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Lapinsky SE, Vasquez DN. Acute Respiratory Failure in Pregnancy. Crit Care Clin 2024; 40:353-366. [PMID: 38432700 DOI: 10.1016/j.ccc.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Respiratory failure may affect up to 1 in 500 pregnancies, due to pregnancy-specific conditions, conditions aggravated by the pregnant state, or other causes. Management during pregnancy is influenced by altered maternal physiology, and the presence of a fetus influencing imaging, and drug therapy choices. Few studies have addressed the approach to invasive mechanical ventilatory management in pregnancy. Hypoxemia is likely harmful to the fetus, but precise targets are unknown. Hypocapnia reduces uteroplacental circulation, and some degree of hypercapnia may be tolerated in pregnancy. Delivery of the fetus may be considered to improve maternal respiratory status but improvement does not always occur.
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Affiliation(s)
- Stephen E Lapinsky
- Mount Sinai Hospital, Toronto, Interdepartmental Division of Critical Care Medicine, University of Toronto, 600 University Avenue, Toronto M5G1X5, Canada.
| | - Daniela N Vasquez
- ICU Head of Department, Sanatorio Anchorena, Tomás M. de Anchorena 1872, City of Buenos Aires, Argentina
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202
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Brusić J, Grubešić A, Jarić F, Vučković T, Lekić A, Šustić A, Protić A. Use of CPAP Ventilation in Non-ICU Wards May Influence Outcomes in Patients with Severe Respiratory COVID-19. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:582. [PMID: 38674228 PMCID: PMC11052437 DOI: 10.3390/medicina60040582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 03/22/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: The COVID-19 disease has significantly burdened the healthcare system, including all units of severe patient treatment. Non-intensive care units were established to rationalize the capacity within the Intensive Care Unit (ICU) and to create a unit where patients with Acute Respiratory Distress Syndrome (ARDS) could be treated with non-invasive Continuous Positive Air Pressure (CPAP) outside the ICU. This unicentric retrospective study aimed to assess the efficacy of NIV Treatment in Patients of the fourth pandemic wave and how its application affects the frequency and mortality of ICU-treated patients at University Hospital Rijeka compared to earlier waves of the COVID-19 pandemic. Furthermore, the study showcases the effect of the Patient/Nurse ratio (P/N ratio) on overall mortality in the ICU. Materials and Methods: The study was conducted on two groups of patients with respiratory insufficiency in the second and third pandemic waves, treated in the COVID Respiratory Centre (CRC) (153 patients). We also reviewed a cohort of patients from the fourth pandemic wave who were initially hospitalized in a COVID-6 non-intensive unit from 1 October 2021 to 1 November 2022 (102 patients), and some of them escalated to CRC. Results: The introduction of the CPAP non-invasive ventilation method as a means of hypoxic respiratory failure treatment in non-intensive care units has decreased the strain, overall number of admissions, and CRC patient mortality. The overall fourth wave mortality was 29.4%, compared to the 58.2% overall mortality of the second and third waves. Conclusions: As a result, this has decreased CRC patient admissions and, by itself, overall mortality.
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Affiliation(s)
- Josip Brusić
- Department of Anesthesiology, Intensive Care and Pain Treatment, Clinical Hospital Center Rijeka, Krešimirova 42, 51 000 Rijeka, Croatia; (J.B.); (A.P.)
- Department of Nursing, Faculty of Health Studies, University of Rijeka, Viktora Cara Emina 5, 51000 Rijeka, Croatia
| | - Aron Grubešić
- Department of Hematology, Clinical Hospital Center Rijeka, Krešimirova 42, 51000 Rijeka, Croatia
- Department of Internal Medicine, Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia
| | - Filip Jarić
- Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia; (F.J.); (T.V.)
| | - Tin Vučković
- Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia; (F.J.); (T.V.)
| | - Andrica Lekić
- Department of Basic Medical Sciences, Faculty of Health Studies, University of Rijeka, Viktora Cara Emina 5, 51000 Rijeka, Croatia;
| | - Alan Šustić
- Department of Anesthesiology, Intensive Care and Pain Treatment, Clinical Hospital Center Rijeka, Krešimirova 42, 51 000 Rijeka, Croatia; (J.B.); (A.P.)
- Department of Nursing, Faculty of Health Studies, University of Rijeka, Viktora Cara Emina 5, 51000 Rijeka, Croatia
- Department of Anesthesiology, Reanimatology, Emergency and Intensive Medicine, Faculty of Medicine, University of Rijeka, Tome Strižića 3, 51000 Rijeka, Croatia
| | - Alen Protić
- Department of Anesthesiology, Intensive Care and Pain Treatment, Clinical Hospital Center Rijeka, Krešimirova 42, 51 000 Rijeka, Croatia; (J.B.); (A.P.)
- Department of Nursing, Faculty of Health Studies, University of Rijeka, Viktora Cara Emina 5, 51000 Rijeka, Croatia
- Department of Anesthesiology, Reanimatology, Emergency and Intensive Medicine, Faculty of Medicine, University of Rijeka, Tome Strižića 3, 51000 Rijeka, Croatia
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203
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Fossali T, Locatelli M, Colombo R, Veronese A, Borghi B, Ballone E, Castelli A, Rech R, Catena E, Ottolina D. Awake pronation with helmet CPAP in early COVID-19 ARDS patients: effects on respiratory effort and distribution of ventilation assessed by EIT. Intern Emerg Med 2024:10.1007/s11739-024-03572-0. [PMID: 38532048 DOI: 10.1007/s11739-024-03572-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/27/2024] [Indexed: 03/28/2024]
Abstract
Prone positioning with continuous positive airway pressure (CPAP) is widely used for respiratory support in awake patients with COVID-19-associated acute respiratory failure. We aimed to assess the respiratory mechanics and distribution of ventilation in COVID-19-associated ARDS treated by CPAP in awake prone position. We studied 16 awake COVID-19 patients with moderate-to-severe ARDS. The study protocol consisted of a randomized sequence of supine and prone position with imposed positive end-expiratory pressure (PEEP) of 5 and 10 cmH2O delivered by helmet CPAP. Respiratory mechanics and distribution of ventilation were assessed through esophageal pressure (PES) and electrical impedance tomography (EIT). At the end of each 20-min phase, arterial blood gas analysis was performed, and PES swing and EIT tracings were recorded for the calculation of the respiratory mechanics and regional ventilation. The patient's position had no significant effects on respiratory mechanics. EIT analysis did not detect differences among global indices of ventilation. A significant proportion of pixels in the sternal region of interest showed an increase in compliance from the supine to prone position and PaO2/FIO2 increased accordingly. The best improvement of both PaO2/FIO2 and sternal compliance was obtained in the prone position with PEEP 10 cmH2O. In the studied subjects, prone positioning during CPAP treatment raised oxygenation without improvement of "protective" ventilation or global ventilatory inhomogeneity indices. Prone positioning with higher PEEP significantly increased the compliance of sternal regions.
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Affiliation(s)
- Tommaso Fossali
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, University of Milan, Via G.B. Grassi, 74, 20157, Milan, Italy
| | - Martina Locatelli
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, University of Milan, Via G.B. Grassi, 74, 20157, Milan, Italy
| | - Riccardo Colombo
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, University of Milan, Via G.B. Grassi, 74, 20157, Milan, Italy
| | - Alice Veronese
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, University of Milan, Via G.B. Grassi, 74, 20157, Milan, Italy
| | - Beatrice Borghi
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, University of Milan, Via G.B. Grassi, 74, 20157, Milan, Italy
| | - Elisabetta Ballone
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, University of Milan, Via G.B. Grassi, 74, 20157, Milan, Italy
| | - Antonio Castelli
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, University of Milan, Via G.B. Grassi, 74, 20157, Milan, Italy
| | - Roberto Rech
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, University of Milan, Via G.B. Grassi, 74, 20157, Milan, Italy
| | - Emanuele Catena
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, University of Milan, Via G.B. Grassi, 74, 20157, Milan, Italy
| | - Davide Ottolina
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, University of Milan, Via G.B. Grassi, 74, 20157, Milan, Italy.
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204
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Yong S, Suping L, Peng Z, Dong L, Qing W. The effects of vitamin C supplementation in the critically ill patients outcomes: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2024; 103:e37420. [PMID: 38518058 PMCID: PMC10956978 DOI: 10.1097/md.0000000000037420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/07/2024] [Indexed: 03/24/2024] Open
Abstract
BACKGROUND Vitamin C has significant anti-inflammatory effects and is particularly important for critically ill patients. However due to inconsistent research findings in critically ill patients in meta-analysis. Therefore, the primary objective of this meta-analysis is to investigate the effects of isolated intravenous supplementation of vitamin C in adults with critical illness by comprehensively incorporating articles from randomized controlled trials. METHODS Articles included searching through PubMed, Embase, Medline, Cochrane Library, and Web of Science up to April 28, 2023, for articles on vitamin C and the critically ill. We calculated pooled standard relative risk (RR), mean difference (MD), and 95% confidence intervals (CIs). And the protocol for the review has been registered on PROSPERO (CRD42023425193). RESULTS There are 2047 critically ill included in 19 articles. Compared with placebo, patients who underwent intravenous vitamin C (IVVC) have reduced duration of vasopressor used (SMD 0.26; CI 0.01-0.51; I2 = 87.0%, P = .044), mechanical ventilation (SMD -0.29; CI -0.55 to -0.03; I2 = 36.8%, P = .031). However, the administration of IVVC had no statistical difference in 28-d mortality (RR 0.95; CI 0.80-1.11; I2 = 12.2%, P = .337), mortality (RR 0.79; CI 0.55-1.12; I2 = 0%, P = .188), fluid intake (SMD -0.02; CI -0.25 to 0.20; I2 = 0%, P = .838), urine output (SMD 0.23; CI -0.03 to 0.49; I2 = 0%, P = .084), ICU days (SMD 0.10; CI -0.03 to 0.22; I2 = 0%, P = .127), hospital stay (SMD 0.10; CI -0.12 to 0.32; I2 = 0%, P = .375), and pneumonia (RR 0.85; CI 0.50-1.44; I2 = 0%, P = .552). CONCLUSION This study comprehensively and systematically evaluated IVVC supplementation in the critically ill through a meta-analysis of RCT. There is no difference except for patients who had reduced duration of vasopressor use and mechanical ventilation by the administration of IVVC. Of course. More scientific and rigorous conclusions can be drawn from multi-center RCT research in the future.
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Affiliation(s)
- Su Yong
- Intensive Care Unit, Pengzhou People’s Hospital, Pengzhou City, Chengdu, Sichuan, China
| | - Liu Suping
- Intensive Care Unit, Pengzhou People’s Hospital, Pengzhou City, Chengdu, Sichuan, China
| | - Zhang Peng
- Department of Gastrointestinal Surgery, Pengzhou People’s Hospital, Pengzhou City, Chengdu, Sichuan, China
| | - Lin Dong
- Department of Urology, Pengzhou People’s Hospital, Pengzhou City, Chengdu, Sichuan, China
| | - Wei Qing
- Intensive Care Unit, Pengzhou People’s Hospital, Pengzhou City, Chengdu, Sichuan, China
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205
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Chang MG, Barbour TA, Bittner EA. Exploring Brain and Heart Interactions during Electroconvulsive Therapy with Point-of-Care Ultrasound. Med Sci (Basel) 2024; 12:17. [PMID: 38525771 PMCID: PMC11024754 DOI: 10.3390/medsci12020017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/05/2024] [Accepted: 03/06/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is a procedure commonly used to treat a number of severe psychiatric disorders, including pharmacologic refractory depression, mania, and catatonia by purposefully inducing a generalized seizure that results in significant hemodynamic changes as a result of an initial transient parasympathetic response that is followed by a marked sympathetic response from a surge in catecholamine release. While the physiologic response of ECT on classic hemodynamic parameters such as heart rate and blood pressure has been described in the literature, real-time visualization of cardiac function using point-of-care ultrasound (POCUS) during ECT has never been reported. This study utilizes POCUS to examine cardiac function in two patients with different ages and cardiovascular risk profiles undergoing ECT. METHODS Two patients, a 74-year-old male with significant cardiovascular risks and a 23-year-old female with no significant cardiovascular risks presenting for ECT treatment, were included in this study. A portable ultrasound device was used to obtain apical four-chamber images of the heart before ECT stimulation, after seizure induction, and 2 min after seizure resolution to assess qualitative cardiac function. Two physicians with expertise in echocardiography reviewed the studies. Hemodynamic parameters, ECT settings, and seizure duration were recorded. RESULTS Cardiac standstill was observed in both patients during ECT stimulation. The 74-year-old patient with a significant cardiovascular risk profile exhibited a transient decline in cardiac function during ECT, while the 23-year-old patient showed no substantial worsening of cardiac function. These findings suggest that age and pre-existing cardiovascular conditions may influence the cardiac response to ECT. Other potential contributing factors to the cardiac effects of ECT include the parasympathetic and sympathetic responses, medication regimen, and seizure duration with ECT. This study also demonstrates the feasibility of using portable POCUS for real-time cardiac monitoring during ECT. CONCLUSION This study reports for the first time cardiac standstill during ECT stimulation visualized using POCUS imaging. In addition, it reports on the potential differential impact of ECT on cardiac function based on patient-specific factors such as age and cardiovascular risks that may have implications for ECT and perioperative anesthetic management and optimization.
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Affiliation(s)
- Marvin G. Chang
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA;
| | - Tracy A. Barbour
- Department of Psychiatry, Division of Behavioral Neurology and Neuropsychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA;
| | - Edward A. Bittner
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA;
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206
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Masood M, Singh P, Hariss D, Khan F, Yameen D, Siraj S, Islam A, Dohare R, Mahfuzul Haque M. Nitric oxide as a double-edged sword in pulmonary viral infections: Mechanistic insights and potential therapeutic implications. Gene 2024; 899:148148. [PMID: 38191100 DOI: 10.1016/j.gene.2024.148148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/21/2023] [Accepted: 01/05/2024] [Indexed: 01/10/2024]
Abstract
In the face of the global pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), researchers are tirelessly exploring novel therapeutic approaches to combat coronavirus disease 2019 (COVID-19) and its associated complications. Nitric oxide (NO) has appeared as a multifaceted signaling mediator with diverse and often contrasting biological activities. Its intricate biochemistry renders it a crucial regulator of cardiovascular and pulmonary functions, immunity, and neurotransmission. Perturbations in NO production, whether excessive or insufficient, contribute to the pathogenesis of various diseases, encompassing cardiovascular disease, pulmonary hypertension, asthma, diabetes, and cancer. Recent investigations have unveiled the potential of NO donors to impede SARS-CoV- 2 replication, while inhaled NO demonstrates promise as a therapeutic avenue for improving oxygenation in COVID-19-related hypoxic pulmonary conditions. Interestingly, NO's association with the inflammatory response in asthma suggests a potential protective role against SARS-CoV-2 infection. Furthermore, compelling evidence indicates the benefits of inhaled NO in optimizing ventilation-perfusion ratios and mitigating the need for mechanical ventilation in COVID-19 patients. In this review, we delve into the molecular targets of NO, its utility as a diagnostic marker, the mechanisms underlying its action in COVID-19, and the potential of inhaled NO as a therapeutic intervention against viral infections. The topmost significant pathway, gene ontology (GO)-biological process (BP), GO-molecular function (MF) and GO-cellular compartment (CC) terms associated with Nitric Oxide Synthase (NOS)1, NOS2, NOS3 were arginine biosynthesis (p-value = 1.15 x 10-9) regulation of guanylate cyclase activity (p-value = 7.5 x 10-12), arginine binding (p-value = 2.62 x 10-11), vesicle membrane (p-value = 3.93 x 10-8). Transcriptomics analysis further validates the significant presence of NOS1, NOS2, NOS3 in independent COVID-19 and pulmonary hypertension cohorts with respect to controls. This review investigates NO's molecular targets, diagnostic potentials, and therapeutic role in COVID-19, employing bioinformatics to identify key pathways and NOS isoforms' significance.
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Affiliation(s)
- Mohammad Masood
- Department of Biotechnology, Faculty of Natural Sciences, Jamia Millia Islamia, New Delhi 110025, India.
| | - Prithvi Singh
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi 110025, India.
| | - Daaniyaal Hariss
- Department of Biosciences, Faculty of Natural Sciences, Jamia Millia Islamia, New Delhi 110025, India.
| | - Faizya Khan
- Department of Biotechnology, Faculty of Natural Sciences, Jamia Millia Islamia, New Delhi 110025, India.
| | - Daraksha Yameen
- Department of Biotechnology, Faculty of Natural Sciences, Jamia Millia Islamia, New Delhi 110025, India.
| | - Seerat Siraj
- Department of Biotechnology, Faculty of Natural Sciences, Jamia Millia Islamia, New Delhi 110025, India.
| | - Asimul Islam
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi 110025, India.
| | - Ravins Dohare
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi 110025, India.
| | - Mohammad Mahfuzul Haque
- Department of Biotechnology, Faculty of Natural Sciences, Jamia Millia Islamia, New Delhi 110025, India.
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207
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Deng X, Yang CY, Zhu ZL, Tian W, Tian JX, Xia M, Pan W. Negative pressure pulmonary edema after laparoscopic cholecystectomy: A case report and literature review. Medicine (Baltimore) 2024; 103:e37443. [PMID: 38489724 PMCID: PMC10939698 DOI: 10.1097/md.0000000000037443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/09/2024] [Indexed: 03/17/2024] Open
Abstract
RATIONALE Negative pressure pulmonary edema (NPPE) is an acute onset of non-cardiogenic interstitial pulmonary edema, commonly seen among surgical patients after extubation from general aneasthesia. It is mainly caused by rapid inspiration with acute upper airway obstruction resulting in significant negative thoracic pressure. PATIENT CONCERNS A 24-year-old female patient who underwent laparoscopic cholecystectomy under general anesthesia and developed NPPE postoperatively. DIAGNOSES Her main clinical manifestation was coughing up pink foamy sputum; postoperative CT showed increased texture in both lungs and bilateral ground glass opacities. INTERVENTIONS Diuretics and steroids were used, and symptomatic supportive treatments such as oxygen were given. OUTCOMES After treatment, on the fourth post-operative day, her symptoms were relieved and her vital signs were stable enough for her to be discharged. LESSONS Although this is a rare and severe complication, the prognosis of NPPE is good when it is managed with proper diagnosis and treatment.
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Affiliation(s)
- Xu Deng
- Department of Hepatobiliary and Pancreatic Surgery, the People’s Hospital of Lezhi, Lezhi, China
| | - Chun-Yuan Yang
- Department of Hepatobiliary and Pancreatic Surgery, the People’s Hospital of Lezhi, Lezhi, China
| | - Zong-Long Zhu
- Department of Hepatobiliary and Pancreatic Surgery, the People’s Hospital of Lezhi, Lezhi, China
| | - Wei Tian
- Department of Hepatobiliary and Pancreatic Surgery, the People’s Hospital of Lezhi, Lezhi, China
| | - Jian-Xing Tian
- Department of Hepatobiliary and Pancreatic Surgery, the People’s Hospital of Lezhi, Lezhi, China
| | - Ming Xia
- Department of Hepatobiliary and Pancreatic Surgery, the People’s Hospital of Lezhi, Lezhi, China
| | - Wei Pan
- Department of Hepatobiliary and Pancreatic Surgery, the People’s Hospital of Lezhi, Lezhi, China
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208
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Zheng Z, Wang L, Wang S, Fan Q, Zhang H, Luo G, Gao B, Yang X, Zhao B, Wang X, Dong H, Nie H, Lei C. Inhaled Nitric Oxide ReDuce postoperatIve pulmoNAry complicaTions in patiEnts with recent COVID-19 infection (INORDINATE): protocol for a randomised controlled trial. BMJ Open 2024; 14:e077572. [PMID: 38485487 PMCID: PMC10941156 DOI: 10.1136/bmjopen-2023-077572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 02/29/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND A history of SARS-CoV-2 infection has been reported to be associated with an increased risk of postoperative pulmonary complications (PPCs). Even mild PPCs can elevate the rates of early postoperative mortality, intensive care unit (ICU) admission and prolong the length of ICU and/or hospital stays. Consequently, it is crucial to develop perioperative management strategies that can mitigate these increased risks in surgical patients who have recently been infected with SARS-CoV-2. Accumulating evidence suggests that nitric oxide (NO) inhalation might be effective in treating COVID-19. NO functions in COVID-19 by promoting vasodilation, anticoagulation, anti-inflammatory and antiviral effects. Therefore, our study hypothesises that the perioperative use of NO can effectively reduce PPCs in patients with recent SARS-CoV-2 infection. METHOD AND ANALYSIS A prospective, double-blind, single-centre, randomised controlled trial is proposed. The trial aims to include participants who are planning to undergo surgery with general anaesthesia and have been recently infected with SARS-CoV-2 (within 7 weeks). Stratified allocation of eligible patients will be performed at a 1:1 ratio based on the predicted risk of PPCs using the Assess Respiratory Risk in Surgical Patients in Catalonia risk index and the time interval between infection and surgery.The primary outcome of the study will be the presence of PPCs within the first 7 days following surgery, including respiratory infection, respiratory failure, pleural effusion, atelectasis, pneumothorax, bronchospasm and aspiration pneumonitis. The primary outcome will be reported as counts (percentage) and will be compared using a two-proportion χ2 test. The common effect across all primary components will be estimated using a multiple generalised linear model. ETHICS AND DISSEMINATION The trial is approved by the Institutional Review Board of Xijing Hospital (KY20232058-F1). The findings, including positive, negative and inconclusive results, will be published in scientific journals with peer-review processes. TRIAL REGISTRATION NUMBER NCT05721144.
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Affiliation(s)
- Ziyu Zheng
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Xian, Shaanxi, China
- Anesthesia Clinical Research Center, Xijing Hospital, Xian, Shaanxi, China
| | - Lini Wang
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Xian, Shaanxi, China
- Anesthesia Clinical Research Center, Xijing Hospital, Xian, Shaanxi, China
| | - Shuxiu Wang
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Xian, Shaanxi, China
| | - Qianqian Fan
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Xian, Shaanxi, China
| | - Hui Zhang
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Xian, Shaanxi, China
| | - Gang Luo
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Xian, Shaanxi, China
| | - Baobao Gao
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Xian, Shaanxi, China
| | - Xue Yang
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Xian, Shaanxi, China
| | - Bingqing Zhao
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Xian, Shaanxi, China
| | - Xiaomei Wang
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Xian, Shaanxi, China
| | - Hailong Dong
- Department of Anesthesiology and Perioprative Medicine, Fourth Military Medical University, Xijing Hospital, Xi'an, Shaanxi, China
| | - Huang Nie
- Department of Anesthesiology, Xijing Hospital, The fourth Military Medical University, Xi'an, China
| | - Chong Lei
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Xian, Shaanxi, China
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209
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Yoo SH, Kang J, Kim HJ, Lee SW, Hong M, Jung EH, Kim YJ, Yon DK, Kang B. Opioid use and subsequent delirium risk in patients with advanced cancer in palliative care: a multicenter registry study. Sci Rep 2024; 14:6004. [PMID: 38472471 PMCID: PMC10933309 DOI: 10.1038/s41598-024-56675-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/08/2024] [Indexed: 03/14/2024] Open
Abstract
The prevalent use of opioids for pain management in patients with advanced cancer underscores the need for research on their neuropsychiatric impacts, particularly delirium. Therefore, we aimed to investigate the potential association between opioid use and the risk of delirium in patients with advanced cancer admitted to the acute palliative care unit. We conducted a retrospective observational study utilizing a multicenter, patient-based registry cohort by collecting the data from January 1, 2019, to December 31, 2020, in South Korea. All data regarding exposures, outcomes, and covariates were obtained through retrospective chart reviews by a team of specialized medical professionals with expertise in oncology. Full unmatched and 1:1 propensity-score matched cohorts were formed, and stratification analysis was conducted. The primary outcome, delirium, was defined and diagnosed by the DSM-IV. Of the 2,066 patients with advanced cancer, we identified 42.8% (mean [SD] age, 64.4 [13.3] years; 60.8% male) non-opioid users and 57.2% (62.8 [12.5] years; 55.9% male) opioid users, respectively. Opioid use was significantly associated with an increased occurrence of delirium in patients with advanced cancer (OR, 2.02 [95% CI 1.22-3.35]). The risk of delirium in patients with advanced cancer showed increasing trends in a dose-dependent manner. High-dose opioid users showed an increased risk of delirium in patients with advanced cancer compared to non-opioid users (low-dose user: OR, 2.21 [95% CI 1.27-3.84]; high-dose user: OR, 5.75 [95% CI 2.81-11.77]; ratio of OR, 2.60 [95% CI 1.05-6.44]). Patients with old age, male sex, absence of chemotherapy during hospitalization, and non-obese status were more susceptible to increased risk of delirium in patients with cancer. In this multicenter patient-based registry cohort study, we found a significant, dose-dependent association between opioid use and increased risk of delirium in patients with advanced cancer. We also identified specific patient groups more susceptible to delirium. These findings highlight the importance of opioid prescription in these patients with advanced cancer, balancing effective doses for pain management and adverse dose-inducing delirium.
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Affiliation(s)
- Shin Hye Yoo
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, South Korea
| | - Jiseung Kang
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Hyeon Jin Kim
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Si Won Lee
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea
- Palliative Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea
| | - Moonki Hong
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea
- Palliative Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea
| | - Eun Hee Jung
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Yu Jung Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Dong Keon Yon
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA.
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea.
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, 23 Kyungheedae-Ro, Dongdaemun-Gu, Seoul, 02447, South Korea.
| | - Beodeul Kang
- Division of Medical Oncology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-Ro, Bundang-Gu, Seongnam, 13496, South Korea.
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210
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Keil N, Rathkolb V, Waller M, Krenn S, Hinterholzer G, Druml W, Hiesmayr M, Schmaldienst S, Hecking M. Challenging the common practice of intravenous fluid administration : Viewpoint on the need for an enteral fluid therapy trial in critically ill patients. Wien Klin Wochenschr 2024:10.1007/s00508-024-02335-3. [PMID: 38456939 DOI: 10.1007/s00508-024-02335-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/06/2024] [Indexed: 03/09/2024]
Affiliation(s)
- Nikolaus Keil
- First Medical Department, Klinik Favoriten, Vienna, Austria
| | | | | | - Simon Krenn
- AIT Austrian Institute of Technology GmbH, Center for Health & Bioresources, Medical Signal Analysis, Vienna, Austria
- Department of Medicine III, Division of Nephrology & Dialysis, Medical University of Vienna, Vienna, Austria
| | | | - Wilfred Druml
- Department of Medicine III, Division of Nephrology & Dialysis, Medical University of Vienna, Vienna, Austria
| | - Michael Hiesmayr
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Manfred Hecking
- Department of Medicine III, Division of Nephrology & Dialysis, Medical University of Vienna, Vienna, Austria
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211
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Lavell AHA, Schramade AE, Sikkens JJ, van der Straten K, van Dort KA, Slim MA, Appelman B, van Vught LA, Vlaar APJ, Kootstra NA, van Gils MJ, Smulders YM, de Jongh RT, Bomers MK. 25-Hydroxyvitamin D concentrations do not affect the humoral or cellular immune response following SARS-CoV-2 mRNA vaccinations. Vaccine 2024; 42:1478-1486. [PMID: 37775466 DOI: 10.1016/j.vaccine.2023.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/04/2023] [Accepted: 08/10/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND To improve effectiveness of vaccination against SARS-CoV-2, it is important to identify factors that influence the immune response induced by vaccination. Evidence for the role of vitamin D in immune response against SARS-CoV-2 is contradictory. It is therefore of interest whether 25-hydroxyvitamin D (25[OH]D) concentrations affect the humoral and/or cellular response following SARS-CoV-2 vaccination. METHODS In this prospective cohort study, blood samples were collected from 98 SARS-CoV-2 naive health care workers (HCW) receiving the first two doses of either BNT162b2 or mRNA-1273 in 2021. Wild-type spike (S) protein binding and neutralizing antibodies were determined approximately three weeks after the first dose and four to five weeks after the second dose. Antigen specific T-cells and functionality (proliferative response and interferon gamma [IFN-γ] release) were determined in 18 participants four weeks after the second dose of BNT162b2. We studied the association between 25(OH)D concentrations, which were determined prior to vaccination, and humoral and cellular immune responses following vaccination. RESULTS We found no association between 25(OH)D concentrations (median 55.9 nmol/L [IQR 40.5-69.8]) and binding or neutralizing antibody titers after complete vaccination (fold change of antibody titers per 10 nmol/L 25(OH)D increase: 0.98 [95% CI 0.93-1.04] and 1.03 [95% CI: 0.96-1.11], respectively), adjusted for age, sex and type of mRNA vaccine. Subsequently, continuous 25(OH)D concentrations were divided into commonly used clinical categories (<25 nmol/L [n = 6, 6%], 25-49 nmol/L [n = 33, 34%], 50-75 nmol/L [n = 37, 38%] and ≥75 nmol/L [n = 22, 22%]), but no association with the humoral immune response following vaccination was found. Also, 25(OH)D concentrations were not associated with the SARS-CoV-2 specific T cell response. CONCLUSION No association was found between 25(OH)D concentrations and the humoral or cellular immune response following mRNA vaccination against SARS-CoV-2. Based on our findings there is no rationale to advise vitamin D optimization preceding SARS-CoV-2 vaccination in HCW with moderate vitamin D status.
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Affiliation(s)
- A H A Lavell
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Internal Medicine, Department of Infectious Diseases and Department of Endocrinology and Metabolism, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Amsterdam Institute for Infection & Immunity, Amsterdam, the Netherlands
| | - A E Schramade
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Internal Medicine, Department of Infectious Diseases and Department of Endocrinology and Metabolism, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Amsterdam Institute for Infection & Immunity, Amsterdam, the Netherlands
| | - J J Sikkens
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Internal Medicine, Department of Infectious Diseases and Department of Endocrinology and Metabolism, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Amsterdam Institute for Infection & Immunity, Amsterdam, the Netherlands
| | - K van der Straten
- Amsterdam Institute for Infection & Immunity, Amsterdam, the Netherlands; Amsterdam UMC Location University of Amsterdam, Department of Medical Microbiology and Infection Prevention, Laboratory of Experimental Virology, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Amsterdam UMC Location University of Amsterdam, Department of Internal Medicine, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - K A van Dort
- Amsterdam Institute for Infection & Immunity, Amsterdam, the Netherlands; Amsterdam UMC Location University of Amsterdam, Department of Experimental Immunology, 1105 AZ, the Netherlands
| | - M A Slim
- Amsterdam UMC Location University of Amsterdam, Center for Experimental and Molecular Medicine, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands; Amsterdam UMC Location University of Amsterdam, Department of Intensive Care, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - B Appelman
- Amsterdam Institute for Infection & Immunity, Amsterdam, the Netherlands; Amsterdam UMC Location University of Amsterdam, Center for Experimental and Molecular Medicine, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands
| | - L A van Vught
- Amsterdam UMC Location University of Amsterdam, Center for Experimental and Molecular Medicine, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands; Amsterdam UMC Location University of Amsterdam, Department of Intensive Care, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - A P J Vlaar
- Amsterdam UMC Location University of Amsterdam, Department of Intensive Care, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Amsterdam UMC Location University of Amsterdam, Laboratory of Experimental Intensive Care and Anesthesiology (L.E.I.C.A.), Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands
| | - N A Kootstra
- Amsterdam Institute for Infection & Immunity, Amsterdam, the Netherlands; Amsterdam UMC Location University of Amsterdam, Department of Experimental Immunology, 1105 AZ, the Netherlands
| | - M J van Gils
- Amsterdam Institute for Infection & Immunity, Amsterdam, the Netherlands; Amsterdam UMC Location University of Amsterdam, Department of Medical Microbiology and Infection Prevention, Laboratory of Experimental Virology, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Y M Smulders
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Internal Medicine, Department of Infectious Diseases and Department of Endocrinology and Metabolism, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Amsterdam Institute for Infection & Immunity, Amsterdam, the Netherlands
| | - R T de Jongh
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Internal Medicine, Department of Infectious Diseases and Department of Endocrinology and Metabolism, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam, the Netherlands
| | - M K Bomers
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Internal Medicine, Department of Infectious Diseases and Department of Endocrinology and Metabolism, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Amsterdam Institute for Infection & Immunity, Amsterdam, the Netherlands.
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212
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Zheng H, Xu Y, Liehn EA, Rusu M. Vitamin C as Scavenger of Reactive Oxygen Species during Healing after Myocardial Infarction. Int J Mol Sci 2024; 25:3114. [PMID: 38542087 PMCID: PMC10970003 DOI: 10.3390/ijms25063114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/31/2024] [Accepted: 02/10/2024] [Indexed: 06/26/2024] Open
Abstract
Currently, coronary artery bypass and reperfusion therapies are considered the gold standard in long-term treatments to restore heart function after acute myocardial infarction. As a drawback of these restoring strategies, reperfusion after an ischemic insult and sudden oxygen exposure lead to the exacerbated synthesis of additional reactive oxidative species and the persistence of increased oxidation levels. Attempts based on antioxidant treatment have failed to achieve an effective therapy for cardiovascular disease patients. The controversial use of vitamin C as an antioxidant in clinical practice is comprehensively systematized and discussed in this review. The dose-dependent adsorption and release kinetics mechanism of vitamin C is complex; however, this review may provide a holistic perspective on its potential as a preventive supplement and/or for combined precise and targeted therapeutics in cardiovascular management therapy.
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Affiliation(s)
- Huabo Zheng
- Department of Cardiology, Angiology and Intensive Care, University Hospital, Rheinisch-Westfälische Technische Hochschule Aachen University, 52074 Aachen, Germany;
- Institute of Molecular Medicine, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark;
| | - Yichen Xu
- Institute of Molecular Medicine, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark;
- Department of Histology and Embryology, Medicine and Life Sciences, Hainan Medical University, Haikou 571199, China
| | - Elisa A. Liehn
- Institute of Molecular Medicine, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark;
- National Institute of Pathology “Victor Babes”, Splaiul Independentei Nr. 99-101, 050096 Bucharest, Romania
| | - Mihaela Rusu
- Institute of Applied Medical Engineering, Helmholtz Institute, Medical Faculty, Rheinisch-Westfälische Technische Hochschule Aachen University, 52074 Aachen, Germany
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213
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Xia J, Li X, Zhu H, Zhou X, Chen J, Li Q, Li S, Chu H, Dong M. The μ-opioid receptor-mediated G i/o protein and β-arrestin2 signaling pathways both contribute to morphine-induced side effects. Eur J Pharmacol 2024; 966:176333. [PMID: 38278466 DOI: 10.1016/j.ejphar.2024.176333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/10/2023] [Accepted: 01/15/2024] [Indexed: 01/28/2024]
Abstract
The μ-opioid receptor-biased agonist theory holds that Gio protein signaling mediates the analgesic effect of opioids and the related side effects via the β-arrestin2 signaling pathway. A series of μ-opioid-biased agonists have been developed in accordance with this theory, and the FDA has approved TRV130 (as a representative of biased agonists) for marketing. However, several reports have raised the issue of opioid side effects associated with the use of agonists. In this study, five permeable peptides were designed to emulate 11 S/T phosphorylation sites at the μ-opioid receptor (MOR) carboxyl-terminal. In vitro experiments were performed to detect the activation level of G proteins from the cAMP inhibition assay and the β-arrestin2 recruitment by the BRET assay. Designed peptides might effectively interfere with the activation of the Gio and β-arrestin2 pathways when combined with morphine. The resulting morphine-induced tolerance, respiratory inhibition, and constipation in mice showed that the β-arrestin2 pathway was responsible for morphine tolerance while the Gio signaling pathway was involved with respiratory depression and constipation and that these side effects were significantly related to phosphorylation sites S363 and T370. This study may provide new directions for the development of safer and more effective opioid analgesics, and the designed peptides may be an effective tool for exploring the mechanism by which μ-opioid receptors function, with the potential of reducing the side effects that are associated with clinical opioid treatment.
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Affiliation(s)
- Jing Xia
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong, China; Department of Medicinal Chemistry, School of Pharmacy, Qingdao University, Qingdao, 266021, China
| | - Xiaoyan Li
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong, China; Department of Medicinal Chemistry, School of Pharmacy, Qingdao University, Qingdao, 266021, China
| | - Hongyu Zhu
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong, China; Department of Medicinal Chemistry, School of Pharmacy, Qingdao University, Qingdao, 266021, China
| | - Xiaohui Zhou
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong, China; Department of Medicinal Chemistry, School of Pharmacy, Qingdao University, Qingdao, 266021, China
| | - Ji Chen
- Department of Medicinal Chemistry, School of Pharmacy, Qingdao University, Qingdao, 266021, China
| | - Qihong Li
- Department of Stomatology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, 100071, China
| | - Shupeng Li
- State Key Laboratory of Oncogenomics, School of Chemical Biology and Biotechnology, Peking University Shenzhen Graduate School, Shenzhen, 518055, China.
| | - Haichen Chu
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong, China
| | - Mingxin Dong
- Department of Medicinal Chemistry, School of Pharmacy, Qingdao University, Qingdao, 266021, China.
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214
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Hauc SC, Stögner VA, Ihnat JM, Hosseini H, Huelsboemer L, Kauke-Navarro M, Rivera JC, Williams M, Glahn JZ, Savetamal A, Pomahac B. Understanding the Drivers of Cost and Length of Stay in a Cohort of 21,875 Patients with Severe Burn. J Burn Care Res 2024; 45:425-431. [PMID: 37882472 DOI: 10.1093/jbcr/irad168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Indexed: 10/27/2023]
Abstract
Burn management has significantly advanced in the past 75 years, resulting in improved mortality rates. However, there are still over one million burn victims in the United States each year, with over 3,000 burn-related deaths annually. The impacts of individual patient, hospital, and regional demographics on length of stay (LOS) and total cost have yet to be fully explored in a large nationally representative cohort. Thus, this study aimed to examine various hospital and patient characteristics using a sample of over 20,000 patients. Inpatient data from the National Inpatient Sample from 2008 to 2015 were analyzed, and only patients with an ICD-9 code for second- or third-degree burns were included. In addition, a major operating room procedure must have been indicated on the discharge summary for patients to be included in the final dataset, ensuring that only severe burns requiring complex care were analyzed. Analysis of covariance models was used to evaluate the impact of various patient, hospital, and regional variables on both LOS and cost. The study found that skin grafts and fasciotomy significantly increased the cost of hospitalization. Having burns on the face, neck, and trunk significantly increased costs for patients with second-degree burns, while burns on the trunk resulted in the longest LOS for patients with third-degree burns. Infections in the hospital and additional procedures, such as flaps and skin grafts, also led to longer stays. The study also found that the prevalence of postoperative complications, such as electrolyte imbalance, was high among patients with burn surgery.
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Affiliation(s)
- Sacha C Hauc
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
| | - Viola Antonia Stögner
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Burn Center, Hannover Medical School, Hannover, Germany
| | - Jacqueline M Ihnat
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
| | - Helia Hosseini
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
| | - Lioba Huelsboemer
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
| | - Martin Kauke-Navarro
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
| | - Jean C Rivera
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
| | - Mica Williams
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
| | - Joshua Z Glahn
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
| | - Alisa Savetamal
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
| | - Bohdan Pomahac
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
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215
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Kiani Z, Khorsand N, Beigi F, Askari G, Sharma M, Bagherniya M. Coenzyme Q10 supplementation in burn patients: a double-blind placebo-controlled randomized clinical trial. Trials 2024; 25:160. [PMID: 38431600 PMCID: PMC10908042 DOI: 10.1186/s13063-024-08006-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 02/22/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Burn injuries are important medical problems that, aside from skin damage, cause a systemic response including inflammation, oxidative stress, endocrine disorders, immune response, and hypermetabolic and catabolic responses which affect all the organs in the body. The aim of this study was to determine the effect of coenzyme Q10 (CoQ10) supplementation on inflammation, oxidative stress, and clinical outcomes in burn patients. METHODS In a double-blind placebo-controlled randomized clinical trial, 60 burn patients were randomly assigned to receive 100 mg CoQ10 three times a day (total 300 mg/day) or a placebo for 10 days. Inflammatory markers including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), oxidative stress markers including total antioxidant capacity (TAC), malondialdehyde (MDA) and superoxide dismutase (SOD) activity, fasting blood glucose (FBG), blood urea nitrogen (BUN), creatinine, white blood cells (WBC), and body temperature were assessed as primary outcomes and albumin, prothrombin time (PT), partial thromboplastin time (PTT), international normalized ratio (INR), other hematological parameters, blood pressure, O2 saturation, ICU duration, and 28-mortality rate were assessed as secondary outcomes. RESULTS Fifty-two participants completed the trial. CRP and ESR levels were not significantly different between CoQ10 and placebo groups at the end of the study (P = 0.550 and P = 0.306, respectively). No significant differences between groups were observed for TAC (P = 0.865), MDA (P = 0.692), and SOD activity (P = 0.633) as well. Administration of CoQ10 resulted in a significant increase in albumin levels compared to placebo (P = 0.031). There was no statistically significant difference between the two groups in other measured outcomes (P > 0.05). CONCLUSION Results showed that in patients with burn injury, CoQ10 administration had no effect on inflammatory markers and oxidative stress, although serum albumin levels were improved after supplementation. Further studies with albumin as the primary outcome are needed to confirm this finding.
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Affiliation(s)
- Zahra Kiani
- Nutrition and Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nadereh Khorsand
- Department of Internal Medicine, Imam Musa Kazem Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fahimeh Beigi
- Pharmaceutical Biotechnology Department, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Science, Isfahan, Iran
- Research and Development Unit, Imam Muss Kazim Hospital, Isfahan University of Medical Science, Isfahan, Iran
| | - Gholamreza Askari
- Nutrition and Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
- Anesthesia and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Manoj Sharma
- Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Mohammad Bagherniya
- Nutrition and Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.
- Anesthesia and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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216
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Santandrea E, Aliakbari F, Truscott E, McCaig L, Donison NS, Graham D, Strong MJ, Volkening K. A technique for repeated blood and cerebrospinal fluid sampling from individual rats over time without the need for repeated anesthesia. Sci Rep 2024; 14:5171. [PMID: 38431711 PMCID: PMC10908789 DOI: 10.1038/s41598-024-55666-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/26/2024] [Indexed: 03/05/2024] Open
Abstract
Ethical animal use follows the 3R's: Replacement, Reduction and Refinement. Here, we present the use of simultaneous jugular vein and cisterna magna catheterization via a port system in rats for repeated fluid sampling for 14 consecutive days without loss of catheter patency. This technique allows repeated intra-animal sampling without anesthesia and, if used with pooling samples from a cohort of animals, replaces the need for terminal collections for sufficient sample volumes.
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Affiliation(s)
- Erin Santandrea
- Molecular Medicine, Robarts Research Institute, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Farhang Aliakbari
- Molecular Medicine, Robarts Research Institute, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Emily Truscott
- Animal Care and Veterinary Services, University of Western Ontario, London, Canada
| | - Lynda McCaig
- Molecular Medicine, Robarts Research Institute, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Neil S Donison
- Molecular Medicine, Robarts Research Institute, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Danielle Graham
- Molecular Medicine, Robarts Research Institute, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Michael J Strong
- Molecular Medicine, Robarts Research Institute, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada.
- Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.
| | - Kathryn Volkening
- Molecular Medicine, Robarts Research Institute, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
- Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
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217
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Almarhabi M, Cornish J, Raleigh M, Philippou J. Developing effective In-Service Education for intensive care nurses: Exploring the views of clinical stakeholders in the Kingdom of Saudi Arabia. NURSE EDUCATION TODAY 2024; 134:106092. [PMID: 38262185 DOI: 10.1016/j.nedt.2024.106092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 11/22/2023] [Accepted: 01/11/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Evidence-based in-service education (ISE) in the intensive care unit (ICU) is essential to maintaining nurse skill and competence in this complex clinical area. However, there has been limited research that has focused on developing and optimising the specialised training required by ICU nurses working in trauma care. OBJECTIVES To explore the perspectives of ICU clinical stakeholders regarding their needs and preferences for ISE to inform the future development and implementation of effective educational interventions. DESIGN A qualitative, multiple-case study supported by the "Empowering Education" theoretical framework, which emphasises the importance of stakeholder involvement in education development. SETTINGS Adult ICUs in three major hospitals located in two geographical areas in Saudi Arabia. PARTICIPANTS Forty clinical nurses, twelve nurse managers, nine nurse leaders and seven clinical educators participated. METHODS Data were collected through semi-structured interviews followed by focus groups. Framework analysis was used for data analysis. FINDINGS Stakeholders wanted ISE and training by subject experts characterised by: (i): relevant educational content; (ii): a range of educational techniques and (iii) flexible delivery and format. Nurses also identified factors that encouraged them to participate in ISE including adequate resources and a supportive work environment, whilst heavy workloads, cost and scheduling issues hindered engagement. CONCLUSION This paper highlights the importance of considering staff needs and local context when developing in-service ICU education to support nurses' competence. Further recommendations and a proposed framework to develop future ISE in the ICU are provided. TWEETABLE ABSTRACT The key to effective in-service education for ICU nurses is understanding stakeholders' needs and motivational drivers, whilst addressing barriers to successful implementation.
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Affiliation(s)
- Maha Almarhabi
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK; Faculty of Nursing, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Jocelyn Cornish
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK.
| | - Mary Raleigh
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK.
| | - Julia Philippou
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK.
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218
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Bihari S, Wiersema UF. Changes in Respiratory Mechanics With Trunk Inclination Differs Between Patients With ARDS With and Without Obesity. Chest 2024; 165:583-589. [PMID: 37832782 DOI: 10.1016/j.chest.2023.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Studies investigating the effect of trunk inclination on respiratory mechanics in mechanically ventilated patients with ARDS have reported postural differences in partition respiratory mechanics. Compared with more upright positions, the supine-flat position provided lower lung and chest wall elastance, allowing reduced driving pressures and end-inspiratory transpulmonary pressure. However, the effect of trunk inclination on respiratory mechanics in patients with obesity and ARDS is uncertain. RESEARCH QUESTION Does the effect of change in posture on partition respiratory mechanics differ between patients with ARDS with and without obesity? STUDY DESIGN AND METHODS In this single-center study, patients with ARDS with and without obesity were randomized into two 15-minute steps in which trunk inclination was changed from semi-recumbent (40° head up) to supine-flat (0°), or vice versa. At the end of each step partition respiratory mechanics, airway opening pressure and arterial blood gases were measured. Paired t test was used to examine respiratory mechanics and blood gas variables in each group. RESULTS Forty consecutive patients were enrolled. Twenty were obese (BMI, 38.4 [34.5-42.3]), and 20 were non-obese (BMI, 26.6 [25.2-28.5]). In the patients with obesity, lung and chest wall elastance, driving pressure, inspiratory transpulmonary pressure, Paco2, and ventilatory ratio were lower supine than semi-recumbent (P < .001). Airways resistance was greater supine (P = .006). In the patients without obesity, only chest wall elastance was lower in supine vs semi-recumbent (P < .001). INTERPRETATION In mechanically ventilated patients with ARDS and obesity, supine posture provided lower lung and chest wall elastance, and better CO2 clearance, than the semi-recumbent posture. CLINICAL TRIAL REGISTRATION This study was registered with Australian New Zealand Clinical Trials Registry (ACTRN12623000794606).
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Affiliation(s)
- Shailesh Bihari
- Department of ICCU, Flinders Medical Centre, Bedford Park, SA, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia.
| | - Ubbo F Wiersema
- Department of ICCU, Flinders Medical Centre, Bedford Park, SA, Australia
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219
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Faltys M, Neto AS, Cioccari L. Physiological changes after fluid bolus therapy in cardiac surgery patients: A propensity score matched case-control study. CRIT CARE RESUSC 2024; 26:32-40. [PMID: 38690188 PMCID: PMC11056405 DOI: 10.1016/j.ccrj.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 11/10/2023] [Indexed: 05/02/2024]
Abstract
Objective Fluid bolus therapy (FBT) is ubiquitous in intensive care units (ICUs) after cardiac surgery. However, its physiological effects remain unclear. Design : We performed an electronic health record-based quasi-experimental ICU study after cardiac surgery. We applied propensity score matching and compared the physiological changes after FBT episodes to matched control episodes where despite equivalent physiology no fluid bolus was given. Setting The study was conducted in a multidisciplinary ICU of a tertiary-level academic hospital. Participants The study included 2,736 patients who underwent Coronary Artery Bypass Grafting and/or heart valve surgery. Main Outcome Measures Changes in cardiac output (CO) and mean arterial pressure (MAP) during the 60 minutes following FBT. Results We analysed 3572 matched fluid bolus (FB) episodes. After FBT, but not in control episodes, CO increased within 10 min, with a maximum increase of 0.2 l/min (95%CI 0.1 to 0.2) or 4% above baseline at 40 min (p < 0.0001 vs. controls). CO increased by > 10% from baseline in 60.6% of FBT and 49.1% of control episodes (p < 0.0001). MAP increased by > 10% in 51.7% of FB episodes compared to 53.4% of controls. Finally, FBT was not associated with changes in acid-base status or oxygen delivery. Conclusion In this quasi-experimental comparative ICU study in cardiac surgery patients, FBT was associated with statistically significant but numerically small increases in CO. Nearly half of FBT failed to induce a positive CO or MAP response.
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Affiliation(s)
- Martin Faltys
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Intensive Care, Austin Hospital, Melbourne, Australia
| | - Ary Serpa Neto
- Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Prahran, VIC 3004, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, Australia
- Data Analytics Research and Evaluation Centre, Austin Hospital, Melbourne, Australia
| | - Luca Cioccari
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Intensive Care Medicine, Kantonsspital Aarau, Aarau, Switzerland
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Swilling AC, O'Dell JC, Beyene RT, Watson CM, Sawyer RG, Chollet-Hinton L, Simpson SQ, Atchison L, Derickson M, Cooper LC, Pennington GP, VandenBerg S, Halimeh BN, Hughes D, Guidry CA. Provider Perceptions of Antibiotic Initiation Strategies for Hospital-Acquired Pneumonia. Surg Infect (Larchmt) 2024; 25:109-115. [PMID: 38252553 DOI: 10.1089/sur.2023.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024] Open
Abstract
Background: The practice of rapidly initiating antibiotic therapy for patients with suspected infection has recently been criticized yet remains commonplace. Provider comfort level has been an understudied aspect of this practice. Hypothesis: We hypothesized that there would be no significant differences in provider comfort level between the two treatment groups. Methods: We prospectively surveyed critical care intensivists who provided care for patients enrolled in the Trial of Antibiotic Restraint in Presumed Pneumonia (TARPP), which was a multicenter cluster-randomized crossover trial that evaluated an immediate antibiotic initiation protocol compared with a protocol of specimen-initiated antibiotic initiation in ventilated patients with suspected new-onset pneumonia. At the end of each enrollment arm, physicians at each center were surveyed regarding their overall comfort level with the recently completed treatment arm, and perception of adherence. Both a paired and unpaired analysis was performed. Results: We collected 51 survey responses from 31 unique participants. Providers perceived a higher rate of adherence to the immediate initiation arm than the specimen-initiated arm (Always Adherent: 37.5% vs. 11.1%; p = 0.045). Providers were less comfortable waiting for objective evidence of infection in the specimen-initiated arm than with starting antibiotic agents immediately (Very Comfortable: 83.3% vs. 40.7%; p = 0.004). For the smaller paired analysis, there was no longer a difference in comfort level. Conclusions: There may be differences in provider comfort levels and perceptions of adherence when considering two different antibiotic initiation strategies for suspected pneumonia in ventilated patients. These findings should be considered when planning future studies.
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Affiliation(s)
- Aubrey C Swilling
- Department of Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jacob C O'Dell
- Department of Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Robel T Beyene
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Robert G Sawyer
- Department of Surgery, Western Michigan Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, USA
| | - Lynn Chollet-Hinton
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Steven Q Simpson
- Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Leanne Atchison
- Department of Pharmaceutical Services, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Michael Derickson
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lindsey C Cooper
- Department of Pharmaceutical Services, Prisma Health Midlands, Columbia, South Carolina, USA
| | - G Patton Pennington
- Department of Surgery, Florida State University School of Medicine, Tallahassee Memorial Healthcare, Tallahassee, Florida, USA
| | - Sheri VandenBerg
- Department of Surgery, Division of Trauma Surgery, Bronson Methodist Hospital, Kalamazoo, Michigan, USA
| | - Bachar N Halimeh
- Department of Surgery, Boston University Medical Center, Boston, Massachusetts, USA
| | - Dorothy Hughes
- Department of Population Health, University of Kansas School of Medicine, Salina, Kansas, USA
| | - Christopher A Guidry
- Department of Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
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Gómez-Ríos MÁ, Sastre JA, Onrubia-Fuertes X, López T, Abad-Gurumeta A, Casans-Francés R, Gómez-Ríos D, Garzón JC, Martínez-Pons V, Casalderrey-Rivas M, Fernández-Vaquero MÁ, Martínez-Hurtado E, Martín-Larrauri R, Reviriego-Agudo L, Gutierrez-Couto U, García-Fernández J, Serrano-Moraza A, Rodríguez Martín LJ, Camacho Leis C, Espinosa Ramírez S, Fandiño Orgeira JM, Vázquez Lima MJ, Mayo-Yáñez M, Parente-Arias P, Sistiaga-Suárez JA, Bernal-Sprekelsen M, Charco-Mora P. Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management. Part II. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024; 71:207-247. [PMID: 38340790 DOI: 10.1016/j.redare.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/28/2023] [Indexed: 02/12/2024]
Abstract
The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.
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Affiliation(s)
- M Á Gómez-Ríos
- Anesthesiology and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
| | - J A Sastre
- Anesthesiology and Perioperative Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - X Onrubia-Fuertes
- Department of Anesthesiology, Hospital Universitary Dr Peset, Valencia, Spain
| | - T López
- Anesthesiology and Perioperative Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - A Abad-Gurumeta
- Department of Anesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - R Casans-Francés
- Department of Anesthesiology, Hospital Universitario Infanta Elena, Valdemoro, Madrid, Spain
| | | | - J C Garzón
- Anesthesiology and Perioperative Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - V Martínez-Pons
- Department of Anesthesiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - M Casalderrey-Rivas
- Department of Anesthesiology. Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - M Á Fernández-Vaquero
- Department of Anesthesiology, Hospital Clínica Universitaria de Navarra, Madrid, Spain
| | - E Martínez-Hurtado
- Department of Anesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - L Reviriego-Agudo
- Department of Anesthesiology, Hospital Clínico Universitario, Valencia, Spain
| | - U Gutierrez-Couto
- Biblioteca, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, Spain
| | - J García-Fernández
- Department of Anesthesiology, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain; President of the Spanish Society of Anesthesiology, Resuscitation and Pain Therapy (SEDAR), Spain
| | | | | | | | | | - J M Fandiño Orgeira
- Emergency Department, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - M J Vázquez Lima
- Emergency Department, Hospital do Salnes, Vilagarcía de Arousa, Pontevedra, Spain; President of the Spanish Emergency Medicine Society (SEMES), Spain
| | - M Mayo-Yáñez
- Department of Otorhinolaryngology/Head Neck Surgery, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - P Parente-Arias
- Department of Otorhinolaryngology/Head Neck Surgery, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - J A Sistiaga-Suárez
- Department of Otorhinolaryngology, Hospital Universitario Donostia, Donostia, Gipuzkoa, Spain
| | - M Bernal-Sprekelsen
- Department of Otorhinolaryngology, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain; President of the Spanish Society for Otorhinolaryngology Head & Neck Surgery (SEORL-CCC), Spain
| | - P Charco-Mora
- Department of Anesthesiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
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Del Santo T, DI Filippo A, Romagnoli S. Rapid sequence induction of anesthesia: works in progress and steps forward with focus to oxygenation and monitoring techniques. Minerva Anestesiol 2024; 90:181-190. [PMID: 37851418 DOI: 10.23736/s0375-9393.23.17569-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
The description of the main scientifically consolidated innovations in recent years on Rapid Sequence Induction have been the subject of this narrative review. Data sources were PubMed, EMBASE, Web of Science, the Cochrane Central Register of Controlled Trials, and ClinicaTrials.gov, searched up to March 21st, 2023; rapid sequence induction and anesthesia were used as key word for the research. In recent years at least three significant innovations which have improved the procedure: firstly the possibility of using drugs which rapidly reverse the action of the myorelaxants and which have made it possible to give up the use of succinylcholine, replaced by rocuronium; secondly, the possibility of using much more effective pre-oxygenation methods than in the past, also through apneic oxygenation techniques which allow longer apnea time, and finally new monitoring systems much more effective than pulse oximetry in identifying and predicting periprocedural hypoxemia and indicating the need for ventilation in patients at risk of hypoxemia and preventing it. The description of three main scientifically consolidated innovations in recent years, in pharmacology, oxygen method of administration and monitoring, have been the subject of this narrative review.
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Affiliation(s)
- Tommaso Del Santo
- Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Stefano Romagnoli
- Department of Health Sciences, University of Florence, Florence, Italy
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223
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Dexter F, Hindman BJ, Bayman EO, Mueller RN. Patient and Operational Factors Do Not Substantively Affect the Annual Departmental Quality of Anesthesiologists' Clinical Supervision and Nurse Anesthetists' Work Habits. Cureus 2024; 16:e55346. [PMID: 38559506 PMCID: PMC10981928 DOI: 10.7759/cureus.55346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION Although safety climate, teamwork, and other non-technical skills in operating rooms probably influence clinical outcomes, direct associations have not been shown, at least partially due to sample size considerations. We report data from a retrospective cohort of anesthesia evaluations that can simplify the design of prospective observational studies in this area. Associations between non-technical skills in anesthesia, specifically anesthesiologists' quality of clinical supervision and nurse anesthetists' work habits, and patient and operational factors were examined. METHODS Eight fiscal years of evaluations and surgical cases from one hospital were included. Clinical supervision by anesthesiologists was evaluated daily using a nine-item scale. Work habits of nurse anesthetists were evaluated daily using a six-item scale. The dependent variables for both groups of staff were binary, whether all items were given the maximum score or not. Associations were tested with patient and operational variables for the entire day. RESULTS There were 40,718 evaluations of faculty anesthesiologists by trainees, 53,772 evaluations of nurse anesthetists by anesthesiologists, and 296,449 cases that raters and ratees started together. Cohen's d values were small (≤0.10) for all independent variables, suggesting a lack of any clinically meaningful association between patient and operational factors and evaluations given the maximum scores. For supervision quality, the day's count of orthopedic cases was a significant predictor of scores (P = 0.0011). However, the resulting absolute marginal change in the percentage of supervision scores equal to the maximum was only 0.8% (99% confidence interval: 0.2% to 1.4%), i.e., too small to be of clinical or managerial importance. Neurosurgical cases may have been a significant predictor of work habits (P = 0.0054). However, the resulting marginal change in the percentage of work habits scores equal to the maximum, an increase of 0.8% (99% confidence interval: 0.1% to 1.6%), which was again too small to be important. CONCLUSIONS When evaluating the effect of assigning anesthesiologists and nurse anesthetists with different clinical performance quality on clinical outcomes, supervision quality and work habits scores may be included as independent variables without concern that their effects are confounded by association with the patient or case characteristics. Clinical supervision and work habits are measures of non-technical skills. Hence, these findings suggest that non-technical performance can be judged by observing the typical small sample size of cases. Then, associations can be tested with administrative data for a far greater number of patients because there is unlikely to be a confounding association between patient and case characteristics and the clinicians' non-technical performance.
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Affiliation(s)
| | | | - Emine O Bayman
- Biostatistics/Anesthesia, University of Iowa, Iowa City, USA
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Liu L, Liu Z, Zhu H, Xu H. Effect of quality nursing intervention on wound healing in patients with burns: A meta-analysis. Int Wound J 2024; 21:e14717. [PMID: 38439182 PMCID: PMC10912375 DOI: 10.1111/iwj.14717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 01/11/2024] [Accepted: 01/11/2024] [Indexed: 03/06/2024] Open
Abstract
This meta-analysis aimed to explore the effects of quality nursing intervention on wound healing in patients with burns. A computerised search was conducted for randomised controlled trials (RCTs) on the effect of quality nursing intervention on wound healing in patients with burns in the PubMed, Embase, Google Scholar, Cochrane Library, China National Knowledge Infrastructure and Wanfang databases from the date of database inception to November 2023. Two researchers independently screened the literature, extracted data and performed quality assessment based on the inclusion and exclusion criteria. Stata 17.0 software was used for the data analysis. Twenty-nine RCTs involving 2637 patients with burns were included. The meta-analysis revealed that compared with conventional nursing, the implementation of quality nursing intervention in patients with burns significantly shortened the wound healing time (standardised mean difference [SMD] = -2.93, 95% confidence interval [CI]: -3.44 to -2.42, p < 0.001). The incidence of wound infections (odds ratio [OR] = 0.14, 95% CI: 0.07-0.27, p < 0.001) and complications (OR = 0.16, 95% CI: 0.11-0.23, p < 0.001) was also reduced significantly. This meta-analysis shows that applying quality nursing interventions in patients with burns can significantly shorten the wound healing time and reduce the incidence of wound infection and complications, thus promoting early patient recovery.
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Affiliation(s)
- Ling Liu
- Department of BurnPeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Zhu‐Feng Liu
- Department of BurnPeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Hong‐Yu Zhu
- Department of BurnPeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Hui‐Qin Xu
- Department of BurnPeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
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Wyler D, Torjman MC, Leong R, Baram M, Denk W, Long SC, Gawel RJ, Viscusi ER, Wainer IW, Schwenk ES. Observational study of the effect of ketamine infusions on sedation depth, inflammation, and clinical outcomes in mechanically ventilated patients with SARS-CoV-2. Anaesth Intensive Care 2024; 52:105-112. [PMID: 38006606 DOI: 10.1177/0310057x231201184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Abstract
Severely ill patients with COVID-19 are challenging to sedate and often require high-dose sedation and analgesic regimens. Ketamine can be an effective adjunct to facilitate sedation of critically ill patients but its effects on sedation level and inflammation in COVID-19 patients have not been studied. This retrospective, observational cohort study evaluated the effect of ketamine infusions on inflammatory biomarkers and clinical outcomes in mechanically ventilated patients with SARS-CoV-2 infection. A total of 186 patients were identified (47 received ketamine, 139 did not). Patients who received ketamine were significantly younger than those who did not (mean (standard deviation) 59.2 (14.2) years versus 66.3 (14.4) years; P = 0.004), but there was no statistically significant difference in body mass index (P = 0.25) or sex distribution (P = 0.91) between groups. Mechanically ventilated patients who received ketamine infusions had a statistically significant reduction in Richmond Agitation-Sedation Scale score (-3.0 versus -2.0, P < 0.001). Regarding inflammatory biomarkers, ketamine was associated with a reduction in ferritin (P = 0.02) and lactate (P = 0.01), but no such association was observed for C-reactive protein (P = 0.27), lactate dehydrogenase (P = 0.64) or interleukin-6 (P = 0.87). No significant association was observed between ketamine administration and mortality (odds ratio 0.971; 95% confidence interval 0.501 to 1.882; P = 0.93). Ketamine infusion was associated with improved sedation depth in mechanically ventilated COVID-19 patients and provided a modest anti-inflammatory benefit but did not confer benefit with respect to mortality or intensive care unit length of stay.
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Affiliation(s)
- David Wyler
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA
| | - Marc C Torjman
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA
| | - Ron Leong
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA
| | - Michael Baram
- Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA
| | - William Denk
- Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Sara C Long
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA
| | - Richard J Gawel
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA
| | - Eugene R Viscusi
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA
| | | | - Eric S Schwenk
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA
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Durham D, Rennie C, Reindel K. Examination of Pediatric Burn Incidence and the Impact of Social Determinants of Health in Florida. Cureus 2024; 16:e57035. [PMID: 38681297 PMCID: PMC11046372 DOI: 10.7759/cureus.57035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 03/27/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction Burn injuries are a major mechanism of trauma worldwide, caused by friction, cold, heat, radiation, chemical, or electric sources. Most often, burn injuries occur due to heat contact from hot liquids, solids, or fire, termed scald burns and flame burns, respectively. These types of injuries are complex and carry major injury and mortality risks, especially in pediatric populations. Burn trauma prevention has been a major focus in the US, with initiatives to increase public health outreach and safety measures. Unfortunately, children in socioeconomically disadvantaged situations may face these types of injuries at disproportionately higher rates, and we aim to highlight these disparities, if any, within our Florida community. Materials and methods This study was designed as a retrospective observational analysis using publicly available data from the Florida Health Community Health Assessment Resource Tool Set (CHARTS). Data was extracted for nonfatal burn injuries resulting in ED visits in the years 2018-2020. This data was limited to those ranging from 0 to 19 years old and converted to rates of burn injuries per 100,000. Sociodemographic details for each county were recorded from County Health Rankings & Roadmaps and compared with burn data in each respective county. Frequencies were generated for categorical data, and statistical analyses for burn rates and sociodemographic details were performed with a generalized linear model using a Poisson distribution and bivariate correlation for a p < 0.05. Results In Florida, the median annual burn rate per 100,000 was 136 (IQR: 96-179), with Jackson county holding the highest rate of 323 and Glades, Hardee, and Lafayette each holding a rate of 0. Of the 18 socioeconomic factors examined, a total of five were found to have no statistically significant effect on nonfatal burn injury ED visits: severe housing problems, percentage of Asians, teen births, percentage of children (<18 years) in poverty, and severe housing cost burden. The two most important factors to be found in nonfatal burn ED visits of pediatric patients were the percentage of those younger than 19 years old without health insurance and the average grade level performance of third-grader reading scores. When adjusting for the small sample size using Firth's bias-adjusted estimates and overdispersion, both reading scores and those without insurance play a significant role in pediatric burn injuries. For each increase in a single point in reading scores, the incidence rate ratio decreases by 97.1% (95% CI). For every percentage increase in children insured, there is a 28.8% decrease in pediatric burn injuries (95% CI). Conclusions This analysis highlights increased pediatric burn rates across multiple social determinants of health (SDOH) in all 67 Florida counties. The findings here demonstrate that there may continue to be a disproportionate distribution of burn rates among lower and higher sociodemographic areas. This study further highlights this trend within the Florida community, and continued research will be necessary to meet the needs of lower sociodemographic areas to improve burn rates in vulnerable populations, such as children, who are at increased risk of injury.
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Affiliation(s)
- Devon Durham
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| | - Christopher Rennie
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| | - Kelsey Reindel
- Osteopathic Principles and Practice, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
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Wei M, Zheng H, Xu X, Ji Y, Yu X, Lu L, Sun Y, Zhao Z, Liu X, Jiang W, Zhang X, Qiu Y, Weng Y. Assessment of Wound-Related Pain Experiences of Patients With Chronic Wounds: A Multicenter Cross-Sectional Study in Eastern China. J Wound Ostomy Continence Nurs 2024; 51:111-116. [PMID: 38527319 DOI: 10.1097/won.0000000000001059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
PURPOSE The primary aims of this study were to evaluate the prevalence of wound-related pain (WRP) in patients with chronic wounds and assess the use of pain relief measures. DESIGN A cross-sectional study. SUBJECTS AND SETTING A convenience sample of patients with chronic wounds was recruited from outpatient clinics of 12 hospitals covering 7 of 13 cities in the Jiangsu province located in eastern China from July 10 to August 25, 2020. The sample comprised 451 respondents, and their mean age was 54.85 (SD 19.16) years; 56.1% (253/451) patients were male. METHODS An investigator-designed questionnaire was used to collect pain-related information from patients. The questionnaire consisted of 4 parts: (1) basic demographic and clinical information (patient and wound characteristics); (2) wound baseline pain; (3) wound-related procedural pain and pain relief method; and (4) the effect of WRP on the patient. Pain was assessed using the Numerical Rating Scale (NRS) scored from 0 (no pain) to 10 (worst pain). Severity of pain was based on NRS scores' classification as mild (1-3), moderate (4-6), and severe (7-10). The survey was conducted from July 10 to August 25, 2020. Participants were instructed on use of the NRS and then completed the questionnaire following dressing change independently. RESULTS The 3 most common types of chronic wounds were traumatic ulcers, surgical wounds, and venous leg ulcers. The 3 most prevalent locations were lower limbs, feet, and thorax/abdomen. Of all patients, 62.5% (282/451) and 93.8% (423/451) patients experienced wound baseline pain and wound-related procedural pain, respectively. The mean score of wound baseline pain was 3.76 (SD 1.60) indicating moderate pain. During wound management, the highest pain score was 6.45 (SD 2.75) indicating severe pain; the most severe pain scores were associated with debridement. The use of drugs to relieve wound pain was low, while the use of nondrug-based analgesia was relatively high. Because of WRP, patients with chronic wounds feared dressing changes, hesitated to move, and showed a decline in sleep quality. CONCLUSIONS Wound baseline pain and wound-related procedural pain were very common in patients with chronic wounds. In the future, targeted intervention plans should be developed by combining drug-based and nondrug-based analgesia according to pain severity.
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Affiliation(s)
- Min Wei
- Min Wei, Master, Wound Care Center, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Huiling Zheng, Bachelor, Department of Cardiothoracic, No. 988 Hospital of Jonit Logistic Support Force, Zhengzhou, Henan, China
- Xinyue Xu, Bachelor, Department of Orthopedics, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Yihong Ji, Bachelor, Wound Care Center, ChangShu No. 1 People's Hospital, ChangShu, Jiangsu, China
- Xiujuan Yu, Bachelor, Wound Care Center, the Second Hospital of Lianyungang, LianYunGang, Jiangsu, China
- Lin Lu, Bachelor, Wound Care Center, XuZhou RenCi Hospital, XuZhou, Jiangsu, China
- Ying Sun, Bachelor, Gastrointestinal Surgery, Huai'An First People's Hospital, Huai'An, Jiangsu, China
- Zhiying Zhao, Bachelor, Burn and Plastic Surgery, the First Affiliated Hospital of Soochow University, Soochow, Jiangsu, China
- Xiaojun Liu, Bachelor, Wound Care Center, Huai'an Second People's Hospital, Huai'An, Jiangsu, China
- Wei Jiang, Bachelor, Wound Care Center, Xuzhou Mining Group General Hospital, Xuzhou, Jiangsu, China
- Xiya Zhang, Bachelor, Wound Care Center, Suqian People's Hospital, Suqian, Jiangsu, China
- Yansen Qiu, Bachelor, Wound Care Center, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
- Yajuan Weng, Master, FAAN, Department of Nursing, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Huiling Zheng
- Min Wei, Master, Wound Care Center, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Huiling Zheng, Bachelor, Department of Cardiothoracic, No. 988 Hospital of Jonit Logistic Support Force, Zhengzhou, Henan, China
- Xinyue Xu, Bachelor, Department of Orthopedics, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Yihong Ji, Bachelor, Wound Care Center, ChangShu No. 1 People's Hospital, ChangShu, Jiangsu, China
- Xiujuan Yu, Bachelor, Wound Care Center, the Second Hospital of Lianyungang, LianYunGang, Jiangsu, China
- Lin Lu, Bachelor, Wound Care Center, XuZhou RenCi Hospital, XuZhou, Jiangsu, China
- Ying Sun, Bachelor, Gastrointestinal Surgery, Huai'An First People's Hospital, Huai'An, Jiangsu, China
- Zhiying Zhao, Bachelor, Burn and Plastic Surgery, the First Affiliated Hospital of Soochow University, Soochow, Jiangsu, China
- Xiaojun Liu, Bachelor, Wound Care Center, Huai'an Second People's Hospital, Huai'An, Jiangsu, China
- Wei Jiang, Bachelor, Wound Care Center, Xuzhou Mining Group General Hospital, Xuzhou, Jiangsu, China
- Xiya Zhang, Bachelor, Wound Care Center, Suqian People's Hospital, Suqian, Jiangsu, China
- Yansen Qiu, Bachelor, Wound Care Center, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
- Yajuan Weng, Master, FAAN, Department of Nursing, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Xinyue Xu
- Min Wei, Master, Wound Care Center, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Huiling Zheng, Bachelor, Department of Cardiothoracic, No. 988 Hospital of Jonit Logistic Support Force, Zhengzhou, Henan, China
- Xinyue Xu, Bachelor, Department of Orthopedics, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Yihong Ji, Bachelor, Wound Care Center, ChangShu No. 1 People's Hospital, ChangShu, Jiangsu, China
- Xiujuan Yu, Bachelor, Wound Care Center, the Second Hospital of Lianyungang, LianYunGang, Jiangsu, China
- Lin Lu, Bachelor, Wound Care Center, XuZhou RenCi Hospital, XuZhou, Jiangsu, China
- Ying Sun, Bachelor, Gastrointestinal Surgery, Huai'An First People's Hospital, Huai'An, Jiangsu, China
- Zhiying Zhao, Bachelor, Burn and Plastic Surgery, the First Affiliated Hospital of Soochow University, Soochow, Jiangsu, China
- Xiaojun Liu, Bachelor, Wound Care Center, Huai'an Second People's Hospital, Huai'An, Jiangsu, China
- Wei Jiang, Bachelor, Wound Care Center, Xuzhou Mining Group General Hospital, Xuzhou, Jiangsu, China
- Xiya Zhang, Bachelor, Wound Care Center, Suqian People's Hospital, Suqian, Jiangsu, China
- Yansen Qiu, Bachelor, Wound Care Center, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
- Yajuan Weng, Master, FAAN, Department of Nursing, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Yihong Ji
- Min Wei, Master, Wound Care Center, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Huiling Zheng, Bachelor, Department of Cardiothoracic, No. 988 Hospital of Jonit Logistic Support Force, Zhengzhou, Henan, China
- Xinyue Xu, Bachelor, Department of Orthopedics, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Yihong Ji, Bachelor, Wound Care Center, ChangShu No. 1 People's Hospital, ChangShu, Jiangsu, China
- Xiujuan Yu, Bachelor, Wound Care Center, the Second Hospital of Lianyungang, LianYunGang, Jiangsu, China
- Lin Lu, Bachelor, Wound Care Center, XuZhou RenCi Hospital, XuZhou, Jiangsu, China
- Ying Sun, Bachelor, Gastrointestinal Surgery, Huai'An First People's Hospital, Huai'An, Jiangsu, China
- Zhiying Zhao, Bachelor, Burn and Plastic Surgery, the First Affiliated Hospital of Soochow University, Soochow, Jiangsu, China
- Xiaojun Liu, Bachelor, Wound Care Center, Huai'an Second People's Hospital, Huai'An, Jiangsu, China
- Wei Jiang, Bachelor, Wound Care Center, Xuzhou Mining Group General Hospital, Xuzhou, Jiangsu, China
- Xiya Zhang, Bachelor, Wound Care Center, Suqian People's Hospital, Suqian, Jiangsu, China
- Yansen Qiu, Bachelor, Wound Care Center, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
- Yajuan Weng, Master, FAAN, Department of Nursing, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Xiujuan Yu
- Min Wei, Master, Wound Care Center, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Huiling Zheng, Bachelor, Department of Cardiothoracic, No. 988 Hospital of Jonit Logistic Support Force, Zhengzhou, Henan, China
- Xinyue Xu, Bachelor, Department of Orthopedics, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Yihong Ji, Bachelor, Wound Care Center, ChangShu No. 1 People's Hospital, ChangShu, Jiangsu, China
- Xiujuan Yu, Bachelor, Wound Care Center, the Second Hospital of Lianyungang, LianYunGang, Jiangsu, China
- Lin Lu, Bachelor, Wound Care Center, XuZhou RenCi Hospital, XuZhou, Jiangsu, China
- Ying Sun, Bachelor, Gastrointestinal Surgery, Huai'An First People's Hospital, Huai'An, Jiangsu, China
- Zhiying Zhao, Bachelor, Burn and Plastic Surgery, the First Affiliated Hospital of Soochow University, Soochow, Jiangsu, China
- Xiaojun Liu, Bachelor, Wound Care Center, Huai'an Second People's Hospital, Huai'An, Jiangsu, China
- Wei Jiang, Bachelor, Wound Care Center, Xuzhou Mining Group General Hospital, Xuzhou, Jiangsu, China
- Xiya Zhang, Bachelor, Wound Care Center, Suqian People's Hospital, Suqian, Jiangsu, China
- Yansen Qiu, Bachelor, Wound Care Center, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
- Yajuan Weng, Master, FAAN, Department of Nursing, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Lin Lu
- Min Wei, Master, Wound Care Center, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Huiling Zheng, Bachelor, Department of Cardiothoracic, No. 988 Hospital of Jonit Logistic Support Force, Zhengzhou, Henan, China
- Xinyue Xu, Bachelor, Department of Orthopedics, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Yihong Ji, Bachelor, Wound Care Center, ChangShu No. 1 People's Hospital, ChangShu, Jiangsu, China
- Xiujuan Yu, Bachelor, Wound Care Center, the Second Hospital of Lianyungang, LianYunGang, Jiangsu, China
- Lin Lu, Bachelor, Wound Care Center, XuZhou RenCi Hospital, XuZhou, Jiangsu, China
- Ying Sun, Bachelor, Gastrointestinal Surgery, Huai'An First People's Hospital, Huai'An, Jiangsu, China
- Zhiying Zhao, Bachelor, Burn and Plastic Surgery, the First Affiliated Hospital of Soochow University, Soochow, Jiangsu, China
- Xiaojun Liu, Bachelor, Wound Care Center, Huai'an Second People's Hospital, Huai'An, Jiangsu, China
- Wei Jiang, Bachelor, Wound Care Center, Xuzhou Mining Group General Hospital, Xuzhou, Jiangsu, China
- Xiya Zhang, Bachelor, Wound Care Center, Suqian People's Hospital, Suqian, Jiangsu, China
- Yansen Qiu, Bachelor, Wound Care Center, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
- Yajuan Weng, Master, FAAN, Department of Nursing, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Ying Sun
- Min Wei, Master, Wound Care Center, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Huiling Zheng, Bachelor, Department of Cardiothoracic, No. 988 Hospital of Jonit Logistic Support Force, Zhengzhou, Henan, China
- Xinyue Xu, Bachelor, Department of Orthopedics, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Yihong Ji, Bachelor, Wound Care Center, ChangShu No. 1 People's Hospital, ChangShu, Jiangsu, China
- Xiujuan Yu, Bachelor, Wound Care Center, the Second Hospital of Lianyungang, LianYunGang, Jiangsu, China
- Lin Lu, Bachelor, Wound Care Center, XuZhou RenCi Hospital, XuZhou, Jiangsu, China
- Ying Sun, Bachelor, Gastrointestinal Surgery, Huai'An First People's Hospital, Huai'An, Jiangsu, China
- Zhiying Zhao, Bachelor, Burn and Plastic Surgery, the First Affiliated Hospital of Soochow University, Soochow, Jiangsu, China
- Xiaojun Liu, Bachelor, Wound Care Center, Huai'an Second People's Hospital, Huai'An, Jiangsu, China
- Wei Jiang, Bachelor, Wound Care Center, Xuzhou Mining Group General Hospital, Xuzhou, Jiangsu, China
- Xiya Zhang, Bachelor, Wound Care Center, Suqian People's Hospital, Suqian, Jiangsu, China
- Yansen Qiu, Bachelor, Wound Care Center, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
- Yajuan Weng, Master, FAAN, Department of Nursing, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Zhiying Zhao
- Min Wei, Master, Wound Care Center, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Huiling Zheng, Bachelor, Department of Cardiothoracic, No. 988 Hospital of Jonit Logistic Support Force, Zhengzhou, Henan, China
- Xinyue Xu, Bachelor, Department of Orthopedics, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Yihong Ji, Bachelor, Wound Care Center, ChangShu No. 1 People's Hospital, ChangShu, Jiangsu, China
- Xiujuan Yu, Bachelor, Wound Care Center, the Second Hospital of Lianyungang, LianYunGang, Jiangsu, China
- Lin Lu, Bachelor, Wound Care Center, XuZhou RenCi Hospital, XuZhou, Jiangsu, China
- Ying Sun, Bachelor, Gastrointestinal Surgery, Huai'An First People's Hospital, Huai'An, Jiangsu, China
- Zhiying Zhao, Bachelor, Burn and Plastic Surgery, the First Affiliated Hospital of Soochow University, Soochow, Jiangsu, China
- Xiaojun Liu, Bachelor, Wound Care Center, Huai'an Second People's Hospital, Huai'An, Jiangsu, China
- Wei Jiang, Bachelor, Wound Care Center, Xuzhou Mining Group General Hospital, Xuzhou, Jiangsu, China
- Xiya Zhang, Bachelor, Wound Care Center, Suqian People's Hospital, Suqian, Jiangsu, China
- Yansen Qiu, Bachelor, Wound Care Center, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
- Yajuan Weng, Master, FAAN, Department of Nursing, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Xiaojun Liu
- Min Wei, Master, Wound Care Center, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Huiling Zheng, Bachelor, Department of Cardiothoracic, No. 988 Hospital of Jonit Logistic Support Force, Zhengzhou, Henan, China
- Xinyue Xu, Bachelor, Department of Orthopedics, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Yihong Ji, Bachelor, Wound Care Center, ChangShu No. 1 People's Hospital, ChangShu, Jiangsu, China
- Xiujuan Yu, Bachelor, Wound Care Center, the Second Hospital of Lianyungang, LianYunGang, Jiangsu, China
- Lin Lu, Bachelor, Wound Care Center, XuZhou RenCi Hospital, XuZhou, Jiangsu, China
- Ying Sun, Bachelor, Gastrointestinal Surgery, Huai'An First People's Hospital, Huai'An, Jiangsu, China
- Zhiying Zhao, Bachelor, Burn and Plastic Surgery, the First Affiliated Hospital of Soochow University, Soochow, Jiangsu, China
- Xiaojun Liu, Bachelor, Wound Care Center, Huai'an Second People's Hospital, Huai'An, Jiangsu, China
- Wei Jiang, Bachelor, Wound Care Center, Xuzhou Mining Group General Hospital, Xuzhou, Jiangsu, China
- Xiya Zhang, Bachelor, Wound Care Center, Suqian People's Hospital, Suqian, Jiangsu, China
- Yansen Qiu, Bachelor, Wound Care Center, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
- Yajuan Weng, Master, FAAN, Department of Nursing, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Wei Jiang
- Min Wei, Master, Wound Care Center, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Huiling Zheng, Bachelor, Department of Cardiothoracic, No. 988 Hospital of Jonit Logistic Support Force, Zhengzhou, Henan, China
- Xinyue Xu, Bachelor, Department of Orthopedics, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Yihong Ji, Bachelor, Wound Care Center, ChangShu No. 1 People's Hospital, ChangShu, Jiangsu, China
- Xiujuan Yu, Bachelor, Wound Care Center, the Second Hospital of Lianyungang, LianYunGang, Jiangsu, China
- Lin Lu, Bachelor, Wound Care Center, XuZhou RenCi Hospital, XuZhou, Jiangsu, China
- Ying Sun, Bachelor, Gastrointestinal Surgery, Huai'An First People's Hospital, Huai'An, Jiangsu, China
- Zhiying Zhao, Bachelor, Burn and Plastic Surgery, the First Affiliated Hospital of Soochow University, Soochow, Jiangsu, China
- Xiaojun Liu, Bachelor, Wound Care Center, Huai'an Second People's Hospital, Huai'An, Jiangsu, China
- Wei Jiang, Bachelor, Wound Care Center, Xuzhou Mining Group General Hospital, Xuzhou, Jiangsu, China
- Xiya Zhang, Bachelor, Wound Care Center, Suqian People's Hospital, Suqian, Jiangsu, China
- Yansen Qiu, Bachelor, Wound Care Center, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
- Yajuan Weng, Master, FAAN, Department of Nursing, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Xiya Zhang
- Min Wei, Master, Wound Care Center, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Huiling Zheng, Bachelor, Department of Cardiothoracic, No. 988 Hospital of Jonit Logistic Support Force, Zhengzhou, Henan, China
- Xinyue Xu, Bachelor, Department of Orthopedics, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Yihong Ji, Bachelor, Wound Care Center, ChangShu No. 1 People's Hospital, ChangShu, Jiangsu, China
- Xiujuan Yu, Bachelor, Wound Care Center, the Second Hospital of Lianyungang, LianYunGang, Jiangsu, China
- Lin Lu, Bachelor, Wound Care Center, XuZhou RenCi Hospital, XuZhou, Jiangsu, China
- Ying Sun, Bachelor, Gastrointestinal Surgery, Huai'An First People's Hospital, Huai'An, Jiangsu, China
- Zhiying Zhao, Bachelor, Burn and Plastic Surgery, the First Affiliated Hospital of Soochow University, Soochow, Jiangsu, China
- Xiaojun Liu, Bachelor, Wound Care Center, Huai'an Second People's Hospital, Huai'An, Jiangsu, China
- Wei Jiang, Bachelor, Wound Care Center, Xuzhou Mining Group General Hospital, Xuzhou, Jiangsu, China
- Xiya Zhang, Bachelor, Wound Care Center, Suqian People's Hospital, Suqian, Jiangsu, China
- Yansen Qiu, Bachelor, Wound Care Center, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
- Yajuan Weng, Master, FAAN, Department of Nursing, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Yansen Qiu
- Min Wei, Master, Wound Care Center, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Huiling Zheng, Bachelor, Department of Cardiothoracic, No. 988 Hospital of Jonit Logistic Support Force, Zhengzhou, Henan, China
- Xinyue Xu, Bachelor, Department of Orthopedics, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Yihong Ji, Bachelor, Wound Care Center, ChangShu No. 1 People's Hospital, ChangShu, Jiangsu, China
- Xiujuan Yu, Bachelor, Wound Care Center, the Second Hospital of Lianyungang, LianYunGang, Jiangsu, China
- Lin Lu, Bachelor, Wound Care Center, XuZhou RenCi Hospital, XuZhou, Jiangsu, China
- Ying Sun, Bachelor, Gastrointestinal Surgery, Huai'An First People's Hospital, Huai'An, Jiangsu, China
- Zhiying Zhao, Bachelor, Burn and Plastic Surgery, the First Affiliated Hospital of Soochow University, Soochow, Jiangsu, China
- Xiaojun Liu, Bachelor, Wound Care Center, Huai'an Second People's Hospital, Huai'An, Jiangsu, China
- Wei Jiang, Bachelor, Wound Care Center, Xuzhou Mining Group General Hospital, Xuzhou, Jiangsu, China
- Xiya Zhang, Bachelor, Wound Care Center, Suqian People's Hospital, Suqian, Jiangsu, China
- Yansen Qiu, Bachelor, Wound Care Center, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
- Yajuan Weng, Master, FAAN, Department of Nursing, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Yajuan Weng
- Min Wei, Master, Wound Care Center, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Huiling Zheng, Bachelor, Department of Cardiothoracic, No. 988 Hospital of Jonit Logistic Support Force, Zhengzhou, Henan, China
- Xinyue Xu, Bachelor, Department of Orthopedics, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
- Yihong Ji, Bachelor, Wound Care Center, ChangShu No. 1 People's Hospital, ChangShu, Jiangsu, China
- Xiujuan Yu, Bachelor, Wound Care Center, the Second Hospital of Lianyungang, LianYunGang, Jiangsu, China
- Lin Lu, Bachelor, Wound Care Center, XuZhou RenCi Hospital, XuZhou, Jiangsu, China
- Ying Sun, Bachelor, Gastrointestinal Surgery, Huai'An First People's Hospital, Huai'An, Jiangsu, China
- Zhiying Zhao, Bachelor, Burn and Plastic Surgery, the First Affiliated Hospital of Soochow University, Soochow, Jiangsu, China
- Xiaojun Liu, Bachelor, Wound Care Center, Huai'an Second People's Hospital, Huai'An, Jiangsu, China
- Wei Jiang, Bachelor, Wound Care Center, Xuzhou Mining Group General Hospital, Xuzhou, Jiangsu, China
- Xiya Zhang, Bachelor, Wound Care Center, Suqian People's Hospital, Suqian, Jiangsu, China
- Yansen Qiu, Bachelor, Wound Care Center, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
- Yajuan Weng, Master, FAAN, Department of Nursing, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
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Gómez-Ríos MÁ, Sastre JA, Onrubia-Fuertes X, López T, Abad-Gurumeta A, Casans-Francés R, Gómez-Ríos D, Garzón JC, Martínez-Pons V, Casalderrey-Rivas M, Fernández-Vaquero MÁ, Martínez-Hurtado E, Martín-Larrauri R, Reviriego-Agudo L, Gutierrez-Couto U, García-Fernández J, Serrano-Moraza A, Rodríguez Martín LJ, Camacho Leis C, Espinosa Ramírez S, Fandiño Orgeira JM, Vázquez Lima MJ, Mayo-Yáñez M, Parente-Arias P, Sistiaga-Suárez JA, Bernal-Sprekelsen M, Charco-Mora P. Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management. Part I. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024; 71:171-206. [PMID: 38340791 DOI: 10.1016/j.redare.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/28/2023] [Indexed: 02/12/2024]
Abstract
The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.
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Affiliation(s)
- M Á Gómez-Ríos
- Anesthesiology and Perioperative Medicine. Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
| | - J A Sastre
- Anesthesiology and Perioperative Medicine. Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - X Onrubia-Fuertes
- Department of Anesthesiology, Hospital Universitari Dr Peset, Valencia, Spain
| | - T López
- Anesthesiology and Perioperative Medicine. Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - A Abad-Gurumeta
- Department of Anesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - R Casans-Francés
- Department of Anesthesiology. Hospital Universitario Infanta Elena, Valdemoro, Madrid, Spain
| | | | - J C Garzón
- Anesthesiology and Perioperative Medicine. Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - V Martínez-Pons
- Department of Anesthesiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - M Casalderrey-Rivas
- Department of Anesthesiology, Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - M Á Fernández-Vaquero
- Department of Anesthesiology, Hospital Clínica Universitaria de Navarra, Madrid, Spain
| | - E Martínez-Hurtado
- Department of Anesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - L Reviriego-Agudo
- Department of Anesthesiology. Hospital Clínico Universitario, Valencia, Spain
| | - U Gutierrez-Couto
- Biblioteca, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, Spain
| | - J García-Fernández
- Department of Anesthesiology, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain; President of the Spanish Society of Anesthesiology, Resuscitation and Pain Therapy (SEDAR), Spain
| | | | | | | | | | - J M Fandiño Orgeira
- Servicio de Urgencias, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - M J Vázquez Lima
- Emergency Department, Hospital do Salnes, Vilagarcía de Arousa, Pontevedra, Spain; President of the Spanish Emergency Medicine Society (SEMES), Spain
| | - M Mayo-Yáñez
- Department of Otorhinolaryngology/Head Neck Surgery, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - P Parente-Arias
- Department of Otorhinolaryngology/Head Neck Surgery, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - J A Sistiaga-Suárez
- Department of Otorhinolaryngology, Hospital Universitario Donostia, Donostia, Gipuzkoa, Spain
| | - M Bernal-Sprekelsen
- Department of Otorhinolaryngology, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain; President of the Spanish Society for Otorhinolaryngology Head & Neck Surgery (SEORL-CCC), Spain
| | - P Charco-Mora
- Department of Anesthesiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
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Rucci JM, Law AC, Bolesta S, Quinn EK, Garcia MA, Gajic O, Boman K, Yus S, Goodspeed VM, Kumar V, Kashyap R, Walkey AJ. Variation in Sedative and Analgesic Use During the COVID-19 Pandemic and Associated Outcomes. CHEST CRITICAL CARE 2024; 2:100047. [PMID: 38576856 PMCID: PMC10994221 DOI: 10.1016/j.chstcc.2024.100047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
BACKGROUND Providing analgesia and sedation is an essential component of caring for many mechanically ventilated patients. The selection of analgesic and sedative medications during the COVID-19 pandemic, and the impact of these sedation practices on patient outcomes, remain incompletely characterized. RESEARCH QUESTION What were the hospital patterns of analgesic and sedative use for patients with COVID-19 who received mechanical ventilation (MV), and what differences in clinical patient outcomes were observed across prevailing sedation practices? STUDY DESIGN AND METHODS We conducted an observational cohort study of hospitalized adults who received MV for COVID-19 from February 2020 through April 2021 within the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS) COVID-19 Registry. To describe common sedation practices, we used hierarchical clustering to group hospitals based on the percentage of patients who received various analgesic and sedative medications. We then used multivariable regression models to evaluate the association between hospital analgesia and sedation cluster and duration of MV (with a placement of death [POD] approach to account for competing risks). RESULTS We identified 1,313 adults across 35 hospitals admitted with COVID-19 who received MV. Two clusters of analgesia and sedation practices were identified. Cluster 1 hospitals generally administered opioids and propofol with occasional use of additional sedatives (eg, benzodiazepines, alpha-agonists, and ketamine); cluster 2 hospitals predominantly used opioids and benzodiazepines without other sedatives. As compared with patients in cluster 2, patients admitted to cluster 1 hospitals underwent a shorter adjusted median duration of MV with POD (β-estimate, -5.9; 95% CI, -11.2 to -0.6; P = .03). INTERPRETATION Patients who received MV for COVID-19 in hospitals that prioritized opioids and propofol for analgesia and sedation experienced shorter adjusted median duration of MV with POD as compared with patients who received MV in hospitals that primarily used opioids and benzodiazepines.
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Affiliation(s)
- Justin M Rucci
- Pulmonary Center, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine
- Center for Healhcare Organization and Implementation Research, VA Boston Healthcare System
| | - Anica C Law
- Pulmonary Center, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine
| | - Scott Bolesta
- Department of Pharmacy Practice, Nesbitt School of Pharmacy, Wilkes University, Wilkes-Barre, PA
| | - Emily K Quinn
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, University of Massachusetts Chan School of Medicine, Worcester MA
| | - Michael A Garcia
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington Medicine Valley Medical Center, Renton, WA
| | - Ognjen Gajic
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Karen Boman
- Society of Critical Care Medicine, Mount Prospect, IL
| | - Santiago Yus
- Department of Intensive Care Medicine, La Paz University Hospital, Madrid, Spain
| | - Valerie M Goodspeed
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, University of Massachusetts Chan School of Medicine, Worcester MA
| | | | - Rahul Kashyap
- Department of Anesthesia and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Allan J Walkey
- Division of Health Systems Science, Department of Medicine, University of Massachusetts Chan School of Medicine, Worcester MA
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von Wedel D, Redaelli S, Suleiman A, Wachtendorf LJ, Fosset M, Santer P, Shay D, Munoz-Acuna R, Chen G, Talmor D, Jung B, Baedorf-Kassis EN, Schaefer MS. Adjustments of Ventilator Parameters during Operating Room-to-ICU Transition and 28-Day Mortality. Am J Respir Crit Care Med 2024; 209:553-562. [PMID: 38190707 DOI: 10.1164/rccm.202307-1168oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 01/08/2024] [Indexed: 01/10/2024] Open
Abstract
Rationale: Lung-protective mechanical ventilation strategies have been proven beneficial in the operating room (OR) and the ICU. However, differential practices in ventilator management persist, often resulting in adjustments of ventilator parameters when transitioning patients from the OR to the ICU. Objectives: To characterize patterns of ventilator adjustments during the transition of mechanically ventilated surgical patients from the OR to the ICU and assess their impact on 28-day mortality. Methods: Hospital registry study including patients undergoing general anesthesia with continued, controlled mechanical ventilation in the ICU between 2008 and 2022. Ventilator parameters were assessed 1 hour before and 6 hours after the transition. Measurements and Main Results: Of 2,103 patients, 212 (10.1%) died within 28 days. Upon OR-to-ICU transition, VT and driving pressure decreased (-1.1 ml/kg predicted body weight [IQR, -2.0 to -0.2]; P < 0.001; and -4.3 cm H2O [-8.2 to -1.2]; P < 0.001). Concomitantly, respiratory rates increased (+5.0 breaths/min [2.0 to 7.5]; P < 0.001), resulting overall in slightly higher mechanical power (MP) in the ICU (+0.7 J/min [-1.9 to 3.0]; P < 0.001). In adjusted analysis, increases in MP were associated with a higher 28-day mortality rate (adjusted odds ratio, 1.10; 95% confidence interval, 1.06-1.14; P < 0.001; adjusted risk difference, 0.7%; 95% confidence interval, 0.4-1.0, both per 1 J/min). Conclusion: During transition of mechanically ventilated patients from the OR to the ICU, ventilator adjustments resulting in higher MP were associated with a greater risk of 28-day mortality.
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Affiliation(s)
- Dario von Wedel
- Department of Anesthesia, Critical Care and Pain Medicine
- Center for Anesthesia Research Excellence, and
| | - Simone Redaelli
- Department of Anesthesia, Critical Care and Pain Medicine
- Center for Anesthesia Research Excellence, and
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Aiman Suleiman
- Department of Anesthesia, Critical Care and Pain Medicine
- Center for Anesthesia Research Excellence, and
- Department of Anesthesia and Intensive Care, Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Luca J Wachtendorf
- Department of Anesthesia, Critical Care and Pain Medicine
- Center for Anesthesia Research Excellence, and
| | - Maxime Fosset
- Department of Anesthesia, Critical Care and Pain Medicine
- Center for Anesthesia Research Excellence, and
- Medical Intensive Care Unit and PhyMedExp, Institut National de la Santé et de la Recherche Médicale, Montpellier University Hospital, Montpellier, France
| | - Peter Santer
- Department of Anesthesia, Critical Care and Pain Medicine
- Center for Anesthesia Research Excellence, and
| | - Denys Shay
- Department of Anesthesia, Critical Care and Pain Medicine
- Center for Anesthesia Research Excellence, and
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; and
| | - Ricardo Munoz-Acuna
- Department of Anesthesia, Critical Care and Pain Medicine
- Center for Anesthesia Research Excellence, and
| | - Guanqing Chen
- Department of Anesthesia, Critical Care and Pain Medicine
- Center for Anesthesia Research Excellence, and
| | - Daniel Talmor
- Department of Anesthesia, Critical Care and Pain Medicine
| | - Boris Jung
- Department of Anesthesia, Critical Care and Pain Medicine
- Center for Anesthesia Research Excellence, and
- Department of Pulmonary, Critical Care & Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Medical Intensive Care Unit and PhyMedExp, Institut National de la Santé et de la Recherche Médicale, Montpellier University Hospital, Montpellier, France
| | - Elias N Baedorf-Kassis
- Department of Pulmonary, Critical Care & Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Maximilian S Schaefer
- Department of Anesthesia, Critical Care and Pain Medicine
- Center for Anesthesia Research Excellence, and
- Department of Anesthesiology, Düsseldorf University Hospital, Dusseldorf, Germany
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Cañizares-Otero MC, Danyalian AM, High DP, Vieira P, Almanzar Zorilla C, Dew J, Lee CC, Lee IM, Diaz R, Zapata D, Danckers M. Implementation and Evaluation of a Trainee Orientation Manual in an Intensive Care Unit Rotation. ATS Sch 2024; 5:109-121. [PMID: 38628303 PMCID: PMC11019769 DOI: 10.34197/ats-scholar.2023-0007oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 10/30/2023] [Indexed: 04/19/2024] Open
Abstract
Background The intensive care unit (ICU) rotation places trainees in a fast-paced, high-intensity environment that requires complex patient care and multidisciplinary coordination. Trainees seek continuous medical knowledge acquisition while tasked with learning ICU-specific workflows, procedures, and policies. The unfamiliarity with rotation logistics and administrative roles and expectations could hinder the ICU rotation learning experience. A lack of standardization and material for trainee orientation to administrative ICU tasks and workflows could affect the trainee's rotation performance and overall learner satisfaction. Objective We evaluated the implementation of an ICU trainee manual to provide trainees with a source of orientation for rotation logistics and nonclinical ICU tasks. We assessd its impact on content retention, learners' satisfaction with the manual, and overall ICU rotation experience. Methods We designed an observational, prospective cohort study that included all trainees scheduled to rotate in the ICU during the 2020-2021 academic year. The ICU manual was delivered electronically and was available throughout the academic year. Trainees received a survey before their first ICU rotation (pretest) and 6 months after their first ICU rotation (retest) to assess content retention, trainees' perception of the ICU manual, and overall rotation satisfaction. Results A total of 95 trainees completed the pretest survey, and 61 completed the retest survey. The target cohort response rate for each survey was 100%. Pretest scores were higher than the matched retest scores (41 of 48 [interquartile range, 37-44] vs. 38 of 48 [34-41]; P < 0.001). The median ICU manual satisfaction score was 32 of 40 (26-36.5). We found positive correlations between ICU manual trainee satisfaction score and the retest score (r[59] = 0.320; P = 0.01) and ICU rotation trainee satisfaction level (r[59] = 0.909; P < 0.001). Conclusion Implementing an ICU manual to orient trainees to their ICU clinical rotation was well received and showed continued retention of orientation content. Higher ICU rotation trainee satisfaction levels were related to a positive perception of the ICU manual.
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Affiliation(s)
| | - Aunie M. Danyalian
- Department of Medicine and
- Division of Critical Care Medicine, HCA
Florida Aventura Hospital, Aventura, Florida
| | - Daniel P. High
- Department of Medicine and
- Division of Critical Care Medicine, HCA
Florida Aventura Hospital, Aventura, Florida
| | | | - Christian Almanzar Zorilla
- Department of Medicine and
- Division of Critical Care Medicine, HCA
Florida Aventura Hospital, Aventura, Florida
| | | | - Chi Chan Lee
- Department of Critical Care, Guam Regional
Medical City, Tamuning, Guam; and
| | - Idle M. Lee
- Division of Critical Care Medicine, HCA
Florida Kendall Hospital, Miami, Florida
| | - Raiko Diaz
- Department of Medicine and
- Division of Critical Care Medicine, HCA
Florida Aventura Hospital, Aventura, Florida
| | - Daniel Zapata
- Division of Critical Care Medicine, HCA
Florida Kendall Hospital, Miami, Florida
| | - Mauricio Danckers
- Department of Medicine and
- Division of Critical Care Medicine, HCA
Florida Aventura Hospital, Aventura, Florida
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Lu T, Khampang P, Beydoun A, Berezovsky A, Rohde R, Hong W, Yu B, Kerschner JE. Continuous monitoring of endotracheal tube position with near infrared light. JOURNAL OF BIOMEDICAL OPTICS 2024; 29:035001. [PMID: 38476221 PMCID: PMC10928496 DOI: 10.1117/1.jbo.29.3.035001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 12/15/2023] [Accepted: 01/12/2024] [Indexed: 03/14/2024]
Abstract
Significance Endotracheal intubation is a common approach for airway management in critically ill patients. However, the position of the endotracheal tube (ETT) may be altered during the procedure due to head movements. Accidental displacement or dislodge of the ETT may reduce the airflow, leading to moderate to severe complications, and in some cases even fatality. Therefore, timely detection of changes in ETT position in the trachea is critical to ensure immediate and intermediate interventions to maintain the ETT in the proper position. Currently, there are no widely utilized tools for real-time monitoring of ETT positions. Aim The goal of this study is to develop a cost-effective and easy-to-use near-infrared (NIR) device, named Opt-ETT, capable of continuously monitoring the ETT position in the trachea of a patient. Approach A side-firing fiber is attached to the side of the ETT to illuminate the trachea tissue with NIR light, and a detector board containing five phototransistors is affixed to the chest skin to measure the intensity of diffusely transmitted light. Displacement of the ETT is estimated using second-order polynomial fitting to the ratios of the phototransistor readings. Monte Carlo simulations, ex vivo experiment on porcine tissue, and in vivo experiments using a swine model have been conducted to assess the feasibility of the device. Results The design of the Opt-ETT device has been verified by the Monte Carlo simulations and ex vivo experiment. The estimation of displacement from in vivo experiments using the Opt-ETT exhibited a high degree of agreement with that measured by a reference sensor, with a discrepancy between - 1.0 to + 1.5 mm within a displacement range from - 15 to + 15 mm . Conclusions The Opt-ETT device provides a potentially cost-effective solution for real-time and continuous monitoring of ETT position in patient during an intubation procedure.
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Affiliation(s)
- Tongtong Lu
- Marquette University, Medical College of Wisconsin, Joint Department of Biomedical Engineering, Milwaukee, Wisconsin, United States
| | - Pawjai Khampang
- Medical College of Wisconsin, Department of Otolaryngology and Communication Sciences, Milwaukee, Wisconsin, United States
| | - Ahmed Beydoun
- Medical College of Wisconsin, Department of Otolaryngology and Communication Sciences, Milwaukee, Wisconsin, United States
| | - Anna Berezovsky
- Medical College of Wisconsin, Department of Otolaryngology and Communication Sciences, Milwaukee, Wisconsin, United States
| | - Rebecca Rohde
- Medical College of Wisconsin, Department of Otolaryngology and Communication Sciences, Milwaukee, Wisconsin, United States
| | - Wenzhou Hong
- Medical College of Wisconsin, Department of Otolaryngology and Communication Sciences, Milwaukee, Wisconsin, United States
| | - Bing Yu
- Marquette University, Medical College of Wisconsin, Joint Department of Biomedical Engineering, Milwaukee, Wisconsin, United States
| | - Joseph E. Kerschner
- Medical College of Wisconsin, Department of Otolaryngology and Communication Sciences, Milwaukee, Wisconsin, United States
- Medical College of Wisconsin, Department of Microbiology and Immunology, Milwaukee, Wisconsin, United States
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233
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Guillamet CV, Kollef MH. Is Zero Ventilator-Associated Pneumonia Achievable? Updated Practical Approaches to Ventilator-Associated Pneumonia Prevention. Infect Dis Clin North Am 2024; 38:65-86. [PMID: 38040518 DOI: 10.1016/j.idc.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
Ventilator-associated pneumonia (VAP) remains a significant clinical entity with reported incidence rates of 7% to 15%. Given the considerable adverse consequences associated with this infection, VAP prevention became a core measure required in most US hospitals. Many institutions took pride in implementing effective VAP prevention bundles that combined at least head of bed elevation, hand hygiene, chlorhexidine oral care, and subglottic drainage. Spontaneous breathing and awakening trials have also consistently been shown to shorten the duration of mechanical ventilation and secondarily reduce the occurrence of VAP.
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Affiliation(s)
| | - Marin H Kollef
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO, USA.
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234
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Haruwaka K, Ying Y, Liang Y, Umpierre AD, Yi MH, Kremen V, Chen T, Xie T, Qi F, Zhao S, Zheng J, Liu YU, Dong H, Worrell GA, Wu LJ. Microglia enhance post-anesthesia neuronal activity by shielding inhibitory synapses. Nat Neurosci 2024; 27:449-461. [PMID: 38177340 PMCID: PMC10960525 DOI: 10.1038/s41593-023-01537-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 11/29/2023] [Indexed: 01/06/2024]
Abstract
Microglia are resident immune cells of the central nervous system and play key roles in brain homeostasis. During anesthesia, microglia increase their dynamic process surveillance and interact more closely with neurons. However, the functional significance of microglial process dynamics and neuronal interaction under anesthesia is largely unknown. Using in vivo two-photon imaging in mice, we show that microglia enhance neuronal activity after the cessation of isoflurane anesthesia. Hyperactive neuron somata are contacted directly by microglial processes, which specifically colocalize with GABAergic boutons. Electron-microscopy-based synaptic reconstruction after two-photon imaging reveals that, during anesthesia, microglial processes enter into the synaptic cleft to shield GABAergic inputs. Microglial ablation or loss of microglial β2-adrenergic receptors prevents post-anesthesia neuronal hyperactivity. Our study demonstrates a previously unappreciated function of microglial process dynamics, which enable microglia to transiently boost post-anesthesia neuronal activity by physically shielding inhibitory inputs.
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Affiliation(s)
| | - Yanlu Ying
- Department of Anesthesiology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China.
| | - Yue Liang
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Min-Hee Yi
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Vaclav Kremen
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Tingjun Chen
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Tao Xie
- Translational Oncology Group, Faculty of Science, School of Life Sciences, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Fangfang Qi
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Shunyi Zhao
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Jiaying Zheng
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Yong U Liu
- Department of Anesthesiology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Hailong Dong
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | | | - Long-Jun Wu
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA.
- Department of Immunology, Mayo Clinic, Rochester, MN, USA.
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235
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Gramish J, Hattan A, Aljuhani O, Parameaswari PJ, Alshehri S, Korayem GB, Alkofide H, Alalawi M, Vishwakarma R, Alsowaida YS, Alqahtani R, Binorayir L, Abutaleb M, Alotaibi A, Aljohani M, Aljohani S, Samreen S, Jawhari S, Alanazi R, Al Sulaiman KA. The Impact of Midodrine Tapering Versus Nontapering Regimens on the Clinical Outcomes of Critically Ill Patients: A Retrospective Cohort Study. Ann Pharmacother 2024; 58:223-233. [PMID: 37248667 DOI: 10.1177/10600280231173290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Midodrine has been used in the intensive care unit (ICU) setting to reduce the time to vasopressor discontinuation. The limited data supporting midodrine use have led to variability in the pattern of initiation and discontinuation of midodrine. OBJECTIVES To compare the effectiveness and safety of 2 midodrine discontinuation regimens during weaning vasopressors in critically ill patients. METHODS A retrospective cohort study was conducted at King Abdulaziz Medical City. Included patients were adults admitted to ICU who received midodrine after being unable to be weaned from intravenous vasopressors for more than 24 hours. Patients were categorized into two subgroups depending on the pattern of midodrine discontinuation (tapered dosing regimen vs. nontapered regimen). The primary endpoint was the incidence of inotropes and vasopressors re-initiation after midodrine discontinuation. RESULTS The incidence of inotropes or vasopressors' re-initiation after discontinuation of midodrine was lower in the tapering group (15.4%) compared with the non-tapering group (40.7%) in the crude analysis as well as regression analysis (odd ratio [OR] = 0.15; 95% CI = 0.03, 0.73, P = 0.02). The time required for the antihypertensive medication(s) initiation after midodrine discontinuation was longer in patients who had dose tapering (beta coefficient (95% CI): 3.11 (0.95, 5.28), P = 0.005). Moreover, inotrope or vasopressor requirement was lower 24 hours post midodrine initiation. In contrast, the two groups had no statistically significant differences in 30-day mortality, in-hospital mortality, or ICU length of stay. CONCLUSION AND RELEVANCE These real-life data showed that tapering midodrine dosage before discontinuation in critically ill patients during weaning from vasopressor aids in reducing the frequency of inotrope or vasopressor re-initiation. Application of such a strategy might be a reasonable approach among ICU patients unless contraindicated.
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Affiliation(s)
- Jawaher Gramish
- Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Ahmed Hattan
- Pharmaceutical Care Services, King Abdullah bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Ohoud Aljuhani
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - P J Parameaswari
- Research Support Department, Research and Innovation Center, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia
| | - Shaden Alshehri
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ghazwa B Korayem
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Hadeel Alkofide
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mai Alalawi
- Department of Pharmaceutical Sciences, Fakeeh College for Medical Sciences, Jeddah, Saudi Arabia
| | | | - Yazed Saleh Alsowaida
- Department of Clinical Pharmacy, College of Pharmacy, Hail University, Hail, Saudi Arabia
| | - Rahaf Alqahtani
- Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Luluh Binorayir
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammed Abutaleb
- Pharmaceutical Care Services, King Fahad Central Hospital, Jazan Health, Jazan, Saudi Arabia
| | - Alanoud Alotaibi
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Majidah Aljohani
- Pharmaceutical Care Division, King Saud Medical City, Riyadh, Saudi Arabia
| | - Sarah Aljohani
- Pharmaceutical Care Services, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Sana Samreen
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Suad Jawhari
- Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Raghad Alanazi
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Khalid A Al Sulaiman
- Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Saudi Critical Care Pharmacy Research Platform, Riyadh, Saudi Arabia
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236
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Saha AK, Segal S. A Quality Improvement Initiative to Reduce Adverse Effects of Transitions of Anesthesia Care on Postoperative Outcomes: A Retrospective Cohort Study. Anesthesiology 2024; 140:387-398. [PMID: 37976442 DOI: 10.1097/aln.0000000000004839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND An intraoperative transfer of care from one anesthesia provider to another, or handover, may result in information loss and contribute to adverse patient outcomes. In 2019 the authors undertook a quality improvement effort to increase the use of a structured intraoperative handover tool incorporated in the electronic medical record. The authors hypothesized that intraoperative handovers of anesthesia care would be associated with adverse patient outcomes, and that increased use of a structured tool would attenuate this effect. METHODS This study included adult patients undergoing noncardiac surgery of at least 1 h duration performed during the period 2016 to 2021. Cases with a handover were identified if either there was a change of attending anesthesiologist or change of nurse anesthetist or resident for more than 35 min. The primary outcome was the occurrence of a composite of postoperative mortality and major postoperative morbidity. The effect of the intervention was analyzed by examining the quarterly change in odds ratio for the primary outcome for cases with and without a handover. RESULTS A total of 121,077 cases, 40.4% of which had a handover, were included. After weighting, the composite outcome was statistically associated with handovers (3,517 of 48,986 [7.2%] in handover cases vs. 4,470 of 72,091 [6.2%] in nonhandover cases; odds ratio, 1.08; 95% CI, 1.04 to 1.12). Time series analysis showed a marked increase in usage of the structured tool after the initial intervention. The odds ratio for the composite outcome showed a significant decrease over time after the initial intervention (t = -3.97; P < 0.001), with the slope of the odds ratio versus time curve decreasing from 0.002 (95% CI, 0.001 to 0.004; P = 0.018) to -0.011 (95% CI, -0.01 to -0.018; P < 0.001). CONCLUSIONS Intraoperative handovers are significantly associated with adverse outcomes even after controlling for multiple confounding variables. Use of a structured handover tool during anesthesia care may attenuate the adverse effect. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Amit K Saha
- Department of Anesthesiology, and Perioperative Outcomes and Informatics Collaborative, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Scott Segal
- Department of Anesthesiology, and Perioperative Outcomes and Informatics Collaborative, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Fagevik Olsén M, Sehlin M, Westerdahl E, Schandl A, Block L, Nygren-Bonnier M, Svensson-Raskh A. First mobilisation after abdominal and cardiothoracic surgery: when is it actually performed? A national, multicentre, cross-sectional study. BMJ Open 2024; 14:e082239. [PMID: 38423778 PMCID: PMC10910679 DOI: 10.1136/bmjopen-2023-082239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/11/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVES Knowledge of clinical practice regarding mobilisation after surgery is lacking. This study therefore aimed to reveal current mobilisation routines after abdominal and cardiothoracic surgery and to identify factors associated with mobilisation within 6 hours postoperatively. DESIGN A prospective observational national multicentre study. SETTING 18 different hospitals in Sweden. PARTICIPANTS 1492 adult patients undergoing abdominal and cardiothoracic surgery with duration of anaesthesia>2 hours. PRIMARY AND SECONDARY OUTCOMES Primary outcome was time to first postoperative mobilisation. Secondary outcomes were the type and duration of the first mobilisation. Data were analysed using multivariate logistic regression and general structural equation modelling, and data are presented as ORs with 95% CIs. RESULTS Among the included patients, 52% were mobilised to at least sitting on the edge of the bed within 6 hours, 70% within 12 hours and 96% within 24 hours. Besides sitting on the edge of the bed, 76% stood up by the bed and 22% were walking away from the bedside the first time they were mobilised. Patients undergoing major upper abdominal surgery required the longest time before mobilisation with an average time of 11 hours post surgery. Factors associated with increased likelihood of mobilisation within 6 hours of surgery were daytime arrival at the postoperative recovery unit (OR: 5.13, 95% CI: 2.16 to 12.18), anaesthesia <4 hours (OR: 1.68, 95% CI: 1.17 to 2.40) and American Society of Anaesthesiologists (ASA) classification 1-2, (OR: 1.63, 95% CI: 1.13 to 2.36). CONCLUSIONS In total, 96% if the patients were mobilised within 24 hours after surgery and 52% within 6 hours. Daytime arrival at the postoperative recovery unit, low ASA classification and shorter duration of anaesthesia were associated with a shorter time to mobilisation. TRIAL REGISTRATION NUMBER FoU, Forskning och Utveckling in VGR, Vastra Gotaland Region (Id:275357) and Clinical Trials (NCT04729634).
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Affiliation(s)
- Monika Fagevik Olsén
- Department of Health and Rehabilitation/Physiotherapy, Institute of Neuroscience and Physiology and Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
| | - Maria Sehlin
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Elisabeth Westerdahl
- University Health Care Research Center and Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Anna Schandl
- Department of Anaesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden/ Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Sweden
| | - Linda Block
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden/ Department of Anaesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Malin Nygren-Bonnier
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden/ Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Svensson-Raskh
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden/ Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
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Yan S, Li Q, He K. The effect of esketamine combined with propofol-induced general anesthesia on cerebral blood flow velocity: a randomized clinical trial. BMC Anesthesiol 2024; 24:66. [PMID: 38378447 PMCID: PMC10877857 DOI: 10.1186/s12871-024-02446-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 02/06/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Esketamine is increasingly used in clinical anesthesia. The effect of esketamine on the blood flow velocity of the middle cerebral artery has a clinical guiding effect. To investigate the effect of esketamine combined with propofol-induced general anesthesia for endotracheal intubation on the blood flow velocity of middle cerebral artery and hemodynamics during the induction period. METHODS The randomized clinical trial included 80 patients aged 20-65 years who would undergo non-intracranial elective surgery under general anesthesia in our hospital from May 2022 to May 2023. The participants were divided into two groups based on anesthesia drugs: sufentanil 0.5μg/kg (group C) or 1.5mg/kg esketamine (group E). The primary outcome was variation value in average cerebral blood velocity. The secondary outcomes included cerebral blood flow velocities (CBFV), blood pressure (BP) and heart rate (HR) at four different time points: before induction of general anesthesia (T0), 1 min after the induction drug injected (T1), before endotracheal intubation (T2), and 1min after endotracheal intubation (T3). The occurrence of hypotension, hypertension, tearing and choking during induction was also documented. RESULTS The variation of average CBFV from time T0 to T2(ΔVm1) and the variation from time T3 to T0 (ΔVm2) were not obviously different. The median consumption of intraoperative sufentanil in group C was obviously lower than that in group E. At T1, the mean HR of group E was significantly higher than that of group C. At T2 and T3, the BP and HR of group E were obviously higher than that of group C. At T2, the CBFV in the group E were obviously higher than those in the group C. The incidence of hypotension was significantly reduced in the group E compared with the group C. There were no differences in the other outcomes. CONCLUSIONS The induction of esketamine combined with propofol does not increase the blood flow velocity of middle cerebral artery. Esketamine is advantageous in maintaining hemodynamic stability during induction. Furthermore, the administration of esketamine did not result in an increased incidence of adverse effects. TRIAL REGISTRATION 15/06/2023 clinicaltrials.gov ChiCTR2300072518 https://www.chictr.org.cn/bin/project/edit?pid=176675 .
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Affiliation(s)
- Shuang Yan
- Department of Anesthesiology, The First Affiliate Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District Chongqing, China
| | - Qiying Li
- Department of Anesthesiology, The First Affiliate Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District Chongqing, China.
| | - Kaihua He
- Department of Anesthesiology, The First Affiliate Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District Chongqing, China
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239
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Psenicka O, Brutvan T, Kratky J, Krizova J. Muscle Dysfunction and Functional Status in COVID-19 Patients during Illness and after Hospital Discharge. Biomedicines 2024; 12:460. [PMID: 38398063 PMCID: PMC10887156 DOI: 10.3390/biomedicines12020460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/09/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND COVID-19 pneumonia is associated with SIRS and hypercatabolism. The aim of this study was to determine muscle loss during the acute phase of COVID-19 pneumonia and evaluate long-term sequelae in discharged patients. METHODS A total of 16 patients with COVID-19 pneumonia and respiratory insufficiency were included in the study. Selected parameters (weight, BMI, LBM = lean body mass, albumin, CRP, NLR = neutrophil-to-lymphocyte ratio, ultrasound measured thickness of rectus femoris muscle = US RF and rectus femoris + vastus intermedius = US RF + VI, handgrip strength, quality of life = EQ-5D questionnaire, and activities of daily living = Barthel's ADLs) were recorded on admission, discharge, and 1, 3, and 6 months after discharge. RESULTS The most significant changes were between hospital admission and discharge: US RF and RF + VI (-1.28 ± 1.97 mm, p = 0.046; -1.76 ± 2.94 mm, p = 0.05), EQ-5D score (14.6 ± 19.2, p = 0.02), and ADLs (17.1 ± 22.6; p = 0.02). There was a significant positive correlation between US RF + VI and handgrip strength (p = 0.014) and a negative correlation between weight and Barthel index (p = 0.012). There was an association between muscle function with an EQ-5D score and ADLs during outpatient check-ups, most noticeably between handgrip strength, US RF+VI, and ADLs (p = 0.08; p = 0.1, respectively). Conclusions: In patients with COVID-19 pneumonia, there is a significant reduction of health-related quality of life, impaired even 6 months after hospital discharge, influenced mainly by muscle loss. During the hospital stay, there was a significant muscle mass reduction. Ultrasound measurement of thigh muscle thickness may be a useful method to monitor muscle loss.
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Affiliation(s)
- Otakar Psenicka
- 3rd Department of Internal Medicine, General University Hospital, 120 00 Prague, Czech Republic; (T.B.); (J.K.); (J.K.)
- 1st Faculty of Medicine, Charles University, 120 00 Prague, Czech Republic
| | - Tomas Brutvan
- 3rd Department of Internal Medicine, General University Hospital, 120 00 Prague, Czech Republic; (T.B.); (J.K.); (J.K.)
- 1st Faculty of Medicine, Charles University, 120 00 Prague, Czech Republic
| | - Jan Kratky
- 3rd Department of Internal Medicine, General University Hospital, 120 00 Prague, Czech Republic; (T.B.); (J.K.); (J.K.)
- 1st Faculty of Medicine, Charles University, 120 00 Prague, Czech Republic
| | - Jarmila Krizova
- 3rd Department of Internal Medicine, General University Hospital, 120 00 Prague, Czech Republic; (T.B.); (J.K.); (J.K.)
- 1st Faculty of Medicine, Charles University, 120 00 Prague, Czech Republic
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Zhang SL, Zhang QF, Li G, Guo M, Qi XX, Xing XH, Wang Z. Case Report: Resuscitation of patient with tumor-induced acute pulmonary embolism by venoarterial extracorporeal membrane oxygenation. Front Cardiovasc Med 2024; 11:1322387. [PMID: 38426120 PMCID: PMC10902156 DOI: 10.3389/fcvm.2024.1322387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/09/2024] [Indexed: 03/02/2024] Open
Abstract
Background Pulmonary embolism is a condition of right cardiac dysfunction due to pulmonary circulation obstruction. Malignant tumor-induced pulmonary embolism, which has a poor therapeutic outcome and a significant impact on hemodynamics, is the cause of sudden death in patients with malignant tumors. Case description A 38-year-old female patient, who had a medical history of right renal hamartoma, and right renal space-occupying lesion, was admitted to the hospital. During the procedure to resect the right renal malignancy, the blood pressure and end-tidal carbon dioxide level dropped, and a potential pulmonary embolism was considered as a possibility. After inferior vena cava embolectomy, the hemodynamics in the patient remained unstable. The successful establishment of venoarterial extracorporeal membrane oxygenation (VA-ECMO) resulted in the stabilization of her hemodynamics and ventilation. On Day 2 of VA-ECMO support, her respiration and hemodynamics were relatively stable, and ECMO assistance was successfully terminated following the "pump-controlled retrograde trial off (PCRTO)" test on Day 6. The patient improved gradually after the procedure and was discharged from the hospital after 22 days. Conclusion VA-ECMO can be used as a transitional resuscitation technique for patients with massive pulmonary embolism. It is critical for the perfusion of vital organs and can assist with surgical or interventional treatment, lower right heart pressure, and hemodynamic stability. VA-ECMO has a significant impact on patient prognosis and can reduce the mortality rate.
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Affiliation(s)
- Shuang-Long Zhang
- Department of Critical Care Medicine, Peking University International Hospital, Beijing, China
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Qi-Feng Zhang
- Department of Critical Care Medicine, Peking University International Hospital, Beijing, China
| | - Gang Li
- Department of Critical Care Medicine, Peking University International Hospital, Beijing, China
| | - Miao Guo
- Department of Critical Care Medicine, Peking University International Hospital, Beijing, China
| | - Xiao-Xia Qi
- Department of Critical Care Medicine, Peking University International Hospital, Beijing, China
| | - Xiao-Hui Xing
- Department of Critical Care Medicine, Peking University International Hospital, Beijing, China
| | - Zheng Wang
- Department of Critical Care Medicine, Peking University International Hospital, Beijing, China
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Asmussen SW, Holme JM, Joensen K, Ibsen S, Bøggild H, Christensen EF, Lindskou TA. Development and inter-rater reliability of a simple prehospital mobility score for use in emergency patients. BMC Emerg Med 2024; 24:27. [PMID: 38360536 PMCID: PMC10868046 DOI: 10.1186/s12873-024-00944-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 02/01/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Mobility assessment enhances the ability of vital sign-based early warning scores to predict risk. Currently mobility is not routinely assessed in a standardized manner in Denmark during the ambulance transfer of unselected emergency patients. The aim of this study was to develop and test the inter-rater reliability of a simple prehospital mobility score for pre-hospital use in ambulances and to test its inter-rater reliability. METHOD Following a pilot study, we developed a 4-level prehospital mobility score based of the question"How much help did the patient need to be mobilized to the ambulance trolley". Possible scores were no-, a little-, moderate-, and a lot of help. A cross-sectional study of inter-rater agreement among ambulance personnel was then carried out. Paramedics on ambulance runs in the North- and Central Denmark Region, as well as The Fareoe Islands, were included as a convenience sample between July 2020-May 2021. The simple prehospital mobility score was tested, both by the paramedics in the ambulance and by an additional observer. The study outcomes were inter-rater agreements by weighted kappa between the paramedics and between observers and paramedics. RESULTS We included 251 mobility assessments where the patient mobility was scored. Paramedics agreed on the mobility score for 202 patients (80,5%). For 47 (18.7%), there was a deviation of one between scores, in two (< 1%) there was a deviation of two and none had a deviation of three (Table 1). Inter-rater agreement between paramedics in all three regions showed a kappa-coefficient of 0.84 (CI 95%: 0.79;0.88). Between observers and paramedics in North Denmark Region and Faroe Islands the kappa-coefficient was 0.82 (CI 95%: 0.77;0.86). CONCLUSION We developed a simple prehospital mobility score, which was feasible in a prehospital setting and with a high inter-rater agreement between paramedics and observers.
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Affiliation(s)
- Søren Westh Asmussen
- Centre for Prehospital and Emergency Research, Aalborg University Hospital, Aalborg University, Selma Lagerløfs Vej 249, Room 11.03.049, Gistrup, 9260, Denmark.
| | - Jacob Metze Holme
- Centre for Prehospital and Emergency Research, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | - Kurt Joensen
- Centre for Prehospital and Emergency Research, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | - Stine Ibsen
- Centre for Prehospital and Emergency Research, Aalborg University Hospital, Aalborg, Denmark
- Department of Physiotherapy, University College of Northern Denmark (UCN), Aalborg, Denmark
| | - Henrik Bøggild
- Department of Health Science and Technology, Public Health and Epidemiology, Faculty of Medicine, Aalborg and Unit of Clinical Biostatistics, Aalborg University, Aalborg University, Aalborg University Hospital, Aalborg, Denmark
| | - Erika Frischknecht Christensen
- Department of Clinical Medicine, Centre for Prehospital and Emergency Research, , Aalborg University Hospital, Aalborg University, Aalborg, Denmark
- Prehospital Emergency Services, North Denmark Region, Aalborg, Denmark
| | - Tim Alex Lindskou
- Centre for Prehospital and Emergency Research, Aalborg University Hospital, Aalborg, Denmark
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Ott S, Müller-Wirtz LM, Sertcakacilar G, Tire Y, Turan A. Non-Neuraxial Chest and Abdominal Wall Regional Anesthesia for Intensive Care Physicians-A Narrative Review. J Clin Med 2024; 13:1104. [PMID: 38398416 PMCID: PMC10889232 DOI: 10.3390/jcm13041104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/29/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024] Open
Abstract
Multi-modal analgesic strategies, including regional anesthesia techniques, have been shown to contribute to a reduction in the use of opioids and associated side effects in the perioperative setting. Consequently, those so-called multi-modal approaches are recommended and have become the state of the art in perioperative medicine. In the majority of intensive care units (ICUs), however, mono-modal opioid-based analgesic strategies are still the standard of care. The evidence guiding the application of regional anesthesia in the ICU is scarce because possible complications, especially associated with neuraxial regional anesthesia techniques, are often feared in critically ill patients. However, chest and abdominal wall analgesia in particular is often insufficiently treated by opioid-based analgesic regimes. This review summarizes the available evidence and gives recommendations for peripheral regional analgesia approaches as valuable complements in the repertoire of intensive care physicians' analgesic portfolios.
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Affiliation(s)
- Sascha Ott
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Deutsches Herzzentrum der Charité-Medical Heart Center of Charité and German Heart Institute Berlin, Department of Cardiac Anesthesiology and Intensive Care Medicine, Augustenburger Platz 1, 13353 Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Lukas M Müller-Wirtz
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center, Saarland University Faculty of Medicine, 66424 Homburg, Germany
| | - Gokhan Sertcakacilar
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Department of Anesthesiology and Reanimation, Bakırköy Dr. Sadi Konuk Training and Research Hospital, 34147 Istanbul, Turkey
| | - Yasin Tire
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Department of Anesthesiology and Reanimation, Konya City Hospital, University of Health Science, 42020 Konya, Turkey
| | - Alparslan Turan
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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Michalak A, Lach T, Szczygieł K, Cichoż-Lach H. COVID-19, Possible Hepatic Pathways and Alcohol Abuse-What Do We Know up to 2023? Int J Mol Sci 2024; 25:2212. [PMID: 38396888 PMCID: PMC10888568 DOI: 10.3390/ijms25042212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 02/25/2024] Open
Abstract
The pandemic period due to coronavirus disease 2019 (COVID-19) revolutionized all possible areas of global health. Significant consequences were also related to diverse extrapulmonary manifestations of this pathology. The liver was found to be a relatively common organ, beyond the respiratory tract, affected by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Multiple studies revealed the essential role of chronic liver disease (CLD) in the general outcome of coronavirus infection. Present concerns in this field are related to the direct hepatic consequences caused by COVID-19 and pre-existing liver disorders as risk factors for the severe course of the infection. Which mechanism has a key role in this phenomenon-previously existing hepatic disorder or acute liver failure due to SARS-CoV-2-is still not fully clarified. Alcoholic liver disease (ALD) constitutes another not fully elucidated context of coronavirus infection. Should the toxic effects of ethanol or already developed liver cirrhosis and its consequences be perceived as a causative or triggering factor of hepatic impairment in COVID-19 patients? In the face of these discrepancies, we decided to summarize the role of the liver in the whole picture of coronavirus infection, paying special attention to ALD and focusing on the pathological pathways related to COVID-19, ethanol toxicity and liver cirrhosis.
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Affiliation(s)
- Agata Michalak
- Department of Gastroenterology with Endoscopy Unit, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland;
| | - Tomasz Lach
- Department of Orthopedics and Traumatology, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland;
| | - Karolina Szczygieł
- Clinical Dietetics Unit, Department of Bioanalytics, Medical University of Lublin, Chodźki 7, 20-093 Lublin, Poland;
| | - Halina Cichoż-Lach
- Department of Gastroenterology with Endoscopy Unit, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland;
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Churchill CC, Peterson CD, Kitto KF, Pflepsen KR, Belur LR, McIvor RS, Vulchanova L, Wilcox GL, Fairbanks CA. Adeno-associated virus-mediated gene transfer of arginine decarboxylase to the central nervous system prevents opioid analgesic tolerance. FRONTIERS IN PAIN RESEARCH 2024; 4:1269017. [PMID: 38405182 PMCID: PMC10884299 DOI: 10.3389/fpain.2023.1269017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/19/2023] [Indexed: 02/27/2024] Open
Abstract
Agmatine, a decarboxylated form of L-arginine, prevents opioid analgesic tolerance, dependence, and self-administration when given by both central and systemic routes of administration. Endogenous agmatine has been previously detected in the central nervous system. The presence of a biochemical pathway for agmatine synthesis offers the opportunity for site-specific overexpression of the presumptive synthetic enzyme for local therapeutic effects. In the present study, we evaluated the development of opioid analgesic tolerance in ICR-CD1 mice pre-treated with either vehicle control or intrathecally delivered adeno-associated viral vectors (AAV) carrying the gene for human arginine decarboxylase (hADC). Vehicle-treated or AAV-hADC-treated mice were each further divided into two groups which received repeated delivery over three days of either saline or systemically-delivered morphine intended to induce opioid analgesic tolerance. Morphine analgesic dose-response curves were constructed in all subjects on day four using the warm water tail flick assay as the dependent measure. We observed that pre-treatment with AAV-hADC prevented the development of analgesic tolerance to morphine. Peripheral and central nervous system tissues were collected and analyzed for presence of hADC mRNA. In a similar experiment, AAV-hADC pre-treatment prevented the development of analgesic tolerance to a high dose of the opioid neuropeptide endomorphin-2. Intrathecal delivery of anti-agmatine IgG (but not normal IgG) reversed the inhibition of endomorphin-2 analgesic tolerance in AAV-hADC-treated mice. To summarize, we report here the effects of AAV-mediated gene transfer of human ADC (hADC) in models of opioid-induced analgesic tolerance. This study suggests that gene therapy may contribute to reducing opioid analgesic tolerance.
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Affiliation(s)
- Caroline C. Churchill
- Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, MN, United States
| | - Cristina D. Peterson
- Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, MN, United States
- Department of Neuroscience, University of Minnesota, Minneapolis, MN, United States
- Department of Pharmaceutics, University of Minnesota, Minneapolis, MN, United States
| | - Kelley F. Kitto
- Department of Neuroscience, University of Minnesota, Minneapolis, MN, United States
| | - Kelsey R. Pflepsen
- Department of Pharmaceutics, University of Minnesota, Minneapolis, MN, United States
| | - Lalitha R. Belur
- Department of Genetics Cell Biology and Development, University of Minnesota, Minneapolis, MN, United States
| | - R. Scott McIvor
- Department of Genetics Cell Biology and Development, University of Minnesota, Minneapolis, MN, United States
| | - Lucy Vulchanova
- Department of Neuroscience, University of Minnesota, Minneapolis, MN, United States
| | - George L. Wilcox
- Department of Neuroscience, University of Minnesota, Minneapolis, MN, United States
- Department of Pharmacology, University of Minnesota, Minneapolis, MN, United States
- Department of Dermatology, University of Minnesota, Minneapolis, MN, United States
| | - Carolyn A. Fairbanks
- Department of Neuroscience, University of Minnesota, Minneapolis, MN, United States
- Department of Pharmaceutics, University of Minnesota, Minneapolis, MN, United States
- Department of Pharmacology, University of Minnesota, Minneapolis, MN, United States
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Scholte JBJ, Strehler JC, Dill T, van Mook WNKA. Trainee-supervisor collaboration, progress-visualisation, and coaching: a survey on challenges in assessment of ICU trainees. BMC MEDICAL EDUCATION 2024; 24:120. [PMID: 38321516 PMCID: PMC10848472 DOI: 10.1186/s12909-023-04980-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/14/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND Assessing trainees is crucial for development of their competence, yet it remains a challenging endeavour. Identifying contributing and influencing factors affecting this process is imperative for improvement. METHODS We surveyed residents, fellows, and intensivists working in an intensive care unit (ICU) at a large non-university hospital in Switzerland to investigate the challenges in assessing ICU trainees. Thematic analysis revealed three major themes. RESULTS Among 45 physicians, 37(82%) responded. The first theme identified is trainee-intensivist collaboration discontinuity. The limited duration of trainees' ICU rotations, large team size operating in a discordant three-shift system, and busy and unpredictable day-planning hinder sustained collaboration. Potential solutions include a concise pre-collaboration briefing, shared bedside care, and post-collaboration debriefing involving formative assessment and reflection on collaboration. The second theme is the lack of trainees' progress visualisation, which is caused by unsatisfactory familiarisation with the trainees' development. The lack of an overview of a trainee's previous achievements, activities, strengths, weaknesses, and goals may result in inappropriate assessments. Participants suggested implementing digital assessment tools, a competence committee, and dashboards to facilitate progress visualisation. The third theme we identified is insufficient coaching and feedback. Factors like personality traits, hierarchy, and competing interests can impede coaching, while high-quality feedback is essential for correct assessment. Skilled coaches can define short-term goals and may optimise trainee assessment by seeking feedback from multiple supervisors and assisting in both formative and summative assessment. Based on these three themes and the suggested solutions, we developed the acronym "ICU-STAR" representing a potentially powerful framework to enhance short-term trainee-supervisor collaboration in the workplace and to co-scaffold the principles of adequate assessment. CONCLUSIONS According to ICU physicians, trainee-supervisor collaboration discontinuity, the lack of visualisation of trainee's development, and insufficient coaching and feedback skills of supervisors are the major factors hampering trainees' assessment in the workplace. Based on suggestions by the survey participants, we propose the acronym "ICU-STAR" as a framework including briefing, shared bedside care, and debriefing of the trainee-supervisor collaboration at the workplace as its core components. With the attending intensivists acting as coaches, progress visualisation can be enhanced by actively collecting more data points. TRIAL REGISTRATION N/A.
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Affiliation(s)
- Johannes B J Scholte
- Department of Intensive Care Medicine, Cantonal Hospital Lucerne, Lucerne, Switzerland.
- Master of Medical Education Student, University of Bern, Bern, Switzerland.
| | - Johannes C Strehler
- Department of Intensive Care Medicine, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Tatjana Dill
- Master of Medical Education Student, University of Bern, Bern, Switzerland
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
- Swiss Air-Ambulance Ltd, Rega, Zurich, Switzerland
| | - Walther N K A van Mook
- Department of Intensive Care Medicine and Academy for Postgraduate Medical Training, Maastricht University Medical Centre, Maastricht, The Netherlands
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
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Likar R, Aroyo I, Bangert K, Degen B, Dziewas R, Galvan O, Grundschober MT, Köstenberger M, Muhle P, Schefold JC, Zuercher P. Management of swallowing disorders in ICU patients - A multinational expert opinion. J Crit Care 2024; 79:154447. [PMID: 37924574 DOI: 10.1016/j.jcrc.2023.154447] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/19/2023] [Accepted: 10/10/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Dysphagia is common in intensive care unit (ICU) patients, yet it remains underrecognized and often unmanaged despite being associated with life-threatening complications, prolonged ICU stays and hospitalization. PURPOSE To propose an expert opinion for the diagnosis and management of dysphagia developed from evidence-based clinical recommendations and practitioner insights. METHODS A multinational group of dysphagia and critical care experts conducted a literature review using a modified ACCORD methodology. Based on a fusion of the available evidence and the panel's clinical experience, an expert opinion on best practice management was developed. RESULTS The panel recommends adopting clinical algorithms intended to promote standardized, high-quality care that triggers timely systematic dysphagia screening, assessment, and treatment of extubated and tracheostomized patients in the ICU. CONCLUSIONS Given the lack of robust scientific evidence, two clinical management algorithms are proposed for use by multidisciplinary teams to improve early systematic detection and effective management of dysphagia in ICU patients. Additionally, emerging therapeutic options such as neurostimulation have the potential to improve the quality of ICU dysphagia care.
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Affiliation(s)
- Rudolf Likar
- Department for Anaesthesiology and Intensive Medicine, Klinikum Klagenfurt am Wörthersee, Austria
| | - Ilia Aroyo
- Department of Neurology and Neurointensive Care Medicine, Klinikum Darmstadt, Germany
| | - Katrin Bangert
- Clinic for Intensive Care Medicine, University Hospital Hamburg, Germany
| | - Björn Degen
- Clinic for Intensive Medicine, Dysphagia Centre, Vienna, Austria
| | - Rainer Dziewas
- Department of Neurology and Neurological Rehabilitation, Klinikum Osnabrück, Osnabrück, Germany
| | - Oliver Galvan
- Department for Hearing, Speech and Voice Disorders, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Markus Köstenberger
- Department for Anaesthesiology and Intensive Medicine, Klinikum Klagenfurt am Wörthersee, Austria; Department for Anaesthesiology and Intensive Care Medicine, Medical University Graz, Graz, Austria.
| | - Paul Muhle
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Germany
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Patrick Zuercher
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
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Molina EA, Travis TE, Hussein L, Oliver MA, Keyloun JW, Moffatt LT, Shupp JW, Carney BC. Treatment of hypopigmented burn hypertrophic scars with short-term topical tacrolimus does not lead to repigmentation. Lasers Surg Med 2024; 56:175-185. [PMID: 38225772 DOI: 10.1002/lsm.23754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/18/2023] [Accepted: 12/28/2023] [Indexed: 01/17/2024]
Abstract
OBJECTIVES Dyschromia is an understudied aspect of hypertrophic scar (HTS). The use of topical tacrolimus has successfully shown repigmentation in vitiligo patients through promotion of melanogenesis and melanocyte proliferation. It was hypothesized that HTSs treated with topical tacrolimus would have increased repigmentation compared to controls. METHODOLOGY Full-thickness burns in red Duroc pigs were either treated with excision and meshed split-thickness skin grafting or excision and no grafting, and these wounds formed hypopigmented HTSs (n = 8). Half of the scars had 0.1% tacrolimus ointment applied to the scar twice a day for 21 days, while controls had no treatment. Further, each scar was bisected with half incurring fractional ablative CO2 laser treatment before topical tacrolimus application to induce laser-assisted drug delivery (LADD). Pigmentation was evaluated using a noninvasive probe to measure melanin index (MI) at Days 0 (pretreatment), 7, 14, and 21. At each timepoint, punch biopsies were obtained and fixed in formalin or were incubated in dispase. The formalin-fixed biopsies were used to evaluate melanin levels by H&E staining. The biopsies incubated in dispase were used to obtain epidermal sheets. The ESs were then flash frozen and RNA was isolated from them and used in quantitative reverse transcription polymerase chain reaction for melanogenesis-related genes: Tyrosinase (TYR), TYR-related protein-1 (TYRP1), and dopachrome tautomerase (DCT). Analysis of variance test with Šídák's multiple comparisons test was used to compare groups. RESULTS Over time, within the grafted HTS and the NS group, there were no significant changes in MI, except for Week 3 in the -Tacro group. (+Tacro HTS= pre = 685.1 ± 42.0, w1 = 741.0 ± 54.16, w2 = 750.8 ± 59.0, w3 = 760.9 ± 49.8) (-Tacro HTS= pre = 700.4 ± 54.3, w1 = 722.3 ± 50.7, w2 = 739.6 ± 53.2, w3 = 722.7 ± 50.5). Over time, within the ungrafted HTS and the NS group, there were no significant changes in MI. (+Tacro HTS= pre = 644.9 ± 6.9, w1 = 661.6 ± 3.3, w2 = 650.3 ± 6.2, w3 = 636.3 ± 7.4) (-Tacro HTS= pre = 696.8 ± 8.0, w1 = 695.8 ± 12.3, w2 = 678.9 ± 14.0, w3 = 731.2 ± 50.3). LADD did not lead to any differential change in pigmentation compared to the non-LADD group. There was no evidence of increased melanogenesis within the tissue punch biopsies at any timepoint. There were no changes in TYR, TYRP1, or DCT gene expression after treatment. CONCLUSION Hypopigmented HTSs treated with 0.1% tacrolimus ointment with or without LADD did not show significantly increased repigmentation. This study was limited by a shorter treatment interval than what is known to be required in vitiligo patients for repigmentation. The use of noninvasive, topical treatments to promote repigmentation are an appealing strategy to relieve morbidity associated with dyschromic burn scars and requires further investigation.
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Affiliation(s)
- Esteban A Molina
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia, USA
| | - Taryn E Travis
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia, USA
- The Burn Center, MedStar Washington Hospital Center, Washington, District of Columbia, USA
- Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia, USA
- Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Lou'ay Hussein
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia, USA
| | - Mary A Oliver
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia, USA
| | - John W Keyloun
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia, USA
- The Burn Center, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Lauren T Moffatt
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia, USA
- The Burn Center, MedStar Washington Hospital Center, Washington, District of Columbia, USA
- Department of Biochemistry and Molecular Biology, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Jeffrey W Shupp
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia, USA
- The Burn Center, MedStar Washington Hospital Center, Washington, District of Columbia, USA
- Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia, USA
- Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, District of Columbia, USA
- Department of Biochemistry and Molecular Biology, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Bonnie C Carney
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia, USA
- The Burn Center, MedStar Washington Hospital Center, Washington, District of Columbia, USA
- Department of Biochemistry and Molecular Biology, Georgetown University School of Medicine, Washington, District of Columbia, USA
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248
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Shipchandler FT, Huntley ES, Holder TF, Ali T, Behnia F, Chauhan SP, Huntley BJF. Maternal and Neonatal Outcomes of Gunshot Wounds in Pregnancy: A Systematic Review of Case Reports. Am Surg 2024; 90:279-291. [PMID: 37864523 DOI: 10.1177/00031348231207298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
A systematic review was performed to compare adverse maternal and neonatal outcomes among pregnant patients with gunshot wounds (GSW) to the abdominopelvic vs other region(s) at > 20 weeks gestation. A search of Medline Ovid, Elsevier Embase, EBSCO CINAHL, and Cochrane Library in July 2022 and reference searches resulted in 1742 studies, which were screened. The 41 included studies reported outcomes for 59 pregnant patients with GSW, of which 31 (52.5%) had an isolated abdominopelvic GSW and 28 (47.5%) had an extremity, thorax, head/neck, back/spine, poly-site, or other/unknown GSW. Stillbirth occurred in 26.7% of abdominopelvic GSW and 26% of non-abdominopelvic GSW. Maternal death occurred in 3.7% of abdominopelvic GSW and 10.7% of non-abdominopelvic GSW. Neonatal death occurred in 9.1% of abdominopelvic GSW and 5.3% of non-abdominopelvic GSW. Further research is needed to standardize the approach for the evaluation and management of patients with GSW in pregnancy.
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Affiliation(s)
| | - Erin S Huntley
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Travis F Holder
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Talha Ali
- Department of Community Health, Tufts University, Medford, MA, USA
| | - Faranak Behnia
- Obstetrix Maternal-Fetal Medicine Specialists of Houston, Katy, TX, USA
| | - Suneet P Chauhan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Benjamin J F Huntley
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
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Athar ZM, Arshad M, Shrivastava S. Exploring the Efficacy of Midodrine for Tapering Off Vasopressors. Cureus 2024; 16:e55192. [PMID: 38558716 PMCID: PMC10981505 DOI: 10.7759/cureus.55192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
Sepsis and septic shock represent critical conditions, often necessitating vasopressor support in the intensive care unit (ICU). Midodrine, an oral vasopressor, has gathered attention as a potential adjunct to vasopressor therapy, aiming to facilitate weaning and improve clinical outcomes. However, the efficacy of midodrine remains questionable, with conflicting evidence from clinical trials and meta-analyses. This article provides a comprehensive review of the literature on midodrine's role in ICU settings by gathering evidence from multicenter trials, retrospective studies, and meta-analyses. While some studies suggest a limited benefit of midodrine in expediting vasopressor weaning and reducing ICU/hospital stays, others report potential advantages, particularly in reducing mortality rates among septic shock patients. Ongoing efforts aim to address knowledge gaps surrounding midodrine's efficacy and safety.
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Affiliation(s)
| | - Mahnoor Arshad
- Internal Medicine, BronxCare Health System, New York, USA
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250
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Zhang T, Wang S, Hua D, Shi X, Deng H, Jin S, Lv X. Identification of ZIP8-induced ferroptosis as a major type of cell death in monocytes under sepsis conditions. Redox Biol 2024; 69:102985. [PMID: 38103342 PMCID: PMC10764267 DOI: 10.1016/j.redox.2023.102985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 11/30/2023] [Accepted: 12/02/2023] [Indexed: 12/19/2023] Open
Abstract
Sepsis is a heterogenous syndrome with concurrent hyperinflammation and immune suppression. A prominent feature of immunosuppression during sepsis is the dysfunction and loss of monocytes; however, the major type of cell death contributing to this depletion, as well as its underlying molecular mechanisms, are yet to be identified. In this study, we confirmed the monocyte loss in septic patients based on a pooled gene expression data of periphery leukocytes. Using the collected reference gene sets from databases and published studies, we identified ferroptosis with a greater capacity to distinguish between sepsis and control samples than other cell death types. Further investigation on the molecular drivers, by a genetic algorithm-based feature selection and a weighted gene co-expression network analysis, revealed that zrt-/irt-like protein 8 (ZIP8), encoded by SLC39A8, was closely associated with ferroptosis of monocytes during sepsis. We validated the increase of ZIP8 of monocytes with in vivo and in vitro experiments. The in vitro studies also showed that downregulation of ZIP8 alleviated the lipopolysaccharide-induced lipid peroxidation, as well as restoring the reduction of GPX4, FTH1 and xCT. These findings suggest that ferroptosis might be a key factor in the loss of monocytes during sepsis, and that the heightened expression of ZIP8 may facilitate this progression.
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Affiliation(s)
- Tong Zhang
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Sheng Wang
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Dongsheng Hua
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Xuan Shi
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Huimin Deng
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Shuqing Jin
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200092, China.
| | - Xin Lv
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200092, China.
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