Anaesthesia and Intensive Care最新文献

{"title":"Comment on 'Reducing plastic in single-use central line insertion packs: a mixed methods observational study'.","authors":"Prashant Sirohiya","doi":"10.1177/0310057X251387732","DOIUrl":"10.1177/0310057X251387732","url":null,"abstract":"","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"394-395"},"PeriodicalIF":1.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145792702","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":"Ventilator-associated pneumonia: an evaluation of definitions from their components.","authors":"Nicolas A Sieben, Sananta Dash","doi":"10.1177/0310057X251397160","DOIUrl":"10.1177/0310057X251397160","url":null,"abstract":"<p><p>Ventilator-associated pneumonia (VAP) is a known complication of mechanical ventilation within the intensive care unit (ICU) that frequently negatively impacts ICU length of stay, morbidity, and mortality of the critically ill. Characterising VAP within ICUs is difficult due to varying definitions, definition component sensitivity, and the subtle pathophysiology of VAP. The extent of VAP morbidity and mortality is not fully known and is a strain in the critically ill population with low physiological reserve. Many detection-prevalence studies exist in parallel with numerous meta-analyses evaluating select components of definitions. Definitions for VAP (and criteria for) exist around the globe in various forms and are often composed of differing components or criteria. Most definitions combine changing oxygenation or ventilatory status, laboratory tests suggestive of infection, duration of ventilation, and microbiology to determine a ventilator-associated event. This narrative review seeks to compare the most common definitions of VAP published in the literature, evaluate VAP definition components, and determine VAP definition usefulness in clinical practice to diagnose VAP accurately.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"328-337"},"PeriodicalIF":1.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147721558","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":"Response to letters to the editor on 'Reducing plastic in single-use central line insertion packs: a mixed methods observational study'.","authors":"Alexandra R Seville, Luise Kazda, Scott McAlister, Katy Jl Bell","doi":"10.1177/0310057X251387729","DOIUrl":"10.1177/0310057X251387729","url":null,"abstract":"","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"396-397"},"PeriodicalIF":1.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13328920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145861722","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":"A summary guide for detecting and reducing nitrous oxide infrastructure leaks in healthcare facilities.","authors":"Eugenie A Kayak, Rebecca E McIntyre, Forbes McGain, Justin J Skowno, Steven J Gaff, Gemma Cooper, Madeleine Skellern, Arthur Wyns","doi":"10.1177/0310057X261449257","DOIUrl":"https://doi.org/10.1177/0310057X261449257","url":null,"abstract":"<p><p>Leaks from nitrous oxide (N₂O) infrastructure have been identified as a significant contributor to the greenhouse gas emissions of healthcare facilities. Recent studies in Australia and in the United Kingdom have found at least half (and often more than 70%) of the N₂O supplied to many healthcare facilities leaks from medical pipelines and associated infrastructure before clinical administration. To assist in addressing this issue, the University of Melbourne, in collaboration with the Interim Australian Centre for Disease Control and the Australian Government's Department of Health and Aged Care, published <i>Detecting and reducing nitrous oxide leaks in healthcare facilities - a practical guide</i> (the 'Guide') in 2024. This article summarises the Guide and best practice approaches for detection and reduction of N₂O leaks in healthcare facilities across Australia. It is intended to assist clinicians and facility managers to identify appropriate methods to test for N₂O leaks, make an informed choice about the most appropriate way to supply N₂O to a facility and reduce waste from N₂O leaks in their healthcare facility.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"310057X261449257"},"PeriodicalIF":1.2,"publicationDate":"2026-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148248821","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":"On pethidine: The 'accidental' opioid that became a 'model' analgesic agent.","authors":"Laurence E Mather, Geoffrey T Tucker","doi":"10.1177/0310057X261442548","DOIUrl":"https://doi.org/10.1177/0310057X261442548","url":null,"abstract":"<p><p>A 1939 German publication on a search for novel synthetic atropine substitutes reported that 'Substanz III', named Dolantin (now generically known as pethidine and meperidine), was found coincidentally to also have morphine-like, albeit markedly weaker, analgesic properties. With a chemical structure not obviously related to morphine, it was thus an 'accidental opioid' and was soon successfully marketed in many countries for pain relief. By the 1970s, continuing advances in analytical chemistry were enabling pharmacokinetic studies of countless drugs. Among opioid analgesic agents, pethidine's larger dosing requirements made it suitable for such research, which was performed in healthy volunteers and patients with various doses and routes of administration, with some reports also including pharmacological responses. Standard postoperative intramuscular pethidine administration revealed steep and unpredictable plasma concentration-analgesic response relationships characterised by marked variability between patients. Novel computer-designed intravenous infusions based on typical pethidine pharmacokinetic data were trialled to replace intramuscular injections. These infusions improved the reliability of postoperative pain management but could not overcome the variability in individual patient requirements. This limitation accelerated the development of empirical 'patient-controlled analgesia' techniques, initially with pethidine, and subsequently with other opioid analgesic agents, thereby enabling personalised pain management. The 1970s' discovery of spinal opioid receptors and mechanisms led to neuraxial pethidine administration being investigated and subsequently integrated into standard clinical practice. Although pethidine has now been superseded in many countries, it served as an important 'model' drug to investigate how to improve the use of opioid analgesic agents for the management of severe pain.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"310057X261442548"},"PeriodicalIF":1.2,"publicationDate":"2026-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148248861","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":"Nitrous oxide added at the end of sevoflurane anaesthesia hastens emergence and eliminates prolonged time to extubation (SEVONATE study): A randomised controlled trial.","authors":"Boris Mraovic, Tatjana Simurina","doi":"10.1177/0310057X261453393","DOIUrl":"https://doi.org/10.1177/0310057X261453393","url":null,"abstract":"<p><p>Nitrous oxide (N₂O) has both MAC (Minimum Anaesthetic Concentration) sparing and rapid pharmacokinetic washout properties. We hypothesised that adding N₂O at the end of surgery would hasten emergence from anaesthesia, decrease variability in emergence duration and reduce the number of prolonged emergences. Adult patients, American Society of Anesthesiologists Physical Status I-III, undergoing general anaesthesia for surgery with duration of over 120 min were randomised into two groups according to carrier gas: air/30% oxygen, and the same mixture until the last 30 min of surgery when 70% N₂O in 30% oxygen was used. Anaesthesia was maintained at ~1 MAC with sevoflurane in both groups. Early and late recovery, postoperative nausea and vomiting, and pain scores and analgesic use were assessed. Time to extubation time was deemed prolonged if it lasted more than 15 min. Fifty-one patients in N₂O/O₂ and 50 in air/O₂ were enrolled. N₂O administration lasted (mean ± standard deviation) 24.8 ± 9.4 min. Time to extubation was faster with N₂O/O₂ (5.5 ± 2.6 min) than with air/O₂ (9.1 ± 4.0 min), mean difference 3.6 min; 95% confidence interval 2.3 to 4.9, <i>p</i> < 0.001. Ability to open eyes, follow commands and being oriented were similarly significantly faster (mean differences 3.6, 3.4 and 3.7 min, respectively, <i>p</i> < 0.001 in all). None of the patients with N₂O/O₂, but 6% of patients with air/O₂, had prolonged time to extubation, <i>p</i> < 0.001. There were no differences between the groups in postoperative pain scores, or in early and late postoperative recovery. Patients administered N₂O/O₂ received significantly less analgesics: tramadol (medians 0 vs 100 mg, <i>p</i> = 0.037), paracetamol (33% vs 62%, <i>p</i> = 0.004) and ketoprofen (16% vs 32%, <i>p</i> = 0.054). Adding N₂O at the end of sevoflurane-based anaesthesia hastened extubation, eye opening, following commands and orientation, and eliminated prolonged time to extubation without increasing early or late complications.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"310057X261453393"},"PeriodicalIF":1.2,"publicationDate":"2026-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148248917","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":"Managing a deliberate 2,4-dinitrophenol overdose: A case report.","authors":"Susan Su Fa Yee, Phuong Thao Le, Olga Gaitsgory, Hwee Min Lee, Ashwin Subramaniam","doi":"10.1177/0310057X251381375","DOIUrl":"10.1177/0310057X251381375","url":null,"abstract":"<p><p>2,4-Dinitrophenol (DNP), previously used as a weight loss drug, was banned owing to its narrow therapeutic index and severe side effects. DNP disrupts mitochondrial oxidative phosphorylation and inhibits adenosine triphosphate synthesis, causing heat production, increased basal metabolic rate and enhanced glycolysis. Despite bans, unregulated online and darknet sales have led to a rise in DNP toxicity cases. We report a case of a young man who survived a deliberate, highly lethal DNP overdose through coordinated team-based care including early aggressive cooling and high-volume mechanical ventilation, crucial in maintaining normothermia and normocapnia. This case adds valuable insights to the literature on DNP toxicity management.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"293-297"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145755163","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 practice survey of airway management in Australian and New Zealand intensive care units: A 6-year follow-up study.","authors":"Michael Toolis, Alastair Brown, Ashwin Subramaniam","doi":"10.1177/0310057X251396401","DOIUrl":"10.1177/0310057X251396401","url":null,"abstract":"<p><p>Airway management in critically ill patients remains an essential component of intensive care medicine and is associated with significant patient risks. We conducted a 6-year follow-up survey among intensive care unit (ICU) medical staff in Australia and New Zealand (ANZ) from June to September 2024 which explored current ICU airway management practices and compared these with our previous survey in 2019. Among 211 respondents (26% response rate), 79.6% were male and 70.6% were intensivists. Video laryngoscopy (VL) availability increased significantly to 100% (<i>P</i>=0.005). VL was the first-line choice for 82% of respondents (adjusted odd ratio (aOR) = 7.41; 95% confidence interval (CI): 4.33 to 12.67) and there was an increase in intubation checklist usage (aOR = 3.32; 95%CI: 1.88 to 5.86). The use of ketamine for induction doubled (33.2% versus 15.3%; aOR = 2.96; 95%CI: 1.65 to 5.31), and rocuronium (89.6%) was the most used neuromuscular-blocking agent. Only 15.1% consistently used a bougie or stylet, and half used bag-mask ventilation post-induction and prior to intubation. Only 54% of respondents were familiar with any guidelines, and less than half of respondents (46.4%) reported having any formal airway management training in the past 3 years. A majority (81%) supports mandatory airway management continuing professional development (CPD) for fellows of the College of Intensive Care Medicine of ANZ (CICM). Despite improvements in airway management among ANZ ICU clinicians, notable gaps persist between current practices and recent trial evidence and guideline recommendations, supporting the need for airway management CPD for CICM fellows.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"269-279"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145660070","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 novel pupillometer smartphone application demonstrates accurate results compared with a validated clinical pupillometer: The Pupillary Light Response Validation (PLR-V) Study.","authors":"Jake C Schmidt, Paul M Middleton, William Davies","doi":"10.1177/0310057X251381378","DOIUrl":"10.1177/0310057X251381378","url":null,"abstract":"<p><p>The pupillary light response is a sensitive biomarker commonly used for neuromonitoring in intensive care units worldwide. Automated pupillometers have demonstrated increased inter-rater reliability compared with manual assessments by clinicians, allowing for objective repeated assessment. The purpose of this study was directly to compare the raw values and reproducibility of results from a novel automated pupillometer smartphone application, MindMirror, against an existing validated pupillometer, the Neuroptics NPi-200. This study was a prospective cohort study comparing pupillary light response values from three consecutive readings from the MindMirror application and the Neuroptics NPi-200 pupillometer in 66 well subjects. Initial diameter values for NPi-200 and MindMirror did not demonstrate a clinically significant mean error (-0.37 mm ± 0.51 mm) with comparable inter-sample repeatability. Other parameters suggestive of reduced constriction amplitude and velocity, were likely to be related to the clinical conditions of collection. The data suggested that the novel MindMirror smartphone application provided accurate results that were predictable and comparable to the gold standard device for automated pupillometry, and may therefore have utility as a portable accessible device for the rapid assessment of pupillary light response, particularly outside the intensive care unit.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":"54 3","pages":"216-226"},"PeriodicalIF":1.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147872486","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 survey of nitrous oxide use, attitudes and environmental sustainability considerations by anaesthetists across metropolitan local health districts in New South Wales.","authors":"Henry Cm Clutterbuck, Timothy J Marshall, Sascha Karunaratne, Daniel Steffens, Michael Paleologos, Charlotte Johnstone","doi":"10.1177/0310057X251396232","DOIUrl":"10.1177/0310057X251396232","url":null,"abstract":"<p><p>Nitrous oxide (N₂O) is a potent greenhouse gas used to provide analgesia and anaesthesia in healthcare. Leaks from the manifold-pipeline systems may result in significant losses of N₂O before delivery to the patient. The provision of N₂O by cylinder at point-of-care is proposed as a leak-reducing alternative to manifold-pipeline systems. The primary endpoint of this study was to determine the percentage of anaesthetists who considered it acceptable for N₂O to be supplied by cylinder rather than a manifold-pipeline system. It also explored the current application of N₂O and prevailing attitudes toward its environmental impact and future role in anaesthetic practice. A cross-sectional survey was administered in 2023 among anaesthetists working across seven metropolitan hospitals in New South Wales, Australia. Participants provided self-reported information on demographics, practice characteristics, views on climate change, the role of anaesthetists in addressing environmental concerns, routine N₂O usage, and the potential shift to cylinder supply of N₂O. Among the 287 respondents, the majority (<i>n</i>=241, 84.6%) were current users of N₂O, although most administered it infrequently (71.5% used it in less than 25% of cases). Attitudes regarding N₂O's environmental impact varied irrespective of career stage. Notably, 219 of 287 (76.3%) favoured using cylinders over the manifold-pipeline network. These findings indicate a decreasing trend in N₂O usage, especially among early career anaesthetists, and suggest that transitioning to cylinder supply is acceptable, provided that strategies are in place to manage supply disruptions without compromising patient care.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"280-287"},"PeriodicalIF":1.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13161483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145773382","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}