Anaesthesia Critical Care & Pain Medicine最新文献

{"title":"The 3C-3V: A comprehensive mnemonic for point-of-care ultrasound in circulatory shock","authors":"Ahmed Hasanin, Maha Mostafa, Yasmin S. Hassabelnaby","doi":"10.1016/j.accpm.2025.101692","DOIUrl":"10.1016/j.accpm.2025.101692","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"45 2","pages":"Article 101692"},"PeriodicalIF":4.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145531005","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":"From Cuffs to Code: Machine Learning in Non-Invasive Blood Pressure Monitoring","authors":"Ravi Pal ,&nbsp;Joshua Le ,&nbsp;Theodora Wingert ,&nbsp;Oren Avram ,&nbsp;Jiayu Yu ,&nbsp;Aidan Adham ,&nbsp;Patrick Schoettker ,&nbsp;Alexandre Joosten ,&nbsp;Maxime Cannesson","doi":"10.1016/j.accpm.2025.101655","DOIUrl":"10.1016/j.accpm.2025.101655","url":null,"abstract":"<div><div>Blood pressure (BP) measurement in both acute care and outpatient settings is essential, as conditions like hypertension and hypotension are common and often asymptomatic until organ damage occurs. These conditions significantly increase the risk of morbidity and mortality but can be effectively managed through early detection and treatment. For decades, cuff-based devices have dominated non-invasive BP monitoring; however, they are often bulky, inconvenient, and limited to intermittent measurements. In recent years, machine learning (ML) and artificial intelligence (AI)–based approaches for BP estimation from non-invasive physiological signals—such as electrocardiography (ECG) and photoplethysmography (PPG)—have generated considerable interest. These innovations promise to enable continuous, cuff-less BP monitoring, expanding the reach of BP assessment into wearable devices and facilitating more dynamic, patient-centered care. This review provides a comprehensive overview of the evolution of non-invasive BP measurement technologies, with particular emphasis on emerging AI-driven methods and trends shaping the development of continuous and wearable solutions. While these technologies offer new opportunities for continuous monitoring and patient engagement, this review focuses on their conceptual and technological development rather than detailed performance evaluation or clinical validation.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"45 2","pages":"Article 101655"},"PeriodicalIF":4.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145460301","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":"Jiancheng dual-channel vs. i-gel laryngeal mask airway for fiberoptic bronchoscopy: A randomized trial","authors":"Ru-Ping Dai ,&nbsp;Wei Luo ,&nbsp;Wen Wang ,&nbsp;Yun-Xuan Huang ,&nbsp;Cong Luo ,&nbsp;Zhao-Lan Hu ,&nbsp;Pei Zhou ,&nbsp;Ru-Yi Luo","doi":"10.1016/j.accpm.2025.101699","DOIUrl":"10.1016/j.accpm.2025.101699","url":null,"abstract":"<div><h3>Background</h3><div>Fiberoptic bronchoscopy (FB) procedures have become increasingly lengthy and complex. Maintaining deep sedation while preventing hypoxemia with conventional oropharyngeal/nasopharyngeal airways presents a significant clinical challenge. Supraglottic airway devices, such as the laryngeal mask airway (LMA), may provide improved oxygenation and procedural efficiency during FB. However, despite the variety of LMA designs, no previous studies have definitively established the optimal type of LMA for FB procedures.</div></div><div><h3>Methods</h3><div>96 patients were randomized to either the i-gel LMA group (group I) or Jiancheng dual-channel LMA group (group J). Remimazolam besylate, ciprofol, and sufentanil were used for anesthesia induction and maintenance in both groups. We measured and recorded the success rate of LMA insertion and entering the main airway through the LMA at first attempt, operational interference, mid-procedure LMA adjustments, procedure interruptions, vital signs, and major adverse events.</div></div><div><h3>Results</h3><div>The patients in group J experienced higher success rates of first-attempt LMA insertion (<em>P</em> &lt; 0.01) and entry into the main airway (<em>P</em> &lt; 0.01) than those in group I. The incidence of coughing was significantly higher in group I than in group J (<em>P</em> &lt; 0.01). The incidence of cardiopulmonary adverse reactions, including respiratory arrest, airway obstruction, airway spasm, laryngospasm, hypertension, and hypotension, was comparable between the two groups. Group I demonstrated a tendency toward prolonged recovery time compared with group J (<em>P</em> = 0.05).</div></div><div><h3>Conclusions</h3><div>The Jiancheng dual-channel LMA is associated with higher first-attempt success for airway insertion and bronchoscopy compared to the i-gel LMA, warranting consideration for broader clinical application.</div></div><div><h3>Trial registration</h3><div><span><span>https://www.chictr.org.cn/showproj.html?proj=265357</span><svg><path></path></svg></span> (registration no. ChiCTR2500100990, principal investigator: Ru-Ping Dai, date of registration: April 17, 2025).</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"45 2","pages":"Article 101699"},"PeriodicalIF":4.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145566011","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":"Disease-free survival after gastrectomy is not influenced by ERAS adherence","authors":"Javier Ripollés-Melchor ,&nbsp;Ane Abad-Motos ,&nbsp;Ana León-Bretscher ,&nbsp;Ángel V. Espinosa ,&nbsp;Sonia Amoza-Pais ,&nbsp;Maria Luz Herrero-Bogajo ,&nbsp;Alfredo Abad-Gurumeta ,&nbsp;Roberto de-la-Plaza-Llamas ,&nbsp;Patricia Galán-Menéndez ,&nbsp;Andrés Zorrilla-Vaca ,&nbsp;Rocío González-López ,&nbsp;Rosalía Navarro-Pérez ,&nbsp;Carlos Jiménez-Viñas ,&nbsp;Felipe Carlos Parreño-Manchado ,&nbsp;Alicia Ruiz Escobar ,&nbsp;Vanessa Concepción-Martín ,&nbsp;Gloria Paseiro-Crespo ,&nbsp;María Asunción Acosta-Mérida ,&nbsp;María Puech-de-Oriol ,&nbsp;María Ángeles Mayo-Ossorio ,&nbsp;César Aldecoa","doi":"10.1016/j.accpm.2025.101661","DOIUrl":"10.1016/j.accpm.2025.101661","url":null,"abstract":"<div><h3>Background</h3><div>Enhanced Recovery After Surgery (ERAS) protocols have been widely adopted in gastric cancer surgery, with consistent benefits in perioperative recovery. However, whether adherence to ERAS influences long-term oncologic outcomes remains unclear. This study aimed to evaluate the association between ERAS adherence and disease-free survival (DFS) following curative-intent gastrectomy.</div></div><div><h3>Methods</h3><div>This was a prespecified substudy of the POWER4 cohort, a prospective, multicentre investigation of perioperative care and outcomes in patients undergoing elective gastrectomy for gastric cancer. ERAS adherence was assessed using 22 predefined components and analysed as a binary (high <em>vs.</em> low), continuous (per 10-point increment), and quartile-based variable. The primary endpoint was DFS, defined as the time from surgery to recurrence or death. Kaplan–Meier estimates and multivariable Cox models were used to evaluate the association between ERAS adherence and DFS, adjusting for age, sex, ASA, BMI, nutritional risk, anaemia, chronic kidney disease, surgical approach, procedure type, operative time, and tumour stage.</div></div><div><h3>Results</h3><div>Among 368 patients with complete oncologic follow-up, the median follow-up was 1616 days. Kaplan–Meier curves suggested a trend toward improved DFS with higher ERAS adherence (log-rank <em>p</em> =  0.10 for binary comparison; <em>p</em> =  0.05 across quartiles). In multivariable Cox models, ERAS adherence was not significantly associated with DFS. Prognosis was independently predicted by tumour stage, chronic kidney disease, ASA ≥ III, and total gastrectomy.</div></div><div><h3>Conclusion</h3><div>In this multicentre cohort, ERAS adherence was not independently associated with long-term DFS after gastrectomy for gastric cancer. Long-term prognosis appeared primarily driven by tumour and patient-related factors rather than perioperative protocol adherence.</div><div>The study was registered on <span><span>Clinicaltrials.gov</span><svg><path></path></svg></span>: <span><span>NCT06790238</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"45 2","pages":"Article 101661"},"PeriodicalIF":4.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145427102","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":"Preventing medication errors in anaesthesia and intensive care","authors":"Aude Carillion ,&nbsp;Anaïs Caillard ,&nbsp;Arthur James ,&nbsp;Nathalie Zappella","doi":"10.1016/j.accpm.2025.101719","DOIUrl":"10.1016/j.accpm.2025.101719","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"45 2","pages":"Article 101719"},"PeriodicalIF":4.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145641654","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":"Longitudinal prevalence of perioperative neurocognitive disorders in older surgical patients: A multicenter prospective cohort study","authors":"Tony Tan ,&nbsp;Ellene Yan ,&nbsp;Yasmin Alhamdah ,&nbsp;Jean Wong ,&nbsp;Frances Chung","doi":"10.1016/j.accpm.2025.101693","DOIUrl":"10.1016/j.accpm.2025.101693","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"45 2","pages":"Article 101693"},"PeriodicalIF":4.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145531016","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":"Prognostic value of venous-to-arterial pCO2 gap during cardiopulmonary bypass for predicting cardiac surgery-associated kidney injury: A bicentric retrospective study","authors":"T. Jeanmougin ,&nbsp;X. Buzin ,&nbsp;A. Mansour ,&nbsp;B. Duceau ,&nbsp;A. Carillion ,&nbsp;P. Dureau ,&nbsp;G. Lebreton ,&nbsp;N. Nesseler ,&nbsp;A. Bouglé ,&nbsp;G. Hariri","doi":"10.1016/j.accpm.2025.101639","DOIUrl":"10.1016/j.accpm.2025.101639","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac surgery-associated acute kidney injury (CSA-AKI) is one of the most frequent and severe complications after cardiac surgery. The association between acute kidney injury and the mismatch between oxygen consumption and delivery has been well established during cardiopulmonary bypass (CPB). In this study, we aim to explore the prognostic value of the central venous-to-arterial pCO₂ gap during CPB to predict CSA-AKI.</div></div><div><h3>Methods</h3><div>Bicentric retrospective study conducted in two teaching hospitals. All patients who underwent cardiac surgery requiring CPB in two periods between 2019 and 2023 were screened for inclusion. Patients were divided into 2 groups according to the presence or absence of an elevated pCO₂ gap during CPB, which was defined as greater than 6 mmHg. The primary outcome was the occurrence of CSA-AKI.</div></div><div><h3>Results</h3><div>Among 318 patients included, 213 were in the low pCO₂ gap group and 105 in the elevated pCO₂ gap group. No significant difference in CSA-AKI occurrence was found between groups (32.4% <em>vs.</em> 23.8%; <em>p</em> = 0.14). pCO₂ gap was not a good predictor of CSA-AKI, with an area under the curve for the ROC curve of 0.63 (<em>p</em> = 0.87). Except for SVO₂ during CPB, we did not find any correlation between pCO₂ gap and other tissue perfusion parameters during or after CPB.</div></div><div><h3>Conclusion</h3><div>We did not find any association between the presence of an elevated pCO₂ gap during CPB and the occurrence of CSA-AKI. This may suggest that a single intraoperative measurement of pCO₂ gap is not a reliable marker of persistent tissue hypoperfusion in this context.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"45 2","pages":"Article 101639"},"PeriodicalIF":4.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253365","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":"Temporal trends in respiratory parameters and their association with mortality in mechanically ventilated patients with COVID-19-related acute respiratory distress syndrome: the importance of driving pressure.","authors":"Stelios Kokkoris, Ilias I Siempos, Panagiotis Kremmydas, Aikaterini Gkoufa, Eleni Margioula, Dimitrios Tsilivarakis, Ilias Premetis, Sofia Mavrommati, Ioanna Dimopoulou, Christina Routsi","doi":"10.1016/j.accpm.2026.101841","DOIUrl":"https://doi.org/10.1016/j.accpm.2026.101841","url":null,"abstract":"<p><strong>Background: </strong>There are limited data on temporal trends of respiratory parameters and their association with mortality in patients with acute respiratory distress syndrome (ARDS). We sought to describe temporal trends of respiratory parameters in mechanically ventilated patients with COVID-19-related ARDS and their relationship with mortality.</p><p><strong>Methods: </strong>Patients with COVID-19-related ARDS, undergoing mechanical ventilation, admitted to an intensive care unit (ICU), were included. Data on respiratory parameters were collected on ICU admission (day 1) and on days 3, 5, 10, 14, and 21 thereafter. Linear mixed effects and time-dependent Cox proportional hazards regression analyses were conducted to assess the association between temporal trends of respiratory parameters and mortality.</p><p><strong>Results: </strong>Data from 585 patients [median (IQR) age 70 [60-77] years, 387 (66%) males] were analyzed. All-cause ICU mortality was 57%. Average values of plateau pressure, respiratory rate, P(A-a)O₂, and PaCO₂ were higher and increased more over time, in non-survivors compared to survivors (regression coefficient r = 1.33, P = 0.005, r = 1.23, P = 0.01, r=67.75, P < 0.001, and r=4.88, P < 0.001, respectively). Average values of respiratory system compliance and PaO₂/FiO₂ ratio were lower and decreased more over time, in non-survivors compared to the survivors (r=-3.49, P = 0.002, and r=-38.03, P < 0.001, respectively). Finally, the average value of driving pressure was higher across time in non-survivors compared to the survivors (r=1.09, P = 0.005), and was independently associated with ICU mortality (Hazard ratio=1.04, 95% confidence interval: 1.01-1.08, P = 0.044).</p><p><strong>Conclusion: </strong>Temporal trends of respiratory parameters were associated with mortality of mechanically ventilated patients with COVID-19-related ARDS. Among respiratory mechanics variables, driving pressure was the only parameter independently associated with mortality when modeled as a time-updated covariate.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101841"},"PeriodicalIF":4.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147617015","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":"Comparison of Time for Endotracheal Intubation with Flexible Tip Bougie Versus Standard Bougie During Videolaryngoscopy in Simulated Cervical Spine Immobilization in Adult Patients - A Randomized Control Trial.","authors":"Shivam Shivam, Renu Sinha, Bikash Ranjan Ray, Armanullah Khan, Kanil Ranjith Kumar, Manpreet Kaur, V Darlong, Jyotsna Punj","doi":"10.1016/j.accpm.2026.101843","DOIUrl":"https://doi.org/10.1016/j.accpm.2026.101843","url":null,"abstract":"<p><strong>Background: </strong>We compared the time for successful endotracheal intubation with flexible-tip bougie (FTB) versus standard bougie (SB) during videolaryngoscopy in adults with simulated cervical spine immobilization.</p><p><strong>Methods: </strong>Seventy-six adult patients were allocated and randomized into the FTB Group and SB Group for intubation. After administration of general anaesthesia and muscle relaxant, the trachea was intubated with either FTB or SB using a CMAC videolaryngoscope Macintosh blade. The primary outcome was a comparison of the time required for successful tracheal intubation with FTB and SB during videolaryngoscopy in simulated cervical spine stabilization with cervical collar in adult patients. Secondary outcomes were best glottic view time, intubation attempts, ease of mouth opening, bougie insertion, intubation, and railroading of endotracheal tube (ETT), maneuvers, and complications.</p><p><strong>Results: </strong>Median [interquartile range (IQR)] total intubation time was comparable between FTB Group 29.6 (25.1-35.5) seconds and SB Group 33.3 (26.7-45.2) seconds; (p = 0.37). First-attempt intubation success was comparable in FTB Group 36 (97.3%) and SB Group 33 (86.8%) (p = 0.325). The median (IQR) bougie insertion time was significantly shorter in the FTB Group vs. the SB Group [5.23 (3.79-7.07) vs. 6.15 (3.91-8.6) seconds; p = 0.048]. Moderate to severe difficult bougie insertion was observed in significantly more patients in the SB Group vs. the FTB Group (10.6% vs. 0%; p = 0.004). Time for best gottic view, railroading ETT, bougie removal, manoeuvres, and complications were comparable.</p><p><strong>Conclusion: </strong>FTB and SB guided total intubation time and number of intubation attempts with CMAC videolaryngoscope by the experienced anesthesiologists were comparable in simulated cervical spine stabilization. However, FTB insertion was significantly easier and shorter than SB insertion.</p><p><strong>Trial registration: </strong>Clinical Trials Registry- India (ICMR-NIMS)- CTRI/2021/04/032512 REGISTRATION LINK: https://www.ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid = NTA2NTc=&Enc=&userName=.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101843"},"PeriodicalIF":4.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147617025","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 hemodialysis in patients at risk of citrate accumulation: The Stewart approach can help","authors":"Frank Bidar ,&nbsp;Baptiste Thibault ,&nbsp;Jean-François Carabalona ,&nbsp;Matthieu Petit ,&nbsp;Thomas Rimmelé","doi":"10.1016/j.accpm.2025.101689","DOIUrl":"10.1016/j.accpm.2025.101689","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"45 2","pages":"Article 101689"},"PeriodicalIF":4.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145530941","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}