British journal of anaesthesia最新文献

{"title":"NAP7: high mortality risk in neonates and very low risk in children","authors":"Tim M. Cook , Richard A. Armstrong , Fiona Oglesby , Andrew D. Kane , Emira Kursumovic , Jasmeet Soar","doi":"10.1016/j.bja.2024.10.034","DOIUrl":"10.1016/j.bja.2024.10.034","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 2","pages":"Pages 574-575"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791445","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}

{"title":"Tracheostomy outcomes in critically ill patients with COVID-19: a systematic review, meta-analysis, and meta-regression. Comment on Br J Anaesth 2022; 129: 679–92","authors":"Fuli Yan , Mingfei Yang","doi":"10.1016/j.bja.2024.10.032","DOIUrl":"10.1016/j.bja.2024.10.032","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 2","pages":"Pages 569-570"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142821931","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}

{"title":"Early endovascular reperfusion during extracorporeal support for massive pulmonary embolism","authors":"Lorenzo Giosa , Francesca Momigliano , Emilia Tomarchio , Ken-win To , Patrick Collins , Jonathan Dutton , Nishanth Sivarasan , Narayan Karunanithy , Benjamin Garfield , Luigi Camporota","doi":"10.1016/j.bja.2024.11.025","DOIUrl":"10.1016/j.bja.2024.11.025","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 2","pages":"Pages 601-603"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871360","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}

{"title":"Deep learning model to identify and validate hypotension endotypes in surgical and critically ill patients","authors":"Zhongping Jian ,&nbsp;Xianfu Liu ,&nbsp;Karim Kouz ,&nbsp;Jos J. Settels ,&nbsp;Simon Davies ,&nbsp;Thomas W.L. Scheeren ,&nbsp;Neal W. Fleming ,&nbsp;Denise P. Veelo ,&nbsp;Alexander P.J. Vlaar ,&nbsp;Michael Sander ,&nbsp;Maxime Cannesson ,&nbsp;David Berger ,&nbsp;Michael R. Pinsky ,&nbsp;Daniel I. Sessler ,&nbsp;Feras Hatib ,&nbsp;Bernd Saugel","doi":"10.1016/j.bja.2024.10.048","DOIUrl":"10.1016/j.bja.2024.10.048","url":null,"abstract":"<div><h3>Background</h3><div>Hypotension is associated with organ injury and death in surgical and critically ill patients. In clinical practice, treating hypotension remains challenging because it can be caused by various underlying haemodynamic alterations. We aimed to identify and independently validate endotypes of hypotension in big datasets of surgical and critically ill patients using unsupervised deep learning.</div></div><div><h3>Methods</h3><div>We developed an unsupervised deep learning algorithm, specifically a deep learning autoencoder model combined with a Gaussian mixture model, to identify endotypes of hypotension based on stroke volume index, heart rate, systemic vascular resistance index, and stroke volume variation observed during episodes of hypotension. The algorithm was developed with data from 871 surgical patients who had 6962 hypotensive events and validated in two independent datasets, one including 1000 surgical patients who had 7904 hypotensive events and another including 1000 critically ill patients who had 53 821 hypotensive events. We defined hypotension as a mean arterial pressure &lt;65 mm Hg for at least 1 min.</div></div><div><h3>Results</h3><div>In the development dataset, we identified four hypotension endotypes. Based on their physiological and clinical characteristics, we labelled them as: vasodilation, hypovolaemia, myocardial depression, and bradycardia. The same four hypotension endotypes were identified in the two independent validation datasets of surgical and critically ill patients.</div></div><div><h3>Conclusions</h3><div>Unsupervised deep learning identified four endotypes of hypotension in surgical and critically ill patients: vasodilation, hypovolaemia, myocardial depression, and bradycardia. The algorithm provides the probability of each endotype for each hypotensive data point. Identifying hypotensive endotypes could guide clinicians to causal treatments for hypotension.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 2","pages":"Pages 308-316"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142939661","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}

{"title":"Mitigating nitrous oxide emissions: the elephant in the room","authors":"Jasper M. Kampman ,&nbsp;Nicolaas H. Sperna Weiland","doi":"10.1016/j.bja.2024.11.031","DOIUrl":"10.1016/j.bja.2024.11.031","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 2","pages":"Pages 608-609"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142963882","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}

{"title":"New device, old algorithm? Bridging generations in perioperative coagulation management","authors":"Andrew R. Milewski ,&nbsp;Marguerite M. Hoyler ,&nbsp;Thorsten Haas ,&nbsp;Melissa M. Cushing","doi":"10.1016/j.bja.2024.12.005","DOIUrl":"10.1016/j.bja.2024.12.005","url":null,"abstract":"<div><div>Viscoelastic testing permits targeted correction of coagulopathy in bleeding patients. As new generations of <em>viscoelastic testing</em> platforms become available, research exploring similarities and differences with older devices can provide insight for institutions seeking to use the newer technologies. Care must be taken to ensure such studies are designed to produce clinically meaningful guidance for adapting existing treatment algorithms to accommodate the latest <em>viscoelastic testing</em> technology.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 2","pages":"Pages 270-273"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142963884","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}

{"title":"Residual neuromuscular block in the postanaesthesia care unit: a single-centre prospective observational study and systematic review","authors":"Veerle Bijkerk ,&nbsp;Piet Krijtenburg ,&nbsp;Tessa Verweijen ,&nbsp;Jörgen Bruhn ,&nbsp;Gert Jan Scheffer ,&nbsp;Christiaan Keijzer ,&nbsp;Michiel C. Warlé","doi":"10.1016/j.bja.2024.07.043","DOIUrl":"10.1016/j.bja.2024.07.043","url":null,"abstract":"<div><h3>Background</h3><div>Concerns regarding residual neuromuscular block (RNMB) have persisted since the introduction of neuromuscular blocking agents, with reported incidences in the 21st century up to 50%. Advances in neuromuscular transmission (NMT) monitoring and the introduction of sugammadex have addressed this issue, but the impact of these developments remains unclear.</div></div><div><h3>Methods</h3><div>This prospective observational study evaluated RNMB in 500 surgical patients in a large Dutch teaching hospital with readily available quantitative NMT monitoring and reversal agents. The anaesthetic technique and intraoperative NMT monitoring were independently chosen by the attending anaesthesiologist. Acceleromyography was performed upon arrival in the PACU for patients who received nondepolarising neuromuscular blocking agents. RNMB was defined as a train-of-four ratio (TOFR) &lt;0.9. A systematic review was conducted to analyse trends in RNMB in contemporary practice.</div></div><div><h3>Results</h3><div>Out of 500 patients, 11 (2.2%) had a TOFR &lt;0.9. Intraoperative NMT monitoring was performed in 77.6% of patients, and sugammadex was administered to 38% of patients. No patient received neostigmine. The only difference was an automatically recorded TOFR ≥0.9 at the end of surgery in 61.1% in the non-RNMB group compared with 18.2% in the RNMB group (<em>P</em>=0.009). Our systematic review identified incidences ranging from 3.5% to 53.3% since 2000, with a decreasing trend in Europe and North America.</div></div><div><h3>Conclusions</h3><div>The incidence of <em>residual neuromuscular block</em> in the PACU was 2.2%. This suggests significant improvement in the prevention of <em>residual neuromuscular block</em> and stresses the importance of rigorous neuromuscular transmission monitoring and adequate use of reversal agents.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 2","pages":"Pages 350-357"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142489625","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}

{"title":"Addressing bias in feature importances derived from XGBoost. Comment on Br J Anaesth 2024;133:351–9","authors":"Yoshiyasu Takefuji","doi":"10.1016/j.bja.2024.11.033","DOIUrl":"10.1016/j.bja.2024.11.033","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 2","pages":"Pages 613-615"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063801","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}

{"title":"Ketamine or esketamine and quality of recovery after surgery: statistical significance versus clinical importance. Comment on Br J Anaesth 2024; 132: 1293-303","authors":"Yi-Sheng Huang ,&nbsp;Yi-Shan Xie ,&nbsp;Bing-Cheng Zhao ,&nbsp;Bao-Lin Zhong ,&nbsp;Wen Zhou","doi":"10.1016/j.bja.2024.11.012","DOIUrl":"10.1016/j.bja.2024.11.012","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 2","pages":"Pages 587-589"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812183","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}

{"title":"Global collaboration between platform trials in surgery and anaesthesia","authors":"James Glasbey ,&nbsp;Steve A. Webb ,&nbsp;Trisha Peel ,&nbsp;Thomas D. Pinkney ,&nbsp;Paul S. Myles","doi":"10.1016/j.bja.2024.09.021","DOIUrl":"10.1016/j.bja.2024.09.021","url":null,"abstract":"<div><div>Large, randomised trials are the bedrock of evidence-based medicine, but the resources required to complete such trials greatly limit the number of important clinical questions that can be addressed within a reasonable period of time. Adaptive platform trials can identify effective, ineffective, or harmful treatments faster. These trials have been shown to deliver rapid evidence through the COVID-19 pandemic and are now being adopted across surgery and anaesthesia, with many opportunities for surgeons, anaesthetists, and other perioperative physicians to conduct and collaborate in platform trials.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 2","pages":"Pages 259-262"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871361","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}