Anaesthesia最新文献

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Flexible-tip bougie vs. stylet for tracheal intubation with a hyperangulated videolaryngoscope in critical care: a randomised controlled trial 在危重病监护中,高角度视像喉镜下气管插管使用柔性尖端导管与样式导管:一项随机对照试验
IF 10.7 1区 医学
Anaesthesia Pub Date : 2025-03-30 DOI: 10.1111/anae.16574
Manuel Taboada, Agustín Cariñena, Ana Estany-Gestal, Manuela de Miguel, Rocío Iraburu, Sara Alonso, Fátima García, Laura Dos Santos, María Eiras, Salomé Selas, Adrián Martínez, Ana Tubio, Olga Campaña, María Diaz-Vieito, Jorge Miguel Alcántara, Julián Alvarez, Teresa  Seoane-Pillado
{"title":"Flexible-tip bougie vs. stylet for tracheal intubation with a hyperangulated videolaryngoscope in critical care: a randomised controlled trial","authors":"Manuel Taboada, Agustín Cariñena, Ana Estany-Gestal, Manuela de Miguel, Rocío Iraburu, Sara Alonso, Fátima García, Laura Dos Santos, María Eiras, Salomé Selas, Adrián Martínez, Ana Tubio, Olga Campaña, María Diaz-Vieito, Jorge Miguel Alcántara, Julián Alvarez, Teresa  Seoane-Pillado","doi":"10.1111/anae.16574","DOIUrl":"https://doi.org/10.1111/anae.16574","url":null,"abstract":"The optimal introducer for tracheal intubation with a hyperangulated blade videolaryngoscope for patients in the ICU remains uncertain. Both stylets and flexible-tip bougies have been used, yet there is limited evidence on which is more efficacious.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"4 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143737076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Intra-operative ventilation strategies and their impact on clinical outcomes: a systematic review and network meta-analysis of randomised trials 术中通气策略及其对临床结果的影响:随机试验的系统回顾和网络荟萃分析
IF 10.7 1区 医学
Anaesthesia Pub Date : 2025-03-25 DOI: 10.1111/anae.16600
Naheed K. Jivraj, Ines Lakbar, Behnam Sadeghirad, Mattia M. Müller, Sei Yon Sohn, John K. Peel, Arzina Jaffer, Vorakamol Phoophiboon, Vatsal Trivedi, Dipayan Chaudhuri, Cong Lu, Yunting Liu, Benedetta Giammarioli, Sharon Einav, Karen E. A. Burns
{"title":"Intra-operative ventilation strategies and their impact on clinical outcomes: a systematic review and network meta-analysis of randomised trials","authors":"Naheed K. Jivraj, Ines Lakbar, Behnam Sadeghirad, Mattia M. Müller, Sei Yon Sohn, John K. Peel, Arzina Jaffer, Vorakamol Phoophiboon, Vatsal Trivedi, Dipayan Chaudhuri, Cong Lu, Yunting Liu, Benedetta Giammarioli, Sharon Einav, Karen E. A. Burns","doi":"10.1111/anae.16600","DOIUrl":"https://doi.org/10.1111/anae.16600","url":null,"abstract":"Postoperative pulmonary complications are common and associated with significant morbidity and mortality; however, the optimal intra-operative ventilation strategy to prevent postoperative pulmonary complications remains unclear. The aim of this study was to evaluate the effect of intra-operative ventilation strategy, including tidal volumes, positive end-expiratory pressure (PEEP) and use of recruitment manoeuvres on the incidence of postoperative pulmonary complications in adults having non-cardiothoracic surgery.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"61 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143703047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The use of iron after surgery: a systematic review and meta-analysis 术后使用铁剂:系统回顾和荟萃分析
IF 10.7 1区 医学
Anaesthesia Pub Date : 2025-03-24 DOI: 10.1111/anae.16605
Jayne Lim, Judie Joo, Beth MacLean, Toby Richards
{"title":"The use of iron after surgery: a systematic review and meta-analysis","authors":"Jayne Lim, Judie Joo, Beth MacLean, Toby Richards","doi":"10.1111/anae.16605","DOIUrl":"https://doi.org/10.1111/anae.16605","url":null,"abstract":"Anaemia in patients having surgery is associated with worse postoperative outcomes. Management with intravenous iron is an attractive therapeutic option, however, pre-operative intravenous iron administration is challenging. Evidence from interventional trials suggests that the greatest benefit is after hospital discharge. As anaemia is common after surgery, this meta-analysis aimed to evaluate the efficacy of postoperative iron therapy to increase haemoglobin levels.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"183 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143695095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Development of a brief test protocol for assessing cognitive change in the peri-operative period in older adults undergoing elective surgery 开发一种评估老年人择期手术围手术期认知变化的简短测试方案
IF 7.5 1区 医学
Anaesthesia Pub Date : 2025-03-24 DOI: 10.1111/anae.16604
Annerixt Gribnau, Gert J. Geurtsen, Hanna C. Willems, Jeroen Hermanides, Mark L. van Zuylen
{"title":"Development of a brief test protocol for assessing cognitive change in the peri-operative period in older adults undergoing elective surgery","authors":"Annerixt Gribnau, Gert J. Geurtsen, Hanna C. Willems, Jeroen Hermanides, Mark L. van Zuylen","doi":"10.1111/anae.16604","DOIUrl":"10.1111/anae.16604","url":null,"abstract":"<p>Many patients are afraid of permanent cognitive impairment after general anaesthesia [<span>1</span>]. However, there is no uniform method to diagnose postoperative neurocognitive disorders extending beyond 1 month after surgery [<span>2</span>]. The gold standard is a time-consuming neuropsychological assessment [<span>3</span>]. We aimed to identify and validate internally the best predictive subset of neuropsychological assessment tests, balancing accuracy and utility suitable for both research and clinical purposes.</p><p>This study used data from a previous study [<span>3</span>]. After ethical approval and informed consent, patients aged ≥ 65 y undergoing elective surgery were enrolled. Patients with hearing impairment, multiple procedures under anaesthesia or pre-existent cognitive impairment were not studied. Neuropsychological assessment was done pre-operatively and 4–8 weeks postoperatively. It covered five cognitive domains, with outcomes for 17 individual subtests and four combined scores (online Supporting Information Appendix S1). Outcomes were reported in T-scores, corrected for age and educational level compared with a healthy Dutch patient group [<span>4</span>]. Missing outcomes were imputed.</p><p>Our previous study used a definition based on composite cognitive domain scores, yielding an 18% incidence of postoperative neurocognitive disorder [<span>3</span>]. However, as predictors would be based on the results of individual tests, we defined postoperative neurocognitive disorder in this analysis as a decline of ≥ 1 SD on ≥ two tests in at least one cognitive domain, or a decline of ≥ 1 SD in total cognitive domain score, aligning with the most used research definition [<span>5</span>]. After checking for multicollinearity, we aimed to create a logistic regression model (online Supporting Information Appendix S2). All 17 individual delta test scores were included, and backward selection based on the Akaike Information Criterion was performed, using different cut-offs. When backward selection included the middle or last subtest from a test, we deemed it necessary to also include the other subtest (e.g. Stroop 1, 2 and 3). When this would make the test protocol too time-consuming, we selected the tests with the lowest p values and their subtests, while also checking AUROC, so time of administration would be acceptable. Internal validation was done using bootstrapping, where AUROC and regression coefficients were corrected uniformly for measured optimism. Calibration was assessed and thresholds determined. Predictions were made using the formula <span></span><math>\u0000 <mfrac>\u0000 <mn>1</mn>\u0000 <mrow>\u0000 <mn>1</mn>\u0000 <mo>+</mo>\u0000 <msup>\u0000 <mi>e</mi>\u0000 <mrow>\u0000 <mo>−</mo>\u0000 <mfenced>\u0000 <mrow>\u0000 ","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 6","pages":"713-715"},"PeriodicalIF":7.5,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16604","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143695102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Rescuing failed direct laryngoscopy in children: one size does not fit all 抢救失败的儿童直接喉镜检查:一个大小不适合所有
IF 7.5 1区 医学
Anaesthesia Pub Date : 2025-03-21 DOI: 10.1111/anae.16577
Michael A. Evans, Thomas J. Caruso
{"title":"Rescuing failed direct laryngoscopy in children: one size does not fit all","authors":"Michael A. Evans, Thomas J. Caruso","doi":"10.1111/anae.16577","DOIUrl":"10.1111/anae.16577","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 6","pages":"621-624"},"PeriodicalIF":7.5,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143666638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comparing videolaryngoscopy and flexible bronchoscopy to rescue failed direct laryngoscopy in children: a propensity score matched analysis of the Pediatric Difficult Intubation Registry 比较视频喉镜检查和柔性支气管镜检查对儿童直接喉镜检查失败的疗效:儿童困难插管登记的倾向评分匹配分析
IF 7.5 1区 医学
Anaesthesia Pub Date : 2025-03-20 DOI: 10.1111/anae.16576
Mary Lyn Stein, Julia Heunis Nagle, T. Wesley Templeton, Steven J. Staffa, Stephen G. Flynn, Martina Bordini, Sydney Nykiel-Bailey, Annery G. Garcia-Marcinkiewicz, Febina Padiyath, Maria Matuszczak, Angela C. Lee, James M. Peyton, Raymond S. Park, Britta S. von Ungern-Sternberg, Patrick N. Olomu, Agnes I. Hunyady, Clyde Matava, John E. Fiadjoe, Pete G. Kovatsis, for the PeDI Collaborative
{"title":"Comparing videolaryngoscopy and flexible bronchoscopy to rescue failed direct laryngoscopy in children: a propensity score matched analysis of the Pediatric Difficult Intubation Registry","authors":"Mary Lyn Stein,&nbsp;Julia Heunis Nagle,&nbsp;T. Wesley Templeton,&nbsp;Steven J. Staffa,&nbsp;Stephen G. Flynn,&nbsp;Martina Bordini,&nbsp;Sydney Nykiel-Bailey,&nbsp;Annery G. Garcia-Marcinkiewicz,&nbsp;Febina Padiyath,&nbsp;Maria Matuszczak,&nbsp;Angela C. Lee,&nbsp;James M. Peyton,&nbsp;Raymond S. Park,&nbsp;Britta S. von Ungern-Sternberg,&nbsp;Patrick N. Olomu,&nbsp;Agnes I. Hunyady,&nbsp;Clyde Matava,&nbsp;John E. Fiadjoe,&nbsp;Pete G. Kovatsis,&nbsp;for the PeDI Collaborative","doi":"10.1111/anae.16576","DOIUrl":"10.1111/anae.16576","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Flexible bronchoscopy is the gold standard for difficult airway management. Clinicians are using videolaryngoscopy increasingly because it is perceived to be easier to use with high success rates. We conducted this study to compare the success rates of the two techniques when used after failed direct laryngoscopy in children with difficult tracheal intubations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We identified cases where initial attempts at direct laryngoscopy failed in the multicentre Pediatric Difficult Intubation Registry from August 2012–September 2023. After propensity score matching, we compared success rates and complications when videolaryngoscopy and flexible bronchoscopy were used as rescue techniques in the matched cohort and in matched patients weighing &lt; 5 kg.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Clinicians chose videolaryngoscopy more frequently than flexible bronchoscopy when direct laryngoscopy failed (64.7%, 1426/2281 vs. 7.3%, 156/2281, p &lt; 0.001). Propensity score matched cohorts did not differ with respect to first-attempt success, eventual success and complications. For the subgroup of infants &lt; 5 kg, clinicians chose videolaryngoscopy more frequently than flexible bronchoscopy to rescue failed direct laryngoscopy (54.3%, 295/543 vs. 8.9%, 44/543, p &lt; 0.001). First-attempt success was 43% (62/145) with videolaryngoscopy and 62% (18/29) with flexible bronchoscopy (odds ratio 2.19, 95%CI 0.96–4.98, p = 0.061). Eventual success was 71% (103/145) with videolaryngoscopy and 90% (26/29) with flexible bronchoscopy (odds ratio 3.53, 95%CI 1.03–12.2, p = 0.046). Complications did not differ between the techniques.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Videolaryngoscopy was chosen more frequently than flexible bronchoscopy as a rescue technique in a cohort of children with difficult direct laryngoscopy, with similar success and complication rates. For small infants, flexible bronchoscopy had a higher eventual success rate, underscoring the importance of maintaining proficiency with flexible bronchoscopy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 6","pages":"625-635"},"PeriodicalIF":7.5,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143666640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Intravenous lidocaine with propofol-based sedation for colonoscopy: a systematic review and meta-analysis with trial sequential analysis 静脉利多卡因联合异丙酚镇静用于结肠镜检查:系统回顾和荟萃分析与试验序列分析
IF 7.5 1区 医学
Anaesthesia Pub Date : 2025-03-18 DOI: 10.1111/anae.16563
Eduardo C. Barbosa, Júlia M. Aguirre, Paulo F. E. Bertoldi, Paula Santo, Stefano Baraldo, Angélica L. Nau, Gilmara C. Meine
{"title":"Intravenous lidocaine with propofol-based sedation for colonoscopy: a systematic review and meta-analysis with trial sequential analysis","authors":"Eduardo C. Barbosa,&nbsp;Júlia M. Aguirre,&nbsp;Paulo F. E. Bertoldi,&nbsp;Paula Santo,&nbsp;Stefano Baraldo,&nbsp;Angélica L. Nau,&nbsp;Gilmara C. Meine","doi":"10.1111/anae.16563","DOIUrl":"10.1111/anae.16563","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Intravenous lidocaine is a promising complementary strategy for sedation during surgical procedures. We performed a systematic review and meta-analysis to compare intravenous lidocaine with placebo as an adjuvant to propofol-based sedation in patients undergoing colonoscopy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched MEDLINE, Embase and Cochrane databases for randomised controlled trials comparing sedation with propofol and lidocaine vs. propofol and placebo in patients undergoing colonoscopy. The primary outcome was total propofol dose. A random-effects model was used to estimate the mean differences and risk ratios.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included eight trials with 520 patients. Compared with placebo, intravenous lidocaine reduced propofol consumption during the procedure (mean difference (95%CI): -42.93 mg (-62.89 to -22.97)); shortened awakening time (mean difference (95%CI): -3.38 minutes (-5.92 to -0.84)); reduced post-procedural pain scores (mean difference (95%CI): -1.38 (-2.72 to -0.04)); and increased patient satisfaction scores (mean difference (95%CI): 0.50 (0.30 to 0.70)). There were no significant differences between the groups in procedure duration; endoscopist satisfaction scores; and risk of hypoxia or hypotension.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>In patients undergoing colonoscopy, the addition of intravenous lidocaine to propofol-based sedation reduced propofol consumption, shortened awakening time, mitigated post-procedural pain and enhanced patient satisfaction compared with placebo. Although the findings are statistically significant, clinical relevance and cost-effectiveness are unclear.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 6","pages":"694-703"},"PeriodicalIF":7.5,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143653594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A UK-wide survey evaluation of capnography variation 一项全英国范围内的血糖变化评估调查
IF 7.5 1区 医学
Anaesthesia Pub Date : 2025-03-17 DOI: 10.1111/anae.16603
Andrew A. Shepherd, Jennifer L. Proc, Patrick A. Ward, Alistair F. McNarry, Mathew Lyons, the CaVa UK Collaborators
{"title":"A UK-wide survey evaluation of capnography variation","authors":"Andrew A. Shepherd,&nbsp;Jennifer L. Proc,&nbsp;Patrick A. Ward,&nbsp;Alistair F. McNarry,&nbsp;Mathew Lyons,&nbsp;the CaVa UK Collaborators","doi":"10.1111/anae.16603","DOIUrl":"10.1111/anae.16603","url":null,"abstract":"&lt;p&gt;When interpreted correctly, waveform capnography can prevent morbidity and mortality during airway management. However, misidentification of capnography as other waveforms (e.g. pressure or flow) continues to cause preventable deaths [&lt;span&gt;1&lt;/span&gt;] and has been implicated in a Coroner's Regulation 28 report [&lt;span&gt;2&lt;/span&gt;]. Non-standardised monitor displays increase the risk of human error, leading to clinical delays or misjudgements [&lt;span&gt;3&lt;/span&gt;]. Despite the capnography recommendations from the Association of Anaesthetists [&lt;span&gt;4&lt;/span&gt;], Project for Universal Management of Airways and capnography safety campaigns, preventable deaths persist [&lt;span&gt;5&lt;/span&gt;]. System design (removing the possibility of error) is the most effective form of error prevention [&lt;span&gt;6&lt;/span&gt;]. In recognition of this, the Safe Anaesthesia Liaison Group (SALG) recommends standardising waveform capnography as a white solid filled-in graph at the bottom of the monitor display [&lt;span&gt;7&lt;/span&gt;]. It is not known how widely this recommendation has been adopted. We aimed to establish the extent of variation in waveform capnography across the UK and assess compliance with the SALG standard.&lt;/p&gt;&lt;p&gt;We devised a survey to collect capnography waveform and equipment data from participating hospitals (online Supporting Information Appendix S1). A website (https://cavastudy.co.uk) was established for hospital registration and respondent survey access. Participation was voluntary and open to all 420 NHS hospitals that provide anaesthesia services [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Survey respondents were asked to identify distinct clinical areas in their hospital where waveform capnography was used, establish the number of different waveforms in each area, and categorise them according to 11 colours, two waveform types and three screen locations. These variants were chosen from a pilot survey in south-east Scotland. Departmental clinical directors of participating hospitals were asked to agree to their hospital's participation and state their personal awareness of the SALG standard. The survey was not anonymised. Research Ethics Committee and Caldicott Guardian approval were not required. Investigators registered the project via their local governance teams.&lt;/p&gt;&lt;p&gt;Survey responses were collected from 9 September 2024 to 31 October 2024 using Microsoft Forms (Microsoft, Redmond, WA, USA). Analysis was conducted in R Studio (R version 4.4.1; R Foundation, Vienna, Austria).&lt;/p&gt;&lt;p&gt;Data were received from 138/420 (33%) eligible hospitals (which were part of 65 NHS Trusts/health boards). We analysed 9052 individual capnography waveforms and identified 36 variants across nine colours, two morphologies (line and filled in) and three monitor locations (top, middle and bottom). The most common waveform was a white line at the bottom of the screen, followed by the SALG standard and then a white line in the middle. The remaining capnographs varied considerably in morphology (Table 1 and Fig. 1).","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 6","pages":"716-719"},"PeriodicalIF":7.5,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16603","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143641137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Stress, strain and mechanical power: let's not forget the shape of the flow 应力、应变和机械动力:我们不要忘记流体的形状
IF 10.7 1区 医学
Anaesthesia Pub Date : 2025-03-17 DOI: 10.1111/anae.16602
Aurio Fajardo-Campoverdi, Adrián Gallardo, Alejandro González-Castro
{"title":"Stress, strain and mechanical power: let's not forget the shape of the flow","authors":"Aurio Fajardo-Campoverdi, Adrián Gallardo, Alejandro González-Castro","doi":"10.1111/anae.16602","DOIUrl":"https://doi.org/10.1111/anae.16602","url":null,"abstract":"&lt;p&gt;We read the work of Buiteman-Kruzinga et al. [&lt;span&gt;1&lt;/span&gt;] and believe that it adds to the evidence regarding the relevance of respiratory rate in the energy transfer of the ventilatory system. For viscoelastic bodies, cyclicity is probably the most important factor to explain the disruption of their initial conformation, which has already been extrapolated to clinical studies [&lt;span&gt;2&lt;/span&gt;], and this study confirms this. However, we believe it is necessary to clarify some points.&lt;/p&gt;\u0000&lt;p&gt;Despite the rigour of the design and the robustness of the clinical trials included, the dichotomisation of initially continuous variables and imputation of the data (even when reducing the variance) can generate biased estimates, even using advanced techniques. The authors assert that the higher the peak pressure (P&lt;sub&gt;peak&lt;/sub&gt;), the greater the mechanical power in patients without acute respiratory distress syndrome, except in the subgroup of patients with low V&lt;sub&gt;T&lt;/sub&gt; and low programmed respiratory rates. Under this premise, it can be inferred that P&lt;sub&gt;peak&lt;/sub&gt; may not be so important when gentle ventilation is ensured. However, this work does not specify the inspiratory flow delivery form, and despite the fact that in the original mechanical power equation this variable has no place, from a rheological and thermodynamic perspective, we know that it has relevance [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;\u0000&lt;p&gt;Bodies that exhibit viscoelastic behaviour have the capacity to store or dissipate energy when deformed by stress. Under this argument, the strain is modified by the cyclicity, but also by the time and the way in which it is exposed to the stress. Anisotropic strain, defined as the rate of deformation under non-uniform stress, changes as a function of lung geography but is also sensitive to variations in flow. Thus, the higher the flow delivery velocity, the higher the P&lt;sub&gt;peak&lt;/sub&gt;, which translates into a higher pulmonary viscoelastic rate with the resulting decrease in the slope of the strain-volume or strain-pressure curve. Several authors have already explored this hypothesis, and although there are no randomised clinical trials, the existence of its association with mechanotransduction cannot be ignored in healthy lungs, acute respiratory distress syndrome, or in paediatric patients [&lt;span&gt;4&lt;/span&gt;].&lt;/p&gt;\u0000&lt;p&gt;We performed a post hoc analysis of the “&lt;i&gt;mechanical power day&lt;/i&gt;” [&lt;span&gt;5&lt;/span&gt;] by means of multiple frequentist linear regression. We observed that ventilation with decelerated flow (coefficient 3.4, 95%CI 2.4–4.5, p &lt; 0. 001) correlated independently with a higher probability of high energy mechanical power (&gt; 17 J.min&lt;sup&gt;-1&lt;/sup&gt;) in patients without acute respiratory distress syndrome (R&lt;sup&gt;2&lt;/sup&gt; = 71%), when compared with constant flow ventilation (coefficient difference -3.4, 95%CI -4.4 to -2.3, p &lt; 0.001). Figure 1 shows the correlation between decelerated flow with high energy mechanical power as a function of driving","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"92 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143641141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Patient blood management – what's the problem with implementation? 病人血液管理——执行上有什么问题?
IF 10.7 1区 医学
Anaesthesia Pub Date : 2025-03-17 DOI: 10.1111/anae.16584
Seema Agarwal, Craig Carroll
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