Anaesthesiology intensive therapy最新文献

{"title":"Endotracheal tube cuff pressure assessment: expectations versus reality.","authors":"Valentyn Sadovyi, Iurii Kuchyn, Kateryna Bielka, Vasyl Horoshko, Dmytro Sazhyn, Liubov Sokolova","doi":"10.5114/ait.2024.145411","DOIUrl":"10.5114/ait.2024.145411","url":null,"abstract":"<p><strong>Background: </strong>Damage to the trachea, although rare, is a serious complication in anesthesiology and intensive care. The main mechanism of such injury is a direct mechanical action associated with excessive pressure in the cuff of the endotracheal tube (ETT). The aim of the study was to evaluate the actual pressure in the cuffs during surgical interventions, correlate this measure with the subjective assessment of the anesthesiologist, and compare different methods of inflating the ETT cuff.</p><p><strong>Methods: </strong>Ninety patients were randomly divided into two equal groups. In the study group, the \"minimum leakage\" technique was used to inflate the cuff. In the control group, the adequacy of pressure was determined by palpation of the cuff balloon. In both groups, the actual pressure was then measured using a mechanical manometer connected to the cuff.</p><p><strong>Results: </strong>The average ETT cuff pressure was 30.4 ± 4.9 cmH 2 O (2.98 ± 0.48 kPa) in the study group and 68.9 ± 23.3 cmH 2 O (6.75 ± 2.28 kPa) in the control group. The pressure in the ETT cuffs was within the standard safe range (i.e. 20-30 cmH 2 O) in 2/45 (4.4%) and 23/45 (51.1%) patients in the control and the study group, respectively.</p><p><strong>Conclusions: </strong>In the majority of cases, the pressure achieved via evaluation by the me-thod of palpation of the control cuff was not adequate. Among various non-mechanical methods of measuring and controlling pressure in the cuff of the intubation tube, the minimum occlusion volume technique deserves attention.</p>","PeriodicalId":7750,"journal":{"name":"Anaesthesiology intensive therapy","volume":"56 4","pages":"241-245"},"PeriodicalIF":1.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11736906/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of multidrug-resistant organisms in intensive care unit patients and rate of subsequent bacteraemia: a 5-year study.","authors":"Moncompu Subramanian Ramachandran, Indunil Sandaradura, Vineet Nayyar","doi":"10.5114/ait.2024.146641","DOIUrl":"10.5114/ait.2024.146641","url":null,"abstract":"<p><strong>Introduction: </strong>Multidrug-resistant organism (MRO) bacteraemia is associated with significant mortality. A limited number of studies have examined the relationship between MRO colonisation and subsequent bacteraemia in critically ill patients.</p><p><strong>Material and methods: </strong>All patients with a positive surveillance swab result and a positive blood culture result for MROs admitted to the Westmead intensive care unit (ICU) between 1 January 2014 and 31 March 2019 had their results matched with ICU data extracted from the ICU database and analysed for the risk of bacteraemia among swab positive patients.</p><p><strong>Results: </strong>There were 3,878 (2,388 males, 1,490 females) assessable admissions during the period. The median APACHE II (Acute Physiology and Chronic Health Evaluation) score was 17. A total of 9,681 swab results were collected from 3,878 patients. Of the 3,878 patients, 818 were positive for MROs, and 3,060 were negative. Thirty-two swab positive patients (3.9%) tested positive for MROs in the blood culture, and 16 (0.52%) in the swab negative group had MROs in their blood cultures. This difference was statistically significant (adjusted [adj] OR 6.33; 95% CI: 3.40-11.76). The swab positive group was also associated with a significantly higher positive blood culture with orga-nisms other than MROs than the swab negatives (11.1% and 6.2%, respectively, adj OR 1.37; 95% CI: 1.04-1.82). The overall mortality was higher in swab positive compared to swab negative patients (20.7% vs. 13.1%, P < 0.001). The overall prevalence of MRO colonisation was 21% in our cohort.</p><p><strong>Conclusions: </strong>The risk of MRO bacteraemia was higher among patients with a positive surveillance swab result for the organism compared to those with a negative swab, but this was not associated with higher mortality in that group.</p>","PeriodicalId":7750,"journal":{"name":"Anaesthesiology intensive therapy","volume":"56 5","pages":"277-284"},"PeriodicalIF":1.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nutritional responsiveness affects novel neutrophil parameters and reduces in-hospital mortality and costs in elective cancer oesophagectomy - a single centre, prospective, observational study.","authors":"Paweł Kutnik, Michał Borys, Kamil Nurczyk, Weronika Domerecka, Jacek Dziedzic, Grzegorz Buszewicz, Grzegorz Teresiński, Helena Donica, Paweł Piwowarczyk, Mirosław Czuczwar","doi":"10.5114/ait.2024.136013","DOIUrl":"10.5114/ait.2024.136013","url":null,"abstract":"<p><strong>Introduction: </strong>Malnutrition in surgical patients remains a common issue affecting the perioperative period. Oesophageal cancer is a disease associated with one of the highest malnutrition rates. Assessment of patient nutritional status remains a challenge due to limited validated tools. Novel parameters to identify malnourished patients and the effectiveness of preoperative nutritional intervention might improve treatment results in the perioperative period.</p><p><strong>Material and methods: </strong>This was a prospective, observational, single-centre study of patients scheduled for elective oesophagectomy. The primary aim of this study was to establish the correlation between neutrophil reactivity intensity (NEUT-RI) and neutrophil granularity intensity (NEUT-GI) and patients' nutritional status. We divided patients into nutritional responders (R group) and nutritional non-responders (NR group) defined as regaining at least 25% of the maximum preoperative body weight loss during the preoperative period.</p><p><strong>Results: </strong>The R group had significantly shorter intensive care unit (ICU) stays: 5.5 (4-8) vs. 13 (7-31) days ( P = 0.01). It resulted in a lower cost of ICU stays in the R group: 4775.2 (3938.9-7640.7) vs. 12255.8 (7787.6-49108.7) euro in the NR group ( P = 0.01). Between the R group and the NR group, we observed statistically significant differences in both preoperative NEUT-RI (48.6 vs. 53.4, P = 0.03) and NEUT-GI (154.6 vs. 159.3, P = 0.02). Apart from the T grade, the only preoperative factor associated with reduced mortality was the nutritional responsiveness: 11.1% vs. 71.4% ( P = 0.008).</p><p><strong>Conclusions: </strong>Preoperative nutritional responsiveness affects neutrophil intensity indexes and reduces in-hospital mortality and costs associated with hospital stay. Further research is required to determine the correlation between novel neutrophil parameters and patients' nutritional status.</p>","PeriodicalId":7750,"journal":{"name":"Anaesthesiology intensive therapy","volume":"56 1","pages":"77-82"},"PeriodicalIF":1.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11022637/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140915684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of outcomes of patients ≥ 80 years old admitted to intensive care units in Poland - a post-hoc analysis of the VIP2 prospective observational study.","authors":"Paweł Melchior Pasieka, Michał Kurek, Wojciech Skupnik, Evan Skwara, Valentyn Bezshapkin, Jakub Fronczek, Anna Kluzik, Bartosz Kudliński, Szymon Białka, Dorota Studzińska, Łukasz Krzych, Szymon Czajka, Jan Stefaniak, Radosław Owczuk, Joanna Sołek-Pastuszka, Jowita Biernawska, Joanna Zorska, Paweł Krawczyk, Katarzyna Cwyl, Maciej Żukowski, Katarzyna Kotfis, Małgorzata Zegan-Barańska, Agnieszka Wieczorek, Wojciech Mudyna, Mariusz Piechota, Szymon Bernas, Waldemar Machała, Łukasz Sadowski, Marta Serwa, Mirosław Czuczwar, Michał Borys, Mirosław Ziętkiewicz, Natalia Kozera, Barbara Adamik, Waldemar Goździk, Paweł Nasiłowski, Paweł Zatorski, Janusz Trzebicki, Piotr Gałkin, Ryszard Gawda, Urszula Kościuczuk, Waldemar Cyrankiewicz, Katarzyna Sierakowska, Wojciech Gola, Hubert Hymczak, Hans Flaatten, Wojciech Szczeklik","doi":"10.5114/ait.2024.138192","DOIUrl":"10.5114/ait.2024.138192","url":null,"abstract":"<p><strong>Introduction: </strong>Elderly patients pose a significant challenge to intensive care unit (ICU) clinicians. In this study we attempted to characterise the population of patients over 80 years old admitted to ICUs in Poland and identify associations between clinical features and short-term outcomes.</p><p><strong>Material and methods: </strong>The study is a post-hoc analysis of the Polish cohort of the VIP2 European prospective observational study enrolling patients > 80 years old admitted to ICUs over a 6-month period. Data including clinical features, clinical frailty scale (CFS), geriatric scales, interventions within the ICU, and outcomes (30-day and ICU mortality and length of stay) were gathered. Univariate analyses comparing frail (CFS > 4) to non-frail patients and survivors to non-survivors were performed. Multivariable models with CFS, activities of daily living score (ADL), and the cognitive decline questionnaire IQCODE as predictors and ICU or 30-day mortality as outcomes were formed.</p><p><strong>Results: </strong>A total of 371 patients from 27 ICUs were enrolled. Frail patients had significantly higher ICU (58% vs. 44.45%, P = 0.03) and 30-day (65.61% vs. 54.14%, P = 0.01) mortality compared to non-frail counterparts. The survivors had significantly lower SOFA score, CFS, ADL, and IQCODE than non-survivors. In multivariable analysis CFS (OR 1.15, 95% CI: 1.00-1.34) and SOFA score (OR 1.29, 95% CI: 1.19-1.41) were identified as significant predictors for ICU mortality; however, CFS was not a predictor for 30-day mortality ( P = 0.07). No statistical significance was found for ADL, IQCODE, polypharmacy, or comorbidities.</p><p><strong>Conclusions: </strong>We found a positive correlation between CFS and ICU mortality, which might point to the value of assessing the score for every patient admitted to the ICU. The older Polish ICU patients were characterised by higher mortality compared to the other European countries.</p>","PeriodicalId":7750,"journal":{"name":"Anaesthesiology intensive therapy","volume":"56 1","pages":"61-69"},"PeriodicalIF":1.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11022638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140915733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilisation and outcomes of a mobile (ambulance and air transport) venovenous extracorporeal membrane oxygenation (VV-ECMO) program in Poland during the COVID-19 pandemic - a retrospective, two-centres, case-series study.","authors":"Elżbieta Rypulak, Marta Szczukocka, Tomasz Czarnik","doi":"10.5114/ait.2024.139526","DOIUrl":"10.5114/ait.2024.139526","url":null,"abstract":"<p><strong>Introduction: </strong>Many patients required mechanical ventilation support due to severe COVID-19 pneumonia. A significant proportion of mechanically ventilated patients also required venovenous extracorporeal membrane oxygenation (VV-ECMO) due to refractory hypoxemia. A high demand for VV-ECMO support during the pandemic was challenging due to many factors, including limited resources and lack of established transfer protocols. This study aims to present the organisation and outcomes of a mobile VV-ECMO program in two high-volume centres in Poland during the COVID-19 pandemic.</p><p><strong>Material and methods: </strong>This retrospective, two-centre case series study, which lasted 36 months, was conducted between March 10, 2020, and January 31, 2023. The data of all patients transferred using venovenous extracorporeal membrane oxygenation (VV-ECMO) were analysed, including five women in the perinatal period with severe respiratory failure attri-buted to the COVID-19 virus. The analysis encompassed baseline patient demographics, Sequential Organ Failure Assessment (SOFA) scores, admission laboratory parameters, ECMO therapy, duration of mechanical ventilation, and patient survival to ICU discharge.</p><p><strong>Results: </strong>We assessed 86 patients who met the ELSO inclusion criteria and were transported during VV-ECMO support. Mortality in the analysed group was high (80.3%). Despite high mortality, VV-ECMO appeared to be a safe procedure in COVID-19 patients with severe ARDS. No complications were noted in more than half of the analysed procedures. Despite the above, many severe complications were observed, including stroke or cerebral haemorrhage (9.8%) and limb or gut ischemia (1.6%). The most common problems co-existing with VV-ECMO treatment were bleeding complications (34.4%).</p><p><strong>Conclusions: </strong>The ICU mortality rate among patients requiring VV-ECMO for COVID-19 in high-volume ECMO centres was high but not associated with the type of transportation.</p>","PeriodicalId":7750,"journal":{"name":"Anaesthesiology intensive therapy","volume":"56 2","pages":"141-145"},"PeriodicalIF":1.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11284578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142016145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distal central airway obstruction: should preemptive extracorporeal membrane oxygenation be the standard of care?","authors":"Juan Camilo Segura-Salguero, Jonathan Yeung, Lorena Díaz-Bohada, Ludwik Fedorko, Marcin Wąsowicz","doi":"10.5114/ait.2024.145409","DOIUrl":"10.5114/ait.2024.145409","url":null,"abstract":"","PeriodicalId":7750,"journal":{"name":"Anaesthesiology intensive therapy","volume":"56 4","pages":"252-255"},"PeriodicalIF":1.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11736905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary alveolar proteinosis flare in the setting of COVID pneumonia.","authors":"Kevin M Chen, Yuli Lim, Jamal Hasoon, Sandeep Markan, Anvinh Nguyen","doi":"10.5114/ait.2024.145184","DOIUrl":"10.5114/ait.2024.145184","url":null,"abstract":"","PeriodicalId":7750,"journal":{"name":"Anaesthesiology intensive therapy","volume":"56 4","pages":"264-266"},"PeriodicalIF":1.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11736904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is locoregional anesthesia for hip fracture a valid third option for high-risk patients?","authors":"Marco Giudice, Riccardo Pulitanò, Enrico Di Sabatino, Francesca La Verde","doi":"10.5114/ait.2024.146746","DOIUrl":"10.5114/ait.2024.146746","url":null,"abstract":"","PeriodicalId":7750,"journal":{"name":"Anaesthesiology intensive therapy","volume":"56 5","pages":"325-326"},"PeriodicalIF":1.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary: PECS II block versus serratus anterior plane block in modified radical mastectomies.","authors":"Raghuraman M Sethuraman, Shanmuga Priya Arulmozhi, Gayathri Ramesh, Rohan Magoon","doi":"10.5114/ait.2024.142758","DOIUrl":"https://doi.org/10.5114/ait.2024.142758","url":null,"abstract":"","PeriodicalId":7750,"journal":{"name":"Anaesthesiology intensive therapy","volume":"56 3","pages":"215-216"},"PeriodicalIF":1.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11483269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142493063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative utilization of tranexamic acid in total knee and hip arthroplasty procedures in Poland - a survey-based study.","authors":"Dorota Studzińska, Izabela Pabjańczyk, Kamil Polok, Wojciech Szczeklik","doi":"10.5114/ait.2024.142670","DOIUrl":"https://doi.org/10.5114/ait.2024.142670","url":null,"abstract":"","PeriodicalId":7750,"journal":{"name":"Anaesthesiology intensive therapy","volume":"56 3","pages":"206-207"},"PeriodicalIF":1.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11483272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142493067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}