Anaesthesia Critical Care & Pain Medicine最新文献

{"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}

{"title":"Life-sustaining treatment limitation decisions: What place for the opinion of patients’ relatives during decision-making meetings in French ICUs?","authors":"Camille Urien ,&nbsp;Marie-France Mamzer ,&nbsp;Mikhael Giabicani","doi":"10.1016/j.accpm.2025.101517","DOIUrl":"10.1016/j.accpm.2025.101517","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 3","pages":"Article 101517"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143895736","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":"Different mortality and transfer rates between teaching and nonteaching urban hospitals among patients presenting with Stevens-Johnson syndrome","authors":"SeungEun Lee,&nbsp;William Rienas,&nbsp;Renxi Li","doi":"10.1016/j.accpm.2025.101505","DOIUrl":"10.1016/j.accpm.2025.101505","url":null,"abstract":"<div><div>Stevens-Johnson Syndrome is a rare disorder of the skin and mucous membranes accompanied by systemic symptoms that are life threatening and require immediate intervention. We sought to determine if different hospital types, specifically urban nonteaching hospitals versus urban teaching hospitals, have different outcomes among patients presenting with Stevens-Johnson Syndrome during hospitalization. Patients presenting to urban teaching and urban nonteaching hospitals were compared. Compared to patients at urban nonteaching hospitals, patients at urban teaching hospitals had significantly increased risk of mortality, and urban nonteaching hospitals had higher rates of transferring patients to another hospital. Future research is needed to explore patient outcomes beyond the hospitalization period and in different hospital settings.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 3","pages":"Article 101505"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630957","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":"Lung resistance - but not compliance - impairs P0.1 and maximal inspiratory pressure measurements","authors":"Mickael Lescroart ,&nbsp;Florian Blanchard ,&nbsp;Jean-Michel Constantin ,&nbsp;Mathieu Specklin ,&nbsp;Alma Revol ,&nbsp;Hind Hani ,&nbsp;Bruno Levy ,&nbsp;Mathieu Koszutski ,&nbsp;Benjamin Pequignot","doi":"10.1016/j.accpm.2025.101501","DOIUrl":"10.1016/j.accpm.2025.101501","url":null,"abstract":"<div><h3>Introduction</h3><div>Bedside tools have been developed to assess inspiratory muscle function and inspiratory drive for patients under invasive mechanical ventilation. Occlusion maneuvers are currently considered but their pitfalls remain underexplored. We aimed to assess the impact of respiratory system compliance and resistance on P0.1 (addressing respiratory drive and inspiratory muscle function) and maximal inspiratory pressure (MIP, assessing global inspiratory muscle function) monitoring for fixed inspiratory muscle pressure (P_MUS) through an <em>in-silico</em> model.</div></div><div><h3>Methods</h3><div>The Active Servo Lung 5000 (ASL-5000) was used to reproduce respiratory conditions under fixed P_MUS of 5, 10 and 20 cmH₂O. From baseline, resistance and compliance challenges were performed. P0.1 and MIP were monitored on a ventilator (Dräger Evita Infinity V500).</div></div><div><h3>Results</h3><div>Resistance challenge impacted the monitoring of both P0.1 and MIP while compliance challenge barely modified P0.1 and MIP under all P_MUS settings. Statistical analysis confirmed significant correlations for increased Resistance and under-estimation of P0.1 and MIP (Spearman coefficient - 0.80, <em>p</em>-value &lt; 0.01), while reduced compliance had inconsistent effect on occlusion maneuver values. We found expiratory (rather than inspiratory) resistances impacted pressure monitoring.</div></div><div><h3>Discussion</h3><div>Lung Resistance - but not Compliance - impairs P0.1 and Maximal Inspiratory Pressure Measurements. Further clinical studies are mandatory to define pitfalls and limits of occlusion maneuver monitoring.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 3","pages":"Article 101501"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630960","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":"Use of norepinephrine for intraoperative hypotension in pediatric anesthesia: a French survey","authors":"Margot Milhiet ,&nbsp;Noemie De Martino ,&nbsp;Matthieu Laborier ,&nbsp;Nada Sabourdin ,&nbsp;Christophe Dadure ,&nbsp;Marco Caruselli ,&nbsp;Fabrice Michel ,&nbsp;RAP-ADARPEF group","doi":"10.1016/j.accpm.2025.101503","DOIUrl":"10.1016/j.accpm.2025.101503","url":null,"abstract":"<div><h3>Introduction</h3><div>Intraoperative hypotension (IOH) is a common complication in the operating room. Vasopressors are crucial in managing IOH but data on their use in children, particularly norepinephrine (NE), are limited. This study aimed to explore NE use in IOH management among French pediatric anesthesiologists.</div></div><div><h3>Materials and methods</h3><div>A survey was conducted using an online Google Forms® questionnaire, validated by experienced pediatric anesthesiologists and the ADARPEF board. Distributed via the ADARPEF Research Network, the survey covered demographics, IOH definitions, treatment approaches, and NE use.</div></div><div><h3>Results</h3><div>We received 205 responses (44.1%). IOH was defined as a percent of fall of preoperative arterial pressure for 63.9% of respondents and normogram or age-based formulae value for 33.6%. Cerebral NIRS and invasive arterial blood pressure were the most common tools for monitoring patients with high risk of IOH. For vasoplegia-induced IOH, the first-line treatment was fluid bolus (49.2%) or ephedrine (35.3%). NE was used as second line treatment by 26.2 % of respondents. For IOH due to blood loss, fluid bolus was the primary treatment followed by NE. NE was used monthly by 79.3% of respondents and weekly by 45.3%. Variations in dilution and dosage practices were noted, with 70.5% reporting the use of highly diluted NE. Side effects were reported by 86.1% of NE users.</div></div><div><h3>Conclusion</h3><div>The survey highlights significant variability to determine the threshold of IOH requiring treatment and vasopressors use. NE is widely used by pediatric anesthesiologists, but practices vary, indicating the need for standardised guidelines and further safety studies.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 3","pages":"Article 101503"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630962","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":"Traumatic cardiac arrest, what clinicians and researchers must know","authors":"Stanislas Abrard ,&nbsp;Dominique Savary ,&nbsp;Daniel Nevin ,&nbsp;Kenji Inaba ,&nbsp;Jean-Stéphane David","doi":"10.1016/j.accpm.2025.101507","DOIUrl":"10.1016/j.accpm.2025.101507","url":null,"abstract":"<div><div>Survival rates for trauma cardiac arrest (TCA) routinely range from 2 to 5% and have not improved in high-income countries over the past two decades, unlike those for medically induced cardiac arrests. This persisting low TCA survival rates have led to debates, about the value of resuscitating TCA patients, considering the significant risks and costs involved compared to the low chances of favorable outcomes. As well, TCA patients are frequently excluded from large randomized controlled trials on cardiac arrest management, with most research consisting of retrospective studies and clinical case series.</div><div>The causes of cardiac arrest following injury are diverse, and hypovolemia, particularly from hemorrhagic shock, is a significant cause of early death. Direct cardiac or large vessel injuries, such as myocardial contusions or tamponade, can also lead to TCA. While TCA from severe brain or spinal injuries are less frequent, survival rates in these cases can be slightly better if return of spontaneous circulation (ROSC) is achieved. The presence of bystander CPR, shockable initial rhythms, and rapid identification and treatment of reversible causes are associated with favorable outcomes. A few strategies should be applied systematically, such as early bleeding source control, oxygen supplementation, hypovolemia correction, and diagnosing and treating compressive pleural or pericardial effusions.</div><div>Emerging techniques are suggested for the management of refractory hemorrhagic shock and cardiac arrest, such as the REBOA (Resuscitative Balloon Occlusion of the Aorta), but further research is needed to determine the most effective approaches to prehospital and in-hospital TCA management.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 3","pages":"Article 101507"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651580","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":"Efficacy of solnatide to treat pulmonary permeability edema in SARS-CoV-2 positive patients with moderate to severe ARDS: A randomized controlled pilot-trial","authors":"Katharina Krenn ,&nbsp;Felix Kraft ,&nbsp;Matthias Urban ,&nbsp;Roman Ullrich ,&nbsp;Erwin Grasmuk-Siegl ,&nbsp;Georg Gelbenegger ,&nbsp;Martin Bauer ,&nbsp;Valentin Al Jalali ,&nbsp;Karolina Anderle ,&nbsp;Anselm Jorda ,&nbsp;Maria Weber ,&nbsp;Arschang Valipour ,&nbsp;Franz König ,&nbsp;Rudolf Lucas ,&nbsp;Markus Zeitlinger","doi":"10.1016/j.accpm.2025.101520","DOIUrl":"10.1016/j.accpm.2025.101520","url":null,"abstract":"<div><h3>Background</h3><div>Because of the initially urgent need for treatments for COVID-19-associated acute respiratory distress syndrome (ARDS), the efficacy and tolerability of inhaled solnatide, a direct activator of the epithelial sodium channel (ENaC) under clinical investigation for the treatment of ARDS, were assessed in a pilot trial.</div></div><div><h3>Methods</h3><div>This randomized controlled double-blind clinical trial was performed at two study centers in Vienna, Austria. Adult mechanically ventilated patients with moderate to severe ARDS (Berlin Definition) caused by COVID-19 were randomized 1:1 to inhalation of solnatide (100 mg) or placebo twice daily for seven days. The primary outcome parameter was ventilator-free days (VFDs) within 28 days; survival was assessed at 28 and 60 days as a secondary outcome.</div></div><div><h3>Results</h3><div>A total of 30 out of the 40 planned patients were included, 15 randomized to solnatide and 15 to placebo. Then the trial was stopped early due to slow recruitment. The median VFDs were 0 in both groups (<em>p</em> =  0.653). Twenty out of 30 patients (66.7%) survived until day 28 [solnatide group: <em>n</em> = 11 (73.3%), placebo group: <em>n</em> = 9 (60%)]. One additional patient per group died until day 60. In total, 41 adverse events (AEs) and 10 serious AEs occurred in the solnatide group, and 26 AEs and 14 serious AEs in the placebo group. No AE was considered to be related to the study treatment.</div></div><div><h3>Conclusions</h3><div>There was no difference in VFDs or survival between the solnatide and the placebo group. Solnatide appeared safe in this limited cohort of critically ill patients with COVID-19.</div></div><div><h3>Registration</h3><div>EU clinical trials register, EudraCT number 2020-001244-26.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 3","pages":"Article 101520"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143933622","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":"Rapid sequence induction and intubation: Can we predict and prevent hypotension?","authors":"Joris Pensier ,&nbsp;Maximilian S. Schaefer ,&nbsp;Kevin P. Seitz","doi":"10.1016/j.accpm.2025.101536","DOIUrl":"10.1016/j.accpm.2025.101536","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 3","pages":"Article 101536"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143923269","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}