Revista espanola de anestesiologia y reanimacion最新文献

{"title":"Rationale and study design for an Individualized PeriopeRative Open lung VEntilatory approach in Emergency Abdominal Laparotomy/scopy: study protocol for a prospective international randomized controlled trial","authors":"G. Laguna ,&nbsp;F. Suárez-Sipmann ,&nbsp;G. Tusman ,&nbsp;J. Ripollés ,&nbsp;O. Díaz-Cambronero ,&nbsp;R. Pujol ,&nbsp;E. Rivas ,&nbsp;I. Garutti ,&nbsp;R. Mellado ,&nbsp;J. Vallverdú ,&nbsp;A. Jacas ,&nbsp;A. Fervienza ,&nbsp;R. Marrero ,&nbsp;J. Librero ,&nbsp;J. Villar ,&nbsp;C. Ferrando","doi":"10.1016/j.redare.2024.04.007","DOIUrl":"10.1016/j.redare.2024.04.007","url":null,"abstract":"<div><h3>Background</h3><p>Postoperative pulmonary complications (PPC) are the most frequent postoperative complications, with an estimated prevalence in elective surgery ranging from 20% in observational cohort studies to 40% in randomized clinical trials. However, the prevalence of PPCs in patients undergoing emergency abdominal surgery is not well defined. Lung-protective ventilation aims to minimize ventilator-induced lung injury and reduce PPCs. The open lung approach (OLA), which combines recruitment manoeuvres (RM) and positive end-expiratory pressure (PEEP) titration, aims to minimize areas of atelectasis and the development of PPCs; however, there is no conclusive evidence in the literature that OLA can prevent PPCs. The purpose of this study is to compare an individualized perioperative OLA with conventional standardized lung-protective ventilation in patients undergoing emergency abdominal surgery with clinical signs of intraoperative lung collapse.</p></div><div><h3>Methods</h3><p>Randomized international clinical trial to compare an individualized perioperative OLA (RM plus individualized PEEP and individualized postoperative respiratory support) with conventional lung-protective ventilation (standard PEEP of 5 cmH₂O and conventional postoperative oxygen therapy) in patients undergoing emergency abdominal surgery with clinical signs of lung collapse. Patients will be randomised to open-label parallel groups. The primary outcome is any severe PPC during the first 7 postoperative days, including: acute respiratory failure, pneumothorax, weaning failure, acute respiratory distress syndrome, and pulmonary infection. The estimated sample size is 732 patients (366 per group). The final sample size will be readjusted during the interim analysis.</p></div><div><h3>Discussion</h3><p>The Individualized Perioperative Open-lung Ventilatory Strategy in emergency abdominal laparotomy (iPROVE-EAL) is the first multicentre, randomized, controlled trial to investigate whether an individualized perioperative approach prevents PPCs in patients undergoing emergency surgery.</p></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140759331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intracardiac mass","authors":"J. Llau García,&nbsp;J. Moreno Pachón,&nbsp;E. Mateo Rodríguez,&nbsp;J. De Andrés Ibáñez","doi":"10.1016/j.redare.2024.02.018","DOIUrl":"10.1016/j.redare.2024.02.018","url":null,"abstract":"","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139998754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with limitation of life support: Post-ICU mortality case study of a tertiary hospital","authors":"U.A. López González ,&nbsp;D. Bautista Rentero ,&nbsp;M. Crespo Gómez ,&nbsp;P. Cárcamo Ibarra ,&nbsp;A.M. Míguez Santiyán","doi":"10.1016/j.redare.2024.02.007","DOIUrl":"10.1016/j.redare.2024.02.007","url":null,"abstract":"<div><h3>Background</h3><p>Life-sustaining treatment limitation (LSV) is the medical act of withdrawing or not initiating measures that are considered futile in a patient's specific situation. LSV in critically ill patients remains a difficult topic to study, due to the multitude of factors that condition it.</p></div><div><h3>Objective</h3><p>To determine factors related to LSV in ICU in cases of post-ICU in-hospital mortality, as well as factors associated with survival after discharge from ICU.</p></div><div><h3>Design</h3><p>Retrospective longitudinal study.</p></div><div><h3>Ambit</h3><p>Intensive care unit of a tertiary hospital.</p></div><div><h3>Patients</h3><p>People who died in the hospitalization ward after ICU treatment between January 2014 and December 2019.</p></div><div><h3>Interventions</h3><p>None. This is an observational study.</p></div><div><h3>Variables of interest</h3><p>Age, sex, probability of death, type of admission, LSV in ICU, oncological disease, dependence, invasive mechanical ventilation, emergency hemodialysis, transfusion of blood products, nosocomial infection (NI), pre-ICU, intra-ICU and post-ICU stays.</p></div><div><h3>Results</h3><p>Of 114 patients who died outside the ICU, 49 had LSV registered in the ICU (42.98%). Age and stay prior to ICU admission were positively associated with LSV (OR 1,03 and 1,08, respectively). Patients without LSV had a higher post-ICU stay, while it was lower for male patients.</p></div><div><h3>Conclusions</h3><p>Our results support that LSV established within the ICU can avoid complications commonly associated with unnecessary prolongation of stay, such as NI.</p></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139718190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uterotonics, magnesium sulphate and antibiotics during childbirth and peripartum: Important obstetric drugs for the anaesthesiologist","authors":"M. Astete ,&nbsp;H.J. Lacassie","doi":"10.1016/j.redare.2024.02.031","DOIUrl":"10.1016/j.redare.2024.02.031","url":null,"abstract":"<div><p>The main causes of maternal mortality are comorbidities, hypertensive pregnancy syndrome, obstetric haemorrhage, and maternal sepsis. For this reason, uterotonics, magnesium sulphate, and antibiotics are essential tools in the management of obstetric patients during labour and in the peripartum period. These drugs are widely used by anaesthesiologists in all departments, and play a crucial role in treatment and patient safety.</p><p>For the purpose of this narrative review, we performed a detailed search of medical databases and selected studies describing the use of these drugs in patients during pregnancy, delivery and the pospartum period.</p><p>Uterotonics, above all oxytocin, play an important role in the prevention and treatment of pospartum haemorrhage, and various studies have shown that in obstetric procedures, such as scheduled and emergency caesarean section, they are effective at lower doses than those hitherto accepted. We also discuss the use of carbetocin as an effective alternative that has a therapeutic advantage in certain clinical circumstances.</p><p>Magnesium sulphate is the gold standard in the prevention and treatment of eclampsia, and also plays a neuroprotective role in preterm infants. We describe the precautions to be taken during magnesium administration.</p><p>Finally, we discuss the importance of understanding microbiology and the pharmacology of antibiotics in the management of obstetric infection and endometritis, and draw attention to the latest trends in antibiotic regimens in labour and caesarean section.</p></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140013883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tranexamic acid in patients with traumatic brain injury: a meta-analysis","authors":"R.M. Sarhan,&nbsp;M.S. Boshra,&nbsp;M.E.A. Abdelrahim,&nbsp;H. Osama","doi":"10.1016/j.redare.2024.02.013","DOIUrl":"10.1016/j.redare.2024.02.013","url":null,"abstract":"<div><h3>Background</h3><p>We performed a meta-analysis to assess the effectiveness and safety of tranexamic acid in patients with traumatic brain injury (TBI).</p></div><div><h3>Methods</h3><p>We searched the literature for articles evaluating the effectiveness and safety of tranexamic acid (TXA) in TBI published between January 2012 and January 2021, and identified 8 studies with a total of 10860 patients: 5660 received TXA and 5200 served as controls. We used a dichotomous or continuous approach with a random or fixed-effect model to assess the efficacy and safety of TXA in TBI, and calculated the mean difference (MD) and odds ratio (OR) with the corresponding 95% confidence interval.</p></div><div><h3>Results</h3><p>In patients with TBI, early administration of TXA was associated with a greater relative benefit (MD −2.45; 95% CI = −4.78 to −0.12; p<!--> <!-->=<!--> <!-->0.04) and less total haematoma expansion (MD - 2.52; 95% CI = −4.85 to −0.19; p<!--> <!-->=<!--> <!-->0.03) compared to controls.</p><p>There were no statistically significant differences in mortality (OR 0.94; 95% CI<!--> <!-->=<!--> <!-->0.85–1.03; p<!--> <!-->=<!--> <!-->0.18), presence of progressive haemorrhage (OR 0.75; 95% CI<!--> <!-->=<!--> <!-->0.56–1.01; p<!--> <!-->=<!--> <!-->0.06), need for neurosurgery (OR 1.15; 95% CI<!--> <!-->=<!--> <!-->0.66–1.98; p<!--> <!-->=<!--> <!-->0.63), high Disability Rating Scale score (OR 0.90; 95% CI<!--> <!-->=<!--> <!-->0.56–1.45; p<!--> <!-->=<!--> <!-->0.68), and incidence of ischaemic or thromboembolic complications (OR 1.34; 95% CI<!--> <!-->=<!--> <!-->0.33–5.46; p<!--> <!-->=<!--> <!-->0.68) between TBI patients treated with TXA and controls.</p></div><div><h3>Conclusions</h3><p>Early administration of TXA in TBI patients may have a greater relative benefit and may inhibit haematoma expansion. There were no significant differences in mortality, presence of progressive haemorrhage, need for neurosurgery, high Disability Rating Scale score, and incidence of ischaemic or thromboembolic complications between TBI patients treated with TXA and controls. Further studies are needed to validate these results.</p></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139934948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of lymphopenia on long-term mortality in septic shock, a retrospective observational study","authors":"J. Rico-Feijoó ,&nbsp;J.F. Bermejo ,&nbsp;A. Pérez-González ,&nbsp;S. Martín-Alfonso ,&nbsp;C. Aldecoa","doi":"10.1016/j.redare.2024.02.014","DOIUrl":"10.1016/j.redare.2024.02.014","url":null,"abstract":"<div><h3>Background and objective</h3><p>The diagnosis of infection, to diagnose septic shock, has been qualified by leukocyte counts and protein biomarkers. Septic shock mortality is persistently high (20%–50%), and rising in the long term. The definition of sepsis does not include leukocyte count, and lymphopenia has been associated with its mortality in the short term. Immunosuppression and increased mortality in the long term due to sepsis have not been demonstrated. The aim is to relate the occurrence of lymphopenia and its lack of recovery during septic shock with mortality at 2 years.</p></div><div><h3>Patients and methods</h3><p>Cohort of 332 elderly patients diagnosed with septic shock. Mortality at 28 days and 2 years was analysed according to leukocyte, neutrophil, and lymphocyte counts, and the ability to recover from lymphopenia (LRec).</p></div><div><h3>Results</h3><p>A total of 74.1% of patients showed lymphopenia, and 73.5% did not improve during ICU stay. Mortality was 31.0% and 50.3% at 28 days and 2 years, respectively. Lymphopenia was a predictor of early mortality (OR 2.96) and LRec of late mortality (OR 3.98). Long-term mortality was associated with LRec (HR 1.69).</p></div><div><h3>Conclusions</h3><p>In elderly patients with septic shock, 28-day mortality is associated with lymphopenia and neutrophilia, and LRec with 2-year mortality; this may represent 2 distinct phenotypes of behaviour after septic shock.</p></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139935122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between different corticosteroid regimens used in severe SARS-CoV-2 infection and short-term mortality: retrospective cohort study","authors":"A. González-Castro,&nbsp;A. Fernandez,&nbsp;E. Cuenca-Fito,&nbsp;Y. Peñasco,&nbsp;J. Ceña,&nbsp;J.C. Rodríguez Borregán","doi":"10.1016/j.redare.2024.02.012","DOIUrl":"10.1016/j.redare.2024.02.012","url":null,"abstract":"<div><h3>Introduction</h3><p>During the SARS-CoV-2 pandemic, several corticosteroid regimens have been used in the treatment of the disease, with disparate results according to drug and regimen used. For this reason, we wanted to analyze differences in early mortality derived from the use of different regimens of dexamethasone and methylprednisolone in SARS-CoV-2 infection in critically ill patients requiring admission to an ICU.</p></div><div><h3>Method</h3><p>Observational, analytical and retrospective study, in an intensive care unit of a third-level university hospital, (March 2020 and June 2021). Adult patients (&gt;18 years old) who were admitted consecutively for proven SARS-CoV-2 infection were included. The association with mortality in ICU at 28 days, different corticosteroid regimens used, was analyzed using a Cox proportional risk regression model.</p></div><div><h3>Results</h3><p>Data from a cohort of 539 patients were studied. Patient age (RR: 1.06; 95% CI: 1.02–1.10; <em>P</em> <!-->=<!--> <!-->&lt;0.01) showed a significant association with 28-day mortality in the ICU. In the comparison of the different corticosteroid regimens analyzed, taking as a reference those patients who did not receive corticosteroid treatment, the dose of dexamethasone of 6<!--> <!-->mg/day showed a clear trend towards statistical significance as a protector of mortality at 28 days in the ICU (RR: 0.40, 95% CI: 0.15–1.02, p<!--> <!-->=<!--> <!-->0.05). The dose of dexamethasone of 6<!--> <!-->mg/day and low doses of methylprednisolone show a similar association with survival at 28 days (OR: 1.19; 95% CI: 0.63–2.26).</p></div><div><h3>Conclusions</h3><p>The use of corticosteroids has been associated with better mortality outcomes in severe cases of SARS-CoV-2 infection. However, the therapeutic benefits of corticosteroids are not limited to dexamethasone alone.</p></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139941405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In reply to “Negative preoperative RT-PCR screening is no guaranty of no SARS-CoV-2 infection”","authors":"M. de la Matta ,&nbsp;J.M. Delgado-Sánchez ,&nbsp;G. Martín-Gutiérrez","doi":"10.1016/j.redare.2024.02.022","DOIUrl":"10.1016/j.redare.2024.02.022","url":null,"abstract":"","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139998753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-anaesthesia assessment in cataract surgery: Recommendations from the SEDAR Working Group","authors":"L. Quecedo Gutierrez ,&nbsp;E. Alsina ,&nbsp;B. del Blanco Narciso ,&nbsp;A. Vazquez Lima ,&nbsp;M. Zaballos Garcia ,&nbsp;A. Abad Gurumeta","doi":"10.1016/j.redare.2024.02.029","DOIUrl":"10.1016/j.redare.2024.02.029","url":null,"abstract":"<div><h3>Introduction and objectives</h3><p>Cataract surgery is one of the most common procedures in outpatient surgery units. The use of information and communication technologies (ICT) in clinical practice and the advent of new health scenarios, such as the Covid pandemic, have driven the development of pre-anaesthesia assessment models that free up resources to improve access to cataract surgery without sacrificing patient safety. The approach to cataract surgery varies considerably among public, subsidised and private hospitals. This raises the need for guidelines to standardise patient assessment, pre-operative tests, management of background medication, patient information and informed consent.</p></div><div><h3>Results</h3><p>In this document, the SEDAR Clinical Management Division together with the Major Outpatient Surgery Division SEDAR Working Group put forward a series of consensus recommendations on pre-anaesthesia testing based on the use of ITCs, health questionnaires, patient information and informed consent supervised and evaluated by an anaesthesiologist.</p></div><div><h3>Conclusions</h3><p>This consensus document will effectivise pre-anaesthesia assessment in cataract surgery while maintaining the highest standards of quality, safety and legality.</p></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2341192924000519/pdfft?md5=e27d36e8efcf14baa8a4b48b1ecc42ae&pid=1-s2.0-S2341192924000519-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140013881","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":"Before diagnosing a SARS-CoV-2-related PRES, alternative diagnoses must be ruled out","authors":"J. Finsterer","doi":"10.1016/j.redare.2023.11.004","DOIUrl":"10.1016/j.redare.2023.11.004","url":null,"abstract":"","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138441916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}