Anaesthesia and Intensive Care最新文献_第8页

A randomised controlled trial of high-flow nasal oxygen compared with standard oxygen delivery in obese patients undergoing gastroscopy. 在接受胃镜检查的肥胖患者中，高流量鼻氧与标准氧输送的随机对照试验。

IF 1.2 4区医学

Anaesthesia and Intensive Care Pub Date : 2026-05-01 Epub Date: 2025-12-08 DOI: 10.1177/0310057X251382261

Ned Douglas, Reny Segal, Kane O'Donnell, Keat Lee, Roni Krieser, Paul Mezzavia, Shan Hung, Ying Wei Chen, Teresa Sindoni, Irene Ng

{"title":"A randomised controlled trial of high-flow nasal oxygen compared with standard oxygen delivery in obese patients undergoing gastroscopy.","authors":"Ned Douglas, Reny Segal, Kane O'Donnell, Keat Lee, Roni Krieser, Paul Mezzavia, Shan Hung, Ying Wei Chen, Teresa Sindoni, Irene Ng","doi":"10.1177/0310057X251382261","DOIUrl":"10.1177/0310057X251382261","url":null,"abstract":"Background: Arterial haemoglobin oxygen desaturation is common during gastroscopy and is associated with patient harm. Obesity increases the risk of desaturation during gastroscopy. High-flow nasal oxygen may reduce the risk of desaturation, but data are lacking.Methods: We conducted a single-centre, parallel group, randomised controlled trial of high-flow nasal oxygen at 50-70 l/min compared with oxygen via nasal prongs 4-10 l/min, enrolling adults having gastroscopy procedures who had a body mass index greater than 30 kg/m2. The primary outcome was the incidence of desaturation, defined as any peripheral oxygen saturation less than 90% during the procedure.Results: We recruited 150 participants (75 in each group). The mean body mass index was similar in each group (35 vs. 36 kg/m2). High-flow nasal oxygen reduced the incidence of desaturation compared with standard oxygen therapy (three (4%) vs. 14 (19%), P = 0.005), and increased the median minimum peripheral oxygen saturation (98% (interquartile range 92-97%) vs. 94% (interquartile range 97-100%), P < 0.001). Fewer patients administered high-flow oxygen required airway interventions (39 (52%) vs. 58 (77%), P < 0.001), while the number of patients requiring interruption to the procedure for airway management were similar in each group (seven (9%) vs. five (7%), P = 0.57). High-flow nasal oxygen was associated with a higher risk of apnoea compared with standard oxygen delivery (17 (23%) vs. six (8%), P = 0.013), and a similar risk of arrhythmias existed between the groups (two (3%) vs. one (1%), P = 0.56).Conclusion: High-flow nasal oxygen reduced the incidence of desaturation during gastroscopy in obese patients.","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"227-234"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145707069","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}

引用次数: 0

Individualising drug therapy in intensive care. 重症监护个体化药物治疗。

IF 1.5 4区医学

Anaesthesia and Intensive Care Pub Date : 2026-05-01 Epub Date: 2026-01-23 DOI: 10.1177/0310057X251404175

Jacqueline A Hannam, Brian J Anderson

引用次数: 0

The history of protamine. 鱼精蛋白的历史。

IF 1.5 4区医学

Anaesthesia and Intensive Care Pub Date : 2026-05-01 Epub Date: 2026-05-11 DOI: 10.1177/0310057X261429114

Christine M Ball, Peter J Featherstone

引用次数: 0

Impact of increased transparency in anaesthesia fellowship selection interviews: A comparative study. 增加透明度对麻醉研究员选择访谈的影响：一项比较研究。

IF 1.5 4区医学

Anaesthesia and Intensive Care Pub Date : 2026-05-01 Epub Date: 2025-12-14 DOI: 10.1177/0310057X251382959

Navdeep S Sidhu, Julia Foley

{"title":"Impact of increased transparency in anaesthesia fellowship selection interviews: A comparative study.","authors":"Navdeep S Sidhu, Julia Foley","doi":"10.1177/0310057X251382959","DOIUrl":"10.1177/0310057X251382959","url":null,"abstract":"Fellowship selection interviews evaluate candidates' suitability for specialised anaesthesia training. Applicants are not commonly provided with specific details of questions or topics although these are often sourced from previous applicants. This study explored whether increased transparency in the interview process, by providing a list of discussion topics beforehand, impacts applicant performance and experience. Data from 91 applicant interviews over four years (2021-2024) were analysed. The traditional interview format was employed in 2021 and 2022. A novel format was introduced in 2023, in which applicants were provided with a list of 14 discussion topics 3 weeks before the interview. 2024 interviews reverted to the traditional format. Applicant performance was compared across the study period, with feedback collected from the 2023 cohort. No significant difference in mean interview scores or variance ratios was found between the novel and traditional formats, nor between local and non-local applicants. A total of 58.3% of applicants preferred the novel format, citing reduced anxiety and improved preparation. One-third preferred the traditional format, arguing that transparency might disadvantage those who typically prepare for interviews independently. Interviewer feedback indicated no perceived disadvantages from increased transparency, and probing questions effectively elicited detailed responses without making answers seem rehearsed. Providing applicants with interview topics in advance did not impact overall ratings but positively affected their experience by reducing anxiety and improving perceptions of the interview process. The findings support the implementation of transparency in selection interviews to enhance fairness and candidate experience without compromising the validity of the selection process.","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"243-249"},"PeriodicalIF":1.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13161486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145754980","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}

引用次数: 0

Identifying as an intensivist: The transition from failure to success in a high-stakes medical specialist exam. 识别为一名重症医师：在高风险的医学专家考试中从失败到成功的转变。

IF 1.2 4区医学

Anaesthesia and Intensive Care Pub Date : 2026-05-01 Epub Date: 2025-12-02 DOI: 10.1177/0310057X251382957

Mary Pinder, Charlotte I Denniston, Sandra E Carr

{"title":"Identifying as an intensivist: The transition from failure to success in a high-stakes medical specialist exam.","authors":"Mary Pinder, Charlotte I Denniston, Sandra E Carr","doi":"10.1177/0310057X251382957","DOIUrl":"10.1177/0310057X251382957","url":null,"abstract":"Failing high-stakes examinations in specialist medical training has devastating effects on trainees, both personally and professionally, with some trainees requiring multiple attempts. Factors enabling the transition from failure to success are under-explored. This study aims to understand how intensive care trainees, taking multiple attempts at the final high-stakes exam for progression to specialist, made the transition from failure to success, and their lived experience of the journey. This qualitative study applied grounded theory design, conducting 11 in-depth interviews. All participants had had two or more failed attempts before achieving success in the final high-stakes examination, a critical hurdle in achieving Fellowship with the College of Intensive Care Medicine. Additional data included exam reports, an external review of the exam processes, and research notes. To achieve exam success participants needed to reconstruct their sense of self, develop a growth mindset and identify as a competent intensivist. The constructed theory, 'Identifying as an intensivist', relates to professional identity formation and 'thinking, acting and feeling' as an intensivist. 'Identifying as an intensivist' was integral to overcoming exam failure for intensive care trainees. Professional identity formation as an aspect of remediation for high-stakes assessments in medical specialty training has not been well described. Furthermore, assessment processes should be constructed to align with a professional identity reflecting the values and diversity of the specialty.","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"207-215"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145660197","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}

引用次数: 0

Cefazolin pharmacokinetics during prolonged intermittent kidney replacement therapy. 长期间歇肾替代治疗期间头孢唑林的药代动力学。

IF 1.2 4区医学

Anaesthesia and Intensive Care Pub Date : 2026-05-01 Epub Date: 2025-12-08 DOI: 10.1177/0310057X251396229

Jessica H Xu, Sam Salman, David Jr Morgan, Hayoung Won, Steven C Wallis, John Dyer, Jason A Roberts, Matthew Dm Rawlins

引用次数: 0

An episode-based approach for assessing the impact of dyskalaemia on critical care outcomes - results from a territory-wide cohort study. 基于事件的方法评估钾血症对重症监护结果的影响——来自一项区域性队列研究的结果。

IF 1.5 4区医学

Anaesthesia and Intensive Care Pub Date : 2026-05-01 Epub Date: 2026-01-18 DOI: 10.1177/0310057X251396226

Pauline Y Ng, Jethro Lai, April Ip, Doris Hua, Simon Wc Sin, Desmond Yh Yap

{"title":"An episode-based approach for assessing the impact of dyskalaemia on critical care outcomes - results from a territory-wide cohort study.","authors":"Pauline Y Ng, Jethro Lai, April Ip, Doris Hua, Simon Wc Sin, Desmond Yh Yap","doi":"10.1177/0310057X251396226","DOIUrl":"10.1177/0310057X251396226","url":null,"abstract":"Background: Dyskalaemias have been reported as an independent prognostic factor for adverse outcomes based on plasma potassium levels upon intensive care unit (ICU) admission or mean potassium levels across ICU stay, but the granular effects of discrete episodes of dyskalaemia have not been extensively studied.Methods: This retrospective observational cohort study included all adult patients admitted to ICUs in public hospitals in Hong Kong between January 2010 and June 2023. Discrete episodes of dyskalaemia were defined if plasma potassium measurements were beyond the reference range of 3.5-5 mmol/l. Patients were classified into four groups based on the potassium levels throughout their ICU stay (normokalaemic, hyperkalaemic, hypokalaemic and mixed dyskalaemic). Patients with prolonged ICU length of stay beyond 14 days were excluded. The main study outcomes were ICU mortality and the incidence of arrhythmias, which was defined based on a pharmacological surrogate of requiring amiodarone between the onset of the dyskalaemic episode and ICU discharge.Results: A total of 167,449 patients were included. A total of 60,953 (36.4%) patients remained normokalaemic. There were 21,820 (13.0%), 79,312 (47.4%) and 5364 (3.2%) patients in the hyperkalaemic, hypokalaemic and mixed dyskalaemic groups respectively. Dyskalaemia was significantly associated with increased ICU mortality (hyperkalaemia: adjusted odds ratio (aOR) 1.95, 95% confidence interval (CI) 1.79 to 2.12, P < 0.0001 vs hypokalaemia: aOR 1.83, 95% CI 1.70 to 1.96, P < 0.0001 vs mixed dyskalaemia: aOR 2·87, 95% CI 2.57 to 3.20, P < 0.0001). The same adverse effects of dyskalaemia were also observed in incidence of arrhythmias.Conclusions: Having dyskalaemic episodes during the ICU stay was significantly associated with increased odds of ICU mortality and arrhythmias.","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"258-268"},"PeriodicalIF":1.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145997208","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}

引用次数: 0

Evaluation of the clinical learning environment in a quaternary trauma anaesthesia department: a pilot project. 第四创伤麻醉科临床学习环境的评估：一个试点项目。

IF 1.2 4区医学

Anaesthesia and Intensive Care Pub Date : 2026-05-01 Epub Date: 2025-12-02 DOI: 10.1177/0310057X251387719

Amelia R Marshallsea, Kara J Allen, Daryl L Williams, Sidhu N

{"title":"Evaluation of the clinical learning environment in a quaternary trauma anaesthesia department: a pilot project.","authors":"Amelia R Marshallsea, Kara J Allen, Daryl L Williams, Sidhu N","doi":"10.1177/0310057X251387719","DOIUrl":"10.1177/0310057X251387719","url":null,"abstract":"Evaluation of the clinical learning environment in teaching hospitals is an important quality improvement metric. The measure for the anaesthesia theatre educational environment is a validated tool measuring the educational environment in the operating theatre, specific to anaesthesia. Monitoring the learning environment provides information about the impact of interventions, the influence of major events such as a global pandemic and is increasingly linked to accreditation requirements. This study was conducted to establish a baseline for monitoring the impact of interventions designed to improve the learning environment. We surveyed trainees at the Royal Melbourne Hospital, a trauma hospital in Melbourne, Australia, aiming to identify areas for improvement in the clinical learning environment and provide a needs analysis for interventions to help anaesthesia trainees set and achieve learning goals. This single centre survey study occurred over a 6-week period from May 2023. Medical staff who had undertaken a training rotation at Royal Melbourne Hospital in the past 6 months were eligible. Twenty-six responses were received (response rate 39%). Areas for improvement included setting learning goals (mean 3.9, median 5, interquartile range 4-5) and assessment of trainee performance (mean 3.8, median 4, interquartile range 3-5). Over 80% of participants had received no training in how to set a learning goal, despite over 90% indicating that it would be of value to their experience. Trainee perception of the learning environment was positive but there is opportunity for improvement. We are planning interventions to assist trainees and consultants to set learning goals while working in a dynamic clinical learning environment.","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"199-206"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145660120","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}

引用次数: 0

Awake tracheal intubation: A survey of practices, barriers and skills maintenance. 清醒气管插管：实践、障碍和技能维持的调查。

IF 1.2 4区医学

Anaesthesia and Intensive Care Pub Date : 2026-05-01 Epub Date: 2025-12-18 DOI: 10.1177/0310057X251397168

Andrew Downey, Chad Oughton, Tim Makar, Yasmin Endlich, Jonathan M Graham, Louise Ellard, John A Law

{"title":"Awake tracheal intubation: A survey of practices, barriers and skills maintenance.","authors":"Andrew Downey, Chad Oughton, Tim Makar, Yasmin Endlich, Jonathan M Graham, Louise Ellard, John A Law","doi":"10.1177/0310057X251397168","DOIUrl":"10.1177/0310057X251397168","url":null,"abstract":"Awake tracheal intubation (ATI) is advocated in situations where complex airway anatomy or deranged physiology make usual post-induction airway management hazardous. The safety of ATI has been described in many settings. Nevertheless, it is not always performed when indicated, and significant patient harm as a consequence is still reported. A survey was conducted to investigate anaesthetists' practices and possible reasons for reticence in performing ATI. The survey also sought to explore solutions to limited opportunities for training and skills maintenance. The 17-question survey was sent to a random selection of 1400 consultant anaesthetists across Australia and New Zealand in 2023. The response rate was 36% (499 of 1400). Forty percent (198 of 499) (95% confidence interval (CI) 35 to 44) of participants had not performed an ATI in the last 12 months. The majority of participants (64% (317 of 499) (95% CI 59 to 68)) agreed that there were barriers in their own practice to performing ATI. There was strong agreement that proficiency in ATI should be within the skillset of on-call anaesthetists (81% (400 of 494) (95% CI 78 to 84)). There was also strong support for ATI to become a mandatory core skill (74% (368 of 497) (95% CI 70 to 78) of participants). Current volume of practice for trainees was almost universally considered insufficient (93% (459 of 496) (95% CI 90 to 95)). There is a disparity between the perceived importance of competence in ATI and the limited volume of practice expected of trainees and paucity of ongoing clinical exposure for consultants. Training and programs to maintain skills in ATI are urgently required to address this.","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"250-257"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145780117","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}

引用次数: 0

Investigating nitrous oxide leaks at St George Hospital: A case study using the discrepancy and pressure testing methods. 调查圣乔治医院的一氧化二氮泄漏：使用差异和压力测试方法的案例研究。

IF 1.5 4区医学

Anaesthesia and Intensive Care Pub Date : 2026-05-01 Epub Date: 2025-12-10 DOI: 10.1177/0310057X251379095

Rebecca Cregan, Kristen Pickles, Philomena Colagiuri, Scott McAlister, Forbes McGain, Katy Bell

{"title":"Investigating nitrous oxide leaks at St George Hospital: A case study using the discrepancy and pressure testing methods.","authors":"Rebecca Cregan, Kristen Pickles, Philomena Colagiuri, Scott McAlister, Forbes McGain, Katy Bell","doi":"10.1177/0310057X251379095","DOIUrl":"10.1177/0310057X251379095","url":null,"abstract":"Nitrous oxide (N2O) is ozone-depleting and a greenhouse gas. Studies have shown a high wastage of N2O from leaking hospital infrastructure. Identifying leaks is a priority action in the Australian national health and climate strategy. Four possible methods to identify leaks have been described: the discrepancy method, cylinder weighing, pressure testing, and flow monitoring. We used the discrepancy and pressure testing methods to investigate possible N2O leaks at St George Hospital, a large tertiary hospital in Sydney providing medical, surgical, birthing, paediatric, and trauma care. Our investigation was in four steps: (a) to determine how much N2O is procured and calculate the associated carbon emissions; (b) to outline the location of pipeline supply; (c) to determine how much N2O is used clinically (operating theatres, delivery suite, other areas); and (d) to assess for leaks throughout the pipeline using pressure testing. We estimated a total annual 'worst case' estimate of maximum possible clinical N2O use of approximately 801,866 litres at St George Hospital in 2021, with 14,846 litres used in the operating theatres and 787,020 litres used in the delivery suite. This estimate was approximately 319,534 litres (or 28%) less than the 1,121,400 litres procured N2O used to supply the manifold, indicating leaks at least this large. Pressure testing of the full manifold system identified leaks in three operating theatres. A substantial amount of the N2O procured by St George Hospital is leaking to the atmosphere causing unnecessary emissions. This N2O provides no benefits to clinical care, has financial costs, and may pose potential occupational exposure risks to clinicians.","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"235-242"},"PeriodicalIF":1.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13161490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145720334","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}

引用次数: 0