Anaesthesia Critical Care & Pain Medicine最新文献

{"title":"Early Management of Adult Severe Traumatic Brain Injury: What Researchers and Clinicians Must Know.","authors":"Jonathon D Taylor, Alisa M Higgins, Colin McArthur, Hervé Quintard, Gentle S Shrestha, Andrew Udy","doi":"10.1016/j.accpm.2025.101604","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101604","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101604"},"PeriodicalIF":4.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193526","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":"Implementation of an emergency abdominal surgery classification: a propensity score-weighted before-after study.","authors":"Stéphane Bar, Jean-Marc Regimbeau, David Wang, Hervé Dupont, Osama Abou Arab","doi":"10.1016/j.accpm.2025.101608","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101608","url":null,"abstract":"<p><strong>Background: </strong>Emergency abdominal surgery is associated with high rates of postoperative morbidity and mortality. A structured classification system for emergency surgery may help prioritize cases more effectively, reducing delays to the operating room and postoperative complications. This study evaluates the impact of a locally implemented classification for emergency abdominal surgery on postoperative complications.</p><p><strong>Methods: </strong>A before-and-after study was conducted in a University Hospital and included patients undergoing emergency abdominal surgery over two 6-month periods: before (September 2019 to March 2020) and after (June 2023 to December 2023) the implementation of a surgical emergency classification. The classification, developed by a panel of local experts, assigned an ideal time to surgery (iTTS) based on five urgency grades. Propensity score-weighted analysis was used to adjust for confounding factors. The endpoint was the occurrence of major postoperative complications within 30 days.</p><p><strong>Results: </strong>A total of 438 patients were analyzed (219 before and 219 after implementation). Excess iTTS measured by the actual time to surgery (aTTS)/iTTS ratio and postoperative complications (respiratory, infectious, digestive, cardiac) as well as acute kidney injury were significantly lower in the post-implementation group (p <  0.05). After inverse probability weighting (IPW), the risk of postoperative complications was significantly associated with the implementation of classification, with a relative risk of 0.40 [95% CI, 0.19-0.85], P < 0.001.</p><p><strong>Conclusions: </strong>This study shows that the implementation of a classification of emergency abdominal surgery could reduce the rate of postoperative complications probably by reducing the delay to surgery.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101608"},"PeriodicalIF":4.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193529","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":"Environmental exposure to air pollution and pollen and the risk of perioperative respiratory adverse events in paediatric anaesthesia: A narrative review.","authors":"Cormac O'Brien, David Sommerfield, Aine Sommerfield, Neil Hauser, Britta S von Ungern-Sternberg","doi":"10.1016/j.accpm.2025.101601","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101601","url":null,"abstract":"<p><p>This narrative review article summarises the current evidence on environmental exposures before surgery. There is emerging evidence suggesting that environmental exposures before surgery, namely exposure to air pollution and allergenic pollen, may significantly influence the risk of these events occurring. Understanding the impact of air pollution and pollen exposure on the risk for perioperative respiratory adverse events, one of the leading causes of morbidity and mortality in children undergoing anaesthesia, could enhance current preoperative risk stratification practices. This review explores the mechanistic pathways by which these exposures exacerbate respiratory vulnerability and evaluates existing evidence linking environmental factors to perioperative outcomes. By raising awareness of these (mainly) modifiable risk factors, anaesthesiologists may better anticipate and manage perioperative respiratory adverse events in paediatric populations, optimising resource utilisation.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101601"},"PeriodicalIF":4.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193539","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":"Infection following a stereotactic brain biopsy: myth or reality? Retrospective study between 2009 and 2023.","authors":"Julie Dupont, Maria Dinkova, Caroline Tabillon, Fares Charfi, Vincent Degos, Anne-Marie Korinek, Bertrand Mathon, Alice Jacquens","doi":"10.1016/j.accpm.2025.101615","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101615","url":null,"abstract":"<p><strong>Introduction: </strong>Stereotactic brain biopsy is a routine diagnostic tool for evaluating brain lesions. Although postoperative hemorrhage, epilepsy, and cerebral edema are recognized complications, surgical site infections are rare but still reported. Despite being classified as \"clean surgery,\" the absence of standardized antibiotic prophylaxis remains a topic of discussion. This study aimed to quantify the incidence of postbiopsy infections (PBI) and assess their impact on patient outcomes.</p><p><strong>Materials: </strong>We conducted a monocentric retrospective study between 2009 et 2023 in order to determine the incidence of post-biopsy infections (PBI+) and compare them with those who were infection-free (PBI-). All patients having a stereotactic brain biopsy were included.</p><p><strong>Results: </strong>Over a 15-year period, 2,312 patients underwent stereotactic brain biopsy. Post-biopsy infections occurred in 11 patients (0.47%), predominantly involving Staphylococcus (36%). There were no significant differences between the PBI + and PBI - groups in terms of demographic or lesion characteristics. However, PBI + patients had longer ICU stays (21 days, p = 0.01) and longer hospital stays (11 days versus 1 day, p = 0.01). There was no significant difference in mortality.</p><p><strong>Conclusions: </strong>Infectious complications following stereotactic brain biopsy are rare and do not significantly affect morbidity or mortality. These findings support the continued omission of routine antibiotic prophylaxis and highlight the importance of rigorous sterile techniques and further research to identify high-risk patients.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101615"},"PeriodicalIF":4.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193570","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":"Inflammatory ARDS Subphenotypes: Stable Enough for Implementation in Clinical Trials?","authors":"Dario von Wedel, Manuel Guerrero, Nicolas Boulet","doi":"10.1016/j.accpm.2025.101619","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101619","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101619"},"PeriodicalIF":4.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193488","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":"Sustainability in critical care units: an opinion paper from the SFAR (French Society of Anaesthesia and Critical Care) Sustainability and Critical Care Committees.","authors":"Stéphanie Pons, Enora Atchade, Erwan d'Aranda, Fanny Vardon, Florence Lallemant, Mathieu Schoeffler, Pierre Trouiller, Claire Dahyot-Fizelier, El Mahdi Hafiani","doi":"10.1016/j.accpm.2025.101609","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101609","url":null,"abstract":"<p><p>The ecodesign of healthcare is an empowering approach that integrates environmental considerations throughout the entire life cycle of care. Its conciliation to both care quality and patient safety in critical care units is possible and essential. New data show that sustainability should be accounted for throughout the entire life cycle of care: design, manufacturing, distribution, use, and end-of-life valorization. Thus, attention has shifted towards a healthcare reform based on value, which encompasses the reduction of healthcare environmental impact. Considering the three pillars of sustainable development (environmental, social, and economic), recent studies on ecodesign of healthcare analyzed how to improve quality, security, and care value while reducing healthcare environmental impact. Here, we also outline potential courses of action in critical care units, including energy sobriety, water resources preservation, sustainable food, transport, waste management, cleaning and hygiene, medical devices and pharmaceuticals management, prescriptions reassessment, and quality of life for patients and healthcare providers. Implementing both sustainable strategies and ecodesign of healthcare in critical care units, as well as training healthcare providers, will help improve our healthcare system to be ecologically acceptable, socially just, and economically sustainable.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101609"},"PeriodicalIF":4.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193637","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 Definition and Aims of Anesthesia: a Delphi-based Consensus Statement.","authors":"Joana Berger-Estilita, Basak Ceyda Meco, Edoardo DeRobertis, Wolfgang Buhre, Peter Kirkegard, Karina Jakobsen, Martin Soehle, Federico Bilotta, Falk von Dincklage, Idit Matot, Yotam Weiss, Vincent Bonhomme, Lian Kah Ti, Ivan Rimstad, Clifford Shelton, Bartosz Kozlowski, Sarah Saxena, Paul McConnell, Anil Hormis, Ahed Zeidan, Jan Mulier, Lisbeth Evered, Paola Aceto, Daniel Schmukler, Patrice Forget, Claudia Marquez Simoes, Luiz Fernando Falcao, Maria Wittman, Ismail Gönegur, Finn Michael Radtke","doi":"10.1016/j.accpm.2025.101614","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101614","url":null,"abstract":"<p><strong>Background: </strong>Anaesthesia is crucial in ensuring patient comfort and safety during surgical procedures by inducing a temporary loss of sensation, memory, and consciousness. However, its multifaceted nature presents challenges in defining its aims and expected outcomes. This study aimed to establish a consensus on anaesthesia's definition and core aims using a structured Delphi process.</p><p><strong>Methods: </strong>We conducted a modified three-round eDelphi method involving 23 international experts. Participants engaged in iterative online surveys to refine a consensus definition and aims. Consensus was predefined as achieving ≥80% agreement. The process included external expert reviews to enhance objectivity and validity. Statistical analyses included median, interquartile range (IQR), and agreement percentages.</p><p><strong>Results: </strong>The Delphi process resulted in consensus on 49 aims and a refined definition of anaesthesia. The final definition emphasises safe, effective, individualised, patient-centred, and empathetic care, ensuring optimal surgical conditions while enhancing patient outcomes. Key aims included preoperative optimisation, stress and pain reduction, organ function preservation, prompt emergence and recovery, interdisciplinary teamwork, continuous outcome assessment, and sustainability in anaesthesia practices. The final agreement rate for the updated definition was 82.6% (median: 10, IQR: 9-10). Additionally, environmental sustainability was recognised as an integral aim.</p><p><strong>Conclusion: </strong>The consensus developed in this study provides a structured framework for defining anaesthesia's objectives, improving patient-centred care, guiding clinical practice, and fostering research. By incorporating sustainability and long-term patient outcomes, the consensus supports the evolution of precision anaesthesia. Future research will validate these defined aims in various perioperative settings and refine the consensus based on real-world applications.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101614"},"PeriodicalIF":4.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193664","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":"Amoxicillin-clavulanic acid resistance in the first postoperative pneumonia after cardiac surgery: risk factors and outcomes from a 10-year cohort analysis.","authors":"David Kovacs, Mohamed Rekik, Marie Lavollay, Fabrice Compain, Chahrazad Bey Boumezrag, Konstantinos Zannis, Christophe Caussin, Elodie Teil, Kamel Bouabdallah, Clarisse Blayau, Paul-Henri Wicky, Nicolas Allou, Marc Beaussier, Mathieu Desmard, Alexy Tran-Dinh","doi":"10.1016/j.accpm.2025.101622","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101622","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pneumonia (POP) is a severe complication after cardiac surgery (CS). A high prevalence of resistant pathogens has been reported. We aimed to identify risk factors and assess the impact on clinical outcomes of POP caused by amoxicillin-clavulanic acid-resistant bacteria (AMC-R POP).</p><p><strong>Methods: </strong>This single-center retrospective cohort study included patients who underwent CS between January 2013 and December 2023 and developed microbiologically documented POP within 7 postoperative days. Clinical characteristics were compared in univariate and multivariate analyses according to AMC susceptibility of causative bacteria. The primary objective was to study the association between AMC-R POP and intensive care unit (ICU) length of stay.</p><p><strong>Results: </strong>Among 352 cases of POP, 186 (53%) were AMC-R. The most common AMC-resistant pathogens were AmpC-producing Enterobacterales (25.6%) and Pseudomonas aeruginosa (14.6%). AMC-R POP was independently associated with longer ICU length of stay (adjusted mean difference of 7.0 (95% CI 2.8; 11.7) days). Patients with AMC-R POP had lower 90-days survival in time-to-event analysis (HR 0.50, 95% CI 0.27; 0.93). Independent risk factors of AMC-R POP included redo surgery (adjusted OR 3.74, 95% CI 1.73; 8.84), multiple major procedures (aOR 1.94, 95% CI 1.18; 3.21), and SAPS II ≥ 35 at ICU admission (aOR 2.42, 95% CI 1.50; 3.91).</p><p><strong>Conclusion: </strong>AMC-R POP represented half of the POP cases occurring within 7 days of CS and was associated with longer ICU length of stay. Patients on redo surgery, particularly those fulfilling other independent risk factors, should be considered to receive empirical antibiotics accordingly in case of suspected POP.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101622"},"PeriodicalIF":4.7,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187386","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":"Prevalence of perioperative functional disability using WHODAS 2.0 and associated adverse outcomes in surgical populations: A systematic review and meta-analysis.","authors":"Priyanjli Sharma, Ellene Yan, Andy Cui, Rihana Kukkadi, Emily Au, Marina Englesakis, Frances Chung","doi":"10.1016/j.accpm.2025.101623","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101623","url":null,"abstract":"<p><strong>Background: </strong>Functional disability affects a significant proportion of surgical patients. The World Health Organization Disability Assessment Schedule (WHODAS) version 2.0 is a validated measure of functional disability in surgical populations. This systematic review and meta-analysis uses the WHODAS to investigate the pooled prevalence of perioperative functional disability and its associated adverse postoperative outcomes.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted across multiple databases for studies published between January 2010 and July 13, 2024. The primary outcome was the prevalence of functional disability at perioperative time points among adult surgical patients. Functional disability was defined using the following WHODAS thresholds: ≥16% exceeded patient-acceptable levels, while ≥25% and ≥35% indicated clinically significant disability.</p><p><strong>Results: </strong>Twenty studies (9,797 participants, mean age 70 ± 12 years, 38% female) were included in qualitative synthesis, with 14 included in meta-analysis. Pooled prevalence of preoperative functional disability exceeding patient-acceptable levels (WHODAS ≥ 16%) was 32% (95% CI: 23%, 42%). For clinically significant disability, preoperative prevalence was 34% (95% CI: 24%, 45%) using WHODAS ≥ 25% and 21% (95% CI: 11%, 35%) using WHODAS ≥ 35%. Postoperative prevalence of clinically significant disability (WHODAS ≥ 25%) decreased to 14% (95% CI: 8%, 23%) at 6 months and 15% (95% CI: 14%, 17%) at 12 months. Preoperative functional disability was associated with postoperative delirium, longer length of stay, non-home discharge, and greater postoperative pain.</p><p><strong>Conclusion: </strong>Functional disability is prevalent in surgical patients and associated with adverse outcomes. Identifying functional disability perioperatively assists in making informed decisions to optimize functionality and improve surgical outcomes.</p><p><strong>Registration: </strong>PROSPERO database under ID CRD42024574108 (https://www.crd.york.ac.uk/PROSPERO/view/CRD42024574108).</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101623"},"PeriodicalIF":4.7,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187389","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":"Comment on \"Intraoperative ketamine and pain after video-assisted thoracoscopic surgery (VATS): A systematic review and meta-analysis\".","authors":"Lakshmi Thangavelu","doi":"10.1016/j.accpm.2025.101627","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101627","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101627"},"PeriodicalIF":4.7,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187357","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}