Anaesthesia and Intensive Care最新文献

{"title":"A perioperative audit of smoking, smoking cessation advice and pharmacological management of nicotine dependence: Are guidelines enough?","authors":"Boris Waldman, Justin W Payne, Tara S Lawson, Thomas C Lang, Natalie A Smith","doi":"10.1177/0310057X251345506","DOIUrl":"https://doi.org/10.1177/0310057X251345506","url":null,"abstract":"<p><p>Smoking increases anaesthetic and surgical complications. The perioperative period provides an opportunity to give advice and initiate ongoing support to patients who smoke. Our aims were to determine perioperative smoking patterns and how well patients were supported to reduce smoking as well as compliance with the Australian and New Zealand College of Anaesthetists guidelines on smoking. We surveyed all adults having non-emergency surgery at Wollongong Hospital over an 8-week period in 2021. For those who smoked, we analysed their medical record for identification of smoking status and smoking cessation pharmacotherapy prescription. Sixteen per cent of patients (<i>n</i> = 111) had smoked in the 30 days before surgery. Of that group, 83% did not think that smoking might cause a problem with their surgery or anaesthetic, and 46% did not report receiving advice to stop smoking. When advice to stop smoking was given, it was associated with an attempt to quit, especially when given by a surgeon. Attendance at the preadmission clinic was associated with the provision of smoking cessation advice but not a quit attempt. Nicotine replacement therapy was used by 11% prior to surgery, and only 7% immediately post-surgery. Our findings show low rates of perioperative smoking cessation advice and nicotine replacement therapy prescription, similar to those reported by other studies over the past two decades in Australia. It provides further evidence that the Australian and New Zealand College of Anaesthetists and other society guidelines alone have not led to major improvements in our management of perioperative smoking, and that hospital-specific routine interventions are needed.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"310057X251345506"},"PeriodicalIF":1.1,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144590282","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":"A four-year retrospective study of palliative care involvement with Australian intensive care patients.","authors":"Mark P Collins, Patrick Steele, Lewis Hackenberger, Christopher MacIsaac, Jeffrey Presneill","doi":"10.1177/0310057X251334659","DOIUrl":"https://doi.org/10.1177/0310057X251334659","url":null,"abstract":"<p><p>This study aimed to characterise specialist palliative care service involvement within the intensive care unit (ICU) and subsequently in post-ICU hospital wards, and compare current ICU referral practices with those suggested by an internationally utilised ICU palliative care referral tool. This was a retrospective cohort study, carried out at a large university-associated ICU in Melbourne, Australia, and was conducted on adult patients aged at least 18 years admitted to ICU between July 2019 and July 2023. The study included 11,449 ICU admission episodes relating to 10,171 patients. The overall ICU mortality for all patients was 9% in ICU with a further 4.3% post-ICU. Within non-survivors, specialist palliative care involvement was uncommon for patients who died in ICU (78/1035, 7.5%), but substantial (287/488, 59%) for those ICU patients who died on a hospital ward after ICU discharge. Compared with ICU patients who did not have an identified palliative care referral, ICU patients with palliative care input averaged longer ICU stays with shorter hospital stays post-ICU discharge. The referral tool showed low sensitivity (39%) when compared with observed current ICU palliative care referral practice. Clinical staff within the ICU provided the majority of palliative care for ICU patients, with a palliative care consultative service taking a proportionally much greater role in post-ICU hospital wards. The selected criteria appeared inadequate for use as an effective referral tool. Future research may explore the quality of palliative care provided by ICU staff and specialist palliative care staff, and the role of decision support tools, so as to provide optimal care for critically ill patients approaching the end of life.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"310057X251334659"},"PeriodicalIF":1.1,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144590281","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":"Development, implementation and evaluation of a bronchoscopy simulation training program for intensive care Fellows and intensivists in the Netherlands.","authors":"Eveline Cf Gerretsen, Ulrich Strauch, Marleen Groenier, Walther Nka van Mook, Frank Wjm Smeenk, Ruud Pj Segers","doi":"10.1177/0310057X251337756","DOIUrl":"https://doi.org/10.1177/0310057X251337756","url":null,"abstract":"<p><p>Simulation-based training can be valuable for teaching bronchoscopy to intensivists, providing a risk-free training environment. We developed, implemented and evaluated a simulation-based flexible bronchoscopy training program for intensive care Fellows and intensivists. This paper presents the development of its design and lessons learned. We used the Analyse, Design, Develop, Implement and Evaluate model for developing and evaluating the training program (Analysis and Design - phase 1, Development - phase 2, Implementation - phase 3, Evaluation - phase 4). In phase 1, two intensivists formulated learning objectives for bronchoscopy in an intensive care setting, which guided the identification and development of training materials and the preliminary training program (phase 2). In phase 3, we tested this program and gathered feedback from participants to guide program modifications. After implementing the adjusted training, we measured participants' satisfaction using a survey based on closed- and open-ended questions (phase 4). Fifty-seven participants attended the training, with 18 (32%) responding to the questionnaire. Respondents highly appreciated the training program, with median satisfaction scores of 4 or higher on a five-point scale for all closed-ended questions. Respondents appreciated the supervision and feedback and found the simulator equipment relevant for learning bronchoscopy. This description of the program's development and its evaluation results can serve as a valuable resource for those wishing to establish similar training programs. We recognise that further implementation of evidence-based instructional design principles might enhance the training program's scientific foundation and effectiveness. We therefore recommend a more evidence-based approach for the design of future bronchoscopy simulation training programs.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"310057X251337756"},"PeriodicalIF":1.1,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564300","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":"Religious objections to obstetric practice? A historical study of obstetric anaesthesia in mid-19th century France.","authors":"Rebecca E Chernick, Manisha S Desai","doi":"10.1177/0310057X251337754","DOIUrl":"https://doi.org/10.1177/0310057X251337754","url":null,"abstract":"<p><p>An early administration of anaesthesia for childbirth occurred on 19 January 1847, when Scottish obstetrician James Young Simpson administered diethyl ether to facilitate the delivery of a child to a woman with a deformed pelvis. Simpson advocated for its use to reduce pain both in surgery and in childbirth. Obstetric anaesthesia was controversial for many reasons, and objections came not only from fellow obstetricians, but also from the public and members of the clergy. While James Young Simpson shed light upon religious objections to obstetric anaesthesia, modern scholars have debated whether such objections truly existed. The aim of this study is to determine whether religious objections to obstetric anaesthesia were endorsed by medical professionals in France during the mid-19th century. A search of the Bibliothèque Nationale de France (National Library of France) was conducted. Primary source documents reveal that French physicians were interested in studying the effects of ether and chloroform during labour and delivery. Nevertheless, the introduction of obstetric anaesthesia was controversial for many reasons, including concerns about its effect on natural labour. The evidence suggests that these objections were not endorsed by the medical community. Much of the controversy surrounding obstetric anaesthesia involved the perceived necessity of the practice during low-risk vaginal deliveries. It appears that French physicians were aware of religious objections to the use of anaesthesia in childbirth but did not endorse them. The use of obstetric anaesthesia in France was guided by scientific evidence and clinical experience, without interference from religious leaders.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"310057X251337754"},"PeriodicalIF":1.1,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564302","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":"Enhancing the readability of anaesthesia-related patient education materials using artificial intelligence.","authors":"Luke Km Chan","doi":"10.1177/0310057X251344625","DOIUrl":"https://doi.org/10.1177/0310057X251344625","url":null,"abstract":"","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"310057X251344625"},"PeriodicalIF":1.1,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564301","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":"Cost-effectiveness of Monitored Anaesthesia Care in the Cardiac Catheterisation Laboratory: A response to Meyerson et al.","authors":"Symret K Singh, Sophie A Meyerson, Ben L Olesnicky","doi":"10.1177/0310057X251342256","DOIUrl":"https://doi.org/10.1177/0310057X251342256","url":null,"abstract":"","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"310057X251342256"},"PeriodicalIF":1.1,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564299","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":"A randomised, open-label trial of nebulised unfractionated heparin in patients mechanically ventilated for COVID-19.","authors":"Roger J Smith, Angajendra N Ghosh, Simone Said, Frank Mp van Haren, John G Laffey, Gordon S Doig, John D Santamaria, Barry Dixon","doi":"10.1177/0310057X251322783","DOIUrl":"10.1177/0310057X251322783","url":null,"abstract":"<p><p>Nebulised unfractionated heparin (UFH) might reduce time to ventilator separation in patients with COVID-19 by reducing virus infectivity, pulmonary coagulopathy, and inflammation, but clinical trial data are limited. Between 1 July 2020 and 23 March 2022, we conducted, at two hospitals in Victoria, Australia, a randomised, parallel-group, open-label, controlled trial of nebulised UFH. Eligible patients were aged 18 years or more, intubated, under intensive care unit management, had a P_aO₂ to F_IO₂ ratio of 300 or less, had acute opacities affecting at least one lung quadrant and attributed to COVID-19, and were polymerase chain reaction-positive for SARS-CoV-2 or had further testing planned. The target sample size was 270, however, the trial was stopped due to slow recruitment. There were 50 enrolments, all of whom were analysed. The median age was 55 (interquartile range (IQR) 46-64) years, 28 (56%) were males, and 46 (92%) had acute respiratory distress syndrome. Twenty-seven (54%) were randomised to nebulised heparin and 23 (46%) to standard care. Nebulised UFH was administered to the heparin group on 6 (IQR 4-10) days; median daily dose of 83 (IQR 75-88) kIU. The primary outcome, time to separation from invasive ventilation to day 28 adjusted for the competing risk of death, was not significantly different between groups but took numerically longer in the nebulised heparin group (12.0, standard deviation (SD) 10.4 days versus 7.4, SD 6.9 days; hazard ratio (HR) 0.56, 95% confidence interval (CI) 0.31 to 1.01, <i>P</i> = 0.052). One patient died by day 28 in each group, fewer than expected. Time to separation from invasive ventilation among survivors to day 28 occurred more quickly than expected in the standard care group and was, without correction for multiple comparisons, significantly slower in the heparin group (11.3, SD 10.0 days, <i>n</i> = 26 versus 6.4, SD 5.2 days, <i>n</i> = 22; HR 0.52, 95% CI 0.30 to 0.92, <i>P</i> = 0.024). Nebulised heparin did not reduce time to ventilator separation in intubated adult patients with COVID-19. The study is limited by the small sample size and potential for sampling bias. Further study is required.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"238-252"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727534","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":"Treatment of and outcomes from hypotension in the post-anaesthesia care unit: A single-centre retrospective cohort study.","authors":"Ned Douglas, Sally Gilbert, Jason Ong, Ben Kave, Kate Leslie, Jai N Darvall","doi":"10.1177/0310057X251330312","DOIUrl":"10.1177/0310057X251330312","url":null,"abstract":"<p><p>Hypotension after non-cardiac surgery is common and associated with harm. Anaesthetists treat hypotension in the post-anaesthesia care unit (PACU) with intravenous (IV) fluids and vasopressor medications. Our aim was to determine the incidence of hypotension after these treatments. We conducted a single centre retrospective cohort study of all adult patients who were hypotensive (systolic blood pressure less than 90 mmHg) in the PACU after non-cardiac, non-obstetric surgery over a one-year period. The primary outcome was a composite of hypotension or vasopressor infusion in the 24 h after PACU discharge. During the study 459 patients were hypotensive in the PACU. No treatment was administered in 232 (51%) episodes, IV fluid alone was administered in 138 (30%) episodes, vasopressors alone were administered in 22 (5%) episodes, and both fluid and vasopressors were administered in 67 (14%) patients. A total of 167 patients (36%) met the primary outcome, of which 118 (25%) were hypotensive and 49 (11%) required vasopressor infusions. The treatment group was significantly associated with the primary outcome (<i>P</i> < 0.001), with 36 (15%) patients who received no treatment becoming hypotensive, compared with 67 (46%, <i>P < </i>0.001) patients who received IV fluid alone, 12 (55%, <i>P</i> < 0.001) who received vasopressors alone and 52 (75%, <i>P < </i>0.001) who received both IV fluid and vasopressors. Patients who were hypotensive in the PACU frequently developed later hypotension or required vasopressors in the 24 h after PACU discharge. Treatments delivered in the PACU had limited long-term effectiveness. Novel treatments to protect patients from subsequent hypotension are urgently needed.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"231-237"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143965412","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":"Reply to Comment on Time to re-evaluate the routine use of sterile gowns in neuraxial anaesthesia.","authors":"Bradley H Tuohey, Cliff L Shelton, Stefan Dieleman, Forbes McGain","doi":"10.1177/0310057X251325888","DOIUrl":"10.1177/0310057X251325888","url":null,"abstract":"","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"287-288"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727541","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":"Survival in hostile environments: Extravehicular activity on the surface of the moon.","authors":"Peter J Featherstone, Christine M Ball","doi":"10.1177/0310057X251342026","DOIUrl":"https://doi.org/10.1177/0310057X251342026","url":null,"abstract":"","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":"53 4","pages":"217-219"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144551741","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}