Acta Anaesthesiologica Scandinavica最新文献

{"title":"Identifying dysphagia in the intensive care unit: Validation of the Swedish version of the Gugging swallowing screen-Intensive care unit.","authors":"Anna Schandl, Liza Bergström, Jenny Selg, Anna Eliasson, Mia Hylèn, Fanny Silfwerbrand, Linda Nymark, Jenny McGreevy, Camilla Brorsson, Thorbjörn Holmlund, Patricia Hägglund","doi":"10.1111/aas.70031","DOIUrl":"10.1111/aas.70031","url":null,"abstract":"<p><strong>Background: </strong>Dysphagia is independently associated with adverse outcomes in intensive care units (ICU). Early identification through dysphagia screening does not occur routinely, negatively impacting optimal patient management. This study aimed to validate the Swedish version of the Gugging Swallowing Screen-Intensive Care Unit (GUSS-IVA).</p><p><strong>Methods: </strong>This is a prospective multicentre study of 56 adult ICU patients with endotracheal intubation exceeding 48 h at three hospitals in Sweden. The GUSS-ICU was translated into Swedish (GUSS-IVA) and used to screen all prolonged intubated patients (>48 h) once extubated. The GUSS-IVA screen was conducted by ICU nursing staff and then compared with a gold standard Flexible Endoscopic Evaluation of Swallowing (FEES) within 2 h of the GUSS-IVA screen. Fifty-one of 56 patients underwent FEES (where assessors were blinded to the GUSS-IVA screen results). Sensitivity and specificity were calculated, as was the area under the receiver operating characteristic curves (AUC) with 95% confidence intervals (CI). For inter-rater reliability, within 2 h of the initial screen, 29/56 patients were GUSS-IVA screened a second time by a nursing staff blinded to the first GUSS-IVA results.</p><p><strong>Results: </strong>Among the 56 patients, 38 (67.9%) were identified as dysphagic using the GUSS-IVA screen. With FEES, 42 of 51 patients (82.4%) were diagnosed with dysphagia; of these, 16 (31.4%) were classified as aspirating. Compared to FEES, GUSS-IVA showed high sensitivity and specificity values (81% and 89%, respectively) with an AUC of 0.85 (95% CI: 0.71-0.95) and a positive predictive value of 97%. High convergent validity was obtained for GUSS-IVA compared with the Dysphagia Outcome Severity Scale (ɸ = 0.57, p < .001) and the Functional Oral Intake Scale (ɸ = 0.52, p < .001) and moderate validity with the Penetration-Aspiration Scale (ɸ = 0.30, p = .033). The inter-rater reliability showed moderate agreement (Cohen's kappa κ = 0.501, p = .006).</p><p><strong>Conclusions: </strong>This study indicates that the Swedish GUSS-IVA is a valid and reliable screen to identify dysphagic ICU patients. Given the negative impact of dysphagia on short and long-term patient outcomes, the Swedish GUSS-IVA is recommended as an essential first step by nursing staff for early identification of dysphagia for further diagnostics and subsequent patient management.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 5","pages":"e70031"},"PeriodicalIF":1.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11947862/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of rehabilitation in the neurointensive care unit on long-term survival in patients with traumatic brain injury.","authors":"Kristin Alvsåker, Rolf Hanoa, Jon Michael Gran, Lisa Maria Högvall, Carl Johan Fredstedt Sogn, Halvard Cartfjord Bech, Theresa Olasveengen","doi":"10.1111/aas.70026","DOIUrl":"10.1111/aas.70026","url":null,"abstract":"<p><strong>Background: </strong>The study aimed to compare the difference in long-term mortality in patients with moderate to severe traumatic brain injury (TBI) receiving Early interdisciplinary rehabilitation (EIR) in our Neurointensive Care Unit (NICU) to patients being discharged from NICU without EIR.</p><p><strong>Methods: </strong>Retrospective observational cohort study of adults aged 18-67 years with moderate to severe TBI (Glasgow Coma Scale 3-14), admitted to the NICU for >72 h from 2010 to 2022. We analyzed mortality differences from the start of follow-up (cessation of sedation in the Standard of care (SC) group and start of EIR in the EIR group) until 31.12.2023, using inverse probability of treatment weighted Cox proportional hazard models and Kaplan-Meier survival curves. Adjustments using weights were made for various variables, including age, days from injury to follow-up start, sociodemographic factors, comorbidities, and injury characteristics.</p><p><strong>Results: </strong>A total of 698 patients were included, 461 received EIR and 237 SC. Sixty-three (27%) patients in the SC group and 59 (13%) patients in the EIR group died by the end of follow-up. In covariate-adjusted Kaplan-Meier curves, estimated survival at the end of follow-up was 56% (95% CI 0.36, 0.69) for the SC group and 74% (95% CI 0.58, 0.83) for the EIR group. Both groups had the highest mortality rate within 30 days. The mortality in the EIR group was significantly lower with an adjusted hazard ratio (HR) at 30 days of 0.57 (95% CI 0.37, 0.87) p-value = .010, and at the end of follow-up of 0.56 (95% CI 0.36, 0.89), p-value = .015.</p><p><strong>Conclusions: </strong>Patients receiving EIR had better long-term survival, with both groups experiencing the highest mortality rate early on. Early rehabilitation in NICU may play an important role in preventing and identifying medical complications and should be explored as a potential mechanism in future prospective trials.</p><p><strong>Editorial comment: </strong>Neurorehabilitation following intensive care for traumatic brain injury is important to help the patients regain function. However, it is uncertain whether survival is improved by the initiation of interdisciplinary rehabilitation already during neurointensive care, consisting of mobilization and training activities of daily living as well as swallowing. This study compared long-term survival in a retrospective cohort of patients with moderate to severe traumatic brain injury and found that those receiving early rehabilitation had a higher long-term survival, which persisted for up to 13 years but was mainly due to improved survival during the first 3 months. Whether this is due to physiological effects or an increased enthusiasm among healthcare providers to continue active treatment is unknown and should be further explored.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 4","pages":"e70026"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11915480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidural analgesia during esophagectomy and esophageal cancer prognosis: A population-based nationwide study in Finland.","authors":"Pia H Petäjäkangas, Olli Helminen, Mika Helmiö, Heikki Huhta, Raija Kallio, Vesa Koivukangas, Arto Kokkola, Simo Laine, Elina Lietzen, Sanna Meriläinen, Vesa-Matti Pohjanen, Tuomo Rantanen, Ari Ristimäki, Jari V Räsänen, Juha Saarnio, Eero Sihvo, Vesa Toikkanen, Tuula Tyrväinen, Antti Valtola, Joonas H Kauppila","doi":"10.1111/aas.70016","DOIUrl":"10.1111/aas.70016","url":null,"abstract":"<p><strong>Background: </strong>The use of epidural analgesia has been proposed to improve the prognosis of esophageal cancer by attenuating the stress response and being less immunosuppressive than opioids. This study aims to evaluate the association, if any, between non-epidural pain management compared to epidural analgesia during minimally invasive or open esophagectomy and esophageal cancer prognosis.</p><p><strong>Materials and methods: </strong>This was a population-based nationwide retrospective cohort study in Finland, using the Finnish National Esophago-Gastric Cancer Cohort (FINEGO). Esophagectomy patients with epidural and no epidural analgesia were compared. Multivariable Cox regression provided hazard ratios (HR) with 95% confidence intervals (CI) non-epidural pain management compared to epidural analgesia, adjusted for the calendar period of surgery, sex, age, comorbidity (Charlson Comorbidity Index), tumor stage, tumor histology, neoadjuvant therapy, type of surgery, and esophageal cancer surgery volume.</p><p><strong>Results: </strong>After exclusions, there were 1381 patients available with information on epidural analgesia. Of these, 969 (70.2%) were men and 832 (60.2%) had esophageal adenocarcinoma. After adjustment for confounding factors, non-epidural pain management was not associated with higher 90-day mortality (HR 1.022 95% CI 0.582-1.794), overall mortality up to 5 years (HR 1.156 95% CI 0.909-1.470), nor with 5 years cancer-specific mortality (HR 1.134 95% CI 0.884-1.456) compared to epidural analgesia.</p><p><strong>Conclusion: </strong>Although the point estimates may hint at a potentially improved prognosis associated with epidural use, this population-based nationwide study suggests no statistically significant association between epidural analgesia during esophagectomy and esophageal cancer prognosis.</p><p><strong>Editorial comment: </strong>This large esophagectomy (cancer) cohort in Finland was used to compare those who received epidural analgesia with those who did not for associations with late mortality in a retrospective analysis and where anesthesia and analgesia treatments were not controlled. The findings showed that when other recognized risks for mortality were taken into account, there was not a meaningful difference in relative risk for late mortality related to the presence or absence of epidural analgesia, though the analgesia treatments were not randomly allocated. These results do not rule out associations of analgesia choice with other outcomes that might be important to patients.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 4","pages":"e70016"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11894786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Training and assessment of skills in flexible optical intubation - Protocol of a scoping review.","authors":"Johan D V Jokinen, Clara Cantby, Anne-Karina A Torkov, Anne C Brøchner, Lars Konge, Anders B Nielsen, Martine S Nielsen","doi":"10.1111/aas.70019","DOIUrl":"10.1111/aas.70019","url":null,"abstract":"<p><strong>Background: </strong>Flexible optical intubation (FOI) is the preferred technique for managing anticipated difficult airways, particularly in awake patients when anatomical factors complicate conventional laryngoscopy. Mastering the procedure requires skills, but a comprehensive overview of the evidence on training and assessment of FOI skills is lacking. There is no evidence-based consensus on educational strategies and recommendations for skill acquisition and retention, thus highlighting a significant gap in airway management training. Accordingly, we aim to assess the current evidence on training and assessment in FOI for future educational recommendations.</p><p><strong>Methods: </strong>This scoping review adheres to the Preferred Reporting Items for Systematic and Meta-Analysis (PRISMA) statement and the PRISMA Extension for Scoping Reviews guideline. Eligible studies include qualitative and quantitative research focusing on education, technical training, and assessment of FOI skills in clinical personnel with no obligate comparator. Outcomes should be assessable using Kirkpatrick's four levels of training evaluation. A systematic literature search will be conducted across multiple databases, including Cochrane Library, EMBASE, Cinahl, Scopus, and PubMed. Two independent authors will screen the studies, with discrepancies resolved by a third reviewer. Extracted data will be analyzed descriptively, with a discussion on potential biases in the included literature. The quality of the studies will be assessed using the Medical Education Research Study Quality Instrument (MERSQI).</p><p><strong>Discussion: </strong>The results of this scoping review may serve as a foundation for educational recommendations. By synthesizing available evidence, this review aims to guide future research and policy recommendations for FOI skill acquisition and maintenance.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 4","pages":"e70019"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11894585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute kidney injury after lung transplantation, incidence, risk factors, and effects: A Swedish nationwide study.","authors":"Edgars Grins, Johanna Wijk, Henrik Bjursten, Maria Zeaiter, Sandra Lindstedt, Göran Dellgren, Per Ederoth, Lukas Lannemyr","doi":"10.1111/aas.70014","DOIUrl":"10.1111/aas.70014","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) is a serious complication after lung transplantation, but the reported incidence varies in the literature. No data on AKI have been published from the Swedish lung transplantation program.</p><p><strong>Methods: </strong>The aim of our study was to investigate the incidence, perioperative risk factors, and effects of early postoperative acute kidney injury (Kidney Disease Improving Global Outcomes [KDIGO] criteria) after lung transplantation. A retrospective, nationwide study of 568 lung-transplanted patients in Sweden between 2011 and 2020 was performed.</p><p><strong>Results: </strong>The incidence of AKI (any grade) was 42%. Renal replacement therapy was used in 5% of the patients. Preoperative factors independently associated with increased incidence of AKI were higher body mass index (odds ratio [OR]: 1.07, 95% CI: 1.02, 1.12) longer time on transplantation waiting list (OR: 1.05 [1.01, 1.09]), re-transplantation (OR: 2.24 [1.05, 4.80]) and moderate to severe tricuspid regurgitation (OR: 2.61 [1.36, 5.03]). Intraoperative factors independently associated with increased incidence of AKI were use of cardiopulmonary bypass (OR: 2.70 [1.57, 4.63]), increasing number of transfused red blood cell units, and use of immunosuppressive therapy other than routine (OR: 2,56 [1.47, 4.46]). A higher diuresis (OR: 0.70, 95% CI: 0.58-0.85) was associated with less incidence of acute kidney injury. Development of AKI was associated with increased time to extubation (median 30 h, IQR [9, 118] vs. 6 [3, 16]), length of stay in the intensive care unit (9 days [4, 25] vs. 3 [2, 5]) and increased rate of primary graft dysfunction (OR 2.33 [1.66, 3.29]) and 30-day mortality (OR: 10.8 [3.0, 69]).</p><p><strong>Conclusions: </strong>Acute kidney injury is common after lung transplantation and affects clinical outcomes negatively. Preoperative factors may be used for risk assessment. The use of cardiopulmonary bypass is a potentially modifiable intraoperative risk factor.</p><p><strong>Editorial comment: </strong>Acute kidney injury is a common complication after lung transplantation that severely influences patient outcomes. This large study of more than 500 patients treated over a decade identified potentially modifiable factors associated with the development of acute kidney injury.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 4","pages":"e70014"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11894586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preferences for thromboprophylaxis in the intensive care unit: An international survey.","authors":"Èmese Robin Hélène Heijkoop, Frederik Keus, Morten Hylander Møller, Anders Perner, Matthew Morgan, Adel Abdelhadi, Nehad Nabeel Mohamed Al Shirawi, Abdulrahman A Al-Fares, Fayez Alshamsi, Prakkash Parangi Ananthan, Anne Sofie Andreasen, Matthew H Anstey, Yaseen M Arabi, Tayyba Naz Aslam, Antony George Attokaran, Morten H Bestle, Neeraj Bhadange, Annika Reintam Blaser, Anne Craveiro Brøchner, Maria Cronhjort, Wojciech Dąbrowski, Ashraf Elhoufi, Begum Ergan, Ricard Ferrer, Ross Freebairn, Tomoko Fujii, Massimiliano Greco, Frank M P van Haren, Thomas Hildebrandt, Peter Buhl Hjortrup, Kwok M Ho, Sandra Jonmarker, Peter Kruger, Manu L N G Malbrain, Jihad Mallat, Prashanti Marella, Mervyn Mer, Tine Sylvest Meyhoff, Marek Nalos, Mohamed Nassef, Rania Omar, Sam Orde, Marlies Ostermann, David Pilcher, Lone Musaeus Poulsen, Sumeet Rai, Kiran Shekar, Martin Siegemund, Martin Ingi Sigurdsson, Bodil Steen Rasmussen, Thomas Tværmose Troelsen, Mette Krag, Paul Young, Karina Meijer, Ruben Julius Eck","doi":"10.1111/aas.70009","DOIUrl":"10.1111/aas.70009","url":null,"abstract":"<p><strong>Background: </strong>Venous thromboembolism (VTE) is a frequent complication in critically ill patients, who often have multiple risk factors. Pharmacological thromboprophylaxis is widely applied to lower this risk, but guidelines lack dosing recommendations.</p><p><strong>Objective: </strong>This survey aims to assess current thromboprophylaxis preferences and willingness to participate in future randomized clinical trials (RCTs) on this topic.</p><p><strong>Method: </strong>We conducted an international online survey between February and May 2023 among intensive care unit (ICU) physicians, including 16 questions about preferences in relation to thromboprophylaxis and preferences on topics for a future RCT. The survey was distributed through the network of the Collaboration for Research in Intensive Care.</p><p><strong>Results: </strong>A total of 715 physicians from 170 ICUs in 23 countries contributed information, with a mean response rate of 36%. In most ICUs, both pharmacological (n = 166, 98%) and mechanical thromboprophylaxis (n = 143, 84%) were applied. A total of 36 pharmacological thromboprophylaxis regimens were reported. Use of low-molecular-weight heparin (LMWH) was most common (n = 149 ICUs, 87%), followed by subcutaneous unfractionated heparin (n = 44 ICUs, 26%). Seventy-five percent of physicians indicated that they used enoxaparin 40 mg (4000 IU), dalteparin 5000 IU, or tinzaparin 4500 IU once daily, whereas 25% reported the use of 16 other LMWH type and dose combinations. Dose adjustment according to weight was common (78 ICUs, 46%). Participants perceived high variation in the application of thromboprophylaxis and were willing to consider an alternative LMWH type (n = 542, 76%) or dose (n = 538, 75%) in the context of an RCT.</p><p><strong>Conclusion: </strong>LMWH was the preferred agent for thromboprophylaxis in critically ill patients. There was considerable variation in the application of LMWH for prophylaxis, reflected by the use of different types, doses, and dosing strategies. Most physicians would be willing to participate in an RCT on thromboprophylaxis.</p><p><strong>Editorial comment: </strong>This survey demonstrates current patterns in implementation preferences for critically ill patients. While there is one approach and drug that is commonly preferred, these findings show that there is some variation in practice.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 4","pages":"e70009"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Training programmes for healthcare professionals in managing epidural analgesia: A scoping review.","authors":"Cornelia Charlotte Lamprecht, Morten Vester-Andersen, Thordis Thomsen, Tanja Eg Thomsen, Anne Mørup-Petersen, Kim Wildgaard","doi":"10.1111/aas.70025","DOIUrl":"10.1111/aas.70025","url":null,"abstract":"<p><strong>Background: </strong>Epidural analgesia (EA) is widely used for postoperative and labour pain management. Systematic training of healthcare professionals, particularly nurses, is essential for the safe administration and management. This scoping review aimed to identify and map existing EA training programmes.</p><p><strong>Methods: </strong>A PRISMA-ScR-guided search was conducted across multiple databases and grey literature. Studies on educational interventions for healthcare professionals in EA management were included. Data extraction and categorisation were performed using Kirkpatrick's Four-Level Training Evaluation Model.</p><p><strong>Results: </strong>Eighteen studies were included, covering classroom training, workshops, self-directed learning, simulation-based training, and on-the-job training. Participants were primarily nurses. Programmes addressed epidural techniques, monitoring and assessment, spinal anatomy and pharmacology, complication management, and patient care. Most studies focused on short-term knowledge gains, with a limited assessment of long-term clinical impacts.</p><p><strong>Conclusion: </strong>Limited research exists on EA training, with most programmes targeting nurses and relying on classroom-based training. Training structures varied, and evaluations primarily assessed short-term knowledge gains.</p><p><strong>Editorial comment: </strong>The authors conducted a literature search to get an overview of programmes that aimed to train healthcare staff in managing epidural pain relief. Most of the identified 18 studies described classroom teaching and focused primarily on knowledge about complications. Patient contact in this type of training was not reported. The effectiveness of this type of training in a clinical context was difficult to evaluate based on the published evidence.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 4","pages":"e70025"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11912511/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative pain management for caesarean section in Denmark: A survey of current clinical practice.","authors":"Anne Juul Wikkelsø","doi":"10.1111/aas.70012","DOIUrl":"10.1111/aas.70012","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pain relief has a decisive role in recovery and early mother-child bonding. Recent Danish surveys show that 45%-66% of patients experience severe pain following caesarean section. The aim of this survey is to review the standard practice for postoperative pain management currently provided at Danish delivery centres.</p><p><strong>Method: </strong>A questionnaire of 16 questions was sent to the anaesthetist team in charge of obstetric anaesthesia, aiming to explore local standard care for caesarean section and pain management at the postoperative care unit and at the ward. The answers were received between April 2023 and November 2023.</p><p><strong>Results: </strong>All Danish centres provided answers (22/22). Only one centre used intrathecal morphine (dose 40 μg) for postoperative pain management combined with a lipophilic opioid and hyperbaric bupivacaine. The same centre used epidural morphine. The rest relied on oral opioids in addition to NSAID and paracetamol. One centre used opioid-free spinal anaesthesia as standard. Five (23%) centres used extended-release morphine for postoperative treatment. No centres used patient-controlled intravenous opioid analgesia. A total of 16 (73%) centres used truncal nerve blocks for 'rescue' treatment, but only 2 (9%) for prophylaxis. Paracetamol treatment was started before or during surgery in 9 (41%) centres. All centres used NSAID as part of the treatment, but at least 7 (32%) centres had 'perioperative blood loss of more than 1-1.5 L' as a contraindication. Large doses of fentanyl or sufentanil were used for caesarean section under general anaesthesia, and 2 (9%) centres used intravenous morphine before extubation. Difficult cases of severe postoperative pain were solved ad hoc between anaesthetists and obstetricians in all centres.</p><p><strong>Conclusion: </strong>Most Danish delivery centres relied on oral morphine in addition to NSAIDs and paracetamol for postoperative pain management following caesarean section. Use of truncal nerve blocks, wound infiltration and extended-release morphine showed many differences between centres. Intrathecal morphine was hardly used despite international recommendations due to the concern of side effects. A national research initiative (www.cepra.nu) will facilitate the evaluation of evidence and treatment options following caesarean section in Denmark.</p><p><strong>Editorial comment: </strong>Using a survey to examine the standard practice for postoperative pain management after caesarean sections in Danish delivery centres, 22 anaesthesia teams responded, reporting the most common postoperative pain management as oral morphine in addition to NSAID and paracetamol. The responses presented variation in local obstetric anaesthetist standard practice. Reporting of intrathecal morphine for post-op analgesia was also noted.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 4","pages":"e70012"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11868978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frequency and outcomes of critically ill COVID-19 patients with tracheostomy, a retrospective two-center cohort study.","authors":"Louise Elander, Anzal Abdirashid, Henrik Andersson, Jonna Idh, Håkan Johansson, Michelle S Chew","doi":"10.1111/aas.70011","DOIUrl":"10.1111/aas.70011","url":null,"abstract":"<p><strong>Background: </strong>The optimal use of tracheostomy in COVID-19 patients is debated, and considerable uncertainties on the frequency, timing, and outcomes of tracheostomy remain. The objective was to study the frequency and timing of tracheostomy in a real-world population of critically ill COVID-19 patients. The secondary aim was to study whether early tracheostomy was associated with days alive and out of intensive care unit (ICU), days free of invasive mechanical ventilation (IMV), 60-day mortality, ventilator weaning rate, and ICU discharge rate compared to late tracheostomy.</p><p><strong>Methods: </strong>The study is a retrospective two-center cohort study. All COVID-19 patients admitted to critical care in the Region Östergötland County Council, Sweden, between March 2020 and September 2021 were included. Early (≤10 days from tracheal intubation) and late (>10 days) tracheostomy were compared. Through the Swedish intensive care registry, 249 mechanically ventilated COVID-19-positive patients ≥18 years old with respiratory failure were included. The pre-defined primary outcomes were the frequency and timing of tracheostomy. Secondary outcomes were days free of mechanical ventilation and intensive care, ICU discharge rate, ventilator weaning rate, and 60-day mortality.</p><p><strong>Results: </strong>Of 319 identified patients (70% men), 249 (78%) underwent endotracheal intubation. Of these, 145 (58%) underwent tracheostomy and 99 (68%) were performed early. Tracheostomy patients (vs. non-tracheostomy) had fewer IMV-free days and ICU-free days (27 [0-43] vs. 52 [43-55], p < .001, and 24 [0-40] vs. 49 [41-52], p < .001). Late (vs. early) tracheostomy patients had fewer IMV- and ICU-free days (16 [0-31] vs. 36 [0-47], p < .001 and 8 [0-28] vs. 32 [0-44], p < .001). Early tracheostomy (vs. late) was associated with a significantly higher ICU discharge rate (adjusted HR = 0.59, 95% CI [0.40-0.86], p = .006), but not with the weaning rate (adjusted HR = 0.64, 95% CI [0.12-3.32], p = .5) or 60-day mortality (adjusted HR = 1.27, 95% CI [0.61-2.67], p = .5).</p><p><strong>Conclusions: </strong>Tracheostomy is common in critically ill COVID-19 patients. In patients predicted to need a tracheostomy at some point, early, rather than late, tracheostomy might be a means to reduce the time spent in ICU. However, we do not have sufficient evidence to suggest that early tracheostomy reduces mortality or weaning rates, compared with late tracheostomy.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 4","pages":"e70011"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sodium and chloride disturbances in critically ill adult patients: A protocol for a sub-study of the FLUID-ICU cohort study.","authors":"Clara Molin, Sine Wichmann, Martin Schønemann-Lund, Morten H Møller, Morten H Bestle","doi":"10.1111/aas.70028","DOIUrl":"10.1111/aas.70028","url":null,"abstract":"<p><strong>Background: </strong>Disturbances in plasma sodium and chloride are common in adults admitted to the intensive care unit (ICU) and may affect patient outcomes. Fluid administration practices in the ICU have changed in recent years with a trend toward using more restrictive fluid strategies. These changes may have influenced the patterns and proportions of electrolyte disturbances in ICU patients. Therefore, we aim to provide contemporary data on the frequency of hypernatremia, hyponatremia, hyperchloremia, and hypochloremia in adult ICU patients, assess risk factors, and association with clinical outcomes in an international cohort.</p><p><strong>Methods: </strong>This is the protocol for a sub-study of the FLUID-ICU study (\"Fluid administration and fluid accumulation in intensive care units-an international inception cohort study\"). The FLUID-ICU study is a prospective international 14-day inception cohort study with a minimum sample size of 1000 patients from more than 50 ICUs. Patients are followed daily from ICU admission to discharge or death with a maximum of 28 days. A follow-up is performed at Day 90 after ICU admission. The primary outcomes of this sub-study are the proportion of patients with hypernatremia, hyponatremia, hyperchloremia, and hypochloremia. We will assess days alive without the use of life support at Day 90, and risk factors for developing disturbances in sodium and chloride including disease severity by SMS-ICU score, type of ICU, use of diuretics, and presence of fluid accumulation. Furthermore, days alive and out of hospital and mortality at Day 90 will be reported descriptively.</p><p><strong>Conclusion: </strong>In this study, we will provide important new epidemiological data on the burden of sodium and chloride disturbances in adult ICU patients internationally.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 4","pages":"e70028"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}