Anaesthesia Critical Care & Pain Medicine最新文献

{"title":"Therapeutic novelties in acute heart failure and practical perspectives.","authors":"Benjamin Deniau, Ayu Asakage, Koji Takagi, Etienne Gayat, Alexandre Mebazaa, Amina Rakisheva","doi":"10.1016/j.accpm.2025.101481","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101481","url":null,"abstract":"<p><p>Acute Heart Failure (AHF) is a leading cause of death and represents the most frequent cause of unplanned hospital admission in patients older than 65 years. Since the past decade, several randomized clinical trials have highlighted the importance and pivotal role of certain therapeutics, including decongestion by the combination of loop diuretics, the need for rapid goal-directed medical therapies implementation before discharge, risk stratification, and early follow-up after discharge therapies. Cardiogenic shock, defined as sustained hypotension with tissue hypoperfusion due to low cardiac output and congestion, is the most severe form of AHF and mainly occurs after acute myocardial infarction, which can progress to multiple organ failure. Although its prevalence is relatively low, cardiogenic shock complicates 12% of acute myocardial infarction. After a brief summary of the epidemiology of AHF and cardiogenic shock, followed by key pathophysiological points, we detailed current treatments in AHF and cardiogenic shock what every anaesthesiologist and intensivist needs to know, based on the latest guidelines and randomized clinical trials published in recent years.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101481"},"PeriodicalIF":3.7,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030193","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 posterior quadratus lumborum block: Determining the minimum effective ropivacaine concentration in 90% of patients (MEC90) for postoperative analgesia after laparoscopic myomectomy.","authors":"Liwei Wang, Yinyin Qu, Yuanli Dun, Xiaowen Wu, Yao Yao, Kun Zhang, Changyi Wu","doi":"10.1016/j.accpm.2025.101480","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101480","url":null,"abstract":"<p><strong>Background: </strong>Quadratus lumborum block (QLB) has gained traction as a regional anesthesia technique to manage postoperative pain following laparoscopic surgery. However, the 90% minimum effective concentration (MEC90) of local anesthetics for posterior QLB remains undetermined.</p><p><strong>Methods: </strong>We conducted a double-blind, comparative dose-finding study involving 54 women scheduled for elective laparoscopic myomectomy under general anesthesia. Each patient received a bilateral posterior QLB with 20 mL of ropivacaine on each side. The concentration administered varied for each patient and was determined based on the response of the previous participant. The initial concentration was set at 0.20%. Upon successful block, the subsequent patient was assigned to receive either the same (probability of 0.89) or a 0.05% lower concentration (probability of 0.11). In cases of block failure, the concentration was increased by 0.05% for the next patient. The trial concluded when 45 successful blocks were achieved, with block success defined as a pain score of three or fewer 30 minutes after arrival in the post-anesthesia care unit.</p><p><strong>Results: </strong>The 90% minimum effective concentration (MEC90) of ropivacaine was 0.340% (95% CI 0.329 to 0.344%).</p><p><strong>Conclusions: </strong>The optimal concentration of ropivacaine for posterior QLB to achieve satisfactory analgesia following laparoscopic myomectomy is a 20 ml volume of 0.340% ropivacaine per side.</p><p><strong>Registration: </strong>Chinese Clinical Trial Registry ChiCTR2200055743.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101480"},"PeriodicalIF":3.7,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025028","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":"Factors influencing the turnover of nurses in French intensive care unit—A multicenter interview survey","authors":"Charles-Hervé Vacheron ,&nbsp;Marlene Bras ,&nbsp;Arnaud Friggeri ,&nbsp;Cyril Manzon ,&nbsp;Emmanuel Vivier ,&nbsp;Lyon Sud Nursing Research Group ,&nbsp;Anaelle Caillet ,&nbsp;Florent Wallet","doi":"10.1016/j.accpm.2024.101460","DOIUrl":"10.1016/j.accpm.2024.101460","url":null,"abstract":"<div><h3>Background</h3><div>Nurse retention is a major concern in healthcare settings, especially among intensive care units (ICU), in which nurses are highly specialized. The objective was to describe the nurse courses after their entrance into the ICU, their motivation for leaving the ICU, and to identify the independent factors that influenced the nurse resignation from their units.</div></div><div><h3>Methods</h3><div>In 3 different centers, every ICU nurse working between 2013 and 2023 was telephonically contacted and was asked to describe their career and, when appropriate, the reasons that influenced their resignation from their units; they rated on a Likert scale of 14 factors that influenced their decision.</div></div><div><h3>Results</h3><div>Among the 405 nurses who worked in these ICUs between 2013 and 2023, 265 (65.0%) were included in the study, and 93 (35.1%) were still working in their unit. The median time of professional experience of the nurses in their ICU was 5.8 [5.0–7.0] years, and at 10 years, 26.3% [20.4–33.9] of the nurses remained in their unit, 23.8% [17.3–32.8] left the ICU but were still in-hospital nurses, and 22.4% [15.8–31.7] underwent specialization. A minority of nurses resigned and changed their careers (9.5% [5.3–17.0]). The main factors influencing the nurse’s resignation from their unit were belonging to Generation Y or Z (HR 1.89 [1.35;2.64]), experiencing symptoms of burnout (2.37 [1.63;3.46]), and pregnancy during the ICU (1.77 [1.41;2.23]). The COVID-19 period was inconsistently associated with nurse resignation depending on the center. The main motivations to leave the unit were organizational (variability of schedule, night shift), personal (willingness to change, personal event), and related to the ICU workload.</div></div><div><h3>Conclusion</h3><div>Nurse retention is an increasing concern, associated with the generational aspects and increased prevalence of burnout. Structural changes will have to be made to reduce the turnover.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 1","pages":"Article 101460"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878323","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":"Extracorporeal membrane oxygenation in trauma patient in France: A retrospective nationwide registry","authors":"Vincent Legros ,&nbsp;Yannick Hourmant ,&nbsp;Louis Genty ,&nbsp;Karim Asehnoune ,&nbsp;Quentin De Roux ,&nbsp;Lucie Picard ,&nbsp;Jean-Denis Moyer ,&nbsp;Fanny Bounes ,&nbsp;Martin Cailloce ,&nbsp;Anais Adolle ,&nbsp;Alexandre Behouche ,&nbsp;Benjamin Bergis ,&nbsp;Jeremy Bourenne ,&nbsp;Cyril Cadoz ,&nbsp;Emilie Charbit ,&nbsp;Jonathan Charbit ,&nbsp;Baptiste Compagnon ,&nbsp;Charlotte Florin ,&nbsp;Nouchan Mellati ,&nbsp;Marie Moisan ,&nbsp;Arthur James","doi":"10.1016/j.accpm.2024.101457","DOIUrl":"10.1016/j.accpm.2024.101457","url":null,"abstract":"<div><h3>Background</h3><div>Indications for Veno-venous (VV) or veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) after trauma rely on poor evidence. The main aims were to describe the population of trauma patients requiring either VV or VA ECMO and report their clinical management and outcomes.</div></div><div><h3>Methods</h3><div>An observational multicentre retrospective study was conducted in 17 Level 1 trauma centres in France between January 2010 and December 2021. All patients admitted for major trauma were screened for inclusion, and those receiving either VV ECMO or VA ECMO were included. The primary outcome was in-hospital mortality.</div></div><div><h3>Results</h3><div>Among the 52,851 patients screened, 179 were included, with 143 supported by VV ECMO (median [Q1-Q3] age 32 years [24–48]; men 83.5%; injury severity score [ISS] 33 [25–43] and 76 (53.6%) with a traumatic brain injury [TBI]) and 36 supported by VA ECMO (median age 39 years [25–55]; men 88.9%; ISS 36 [25–56] and 23 (63.9%) with a TBI). In the VV ECMO group, three indications for ECMO implementation were chest injuries (<em>n</em> = 68, 47.6%), ventilator-associated pneumonia (VAP; <em>n</em> = 57, 39.9%), and extra-respiratory acute respiratory distress syndrome (ARDS; <em>n</em> = 57, 39.9%). In the VV ECMO group, 45.8% (n = 65) died in the hospital, with 33 (48.5%) deaths following cannulation for chest injuries, 22 (39.3%) following cannulation for VAP, and 10 (55.6%) following cannulation for extrapulmonary ARDS. In the VA ECMO group, 75.0% (<em>n</em> = 27) died during their hospital stay.</div></div><div><h3>Conclusions</h3><div>In-hospital mortality of trauma patients requiring ECMO for refractory ARDS varied according to indications. The best prognosis was observed in the subgroup of pneumonia-induced ARDS patients.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 1","pages":"Article 101457"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878363","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":"Self-reported penicillin allergy and beta-lactam allergy label: Is ICU so different?","authors":"Charles Tacquard,&nbsp;Marc Leone,&nbsp;Aurélie Gouel-Cheron","doi":"10.1016/j.accpm.2024.101467","DOIUrl":"10.1016/j.accpm.2024.101467","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 1","pages":"Article 101467"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899829","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":"Recent advances in perioperative care of patients using new antihyperglycaemic drugs and devices dedicated to diabetes","authors":"Rami El Ojaimi ,&nbsp;Gaëlle Cheisson ,&nbsp;Emmanuel Cosson ,&nbsp;Carole Ichai ,&nbsp;Sophie Jacqueminet ,&nbsp;Bogdan Nicolescu-Catargi ,&nbsp;Alexandre Ouattara ,&nbsp;Igor Tauveron ,&nbsp;Paul Valensi ,&nbsp;Dan Benhamou","doi":"10.1016/j.accpm.2024.101468","DOIUrl":"10.1016/j.accpm.2024.101468","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 1","pages":"Article 101468"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916119","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":"Self-Reported Penicillin Allergy and antibiotic use in critical care: An observational, retrospective study","authors":"Elise Davis ,&nbsp;Catherine Snelson ,&nbsp;Nick Murphy ,&nbsp;James Hodson ,&nbsp;Miruna David ,&nbsp;Tonny Veenith ,&nbsp;Tony Whitehouse","doi":"10.1016/j.accpm.2024.101461","DOIUrl":"10.1016/j.accpm.2024.101461","url":null,"abstract":"<div><h3>Background</h3><div>Patients with Self-Reported Penicillin Allergy (SRPA) receive alternative antibiotics, which increase the length of stay and hospital costs, but the impact of SRPA on mortality in critically ill patients is not well described.</div></div><div><h3>Methods</h3><div>This was a single-center, retrospective analysis of routinely gathered clinical data for all intensive care unit (ICU) admissions over nine years. The primary outcome was 28-day mortality, which was analyzed using a time-to-event approach with multivariable models to adjust for confounding factors, including age, comorbidities, sex, and admission SOFA score (as a measure of organ dysfunction). Antibiotic prescriptions during the ICU stay were also interrogated and compared.</div></div><div><h3>Results</h3><div>Of 35,319 admissions, 11.7% had SRPA. Compared with non-SRPA, patients with SRPA were more likely to be female (52.2% <em>vs.</em> 37.4%, <em>p</em> &lt; 0.001) and had more comorbidities (<em>p</em> &lt; 0.001) but had similar admission SOFA scores (median: 3.5 in both groups, <em>p</em> = 0.839). Patients with SRPA had significantly lower 28-day mortality (9.6% <em>vs.</em> 10.9%, <em>p</em> = 0.011). After multivariable adjustment for baseline characteristics, this effect persisted for unplanned (hazard ratio [HR]: 0.76, 95% CI: 0.68−0.86, <em>p</em> &lt; 0.001), but not planned admissions (HR: 1.21, 95% CI: 0.92−1.58, <em>p</em> = 0.172). Whilst the duration of antibiotics in ICU was similar in the SRPA and non-SRPA groups (mean: 3.4 <em>vs.</em> 3.4 days, <em>p</em> = 0.663), the antibiotics used differed, with SRPA patients being significantly more likely to receive quinolones or other anti-Gram-positive antibiotics (<em>p</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>SRPA was associated with a survival benefit that persisted after adjustment for confounders for unplanned ICU admissions. Patients with SRPA were more likely to receive antibiotics that are not active against anaerobic bacteria.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 1","pages":"Article 101461"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883184","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":"Significance of ongoing enhancement of Pediatric Intensive Care Unit follow-up","authors":"Pawel Wieczorek ,&nbsp;Michal Pruc ,&nbsp;Lukasz Szarpak","doi":"10.1016/j.accpm.2024.101464","DOIUrl":"10.1016/j.accpm.2024.101464","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 1","pages":"Article 101464"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883244","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 ,&nbsp;D.G.P. Luther ,&nbsp;Hon Sen Tan ,&nbsp;Nabilah Rahman ,&nbsp;Mihir Gandhi ,&nbsp;Rehena Sultana ,&nbsp;Alex Tiong Heng Sia ,&nbsp;Ban Leong Sng","doi":"10.1016/j.accpm.2024.101450","DOIUrl":"10.1016/j.accpm.2024.101450","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 1","pages":"Article 101450"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","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":"A French regional survey of the role of general practitioners in the follow-up of patients with post-intensive-care syndrome (PICS)","authors":"N. Elhadjene ,&nbsp;A. Crouzet,&nbsp;R. Charles,&nbsp;J. Morel","doi":"10.1016/j.accpm.2024.101466","DOIUrl":"10.1016/j.accpm.2024.101466","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 1","pages":"Article 101466"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883157","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}