Anaesthesia Critical Care & Pain Medicine最新文献

{"title":"Epidemiology of hypophosphatemia in critical illness: A multicentre, retrospective cohort study","authors":"Antony George Attokaran ,&nbsp;Kyle C White ,&nbsp;Ra'eesa Doola ,&nbsp;Philippa McIlroy ,&nbsp;Siva Senthuran ,&nbsp;Stephen Luke ,&nbsp;Peter Garrett ,&nbsp;Alexis Tabah ,&nbsp;Kiran Shekar ,&nbsp;Felicity Edwards ,&nbsp;Hayden White ,&nbsp;James PA McCullough ,&nbsp;Rod Hurford ,&nbsp;Pierre Clement ,&nbsp;Kevin B Laupland ,&nbsp;Mahesh Ramanan","doi":"10.1016/j.accpm.2024.101410","DOIUrl":"10.1016/j.accpm.2024.101410","url":null,"abstract":"<div><h3>Introduction</h3><div>Hypophosphatemia is common in critically ill patients. We have described the epidemiology of hypophosphatemia in patients admitted to the Intensive Care Units.</div></div><div><h3>Methods</h3><div>A multicentre, retrospective cohort study of 12 ICUs in Queensland, Australia from January 1st, 2015, to December 31st, 2021. Exclusions included readmissions, renal replacement therapy, end-stage renal disease, and palliative intent admissions and transfers from other ICUs. Patients were classified into four groups based on the severity of the first episode of low serum phosphate (PO₄): “None” (PO4: ≥0.81 mmol/L, “Mild” (PO4: ≥0.50 &amp; &lt;0.81 mmol/L) “Moderate” (PO4: ≥0.30 &amp; &lt;0.50 mmol/L) and “Severe” (PO4: &lt;0.30 mmol/L). A mixed-effect logistic regression model, including hospital as a random effect, was developed to examine factors associated with 90-day case fatality.</div></div><div><h3>Results</h3><div>Of the 89,776 patients admitted, 68,699 patients were included in this study, with 23,485 (34.2%) having hypophosphatemia with onset mostly on Day 2 of ICU admission and correcting to normal 3 days after hypophosphatemia was identified. There was substantial variation among participating ICUs in phosphate replacement; the threshold, and the route by which it was replaced. Day-90 case fatality increased with severity of hypophosphatemia (None: 3974 (8.8%), Mild: 2306 (11%), Moderate: 377 (14%); Severe: 108 (21%) (<em>p</em> &lt; 0.001)). Multivariable regression analysis showed that compared to those without hypophosphatemia, patients with moderate (odds ratio (OR) 1.24; 95% confidence intervals (CI) 1.07–1.44; <em>p</em> = 0.004) or severe (OR 1.49; 95% CI 1.13–1.97; <em>p</em> = 0.005) hypophosphatemia had increased risk of 90-day case fatality.</div></div><div><h3>Conclusion</h3><div>Hypophosphatemia was common, and mostly occurred on day 2 with early correction of serum phosphate. Phosphate replacement practices were variable among ICUs. Moderate and severe hypophosphatemia was associated with increased 90-day case fatality.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 5","pages":"Article 101410"},"PeriodicalIF":3.7,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876381","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":"Optimizing antibiotic prophylaxis in obese patients undergoing surgery: Weight-based dosing on the rocks?","authors":"Sylvain Goutelle ,&nbsp;Matthieu Boisson","doi":"10.1016/j.accpm.2024.101412","DOIUrl":"10.1016/j.accpm.2024.101412","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 5","pages":"Article 101412"},"PeriodicalIF":3.7,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876428","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 of velocity-pressure loop-derived values recorded during neurosurgical procedures with postoperative organ failure biomarkers: a retrospective single-center study","authors":"","doi":"10.1016/j.accpm.2024.101405","DOIUrl":"10.1016/j.accpm.2024.101405","url":null,"abstract":"<div><h3>Background</h3><div>Perioperative renal and myocardial protection primarily depends on preoperative prediction tools, along with intraoperative optimization of cardiac output (CO) and mean arterial pressure (MAP). We hypothesise that monitoring the intraoperative global afterload angle (GALA), a proxy of ventricular afterload derived from the velocity pressure (VP) loop, could better predict changes in postoperative biomarkers than the recommended traditional MAP and CO.</div></div><div><h3>Method</h3><div>This retrospective monocentric study included patients programmed for neurosurgery with continuous VP loop monitoring. Patients with hemodynamic instability were excluded. Those presenting a 1-day post-surgery increase in creatinine, B-type natriuretic peptide, or troponin Ic us were labelled Bio+, Bio− otherwise. Demographics, intra-operative data, and comorbidities were considered as covariates. The study aimed to determine if intraoperative GALA monitoring could predict early postoperative biomarker disruption.</div></div><div><h3>Result</h3><div>From November 2018 to November 2020, 86 patients were analysed (Bio+/Bio− = 47/39). Bio+ patients were significantly older (62 [54−69] vs. 42 [34−57] years, <em>p</em> &lt;  0.0001), More often hypertensive (25% vs. 9%, <em>p</em> = 0.009), and more frequently treated with antihypertensive drugs (31.9% vs. 7.7%, <em>p</em> = 0.013). GALA was significantly larger in Bio+ patients (40 [31−56] vs. 23 [19–29] °, <em>p</em> &lt; 0.0001), while CO, MAP, and cumulative time spent &lt;65mmHg were similar between groups. GALA exhibited strong predictive performances for postoperative biological deterioration (AUC = 0.88 [0.80−0.95]), significantly outperforming MAP (MAP AUC = 0.55 [0.43−0.68], <em>p</em> &lt; 0.0001).</div></div><div><h3>Conclusion</h3><div>GALA under general anaesthesia prove more effective in detecting patients at risk of early cardiac or renal biological deterioration, compared to classical hemodynamic parameters.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 5","pages":"Article 101405"},"PeriodicalIF":3.7,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141601980","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":"Dexmedetomidine, more than just an anaesthetic aid? An overview of latest evidence","authors":"","doi":"10.1016/j.accpm.2024.101406","DOIUrl":"10.1016/j.accpm.2024.101406","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 5","pages":"Article 101406"},"PeriodicalIF":3.7,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141591796","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":"Perioperative Patient Blood Management (excluding obstetrics): Guidelines from the French National Authority for Health","authors":"","doi":"10.1016/j.accpm.2024.101404","DOIUrl":"10.1016/j.accpm.2024.101404","url":null,"abstract":"<div><div>The French National Authority for Health (HAS) recently issued guidelines for patient blood management (PBM) in surgical procedures. These recommendations are based on three usual pillars of PBM: optimizing red cell mass, minimizing blood loss and optimizing anemia tolerance. In the preoperative period, these guidelines recommend detecting anemia and iron deficiency and taking corrective measures well in advance of surgery, when possible, in case of surgery with moderate to high bleeding risk or known preoperative anemia. In the intraoperative period, the use of tranexamic acid and some surgical techniques are recommended to limit bleeding in case of high bleeding risk or in case of hemorrhage, and the use of cell salvage is recommended in some surgeries with a major risk of transfusion. In the postoperative period, the limitation of blood samples is recommended but the monitoring of postoperative anemia must be carried out and may lead to corrective measures (intravenous iron in particular) or more precise diagnostic assessment of this anemia. A “restrictive” transfusion threshold considering comorbidities and, most importantly, the tolerance of the patient is recommended postoperatively. The implementation of a strategy and a program for patient blood management is recommended throughout the perioperative period in healthcare establishments in order to reduce blood transfusion and length of stay. This article presents an English translation of the HAS recommendations and a summary of the rationale underlying these recommendations.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 5","pages":"Article 101404"},"PeriodicalIF":3.7,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141591797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of beta-blockers in major surgery and critical care: The right use may be in the details","authors":"","doi":"10.1016/j.accpm.2024.101403","DOIUrl":"10.1016/j.accpm.2024.101403","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 5","pages":"Article 101403"},"PeriodicalIF":3.7,"publicationDate":"2024-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141555766","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":"Impact of universal use of a hyperangulated videolaryngoscope as the first option for all intubations in the ICU: A prospective before-after study","authors":"","doi":"10.1016/j.accpm.2024.101402","DOIUrl":"10.1016/j.accpm.2024.101402","url":null,"abstract":"<div><h3>Background</h3><div>Tracheal intubation in ICU is associated with high incidence of difficult intubations. The study aimed to investigate whether the “universal” use of a hyperangulated videolaryngoscope would increase the frequency of “easy intubation” in ICU patients compared to direct laryngoscopy.</div></div><div><h3>Methods</h3><div>A prospective before-after study was conducted. The pre-interventional period (36 months) involved tracheal intubations using direct laryngoscopy as the first intubation option. In the interventional period (18 months) a hyperangulated videolaryngoscope was the first intubation option. The primary outcome was the percentage of patients with “easy intubation” defined as intubation on the first attempt and easy laryngoscopy (modified Cormack-Lehane glottic view of I-IIa). Secondary outcomes included difficult laryngoscopy, operator technical difficulty, and complications.</div></div><div><h3>Results</h3><div>We enrolled 407 patients, 273 in non-interventional period, and 134 in interventional period. Tracheal intubation in the interventional period was associated with higher incidence of “easy intubation” (92.5%) compared with the non-interventional period (75.8%); <em>P</em> &lt; 0.001)). Glottic visualization improved in the interventional period, with a reduced incidence of difficult laryngoscopy (1.5% <em>vs.</em> 22.5%; <em>P</em> &lt; 0.001). The proportion of first-success rate intubation was 92.5% in the interventional period, and 87.8% in the non-interventional period (<em>P</em> = 0.147). Moderate and severe technical difficulty of intubation reported decreased in the interventional period (6% <em>vs.</em> 17.6%; <em>P</em> &lt; 0.001). There was no significant difference between both periods in the incidence of complications.</div></div><div><h3>Conclusion</h3><div>“Universal” use of hyperangulated videolaryngoscopy for tracheal intubation in patients admitted in ICU improves the percentage of <em>easy intubation</em> compared to direct laryngoscopy.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 5","pages":"Article 101402"},"PeriodicalIF":3.7,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141535758","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":"Comparing analgesic efficacy of different-dose intrathecal morphine after cesarean delivery with spinal anesthesia","authors":"Fu-Shan Xue ,&nbsp;Nong He ,&nbsp;Yi Cheng","doi":"10.1016/j.accpm.2024.101400","DOIUrl":"10.1016/j.accpm.2024.101400","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 4","pages":"Article 101400"},"PeriodicalIF":3.7,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141187177","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":"Pediatric intensive care unit follow-up: Thinking before acting","authors":"Guillaume Mortamet ,&nbsp;Sandrine Birsan ,&nbsp;Justine Zini ,&nbsp;Luc Morin ,&nbsp;Karine Kolev ,&nbsp;Sonia Pelluau ,&nbsp;Marie Pouletty ,&nbsp;Denis Thiberghien ,&nbsp;Sophie Beldjilali ,&nbsp;Olivier Brissaud ,&nbsp;Christophe Milési ,&nbsp;Camille Brotelande ,&nbsp;Audrey Dupont ,&nbsp;Marion Giraud ,&nbsp;Sophie Ariane Hassid ,&nbsp;Michael Tsapis ,&nbsp;Aben Essid ,&nbsp;Clélia Villemain ,&nbsp;Sandrine De Sampaio ,&nbsp;Sarah Troff ,&nbsp;Michael Levy","doi":"10.1016/j.accpm.2024.101401","DOIUrl":"10.1016/j.accpm.2024.101401","url":null,"abstract":"<div><h3>Objective</h3><p>It is now well established that post-intensive care syndrome is frequent in critically ill children after discharge from the pediatric intensive care unit (PICU). Nevertheless, post-intensive care follow-up is highly heterogenous worldwide and is not considered routine care in many countries. The purpose of this viewpoint was to report the reflections of the French PICU society working group on how to implement post-PICU follow-up.</p></div><div><h3>Methods</h3><p>A working group was set up within the Groupe Francophone de Reanimation et d’Urgences Pédiatriques (GFRUP) to provide conceptual and practical guidance for developing post-PICU follow-up. The working group included psychologists, PICU physicians, physiotherapists, and nurses, from different French PICUs. Five virtual meetings have been held.</p></div><div><h3>Results</h3><p>First, we described in this work the objectives of the follow-up program and the population to be targeted. We also provided a framework to implement post-PICU follow-up in clinical practice. Finally, we detailed the potential obstacles and challenges to consider.</p></div><div><h3>Conclusion</h3><p>Although implementing a post-PICU follow-up program is a challenge, the benefits could be significant for both patient and relatives, as well as for the health care professionals involved.</p></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 4","pages":"Article 101401"},"PeriodicalIF":3.7,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352556824000596/pdfft?md5=fd9a640506005c4a765595c9c770214a&pid=1-s2.0-S2352556824000596-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141187178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can bacterial culture be used as a golden standard for diagnostic research of multiplex PCR? Implications to its reporting in meta-analysis","authors":"Teuku Fais Duta ,&nbsp;Muhammad Iqhrammullah","doi":"10.1016/j.accpm.2024.101399","DOIUrl":"10.1016/j.accpm.2024.101399","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 4","pages":"Article 101399"},"PeriodicalIF":3.7,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141185109","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}