European journal of anaesthesiology and intensive care最新文献

{"title":"Impact of a departmental protocol and training on physician confidence in paediatric emergency front of neck access.","authors":"Éanna O'Sullivan, Bill Walsh","doi":"10.1097/EA9.0000000000000049","DOIUrl":"10.1097/EA9.0000000000000049","url":null,"abstract":"","PeriodicalId":520410,"journal":{"name":"European journal of anaesthesiology and intensive care","volume":"3 2","pages":"e0049"},"PeriodicalIF":0.0,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11798368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143367000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative hypotension and its association with acute kidney injury in patients undergoing elective cardiac surgery: a large retrospective cohort study.","authors":"Hilke Jung, Niklas Mohr, Nikolai Hulde, Alexander Krannich, Christian Storm, Vera von Dossow","doi":"10.1097/EA9.0000000000000048","DOIUrl":"10.1097/EA9.0000000000000048","url":null,"abstract":"<p><strong>Background: </strong>Intraoperative hypotension (IOH) is known to affect renal outcomes in noncardiac surgery. However, it is unclear whether intraoperative hypotension (IOH) causes postoperative acute kidney injury following cardiac surgery.</p><p><strong>Objective: </strong>This study aimed to determine whether the duration of IOH during cardiac surgery is associated with the incidence of postoperative acute kidney injury (AKI) and identify its impact on long-term outcomes.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Academic university hospital (Heart and Diabetes Center, Bad Oeynhausen, Germany).</p><p><strong>Patients: </strong>A cohort of 28 909 patients who underwent elective cardiac surgery between 1 January 2009 and 31 December 2018.</p><p><strong>Interventions: </strong>IOH was defined as intraoperative mean arterial blood pressure (MAP) of less than 60 mmHg for more than 2 min. The cumulative duration of these IOH events was recorded each patient.</p><p><strong>Main outcome measures: </strong>The primary outcome was the incidence of AKI according to the KDIGO criteria (Kidney Disease: Improving Global Outcomes). Logistic regression analysis was used to analyse the associations between IOH and the incidence of AKI. Secondary outcomes were the independent predictors for the incidence of AKI.</p><p><strong>Results: </strong>Postoperative AKI was observed in 42.9% of patients. The cumulative duration of IOH (minutes) had a significant influence on the incidence of AKI [odds ratio (OR) 1.004; 95% confidence interval (CI) 1.003 to 1.005; <i>P</i> < 0.001] (<i>P</i> > 0.001 versus <i>P</i> < 0.001). The survival time was significantly shorter in patients with a higher cumulative duration of IOH, patients aged more than 70 years, and those who developed AKI (<i>P</i> < 0.001). Logistic regression analysis identified eight predictors of AKI: age, cumulative duration of IOH, duration of surgery, chronic obstructive pulmonary disease, body mass index, type of surgery, American Society of Anesthesiologists stage, and Euroscore 2.</p><p><strong>Conclusions: </strong>The cumulative duration of IOH is an independent risk factor for the occurrence of postoperative AKI after cardiac surgery.</p><p><strong>Trial registration: </strong>Ethics Committee of the Ruhr University Bochum (Register number 2019-491).</p>","PeriodicalId":520410,"journal":{"name":"European journal of anaesthesiology and intensive care","volume":"3 2","pages":"e0048"},"PeriodicalIF":0.0,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11798382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143367134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Initial experience with the anaesthetic management of fetoscopic spina bifida repair at a German University Hospital: A case series of 15 patients.","authors":"Nicolas Schmitt, Ann-Kristin Schubert, Hinnerk Wulf, Corinna Keil, Caitlin Dooley Sutton, Ivonne Bedei, Gerald Kalmus","doi":"10.1097/EA9.0000000000000047","DOIUrl":"10.1097/EA9.0000000000000047","url":null,"abstract":"<p><p>Spina bifida aperta (SBA) is a serious neural tube defect that can lead to a range of disabilities and health complications in affected individuals. In recent years, fetoscopic surgical repair has emerged as a promising new approach to treat spina bifida prenatally, offering the potential for improved outcomes compared with traditional open surgery. As one of the few centres in Europe to offer this innovative technique, the Departments of Obstetrics and Gynaecology, Neurosurgery, and Anaesthesiology and Intensive Care Medicine at the University Medical Centre of Marburg (UKGM Marburg) have faced unique challenges in developing and establishing standards of care for the pregnant patients undergoing this complex procedure. In this publication, we aim to present details of our initial experience with the first 15 patients and propose a clinical concept for the rather complex perioperative management of these patients.</p>","PeriodicalId":520410,"journal":{"name":"European journal of anaesthesiology and intensive care","volume":"3 2","pages":"e0047"},"PeriodicalIF":0.0,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11798392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143367060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrophysiological monitoring of neurological functions at the acute phase of brain injury: An overview of current knowledge and future perspectives in the adult population.","authors":"Florent Gobert, Frédéric Dailler, Sylvain Rheims, Nathalie André-Obadia, Baptiste Balança","doi":"10.1097/EA9.0000000000000044","DOIUrl":"10.1097/EA9.0000000000000044","url":null,"abstract":"<p><p>The continuous monitoring of physiological parameters is now considered as a standard of care in intensive care units (ICU). While multiple techniques are available to guide hemodynamic or respiratory management, the monitoring of neurological function in unconscious patients is usually limited to discontinuous bedside neurological examination or morphological brain imaging. However, cortical activity is accessible at the bedside with electroencephalography (EEG), electrocorticography (ECoG) or evoked potentials. The analysis of the unprocessed signal requires a trained neurophysiologist and could be time consuming. During the past decades, advances in neurophysiological signal acquisition make it possible to calculate quantified EEG parameters in real-time. New monitors also provide ICU friendly display for a dynamic and live assessment of neurological function changes. In this review, we will describe the technical aspects of EEG, ECoG and evoked potentials required for a good signal quality before interpretation. We will discuss how to use those electrophysiological techniques in the ICU to assess neurological function in comatose patients at the acute phase of brain injuries such as traumatic brain injuries, haemorrhagic or ischemic stroke. We will discuss, which quantitative EEG or evoked potentials monitoring parameters can be used at the bedside to guide sedation, evaluate neurological function during awaking and look for new neurological (encephalic or brainstem) injuries. We will present the state of the art and discuss some analyses, which may develop shortly.</p>","PeriodicalId":520410,"journal":{"name":"European journal of anaesthesiology and intensive care","volume":"3 2","pages":"e0044"},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11798378/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of tier three therapies in acute brain injured patients: Insight from the Extubation strategies in Neuro-Intensive care unit patients and associations with Outcomes observational study.","authors":"Carolina Iaquaniello, Fabio Gallo, Raphael Cinotti, Giuseppe Citerio, Fabio S Taccone, Paolo Pelosi, Rafael Badenes, Chiara Robba","doi":"10.1097/EA9.0000000000000043","DOIUrl":"10.1097/EA9.0000000000000043","url":null,"abstract":"<p><strong>Background: </strong>In patients with acute brain injury (ABI) and refractory intracranial hypertension, the so-called 'tier three therapies' (TTT) (hypothermia, metabolic suppression with barbiturates, and decompressive craniectomy) may be used.</p><p><strong>Objective: </strong>We aimed to describe the incidence of use of TTT, and to assess their effect on outcome.</p><p><strong>Design: </strong>A secondary analysis of the ENIO observational study.</p><p><strong>Setting: </strong>Seventy-three intensive care units (ICUs) in 18 countries worldwide between June 2018 and November 2020.</p><p><strong>Patients: </strong>One thousand five hundred and twelve adult patients admitted to an intensive care unit (ICU) with ABI were included and categorised according to use or not of one or more TTT.</p><p><strong>Results: </strong>Three hundred and ninety-six patients (26.2%) received at least one TTT during the ICU stay. Five patients (0.3%) received all three TTT. TTT patients were younger (<i>P</i> < 0.0001), less likely to have a preinjury history of hypertension (<i>P</i> = 0.0008), and less frequently anisocoric within 24 h from ICU admission (<i>P</i> < 0.0001) than those with no tier three therapy. TTT were used less frequently in high-income countries than in upper income and lower middle-income countries (no TTT in 78% of patients in high-income countries, in 60.6% of patients in upper middle-income countries, and in 56.6% of patients in lower middle-income countries; <i>P</i> < 0.0001). TTT were more frequent in patients with traumatic brain injury (TBI) compared with other types of ABI and in patients with invasive intracranial pressure (ICP) monitoring (<i>P</i> < 0.0001). TTT use was associated with a higher incidence of ventilator-associated pneumonia (<i>P</i> < 0.0001), need for tracheostomy (<i>P</i> = 0.0194), and prolonged ICU length of stay (LOS; <i>P</i> < 0.0001) but not with increased ICU or hospital mortality (<i>P</i> = 0.999).</p><p><strong>Conclusion: </strong>Patients with ABI are frequently managed using at least one TTT. Their use varies according to a country's economic resources, the type of ABI, and ICP monitoring and is associated with a higher risk of complications but not with ICU or hospital mortality.</p>","PeriodicalId":520410,"journal":{"name":"European journal of anaesthesiology and intensive care","volume":"3 1","pages":"e0043"},"PeriodicalIF":0.0,"publicationDate":"2024-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11798370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143367236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peri-operative stroke: isolated oculomotor palsy following Hartmann's procedure.","authors":"Craig Alistair Wood","doi":"10.1097/EA9.0000000000000045","DOIUrl":"10.1097/EA9.0000000000000045","url":null,"abstract":"","PeriodicalId":520410,"journal":{"name":"European journal of anaesthesiology and intensive care","volume":"3 1","pages":"e0045"},"PeriodicalIF":0.0,"publicationDate":"2024-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11798395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143367234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survey on the implementation of the European training requirements in anaesthesiology.","authors":"Sibylle Langenecker, Kateryna Bielka, Ted Rees, Kresimir Oremus","doi":"10.1097/EA9.0000000000000046","DOIUrl":"10.1097/EA9.0000000000000046","url":null,"abstract":"","PeriodicalId":520410,"journal":{"name":"European journal of anaesthesiology and intensive care","volume":"3 1","pages":"e0046"},"PeriodicalIF":0.0,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11798404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143367235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness of greenhouse gas emission reductions with desflurane and sevoflurane waste gas recovery: A computer simulation study.","authors":"Stephan Williams, Gabriel Paquin-Lanthier, Laurelie Perret","doi":"10.1097/EA9.0000000000000040","DOIUrl":"10.1097/EA9.0000000000000040","url":null,"abstract":"","PeriodicalId":520410,"journal":{"name":"European journal of anaesthesiology and intensive care","volume":"2 6","pages":"e0040"},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11798371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143367231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis of frailty and implications on surgical process in the elderly: A narrative review.","authors":"Paola Aceto, Chiara Schipa, Ersilia Luca, Chiara Cambise, Claudia Galletta, Concezione Tommasino, Liliana Sollazzi","doi":"10.1097/EA9.0000000000000041","DOIUrl":"10.1097/EA9.0000000000000041","url":null,"abstract":"<p><p>Longevity has increased the proportion of the elderly in the population, and as a result ageing has become the leading factor for diseases such as cerebrovascular and cardiovascular disorders. It also makes surgical procedures more complex with potential life-threatening complications. In order to further investigate the role of ageing in modern healthcare, the term 'frailty' has been proposed to describe a condition of reduced functional reserve that leads to an increased risk of adverse health outcomes. The aim of this study was to review the pathophysiology of frailty and to highlight the most important tools to diagnose it, and their ability to predict the postoperative outcome. There are two major conceptual models that provide guidance for the detection of frailty: the Fried Phenotype Model and the Cumulative Deficit Model. These two main models have provided a base from which the assessment of frailty has developed. Two frailty assessment tools, the modified frailty index and the simplified frailty index play a key role in the preoperative setting because of their predictive power for postoperative risk quantification. Assessments of independence and/or cognitive function represent the main components that an ideal frailty tool should have to identify elderly people who are at risk of postoperative functional and cognitive deterioration. Cognitive impairment undoubtedly has a high association with frailty, but cognitive status is not included in many frailty assessments. In this regard, comprehensive geriatric assessment is a more complete evaluation tool, and it should be used whenever a frailty tool screening gives a positive result. Finally, frailty assessment is useful to explore the cumulative effect of comorbidities on the ageing patients' functional reserves and to identify the appropriate level of in-hospital and postdischarge care.</p>","PeriodicalId":520410,"journal":{"name":"European journal of anaesthesiology and intensive care","volume":"2 6","pages":"e0041"},"PeriodicalIF":0.0,"publicationDate":"2023-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11798398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143367233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Critical and non-critical coronavirus disease 2019 patients: which is the most predictive biomarker for disease severity and outcome?: A multicentre prospective cohort study comparing mid-regional pro-adrenomedullin, inflammatory and immunological patterns.","authors":"Giorgia Montrucchio, Eleonora Balzani, Gabriele Sales, Cesare Bolla, Cristina Sarda, Andrea Della Selva, Massimo Perotto, Fulvio Pomero, Enrico Ravera, Francesca Rumbolo, Tiziana Callegari, Vito Fanelli, Giulio Mengozzi, Luca Brazzi","doi":"10.1097/EA9.0000000000000039","DOIUrl":"10.1097/EA9.0000000000000039","url":null,"abstract":"<p><strong>Background: </strong>Severe acute respiratory syndrome-coronavirus-2 in coronavirus disease 2019 (COVID-19) patients leads to a wide range of clinical manifestations. The evaluation of mid-regional pro-adrenomedullin (MR-proADM) as a prognostic biomarker in noncritical wards (NON-ICU) and intensive care units (ICU), may have a potential in predicting disease severity and outcomes.</p><p><strong>Objective: </strong>To assess the difference in the prognostic power of MR-proADM in NON-ICU wards and in ICUs in a prospective multicentre cohort study.</p><p><strong>Design: </strong>From January to July 2021, all adult COVID-19 patients requiring admission for more than 48 h.</p><p><strong>Setting: </strong>One primary centre and two secondary centre hospitals.</p><p><strong>Patients: </strong>One hundred and twenty-three ICU and 77 NON-ICU patients.</p><p><strong>Intervention: </strong>MR-proADM, lymphocyte subpopulations and immunoglobulins were measured within 48 h and on days 3 and 7. A Log-rank test was used to compare survival curves, using a MR-proADM cut-off value of 1.5 nmol l^-1. The predictive ability for mortality was compared using the area under the curve and 95% confidence interval (CI) of different receiver-operating characteristic curves.</p><p><strong>Main outcome measures: </strong>The first 48 h MR-proADM values were significantly higher in the ICU group (median value 1.10 [IQR, 0.80 to 1.73] pg ml^-1 vs. 0.90 [0.70 to 1.20] pg ml^-1, <i>P</i> = 0.020), and statistically significant changes were observed over time for MR-proADM, CD3+, CD4+ and CD56+. In univariate analysis, MR-proADM was the only biomarker that significantly predicted mortality (<i>P</i> = 0.006). The logistic regression model showed an odds ratio for mortality equal to 1.83 (95% CI, 1.08 to 3.37) <i>P</i> = 0.035 for MR-proADM, 1.37 (1.15 to 1.68) <i>P</i> = 0.001 for MuLBSTA and 1.11 (1.05 to 1.18) <i>P</i> less than 0.001 for SAPS II.</p><p><strong>Conclusion: </strong>MR-proADM admission values and trends over time appear to be a suitable marker of illness severity and a patient's risk of mortality in both ICU and NON-ICU settings. Lymphocyte subpopulation dysfunction seems to play a role in defining the severity of COVID-19 but is limited to ICU setting.</p><p><strong>Trial registration: </strong>on clinicaltrials.gov, NCT04873388 registered on March 2020.</p>","PeriodicalId":520410,"journal":{"name":"European journal of anaesthesiology and intensive care","volume":"2 6","pages":"e0039"},"PeriodicalIF":0.0,"publicationDate":"2023-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11798374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143367232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}