Anaesthesia Critical Care & Pain Medicine最新文献

{"title":"Management of new-onset atrial fibrillation in critically ill patients: A national multicenter prospective cohort.","authors":"Emmanuel Pardo, Emmanuel Futier, Laurent Muller, Guillaume Besch, Fanny Vardon-Bounes, Eric Kipnis, Sigismond Lasocki, Stanislas Ledochowski, Evelina Ochin, Jeremy Bourenne, Guillaume Grillet, Adrien Auvet, Armand Mekontso Dessap, Cédric Bruel, Yoann Launey, Maxence Fiorillo, Matthieu Jabaudon, Thomas Godet, Aurelien Mulliez, Jean-Michel Constantin","doi":"10.1016/j.accpm.2025.101617","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101617","url":null,"abstract":"<p><strong>Background: </strong>New-onset atrial fibrillation (NOAF) occurs in 10% of intensive care unit (ICU) stays and worsens clinical outcomes. Despite its significance, no specific guidelines exist for the general ICU population. Our study investigates potential therapeutic approaches to NOAF, focusing on the rhythmic and haemodynamic outcomes associated with dedicated strategies.</p><p><strong>Methods: </strong>In our prospective multicentre cohort study, we included adult patients admitted to 33 ICUs in France, exhibiting at least one episode of NOAF. Exclusions included permanent and post-cardiac/thoracic surgery AF. Data on demographics, clinical history, haemodynamic monitoring, and treatment choice for NOAF episodes were prospectively recorded. Heart rate, blood pressure, and rhythm status were assessed immediately before, at +5, +30, +60 minutes, and +24 hours after NOAF onset.</p><p><strong>Results: </strong>Between May and December 2019, 453 ICU patients with 735 NOAF episodes were included. Therapeutic approaches included wait-and-see (n = 159 (22%)), IV fluid (n = 338 (46%)), magnesium (n = 299 (41%)), amiodarone (n = 295 (40%)), and beta blockers (n = 73 (10%)); alone or combined in 354 episodes (61%). Electric cardioversion, preferred for poor haemodynamic tolerance, was most effective for sinus rhythm conversion at +1 h (n = 17/30 (57%)). Heart rate and rhythm control were achieved at 87% (n = 588/674) and 80% (n = 259/654) at +24 h, with no significant difference between the strategies. On ICU discharge, 48 (13%) patients remained in AF; independent predictors included age, obesity, prior stroke, and hypercholesterolemia.</p><p><strong>Conclusions: </strong>Therapeutic approaches for NOAF in ICU patients were heterogeneous, with nearly a quarter managed by a wait-and-see approach. Most strategies achieved rhythm and rate control within 24 hours. These findings highlight the frequent transient nature of NOAF episodes and support the need for individualized treatment decisions, particularly in unstable patients and those at risk for persistent AF. Trial registration ClinicalTrials.gov NCT03977883 (https://clinicaltrials.gov/study/NCT03977883?term=NCT03977883&rank=1).</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101617"},"PeriodicalIF":4.7,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187324","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":"Transcranial electrical stimulation (tES) in chronic pain patients: effects on daily-reported symptoms.","authors":"Antonio Gil-Ugidos, Jorge Alcántara-Espinosa, Lara Rubal-Otero, Mónica Mayo-Moldes, Noelia Samartin-Veiga, María Teresa Carrillo-de-la-Peña","doi":"10.1016/j.accpm.2025.101613","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101613","url":null,"abstract":"<p><strong>Background: </strong>Transcranial electrical stimulation has yielded positive results for relieving pain in patients with chronic pain (CP), but the existing evidence is insufficient. In order to address some gaps in the literature, we conducted a randomized, double blind, sham-controlled clinical trial aimed at evaluating the feasibility and efficacy of home-based neurostimulation in a sample of 120 patients.</p><p><strong>Methods: </strong>The patients completed 15 self-administered home-based sessions of either transcranial direct current stimulation (tDCS, n = 48), transcranial alternate current stimulation (tACS, n = 48), or sham stimulation (n = 24). The primary outcome variable, i.e., pain intensity, and related variables were assessed online (using numerical rating scales from 0 to 10) throughout 45 days (pre-treatment, treatment, and post-treatment periods each of 15 days).</p><p><strong>Results: </strong>ANOVA (classical and Bayesian frameworks) and time series analysis consistently showed that both tDCS and tACS decreased the patients' daily reported pain intensity (tDCS: tau = -0.553; p < 0.001; tACS: tau = -0.563; p < 0.001), pain unpleasantness (tDCS: tau = -0.489; p < 0.001; tACS: tau = -0.537; p < 0.001), interference due to pain (tDCS: tau = -0.368; p < 0.001; tACS: tau = -0.424; p < 0.001), and other symptoms such as fatigue (tDCS: tau = -0.255; p = 0.02; tACS: tau = -0.556; p < 0.001) and stress/anxiety (tDCS: tau = -0.245; p = 0.02; tACS: tau = -0.685; p < 0.001). No such improvement was observed in the group receiving the sham stimulation. The home-based treatment was associated with low drop-out rates (6.66%) and moderate satisfaction with the procedure (around 5 out of 10 in all groups), and minimal adverse effects of transcranial electrical stimulation were reported.</p><p><strong>Conclusions: </strong>tDCS and tACS significantly reduced daily-reported pain in chronic pain patients. Home-based intervention could significantly reduce the high economic burden associated with chronic pain management in healthcare systems. Inclusion of daily reports assessed by time series analysis can improve clinical trials in the field of chronic pain.</p><p><strong>Study registration: </strong>ClinicalTrials.gov ID number: NCT05099406 (https://clinicaltrials.gov/study/NCT05099406?term=NCT05099406%20&rank=1).</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101613"},"PeriodicalIF":4.7,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182443","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":"Women in Anaesthesia and Critical Care: a narrative review of their impact on Patient Care, Research Innovation, and Team Performance.","authors":"Anne Godier, Aurélie Gouel-Chéron, Anne-Claire Lukaszewicz","doi":"10.1016/j.accpm.2025.101612","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101612","url":null,"abstract":"<p><strong>Background: </strong>Despite the growing proportion of female doctors, gender imbalance persists in Anaesthesia and Critical Care (ACC).</p><p><strong>Purpose: </strong>To provide an overview of gender imbalance incidence and consequences in ACC, focusing on the impact of female ACC physicians on patient care, research, and team performance.</p><p><strong>Methods: </strong>Narrative review based on a comprehensive search on gender parity performed using Medline/PubMed, Cochrane Library, and Google Scholar.</p><p><strong>Main findings: </strong>Several high-level studies show that female physicians consistently achieve better patient outcomes, with greater benefits for female patients. In research, female ACC physicians contribute significantly to women's health: female-led teams are more likely to include women in clinical trials and to analyse gender-disaggregated data, leading to improved medical knowledge for women. The presence of female ACC physicians also improves global team performance: medical teams with more female physicians report better patient outcomes overall, and gender-balanced research teams produce more innovative and impactful studies. In leadership roles, women drive better team engagement and decision-making, improving individual, team, and organisational performance. Finally, increasing the proportion of female physicians in ACC creates a virtuous circle by improving the recruitment of women into clinical and academic positions. Various measures have been reported to improve gender balance, particularly in institutional programmes. Artificial Intelligence, if not carefully managed, risks reinforcing gender biases, highlighting the need for ethical algorithm development.</p><p><strong>Conclusions: </strong>Gender parity in ACC is a critical factor in improving medical care, research, and team performance. Achieving parity will lead to a more efficient healthcare system that benefits patients.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101612"},"PeriodicalIF":4.7,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182407","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":"Universal videolaryngoscopy for double-lumen tube tracheal intubation: subanalysis of the VIDEOLAR-SURGERY trial.","authors":"Manuel Taboada, Jorge Fernández, Cristina Francisco, Pedro Martínez, Carmen Novoa, Ana Isabel Gómez, Cristina Barreiro, Fernando Otero, Begoña Bascuas, María José Castro, Andrea Naveiro, Daniel Campaña, Sofía Paredes, Luis Martín, Marta Estévez, Manuel González, Julia Regueira, Marcos Peiteado, María Eiras, Enma Paz, Ana Sarmiento, Enrique Domínguez, Alejandro Bedoya, Ana Velasco, Ana Estany-Gestal, Teresa Seoane-Pillado","doi":"10.1016/j.accpm.2025.101618","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101618","url":null,"abstract":"<p><strong>Background: </strong>Double-lumen endotracheal tube (DLT) is technically challenging and associated with higher rates of difficult intubation compared to single-lumen tubes. This post hoc analysis of the VIDEOLAR-SURGERY trial aimed to assess whether the universal use of a videolaryngoscope improves the rate of easy intubation in patients requiring DLT placement.</p><p><strong>Methods: </strong>We conducted a post hoc subanalysis of a prospective, multicenter, before-and-after study involving 5,135 surgical patients. In the non-interventional phase (June-December 2023), DLT intubations were performed using direct laryngoscopy as the first-choice technique. In the interventional phase (February-September 2024), a Macintosh-type videolaryngoscope was used as the first-choice device. The primary outcome was the rate of easy intubation, defined as first-attempt success, a modified Cormack-Lehane grade I or IIa glottic view, and no need for adjuvant airway devices. Secondary outcomes included glottic visualization, perceived technical difficulty, and complications.</p><p><strong>Results: </strong>A total of 189 patients were included, 95 in the non-interventional phase and 94 in the interventional phase. The rate of easy intubation was significantly higher with videolaryngoscopy (91.5%) compared with direct laryngoscopy (76.8%) (absolute risk difference 14.6%; 95% CI, 4.5% to 24.8%). First-attempt success was also higher with videolaryngoscopy (94.7% vs. 82.1%; absolute risk difference 12.6%; 98.3% CI, 2.9% to 22.3%). The interventional phase was also associated with a trend toward improved glottic visualization (94.7% vs. 87.4%), lower perceived technical difficulty, and fewer complications.</p><p><strong>Conclusion: </strong>Universal videolaryngoscopy improved glottic visualization and the rate of easy double lumen tube intubation compared with direct laryngoscopy, while reducing technical difficulty and complications.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101618"},"PeriodicalIF":4.7,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182445","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":"Hemodynamic Failure during Sepsis: What Clinicians and Researchers Must Know.","authors":"Marc Leone, Lene Russell, Maurizio Cecconi, Ashish K Khanna, Romain Pirracchio, Michael Bauer, Jordi Rello","doi":"10.1016/j.accpm.2025.101602","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101602","url":null,"abstract":"<p><p>Sepsis remains the most common syndrome in intensive care units and the leading cause of mortality. This narrative review aims to synthesize the literature that should be known by most intensivists. After a brief overview of pathophysiology, this review summarizes the data on fluid resuscitation and vasopressors. The preference to use a personalized approach for fluid resuscitation and balanced fluid instead of saline was underlined, although the level of evidence remains weak. For vasopressors, innovative strategies, including an early multimodal approach, have been recently developed to overcome the excess of mortality associated with the use of high doses of norepinephrine. Future advances include an insight into the prediction of hemodynamic failure using monitoring and artificial intelligence, as well as new directions in terms of treatments targeting metabolisms and new pathways. Finally, although the literature in the field is vast, the level of evidence for most interventions is weak to moderate, but the clinical research remains intense.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101602"},"PeriodicalIF":4.7,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182440","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 prevalence and trajectory of frailty in older surgical patients: A longitudinal multicentre cohort study","authors":"Yu Tong Lu ,&nbsp;Ellene Yan ,&nbsp;Yasmin Alhamdah ,&nbsp;Paras Kapoor ,&nbsp;Leif Erik Lovblom ,&nbsp;Aparna Saripella ,&nbsp;Jean Wong ,&nbsp;Frances Chung","doi":"10.1016/j.accpm.2025.101582","DOIUrl":"10.1016/j.accpm.2025.101582","url":null,"abstract":"<div><h3>Background</h3><div>Frailty is a state of increased vulnerability and decreased physiological reserve, which can reduce one’s capacity to cope with external stressors such as a major surgery. We aimed to (1) investigate the preoperative and postoperative prevalence of frailty in older surgical patients; and (2) evaluate preoperative risk factors associated with postoperative frailty.</div></div><div><h3>Methods</h3><div>This multicentre prospective study included 307 non-cardiac surgical patients aged ≥65 years. Clinical frailty was assessed online using the five-item FRAIL scale (<u>F</u>atigue, <u>R</u>esistance, <u>A</u>mbulation, <u>I</u>llness, weight-<u>L</u>oss) preoperatively and postoperatively at 30, 90, and 180 days. Trajectories of FRAIL scores were assessed with linear mixed-effects models, stratified by preoperative frailty. Preoperative risk factors associated with frailty at 180 days were explored by logistic regression.</div></div><div><h3>Results</h3><div>Preoperatively, 36% of patients were robust, 52% were prefrail, and 12% were frail. Frail patients experienced a significant improvement in frailty by 90 and 180 days. Prefrail patients experienced a transient worsening of frailty level with subsequent improvement by 180 days. Robust patients experienced similar worsening in frailty but remained clinically robust, despite a small absolute difference in FRAIL score. Preoperative frailty and functional disability were both associated with greater odds of 180-day frailty (aOR 2.65, 95% CI [1.51, 4.97] and aOR 4.71, 95% CI [1.41, 15.65], respectively).</div></div><div><h3>Conclusions</h3><div>The prevalence of preoperative prefrailty and frailty was high among older surgical patients. A high preoperative FRAIL score and severe functional disability were associated with greater odds of postoperative 180-day frailty. Preoperative frailty assessment can risk-stratify patients and inform postoperative targets.</div></div><div><h3>Registration</h3><div>The trial was registered on <span><span>www.clinicaltrials.gov</span><svg><path></path></svg></span> on April 7, 2021 (NCT04850833).</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 5","pages":"Article 101582"},"PeriodicalIF":4.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530581","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":"Non-invasive ventilation individualisation after major abdominal surgery: Patients’ preference matters","authors":"Maxime Nguyen ,&nbsp;Pierre-Grégoire Guinot","doi":"10.1016/j.accpm.2025.101586","DOIUrl":"10.1016/j.accpm.2025.101586","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 5","pages":"Article 101586"},"PeriodicalIF":4.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561599","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":"Role of ultrasound guided recto-intercostal fascial plane block for right sub-costal incision","authors":"Poonam Kumari,&nbsp;Amarjeet Kumar,&nbsp;Soumya Singh,&nbsp;Chandni Sinha,&nbsp;Smitha CB","doi":"10.1016/j.accpm.2025.101568","DOIUrl":"10.1016/j.accpm.2025.101568","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 5","pages":"Article 101568"},"PeriodicalIF":4.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310584","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":"Liberal vs. restrictive transfusion strategy for acute brain injury: A meta-analysis with trial sequential analysis of randomized clinical trials","authors":"Wen-Wen Tsai ,&nbsp;Jheng-Yan Wu ,&nbsp;Kuan-Hsien Lu ,&nbsp;Hong-Xiang Zheng ,&nbsp;Hung-Hsi Tan ,&nbsp;Chih-Cheng Lai","doi":"10.1016/j.accpm.2025.101566","DOIUrl":"10.1016/j.accpm.2025.101566","url":null,"abstract":"<div><h3>Background</h3><div>Acute brain injury is a critical health challenge with substantial mortality and morbidity. While anemia is common in these patients and may worsen outcomes, the optimal red blood cell transfusion strategy remains controversial.</div></div><div><h3>Objective</h3><div>We conducted a meta-analysis with trial sequential analysis of randomized controlled trials (RCTs) comparing liberal <em>versus</em> restrictive transfusion strategies in patients with acute brain injury.</div></div><div><h3>Methods</h3><div>Pubmed, Embase, and the Cochrane Library databases were searched through December 15, 2024, for RCT comparing liberal (hemoglobin threshold 9−10 g/dL) <em>versus</em> restrictive (hemoglobin threshold 7−8 g/dL) transfusion strategies in adults with acute brain injury. The primary outcome was an unfavorable neurological outcome.</div></div><div><h3>Results</h3><div>Six RCTs involving 2599 patients were included. There was no significant difference in unfavorable neurological outcomes between liberal and restrictive strategies (risk ratio [RR], 0.97; 95% confidence interval [CI], 0.83–1.14; <em>p</em> = 0.70). Similarly, no differences were observed in overall mortality (RR, 0.98; 95% CI, 0.85–1.12; <em>p</em> = 0.75), hospital mortality (RR, 1.02; 95% CI, 0.79–1.31; <em>p</em> = 0.89), or intensive care unit (ICU) mortality (RR, 0.74; 95% CI, 0.28–1.91; <em>p</em> = 0.53). Although transfusion reaction was non-significantly more frequent with liberal transfusion (RR, 1.13; 95% CI, 0.35–3.58; <em>p</em> = 0.84).</div></div><div><h3>Conclusions</h3><div>In patients with acute brain injury, a restrictive transfusion strategy was not associated with worse neurological outcomes or higher mortality compared to a liberal strategy.</div></div><div><h3>Implications for clinical practice</h3><div>Maintaining hemoglobin levels above 7–8 g/dL may be effective for patients with acute brain injury, potentially reducing unnecessary transfusions and associated risks.</div></div><div><h3>Meta-analysis registration</h3><div>registered on PROSPERO under number CRD42025639745.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 5","pages":"Article 101566"},"PeriodicalIF":4.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303380","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":"Safely combining renal replacement therapy and extracorporeal membrane oxygenation","authors":"Frank Bidar ,&nbsp;Matthias Jacquet-Lagreze ,&nbsp;Benoit Bouisset ,&nbsp;Jean-Luc Fellahi ,&nbsp;Thomas Rimmelé","doi":"10.1016/j.accpm.2025.101599","DOIUrl":"10.1016/j.accpm.2025.101599","url":null,"abstract":"<div><div>Extracorporeal membrane oxygenation (ECMO) is an extracorporeal technique used in acute circulatory and respiratory failures refractory to conventional therapies. ECMO patients are at risk of developing severe acute kidney injury, with approximately 50% requiring renal replacement therapy (RRT). Different combinations of RRT and ECMO circuits have been reported: RRT can be performed independently using a specific vascular access or directly integrated into the ECMO circuit. The use of an integrated combination may reduce the risk of vascular access-related complications. However, a comprehensive knowledge of both extracorporeal therapies is required to optimize the management of an integrated combination. We report herein how to safely combine the RRT and ECMO circuits using Cardiohelp® and Xenios® consoles. We suggest connecting RRT on the positive pressure sections of the ECMO circuit, with the return line placed before the oxygenator and without modification of the ECMO circuit. This configuration minimizes the risk of air embolism in the circuit, while the oxygenator prevents any arterial air embolism from entering the patient's circulation. We also outline the factors influencing RRT circuit pressures to assist physicians in effectively managing elevated pressures within the RRT circuit. Last, we explain other combinations of RRT and ECMO that can be performed on other ECMO circuits in case of high pressures.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 5","pages":"Article 101599"},"PeriodicalIF":4.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144849370","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}