Anaesthesia Critical Care & Pain Medicine最新文献

{"title":"Is quantitative neuromuscular monitoring mandatory after administration of the recommended dose of sugammadex? A prospective observational study","authors":"Chang-Hoon Koo ,&nbsp;Soowon Lee ,&nbsp;Subin Yim ,&nbsp;Yu Kyung Bae ,&nbsp;Insun Park ,&nbsp;Ah-Young Oh","doi":"10.1016/j.accpm.2024.101445","DOIUrl":"10.1016/j.accpm.2024.101445","url":null,"abstract":"<div><h3>Background</h3><div>Some anaesthetists wonder whether confirming a train-of-four ratio (TOFR) ≥0.9 is necessary when using sugammadex to antagonise neuromuscular blockade (NMB). In this study, we aimed to determine whether using sugammadex at the recommended dose under neuromuscular monitoring (NMM) would ensure complete recovery, even without further NMM.</div></div><div><h3>Methods</h3><div>This prospective observational study included 51 patients who underwent robot-assisted surgery under general anaesthesia between March and May 2023. At the end of surgery, sugammadex was administered (2 mg/kg for a train-of-four (TOF) count ≥1 and 4 mg/kg for a TOF count = 0 and a post-tetanic count ≥1). NMM was discontinued, and subsequent recovery was completed at the discretion of the attending anaesthetist. TOFR was measured twice immediately upon admission to the post-anaesthesia care unit (PACU). The primary outcome was the incidence of a non-normalised TOFR (nTOFR) &lt;0.9 upon arrival in PACU. The secondary outcomes were the incidences of a nTOFR &lt;0.7 or 1.0, symptoms/signs of residual NMB (diplopia, dyspnoea, and desaturation) and recovery profiles in PACU.</div></div><div><h3>Results</h3><div>The incidence of a nTOFR &lt;0.9 upon arrival in PACU was 5.9% (3/51 patients). No patient had a nTOFR &lt;0.7, and 47.1% (24 patients) had a nTOFR &lt;1.0, but no patients showed clinical symptoms/signs of residual NMB.</div></div><div><h3>Conclusions</h3><div>When the recommended dose of sugammadex was administered under qualitative NMM, residual NMB at the time of PACU arrival occurred frequently, indicating that quantitative NMM is necessary to ensure adequate recovery.</div></div><div><h3>Registration</h3><div>ClinicalTrials, NCT 05760560.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 6","pages":"Article 101445"},"PeriodicalIF":3.7,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478216","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":"Intraoperative ketamine and pain after video-assisted thoracoscopic surgery (VATS): A systematic review and meta-analysis","authors":"Umar Akram ,&nbsp;Zain Ali Nadeem ,&nbsp;Haider Ashfaq ,&nbsp;Eeshal Fatima ,&nbsp;Hamza Ashraf ,&nbsp;Muhammad Ahmed Raza ,&nbsp;Shahzaib Ahmed ,&nbsp;Arsalan Nadeem ,&nbsp;Sana Rehman ,&nbsp;Muhammad Hassan Ahmad","doi":"10.1016/j.accpm.2024.101444","DOIUrl":"10.1016/j.accpm.2024.101444","url":null,"abstract":"<div><h3>Background</h3><div>Video-assisted thoracoscopic surgery (VATS) reduces postoperative discomfort and expedites recovery compared to open thoracotomy. Effective postoperative pain management is crucial to enhance recovery and reduce complications. Ketamine, an NMDA receptor antagonist, has shown promise, though its efficacy in VATS remains uncertain. This meta-analysis aims to evaluate the efficacy and safety of ketamine in reducing acute pain in VATS patients.</div></div><div><h3>Methods</h3><div>A comprehensive search of MEDLINE (PubMed), CENTRAL, Embase, Science Direct, Scopus, and clinicaltrials.gov was conducted. Eligible studies were randomized controlled trials (RCTs) comparing intraoperative intravenous ketamine with normal saline in VATS patients and reporting postoperative pain scores. Statistical analyses were performed using R version 4.3.3. Cochrane risk of bias (RoB2) tool was used to assess the quality of included studies.</div></div><div><h3>Results</h3><div>A total of 10 RCTs with 1151 participants were included. Ketamine was associated with a significant reduction in postoperative pain at 12 (MD −0.65, p = 0.04) and 48 h (MD −0.55 points, p &lt; 0.01) post-surgery. No significant difference was observed in pain scores within the first 3 h, at 6 and 12 h, 24-h postoperative opioid consumption, urine output, surgery duration, rescue analgesia, mean arterial pressure, infusion volume, heart rate, extubation time, and blood loss. The certainty of evidence ranged from moderate to low across the outcomes.</div></div><div><h3>Conclusions</h3><div>Intraoperative intravenous ketamine effectively reduces acute postoperative pain in VATS patients but does not significantly impact opioid consumption, hemodynamic parameters, and adverse events. Large-scale studies are needed to confirm these findings and explore ketamine’s potential benefits for chronic pain management.</div></div><div><h3>Registration</h3><div>PROSPERO (CRD42024527858).</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 6","pages":"Article 101444"},"PeriodicalIF":3.7,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478215","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":"Motivations and barriers to clinical research participation among anaesthesiology and intensive care staff in France","authors":"Aurélie Gouel-Chéron ,&nbsp;Ludovic Meuret ,&nbsp;Hélène Beloeil ,&nbsp;Raphaël Cinotti ,&nbsp;Maxime Léger ,&nbsp;the SFAR research network","doi":"10.1016/j.accpm.2024.101442","DOIUrl":"10.1016/j.accpm.2024.101442","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 6","pages":"Article 101442"},"PeriodicalIF":3.7,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478217","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":"Incidence and clinical impact of aspiration during cesarean delivery: A multi-center retrospective study","authors":"Morgan Le Guen ,&nbsp;Ahed Zeidan ,&nbsp;Paul Thourel","doi":"10.1016/j.accpm.2024.101437","DOIUrl":"10.1016/j.accpm.2024.101437","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 6","pages":"Article 101437"},"PeriodicalIF":3.7,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478213","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":"Incidence of unplanned extubation in French intensive care units: are we ready for a SAFE-ICU plan!","authors":"Luigi Vetrugno ,&nbsp;Andrea Cortegiani","doi":"10.1016/j.accpm.2024.101439","DOIUrl":"10.1016/j.accpm.2024.101439","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 6","pages":"Article 101439"},"PeriodicalIF":3.7,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478214","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":"Hypocalcemia in critical care settings, from its clinical relevance to its treatment: A narrative review","authors":"Catarina Fernandes ,&nbsp;Luciano Pereira","doi":"10.1016/j.accpm.2024.101438","DOIUrl":"10.1016/j.accpm.2024.101438","url":null,"abstract":"<div><h3>Background</h3><div>Hypocalcemia, measured through ionized calcium, is a common derangement in critically ill patients. Hypocalcemia is corrected as a routine procedure in intensive care units; however, no clear guidelines exist for its management.</div></div><div><h3>Objectives</h3><div>This narrative review aims to provide an overview of hypocalcemia in critical care settings. This includes its association with important clinical outcomes and the assessment of the need for its correction in critically ill patients in general and in two subgroups: those with trauma and sepsis.</div></div><div><h3>Methods</h3><div>An extensive article search on hypocalcemia in critically ill patients was performed using PubMed, Web of Science, Cochrane Library, and Google Scholar.</div></div><div><h3>Findings</h3><div>Several studies showed an association between hypocalcemia and high mortality and disease severity in critically ill patients. However, the scientific evidence concerning its correction remains conflicting. Most studies showed that calcium supplementation did not improve clinical outcomes, such as mortality, and in some cases, ionized calcium levels normalized without supplementation. Patients with trauma and sepsis are subgroups, with special characteristics that should be considered when treating hypocalcemia.</div></div><div><h3>Conclusions</h3><div>We concluded that hypocalcemia is associated with several important clinical outcomes. Treating severe hypocalcemia is generally recommended, whereas treating moderate or mild hypocalcemia can lead to higher mortality and organ dysfunction, outweighing the potential clinical benefits, particularly in patients with sepsis. Hence, multicenter clinical trials are needed to assess the efficacy and safety of hypocalcemia treatment in these patients.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 6","pages":"Article 101438"},"PeriodicalIF":3.7,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478212","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":"Early deep-to-light sedation versus continuous light sedation for ICU patients with mechanical ventilation: A cohort study","authors":"Jiayue Xu ,&nbsp;Qiao He ,&nbsp;Mingqi Wang ,&nbsp;Zichen Wang ,&nbsp;Wenkai Wu ,&nbsp;Li Lingling ,&nbsp;Wen Wang ,&nbsp;Xin Sun","doi":"10.1016/j.accpm.2024.101441","DOIUrl":"10.1016/j.accpm.2024.101441","url":null,"abstract":"<div><h3>Background</h3><div>Sedation strategies have not been well established for patients being treated with invasive mechanical ventilation (MV). This study aimed to compare the potential effects of alternative sedation strategies – including early deep-to-light sedation (DTLS), continuous deep sedation (CDS) and continuous light sedation (CLS, the currently recommended strategy) – on ventilator, intensive care unit (ICU) or hospital mortality.</div></div><div><h3>Methods</h3><div>A cohort study was conducted using two large validated ICU databases, including the Registry of Healthcare-associated Infections in ICUs in China (ICU-HAI) and the Medical Information Mart for Intensive Care (MIMIC). Patients who received MV for more than 3 days with one of three sedation strategies were included. Multivariable survival analyses with inverse probability-weighted competing risk models were conducted separately for ICU-HAI and MIMIC cohorts. Adjusted estimates were pooled using fixed-effects models.</div></div><div><h3>Results</h3><div>In total, 6700 patients (2627 ICU-HAI, 4073 MIMIC) were included in the cohort study, of whom 2689 received CLS, 2079 CDS and 1932 DTLS. Compared to CLS, DTLS was associated with lower ICU mortality (9.3% <em>vs.</em> 11.0%; pooled adjusted HR 0.78, 95% CI 0.66−0.94) and hospital mortality (16.0% <em>vs.</em> 14.1%; 0.86, CI 0.74–1.00); and CDS was associated with higher ventilator mortality (32.8% <em>vs.</em> 7.0%; 4.65, 3.91–5.53), ICU mortality (40.6% <em>vs.</em> 11.0%; 3.39, 2.95–3.90) and hospital mortality (46.8% <em>vs.</em> 14.1%; 3.27, 2.89–3.71) than CLS. All HRs were qualitatively consistent in both cohorts.</div></div><div><h3>Conclusions</h3><div>Compared to the continuous light sedation, early deep-to-light sedation strategy was associated with improved patient outcomes, and continuous deep sedation was confirmed with poorer patient outcomes.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 6","pages":"Article 101441"},"PeriodicalIF":3.7,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478211","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 versus opioid sparing strategies for multimodal antinociception during laparoscopic colectomy: a randomised controlled trial","authors":"Vincent Collange ,&nbsp;Jean Baptiste Berruet ,&nbsp;Frederic Aubrun ,&nbsp;Marie Poiblanc ,&nbsp;Eric Olagne ,&nbsp;Nadège Golliet Mercier ,&nbsp;Sebastien Parent ,&nbsp;Philippe Noel ,&nbsp;Simon Devillez ,&nbsp;Maya Perrou ,&nbsp;Joanna Ramadan ,&nbsp;Sean Coeckelenbergh ,&nbsp;Alexandre Joosten","doi":"10.1016/j.accpm.2024.101436","DOIUrl":"10.1016/j.accpm.2024.101436","url":null,"abstract":"<div><h3>Background</h3><div>It remains unclear whether opioid-free anesthesia (OFA), when compared to opioid-sparing anesthesia (OSA), reduces postoperative opioid consumption while still providing adequate pain control. We thus tested the hypothesis that patients having an OFA strategy during laparoscopic colectomy would require less postoperative opioids when compared to an OSA strategy.</div></div><div><h3>Methods</h3><div>This single-center, prospective randomized controlled superiority trial, randomly allocated consecutive patients undergoing laparoscopic colectomy to receive either sevoflurane-dexmedetomidine anesthesia with a continuous infusion of lidocaine and ketamine (OFA group) or sevoflurane-sufentanil boluses anesthesia with a continuous infusion of lidocaine (OSA group). Both groups received multimodal antinociception with boluses of dexamethasone, lidocaine, and ketamine during anesthesia induction, as well as acetaminophen, ketoprofen, and nefopam before the end of the surgery. OFA patients also received a dose of magnesium sulfate during induction. The primary outcome was cumulative opioid consumption at 48 h after surgery, expressed in oral morphine equivalents (OME). Secondary exploratory outcomes were pain scores, opioid-related adverse events, and patient quality of life (WHODAS score).</div></div><div><h3>Results</h3><div>Of the 160 randomized patients, 155 were included in a modified intention-to-treat analysis. Median [Q1–Q3] OME consumption at 48 h after surgery did not differ between groups (9 [0–30] mg for OFA <em>vs.</em> 14 [0–30] mg for OSA; <em>p</em> = 0.861). Key secondary outcomes were not different between groups except a three time higher incidence of bradycardia in the OFA group.</div></div><div><h3>Conclusions</h3><div>In patients undergoing laparoscopic colectomy with a multimodal antinociception protocol, OFA, when compared to OSA, did not decrease postoperative opioid consumption.</div></div><div><h3>Clinical trial registry and number</h3><div>NCT05031234.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 6","pages":"Article 101436"},"PeriodicalIF":3.7,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407073","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":"Accuracy of preoperative lung ultrasound score for the prediction of major adverse cardiac events in elderly patients undergoing HIP surgery under spinal anesthesia: The LUSHIP multicenter observational prospective study","authors":"Luigi Vetrugno ,&nbsp;Enrico Boero ,&nbsp;Paola Berchialla ,&nbsp;Francesco Forfori ,&nbsp;Mattia Bernardinetti ,&nbsp;Savino Spadaro ,&nbsp;Gianmaria Cammarota ,&nbsp;Andrea Bruni ,&nbsp;Eugenio Garofalo ,&nbsp;Marco Tescione ,&nbsp;Cristian Deana ,&nbsp;Nicola Federici ,&nbsp;Lisa Mattuzzi ,&nbsp;Francesco Meroi ,&nbsp;Luca Flaibani ,&nbsp;Andrea Cortegiani ,&nbsp;Federico Longhini ,&nbsp;Alessandro Cavarape ,&nbsp;Daniele Guerino Biasucci ,&nbsp;Stefano D’Incà ,&nbsp;Erika Taddei","doi":"10.1016/j.accpm.2024.101432","DOIUrl":"10.1016/j.accpm.2024.101432","url":null,"abstract":"<div><h3>Background and objective</h3><div>We hypothesize that lung ultrasound scores (LUS) can help stratify the cardiac risk of elderly patients undergoing orthopedic surgery for hip fracture, adding value to the Revised Cardiac Risk Index (RCRI), the American Society of Anesthesiologists Physical Status (ASA-PS) and the National Surgical Quality Improvement Program Myocardial infarction and Cardiac arrest (NSQIP-MICA).</div></div><div><h3>Methods</h3><div>Prospective, observational multicenter study of 11 Italian hospitals on patients aged &gt;65 years with hip fractures needing urgent surgery. Subjects with major adverse cardiovascular events (MACE) in the previous 6 months or with ongoing acute heart failure were excluded. Trained anesthesiologists obtained preoperative LUS scores during preoperative evaluation. ROC curve analysis and comparison were used to evaluate test accuracy.</div></div><div><h3>Results</h3><div>A total of 877 patients were enrolled in the study period. 108 MACE events occurred in 98 patients, with an overall incidence of 11.2%. LUS score was higher in complicated than non-complicated patients, 11.6 ± 6.64 <em>vs.</em> 4.97 ± 4.90 (<em>p</em> &lt; 0.001). Preoperative LUS score ≥8 showed both better AUC (0.78) and accuracy (0.76) in predicting MACE than the RCRI scores (<em>p</em> &lt; 0.001), MICA scores (<em>p</em> = 0.001) and ASA classes (<em>p</em> &lt; 0.001). LUS sensitivity was 0.71, specificity was 0.76, negative predictive value was 0.95. LUS score ≥8 showed an OR for MACE of 5.81[95% CI 3.55–9.69] at multivariate analysis. 91 patients (10.4%) experienced postoperative pneumonia showing a preoperative LUS score higher in the non-pneumonia group, <em>p</em> &lt; 0.001.</div></div><div><h3>Conclusions</h3><div>The preoperative LUS score, with its high negative predictive value, could improve patients’ risk stratification when used alone or add further value to the RCRI score.</div></div><div><h3>Registration</h3><div>Registered at clinicaltrials.gov as NCT04074876.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 6","pages":"Article 101432"},"PeriodicalIF":3.7,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382090","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":"Rapid uptake of adjunctive corticosteroids for critically ill adults with septic shock following publication of ADRENAL trial. A multicenter, retrospective analysis of prescribing practices in Queensland Intensive Care Units","authors":"Kyle C. White ,&nbsp;Anis Chaba ,&nbsp;Jason Meyer ,&nbsp;Mahesh Ramanan ,&nbsp;Alexis Tabah ,&nbsp;Antony G. Attokaran ,&nbsp;Aashish Kumar ,&nbsp;James McCullough ,&nbsp;Kiran Shekar ,&nbsp;Peter Garrett ,&nbsp;Philippa McIlroy ,&nbsp;Siva Senthuran ,&nbsp;Stephen Luke ,&nbsp;Kevin B. Laupland ,&nbsp;on behalf of the Queensland Critical Care Research Network (QCCRN)","doi":"10.1016/j.accpm.2024.101435","DOIUrl":"10.1016/j.accpm.2024.101435","url":null,"abstract":"<div><h3>Background</h3><div>Septic shock is common and associated with significant morbidity and mortality. The ADRENAL trial examined the use of hydrocortisone in patients with septic shock, demonstrating no difference in patient-centred outcomes but a decrease in the time to shock resolution. The change in clinical practice related to the publication of the ADRENAL trial is currently unknown.</div></div><div><h3>Methods</h3><div>A retrospective cohort study examining the use of hydrocortisone in patients with septic shock was conducted in 12 intensive care units (ICUs). A segmented linear regression was performed to identify a stepwise change in hydrocortisone administration and 90-day mortality associated with the publication of the ADRENAL trial.</div></div><div><h3>Results</h3><div>We included 4,198 patients with a mean age of 58 years (standard deviation, SD17), and the median noradrenaline equivalent score (NEE) was 0.07 μg/kg/min (IQR 0.02–0.17). Segmented regression analysis for hydrocortisone administration identified two breakpoints, 3 months before and 6 months after publication, leading to three periods: Pre-publication, Transition, and Post-publication. Compared to the pre-publication period, the Transition and Post-publication cohorts had a higher proportion of hydrocortisone administration (28% <em>vs.</em> 34% <em>vs.</em> 43%; <em>p</em> &lt; 0.0001). Furthermore, after adjustment for temporal change, the transition period had a significant change in the slope of the proportion of patients receiving hydrocortisone (−0.1% per month <em>vs.</em> +1.4% per month; <em>p</em> = 0.026), whereas this was not statistically significant during the post-publication period (+0.1% per month, p = 0.66). After adjusting for confounders, the Transition and Post-publication periods were independently associated with an increase in hydrocortisone (OR 1.4, 95% CI 1.14–1.77; <em>p</em> = 0.0015 and OR 2.03; 95% CI 1.74–2.36; <em>p</em> &lt; 0.001, respectively). Furthermore, after adjusting for confounders, when compared to the Pre-transition period, the use of hydrocortisone was associated with a statistically significant decrease in 90-day mortality (14% <em>vs.</em> 24% absolute difference, aHR for hydrocortisone effect −0.81; 95% CI 0.65–0.99; <em>p</em> = 0.044).</div></div><div><h3>Conclusion</h3><div>Publication of the ADRENAL trial changed clinical practice in Queensland ICUs with increased prescription of hydrocortisone for patients with septic shock with an associated reduction in mortality.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 6","pages":"Article 101435"},"PeriodicalIF":3.7,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382091","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}