Anaesthesia Critical Care & Pain Medicine最新文献

{"title":"Post-induction hypotension during rapid sequence intubation in the operating room: A post hoc analysis of the randomized controlled REMICRUSH trial","authors":"Nicolas Grillot ,&nbsp;Victoire Gonzalez ,&nbsp;Romain Deransy ,&nbsp;Armine Rouhani ,&nbsp;Guillaume Cintrat ,&nbsp;Paul Rooze ,&nbsp;Edouard Naux ,&nbsp;Christelle Volteau ,&nbsp;Marwan Bouras ,&nbsp;Raphael Cinotti ,&nbsp;Antoine Roquilly","doi":"10.1016/j.accpm.2025.101502","DOIUrl":"10.1016/j.accpm.2025.101502","url":null,"abstract":"<div><h3>Background</h3><div>We explored the risk factors of post-induction hypotension during rapid sequence intubation.</div></div><div><h3>Methods</h3><div>We performed an ancillary analysis of a multicenter randomized clinical trial comparing remifentanil <em>versus</em> neuromuscular blockers associated with hypnotic in patients at risk for aspiration who underwent tracheal intubation in the operating room. The primary outcome was post-induction hypotension, defined as an episode of hypotension (MBP ≤ 55 mmHg and/or SBP ≤ 80 mmHg) within 10 min after anesthetic induction.</div></div><div><h3>Results</h3><div>From 15 hospitals, 1137 adult patients were included, and 291 (26%) had post-induction hypotension. Propofol was used in 1117 (98%) patients and was associated with low doses of ketamine in 209 (18 %) patients. The independent risk factors associated with post-induction hypotension were age (OR 1.03, 95% CI [1.02; 1.04] <em>p</em> &lt; 0.0001), baseline heart rate (<em>p</em> = 0.0068), bowel occlusion requiring nasogastric tube placement before intubation (OR 1.96, 95% CI [1.33; 2.87] <em>p</em> = 0.0006) and use of remifentanil (OR 3.54, 95%CI (2.61; 4.81) <em>p</em> &lt; 0.0001). Use of low doses of ketamine (OR 0.61, 95% CI [0.41; 0.92] <em>p</em> = 0.0175) and basal SBP (OR 0.98, 95% CI [0.97; 0.99] <em>p</em> &lt; 0.0001) were protective factors. The precision of the final model including the above-mentioned variables gave an AUC of 0.74 [95% CI 0.71; 0.77] for post-induction hypotension prediction.</div></div><div><h3>Conclusions</h3><div>Post-induction hypotension was frequent during rapid sequence intubation. Sedation associating propofol with low doses of ketamine was associated with a low risk of post-induction hypotension. Further studies are required to demonstrate a causal effect.</div></div><div><h3>Registration</h3><div>ClinicalTrials.gov NCT03960801</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 3","pages":"Article 101502"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630961","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":"Relationship between high-density lipoprotein cholesterol (HDL-C) concentration and ventilator-associated pneumonia in ICU COVID-19 patients.","authors":"Stefan Andrei, Meilhac Olivier, Christian De Tymowski, Aurélie Snauwaert, Jules Stern, Tiphaine Robert, Brice Lortat-Jacob, Enora Atchade, Elie Kantor, Floran Begue, Philippe Montravers, Sébastien Tanaka","doi":"10.1016/j.accpm.2025.101535","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101535","url":null,"abstract":"<p><strong>Background: </strong>Ventilator-associated pneumonia (VAP) is frequent during severe COVID-19 infection, but diagnosis remains difficult. During bacterial sepsis and COVID-19, high-density lipoprotein cholesterol (HDL-C) concentration is decreased. Furthermore, HDL particles exerting in normal conditions endothelial-protective effects are dysfunctional in bacterial sepsis. The lipidic profile in COVID-19 with associated bacterial infections is unexplored. The aim of the present study was to determine the relationship between HDL-C concentration on admission to the intensive care unit (ICU) for COVID-19 and the occurrence of VAP.</p><p><strong>Methods: </strong>French prospective study (LIPICOR study) recording HDL-C concentration during severe COVID-19 in ICU. VAP episodes were reported prospectively.</p><p><strong>Results: </strong>122 patients were consecutively included in the analysis between October 2020 and May 2021. A total of 32 patients (26%) developed at least one VAP episode during the ICU stay. The median delay of VAP occurrence was 7 [3,10] days. Upon ICU admission, the median HDL-C concentration was 0.80 [0.65, 1.03] mmol/L. HDL-C was significantly higher in patients who secondarily developed VAP (HDL-C: 0.93 mmol/L [0.79, 1.12] vs. 0.77 mmol/L [0.63, 0.99], p =  0.003). Surprisingly, multivariable analyses with VAP showed that HDL-C at admission is associated with the occurrence of VAP (HR = 3.91 (1.45-10.5), p =  0.007). VAP occurrence in patients with HDL-C levels above 0.8 mmol/L at admission was higher (log-rank test, p =  0.003).</p><p><strong>Conclusion: </strong>Increased HDL-C concentration on admission is strongly associated with the occurrence of VAP during severe COVID-19 infection.</p><p><strong>Registration: </strong>ClinicalTrials.gov Identifier: NCT05113836.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101535"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043928","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 sodium-glucose cotransporter 2 inhibitors in perioperative and intensive care settings","authors":"Marc-Olivier Fischer ,&nbsp;Pierre-Grégoire Guinot","doi":"10.1016/j.accpm.2025.101511","DOIUrl":"10.1016/j.accpm.2025.101511","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 3","pages":"Article 101511"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754849","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":"Meeting the needs of every child: Time to set the highest expectations","authors":"W. Habre ,&nbsp;N. Disma","doi":"10.1016/j.accpm.2025.101538","DOIUrl":"10.1016/j.accpm.2025.101538","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 3","pages":"Article 101538"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143948676","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":"Adjuvant nefopam versus standard of care in mechanically ventilated surgical critically ill patients: A randomized, double-blind controlled study","authors":"Mohammed Gamal Abdelraouf ,&nbsp;Samar Farghali Farid ,&nbsp;Ahmed Mohammed Mukhtar ,&nbsp;Nirmeen Ahmed Sabry","doi":"10.1016/j.accpm.2025.101518","DOIUrl":"10.1016/j.accpm.2025.101518","url":null,"abstract":"<div><h3>Background</h3><div>Multimodal analgesia, through combining different classes of analgesia that target pain pathways with different mechanisms reduces opioid consumption. This study aimed to determine the impact of adjunct nefopam infusion on opiate consumption when added to standard-of-care analgesia and sedation in mechanically ventilated critically ill patients.</div></div><div><h3>Methods</h3><div>This was a prospective, randomized, active control, double-blind study. Patients admitted to the ICU, being mechanically ventilated and candidates for analgesia and sedation protocols were randomized to the intervention group (<em>n</em> = 30) or to the control group (<em>n</em> = 30).</div><div>The primary outcome was the cumulative dose of fentanyl in the first 24 h after inclusion. The secondary outcomes were the proportion of patients with positive pain scores, change in mean arterial pressure (MAP), heart rate (HR), ICU mortality, and others.</div></div><div><h3>Results</h3><div>A total of 60 patients were included in the final analysis; median (Q1, Q3) cumulative fentanyl consumption mcg/24 h was significantly (<em>p</em> = 0.001) lower in the intervention group compared to the control group 1300 (575, 2087.5) <em>vs.</em> 2400 (1612.5, 2665) mcg/24 h respectively. Pain and sedation scores were comparable between the two study groups. ICU mortality was 25 (83.3%) in the intervention group <em>vs</em>. 20 (66.7%) in the control group (<em>P</em> = 0.136).</div></div><div><h3>Conclusions</h3><div>Nefopam was found to be an effective non-opioid option for analgesia in mechanically ventilated surgical and trauma critically ill patients, and more studies are needed to evaluate its safety.</div></div><div><h3>Clinical trial registry and number</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> (identifier: <span><span>NCT05071352</span><svg><path></path></svg></span>).</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 3","pages":"Article 101518"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143904496","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":"Early extubations in children intubated prior to arrival in Paediatric Burn ICU: A single center retrospective study over 1520 admissions","authors":"Sébastien Lebrun ,&nbsp;Nicolas Louvet ,&nbsp;Nada Sabourdin ,&nbsp;Isabelle Constant","doi":"10.1016/j.accpm.2025.101500","DOIUrl":"10.1016/j.accpm.2025.101500","url":null,"abstract":"<div><h3>Background</h3><div>In adult burns intensive care units, more than 30% of patients arriving intubated, are extubated within 2 days (potentially unnecessary intubation, PUNI). Such data are lacking in paediatric populations. Exploring this paediatric PUNI rate was the primary aim of the study.</div></div><div><h3>Methods</h3><div>Data from all the admissions to our paediatric burn intensive care unit were retrospectively analyzed over an 8-years period. Extubations within the first two days among patients arriving intubated were assessed as the primary outcome (PUNI rate). Using a univariate logistic regression and a multivariate model, we analyzed factors associated with intubation lasting more than 2 days (potentially necessary intubation, PNI). Finally, we developed a score to predict the probability of PNI.</div></div><div><h3>Results</h3><div>Among the 1520 admitted children (age: 0–17; Percentage of Total Body Surface Area (%TBSA): 1%–97%), 56 (4%) arrived intubated, 20 (36%) of whom were considered PUNI. These patients had smaller %TBSA burned compared to those having PNI (24% ± 17% <em>vs</em>. 48% ± 24%, <em>p</em> = 0.002). We developed a score based on factors independently associated with PNI: %TBSA burned (OR = 1.12 [1.09–1.15] for each additional per cent), flame burns (OR = 4.43 [1.64–11.6]) and facial burns (OR = 12.28 [3.41–67.4]). Seven children (&lt;0.5%) were intubated after admission.</div></div><div><h3>Conclusion</h3><div>Intubation before admission to a burn intensive care unit was less frequent in children. The paediatric rate of PUNI, however, was close to findings reported in adults: approximately one-third of intubated children were extubated within 2 days.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 3","pages":"Article 101500"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484417","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":"Weaning from external ventricular drainage after non-traumatic subarachnoid hemorrhage: Rapid vs. gradual weaning and predicting closure trial failure. The SEVDVE retrospective multicenter cohort study","authors":"Henri Lomo ,&nbsp;Joseph Brasselet ,&nbsp;Hélène Gohel ,&nbsp;Simon Praud ,&nbsp;Vincent Roux ,&nbsp;Julie Faule ,&nbsp;Tiphaine Bernard ,&nbsp;Karim Lakhal ,&nbsp;Yoann Launey ,&nbsp;Etienne Botquelen ,&nbsp;Claire Dahyot-Fizelier ,&nbsp;Antoine Roquilly ,&nbsp;Maeva Campfort ,&nbsp;Maxime Leger ,&nbsp;Sigismond Lasocki ,&nbsp;for ATLANREA study Group","doi":"10.1016/j.accpm.2025.101508","DOIUrl":"10.1016/j.accpm.2025.101508","url":null,"abstract":"<div><h3>Background</h3><div>Weaning from external ventricular drainage (EVD) following subarachnoid hemorrhage (SAH) typically requires an EVD closure trial, performed either straightforwardly (rapid weaning) or after gradual elevation of EVD (gradual weaning). We wanted to compare these two methods and build a sore to predict closure trial failure.</div></div><div><h3>Methods</h3><div>Among adult SAH patients, this multicenter (<em>n</em> = 5) retrospective study, compared rapid and gradual EVD weaning methods, and identified factors associated with EVD closure trial failure through logistic regressions. We developed a score to predict closure trial failure by splitting the dataset into training (2/3) and testing (1/3) sets.</div></div><div><h3>Results</h3><div>Among 1141 patients with an EVD between 01/01/2018 and 12/31/2022, 407 were hospitalized for SAH and had at least one EVD weaning attempt, 249 (61%) underwent gradual and 158 (39%) rapid weaning. Rapid weaning was associated with more failure (72 (46%) <em>vs.</em> 86 (35%), <em>p</em> = 0.044), but shorter length of stay (LOS) in both ICU and hospital. EVD closure trial failure was independently associated with prolonged EVD maintenance (<em>p</em> &lt; 0.001), prolonged ICU (<em>p</em> = 0.001) and hospital LOS (<em>p</em> = 0.05). We developed a failure closure score using the difference in intracranial pressures (from H0 to H3 after closure), time since EVD insertion, and EVD level. The model’s area under the receiver operating curve was 0.63 [0.53–0.74], indicating fair discrimination ability.</div></div><div><h3>Conclusions</h3><div>EVD weaning strategies vary across centres. Rapid weaning was associated with a high risk of closure trial failure, but shorter LOS. EVD closure trial failure was associated with worse outcomes. A simple 3-criteria score could help.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 3","pages":"Article 101508"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143650346","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":"Elevating anesthesia standards for adult congenital heart disease patients: comprehensive guidelines for non-cardiac surgery.","authors":"Magalie Ladouceur, Tuan-Chen Aw, Michael A Gatzoulis","doi":"10.1016/j.accpm.2025.101541","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101541","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101541"},"PeriodicalIF":3.7,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991365","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":"Guidelines for anaesthesia of adults with congenital heart disease in non-cardiac surgery","authors":"Anais Caillard ,&nbsp;Aude Carillion ,&nbsp;Elise Langouet ,&nbsp;Thomas Clavier ,&nbsp;Osama Abou-Arab ,&nbsp;on behalf of the SoMe Team of ACCPM","doi":"10.1016/j.accpm.2025.101539","DOIUrl":"10.1016/j.accpm.2025.101539","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 4","pages":"Article 101539"},"PeriodicalIF":3.7,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143922389","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":"Guidelines for anaesthesia of adults with congenital heart disease in non-cardiac surgery.","authors":"Nadir Tafer, Elise Langouet, Xavier Alacoque, Pascal Amedro, Miréla Bojan, Marie Bruyère, Bernard Cholley, Catherine Koffel, Magalie Ladouceur, Stéphane Lebel, Bertrand Leobon, Loïc Mace, Estelle Morau, Caroline Ovaert, Jean-Benoît Thambo, Diane Zotnik, Hugues de Courson, Marc-Olivier Fischer","doi":"10.1016/j.accpm.2025.101540","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101540","url":null,"abstract":"<p><strong>Objective: </strong>To provide guidelines for the anesthetic management of adults with congenital heart disease for non-cardiac surgery.</p><p><strong>Design: </strong>A consensus committee of 16 experts was convened. A formal conflict-of-interest (COI) policy was developed at the beginning of the process and enforced throughout. The entire guidelines process was conducted independently of any industrial funding (i.e., pharmaceutical, medical devices). The authors were required to follow the rules of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE®) system to guide the assessment of the quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized.</p><p><strong>Methods: </strong>The committee studied 10 questions within 4 fields: preoperative evaluation, intraoperative management, postoperative care, and obstetrics. Each question was formulated in a PICO (Patients Intervention Comparison Outcome) format and evidence profiles were produced. The literature review and recommendations were made according to the GRADE® methodology.</p><p><strong>Results: </strong>The experts' synthesis work and the application of the GRADE® method resulted in 11 expert opinions. Some of the questions did not find any response in the literature. After one round of scoring, a strong agreement was reached for all recommendations.</p><p><strong>Conclusions: </strong>There was strong agreement among experts for 10 recommendations to improve practices for the anesthetic management of adults with congenital heart disease for non-cardiac surgery.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101540"},"PeriodicalIF":3.7,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988914","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}