Anaesthesia Critical Care & Pain Medicine最新文献

{"title":"Association between Driving Pressure, Systemic Inflammation and Non-pulmonary Organ Dysfunction in Patients with Acute Respiratory Distress Syndrome, a Prospective Pathophysiological Study.","authors":"Enric Barbeta, Carlos Ferrando, Rubén López-Aladid, Anna Motos, Letícia Bueno-Freire, Laia Fernández-Barat, Alba Soler-Comas, Andrea Palomeque, Albert Gabarrús, Antonio Artigas, Marta Camprubí-Rimblas, Gianluigi Li Bassi, Teresa López-Sobrino, Elena Sandoval, David Toapanta, Sara Fernández, Ricard Mellado-Artigas, Luigi Zattera, Jordi Vallverdú, John G Laffey, Miquel Ferrer, Antoni Torres","doi":"10.1016/j.accpm.2024.101458","DOIUrl":"https://doi.org/10.1016/j.accpm.2024.101458","url":null,"abstract":"<p><strong>Background: </strong>Driving pressure is thought to determine the effect of low tidal ventilation on survival in patients with acute respiratory distress syndrome. The leading cause of mortality in these patients is non-pulmonary multiorgan dysfunction, which is believed to worsen due to the biological response to mechanical ventilation (biotrauma). Therefore, we aimed to analyze the association between driving pressure, biotrauma, and non-pulmonary multiorgan dysfunction. Additionally, we analyzed this relationship for tidal volume / predicted body weight.</p><p><strong>Methods: </strong>Observational study that included adult patients with acute respiratory distress syndrome undergoing invasive mechanical ventilation admitted to the Hospital Clinic of Barcelona, Spain, between June 2019 and February 2021. We conducted mixed-effects models to assess the effects of driving pressure and tidal volume/predicted body weight on the evolution of 22 log-transformed biomarker variables during the first, third, and fifth days after study enrollment. These 22 systemic biomarkers characterized epithelial and endothelial pulmonary dysfunction, inflammation, and coagulation disorders in the included patients. In the same fashion, the association between driving pressure and non-pulmonary multiorgan dysfunction was evaluated by the non-pulmonary sequential organ failure assessment score (non-pulmonary SOFA) and its associated variables. Finally, we performed mediation analyses to assess whether the relationship between biomarkers and driving pressure was mediated by other ventilator-induced lung injury parameters.</p><p><strong>Results: </strong>Thirty-eight patients were included. The driving pressure was independently associated with soluble Receptor for advanced glycation end-products, Interleukin (IL)-8, IL-6, IL-10, IL-17, Interferon-ɣ, Chemokine (C-C motif)-2, Vascular endothelial growth factor, Tissue factor, Protein C, Protein S, and higher dose of norepinephrine. However, this relationship attenuated over time. In contrast, tidal volume/predicted body weight was not associated with any of the 22 biomarkers tested response. A concomitant increase in positive end-inspiratory plateau pressure or tidal volume did not mediate the effect of driving pressure on biomarkers. Conversely, the association between compliance of the respiratory system and pulmonary epithelial dysfunction was primarily mediated by driving pressure.</p><p><strong>Conclusions: </strong>Driving pressure, but not tidal volume/predicted body weight, was correlated with epithelial and endothelial pulmonary dysfunction, inflammation, coagulation disorders, and hemodynamic dysfunction. However, this relationship diminished over time.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101458"},"PeriodicalIF":3.7,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878356","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 Protective Role of Specialized Supraglottic Airway Devices in Gastrointestinal Endoscopy.","authors":"André Van Zundert, Paul Zilberman, Dan Benhamou","doi":"10.1016/j.accpm.2024.101459","DOIUrl":"https://doi.org/10.1016/j.accpm.2024.101459","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101459"},"PeriodicalIF":3.7,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878368","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":"Microbiological monitoring during antibiotic therapy in patients with ventilated acquired pneumonia: A proof-of-concept.","authors":"Emmanuel Dudoignon, Julia Schneider, Francois Caméléna, Christian de Tymowski, François Dépret","doi":"10.1016/j.accpm.2024.101454","DOIUrl":"https://doi.org/10.1016/j.accpm.2024.101454","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101454"},"PeriodicalIF":3.7,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873127","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":"Application of a novel gastro-laryngeal mask in upper gastrointestinal endoscopy surgery: A pilot randomized clinical trial.","authors":"Junfei Zhou, Lu Li, Chang Xu, Erxian Zhao, Jianjun Yang, Yunqi Lv","doi":"10.1016/j.accpm.2024.101456","DOIUrl":"https://doi.org/10.1016/j.accpm.2024.101456","url":null,"abstract":"<p><strong>Background: </strong>The Gastro-Laryngeal Mask (Jcerity Endoscoper^TM Airway) is a new airway management technique utilized in patients undergoing upper gastrointestinal endoscopy surgery under general anesthesia, but evidence of its effectiveness and safety is scarce.</p><p><strong>Objective: </strong>To assess the success rate of insertion, cardiovascular response, airway pressure, time taken for placement, nausea or vomiting, pharyngodynia, and other complications of using the new type of back-open gastroscopy laryngeal mask.</p><p><strong>Methods: </strong>We screened 1401 patients; 105 were ineligible, and 40 declined to participate. Participants were randomly allocated into the Jcerity Endoscoper^TM Airway (JEA) group and the endotracheal tube (ET) group. Among them, 1266 patients were randomly assigned to receive endotracheal intubation (n = 633) or JEA (n = 633).</p><p><strong>Results: </strong>Compared with the ET group, the JEA group had a significantly shorter insertion time and less cardiovascular response during insertion. The time taken for extubation after anesthesia and residence time in PACU in the JEA group was shorter than in the ET group. Especially, the incidence of pharyngodynia in the JEA group was lower than that in the ET group. The satisfaction of endoscopists with the JEA reached 99.4%.</p><p><strong>Conclusions: </strong>This study showed that the back-open JEA can not only provide a safe and effective airway guarantee for patients but also provide convenience for gastroenterologists to carry out endoscopic operations.</p><p><strong>Trial registration: </strong>The trial was registered before patient enrollment at the Chinese Clinical Trial Registry Center (ChiCTR2100046864, principal investigator: Yunqi Lv, date of registration: 2021-05-29). The study was conducted in the painless diagnosis and treatment center of the First Affiliated Hospital of Zhengzhou University from June 2021 to October 2023(Date of enrolment of the first research participant:2021-06-01).</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101456"},"PeriodicalIF":3.7,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873085","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":"Jet versus vibrating mesh nebulizer for tobramycin aerosol in spontaneously breathing children with tracheostomies - a simulation study.","authors":"Natalie V E Anderson, William G F Ditcham, Barry S Clements, Britta S von Ungern-Sternberg","doi":"10.1016/j.accpm.2024.101455","DOIUrl":"https://doi.org/10.1016/j.accpm.2024.101455","url":null,"abstract":"<p><p>Tracheostomy tubes act as foreign bodies, predisposing the surrounding airway to respiratory infections. Initial treatment for infections is topical - nebulized tobramycin - although guidelines for standardized treatment are lacking. To quantify tobramycin delivery to simulated, tracheostomized children to inform future administration guidelines. A breathing simulator was programmed for volume-controlled ventilation at 6 mL.kg^-1, for a 3 kg and a 16 kg child representing under or over 6-yrs, respectively. Nebulized tobramycin doses based on current guidelines for non-tracheostomized children (80 mg, or 300 mg, under and over 6-yrs, respectively) were delivered using standard hospital protocol, collected on filters, and assayed with chromatography to quantify average tobramycin delivered dose from six replicate measurements. The jet nebulizer delivered more tobramycin than the vibrating mesh nebulizer from an 80 mg (ages <6-yrs) dose for both a 3 kg child: 2.1 vs. 0.7 mg (3 mm, p = 0.047) and a 16 kg child: 8.7 vs. 3.5 mg (5 mm size, p = 0.022), 11.4 vs. 8.3 mg (4 mm size, p = 0.2). The jet nebulizer delivered more tobramycin than the vibrating mesh nebulizer for both a 3 kg child: 8.4 vs. 3.7 mg (3 mm, p = 0.00076) and a 16 kg child: 33.2 vs. 25 mg (5 mm, p = 0.2) but not for a 16 kg child: 39.4 vs. 46.5 mg (4 mm, p = 0.18) The low amount and poor distribution of drug delivered warrants consideration and review of dosing regimens for treatment. Future research should investigate improving the efficiency of drug delivery to tracheostomized children and the safety and efficacy of higher-dosage regimens.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101455"},"PeriodicalIF":3.7,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873124","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":"Opioid-free anaesthesia and postoperative quality of recovery: a systematic review and meta-analysis with trial sequential analysis.","authors":"Yijun Liu, Wei Ma, Yunxia Zuo, Qian Li","doi":"10.1016/j.accpm.2024.101453","DOIUrl":"https://doi.org/10.1016/j.accpm.2024.101453","url":null,"abstract":"<p><strong>Background: </strong>There is still debate over whether opioid-free anaesthesia (OFA) can improve the patient-reported quality of recovery (QoR).</p><p><strong>Methods: </strong>A search was conducted across Pubmed, Cochrane Library, and EMBASE until June 2024 for randomized controlled trials comparing the impact of OFA and opioid-based anaesthesia (OBA) on QoR in adult patients undergoing general anaesthesia. The primary outcome was the quality of recovery measured with the QoR scale. The secondary outcomes were the five dimensions of the QoR scale.</p><p><strong>Results: </strong>The analysis included 15 studies, and showed that compared with OBA, OFA improved the global QoR score at postoperative 24 h (SMD 0.87; 95% CI, 0.48 to 1.27; I²: 92%; low-level evidence). Among them, 10 studies revealed a greater QoR-40 score at postoperative 24 h in the OFA than in the OBA (MD 6.59; 95% CI, 2.84 to 10.34; I²: 93%; moderate-level evidence), which exceeded the minimal clinically important difference of 6.3. Conversely, the synthetic data of 4 studies did not reveal an improvement in the global QoR-15 score at postoperative 24 h (MD 9.94; 95% CI, -0.15 to 12.35; I²: 97%; low-level evidence). Regarding different domains of scale, OFA had positive effects on physical comfort (SMD 0.75; 95% CI, 0.25 to 1.25; I²: 93%; moderate-level evidence) and pain (SMD 0.59; 95% CI, 0.15 to 1.03; I²: 91%; moderate-level evidence).</p><p><strong>Conclusions: </strong>The meta-analysis indicate OFA can improve the quality of recovery at postoperative 24 h, particularly in terms of enhancing physical comfort and reducing pain. However, due to significant heterogeneity and moderate-to-low level of evidence, the external validity of OFA for improving postoperative recovery remains to be further validated.</p><p><strong>Registration: </strong>The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database on December 07, 2023 (CRD42023486235).</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101453"},"PeriodicalIF":3.7,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822751","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":"Severe acute kidney injury in patients with COVID-19 acute respiratory distress syndrome: A multicenter retrospective study: Kidney Injury Working Initiative in Critically ill eurOpean patients during Coronavirus Outbreak (KIWI COCO study).","authors":"Khalil Chaïbi, Damien Roux, Tài Pham, Xosé Pérez-Fernandez, Guillaume Louis","doi":"10.1016/j.accpm.2024.101452","DOIUrl":"https://doi.org/10.1016/j.accpm.2024.101452","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101452"},"PeriodicalIF":3.7,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711026","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 association between neuraxial labor analgesia and subacute pain after childbirth: a randomized controlled trial.","authors":"Chin Wen Tan, Dgp Luther, Hon Sen Tan, Nabilah Rahman, Mihir Gandhi, Rehena Sultana, Alex Tiong Heng Sia, Ban Leong Sng","doi":"10.1016/j.accpm.2024.101450","DOIUrl":"https://doi.org/10.1016/j.accpm.2024.101450","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101450"},"PeriodicalIF":3.7,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644641","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":"Prevention of perioperative venous thromboembolism: 2024 guidelines from the French Working Group on Perioperative Haemostasis (GIHP) developed in collaboration with the French Society of Anaesthesia and Intensive Care Medicine (SFAR), the French Society of Thrombosis and Haemostasis (SFTH) and the French Society of Vascular Medicine (SFMV) and endorsed by the French Society of Digestive Surgery (SFCD), the French Society of Pharmacology and Therapeutics (SFPT) and INNOVTE (Investigation Network On Venous ThromboEmbolism) network.","authors":"Anne Godier, Dominique Lasne, Gilles Pernod, Normand Blais, Fanny Bonhomme, Fanny Bounes, Alex Bourguignon, Ariel Cohen, Emmanuel de Maistre, Pierre Fontana, Jean-Philippe Galanaud, Delphine Garrigue Huet, Alexandre Godon, Isabelle Gouin-Thibault, Samia Jebara, Silvy Laporte, Thomas Lecompte, Dan Longrois, Jerrold H Levy, Grégoire Le Gal, Yves Gruel, Alexandre Mansour, Anne-Céline Martin, Mikael Mazighi, Pierre-Emmanuel Morange, Serge Motte, François Mullier, Philippe Nguyen, Nadia Rosencher, Stéphanie Roullet, Pierre-Marie Roy, Jean-François Schved, Marie-Antoinette Sevestre, Pierre Sié, Sophie Susen, Charles Tacquard, André Vincentelli, Paul Zufferey, Patrick Mismetti, Pierre Albaladejo","doi":"10.1016/j.accpm.2024.101446","DOIUrl":"https://doi.org/10.1016/j.accpm.2024.101446","url":null,"abstract":"<p><strong>Background: </strong>Any surgical procedure carries a risk for venous thromboembolism (VTE), albeit variable. Improvements in medical and surgical practices and the shortening of care pathways due to the development of day surgery and enhanced recovery after surgery, have reduced the perioperative risk for VTE.</p><p><strong>Objective: </strong>A collaborative working group of experts in perioperative haemostasis updated in 2024 the recommendations for the Prevention of perioperative venous thromboembolism published in 2011.</p><p><strong>Methods: </strong>The addressed questions were defined by 40 experts (GIHP, SFAR, SFTH and SFMV) and formulated in a PICO format. They performed the literature review and formulated recommendations according to the Grading of GRADE system. Recommendations were then validated by a vote determining the strength of each recommendation. Of note, these recommendations do not cover all surgical specialties. Especially, thromboprophylaxis in cardiac surgery, neurosurgery and obstetrics is not addressed.</p><p><strong>Results: </strong>78 recommendations were formalized into 17 sections, including patient-related VTE risk factors, types of surgery, extreme body weight, renal impairment, mechanical prophylaxis, distal deep vein thrombosis; 27 were found to have a high level of evidence (GRADE 1) and 41 a low level of evidence (GRADE 2) and 10 were expert opinion. All had strong agreement among the experts.</p><p><strong>Conclusions: </strong>These guidelines help to weigh the perioperative risk for VTE (which includes the risk associated to surgery and the patient-related risk) against the adverse effects of thromboprophylaxis, either pharmacological or mechanical. This includes particularly the bleeding risk induced by antithrombotic drugs as well as costs.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101446"},"PeriodicalIF":3.7,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142511034","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":"Developing a sustainable team in critical care: focus on gender-based diversity","authors":"Luciana Mascia ,&nbsp;Francesca Rubulotta ,&nbsp;Irene Aragao ,&nbsp;Maria Cruz Martin Delgado ,&nbsp;Jordi Rello ,&nbsp;Olfa Hamzaoui","doi":"10.1016/j.accpm.2024.101443","DOIUrl":"10.1016/j.accpm.2024.101443","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 6","pages":"Article 101443"},"PeriodicalIF":3.7,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478210","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}