Anaesthesia Critical Care & Pain Medicine最新文献

{"title":"Evaluating early mobilisation in critically ill COVID-19 patients: secondary analysis from the ESICM UNITE-COVID-II multicentre observational study.","authors":"Maximilian Markus, Maximilian Lindholz, Nils Daum, Anne Pohrt, Elie Azoulay, Maurizio Cecconi, Giuseppe Citerio, Thomas De Corte, Frantisek Duska, Laura Galarza, Massimiliano Greco, Armand R J Girbes, Jozef Kesecioglu, Johannes Mellinghoff, Marlies Ostermann, Mariangela Pellegrini, Jean-Louis Teboul, Jan J De Waele, Adrian Wong, Stefan J Schaller","doi":"10.1016/j.accpm.2025.101550","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101550","url":null,"abstract":"<p><strong>Background: </strong>Early mobilisation (EM) within the first 72 hours of ICU admission is essential for preventing ICU-acquired weakness; however, mobilisation rates remained low among mechanically ventilated (MV) COVID-19 patients during the pandemic waves. This study aimed to characterise the association between EM and 60-day outcomes.</p><p><strong>Methods: </strong>A multicentre observational study conducted by the European Society of Intensive Care Medicine (ESICM) examined mobilisation strategies during the second COVID-19 wave (UNITE-COVIDed2021). All patients with confirmed SARS-CoV-2 infection who were in the ICU on the peak day between 1 January and 1 June 2021 were included. The analysis expanded on the UNITE-COVIDed2020 study, comparing the first and second COVID-19 waves using a combined dataset.</p><p><strong>Results: </strong>Data from 2,053 patients during the second wave across 103 ICUs in 35 countries were analysed and compared with 4,190 patients from the first wave. EM was achieved in 801 (39%) vs. 1114 (27%), p < 0.001, respectively. In the combined cohort, MV on admission significantly reduced the likelihood of EM (OR 0.29, 95% CI: 0.25-0.33, p = 0.001). While EM did not improve ICU or hospital length of stay, it was associated with reduced 60-day mortality (OR 0.74, 95% CI: 0.64-0.86, p = 0.001) and transfer rates to other care facilities (OR 0.74, 95% CI: 0.59-0.94, p = 0.001).</p><p><strong>Conclusion: </strong>EM is feasible and beneficial for critically ill COVID-19 patients. It was associated with reduced mortality and lower transfer rates to other care facilities, which underscores the critical role of EM in enhancing patient recovery during a pandemic.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101550"},"PeriodicalIF":3.7,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102622","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":"Early mobilization in septic acute respiratory distress syndrome: the UNITE-COVID-II Study.","authors":"Joris Pensier, Denise Battaglini, Elias Baedorf-Kassis","doi":"10.1016/j.accpm.2025.101553","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101553","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101553"},"PeriodicalIF":3.7,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102643","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 traumatic coagulopathy: what you should know, what is debated and what should come next.","authors":"Arthur James, Elaine Cole, Martin Dünser, Pierre Bouzat, Tobias Gauss","doi":"10.1016/j.accpm.2025.101543","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101543","url":null,"abstract":"<p><p>Managing acute traumatic coagulopathy involves several interventions, including tranexamic acid, plasma transfusion, factor administration, or coagulation therapy guided by viscoelastic methods. However, the range of evidence to support these strategies is variable or needs more consensus, and translation to clinical practice is challenging. To address these challenges, we propose a narrative review of randomized controlled trials published during the last two decades. This review will clarify how interventions have been evaluated, the specific populations involved, and the potential benefits and risks identified. By synthesizing the evidence from these randomized controlled trials, this review aims to provide clinicians with a clearer understanding of which strategies should change their clinical practices. Finally, this review also seeks to highlight gaps in the current literature, guiding future research and helping to establish more definitive clinical guidelines.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101543"},"PeriodicalIF":3.7,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095386","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":"Shifting the paradigm regarding general anesthesia management using point-of-care gastric ultrasound guided by fasting status in non-laboring term pregnant women.","authors":"François-Pierrick Desgranges, Peter Van de Putte, Lionel Bouvet","doi":"10.1016/j.accpm.2025.101551","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101551","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101551"},"PeriodicalIF":3.7,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095364","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":"Practical significance and assessment of gastric ultrasound in preoperative carbohydrate loading: A retrospective analysis of 746 patients within the Enhanced Recovery After Surgery Pathway.","authors":"Yeon Ju Kim, Hyun-Jung Kwon, Hye-Mee Kwon, Jonghyuk Lee, Mi Yeon Park, Yong-Hee Park, Doo-Hwan Kim, Sung-Moon Jeong","doi":"10.1016/j.accpm.2025.101547","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101547","url":null,"abstract":"<p><strong>Background: </strong>Although preoperative carbohydrate loading (PCL) is generally regarded as safe, the significance of assessing gastric status by gastric ultrasound after PCL application has not been adequately explored in real-world clinical settings. Therefore, this study evaluated gastric status after PCL using gastric ultrasound and its potential role in enhancing patient safety within a large surgical cohort under Enhanced Recovery After Surgery (ERAS) protocols.</p><p><strong>Methods: </strong>We retrospectively analyzed patients who received PCL and underwent hepatobiliary surgery within ERAS protocol between November 2018 to December 2023. The primary outcome was the incidence of an increased gastric content. Secondary outcomes included PCL compliance, gastric ultrasound data, fasting intervals, the incidence of rapid sequence intubation (RSI) and aspiration, and predictive factors for increased gastric content.</p><p><strong>Results: </strong>Of the 1,187 patients, the compliance rate for PCL applications within the ERAS protocol reached 88%, with 746 patients included in the final analysis. Fasting hours duration < 2 hours in 7.2% of cases. The incidence of an increased gastric content was 4.8% (95% confidence interval [CI] 3.5-6.6%), observed in 36 patients. RSI was performed in all patients with an increased gastric content, with no aspiration reported. Multivariate logistic regression identified BMI as the only independent predictor of increased gastric content (OR 0.66, 95% CI 0.57-0.77, P <  0.001).</p><p><strong>Conclusions: </strong>Patients receiving PCL within the ERAS protocol may be safe in clinical practice without an elevated risk of having an increased gastric content. However, individual variability and associated risk factors need consideration.</p><p><strong>Registration: </strong>Not applicable.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101547"},"PeriodicalIF":3.7,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095392","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":"Impact of Erythromycin and Metoclopramide on Gastric Emptying of Solids in Term Pregnant Women Scheduled for Elective Cesarean Delivery: A Randomized Controlled Trial.","authors":"Amr Samir Wahdan, Nesrine Abdelrahman Elrefai, Nashwa Samy Elzayat, Ayman Salaheldin Aziz, Mennatallah Magdi Mohamed","doi":"10.1016/j.accpm.2025.101544","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101544","url":null,"abstract":"<p><strong>Background: </strong>We hypothesized that the preoperative administration of oral erythromycin and metoclopramide would reduce the risk of high gastric volume and contents, evaluated by bedside gastric ultrasonography in non-laboring pregnant subjects preparing for elective cesarean delivery.</p><p><strong>Methods: </strong>This randomized double-blinded study included 150 parturients undergoing elective cesarean delivery. They received flavored water with oral erythromycin 400 mg (group E), oral metoclopramide 10 mg (group M), or placebo (group C) after standard meal ingestion, followed by ultrasonography measurement of gastric volume before and hourly after drug administration. The primary outcome was the mean gastric volume after six hours of fasting. Secondary outcomes included measuring gastric contents hourly until a safe level and assessing aspiration risk.</p><p><strong>Results: </strong>Significant differences in mean (±SD) gastric volume (mL/kg) were observed after six hours among groups C, E, and M, with values of 1.05 ± 0.49, 0.71 ± 0.46, and 0.75 ± 0.48, respectively (p <  0.001). Six hours after ingesting a standard meal, low-risk gastric contents were observed in 42 parturients (84%) in Group E, 41 parturients (82%) in Group M, and 31 parturients (62%) in Group C (p =  0.017). At both the fifth- and sixth-hours post-ingestion, parturients in Groups E and M demonstrated a significantly higher gastric emptying fraction compared to Group C. Additionally, parturients in Groups E and M exhibited the shortest half-time gastric emptying and gastric emptying time.</p><p><strong>Conclusions: </strong>Premedication with oral erythromycin or metoclopramide before elective cesarean delivery accelerated gastric emptying and may reduce aspiration risk after a standard meal.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101544"},"PeriodicalIF":3.7,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086618","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":"Patients and relatives’ point of view on the choice of outcomes for a randomized-controlled trial in moderate-to-severe Traumatic Brain Injury","authors":"Guillaume Chatelain ,&nbsp;Yvan Derouin ,&nbsp;Raphaël Cinotti","doi":"10.1016/j.accpm.2025.101533","DOIUrl":"10.1016/j.accpm.2025.101533","url":null,"abstract":"<div><div>Traumatic Brain Injury (TBI) is a major cause of mortality and disability worldwide. Clinical research is a cornerstone to improve patients’ outcomes. The empowerment of patients and relatives in research initiatives is now recommended to improve the relevance of trials. We performed an online survey in collaboration with the French National Association of Patients with Brain Injury (France Cérébrolésion) from November to December 2024, to understand their point of view regarding potential outcomes that could qualify hypertonic saline perfusion as relevant in the coming multicentric randomized-controlled COSMOS trial involving 760 moderate-to-severe TBI. 32 persons responded (19 (59.4%) relatives and 13 (40.6%) former patients). Using a 5-grade Likert scale, 23 (71.9%) responders rather agreed or entirely agreed that mortality was a relevant outcome; 26 (81.3%) rated activities of daily living as relevant; 27 (84.4%) rated cognitive function as relevant; 30 (93.7%) rated memory function as relevant; 17 (53.2%) rated functional outcome as relevant; 26 (81.3%) rated anxiety and depression symptoms as relevant; 27 (84.4%) rated quality of life as relevant. Ten (31.3%) responders could not understand the concept of functional outcome. The highest-ranked outcomes were mortality (16 responders gave the highest mark of 7), activities in daily living (14 responders), and memory (11 responders). Although this survey does not have the value of a consensus and further studies are needed to encompass other stakeholders’ opinions, we have modified the primary outcomes in COSMOS: functional outcome has been replaced by a hierarchy with 1/ survival and 2/activities in daily living.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 4","pages":"Article 101533"},"PeriodicalIF":3.7,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143948585","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":"Preoperative oral caffeine as prophylaxis against post-spinal hypotension in patients undergoing orthopedic lower limb surgery: A randomized, placebo-controlled, double-blinded study.","authors":"Sohila Samir Antar, Abdelaziz Metaweh, Hamed Neamatallah, Mahmoud Abdelfattah, Ibrahim Abdelbaser, Karim Ali Awad","doi":"10.1016/j.accpm.2025.101537","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101537","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to investigate the efficacy of preoperative a caffeine tablet as prophylaxis against post-spinal hypotension in adult patients undergoing lower extremity orthopedic surgery.</p><p><strong>Methods: </strong>Patients aged 18-70 years who underwent lower limb orthopedic surgery were enrolled. In the caffeine group, the patient ingested a 200 mg caffeine tablet. In the control group, the patient ingested a placebo. The primary outcome was the number of patients with one or more hypotensive episodes within the first hour of spinal anesthesia, which was defined as a decrease in mean arterial pressure (MAP) < 60 mmHg or a >20% decrease in MAP from baseline. The secondary outcomes were the number of patients who received ephedrine and the amount of ephedrine per patient within the first hour of spinal anesthesia.</p><p><strong>Results: </strong>80 patients were randomized to the caffeine group (n = 40) and control group (n = 40). One patient in the caffeine group was lost to follow-up. The number of patients with one or more hypotensive episodes within the first hour of spinal anesthesia was significantly lower (p = 0.013) in the caffeine group (n = 6, 15.3%) than in the control group (n = 17, 42.5%). The number of patients who received ephedrine as well as the amount of ephedrine per patient within the first hour of spinal anesthesia were significantly lower in the caffeine group than in the control group.</p><p><strong>Conclusion: </strong>The preoperative ingestion of a 200 mg caffeine tablet could decrease the number of patients with hypotensive episodes and ephedrine requirements within the first hour of spinal anesthesia.</p><p><strong>Registration: </strong>Pan African Clinical Trial Registry, registration number PACTR202311786558285, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=26993.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101537"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057807","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 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":"Objective real-time epidural pressure measurement using the CompuFlo® device, a mono-center observational study.","authors":"Laurent Hertz, Chrystelle Sola, Julien Pico, Juliette Aros, Christopher Scott, Philippe Pirat, Olivier Choquet, Sophie Bringuier, Christophe Dadure","doi":"10.1016/j.accpm.2025.101530","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101530","url":null,"abstract":"<p><strong>Background: </strong>Epidural anesthesia (EA) is particularly relevant in the cases of expected intense and lasting postoperative pain. Yet, this technique is considered challenging in young children because of the difficulty in perceiving the loss of resistance (LOR) required to detect the epidural space. The CompuFlo® device is a computerized injection pump that accurately detects real-time pressure at the tip of a needle. This prospective observational study aimed to describe pressure levels during EA in children. Therefore, we hypothesized that pressures would be lower in smaller children.</p><p><strong>Methods: </strong>All surgical patients requiring an EA were eligible for inclusion. During the procedure, pressures before LOR were measured in real-time using both modes (manual and automatic) of the CompuFlo® device. Factors that may influence pressure levels, such as weight, were also investigated.</p><p><strong>Results: </strong>We analyzed the last pressures just before LOR during 56 procedures performed on 47 patients. Median pressures (quartiles) were 174 (120; 314) mmHg. The pressure before LOR was correlated to the weight (r = 0.61 in the automatic group), with values significantly lower in the group of children under 5 kg (p = 0.02) compared to the other weight groups.</p><p><strong>Conclusion: </strong>The CompuFlo® device allowed a pressure measurement prior to obtaining LOR during EA catheter placement in children. Younger children appear to have lower pressure levels. This could partly explain the difficulty in detecting the epidural space in infants. This observational study describes initial results that could be used as a basis for future hypotheses.</p><p><strong>Registration: </strong>ClinicalTrial.gov, NCT03672526.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101530"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992358","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}