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Publisher: Elsevier   (Total: 3181 journals)

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Showing 1 - 200 of 3181 Journals sorted alphabetically
Academic Pediatrics     Hybrid Journal   (Followers: 39, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 26, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 105, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 28, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 42, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 7)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 6)
Acta Astronautica     Hybrid Journal   (Followers: 443, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 30, SJR: 1.967, CiteScore: 7)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 3)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Ecologica Sinica     Open Access   (Followers: 11, SJR: 0.18, CiteScore: 1)
Acta Histochemica     Hybrid Journal   (Followers: 5, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 319, SJR: 3.263, CiteScore: 6)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.504, CiteScore: 1)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.542, CiteScore: 1)
Acta Oecologica     Hybrid Journal   (Followers: 12, SJR: 0.834, CiteScore: 2)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 2, SJR: 0.307, CiteScore: 0)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2, SJR: 1.793, CiteScore: 6)
Acta Poética     Open Access   (Followers: 4, SJR: 0.101, CiteScore: 0)
Acta Psychologica     Hybrid Journal   (Followers: 26, SJR: 1.331, CiteScore: 2)
Acta Sociológica     Open Access   (Followers: 1)
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.052, CiteScore: 2)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3, SJR: 0.374, CiteScore: 1)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.344, CiteScore: 1)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 7, SJR: 0.19, CiteScore: 0)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 8)
Acute Pain     Full-text available via subscription   (Followers: 15, SJR: 2.671, CiteScore: 5)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.53, CiteScore: 4)
Addictive Behaviors     Hybrid Journal   (Followers: 18, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 9, SJR: 0.755, CiteScore: 2)
Additive Manufacturing     Hybrid Journal   (Followers: 11, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 23)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 187, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 12, SJR: 1.167, CiteScore: 4)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.694, CiteScore: 3)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.277, CiteScore: 1)
Advances in Agronomy     Full-text available via subscription   (Followers: 17, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 30, SJR: 0.126, CiteScore: 0)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 12, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 12, SJR: 1.551, CiteScore: 4)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 24, SJR: 2.089, CiteScore: 5)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 15, SJR: 0.572, CiteScore: 2)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.61, CiteScore: 7)
Advances in Botanical Research     Full-text available via subscription   (Followers: 2, SJR: 0.686, CiteScore: 2)
Advances in Cancer Research     Full-text available via subscription   (Followers: 34, SJR: 3.043, CiteScore: 6)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 1.453, CiteScore: 2)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 1.992, CiteScore: 5)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 5)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 14)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 29, SJR: 0.156, CiteScore: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 11, SJR: 0.713, CiteScore: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.316, CiteScore: 2)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 26, SJR: 1.562, CiteScore: 3)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 20, SJR: 1.977, CiteScore: 8)
Advances in Computers     Full-text available via subscription   (Followers: 14, SJR: 0.205, CiteScore: 1)
Advances in Dermatology     Full-text available via subscription   (Followers: 15)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 13)
Advances in Digestive Medicine     Open Access   (Followers: 12)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 7)
Advances in Drug Research     Full-text available via subscription   (Followers: 26)
Advances in Ecological Research     Full-text available via subscription   (Followers: 44, SJR: 2.524, CiteScore: 4)
Advances in Engineering Software     Hybrid Journal   (Followers: 29, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 8)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 52, SJR: 5.39, CiteScore: 8)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 1)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 9)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 67, SJR: 0.591, CiteScore: 2)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 17)
Advances in Genetics     Full-text available via subscription   (Followers: 21, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 7, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 26, SJR: 0.368, CiteScore: 1)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 11, SJR: 0.749, CiteScore: 3)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 26)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 3, SJR: 0.193, CiteScore: 0)
Advances in Immunology     Full-text available via subscription   (Followers: 37, SJR: 4.433, CiteScore: 6)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 10, SJR: 1.163, CiteScore: 2)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.938, CiteScore: 3)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6, SJR: 0.176, CiteScore: 0)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 9, SJR: 0.682, CiteScore: 2)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 8)
Advances in Marine Biology     Full-text available via subscription   (Followers: 21, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 15, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 8, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 6)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 5, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 25)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 8)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.182, CiteScore: 0)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 5)
Advances in Oncobiology     Full-text available via subscription   (Followers: 2)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 18, SJR: 1.875, CiteScore: 4)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.174, CiteScore: 0)
Advances in Parasitology     Full-text available via subscription   (Followers: 5, SJR: 1.579, CiteScore: 4)
Advances in Pediatrics     Full-text available via subscription   (Followers: 27, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 19)
Advances in Pharmacology     Full-text available via subscription   (Followers: 17, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 0.574, CiteScore: 1)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.109, CiteScore: 1)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 10)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 6)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 19)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 0.791, CiteScore: 2)
Advances in Psychology     Full-text available via subscription   (Followers: 68)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (Followers: 2, SJR: 0.263, CiteScore: 1)
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.101, CiteScore: 0)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 6)
Advances in Space Research     Full-text available via subscription   (Followers: 423, SJR: 0.569, CiteScore: 2)
Advances in Structural Biology     Full-text available via subscription   (Followers: 5)
Advances in Surgery     Full-text available via subscription   (Followers: 13, SJR: 0.555, CiteScore: 2)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 38, SJR: 2.208, CiteScore: 4)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 20)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 15)
Advances in Virus Research     Full-text available via subscription   (Followers: 6, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 54, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 384, SJR: 0.796, CiteScore: 3)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.42, CiteScore: 2)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.296, CiteScore: 0)
Ageing Research Reviews     Hybrid Journal   (Followers: 12, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 482, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (Followers: 1, SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 18, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 32, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 45, SJR: 1.272, CiteScore: 3)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 4)
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 58, SJR: 1.747, CiteScore: 4)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.589, CiteScore: 3)
Air Medical J.     Hybrid Journal   (Followers: 8, SJR: 0.26, CiteScore: 0)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.19, CiteScore: 0)
Alcohol     Hybrid Journal   (Followers: 12, SJR: 1.153, CiteScore: 3)
Alcoholism and Drug Addiction     Open Access   (Followers: 12)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 2, SJR: 0.604, CiteScore: 3)
Alexandria J. of Medicine     Open Access   (Followers: 1, SJR: 0.191, CiteScore: 1)
Algal Research     Partially Free   (Followers: 11, SJR: 1.142, CiteScore: 4)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.504, CiteScore: 1)
Allergology Intl.     Open Access   (Followers: 5, SJR: 1.148, CiteScore: 2)
Alpha Omegan     Full-text available via subscription   (SJR: 3.521, CiteScore: 6)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 11, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 54, SJR: 4.66, CiteScore: 10)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 6, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 6, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 58, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 66, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 47, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 13)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 37, SJR: 7.45, CiteScore: 8)
American J. of Infection Control     Hybrid Journal   (Followers: 29, SJR: 1.062, CiteScore: 2)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 36, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 50)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3, SJR: 1.967, CiteScore: 2)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 265, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 66, SJR: 3.184, CiteScore: 4)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 5, SJR: 0.265, CiteScore: 0)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.289, CiteScore: 1)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, CiteScore: 1)
American J. of Pathology     Hybrid Journal   (Followers: 32, SJR: 2.139, CiteScore: 4)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 28, SJR: 2.164, CiteScore: 4)
American J. of Surgery     Hybrid Journal   (Followers: 39, SJR: 1.141, CiteScore: 2)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.767, CiteScore: 1)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 7)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.144, CiteScore: 3)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 67, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 25, SJR: 0.411, CiteScore: 1)
Anales de Cirugia Vascular     Full-text available via subscription   (Followers: 1)
Anales de Pediatría     Full-text available via subscription   (Followers: 3, SJR: 0.277, CiteScore: 0)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription  
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 5, SJR: 4.849, CiteScore: 10)
Analytica Chimica Acta     Hybrid Journal   (Followers: 44, SJR: 1.512, CiteScore: 5)
Analytica Chimica Acta : X     Open Access  
Analytical Biochemistry     Hybrid Journal   (Followers: 210, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 13, SJR: 0.411, CiteScore: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 14)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 25, SJR: 0.683, CiteScore: 2)
Angiología     Full-text available via subscription   (SJR: 0.121, CiteScore: 0)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1, SJR: 0.111, CiteScore: 0)
Animal Behaviour     Hybrid Journal   (Followers: 227, SJR: 1.58, CiteScore: 3)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 7, SJR: 0.937, CiteScore: 2)
Animal Reproduction Science     Hybrid Journal   (Followers: 7, SJR: 0.704, CiteScore: 2)

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Similar Journals
Journal Cover
Anaesthesia Critical Care & Pain Medicine
Journal Prestige (SJR): 0.411
Citation Impact (citeScore): 1
Number of Followers: 25  
 
  Full-text available via subscription Subscription journal
ISSN (Online) 2352-5568
Published by Elsevier Homepage  [3181 journals]
  • [TIMP-2]*[IGFBP7] for Predicting Early AKI. Response to Prof. Tyagi
    • Abstract: Publication date: Available online 1 November 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Cédrick Zaouter, Alexandre Ouattara
       
  • “Cost-effectiveness, improvement in trauma bleeding management: whole
           blood transfusion might also be considered!”, response to Dr Cordier
    • Abstract: Publication date: Available online 18 October 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Jean-Stéphane David, Kenji Inaba
       
  • Clarifications on the perioperative management of adult diabetic patients
    • Abstract: Publication date: Available online 16 October 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): M.S. Raghuraman, A. Arthi, M.S. Iswaryarajan Hercule
       
  • Clinical benefits of bilateral sternal infusion of ropivacaine with
           multihole catheters inserted before sternotomy
    • Abstract: Publication date: Available online 14 October 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Alaa Azhari, Nicolas D’Ostrevy, Bruno Pereira, Lionel Camilleri, Vedat Eljezi
       
  • Terrorist threat: creating a nationwide damage control training program
           for non-trauma care providers
    • Abstract: Publication date: Available online 12 October 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Astrée Swiech, Gaël de Rocquigny, Thibault Martinez, Gwion Loarer, Sylvain Vico, Jérôme Planchon, Arnaud Le Goff, Kilian Bertho, Clément Derkenne, Stéphane Travers, Brice Malgras, Christophe Martinaud, Cyril Carfantan, Stéphane Gaudry, Mathieu Boutonnet, Pierre Pasquier Introduction: The terrorist threat leads to challenge nations to train numerous non-trauma care providers, with different backgrounds, in damage control (DC) strategies. The purpose of this work was to propose a specific DC training program.Methods: A Task Force of 16 civilian and military physicians met for a 24-hour session, to propose the construction of a DC training program for non-specialised caregivers.Results: Existing DC training programs are heterogeneous, mainly theoretical and almost only for physicians. A program entitled Damage Control for Terrorist Attack Victims (DC-TAV) was then proposed. Identified training targets were care providers from prehospital and hospital staffs, with no trauma experience. The training objectives were the improvement of individual and collective skills for DC strategies for management of terrorist attacks casualties. The tools selected for training concerned e-learning on a dedicated digital teaching platform (including a core section of four modules with types and mechanisms of injury, basic DC techniques, triage, organisation of emergency medical response; and two complementary modules for doctors with DC resuscitation including remote transfusion and DC surgery), hands-on workshops with procedural simulation and full-scale simulation exercises, technical (tourniquets, haemostatic gauzes, needle thoracostomy, chest tube drainage, management of airway, coniotomy) and non-technical (leadership, communication, coordination and triage, decision-making, appropriate use of resources) skills. Finally, an evaluation of the DC-TAV program was planned.Conclusions: The DC-TAV program is an ambitious, civilian-military, nationwide and long-term program, based on a harmonised standard of care and including multidimensional training. Further studies are required to assess its efficacy.
       
  • Efficacy and Safety of Remifentanil in a Rapid Sequence Induction in
           elderly patients: a three-arm parallel double blind randomised controlled
           trial
    • Abstract: Publication date: Available online 12 October 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Arnaud Chaumeron, Jeremie Castanie, Louis Philippe Fortier, Patrick Basset, Sophie Bastide, Sandrine Alonso, Jean-Yves Lefrant, Philippe CuvillonABSTRACTBackground: Rapid sequence induction (RSI) is recommended in patients at risk of aspiration, but induced hemodynamic adverse events, including tachycardia. In elderly patients, this trial aimed to assess the impact of the addition of remifentanil during RSI on the occurrence of: tachycardia (primary outcome), hypertension (due to intubation) nor hypotension (remifentanil).Methods: In this three-arm parallel, double blind, multicentre controlled study, elderly patients (65 to 90 years old) hospitalised in three centres and requiring RSI were randomly allocated to three groups, where anaesthesia was induced with etomidate (0.3 mg/kg) followed within 15 seconds by either placebo, or low (0.5 µg/kg), or high (1.0 µg/kg) doses of Remifentanil, followed by succinylcholine 1.0 mg/kg. Heart rate (HR) and mean arterial pressure (MAP) were recorded before induction and after intubation.Results: In total, eighty patients were randomised and analysed. Baseline HR and MAP were similar between groups. For primary endpoint, the absolute change in HR between induction and intubation was greater in the control group (15 bpm; 95% CI [8-21]) than that in the remifentanil 0.5 µg/kg group (4 bpm; 95% CI [-1-+8]; p = 0.005) and the remifentanil 1.0 µg/kg group (-3 bpm; 95% CI [-9-+3]; p < 0.0001). The increase in MAP was greater in the placebo group than in both remifentanil groups (p < 0.0001). Twice as many hypertension episodes were recorded in the placebo group compared to the remifentanil 0.5 µg/kg and 1.0 µg/kg groups (60%, 30%, and 28% patients respectively; p = 0.032), but no placebo patients experienced hypotension episodes versus 11% and 24% in the remifentanil 0.5 µg/kg and 1.0 µg/kg groups respectively (p = 0.016).Conclusion: Remifentanil (0.5-1.0 µg/kg) prevents the occurrence of tachycardia and hypertension in elderly patients requiring RSI.
       
  • Update in Antibiotic Therapy in Intensive Care Unit Report from the 2019
           Nimes International Symposium
    • Abstract: Publication date: Available online 10 October 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Marc Leone, Jason A. Roberts, Matteo Bassetti, Adrien Bouglé, Jean-Philippe Lavigne, Matthieu Legrand, Michael Neely, José-Artur Paiva, Didier Payen, Jordi Rello, Claire Roger, Fredrik Sjövall, Boris Jung The 2019 Nîmes International Symposium in Antibiotic Therapy Optimisation aimed at determining the best approaches of a number of the antibiotic management strategies for critically ill patients. Experts reviewed the latest literature relating to requirements for an optimal antibiotic stewardship program, risks of sub-therapeutic dosing of antibiotics in critically ill patients, persisting issues about efficiency of combination therapy and the value of de-escalation, new perspectives of pharmacokinetics, drug toxicities including collateral damages-associated with antibiotics, the place of nebulisation of antibiotics, management of patients receiving extracorporeal therapies and the place of new antibiotics. In this paper, each of these issues is discussed with key messages presented after a brief review of evidence.
       
  • Active participation in high fidelity simulation might be associated with
           higher stress level and better learning outcomes at three months than
           external observation
    • Abstract: Publication date: October 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 5Author(s): Marc Lilot, Jean-Noël Evain, Antoine Duclos, Jean-Jacques Lehot, Thomas Rimmelé
       
  • Data quality and blockchain technology
    • Abstract: Publication date: October 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 5Author(s): Valentina Bellini, Alberto Petroni, Giuseppina Palumbo, Elena Bignami
       
  • Reply letter to: Physician's experience in decisions of withholding and
           withdrawing life-sustaining treatments: A multicenter survey in emergency
           departments
    • Abstract: Publication date: October 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 5Author(s): Antoine Lamblin, Clement Derkenne
       
  • How to deal with peripheral regional anaesthesia while antithrombotics on
           board'
    • Abstract: Publication date: October 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 5Author(s): Anne Godier, Sébastien Bloc
       
  • Sensory selective peripheral nerve block for wide-awake surgery
    • Abstract: Publication date: October 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 5Author(s): Subin Yoo, Seunguk Bang, Sang-Eun Park
       
  • Epidemiology of trauma: From medico-administrative database to large
           prospective registry
    • Abstract: Publication date: October 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 5Author(s): Tobias Gauss, Pierre Bouzat, Thomas Geeraerts
       
  • Positive end expiratory pressure (PEEP) in the operative theatre: What's
           next'
    • Abstract: Publication date: October 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 5Author(s): Thomas Godet, Pierre-Julien Cungi, Emmanuel Futier
       
  • What is the most appropriate spontaneous breathing trial before extubation
           in ICU ventilated patients'
    • Abstract: Publication date: October 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 5Author(s): Audrey De Jong, Mathieu Capdevila, Gerald Chanques, Laure Cazenave, Samir Jaber
       
  • A small step for sedation that may become a giant leap for critical care
           medicine
    • Abstract: Publication date: October 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 5Author(s): Jean-Michel Constantin, Thomas Godet, Arthur James, Antoine Monsel
       
  • Should we continue to test soluble thrombomodulin, or other systemic
           anticoagulants, as a life-saving therapy for sepsis-induced
           coagulopathy'
    • Abstract: Publication date: October 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 5Author(s): Pierre-Francois Laterre, Mitchell M. Levy, Xavier Wittebole, Thierry Dugernier, Bruno Francois, Steven M. Opal
       
  • Neuro-prognostication: Don’t forget that time is brain!
    • Abstract: Publication date: October 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 5Author(s): E. Bouchereau, V. Degos
       
  • In Memoriam of Professor Claude Martin 1949–2019
    • Abstract: Publication date: October 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 5Author(s): Marc Leone, Laurent Papazian
       
  • Position of the French Working Group on Perioperative Haemostasis (GIHP)
           on viscoelastic tests: What role for which indication in bleeding
           situations'
    • Abstract: Publication date: October 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 5Author(s): Stéphanie Roullet, Emmanuel de Maistre, Brigitte Ickx, Normand Blais, Sophie Susen, David Faraoni, Delphine Garrigue, Fanny Bonhomme, Anne Godier, Dominique Lasne, GIHP PurposeViscoelastic tests (VETs), thromboelastography (TEG®) and thromboelastometry (ROTEM®) are global tests of coagulation performed on whole blood. They evaluate the mechanical strength of a clot as it builds and develops after coagulation itself. The time required to obtain haemostasis results remains a major problem for clinicians dealing with bleeding, although some teams have developed a rapid laboratory response strategy. Indeed, the value of rapid point-of-care diagnostic devices such as VETs has increased over the years. However, VETs are not standardised and there are few recommendations from the learned societies regarding their use. In 2014, the recommendations of the International Society of Thrombosis and Haemostasis (ISTH) only concerned haemophilia. The French Working Group on Perioperative haemostasis (GIHP) therefore proposes to summarise knowledge on the clinical use of these techniques in the setting of emergency and perioperative medicine.MethodsA review of the literature.Principal findingsThe role of the VETs seems established in the management of severe trauma and in cardiac surgery, both adult and paediatric. In other situations, their role remains to be defined: hepatic transplantation, postpartum haemorrhage, and non-cardiac surgery. They must be part of the global management of haemostasis based on algorithms defined in each centre and for each population of patients. Their position at the bedside or in the laboratory is a matter of discussion between clinicians and biologists.ConclusionVETs must be included in algorithms. In consultation with the biology laboratory, these devices should be situated according to the way each centre functions.
       
  • Management of liver failure in General Intensive Care Unit
    • Abstract: Publication date: Available online 13 September 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): E. Weiss, L. Velly Objective: To produce French guidelines on Management of Liver failure in general Intensive Care Unit (ICU)
       
  • Routine use of viscoelastic tests for severe trauma management: the dark
           side
    • Abstract: Publication date: Available online 7 August 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Fabrice Cook, Guillaume Bouhours, Pierre Pasquier
       
  • Unmet medical needs, resources allocation and issues regarding
           cost-effectiveness in critical care
    • Abstract: Publication date: Available online 31 July 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Arnaud Valent, Benoit Plaud, Alexandre Mebazaa, Etienne Gayat
       
  • T regulatory cells activation and distribution are modified in critically
           ill patients with acute respiratory distress syndrome: a prospective
           single-centre observational study
    • Abstract: Publication date: Available online 30 July 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Sebastien Halter, Lucrèce Aimade, Michèle Barbié, Hélène Brisson, Jean-Jacques Rouby, Olivier Langeron, David Klatzmann, Michelle Rosenzwajg, Antoine MonselABSTRACTBackgrounds: Acute respiratory distress syndrome (ARDS) is a common and fatal inflammatory condition. Whether T regulatory cells (Tregs) are beneficial or detrimental remains controversial, and longitudinal studies are lacking. Phenotyping of Tregs activation markers has been poorly reported. We aimed to evaluate quantitative and functional alterations in blood and bronchoalveolar Treg phenotype of ARDS patients.Methods: We performed a single-center observational study in a French intensive care unit. The study enrolled 60 ARDS and 45 non-ARDS patients. Patients under 18 years old or with immunosuppression (native or acquired) were excluded. Tregs phenotypes were assessed by flow cytometry, while cytokines were measured by multiplex-based assays in blood and bronchoalveolar samples collected over 3 weeks after the onset of ARDS.Results: Blood Tregs/CD4+ percentage (median %, 25-75% interquartile) was higher in ARDS patients than in non-ARDS patients: 12.1% [9.0-16.0] versus 9.9% [8.1-12.6], p = 0.01. Alveolar Tregs/CD4+ percentage was lower in ARDS patients than in non-ARDS patients: 10.4% [6.3-16.6] versus 16.2% [12.4-21.1], p = 0.03. In ARDS patients, Tregs activation was reduced in the blood and increased in the alveolus, compared to non-ARDS patients. ROC analysis revealed a threshold of 10.4% for the Tregs/CD4+ percentage in the blood collected within the first week of ARDS to discriminate between survivors and non-survivors (sensitivity: 75%; specificity 76 %; area under the curve [95% confidence interval]: 0.72 [0.5-0.9]).Conclusions: Quantitative and functional alterations in Treg phenotype were observed in patients with ARDS. Whether rebalancing Tregs phenotype with therapeutic interventions would be beneficial deserves further investigations.
       
  • Anaesthesia-specific checklists: A systematic review of impact
    • Abstract: Publication date: Available online 30 July 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Sarah Saxena, Jens W Krombach, Daniel A Nahrwold, Romain Pirracchio Checklists are recognised as powerful tools to prevent avoidable errors in high-reliability organisations. In healthcare, the perioperative area has been a leading field in the development of a wide range of checklists. However, clinical literature on this subject is still sparse and heterogeneous, producing results that are sometimes conflicting.This systematic review assesses the current literature on perioperative routine and crisis checklists. Literature searches did not use a date limit and included articles up to March 2019. The methodological heterogeneity precluded combining data from the individual studies into a quantitative meta-analysis. Data are presented by means of a qualitative comparison with the reference groups based on a content analysis approach.Of the 874 identified articles, 25 were included in this review.Most identified studies (23, 92%) have shown that the use of checklists in anaesthesia can decrease human error, improve patient safety and teamwork, and increase quality of care.Beyond the WHO surgical time-out, anaesthesia-specific checklists have been shown to be useful for provider handoffs, emergencies, and routine anaesthesia procedures. However, literature on anaesthesia-specific checklists is still limited and very heterogeneous. More large-scale studies are necessary to identify an ideal anaesthesia checklist and its most appropriate implementation method.
       
  • Routine use of viscoelastic tests for severe trauma management: the bright
           side
    • Abstract: Publication date: Available online 29 July 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Delphine Garrigue, Bertrand Prunet, Julien Pottecher
       
  • End-of-life care in the French ICU: Impact of Claeys-Leonetti law on
           decision to withhold or withdraw life-supportive therapy
    • Abstract: Publication date: Available online 26 July 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Matthieu Le Dorze, Stanislas Kandelman, Benoit Veber
       
  • Deep continuous sedation maintained until death, in French Intensive Care
           Units
    • Abstract: Publication date: Available online 26 July 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Matthieu Le Dorze, Stanislas Kandelman, Benoit Veber, the Sfar Ethics Committee
       
  • MAGNESIUM SULFATE ADMINISTRATION FOR THE MANAGEMENT OF ECLAMPSIA:
           ASSESSMENT OF PRACTICES IN UNIVERSITY HOSPITALS OF LIBREVILLE (GABON)
    • Abstract: Publication date: Available online 26 July 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): P.C. Nze Obiang, P. Nzoghe Nguema, J.F. Ngomas, A. Sima Zue, H. Keita
       
  • Impact of uterine exteriorisation on intraoperative nausea or vomiting
           during caesarean delivery under neuraxial anaesthesia
    • Abstract: Publication date: Available online 26 July 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): F. Vial, L. Simon, T. Auchet, D. Herbain, N.E. Baka, H. Bouaziz
       
  • Consider brain perfusion imaging rather than just the delay from symptoms
           onset to indicate reperfusion strategies after stroke: Implications for
           perioperative care
    • Abstract: Publication date: August 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 4Author(s): Thomas Geeraerts, Ségolène Mrozek, Clément Monet, Jean-Marc Olivot
       
  • Ketamine infusions for sedation in ICU
    • Abstract: Publication date: August 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 4Author(s): Georges Mion
       
  • Continuous ultrasound guided erector spinae plane block for the management
           of chronic pain
    • Abstract: Publication date: August 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 4Author(s): Ali Ahiskalioglu, Haci Ahmet Alici, Bahadir Ciftci, Mine Celik, Omer Karaca
       
  • Confirmation of endotracheal tube placement with ultrasound – direct
           visualisation with anterior neck compression and continued surveillance
    • Abstract: Publication date: August 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 4Author(s): Jui Shih Kao, Desmond Mao, Ruei-Fang Wang, Chee-Fah Chong, Kuo-Chih Chen
       
  • Can intraoperative Surgical Pleth Index values be predictive of acute
           postoperative pain'
    • Abstract: Publication date: August 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 4Author(s): L. Bapteste, A.S. Szostek, D. Chassard, F.P. Desgranges, L. Bouvet
       
  • Tumescent local anaesthesia for breast cancer surgery in elderly women:
           about 6 cases
    • Abstract: Publication date: August 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 4Author(s): C. Riff, A. Diaz, O. Blin, M. Leone, R. Guilhaumou, A. Bourgoin
       
  • Prolonged continuous wound infiltration with a local anaesthetic after
           total mastectomy: pharmacokinetics and preliminary results on
           postoperative pain
    • Abstract: Publication date: August 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 4Author(s): Daniel Francon, Camille Riff, Olivier Blin, Monique Cohen, Romain Guilhaumou
       
  • Big data and targeted machine learning in action to assist medical
           decision in the ICU
    • Abstract: Publication date: August 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 4Author(s): Romain Pirracchio, Mitchell J Cohen, Ivana Malenica, Jonathan Cohen, Antoine Chambaz, Maxime Cannesson, Christine Lee, Matthieu Resche-Rigon, Alan Hubbard, the ACTERREA Research Group Historically, personalised medicine has been synonymous with pharmacogenomics and oncology. We argue for a new framework for personalised medicine analytics that capitalises on more detailed patient-level data and leverages recent advances in causal inference and machine learning tailored towards decision support applicable to critically ill patients. We discuss how advances in data technology and statistics are providing new opportunities for asking more targeted questions regarding patient treatment, and how this can be applied in the intensive care unit to better predict patient-centred outcomes, help in the discovery of new treatment regimens associated with improved outcomes, and ultimately how these rules can be learned in real-time for the patient.
       
  • Augmented renal clearance in critically ill trauma patients: A
           pathophysiologic approach using renal vascular index
    • Abstract: Publication date: August 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 4Author(s): Cedric Carrie, Alexandre Lannou, Sebastien Rubin, Hugues De Courson, Laurent Petit, Matthieu Biais BackgroundThe aim of the present study was to explore the relationship between creatinine clearance (ClCr), cardiac index (CI) and renal vascular index (RVI) in order to assess the potential mechanisms driving ARC in critically ill trauma patient. The secondary objective was to assess the performance of RVI for prediction of ARC.MethodsEvery trauma patient who underwent cardiac and renal ultrasound measurements during their initial ICU management was retrospectively reviewed over a 3-month period. ARC was defined by a 24-hr measured ClCr ≥ 130 mL/min/1.73m2. A mixed effect model was constructed to explore covariates associated with ClCr over time. The performance of RVI for prediction of ARC was assessed by receiver operating characteristic (ROC) curve and compared to the ARCTIC (ARC in trauma intensive care) predictive scoring model.ResultsThirty patients, contributing for 121 coupled physiologic data, were retrospectively analysed. There was a significant correlation between ClCr values and RVI (r = −0.495; P = 0.005) but not between ClCr and CI values (r = 0.023; P = 0.967) at day 1. Using a mixed effect model, only age remained associated with ClCr variations over time. The area under the ROC curve of RVI for predicting ARC was 0.742 (95% CI: 0.649–0.834; P 
       
  • Maternal admissions to intensive care units in France: Trends in rates,
           causes and severity from 2010 to 2014
    • Abstract: Publication date: August 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 4Author(s): Y. Barry, C. Deneux-Tharaux, M. Saucedo, V. Goulet, I. Guseva-Canu, N. Regnault, A.A. Chantry IntroductionMaternal intensive care unit admission is an indicator of severe maternal morbidity. The objective of this study was to estimate rates of maternal intensive care unit admission during or following pregnancy in France, and to describe the characteristics of women concerned, the severity of their condition, associated diagnoses, regional disparities, and temporal trends between 2010 and 2014.MethodsWomen hospitalised in France in intensive care units during pregnancy or up to 42 days after pregnancy between January 2010 and December 2014 were identified using the national hospital discharge database (PMSI-MCO). Trends in incidence rates were quantified using percentages of average annual variation based on a Poisson regression model.ResultsIn total, 16,011 women were admitted to intensive care units, representing an overall incidence of 3.97‰ deliveries. This number decreased significantly by 1.7% on average per year. For women who gave birth (60.5% by C-section), 62.5% of admissions occurred during their hospitalisation for delivery. The SAPS II score, an indicator of severity, significantly increased from 18.4 in 2010 to 21.5 in 2014. Obstetrical haemorrhage (39.8%) and hypertensive complications during pregnancy (24.8%) were the most common reasons for admission. In mainland France, the Ile-de-France (i.e., greater Paris) region had the highest rates of intensive care units admission (5.05‰) while the Pays-de-la-Loire region had the lowest (2.69‰).ConclusionThe rate of maternal intensive care unit admission decreased from 2010 to 2014 in France, with a concomitant increase in case severity. In-depth studies are needed to understand the territorial disparities identified.
       
  • Choosing appropriate size of I-Gel® for initial success insertion: a
           prospective comparative study
    • Abstract: Publication date: August 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 4Author(s): Gilles Guerrier, Christine Agostini, Marion Antona, Fiorella Sponzini, Anne Paoletti, Isabelle Martin, Jean-Michel Ekherian, Christophe Baillard PurposeThe optimal size of the I-Gel® remains unclear since the manufacturer's weight-based formula (size 3 for weight  90 kg) for the laryngeal mask airway I-Gel® is not evidence-based. We hypothesised that sex may also guide the choice of I-Gel® size.MethodsInsertion success rates of the I-Gel® chosen according to the weight-based formula were prospectively recorded and compared with those of a patients’ cohort ventilated with an I-Gel® chosen according to the sex-based formula recorded. Two periods of 18 months were randomised in three independent hospitals in France to study each choice strategy. Patients requiring I-Gel® size change were compared with those who where successfully ventilated with the initially chosen device. Complications linked to the I-Gel® and factors for changing the size of the I-Gel® were also recorded and analysed.ResultsData from 900 patients were prospectively collected in the three participating centres. The overall initial ventilation was inadequate in 80 cases, including 7% (n = 31) in the weight-based group and 3% (n = 13) in the sex-based group (P = 0.01). In the weight-based group, changing size of I-Gel® was successful in 28 (90%) cases. In the sex-based group, changing size of I-Gel® was useful in 1 case only. Endotracheal tube insertion was necessary in 15 cases despite changing I-Gel® size, including 3 cases in the weight-based group and 12 cases in the sex-based group. Ease of insertion and postoperative pharyngo-laryngeal problems were similar between groups with or without changing size of I-Gel®.ConclusionAdequate ventilation is achieved most of the time using size selection for the I-Gel® laryngeal mask airway according to the manufacturer's weight-based formula. However, our results suggest that the sex-based formula in healthy, anaesthetised, adult patients may also be appropriate for I-Gel® size choice.
       
  • Etomidate-induced hypotension: a pathophysiological approach using
           arterial elastance
    • Abstract: Publication date: August 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 4Author(s): Osama Abou Arab, Marc Olivier Fischer, Alexis Carpentier, Christophe Beyls, Pierre Huette, Abdel Hchikat, Amar Benammar, Beatris Labont, Yazine Mahjoub, Stéphane Bar, Pierre-Grégoire Guinot, Emmanuel Lorne Introduction: Anaesthesia frequently induces hypotension. Several recent studies have analysed arterial elastance (Ea) in order to describe clinical variations of mean arterial pressure (MAP). The objective of the study was to assess Ea to explain MAP variation following etomidate induction.Methods: We conducted a prospective single-centre study. Inclusion criteria were patients undergoing elective cardiac surgery with invasive blood pressure monitoring. Ea was expressed as Pes/SV (Pes: end systolic pressure, SV: stroke volume). Cardiac index (CI), peripheral vascular resistance (PVR) and arterial compliance (C) was compared before and 2 minutes after etomidate induction. Arterial hypotension was defined as a decrease greater than 15% of the baseline MAP.Results: Of the 45 patients included, 24 (53%) had a preserved MAP and 21 (47%) had an etomidate-induced hypotension. Ea was similar before induction and decreased in the decreased MAP group 2 minutes after induction (2.0 mmHg.ml-1 [1.7-2.4] vs 1.4 mmHg.ml-1 [0.9-1.9]; p = 0.001). Arterial compliance (C) increased in the decreased MAP group 2 minutes after induction (0.8 ml. mmHg-1 [0.6-1.0] vs 0.5 ml. mmHg-1 [0.4-0.6], p 
       
  • The effect of playing video games on fiberoptic intubation skills
    • Abstract: Publication date: August 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 4Author(s): Aysun Ankay Yilbas, Ozgur Canbay, Basak Akca, Filiz Uzumcugil, Asli Melek, Mert Calis, İbrahim Vargel IntroductionThe effect on hand-eye coordination and visuospatial skills made videogames popular for training in laparoscopic surgery. Although similar effects may be true for fiberoptic intubation (FOI), it has not been studied before. The aim of this study was to investigate the effect of playing videogames with gamepad on FOI skills.MethodsAfter obtaining ethical approval and informed consent, 36 anaesthesia residents with no experience on fiberoptic intubation were divided into two groups. Group C (n = 18) consisted of the residents without any videogame experience with gamepad. Group PS (n = 18) played a videogame 30 minutes/day for five days. All residents performed their first nasal FOI on a patient undergoing orthognathic surgery with no known difficult intubation under general anaesthesia under supervision of an experienced anaesthesiologist. Intubation time, success rate, pre- and post-intubation SpO2 and etCO2 values were recorded.ResultsIntubation time was shorter (P = 0.017) and success rate at the first attempt was higher in Group PS (P = 0.045) compared to Group C. We performed multivariate linear regression analysis to investigate which independent variables (gender of residents, experience in anaesthesiology, dominant hand, study group and previous history of videogame experience) affected our dependent variable intubation time. Backward analysis revealed previous videogame playing history (previous players vs. non-players) was the only significant predictor of intubation time (P = 0.010).ConclusionAlthough we cannot reliably suggest using videogames as an educational tool for FOI, the results of our study showed that videogame playing history may provide an improvement in FOI time of novices in actual operating-theatre environment.
       
  • Obstetric critical care patients in France: Admission shift from general
           intensive care units (ICU) to general high-dependency units (HDU) and now
           to obstetric high-dependency units (OHDU)'
    • Abstract: Publication date: August 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 4Author(s): D. Benhamou, F. Fuchs, F.J. Mercier
       
  • High-fidelity simulation in airway management: Aim or tool towards skills
           and safety'
    • Abstract: Publication date: August 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 4Author(s): Morgan Le Guen, Frederic Martin
       
  • Is variability a natural phenomenon in patients, providers and
           institutions'
    • Abstract: Publication date: August 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 4Author(s): Rashid Nadeem, Jawed Shafaq
       
  • The EPOCH trial: A non-resolved dilemma between ambition and
           pragmatism'
    • Abstract: Publication date: August 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 4Author(s): Serge Molliex, Julien Lanoiselée, Vincent Bruckert
       
  • Neuromuscular blocking agents as part of lung-protective strategy in
           severe ARDS patients
    • Abstract: Publication date: August 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 4Author(s): Laurent Papazian, Sami Hraiech, Laure Cazenave, Jean-Marie Forel
       
  • Iris and PreVent trial: Pioneers to complete the current guidelines'
    • Abstract: Publication date: August 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 4Author(s): Stéphane Bar, Arthur James, Bertrand Debaene
       
  • Vena Cava filters in severely-injured patients: One size does not fit all
    • Abstract: Publication date: August 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 4Author(s): Kwok M. Ho, Anthony Holley, Jeffrey Lipman
       
  • Reply to the letter to the editor
    • Abstract: Publication date: August 2019Source: Anaesthesia Critical Care & Pain Medicine, Volume 38, Issue 4Author(s): Joseph Rinehart, Philippe Van der Linden, Alexandre Joosten
       
  • Physical instability of an infusion containing ropivacaine, clonidine and
           adrenaline tartrate in syringes for pre-operative administration
    • Abstract: Publication date: Available online 18 July 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Marie-Lise Colsoul, Benjamin Lardinois, Laurence Galanti, Laura Soumoy, Jean-Daniel Hecq
       
  • May Levosimendan be safe and effective in refractory vasospasm despite
           adequate treatment with repeated angiography and Milrinone infusion after
           subarachnoid haemorrhage'
    • Abstract: Publication date: Available online 16 July 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Vincent Cottenceau, Bastien Poutier, Florent Gariel, Noemie Suvage, Laurent Petit, Cedric Carrie, Matthieu Biais
       
  • Antimicrobial therapy during ECMO – customised dosing with therapeutic
           drug monitoring: the way to go'
    • Abstract: Publication date: Available online 16 July 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): H. Abdul-Aziz Mohd, Kiran Shekar, Jason A. Roberts
       
  • The Twilight Zone: Ten beliefs about viscoelastic tests
    • Abstract: Publication date: Available online 16 July 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Tobias Gauss, Antoine Lamblin, Pierre Bouzat
       
  • Dexmedetomidine to facilitate non-invasive ventilation after blunt chest
           trauma: a randomised, double-blind, crossover, placebo-controlled pilot
           study
    • Abstract: Publication date: Available online 15 July 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Baptiste Deletombe, Thibaut Trouve-Buisson, Alexandre Godon, Dominique Falcon, Lise Giorgis-Allemand, Pierre Bouzat, Jean-Luc Bosson, Jean-Francois Payen Background: Although non-invasive ventilation (NIV) is recommended in patients with chest trauma, this procedure may expose to discomfort and even failure due to agitation or excessive pain. We tested the impact of dexmedetomidine on the duration of the first session of NIV.Methods: This randomised, crossover study enrolled 19 patients with blunt chest trauma who needed NIV. During one cycle comprising two NIV sessions, patients received in a random order an intravenous infusion of dexmedetomidine (0.7 mcg/kg/h) and placebo (saline solution) that was initiated 60 min prior to NIV. Dexmedetomidine (or placebo) was titrated to maintain a Richmond Agitation Sedation Scale (RASS) score between 0 and -3. A 6h washout period was observed between NIV sessions. The reproducibility of the drug-related effects was tested during a second cycle of two NIV sessions.Results: During the first cycle, dexmedetomidine prolonged the duration of NIV compared to placebo: 280 min (118-450) (median, 25-75th quartiles) versus 120 min (68-287) respectively, corresponding to a median increased duration of 96 min (12-180) (P=0.03). Dexmedetomidine was associated with a lower score for RASS: -0.8 (-1.0;0.0) versus 0.0 (-0.5;0.0) (P
       
  • Transcatheter Aortic Valve Replacement for symptomatic aortic stenosis:
           the default strategy'
    • Abstract: Publication date: Available online 28 June 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Baptiste Duceau, Vincent Bruckert, Nicolas Mongardon, Adrien Bouglé
       
  • Obstructive Sleep Apnoea and Postoperative Complications: a Significant
           Link'
    • Abstract: Publication date: Available online 27 June 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Eric Deflandre, Jean-Francois Brichant
       
  • Learning from the EPOCH trial (Editorial) What we have learnt from a trial
           of an intervention to improve survival following emergency laparotomy'
           
    • Abstract: Publication date: Available online 26 June 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Tim Stephens, Rupert M. Pearse
       
  • Per-anaesthesia malignant hyperthermia: not so rare, not so usual
    • Abstract: Publication date: Available online 19 June 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Pierre-Yves Cordier, Matthieu Laurent, Eliott Gaudray, Éric Peytel, Julien Bordes
       
  • Is there an association between emergency physicians’ gender and their
           decision-making during out-of-hospital cardiac arrest'
    • Abstract: Publication date: Available online 19 June 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Clément Derkenne, Olivier Bylicki, Romain Kedzierewicz, Antoine Lamblin, Daniel Jost
       
  • Short-term and long-term prognosis after cardiac surgery: do anaesthetics
           protect against ischemia-reperfusion injury'
    • Abstract: Publication date: Available online 13 June 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Osama Abou-Arab, André Ly, Idris Amrouche, Stefan Andrei, Nicolas Mongardon
       
  • Cost-effectiveness improvement in trauma bleeding management: whole blood
           transfusion might also be considered!
    • Abstract: Publication date: Available online 13 June 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Pierre-Yves Cordier, Frédérik Bélot De Saint Leger, Stéphane Bégué, Éric Peytel, Christophe Martinaud
       
  • Description of practices and complications in the French centres that
           participated to APRICOT: A secondary analysis
    • Abstract: Publication date: Available online 11 June 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Souhayl Dahmani, Anne Laffargue, Christophe Dadure, Francis Veyckemans, The French Apricot Trial Group Introduction: Analysing national patients’ profile and organisation of human resources are important for improving the perioperative quality of care. The aim of the current study was to achieve these goals using the French data from the APRICOT study.Material and Methods: Data from the French centres that participated to the APRICOT study were extracted and analysed. The primary goal of the study was to describe patients’ characteristics, procedures and perioperative anaesthetic management in France and compare them to the results of the European APRICOT trial. Secondary outcomes were the description of major perioperative complications and the determination of human resources organisation possibly associated with these perioperative complications.Results: Overall 3535 procedures collected in 20 facilities (17 teaching hospitals, one community hospital and two private institutions) were analysed. Comparison between the French and European APRICOT cohorts found differences related to the more specialised French centres participating to the study. Overall complications (respiratory complications, haemodynamic instability, cardiac arrest, drug errors, and anaphylactic reactions) were observed in 6.4 % [95% CI: 5.6; 6.3] of cases. Multivariate analysis identified the anaesthesiologist’s experience of < 15 years and the absence of an anaesthetic nurse as human factors independently associated with an increased risk for perioperative complications.Discussion: The current study identified some important differences between the French and the whole APRICOT cohort in terms of preoperative evaluation, surgical specialties involved, and monitoring of neuromuscular blockade. It confirms that, in France, the presence of an anaesthetic nurse and of an experienced anaesthesiologist prevents anaesthetic complications.
       
  • Does intermittent pneumatic compression PREVENT deep vein thrombosis in
           the ICU'
    • Abstract: Publication date: Available online 31 May 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Kevin B Laupland, Alexis Tabah, Charlotte Kelway, Jeffrey Lipman
       
  • sIs Artificial Intelligence (AI) at the doorstep of Intensive Care Units
           (ICU) and Operating Room (OR)'
    • Abstract: Publication date: Available online 15 May 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): X. Chapalain, O. Huet
       
  • Thiopental versus Propofol on the outcome of the newborn after caesarean
           section: Can urgency grade affect the impact'
    • Abstract: Publication date: Available online 15 May 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Habib Reazaul Karim
       
  • Big data are here to stay!
    • Abstract: Publication date: Available online 9 May 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Jean-Louis Vincent, Jacques Creteur
       
  • Opioid-free anaesthesia: the need for evidence-based proofs
    • Abstract: Publication date: Available online 9 May 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): H. Beloeil
       
  • Genetic contribution to PONV risk
    • Abstract: Publication date: Available online 8 May 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Stefanie Klenke, Gudrun J. de Vries, Laura Schiefer, Nina Seyffert, Hagen S. Bachmann, Jürgen Peters, Ulrich H. Frey Background:Clinical risk factors for post-operative nausea and vomiting (PONV) are usually stratified using the Apfel score. While a genetic predisposition has recently been demonstrated with the muscarinic acetylcholine receptor (CHRM3) rs2165870 single nucleotide polymorphism (SNP), we investigated whether (1) other SNPs contribute to PONV risk and (2) a genetic risk score might summarise genetic PONV risk.Methods:We retrospectively analysed data from a study with 472 patients undergoing elective surgery. We investigated the SNPs rs3218315 (IL2RB), rs349358 (KCNB2), rs703363 (intergenic variant), rs1800497 (DRD2), rs1799971 (OPRM1), and rs1176713 (HTR3A). A genetic risk score was established and association with PONV investigated.Results: Early PONV occurred in 37%. There was a significant association of the KCNB2 rs349358 SNP with nausea (p = 0.021), retching (p = 0.001), and PONV (p = 0.006). The rs349358 genotype distribution was TT in 310 and TC/CC in 155 patients. The KCNB2 SNP was associated with an Odds Ratio (OR) of 1.6 for CT/CC vs. TT (95% CI 1-2.5; p = 0.031) to develop PONV and this was independent from the Apfel score, and the CHRM3 rs2165870 SNP. A genetic risk score based on the CHRM3 rs2165870 and the KCNB2 rs349358 SNP was created and this genetic score (OR per genetic risk score point: 1.6 (1.3-2.1), p 
       
  • Limitations of the Ultrasound-assisted Shamrock approach for Lumbar plexus
           nerve block in elderly patients
    • Abstract: Publication date: Available online 23 April 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Theodosios Saranteas, Eleftheria Soulioti, Andreas Kostroglou, Dimitrios Anagnostopoulos, Dimosthenis Koutsomanolis, Penelope Kouki
       
  • Neurotoxicity of anaesthetics on developing brain: a relevant question or
           just a “bias”'
    • Abstract: Publication date: Available online 21 April 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Souhayl Dahmani, Vincent Laudenbach
       
  • Concentrations of direct oral anticoagulants according to guidelines for
           the periprocedural management of low bleeding risk procedures
    • Abstract: Publication date: Available online 13 April 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Anne Godier, Anne-Céline Martin, Sarah Lessire, François Mullier, Isabelle Leblanc, Isabelle Gouin-Thibault
       
  • Thoracic paravertebral block: comparison of different approaches and
           techniques. A study on 27 human cadavers
    • Abstract: Publication date: Available online 9 April 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Laura RUSCIO, Régis RENARD, Cédric LEBACLE, Paul ZETLAOUI, Dan BENHAMOU, Thomas BESSEDE Background and Objectives: The success rate and the spread of thoracic paravertebral block (TPVB) are variable and difficult to predict. It is now recommended that an ultrasound guidance technique should replace the traditional landmark technique. The objective was to compare anatomical outcomes of both techniques on cadavers.Methods:A landmark technique (loss of resistance technique [LOR]) and a USG technique (3 approaches: sagittal, transversal in-plane, transverse out-of-plane) were performed on 27 thawed non-embalmed cadavers. Each of the 4 approaches was performed in each body (T3-T5 and T9-T11 x right and left). A coloured solution (13 mL, saline 0.9%) was injected in the targeted thoracic paravertebral space (TPVS). A successful thoracic paravertebral injection (TPVI) was defined by the presence of dye in at least one TPVS during anatomical dissection.Results:In 104 TPVIs analysed, the overall success rate was 78%. Factors associated with success were: USG versus LOR technique (85% vs. 52%, p 
       
  • Thiopental versus propofol on the outcome of the newborn after caesarean
           section: an impact study
    • Abstract: Publication date: Available online 9 April 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Olivier Montandrau, Fabien Espitalier, Joseph Bouyou, Marc Laffon, Francis RemérandSummaryBackground:In 2011, the company that produced thiopental in France and in the United States stopped its marketing. Because of limited evidences, the choice of the best induction agent for caesarean section remains controversial, especially in emergency. The objective of this study was to compare the effects of propofol versus thiopental on the Apgar score of the newborn.Methods:Newborns delivered by elective or emergency caesarean section under general anaesthesia in a university hospital were included from January 2009 to December 2013. Two periods, according to the hypnotic drug used, were compared in this before-and-after comparative study: thiopental before May 2011 and propofol after. The primary outcome was to compare the proportion of newborns with a 5-minute Apgar score
       
  • Erratum to “Early management of severe pelvic injury (first 24 hours)”
           [Anaesth Crit Care Pain Med 38 (2019) 199–207.
           https://doi.org/10.1016/j.accpm.2018.12.003]
    • Abstract: Publication date: Available online 6 April 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Pascal Incagnoli, Alain Puidupin, Sylvain Ausset, Jean Paul Beregi, Jacques Bessereau, Xavier Bobbia, Julien Brun, Elodie Brunel, Clément Buléon, Jacques Choukroun, Xavier Combes, Jean Stéphane David, François-Régis Desfemmes, Delphine Garrigue, Jean-Luc Hanouz, Isabelle Plénier, Fréderic Rongieras, Benoit Vivien, Tobias Gauss, Anatole Harrois
       
  • AUGMENTED RENAL CLEARANCE: A REAL PHENOMENON WITH AN UNCERTAIN CAUSE
    • Abstract: Publication date: Available online 9 March 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): João Pedro Baptista, Jason A. Roberts, Andrew A. Udy
       
  • Antibioprophylaxis in surgery and interventional medicine. (adult
           patients) Update 2017
    • Abstract: Publication date: Available online 2 March 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): C. Martin, C. Auboyer, M. Boisson, H. Dupont, R. Gauzit, M. Kitzis, M. Leone, A. Lepape, O. Mimoz, P. Montravers, J.L. PourriatSummaryInfection is a risk for any intervention. In surgery, for example, pathogenic bacteria are found in more than 90% of operative wounds during closure. This exists whatever the surgical technique and whatever the environment (the laminar flow does not entirely eliminate this risk). These bacteria are few in number but can proliferate. They find in the operative wound a favourable environment (haematoma, ischaemia, modification of oxido-reduction potential…) and the intervention induces anomalies of the immune defences. In the case of the installation of foreign material, the risk is increased. The objective of antibiotic prophylaxis (ABP) is to prevent bacterial growth in order to reduce the risk of infection at the site of the intervention. The preoperative consultation represents a privileged moment to decide on the prescription of a ABP. It is possible to define the type of intervention planned, the associated risk of infection (and therefore the necessity or not of ABP), the time of prescription before surgery and any allergic antecedents which may modify the choice of the selected antibiotic molecule.
       
  • PHARMECMO: Therapeutic drug monitoring and adequacy of current dosing
           regimens of antibiotics in patients on Extracorporeal Life Support
    • Abstract: Publication date: Available online 1 March 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Adrien Bouglé, Olivier Dujardin, Victoria Lepère, Nora Ait Hamou, Charles Vidal, Guillaume Lebreton, Joe-Elie Salem, Najoua El-Helali, Grégoire Petijean, Julien Amour
       
  • Revision of Expert Panel’s Guidelines on Postoperative Pain
           Management
    • Abstract: Publication date: Available online 26 February 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Frédéric Aubrun, Karine Nouette-Gaulain, Dominique Fletcher, Anissa Belbachir, Hélène Beloeil, Michel Carles, Philippe Cuvillon, Christophe Dadure, Gilles Lebuffe, Emmanuel Marret, Valeria Martinez, Michel Olivier, Nada Sabourdin, Paul Zetlaoui The French Society of Anaesthesia and Intensive Care Medicine (SFAR) published experts’ guidelines on the care of postoperative pain. This was an update of the 2008 guidelines. Fourteen experts analysed the literature (PubMed™, Cochrane™) on questions that had not been treated in the previous guidelines, or to modify the guidelines following new data in the published literature. The used method is invariably the GRADE© method, which guarantees a rigorous work. Seventeen recommendations were formalised on the assessment of perioperative pain, and most particularly in non-communicating patients, on opioid and non-opioid analgesics and on anti-hyperalgesic drugs, such as ketamine and gabapentinoids, as well as on local and regional anaesthesia. The concept of vulnerability and therefore the identification of the most fragile patients in terms of analgesics requirements were specified. Because of the absence of sufficient data or new information, no recommendation was made about analgesia monitoring, the procedures for the surveillance of patients in conventional care structures, or perinervous or epidural catheterism.
       
  • Ketamine infusion for sedation in ICU, Response to Dr Mion
    • Abstract: Publication date: Available online 26 February 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Perbet Sebastien, Godet Thomas, Constantin Jean-Michel
       
  • Sugammadex for reversal of neuromuscular blockade in paediatric patients:
           a two-year single-centre retrospective study
    • Abstract: Publication date: Available online 25 February 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): A. Simonini, E. Brogi, M.G. Calevo, M. Carron
       
  • Do observers and active participants learn similarly during high fidelity
           sessions'
    • Abstract: Publication date: Available online 25 February 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): A Blanie, D Benhamou
       
  • EFFECTS OF MODIFICATION OF TRAUMA BLEEDING MANAGEMENT: A BEFORE AND AFTER
           STUDY
    • Abstract: Publication date: Available online 23 February 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Cécile Guth, Olivia Vassal, Arnaud Friggeri, Pierre-François Wey, Kenji Inaba, Evelyne Decullier, François-Xavier Ageron, Jean-Stéphane David ObjectiveWe hypothesised that the association of tranexamic acid (TXA) administration and thromboelastometry-guided haemostatic therapy (TGHT) with implementation of Damage Control Resuscitation (DCR) reduced blood products (BP) use and massive transfusion (MT).MethodsRetrospective comparison of 2 cohorts of trauma patients admitted in a university hospital, before (Period 1) and after implementation of DCR, TXA (first 3-hours) and TGHT (Period 2). Patients were included if they received at least 1 BP (RBC, FFP or platelet) or coagulation factor concentrates (fibrinogen or prothrombin complex) during the first 24-hours following the admission.Results380 patients were included. Patients in Period 2 (n = 182) received less frequently a MT (8% vs. 33%, p 
       
  • Management of Malignant Hyperthermia in France: current organisation
    • Abstract: Publication date: Available online 23 February 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Florence Julien-Marsollier, Nathalie Roux-Buisson, Anne-Frederique Dalmas, Beatrice Bruneau, Souhayl Dahmani
       
  • Answer to the reply letter to: Physician’s experience in decisions of
           withholding, withdrawing life-sustaining treatments: a multicentre survey
           in emergency departments
    • Abstract: Publication date: Available online 23 February 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): DOUPLAT Marion, JACQUIN Laurent, TAZAROURTE Karim, LE COZ Pierre
       
  • Low interleukin-10 release after ex vivo stimulation of whole blood is
           associated with persistent organ dysfunction in sepsis: a prospective
           observational study
    • Abstract: Publication date: Available online 21 February 2019Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Nicolas NESSELER, Corinne MARTIN-CHOULY, Harmonie PERRICHET, James T. ROSS, Chloé ROUSSEAU, Pratik SINHA, Sonia ISSLAME, Elodie MASSERET, Yannick MALLÉDANT, Yoann LAUNEY, Philippe SEGUIN Background: Sepsis profoundly alters immune homeostasis. Cytokine release after whole blood lipopolysaccharide (LPS)-stimulation reflects cell function across multiple immune cell classes and represents the immune response to LPS. The main goal of this study was to evaluate the prognostic value of ex vivo stimulation of whole blood with LPS in sepsis.Methods: Blood was drawn on day 1 and day 7 after admission, and stimulated ex vivo with LPS. Tumour necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6 and IL-10 were measured with and without stimulation. Our primary outcome measure was the persistence of at least one organ dysfunction at day 7. Organ dysfunction was defined according to the SOFA components by a score> = 2.Results: Forty-nine patients with sepsis from a 21-bed intensive care unit, and 23 healthy volunteers were enrolled. The blood of septic patients was less responsive to ex vivo stimulation with LPS than that of healthy controls at day 1 and 7, as demonstrated by lower TNF-α, IL-1β, IL-6 and IL-10 release. Persistent organ dysfunction was more frequent in patients with lower IL-10 release at day 1 but such an association was not found for pro-inflammatory cytokines. A persistent low IL-10 release at day 7 was also associated with persistent organ dysfunction.Conclusion: These data suggest that the capacity to produce IL-10 in response to whole blood ex vivo stimulation early in sepsis, as well as persistent low IL-10 response over time, may help in prognostication and patient stratification. These results will need to be confirmed in future studies.
       
 
 
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