the surgical drain started to be placed. The primary outcome was the incidence of POSD within the postoperative first three days (defined as an Athens Insomnia Scale score ≥ 6 points on at least one day of postoperative first three days). The secondary outcome was the duration of sleep structures, collected from the Fitbit Charge 2® smart bracelet (Fitbit, Inc., San Francisco, CA, USA).</p></div><div><h3>Results</h3><p>There were 188 women analyzed with the modified intention-to-treat method. The incidences of POSD in the dexmedetomidine and placebo groups were similar (<em>p</em> = 0.649). In the sevoflurane sedation strategy, dexmedetomidine decreased nocturnal wakefulness on postoperative first day (<em>p</em> = 0.001). In the propofol sedation strategy, dexmedetomidine increased nocturnal deep sleep on postoperative first (<em>p</em> &lt; 0.001) and third (<em>p</em> &lt; 0.001) days.</p></div><div><h3>Conclusion</h3><p>Intra-operative infusion of dexmedetomidine had no significant effect on POSD but decreased nocturnal wakefulness in the sevoflurane group and increased nocturnal deep sleep in the propofol group.</p></div><div><h3>Trial registration</h3><p>Registered at <span>www.chictr.org.cn</span><svg><path></path></svg> (ChiCTR2300070136).</p></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 3","pages":"Article 101358"},"PeriodicalIF":5.5,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139747590","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":"Tidal volume in mechanically ventilated patients: Searching for Cinderella’s shoe rather than 6 mL/kg for all","authors":"R. Mounier ,&nbsp;S. Diop ,&nbsp;H. Kallel ,&nbsp;J.M. Constantin ,&nbsp;A. Roujansky","doi":"10.1016/j.accpm.2024.101356","DOIUrl":"10.1016/j.accpm.2024.101356","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 3","pages":"Article 101356"},"PeriodicalIF":5.5,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139747591","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":"Continuous infusion of beta-lactam antibiotics in pediatric intensive care unit: A monocenter before/after implementation study","authors":"Gwendoline Ragonnet ,&nbsp;Romain Guilhaumou ,&nbsp;Omar Hanafia ,&nbsp;Nadège Néant ,&nbsp;Solène Denante ,&nbsp;Noémie Vanel ,&nbsp;Stéphane Honoré ,&nbsp;Fabrice Michel","doi":"10.1016/j.accpm.2024.101354","DOIUrl":"10.1016/j.accpm.2024.101354","url":null,"abstract":"<div><h3>Context</h3><p>Beta-lactam continuous infusion (CI) is currently recommended in adult intensive care units to achieve target concentrations. In pediatric intensive care (PICU), few studies suggest the value of Beta-lactam CI to achieve target concentration. Our objective was to analyze the impact of Beta-lactam CI protocolization on the achievement of target concentration in PICU patients.</p></div><div><h3>Material and methods</h3><p>We conducted a single-center retrospective study in patients with beta-lactam treatment for more than 2 days and at least one sample for therapeutic drug monitoring (TDM). From January 2018 to February 2022 (period 1, P1), BL were administered as an intermittent infusion with TDM upon request. From February to September 2022 (period 2, P2), Beta-lactam CI with TDM at day one was protocolized. The primary endpoint concerned achieving fT&gt;4× Minimum Inhibitory Concentration = 100%.</p></div><div><h3>Results</h3><p>In P1, 214 assays involved 103 patients; in P2, 199 assays involved 72 patients. Target concentration achievement was more frequent in P2 (P2 = 73.7% <em>vs.</em> P1 = 29.1%; <em>p</em> &lt; 0.001). At day 5/6 after Beta-lactam initiation, c-reactive protein concentrations were P1 = 84.9 ± 79.2 mg/L; P2 = 53.7±49.8 mg/L (<em>p</em> &lt; 0.05). In the multivariable logistic regression model: P2, BSA, and albumin were positively associated with target achievement; urea, and male sex were negatively associated with target achievement. The daily average cost of beta-lactam vial consumption per child was: P1 = 5.04 ± 2.6 € <em>vs</em>. P2 = 3.21 ± 2.7 € (<em>p</em>-value &lt; 0.001). The daily average reconstitution time of Beta-lactam syringes per child was: P1 = 23.5 ± 8.7 min, P2 = 13.9 ± 9.2 min (<em>p</em>-value &lt; 0.001).</p></div><div><h3>Conclusion</h3><p>Protocolization of Beta-lactam continuous infusion was associated with more frequent target concentration achievements in PICU. This implementation could be cost-effective and nurse time-saving.</p></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 3","pages":"Article 101354"},"PeriodicalIF":5.5,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139742331","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":"Preparedness for severe maternal morbidity in European hospitals: The MaCriCare study","authors":"Paweł Krawczyk ,&nbsp;Dominika Dabrowska ,&nbsp;Emilia Guasch ,&nbsp;Henrik Jörnvall ,&nbsp;Nuala Lucas ,&nbsp;Frédéric J. Mercier ,&nbsp;Alexandra Schyns-van den Berg ,&nbsp;Carolyn F. Weiniger ,&nbsp;Łukasz Balcerzak ,&nbsp;Steve Cantellow ,&nbsp;MaCriCare study group","doi":"10.1016/j.accpm.2024.101355","DOIUrl":"10.1016/j.accpm.2024.101355","url":null,"abstract":"<div><h3>Purpose</h3><p>To evaluate obstetric units (OUs) and intensive care units (ICUs) preparedness for severe maternal morbidity (SMM).</p></div><div><h3>Methods</h3><p>From September 2021 to January 2022, an international multicentre cross-sectional study surveyed OUs in 26 WHO Europe Region countries. We assessed modified early obstetric warning score usage (MEOWS), approaches to four SMM clinical scenarios, invasive monitoring availability in OUs, and access to high-dependency units (HDUs) and onsite ICUs. Within ICUs, we examined the availability of trained staff, response to obstetric emergencies, leadership, and data collection.</p></div><div><h3>Results</h3><p>1133 responses were evaluated. MEOWS use was 34.5%. Non-obstetric early warning scores were being used. 21.4% (242) of OUs provided invasive monitoring in the OU. A quarter lacked access to onsite HDU beds. In cases of SMM, up to 13.8% of all OUs indicated the need for transfer to another hospital. The transfer rate was highest (74.0%) in small units. 81.9% of centers provided onsite ICU facilities to obstetric patients. Over 90% of the onsite ICUs provided daily specialist obstetric reviews but lacked immediate access to key resources: 3.4% - uterotonic drugs, 7.5% - neonatal resuscitation equipment, 9.2% - neonatal resuscitation team, 11.4% - perimortem cesarean section equipment. 41.2% reported obstetric data to a national database.</p></div><div><h3>Conclusion</h3><p>Gaps in provision exist for obstetric patients with SMM in Europe, potentially compromising patient safety and experience. MEOWS use in OUs was low, while access to invasive monitoring and onsite HDU and ICU facilities was variable. ICUs frequently lacked resources and did not universally collect obstetric data for quality control.</p></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 3","pages":"Article 101355"},"PeriodicalIF":5.5,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352556824000134/pdfft?md5=dc552f36e50d87e79224dab2cb82243b&pid=1-s2.0-S2352556824000134-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139742332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Should proactive smoking cessation support before spinal surgery be routine and universal?","authors":"Ashley Webb ,&nbsp;Mette Rasmussen","doi":"10.1016/j.accpm.2024.101357","DOIUrl":"10.1016/j.accpm.2024.101357","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 2","pages":"Article 101357"},"PeriodicalIF":5.5,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139742333","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":"Systematic review and meta-analysis on Staphylococcus aureus methicillin resistance detection performance and discrepancy analysis with the BIOFIRE® FILMARRAY® Pneumonia Panel","authors":"Ophélie Hurtado ,&nbsp;Tristan T. Timbrook ,&nbsp;Benjamin Hommel","doi":"10.1016/j.accpm.2024.101352","DOIUrl":"10.1016/j.accpm.2024.101352","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 2","pages":"Article 101352"},"PeriodicalIF":5.5,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139736488","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 evaluation of the BioFire Respiratory Pathogen Panel for the guidance of empirical antimicrobial therapy in critically ill patients with hospital-acquired pneumonia: A multicenter, quality improvement project","authors":"Cécile Poulain ,&nbsp;Yoann Launey ,&nbsp;Marwan Bouras ,&nbsp;Karim Lakhal ,&nbsp;Laura Dargelos ,&nbsp;Lise Crémet ,&nbsp;Sophie-Anne Gibaud ,&nbsp;Stéphane Corvec ,&nbsp;Philippe Seguin ,&nbsp;Bertrand Rozec ,&nbsp;Karim Asehnoune ,&nbsp;Fanny Feuillet ,&nbsp;Antoine Roquilly","doi":"10.1016/j.accpm.2024.101353","DOIUrl":"10.1016/j.accpm.2024.101353","url":null,"abstract":"<div><h3>Background</h3><p>We aimed to determine whether implementing antimicrobial stewardship based on multiplex bacterial PCR examination of respiratory fluid can enhance outcomes of critically ill patients with hospital-acquired pneumonia (HAP).</p></div><div><h3>Methods</h3><p>We conducted a quality improvement study in two hospitals in France. Adult patients requiring invasive mechanical ventilation with a diagnosis of HAP were included. In the pre-intervention period (August 2019 to April 2020), antimicrobial therapy followed European guidelines. In the «intervention» phase (June 2020 to October 2021), treatment followed a multiplex PCR-guided protocol. The primary endpoint was a composite endpoint made of mortality on day 28, clinical cure between days 7 and 10, and duration of invasive mechanical ventilation on day 28. The primary outcome was analyzed with a DOOR strategy.</p></div><div><h3>Results</h3><p>A total of 443 patients were included in 3 ICUs from 2 hospitals (220 pre-intervention; 223 intervention). No difference in the ranking of the primary composite outcome was found (DOOR: 50.3%; 95%CI, 49.9%–50.8%). The number of invasive mechanical ventilation-free days at day 28 was 10.0 [0.0; 19.0] in the baseline period and 9.0 [0.0; 20.0] days during the intervention period (p = 0.95). The time-to-efficient antimicrobial treatment was 0.43 ± 1.29 days before <em>versus</em> 0.55 ± 1.13 days after the intervention (<em>p</em> = 0.56).</p></div><div><h3>Conclusion</h3><p>Implementation of Rapid Multiplex PCR to guide empirical antimicrobial therapy for critically ill patients with HAP was not associated with better outcomes. However, adherence to stewardship was low, and the study may have had limited power to detect a clinically important difference.</p></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 2","pages":"Article 101353"},"PeriodicalIF":5.5,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139736487","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":"Anaesthesia Critical Care & Pain Medicine: 9 years of international publication","authors":"Jean-Yves Lefrant ,&nbsp;Emmanuel Lorne ,&nbsp;Romain Pirracchio ,&nbsp;Dan Benhamou ,&nbsp;Alexandre Milman ,&nbsp;Antoine Roquilly","doi":"10.1016/j.accpm.2023.101328","DOIUrl":"10.1016/j.accpm.2023.101328","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 1","pages":"Article 101328"},"PeriodicalIF":5.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138048244","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}