Anestezjologia Intensywna Terapia

Patients with major burn injury are prone to hypothermia, potentially resulting in an increase in mortality and length of hospital stay. Our study comprehensively evaluates the practicalities of physiological thermoregulation and temperature control in the largest cohort of critically ill adult burn patients to date.This retrospective study of routinely collected patient data from the Intensive Care Unit (ICU) of the West Midlands Burn Centre was conducted over a three-year period (2016-2019). Data were analysed to assess temperature control against local and International Society for Burn Injury (ISBI) standards.Thirty-one patients with significant burn injuries, requiring active critical care treatment for more than 48 hours were included (total body surface area [TBSA] mean = 42.7%, SD = 18.1%; revised Baux score [rBaux] = 99, SD = 25). The majority were male (77.29%) with an average age of 44 years (17-77 years). The patients were cared for in the ICU for a total of 15 119 hours. Hypothermia, defined as core temperature below 36.0°C, was recorded for 251 hours (2% of total stay). Only 27 patients (87%) had their temperature ≥ 36°C for more than 95% of their admission. Non-survivors were more prone to hypothermia during their stay in ICU. There was an association between rBaux score and post-opera-tive temperature, with a 0.12°C decrease per 10 points increase in rBaux score (P = 0.04).We have observed a high variability of temperature control between individual patients, especially in non-survivors, and have demonstrated an association between high rBaux score and poor temperature control, specifically during the postoperative period.

Jennifer Driver

Alexandra Fielding

Randeep Mullhi

Elizabeth Chipp

Tomasz Torlinski

Anaesthesiology Intensive Therapy

Temperature management of adult burn patients in intensive care: findings from a retrospective cohort study in a tertiary centre in the United Kingdom

成人烧伤患者重症监护中的体温管理：英国一家三级医疗中心的回顾性队列研究结果

Sepsis is associated with generalised endothelial injury and capillary leak and has traditionally been treated with large volume fluid resuscitation. Some patients with sepsis will accumulate bodily fluids. The aim of this study was to systematically review the association between a positive fluid balance/fluid overload and outcomes in critically ill adults, and to determine whether interventions aimed at reducing fluid balance may be linked with improved outcomes.We searched MEDLINE, PubMed, EMBASE, Web of Science, The Cochrane Database, clinical trials registries, and bibliographies of included articles. Two authors independently reviewed citations and selected studies examining the association between fluid balance and outcomes or where the intervention was any strategy or protocol that attempted to obtain a negative or neutral cumulative fluid balance after the third day of intensive care compared to usual care. The primary outcomes of interest were the incidence of IAH and mortality.Among all identified citations, one individual patient meta-analysis, 11 randomised controlled clinical trials, seven interventional studies, 24 observational studies, and four case series met the inclusion criteria. Altogether, 19,902 critically ill patients were studied. The cumulative fluid balance after one week of ICU stay was 4.4 L more positive in non-survivors compared to survivors. A restrictive fluid management strategy resulted in a less positive cumulative fluid balance of 5.6 L compared to controls after one week of ICU stay. A restrictive fluid management was associated with a lower mortality compared to patients treated with a more liberal fluid management strategy (24.7% vs 33.2%; OR, 0.42; 95% CI 0.32-0.55; P < 0.0001). Patients with intra-abdominal hypertension (IAH) had a more positive cumulative fluid balance of 3.4 L after one week of ICU stay. Interventions to decrease fluid balance resulted in a decrease in intra-abdominal pressure (IAP): an average total body fluid removal of 4.9 L resulted in a drop in IAP from 19.3 ± 9.1 mm Hg to 11.5 ± 3.9 mm Hg.A positive cumulative fluid balance is associated with IAH and worse outcomes. Interventions to limit the development of a positive cumulative fluid balance are associated with improved outcomes. In patients not transgressing spontaneously from the Ebb to Flow phases of shock, late conservative fluid management and late goal directed fluid removal (de-resuscitation) should be considered.

Manu L.N.G. Malbrain

Paul E. Marik

Ine Witters

Colin Cordemans

Andrew W. Kirkpatrick

Derek J. Roberts

Niels Van Regenmortel

Anestezjologia, Intensywna Terapia

Anaesthesiol Intensive Ther

Fluid overload, de-resuscitation, and outcomes in critically ill or injured patients: a systematic review with suggestions for clinical practice

流体超负荷、减复苏与危重或受伤患者预后：系统综述及临床实践建议

Costoclavicular brachial plexus block has become a procedure of choice for surgical anaesthesia or analgesia in upper limb surgery. The technique is not standardised yet, and two approaches are currently employed: the medial and lateral approach. Our study aims to compare the two approaches in terms of performance time and patient-specific clinical outcomes.

Saranlal Am

Nishant Patel

Rakesh Kumar

Kanil R Ranjith

Thilaka Muthiah

Arshad Ayub

Akhil Kant Singh

Puneet Khanna

Bikash Ranjan Ray

Medial versus lateral approach in ultrasound-guided costoclavicular brachial plexus block for upper limb surgery: a randomized control trial

超声引导下肋锁间隙臂丛神经阻滞在上肢手术中的内侧入路与外侧入路比较：一项随机对照试验

Piotr F. Czempik

Cezary Kapłan

Monika Krok

Nadia Woźniak

Skutki wprowadzenia zespołu wczesnego reagowania w uniwersyteckim szpitalu klinicznym – analiza wstępna

大学临床医院引入应急小组的初步分析

Bartosz Horosz

Małgorzata Malec-Milewska

Inadvertent perioperative hypothermia

术中意外低体温

Background Femoral neck fractures are common orthopaedic fractures, especially in old age, and they represent a life-threatening condition requiring surgical intervention. In this study, we aimed to compare 2 regional techniques used to decrease perioperative pain. Methods In this parallel group randomized controlled clinical trial we enrolled 68 patients from both sexes scheduled for hip surgery after femoral neck fractures. The patients were randomly allocated to 2 equal groups with one receiving ultrasound- guided supra-inguinal fascia iliaca block (FIB) and the other receiving ultrasound- guided anterior quadratus lumborum block (QLB). Our primary outcome was the duration of postoperative analgesia. The secondary outcome was measuring the Visual Analog Scale (VAS) during patient positioning while applying the neuraxial block, the total analgesic requirement in the postoperative period, patient satisfaction in the postoperative period, and the frequency of adverse effects. Results The group receiving supra-inguinal FIB had a significantly longer time of postoperative analgesia 18 (4–24), compared to the group receiving anterior QLB 2 (1–24), P = 0.005. They consumed less morphine throughout 24 hours postoperatively, 5.3 ± 0.9 mg compared to 6.9 ± 1.87 mg (95% CI: 6.45–3.92, P = 0.008), and they showed less pain during positioning for spinal anaesthesia. Conclusions Supra-inguinal FIB provides prolonged postoperative analgesia compared to anterior QLB in patients undergoing hip surgery. It was associated with less pain during positioning in spinal anaesthesia and decreased total morphine consumption.

Sameh Refaat

Mohamed M. Ali

Ibrahim M.E. Elsherief

Marwa M. Mohamed

Ultrasound-guided fascia iliaca block versus quadratus lumborum block for perioperative analgesia in patients undergoing hip surgery. A randomised controlled trial

超声引导下髂筋膜阻滞与腰方肌阻滞在髋关节手术患者围手术期镇痛中的比较：一项随机对照试验

Background Induction of general anaesthesia is commonly associated with hypotension. This exposes patients to perioperative organ hypoperfusion and eventually damage. This study was designed to assess the ability of preoperative perfusion index (PI), plethysmographic variability index (PVI), and dicrotic plethysmography (Dicpleth) to predict hypotension after induction of general anaesthesia. Methods In this cohort study, 95 ASA I and II adult patients who were scheduled for elective surgery under general anaesthesia were enrolled. The correlation between preoperative PI, PVI, Dicpleth and percentage decrease in mean arterial blood pressure after anaesthesia induction was investigated. Ability of PI, PVI, Dicpleth to detect post-induction hypotension was also analysed. Results The percent decrease in MAP after anaesthesia correlated with baseline PI (r = –0.45, P < 0.001), PVI (r = 0.45, P = 0.001) and Dicpleth (r = 0.16, P = 0.12). The PI cut-off value was ≤ 3.03 for a patient at risk for post-induction hypotension with 77.8% sensitivity, 75% specificity, positive and negative predictive values of 74.5% and 78.3%, respectively. Similarly, the ROC analysis revealed that baseline PVI (AUC = 0.73, 95% CI = 0.622–0.812) was suitable for detecting post-induction hypotension. Moreover, baseline Dicpleth (AUC = 0.63) showed significant predictive ability. Conclusions The pre-anaesthetic PI and PVI < 3.03 and > 17, respectively, have a good ability to predict those at risk of developing post-induction hypotension in adult patients undergoing elective surgery under general anaesthesia. Future studies are needed in order to investigate the usefulness of Dicpleth in different circumstances during anaesthesia. Clinical trial registration ID The study was registered at clinicaltrials.gov (NCT04217226).

Bassant Abdelhamid

Akram Yassin

Abeer Ahmed

Shereen Amin

Ayman Abougabal

Perfusion index-derived parameters as predictors  of hypotension after induction of general anaesthesia: a prospective cohort study

灌注指数衍生参数作为全身麻醉诱导后低血压预测因子的前瞻性队列研究

Enhanced Recovery After Surgery (ERAS) is a multidisciplinary approach that uses a combination of evidence-based methods to improve patient care. Different ERAS protocols are used in various surgical fields but for spine surgery there is no widely used standard ERAS protocol. We compiled and examined the multiple available publications on ERAS protocols for spine surgery. Some general commonalities exist between ERAS protocols; however, a great deal of variety is observed in the granularity of important details such as differing drug choices or specific dosing. To assess and relate the different available ERAS protocols, we conducted a comprehensive narrative literature review focused on comparing commonalities and differences among the following aspects of ERAS protocols: mechanisms of action, post-surgery pain levels, opioid consumption, utilization of muscle relaxants, use of anti-inflammation drugs, and ambulation after surgery. Our goal in this project was to simplify the search process for institutions who review the literature. In this review, certain ERAS elements such as early ambulation, blood loss, pain management, and patient positioning are further explored in more depth.

Rotem Naftalovich

Amit Singal

Andrew J. Iskander

Enhanced Recovery After Surgery (ERAS) protocols for spine surgery – review of literature

脊柱手术后加速康复(ERAS)方案的文献综述

Abbreviation	Anaesthesiol Intensive Ther
Journal Impact	1.47
Quartiles(Global)	ANESTHESIOLOGY(Q2)

Publication Information	Publisher: Polish Society of Anaesthesiology and Intensive Therapy，Publishing cycle: ，Journal Type: journal，Open Access Journals: No
Basic data	Year of publication: 2003，Proportion of original research papers: ，Self Citation Rate:， Gold OA Rate:

Anestezjologia Intensywna Terapia

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Temperature management of adult burn patients in intensive care: findings from a retrospective cohort study in a tertiary centre in the United Kingdom

Fluid overload, de-resuscitation, and outcomes in critically ill or injured patients: a systematic review with suggestions for clinical practice

Medial versus lateral approach in ultrasound-guided costoclavicular brachial plexus block for upper limb surgery: a randomized control trial

Skutki wprowadzenia zespołu wczesnego reagowania w uniwersyteckim szpitalu klinicznym – analiza wstępna

Inadvertent perioperative hypothermia

Medial versus lateral approach in ultrasound-guided costoclavicular brachial plexus block for upper limb surgery: a randomized control trial

Ultrasound-guided fascia iliaca block versus quadratus lumborum block for perioperative analgesia in patients undergoing hip surgery. A randomised controlled trial

Temperature management of adult burn patients in intensive care: findings from a retrospective cohort study in a tertiary centre in the United Kingdom

Perfusion index-derived parameters as predictors of hypotension after induction of general anaesthesia: a prospective cohort study

Enhanced Recovery After Surgery (ERAS) protocols for spine surgery – review of literature