Anaesthesia Critical Care & Pain Medicine最新文献

{"title":"A phase 2 open-label pilot study of Remimazolam for sedation in critically ill patients","authors":"Nicolas Grillot ,&nbsp;Mickaël Vourc’h ,&nbsp;Yannick Hourmant ,&nbsp;Marwan Bouras ,&nbsp;Bertrand Rozec ,&nbsp;Armine Rouhani ,&nbsp;Thomas Stoehr ,&nbsp;Alexandra Jobert ,&nbsp;Antoine Roquilly ,&nbsp;Raphaël Cinotti","doi":"10.1016/j.accpm.2025.101510","DOIUrl":"10.1016/j.accpm.2025.101510","url":null,"abstract":"<div><h3>Introduction</h3><div>Remimazolam is a novel benzodiazepine with an ultra-short half-life. It is a potentially interesting alternative for sedation in the Intensive Care Unit, but there is limited data regarding its use in critically ill patients.</div></div><div><h3>Methods</h3><div>Phase 2, investigator-initiated, single-center, non-randomized, open-label study. Patients with an expected duration of sedation ≥ 24 h were eligible and received a maximum 48-h infusion of Remimazolam, with a dose ranging from 0.1 to 1 mg/min.</div><div>The primary endpoint was a composite of the ability to reach a targeted sedation level without the use of another hypnotic drug and hemodynamic stability (no drop in mean arterial pressure ≤ 65 mmHg and no increase in norepinephrine dose ≥ 50% for more than 1 h), during the first 8 h after start. Secondary endpoints included the monitoring of Adverse Events (AE) and pharmacokinetics.</div></div><div><h3>Results</h3><div>30 patients were included with a median age of 60 [51–70] years, a SAPS II 38 [30–46], and a mortality rate of 23.3%. Fourteen (46.7%) patients met the primary endpoint. Ten (33.3%) patients received Remimazolam for 48 h and 4 (13.3%) patients received the highest dose. 54 AEs were reported in 23 patients and 11 were classified as Serious AEs in 8 patients. Ten AEs were related to Remimazolam. The pharmacokinetics analysis showed steady plasma levels throughout the infusion and rapid elimination after dosing discontinuation.</div></div><div><h3>Discussion</h3><div>Remimazolam could be useful for sedation in the ICU but deserves further investigation before routine use.</div></div><div><h3>Trial registration</h3><div>NCT04611425. Registered 2 November 2020.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 3","pages":"Article 101510"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774726","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":"Conscious sedation for intracranial venous manometry and sinus stenting: 3 in 1 procedure","authors":"Rami El Ojaimi ,&nbsp;Luca Scarcia ,&nbsp;Dan Benhamou ,&nbsp;Christophe Quesnel ,&nbsp;Erwah Kalsoum","doi":"10.1016/j.accpm.2025.101514","DOIUrl":"10.1016/j.accpm.2025.101514","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 3","pages":"Article 101514"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143895735","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 arterial carbon dioxide tension and poor outcomes after cardiac arrest: A meta-analysis","authors":"Ru-Ting Xue ,&nbsp;Ran-Hong Sun ,&nbsp;Min Wang ,&nbsp;Hao Guo ,&nbsp;Jie Chang","doi":"10.1016/j.accpm.2025.101522","DOIUrl":"10.1016/j.accpm.2025.101522","url":null,"abstract":"<div><h3>Background</h3><div>Abnormal arterial carbon dioxide tension (PaCO₂) is a common finding after cardiac arrest (CA). Inconsistent results regarding the association between abnormal PaCO₂ and poor outcomes have been reported previously. We performed a meta-analysis to evaluate whether hypocapnia or hypercapnia is associated with an increased risk of hospital mortality and poor neurological outcomes in adult patients with CA.</div></div><div><h3>Methods</h3><div>PubMed, Embase, and the Cochrane Library databases were searched through October 2024 to determine studies investigating the association between PaCO₂ and the risk of hospital mortality and/or poor neurological outcomes in adult patients with CA. A random-effects model was used to calculate the pooled odds ratio (OR) with 95% confidence intervals (CIs) for cohort studies and relative risks (RRs) with 95% CIs for randomized controlled trials (RCTs).</div></div><div><h3>Results</h3><div>A total of 14 cohort studies and 3 RCTs comprising 72344 patients were included. Pooled analysis indicated that hypocapnia was associated with an increased risk of hospital mortality (nine cohort studies, OR 1.37; 95% CI, 1.18–1.59; <em>P</em> &lt; 0.0001) and poor neurological outcomes (five cohort studies, OR, 1.75; 95% CI, 1.04–2.96; <em>P</em> = 0.035). Within cohort studies, hypercapnia was associated with increased risk of hospital mortality (10 trials, OR 1.40; 95% CI, 1.13–1.73; <em>P</em> = 0.002), but not associated with poor neurological outcomes (six cohort studies, OR, 1.57; 95% CI, 0.87–2.83; <em>P</em> = 0.130). Within RCTs, mild hypercapnia was not associated with an increased risk of poor neurological outcomes after CA.</div></div><div><h3>Conclusions</h3><div>Current evidence indicated that hypocapnia was associated with an increased risk of hospital mortality and poor neurological outcomes after CA; however, hypercapnia was associated with an increased risk of hospital mortality but did not appear to be associated with increased poor neurological outcomes after CA.</div></div><div><h3>Systematic review protocol</h3><div>INPLASY 2024100120. Registered 28 October 2024.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 3","pages":"Article 101522"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143904497","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":"Gender imbalance in critical care medicine journals","authors":"Cristina Santonocito ,&nbsp;Martina Maria Giambra ,&nbsp;Maria Grazia Lumia ,&nbsp;Filippo Sanfilippo ,&nbsp;Vittorio Del Fabbro ,&nbsp;Francesca Rubulotta ,&nbsp;Elena Giovanna Bignami ,&nbsp;Domenico Abelardo ,&nbsp;Jean-Yves Lefrant ,&nbsp;Jordi Rello","doi":"10.1016/j.accpm.2025.101504","DOIUrl":"10.1016/j.accpm.2025.101504","url":null,"abstract":"<div><h3>Introduction</h3><div>The present study aimed at assessing gender balance in the Editorial roles of Critical Care Medicine (CCM) journals.</div></div><div><h3>Methods</h3><div>A cross-sectional survey was performed for assessing the gender distribution in Editorial Board (EB) roles of journals indexed under Clarivate Journal Citation Reports and Scimago Journal &amp; Country Rank. The influences of editorial roles and of journal rank (separated in quartiles) on gender balance were also assessed.</div></div><div><h3>Results</h3><div>Among 99 screened CCM journals, 92 journals were included. There were 937 women among 4002 EB members (23.4%). We found a greater imbalance among Editors-in-Chief (females: n = 12/104, 11.5%) as compared to editorial roles with lower responsibilities (Senior Editors, n = 22/104, 21.2%, <em>p</em> = 0.04; Associate Editors, n = 208/739, 28.1%, <em>p</em> = 0.0002; EB members, n = 695/3055, 22.7%, <em>p</em> = 0.0038). In a post-hoc analysis conducted separating the journals according to their ranking quartiles (1–2 <em>vs.</em> 3–4), we found no influence of ranking on gender balance. When exploring the gender balance according to the journals’ impact factor, there was a majority of men as editors in all 4 quartiles across all EB roles.</div></div><div><h3>Conclusions</h3><div>We found a large gap in gender distribution across EB members’ roles in CCM journals, especially in the role of Editor-in-Chief, regardless of the journal ranking.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 3","pages":"Article 101504"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630958","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":"Difficult Airway Management: An Analysis of Systematic Review Evidence Underpinning Clinical Practice Guidelines.","authors":"Bryan Dunford, Bethany Sutterfield, Will Roberts, Cole Williams, Rigel Bacani, Trevor Torgerson, Ryan Ottwell, Michael Tran, Aaron Relic, Brad White, Adam Khan, Micah Hartwell, Matt Vassar","doi":"10.1016/j.accpm.2025.101534","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101534","url":null,"abstract":"<p><strong>Background: </strong>Systematic reviews (SRs) underpin the recommendations in clinical practice guidelines (CPGs) for difficult airway management (DAM), yet their methodological and reporting quality varies, potentially impacting clinical decision-making and patient outcomes. Accurate evidence-based medicine is crucial for healthcare workers to make informed decisions in managing a difficult airway, ensuring safer practices and improved outcomes. This study evaluates these SRs using PRISMA and AMSTAR-2 tools to provide insights into their reliability and identify areas for improvement.</p><p><strong>Methods: </strong>A comprehensive PubMed search identified DAM CPGs published between 2015 and 2021. SRs cited within these CPGs were screened for eligibility and assessed using the PRISMA and AMSTAR-2 checklists to evaluate reporting clarity and methodological rigor. A secondary analysis compared quality scores between Cochrane and non-Cochrane SRs, emphasizing their relative contribution to guideline quality and applicability.</p><p><strong>Results: </strong>Fourteen CPGs yielded 63 SRs, 20 of which directly informed guideline recommendations. The mean PRISMA and AMSTAR-2 completion scores for these SRs were 73.4% and 49.3%, respectively, with most SRs rated as moderate or critically low in quality. Only three Cochrane SRs were included, scoring higher on AMSTAR-2 than non-Cochrane SRs.</p><p><strong>Conclusion: </strong>SRs cited in DAM CPGs demonstrate inconsistent quality, reflecting a need for stricter adherence to reporting and methodological standards. Limited use of Cochrane SRs may reduce the robustness of recommendations. Incorporating higher-quality SRs, particularly from Cochrane, and ensuring rigorous evaluation during guideline development are critical for enhancing DAM CPGs' reliability, applicability, and impact on clinical practice and patient care.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101534"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042134","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":"Structural, material and functional organisation of centres performing paediatric anaesthesia","authors":"Mathilde De Queiroz ,&nbsp;Isabelle Constant ,&nbsp;Anne Laffargue ,&nbsp;Gilles Orliaguet ,&nbsp;Claire Barbarot ,&nbsp;Nathalie Bourdaud ,&nbsp;Michael Brackhahn ,&nbsp;Anne Emmanuelle Colas ,&nbsp;Souhayl Dahmani ,&nbsp;Claude Ecoffey ,&nbsp;Frederic Lacroix ,&nbsp;Karine Nouette ,&nbsp;Nada Sabourdin ,&nbsp;Nadia Smail ,&nbsp;Chrystelle Sola ,&nbsp;Francis Veyckemans ,&nbsp;Philippe Cuvillon ,&nbsp;Daphné Michelet","doi":"10.1016/j.accpm.2025.101542","DOIUrl":"10.1016/j.accpm.2025.101542","url":null,"abstract":"<div><h3>Objective</h3><div>The French Society of Anesthesiology and Critical Care (<em>Société Française d'Anesthésie et de Réanimation</em> (SFAR)) and the French association of paediatric intensive care anaesthetists (<em>Association des Anesthésistes Réanimateurs Pédiatriques d'Expression Française</em> (ADARPEF)) have joined forces to provide guidelines for professional practice on the structural, material, and functional organisation of centres performing pediatric anesthesia.</div></div><div><h3>Design</h3><div>A consensus committee of 16 experts from the SFAR and the ADARPEF was convened. The experts declared no conflict of interest before and throughout the process. The entire guidelines process was conducted independently of any industry funding. The authors were asked to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide the assessment of the quality of evidence.</div></div><div><h3>Methods</h3><div>Four fields were defined: (1) structure and logistics; (2) equipment and materials; (3) training; and (4) functional organisation. For each field, the objective of the recommendations was to answer a number of questions formulated according to the PICO model (<em>population, intervention, comparison</em>, and <em>outcomes</em>). Based on these questions, an extensive bibliographic search was carried out on works published from 2000 to 2022, using predefined keywords according to PRISMA guidelines and analyzed using the GRADE® methodology. Because of the very small number of studies that could provide the necessary power for the most important endpoint (i.e., morbidity), it was decided, before drafting the recommendations, to adopt a Recommendations for Professional Practice (RPP) format rather than a Formalised Recommendations of Experts (RFE) format. The recommendations were formulated according to the GRADE® methodology, before being voted on by all the experts according to the GRADE grid method.</div></div><div><h3>Results</h3><div>The experts' synthesis work and the application of the GRADE® method resulted in 34 recommendations dealing with the structural, material and functional organization of centers performing pediatric anaesthesia. After three rounds of rating and several amendments, an agreement was reached on all the recommendations.</div></div><div><h3>Conclusions</h3><div>Strong agreement exists among the experts to provide recommendations aimed at improving the structural, material and functional organization of centers performing paediatric anaesthesia.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 3","pages":"Article 101542"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054611","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":"ICU Mobility Scale translation to French and validation","authors":"Henri de Noray ,&nbsp;Audrey El Kaïm ,&nbsp;Florian Blanchard ,&nbsp;Alice Jacquens","doi":"10.1016/j.accpm.2025.101532","DOIUrl":"10.1016/j.accpm.2025.101532","url":null,"abstract":"<div><div>The ICU Mobility Scale (IMS) is a valid tool to describe a patient’s mobility in the ICU. The primary objective of this study was to translate IMS into French and assess its inter-rater reliability. Secondary objectives included describing the mobility and suitability of IMS to French practices.</div><div>French physiotherapists created a French version of IMS (IMS-FR) through a structured translation process. The English back-translation was validated by the author of the original IMS, confirming the semantic conservation.</div><div>Inter-rater reliability was assessed in a multicentric prospective study across six French ICUs. The concordance of six assessors, including physiotherapists, nurses, and physicians was measured through Kendall's W and weighted kappa. A total of 92 patients were included, with a median ICU stay of 5 (2−13) days and median age of 63 (54−82) years. Median IMS-FR score was 1 (0.5−5). Overall inter-rater reliability was excellent, with a Kendall's W of 0.90. Among the same professional group, weighted kappa were 0.80 for nurses, 0.86 for physicians, and 0.97 for physiotherapists. Between different professional groups, weighted kappa were 0.82 for nurses compared to both physicians and physiotherapists and 0.89 for physicians compared to physiotherapists.</div><div>An additional form was sent to 30 French physiotherapists to explore the correspondence of IMS-FR classification with their clinical practices. Their ranking of IMS-FR items was well-aligned with the original of IMS.</div><div>IMS-FR is available for French ICUs, supporting the implementation of early mobilization strategies and enhancing interdisciplinary communication. Future studies should explore other psychometric properties of the IMS-FR and its impact on rehabilitation practices in ICUs.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 4","pages":"Article 101532"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042632","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":"Optimal brain perfusion pressure derived from the continuous monitoring of cerebral autoregulation status during neonatal heart surgery under cardiopulmonary bypass in relation to brain injury: An observational study","authors":"Pierre Bourgoin ,&nbsp;Erta Beqiri ,&nbsp;Peter Smielewski ,&nbsp;Alexis Chenouard ,&nbsp;Aurélie Gaultier ,&nbsp;Flavie Sadones ,&nbsp;Ugo Gouedard ,&nbsp;Nicolas Joram ,&nbsp;Pascal Amedro","doi":"10.1016/j.accpm.2025.101509","DOIUrl":"10.1016/j.accpm.2025.101509","url":null,"abstract":"<div><h3>Background</h3><div>Understanding cerebral blood flow regulation and later optimizing brain perfusion is part of neuroprotection during cardiopulmonary bypass (CPB) in neonates.</div></div><div><h3>Methods</h3><div>A total of 38 neonates undergoing CPB were monitored using near-infrared spectrometry and mean arterial pressure (MAP). Cerebral autoregulation (CAR) was assessed through the continuous measurement of the Cerebral Oxygenation Index (COx), and CAR-derived metrics were determined by plotting averaged COx values by MAP: Optimal MAP (MAPopt), lower limit of CAR (LLA), upper limit of CAR (ULA).</div></div><div><h3>Results</h3><div>Out of 38, 17 (45%) neonates exhibited moderate to severe brain lesions post-operatively. The onset of CPB was associated with CAR disruption (mean COx pre-CPB = 0.16 ± 0.11; during CPB: 0.39 ± 0.37, <em>p</em> &lt; 0.001). A LLA was identified in 31 out of 38 (82%), 23 out of 38 (61%), and 14 out of 38 (37%) patients before, during, and after CPB, respectively. An ULA was identified in 29 out of 38 (76%), 22 out of 38 (58%), and 14 out of 38 (37%) patients in the same time frames. Patients with abnormal post-operative brain MRI spent more time below the LLA during CPB: 28.3% [17.1–32.9] <em>versus</em> 9.9% [6.9–18.5] in patients without detected brain injury, <em>p</em> = 0.039. No differences were observed regarding the time spent above the upper limit of autoregulation.</div></div><div><h3>Conclusion</h3><div>The study provides valuable insights into the intricate relationship between intraoperative cerebral hemodynamics and post-operative brain injury. Further research is warranted to explore potential interventions based on CAR-derived metrics during CPB in neonates.</div></div><div><h3>Clinical trial registration number</h3><div>Not applicable.</div></div><div><h3>Prior presentation</h3><div>Not applicable.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 3","pages":"Article 101509"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744171","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":"Comparative analysis of patient and family satisfaction in Spanish Intensive Care Units: A cross-sectional study of the impact of diagnosis","authors":"Eva de Miguel-Balsa ,&nbsp;Esther Rios-Albert ,&nbsp;Beatriz Quevedo-Sánchez ,&nbsp;Angela Jorda-Miñana ,&nbsp;Cristina Portillo-Requena ,&nbsp;Sonia Perez-Quesada ,&nbsp;Elena Alfaro-Garcia ,&nbsp;Adoración Alcalá-López","doi":"10.1016/j.accpm.2025.101515","DOIUrl":"10.1016/j.accpm.2025.101515","url":null,"abstract":"<div><h3>Background</h3><div>Analysing relatives and patients experiences and satisfaction can highlight areas for improving Intensive Care Units (ICUs) care. Patients and families may differ about satisfaction and experience, depending on the diagnosis and procedures. We aimed to compare the experience and satisfaction of patients according to diagnosis, severity, and the procedures received, and also between relatives and patients.</div></div><div><h3>Methods</h3><div>Prospective analysis of voluntary responses to the FS (Family Satisfaction)- ICU 24 R questionnaire from surviving ICU patients and their relatives (January-April 2023) in four Spanish hospitals, according to diagnostic groups. Responses were scored on a Likert scale (0: worst score; 100: best score), and means and standard deviations were compared.</div></div><div><h3>Results</h3><div>185 responses were analysed, mostly acute cardiac pathology patients (91, 50.83%), followed by septic shock patients (22.9%). Patients rated the team performance higher than their relatives (98.79 ± 5.37 vs 89.68 ± 18.43; <em>p</em> &lt; 0.0001), also symptom management such as pain (95.62 ± 9.52 vs 89.64 ± 17.24; p = 0.0001, and dyspnoea (94.23 ± 12.27 vs 88.09 ± 17.87; <em>p</em> = &lt;0.001), the information process (91.50 ± 13.43 vs 83.17 ± 21.00; p &lt; 0.001), and decision-making (80.38 ± 13.60 vs 65.84 ± 23.60; <em>p</em> &lt; 0.001). Patients found visits to be scarce (43.75 ± 20.79), although their families were satisfied with their involvement in care (85.49 ± 19.64). Patients with sepsis and septic shock rated pain management the lowest compared to other diagnostic groups (sepsis/septic shock 89.58 ± 12.5 vs 98.61 ± 5.89; <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Open visiting policies and enhancing the protocols for conscious sedation/analgesia in invasive procedures are opportunities to improve the satisfaction and experience of ICU patients and their families.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 3","pages":"Article 101515"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143895269","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":"Norepinephrine infusion for preventing hypotension during hepatic exteriorization in Kasai portoenterostomy in infants with biliary atresia: A randomized controlled trial","authors":"Khaled Sarhan,&nbsp;Nehal Ashraf,&nbsp;Ahmed Hasanin,&nbsp;Marwa Zayed,&nbsp;Reham Saleh,&nbsp;Manal Elgohary,&nbsp;Ramy Alkonaiesy,&nbsp;Kareem Nawwar","doi":"10.1016/j.accpm.2025.101519","DOIUrl":"10.1016/j.accpm.2025.101519","url":null,"abstract":"<div><h3>Background</h3><div>Hepatic exteriorization during Kasai portoenterostomy is usually associated with profound hypotension. This study aimed to assess the role of prophylactic norepinephrine infusion in maintaining blood pressure in infants undergoing Kasai portoenterostomy operation.</div></div><div><h3>Methods</h3><div>Thirty-two infants scheduled for Kasai portoenterostomy operation were randomly assigned to one of two groups: Norepinephrine group: this group received prophylactic intraoperative norepinephrine infusion, Control group: this group received placebo saline infusion. The primary outcome was the incidence of hypotension during liver exteriorization, defined as a persistent reduction of the mean arterial pressure (MAP) ≥20% of the baseline reading requiring release of the liver. Other outcomes included: the frequency of stoppage of surgery and release of the liver, liver function variables, arterial blood gases parameters, total volume of intraoperative infused fluids, and incidence of bradycardia and hypertension.</div></div><div><h3>Results</h3><div>The incidence of persistent hypotension (defined as the need for liver release after administering IV fluid and vasopressor boluses) during liver exteriorization, was 12.5% (2 patients) in the norepinephrine group compared to 75% (12 patients) in the control group, relative risk (95% confidence interval [CI]): 0.17 (0.04−0.63), <em>p</em> =  0.001. Rescue norepinephrine boluses were used in 3 patients (18.8%) in the norepinephrine group compared to 13 patients (81.3%) in the control group, relative risk (95% CI): 0.23 (0.08−0.66), <em>p</em> =  0.001.</div></div><div><h3>Conclusion</h3><div>Among infants with biliary atresia undergoing Kasai portoenterostomy operation, norepinephrine infusion significantly reduced the incidence of persistent severe hypotension during hepatic exteriorization requiring liver release.</div></div><div><h3>Clinical trial identifier</h3><div><span><span>NCT05521152</span><svg><path></path></svg></span>.</div></div><div><h3>Registration URL</h3><div><span><span>https://clinicaltrials.gov/study/NCT05521152</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 3","pages":"Article 101519"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143903374","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}