Acta Anaesthesiologica Scandinavica最新文献

{"title":"Clinical practice and outcomes in European pediatric cardiac anesthesia: A secondary analysis of the APRICOT and NECTARINE studies.","authors":"Albert Gyllencreutz Castellheim, Walid Habre, Tom Giedsing Hansen","doi":"10.1111/aas.14585","DOIUrl":"10.1111/aas.14585","url":null,"abstract":"<p><strong>Background: </strong>Despite advancements in surgical techniques and perioperative care, pediatric cardiac patients remain at an increased risk of adverse events. The APRICOT (2017) study aimed to establish the incidence of severe critical events in children undergoing anesthesia in Europe, while the NECTARINE (2021) study aimed to assess anesthesia practices and outcomes in neonates and infants under 60 weeks postconceptual age. Our goal was to conduct a secondary analysis of the cardiac cohorts from these two studies to determine mortality rates and other outcomes after cardiac procedures at 30 and 90 days, identify factors influencing mortality, illustrate clinical practices, and assess the methodology of the two studies.</p><p><strong>Methods: </strong>Sub-analysis of the data from APRICOT and NECTARINE. Data representativity was assessed through a systematic categorization process. European countries were divided into four income groups based on their gross national income per capita. Subsequently, the total number of patients across all four income groups was calculated for both the Apricot and Nectarine studies, and then the specific contribution of each income group to the total population of each study was determined.</p><p><strong>Results: </strong>This analysis comprised 1016 cases (Apricot, n = 476 and Nectarine, n = 540). There was a considerable variability in clinical practice in Europe. The overall mortality rates were 0.84% (APRICOT) and 8.1% (NECTARINE). In both cohorts, substantial mortality was observed among low-age and low-weight infants. Stratifying the participating countries by income illustrated that the data originated from highest-income and upper-middle-income European countries and were not representative of low-income and middle-income countries.</p><p><strong>Conclusions: </strong>In this secondary analysis of the APRICOT and NECTARINE studies, we found that fatal cases primarily occurred in low-age and low-weight neonates and infants.</p><p><strong>Editorial comment: </strong>This secondary analysis of the APRICOT and NECTARINE studies focused on pediatric cardiac surgical cases. Outcomes differed according to weight and age of the children, where mortality risk was higher for very young and low-weight children.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 3","pages":"e14585"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11780212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143062865","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":"High-dose glucocorticoids in the treatment of postoperative pain after video-assisted thoracoscopic surgery-protocol for systematic review and meta-analysis.","authors":"Bertram Vorm, Anni Nørgaard Jeppesen, Lene Mølgaard Hansen, Mads Lumholdt, Thomas Lass Klitgaard, Allan Vestergaard Danielsen, Peter Juhl-Olsen, Phillip Sperling, Jannie Bisgaard","doi":"10.1111/aas.14577","DOIUrl":"10.1111/aas.14577","url":null,"abstract":"<p><strong>Background: </strong>Video-assisted thoracoscopic surgery (VATS) is widely used in lung cancer surgery, as this technique causes less pain and faster recovery than open thoracotomy. However, significant postoperative pain persists in a number of patients, often leading to increased opioid use and opioid-related adverse events in addition to prolonged admission times. Perioperatively administered glucocorticoids have been demonstrated effective in reducing pain after other types of surgeries, but the effect in VATS remains unclear.</p><p><strong>Methods: </strong>This systematic review will assess the impact of glucocorticoids on postoperative pain in adult patients undergoing VATS. We will include randomised trials comparing higher doses of glucocorticoids to lower doses, placebo or no treatment. The review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement and Cochrane methodology. The certainty of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation system. The primary outcome is standardised dynamic pain scores within 24 h. Secondary outcomes are opioid use, time to first mobilisation, length of hospital stay and numeric rating score >3 at any point within the first 24 h following surgery. Exploratory outcomes are opioid-related adverse effects and glucocorticoid-related adverse effects classified in major and minor events. Data will be meta-analysed with sensitivity and subgroup analyses and trial sequential analyses. Furthermore, we will assess the risk of reporting bias and heterogeneity.</p><p><strong>Conclusion: </strong>This systematic review and meta-analysis will provide an overview of the current evidence of how glucocorticoids affect postoperative pain and recovery in adult patients undergoing VATS.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 3","pages":"e14577"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11757097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143031805","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":"Fluid accumulation in adult ICU patients - A protocol for a scoping review.","authors":"Clara Molin, Sine Wichmann, Martin Schønemann-Lund, Morten Hylander Møller, Morten Heiberg Bestle","doi":"10.1111/aas.14584","DOIUrl":"10.1111/aas.14584","url":null,"abstract":"<p><strong>Introduction: </strong>Fluid accumulation in critically ill patients is associated with adverse outcomes. However, there is a substantial variability in the terminology and definitions used to describe fluid accumulation. We aim to provide an overview of evidence describing fluid accumulation in critically ill adult patients admitted to the intensive care unit (ICU), including how it is defined, patient characteristics associated with fluid accumulation, ICU population, and outcomes assessed.</p><p><strong>Methods: </strong>We will conduct a scoping review prepared according to the Preferred Reporting Items for Systematic and Meta-analysis extension for Scoping reviews (PRISMA-ScR). Pubmed, MEDLINE, EMBASE, and Cochrane Library will be searched systematically. All clinical studies reporting original data and investigating fluid accumulation, as defined by authors, in adult ICU patients will be included. We will assess the study design, the definition of fluid accumulation, ICU population, and the outcomes measured, categorised as patient-important or non-patient important, in the included studies. The results will be reported descriptively. The certainty of evidence will be assessed using a modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE) on the research question level.</p><p><strong>Discussion: </strong>This scoping review will provide an overview of definitions used for fluid accumulation, and describe ICU patient populations, patient characteristics, and outcomes assessed in ICU research.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 3","pages":"e14584"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11757096/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143031803","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":"Adverse event signal analysis of remimazolam using the FDA adverse event reporting system database.","authors":"Hongtao Liu, Zhaoyu Li, Su Yan, Shaopeng Ming","doi":"10.1111/aas.14588","DOIUrl":"10.1111/aas.14588","url":null,"abstract":"<p><strong>Background: </strong>Remimazolam, a novel ultra-short-acting benzodiazepine, has gained popularity in various anesthetic applications due to its pharmacokinetic advantages. However, as its use increases, safety concerns also rise, necessitating thorough examination. Additionally, the limited reports on its side effects require a broader investigation to better understand the drug's safety profile.</p><p><strong>Methods: </strong>This observational study systematically investigated adverse drug events (ADEs) associated with remimazolam using the FAERS database from Q1 2020 to Q4 2023. The primary objective was to assess potential safety signals and provide comprehensive information for clinical and regulatory purposes.</p><p><strong>Results: </strong>A total of 67 cases and 161 ADEs were identified. The incidence of ADEs was higher in patients aged >45 years, particularly those >65 years. Intravenous general anaesthesia was the most common administration method. Notable ADE signals included serious events such as allergic reactions, respiratory and cardiac arrest, and vascular access occlusion.</p><p><strong>Conclusion: </strong>Clinicians should be vigilant about potential allergic reactions to remimazolam, especially in older patients, and avoid off-label use until more data are available. Continuous monitoring of post-market surveillance data is essential for uncovering undetected ADEs and ensuring the safe use of remimazolam.</p><p><strong>Editorial comment: </strong>This study analyzed adverse drug events (ADEs) associated with remimazolam using the FAERS database, identifying serious safety signals like allergic reactions, respiratory and cardiac arrests, and vascular access site occlusions, especially in older patients. The findings highlight the need for vigilant monitoring, cautious off-label use, and ongoing post-marketing surveillance.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 3","pages":"e14588"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412684","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":"Perceptions of eHealth and digitalization among professional anaesthesia personnel: A Swedish national study.","authors":"Pether Jildenstål, Camilla Viseu, Kristian Hermander, Carina Sjöberg, Katarina Hallén, Randolph Schnorbus, Annelie Augustinsson","doi":"10.1111/aas.14587","DOIUrl":"10.1111/aas.14587","url":null,"abstract":"<p><strong>Background: </strong>The objective of this study was to evaluate anaesthesia care professionals' perceptions and attitudes regarding the implementation and advancement of digital solutions in perioperative care.</p><p><strong>Methods: </strong>Anaesthesia personnel working in public Swedish institutions where anaesthesia is administered were invited to respond to an online survey regarding their attitudes towards digitalization in the workplace and their perceptions of information provision and future digitalization within anaesthesia and surgical healthcare. Data were analyzed using descriptive statistics, independent-samples Kruskal-Wallis tests, and post-hoc pairwise comparisons.</p><p><strong>Results: </strong>The survey response rate was 64.0% (n = 627). Most respondents agreed/strongly agreed that digital solutions facilitate their work, the preoperative preparation, patient participation, and being involved in the patients' journeys throughout the perioperative care process. The majority also agreed/strongly agreed that digital solutions could make more patients adequately prepared before anaesthesia/surgery, reduce the number of non-optimized patients, and adapt the perioperative process to the patients' individual needs, as well as lead to reduced costs for the healthcare provider and reduced cancelled anaesthesia/surgeries. However, there were statistically significant differences between responses in relation to age groups, where the largest differences were observed between respondents in the age groups 20-30 and 61-70 years and in relation to what part of Sweden respondents worked in, with the largest differences between respondents working in Southern Sweden and the middle part of Sweden.</p><p><strong>Conclusion: </strong>Swedish anaesthesia personnel are confident that digital solutions may enhance the efficiency of care within the anaesthesia setting. However, varying perceptions on the benefits and necessity of digital solutions are indicated.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 3","pages":"e14587"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781013/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143062903","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 nitroglycerin-induced vasodilation on stroke volume and diuretic response in acute heart failure: A protocol for a mechanistic trial.","authors":"Frederik F Lau, Nora Olsen El Caidi, Ana-Marija Hristovska, Maryam Noory, Jasmin Dam Lukoschewitz, Jens Dahlgaard Hove, Nicolai Bang Foss, Johannes Grand","doi":"10.1111/aas.14575","DOIUrl":"10.1111/aas.14575","url":null,"abstract":"<p><strong>Background: </strong>Acute heart failure is a clinical syndrome characterized by cardiac dysfunction and neurohumoral activation, encompassing complex underlying pathophysiology which may vary across phenotypes. Nitroglycerine is a nitrate donor with vasodilatory effects on both venous capacitance vessels and arterial resistance vessels in higher doses, typically used with the aim of reducing congestion, preload, and afterload. A limited number of studies have proposed that nitroglycerin could promote diuresis and natriuresis. However, the exact hemodynamic effects of nitroglycerin remain uncertain in the clinical setting of acute decompensated heart failure. We hypothesize that intravenous nitroglycerin induces a significant increase in stroke volume and urinary output while lowering cardiac filling pressures.</p><p><strong>Methods: </strong>This will be a prospective single-center interventional clinical study of 21 patients hospitalized with a diagnosis of AHF. Patients are examined before and after administration of intravenous nitroglycerin. To characterize hemodynamic phenotypes of AHF, continuous estimates of stroke volume will be obtained, and total blood volume estimated. Vital signs and estimates of peripheral perfusion will be recorded continuously. Measures of cardiac function, renal function, volume status, and autonomic function will be assessed sequentially.</p><p><strong>Conclusion: </strong>This study will assess the acute effects of vasodilation on stroke volume and urinary output in hospitalized patients with AHF. Furthermore, characterizing the hemodynamic profile of the patient prior to vasodilation may help explore which patients will benefit from vasodilation.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 3","pages":"e14575"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143254455","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":"Analgesia and anesthesia for closed reduction of dislocated total hip arthroplasty: Protocol for a scoping review.","authors":"Rasmus Linnebjerg Knudsen, Rikke Helene Frølund Bjulf, Aurelien-Xuan Rosendal Bahuet, Mathias Therkel Steensbæk, Anne-Sofie Linde Jellestad, Kai Henrik Wiborg Lange, Lars Hyldborg Lundstrøm, Anders Kehlet Nørskov","doi":"10.1111/aas.70006","DOIUrl":"10.1111/aas.70006","url":null,"abstract":"<p><strong>Background: </strong>Total hip arthroplasty is a common surgical procedure, but dislocation remains a significant complication often requiring closed reduction. Current anesthetic practices for closed reduction of total hip arthroplasty vary widely, and evidence on the efficacy, safety, and cost-effectiveness of different anesthetic and analgetic regimens is limited.</p><p><strong>Methods: </strong>This scoping review follows the Joanna Briggs Institute (JBI) guidelines and PRISMA-ScR framework. A systematic search will be conducted in major databases to identify studies on anesthetic approaches for closed reduction of dislocated total hip arthroplasty. Eligible studies will include adult patients and focus on outcomes such as success rate, complications, patient satisfaction, and procedural efficiency. Data will be extracted and synthesized narratively and descriptively.</p><p><strong>Results: </strong>The review will map the existing evidence on anesthetic and analgetic regimens, including their success rates, associated complications, and cost-effectiveness. It will also highlight gaps in the literature and variations in practice across different settings.</p><p><strong>Conclusion: </strong>By summarizing current evidence and identifying research gaps, this scoping review aims to inform clinical practice and guide future studies, ultimately improving the safety, effectiveness, and efficiency of anesthetic strategies for closed reduction of dislocated total hip arthroplasties.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 3","pages":"e70006"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466502","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":"Plasma expansion and renal perfusion in critical COVID-19 with AKI: A prospective case control study.","authors":"Tomas Luther, Per Eckerbom, Eleanor Cox, Miklos Lipcsey, Sara Bülow-Anderberg, Michael Hultström, Jan Weis, Fredrik Palm, Susan Francis, Per Liss, Robert Frithiof","doi":"10.1111/aas.70004","DOIUrl":"10.1111/aas.70004","url":null,"abstract":"<p><strong>Introduction: </strong>A decrease in renal perfusion during acute kidney injury (AKI) due to critical COVID-19 has previously been demonstrated. The objective of this study was to compare the effects of plasma expansion with a standardized fluid bolus on renal perfusion in critically ill patients with AKI compared to similar patients without AKI.</p><p><strong>Methods: </strong>A case control study design was used to investigate group differences before and after a standardized intervention. ICU-treated COVID-19 patients without underlying kidney disease were assigned to two groups based on KDIGO Creatinine criteria for AKI. Renal perfusion was assessed by magnetic resonance imaging using phase contrast and arterial spin labeling before and directly after plasma expansion with 7.5 mL/kg Ringer's Acetate (Baxter). Arithmetic means of mean arterial pressures (MAP) recorded before and after plasma infusion were compared. Data was analyzed with a mixed model repeated measures ANOVA for all kidneys using a random effect to account for research subjects.</p><p><strong>Results: </strong>Nine patients with AKI and eight without were included in the study. The hemodynamic response to plasma expansion was similar in both groups, with increases in MAP by 9 mmHg (95% CI 0.5-18) and 15 mmHg (95% CI 5-24) in patients with and without AKI, respectively. Total renal perfusion and cortical perfusion were not significantly changed by plasma expansion in either group. There was a reduction of medullary perfusion in patients without AKI from 55 (95% CI 39-79) to 34 (95% CI 24-48) mL/min/100 g (p = .0027).</p><p><strong>Conclusion: </strong>Plasma expansion with a standardized fluid bolus did not increase renal perfusion in critically ill patients with COVID-19, with or without AKI.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 3","pages":"e70004"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11848233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143481997","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":"Avoidance versus use of neuromuscular blocking agents for optimizing video laryngoscopy-assisted tracheal intubation: A protocol for a systematic review with meta-analysis and trial sequential analysis.","authors":"Andreas Creutzburg, Anders Kehlet Nørskov, Michelle Icka Christensen, Arash Afshari, Lars Hyldborg Lundstrøm, Louise Bill, Helene Korvenius Nedergaard, Matias Vested","doi":"10.1111/aas.70008","DOIUrl":"10.1111/aas.70008","url":null,"abstract":"<p><strong>Background: </strong>Both the European Society of Anaesthesiology and Intensive Care and the Difficult Airway Society recommend the use of neuromuscular blocking agents (NMBAs) to facilitate tracheal intubation and to reduce the risk of complications. Even though it is recommended to use video laryngoscopy for intubation, especially in circumstances where difficult tracheal intubation is expected, the evidence for the combination of video laryngoscopy and NMBAs is sparse. This protocol outlines a systematic review of the effect of avoidance versus use of NMBAs for tracheal intubation during video laryngoscopy in adults.</p><p><strong>Methods: </strong>This protocol is made in accordance with reporting items for systematic reviews and meta-analyses protocols recommendations. We intent to include randomised controlled trials assessing the effect of avoidance versus use of NMBAs during video laryngoscopy to facilitate tracheal intubation (either nasal or oral) in the adult population. The primary outcome is failed first-pass intubation. Our secondary outcomes include adverse and serious adverse events. A thorough search will be done to identify relevant trials, including CENTRAL, MEDLINE, EMBASE, BIOSIS, Web of Science and CIHNAL. Furthermore, trial registries will be searched for unpublished trials. Each trial will be evaluated for bias. We will use appropriate packages in R to perform the meta-analysis. Additionally, we will perform trial sequential analysis on the meta-analysis of our primary outcome. Lastly, we will employ the GRADE approach and create \"Summary of Findings\" tables.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 3","pages":"e70008"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466549","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":"Can intubate, cannot ventilate: A proposed algorithm to handle problems with ventilation and oxygenation after intubation.","authors":"Kjetil Fosse, Magnus Salomonsen, Sven Erik Gisvold, Bjørnar Gundersen, Trond Nordseth","doi":"10.1111/aas.70007","DOIUrl":"10.1111/aas.70007","url":null,"abstract":"<p><strong>Background and methods: </strong>Few guidelines address how to handle unanticipated ventilatory problems and hypoxemia in a successfully intubated patient. We will refer to this situation as \"can intubate-cannot ventilate.\" The situation may occur immediately after intubation or later during general anaesthesia. The aim of this paper is to describe an algorithm for handling this situation. In an intubated patient, the airway can be considered a continuum from the ventilator to the alveoli, and the problem is somewhere along this route: Ventilator → Hoses → Filter → Tracheal tube (TT) → Tracheae → Bronchi → Bronchioles → Alveoli. The proposed algorithm is based on clinical experience and has not been externally validated.</p><p><strong>Results: </strong>The first critical decision to be made is whether the TT has been placed correctly in the trachea or not. Positive wave-formed capnography is the primary marker for correct intubation. Video and/or direct laryngoscopy can be used for further verification. The patient should be disconnected from the ventilator and manually ventilated with bag-valve and 100% oxygen. An open tube should then be verified by applying a suction catheter through the tube. If these measures do not improve the situation, a fibreoptic scope should be inserted to further assess possible causes of difficult ventilation. If no obvious treatable cause is detected at this point, bronchospasm, anaphylaxis, or pneumothorax should be ruled out or treated. Further handling should focus on optimizing gas exchange in the lungs and considering more advanced treatment options to improve oxygenation and circulation.</p><p><strong>Conclusions: </strong>We have proposed an algorithm to handle unanticipated problems with ventilation and oxygenation in a patient who has been successfully intubated. Equipment failure and a blocked TT should be ruled out before diagnosing and treating medical or surgical causes of ventilatory problems.</p><p><strong>Editorial comment: </strong>This article presents a logical approach to the time-sensitive and critical situation where, for some reason, after intubation, ventilation of the lungs is not succeeding. The authors propose steps for a systematic approach, and recognition of different possible explanations for ventilation not working is informative.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 3","pages":"e70007"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11848235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143481985","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}