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Publisher: Elsevier   (Total: 3175 journals)

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Showing 1 - 200 of 3175 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 9)
AASRI Procedia     Open Access   (Followers: 14)
Academic Pediatrics     Hybrid Journal   (Followers: 30, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 22, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 87, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 25, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 35, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 5)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 6, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 388, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 27, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 2)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (Followers: 1, SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 243, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 10, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 2, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 1)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 25, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.383, h-index: 19)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 6, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 6)
Acute Pain     Full-text available via subscription   (Followers: 14)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 7)
Additive Manufacturing     Hybrid Journal   (Followers: 9, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Cement Based Materials     Full-text available via subscription   (Followers: 3)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 134, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 16, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 8, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 12, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 27, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 10, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 10, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 22, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 14, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 2, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 29, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 7, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 3)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 27, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 19, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 14, SJR: 0.223, h-index: 22)
Advances in Dermatology     Full-text available via subscription   (Followers: 15)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 8)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 21)
Advances in Ecological Research     Full-text available via subscription   (Followers: 42, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 27, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 43, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 1)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 7)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 53, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 15)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 8)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 21, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 22)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 36, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 15, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 11, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 21)
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: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 3)
Advances in Oncobiology     Full-text available via subscription   (Followers: 1)
Advances in Organ Biology     Full-text available via subscription   (Followers: 1)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 6, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 5, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 10)
Advances in Pharmacology     Full-text available via subscription   (Followers: 15, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 7)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 17)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 18, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 59)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.1, h-index: 2)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 5)
Advances in Space Research     Full-text available via subscription   (Followers: 386, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 5)
Advances in Surgery     Full-text available via subscription   (Followers: 9, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 29, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 17)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 46, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 336, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 10, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 440, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 43, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 1)
Agriculture and Natural Resources     Open Access   (Followers: 2)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 56, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 6, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 11, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 9)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access   (Followers: 1)
Algal Research     Partially Free   (Followers: 9, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 5, SJR: 0.776, h-index: 35)
Alpha Omegan     Full-text available via subscription   (SJR: 0.121, h-index: 9)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 9, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 48, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 6)
American Heart J.     Hybrid Journal   (Followers: 50, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 51, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 44, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 10, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 31, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 26, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 34, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 42, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 195, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 62, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 6)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 27, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 27, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 37, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 6)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 62, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 14)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 3, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 4, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 39, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 170, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 10, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 11)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 1)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 22, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1)

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Journal Cover Anaesthesia Critical Care & Pain Medicine
  [14 followers]  Follow
    
   Full-text available via subscription Subscription journal
   ISSN (Online) 2352-5568
   Published by Elsevier Homepage  [3175 journals]
  • Veno-arterial ECMO in critically ill patients: The age of maturity'
    • Authors: Nicolas Mongardon; Quentin De Roux; Simon Clariot
      Pages: 193 - 194
      Abstract: Publication date: June 2018
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 3
      Author(s): Nicolas Mongardon, Quentin De Roux, Simon Clariot


      PubDate: 2018-05-03T09:17:21Z
      DOI: 10.1016/j.accpm.2017.10.002
       
  • Tracheostomy in intensive care: Patients and families will never walk
           alone!
    • Authors: Paolo Pelosi; Lorenzo Ball; Iole Brunetti; Maria Vargas; Nicolò Patroniti
      Pages: 197 - 199
      Abstract: Publication date: June 2018
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 3
      Author(s): Paolo Pelosi, Lorenzo Ball, Iole Brunetti, Maria Vargas, Nicolò Patroniti


      PubDate: 2018-05-03T09:17:21Z
      DOI: 10.1016/j.accpm.2018.04.001
       
  • Changes in the availability of bedside ultrasound practice in emergency
           rooms and prehospital settings in France
    • Authors: X. Bobbia; M. Abou-Badra; N. Hansel; P. Pes; T. Petrovic; P.G. Claret; J.Y. Lefrant; J.E. de La Coussaye
      Pages: 201 - 205
      Abstract: Publication date: June 2018
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 3
      Author(s): X. Bobbia, M. Abou-Badra, N. Hansel, P. Pes, T. Petrovic, P.G. Claret, J.Y. Lefrant, J.E. de La Coussaye
      Objective Ensuring the availability of ultrasound devices is the initial step in implementing clinical ultrasound (CUS) in emergency services. In France in 2011, 52% of emergency departments (EDs) and only 9% of mobile intensive care stations (MICS) were equipped with ultrasound devices. The main goal of this study was to determine the movement of these rates since 2011. Methods We conducted a cross-sectional, descriptive, multicentre study in the form of a questionnaire. To estimate the numbers of EDs and MICS equipped with at least one ultrasound system with a confidence level of 95% and margin of error of 5%, 170 responding EDs and 145 MICS were required. Each service was solicited three times by secure online questionnaire and then by phone. Results Three hundred and twenty-eight (84%) services responded to the questionnaire: 179 (86%) EDs and 149 (82%) MICS. At least one ultrasound machine was available in 127 (71%, 95% CI [64; 78]) EDs vs. 52% in 2011 (P <0.01). 42 (28%, 95% CI [21; 35]) MICS were equipped vs. 9% in 2011 (P <0.01). In 97 (76%) EDs and 24 (55%) MICS, less than a half of physicians were trained. CUS was used at least three times a day in 52 (41%) EDs and in 8 (19%) MICS. Conclusion Our study demonstrates improved access to ultrasound devices in French EDs and MICS. Almost three-quarters of EDs and nearly one-third of MICS are now equipped with at least one ultrasound device. However, the rate of physicians trained per service remains insufficient.

      PubDate: 2018-05-03T09:17:21Z
      DOI: 10.1016/j.accpm.2017.06.008
       
  • Impact of a visual aid on discordance between physicians and family
           members about prognosis of critically ill patients
    • Authors: Gabrielle Burelli; Chloé Berthelier; Hélène Vanacker; Léonard Descaillot; Bénédicte Philippon-Jouve; Xavier Fabre; Mahmoud Kaaki; Jean-Charles Chakarian; Alexandre Domine; Pascal Beuret
      Pages: 207 - 210
      Abstract: Publication date: June 2018
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 3
      Author(s): Gabrielle Burelli, Chloé Berthelier, Hélène Vanacker, Léonard Descaillot, Bénédicte Philippon-Jouve, Xavier Fabre, Mahmoud Kaaki, Jean-Charles Chakarian, Alexandre Domine, Pascal Beuret
      Objective This study aimed to evaluate the impact of a visual aid on the discordance about prognosis between physicians and family members. Methods The study was performed in a general intensive care department with two 6-bed units. In the unit A, family members could consult a visual aid depicting day by day the evolution of global, hemodynamic, respiratory, renal and neurological conditions of the patient on a 10-point scale. In the unit B, they only received oral medical information. On day 7 of the ICU stay, the physician and family members estimated the prognosis of the patient among four proposals (life threatened; steady state but may worsen; steady state, should heal; will heal). Then we compared the rate of discordance about prognosis between physicians and family members in the two units. Results Seventy-nine consecutive patients admitted in the intensive care department and still present at day 7, their family members and physicians, were enrolled. Patients in the two units were comparable in age, sex ratio, reason for admission, SAPS II at admission and SOFA score at day 7. In the unit A, physician-family members discordance about prognosis occurred for 12 out of 39 patients (31%) vs. 22 out of 40 patients (55%) in the unit B (P =0.04). Conclusion In our study, adding a visual aid depicting the evolution of the condition of critically ill patients day by day to classic oral information allowed the family to have an estimate of the prognosis less discordant with the estimate of the physician.

      PubDate: 2018-05-03T09:17:21Z
      DOI: 10.1016/j.accpm.2017.05.006
       
  • Bundle of care for blunt chest trauma patients improves analgesia but
           increases rates of intensive care unit admission: A retrospective
           case-control study
    • Authors: Cédric Carrie; Laurent Stecken; Elsa Cayrol; Vincent Cottenceau; Laurent Petit; Philippe Revel; Matthieu Biais; François Sztark
      Pages: 211 - 215
      Abstract: Publication date: June 2018
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 3
      Author(s): Cédric Carrie, Laurent Stecken, Elsa Cayrol, Vincent Cottenceau, Laurent Petit, Philippe Revel, Matthieu Biais, François Sztark
      Introduction This single-centre retrospective case-control study aimed to assess the effectiveness of a multidisciplinary clinical pathway for blunt chest trauma patients admitted in emergency department (ED). Patients and methods All consecutive blunt chest trauma patients with more than 3 rib fractures and no indication of mechanical ventilation were compared to a retrospective cohort over two 24-month periods, before and after the introduction of the bundle of care. Improvement of analgesia was the main outcome investigated in this study. The secondary outcomes were the occurrence of secondary respiratory complications (pneumonia, indication for mechanical ventilation, secondary ICU admission for respiratory failure or death), the intensive care unit (ICU) and hospital length of stay (LOS). Results Sixty-nine pairs of patients were matched using a 1:1 nearest neighbour algorithm adjusted on age and indices of severity. Between the two periods, there was a significant reduction of the rate of uncontrolled analgesia (55 vs. 17%, P <0.001). A significant increase in the rate of primary ICU transfer during the post-protocol period (23 vs. 52%, P <0.001) was not associated with a reduction of secondary respiratory complications or a reduction of ICU or hospital LOS. Only the use of non-steroidal anti-inflammatory drugs appeared to be associated with a significant reduction of secondary respiratory complications (OR=0.3 [0.1–0.9], P =0.03). Conclusion Implementation of a multidisciplinary clinical pathway significantly improves pain control after ED management, but increases the rate of primary ICU admission without significant reduction of secondary respiratory complications.

      PubDate: 2018-05-03T09:17:21Z
      DOI: 10.1016/j.accpm.2017.05.008
       
  • Sevoflurane-induced cardioprotection in coronary artery bypass graft
           surgery: Randomised trial with clinical and ex-vivo endpoints
    • Authors: Sandrine Lemoine; Lan Zhu; Jean-Louis Gérard; Jean-Luc Hanouz
      Pages: 217 - 223
      Abstract: Publication date: June 2018
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 3
      Author(s): Sandrine Lemoine, Lan Zhu, Jean-Louis Gérard, Jean-Luc Hanouz
      Background Myocardial ischaemia reperfusion injury following cardiac surgery with cardiopulmonary bypass (CPB) increases postoperative mortality. Setting techniques to protect the heart during this critical period therefore represents a considerable challenge. Method A randomised controlled study in Caen University Hospital Centre, investigated whether the clinical cardio protective effects of administration sevoflurane before cardiopulmonary bypass during coronary artery bypass graft surgery (CABG) could translate into protected atrial trabeculae contractility against hypoxia–reoxygenation in vitro. Patients undergoing elective on-pump CABG surgery were allocated to receive either sevoflurane (n =24) or no halogenated volatile anaesthetic (n =21). Main outcome measures: the relationship between sevoflurane exposure before CPB and the incidence of major adverse cardiac events, with primary endpoint: the postoperative troponin I peak level, and secondary endpoints: the inotropic support, and the duration of stay in intensive unit and in-hospital stay were chosen as study endpoints. The right atrial was collected at the beginning of bypass surgery for the in vitro experimentation. Isometrically contracting isolated human right atrial trabeculae obtained from the two groups were exposed to 30-min hypoxia followed by 60-min reoxygenation. Results The patients receiving sevoflurane prior to aortic clamping significantly exhibited less cardiac Troponin I (1.39 [0.34–2.97] vs. 2.80 [2.54–3.64] ng·mL−1 in Control; P =0.03) and required a reduced inotropic drug support (P <0.001). Isolated trabeculae from patients receiving sevoflurane enhanced the recovery of force after reoxygenation compared to the Control group (79±5% vs. 53±8% of baseline in Control; P <0.001). Conclusions Administration of sevoflurane before CPB induced cardioprotection in patients undergoing CABG and preconditioned human myocardium against hypoxia-reoxygenation in vitro.

      PubDate: 2018-05-03T09:17:21Z
      DOI: 10.1016/j.accpm.2017.05.009
       
  • Retrospective study of anaesthetic management of pregnancy patients with
           mechanical heart valve prosthesis and anticoagulants
    • Authors: Benoît Cousin; Jean Guglielminotti; Bernard Iung; Philippe Montravers
      Pages: 225 - 231
      Abstract: Publication date: June 2018
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 3
      Author(s): Benoît Cousin, Jean Guglielminotti, Bernard Iung, Philippe Montravers
      Pregnancies among patients with a mechanical prosthetic valve and receiving anticoagulant medication are rare. Informations about their anesthetic management is poor. The objective of this study was to investigate the anaesthetic management of these patients in a reference medical centre as well as to identify possible ways for improvement. To this aim, the medical records of patients with a mechanical heart valve prosthesis having given birth at our center were analysed. In particular, the characteristics of patients and deliveries, the management of anticoagulation, as well as the type of anaesthesia performed, were collected and analysed. Eighteen cases were studied and compared to 36 controls. All studied cases were being administered anticoagulants. Five of these 8 patients delivered vaginally, one with epidural analgesia. Three of them have had a caesarean during labor, all under general anaesthesia. During the anticoagulation window, the teams had to perform an epidural in 3 (37%) of these 8 patients. Ten cases (55%) had a planned caesarean delivery, all performed under general anaesthesia. The anticoagulation interruption allowed spinal anaesthesia for 4 out of 10 caesarean delivery. The reoperation rate for secondary haemorrhage was significantly higher (P =0.0032) and the duration of the hospitalisation was extended (P <0.001). A context of anticoagulant overdose was identified in 60% of the bleeding cases. Progress can be made in the anaesthetic management of those patients by optimising the use of neuraxial anaesthesia and by improving the management of bleeding risk after delivery.

      PubDate: 2018-05-03T09:17:21Z
      DOI: 10.1016/j.accpm.2017.08.005
       
  • The pupillary light reflex for predicting the risk of hypotension after
           spinal anaesthesia for elective caesarean section
    • Authors: Céline Riffard; Truong Quoc Viêt; François-Pierrick Desgranges; Lionel Bouvet; Bernard Allaouchiche; Adrienne Stewart; Dominique Chassard
      Pages: 233 - 238
      Abstract: Publication date: June 2018
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 3
      Author(s): Céline Riffard, Truong Quoc Viêt, François-Pierrick Desgranges, Lionel Bouvet, Bernard Allaouchiche, Adrienne Stewart, Dominique Chassard
      Introduction The balance between the sympathetic and parasympathetic systems could be used to predict the onset of hypotension following spinal anaesthesia. The autonomic innervation of the pupil may reflect this balance. The aim of this study was to evaluate the ability of pupillometry to predict the risk of hypotension after spinal anaesthesia for caesarean section. Methods Two hundred patients receiving spinal anaesthesia for caesarean section were recruited. Changes in pupillary diameter, pupillary reaction latency, pupil constriction velocity and maximum and minimum pupillary diameters were measured with a pupillometer (Neurolight®, IDMed) prior to induction of spinal anaesthesia with 10mg bupivacaine and fentanyl 30μg. Hypotension was defined as a systolic blood pressure drop of > 20% compared with the baseline value. Results A total of 141 patients (70%) presented at least one episode of hypotension. Pupillary reaction latency can poorly predict hypotension and severe hypotension after spinal anaesthesia. The areas under the receiver-operating characteristic curves were 0.654 (95% confidence interval: 0.584–0.720, P =0.0001) and 0.633 (95% confidence interval: 0.562–0.700, P =0.004) for optimal threshold values of 223 and 231ms, respectively. In multivariate analysis, a baseline systolic blood pressure > 130mmHg (odds ratio: 1.98, P =0.04) and a PRL > 223ms (odds ratio: 3.42, P =0.0002) were independently associated with the risk of spinal anaesthesia-related hypotension. Conclusion Following spinal anaesthesia in patients undergoing caesarean section, though the predictive capacity pupillary reaction latency for the onset of hypotension and severe hypotension is poor, it is nevertheless the strongest predictor of hypotension identified in our study.

      PubDate: 2018-05-03T09:17:21Z
      DOI: 10.1016/j.accpm.2016.10.004
       
  • Recent directions in personalised acute respiratory distress syndrome
           medicine
    • Authors: Matthieu Jabaudon; Raiko Blondonnet; Jules Audard; Marianne Fournet; Thomas Godet; Vincent Sapin; Jean-Michel Constantin
      Pages: 251 - 258
      Abstract: Publication date: June 2018
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 3
      Author(s): Matthieu Jabaudon, Raiko Blondonnet, Jules Audard, Marianne Fournet, Thomas Godet, Vincent Sapin, Jean-Michel Constantin
      Acute respiratory distress syndrome (ARDS) is heterogeneous by definition and patient response varies depending on underlying biology and their severity of illness. Although ARDS subtypes have been identified with different prognoses in past studies, the concept of phenotypes or endotypes does not extend to the clinical definition of ARDS. This has possibly hampered the development of therapeutic interventions that target select biological mechanisms of ARDS. Recently, a major advance may have been achieved as it may now be possible to identify ARDS subtypes that may confer different responses to therapy. The aim of personalised medicine is to identify, select, and test therapies that are most likely to be associated with a favourable outcome in a specific patient. Several promising approaches to ARDS subtypes capable of predicting therapeutic response, and not just prognosis, are highlighted in this perspective paper. An overview is also provided of current and future directions regarding the provision of personalised ARDS medicine. The importance of delivering the right care, at the right time, to the right patient, is emphasised.

      PubDate: 2018-05-03T09:17:21Z
      DOI: 10.1016/j.accpm.2017.08.006
       
  • Veno-arterial-ECMO in the intensive care unit: From technical aspects to
           clinical practice
    • Authors: Arthur Le Gall; Arnaud Follin; Bernard Cholley; Jean Mantz; Nadia Aissaoui; Romain Pirracchio
      Pages: 259 - 268
      Abstract: Publication date: June 2018
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 3
      Author(s): Arthur Le Gall, Arnaud Follin, Bernard Cholley, Jean Mantz, Nadia Aissaoui, Romain Pirracchio
      The use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as a salvage therapy in cardiogenic shock is becoming of current practice. While VA-ECMO is potentially a life-saving technique, results are sometimes mitigated, emphasising the need for selecting the right indication in the right patient. This relies upon a clear definition of the individual therapeutic project, including the potential for recovery as well as the possible complications associated with VA-ECMO. To maximise the benefits of VA-ECMO, the basics of extracorporeal circulation should be perfectly understood since VA-ECMO can sometimes be detrimental. Hence, to be successful, VA-ECMO should be used by teams with sufficient experience and initiated after a thorough multidisciplinary discussion considering patient's medical history, pathology as well the anticipated evolution of the disease.

      PubDate: 2018-05-03T09:17:21Z
      DOI: 10.1016/j.accpm.2017.08.007
       
  • Central venous catheter placement during extracorporeal membrane
           oxygenation therapy
    • Authors: Lucile Picard; Chamsedine Cherait; Ophélie Constant; Boris Boulanger; Amandine Dorget; Dominique Vodovar; Antonio Fiore; Hakim Haouache; Gilles Dhonneur; Nicolas Mongardon
      Pages: 269 - 270
      Abstract: Publication date: June 2018
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 3
      Author(s): Lucile Picard, Chamsedine Cherait, Ophélie Constant, Boris Boulanger, Amandine Dorget, Dominique Vodovar, Antonio Fiore, Hakim Haouache, Gilles Dhonneur, Nicolas Mongardon


      PubDate: 2018-05-03T09:17:21Z
      DOI: 10.1016/j.accpm.2017.05.005
       
  • Massive air embolism from central venous catheter during veno-arterial
           ECMO therapy
    • Authors: Edris Omar; Guillaume Lebreton; Adrien Bouglé; Julien Amour
      Pages: 271 - 272
      Abstract: Publication date: June 2018
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 3
      Author(s): Edris Omar, Guillaume Lebreton, Adrien Bouglé, Julien Amour


      PubDate: 2018-05-03T09:17:21Z
      DOI: 10.1016/j.accpm.2017.07.008
       
  • A history of community-acquired hypervirulent Klebsiella pneumoniae severe
           sepsis
    • Authors: Camille Delatour; Nellie Chalvon; Nathalie Prieur; Philippe Mateu
      Pages: 273 - 275
      Abstract: Publication date: June 2018
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 3
      Author(s): Camille Delatour, Nellie Chalvon, Nathalie Prieur, Philippe Mateu


      PubDate: 2018-05-03T09:17:21Z
      DOI: 10.1016/j.accpm.2017.09.003
       
  • Supraventricular tachycardia in a trauma patient masquerading as a
           Wolff–Parkinson–White syndrome
    • Authors: Abdelghafour Elkoundi; Amine Meskine; Zakaria Lahlafi; Mustapha Bensghir; Salim Jaafar Lalaoui
      Pages: 277 - 279
      Abstract: Publication date: June 2018
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 3
      Author(s): Abdelghafour Elkoundi, Amine Meskine, Zakaria Lahlafi, Mustapha Bensghir, Salim Jaafar Lalaoui


      PubDate: 2018-05-03T09:17:21Z
      DOI: 10.1016/j.accpm.2017.08.004
       
  • “Nudging” advance directives drafting in ICU: May the intensivist play
           the role of the choice architect'
    • Authors: Armelle Nicolas-Robin
      Pages: 99 - 100
      Abstract: Publication date: April 2018
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 2
      Author(s): Armelle Nicolas-Robin


      PubDate: 2018-04-15T09:23:53Z
      DOI: 10.1016/j.accpm.2018.02.003
       
  • Cultural influences on the rates, acceptability and utility of advance
           care directives
    • Authors: Michael C. Reade
      Pages: 101 - 103
      Abstract: Publication date: April 2018
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 2
      Author(s): Michael C. Reade


      PubDate: 2018-04-15T09:23:53Z
      DOI: 10.1016/j.accpm.2018.02.004
       
  • The essential role of qualitative research in building knowledge on health
    • Authors: Serge Daneault
      Pages: 105 - 107
      Abstract: Publication date: April 2018
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 2
      Author(s): Serge Daneault


      PubDate: 2018-04-15T09:23:53Z
      DOI: 10.1016/j.accpm.2018.02.005
       
  • Septic shock in intermediate care unit: Don’t play with fire
    • Authors: Marc Leone; Sophie Medam; Djamel Mokart
      Pages: 109 - 110
      Abstract: Publication date: April 2018
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 2
      Author(s): Marc Leone, Sophie Medam, Djamel Mokart


      PubDate: 2018-04-15T09:23:53Z
      DOI: 10.1016/j.accpm.2018.02.006
       
  • The latest French Guidelines for the management in the first 24hours of
           patients with severe traumatic brain injury (TBI): Translating limited
           science evidence into robust practical recommendations
    • Authors: Mauro Oddo
      Pages: 111 - 112
      Abstract: Publication date: April 2018
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 2
      Author(s): Mauro Oddo


      PubDate: 2018-04-15T09:23:53Z
      DOI: 10.1016/j.accpm.2018.02.007
       
  • A comparison between intravascular and traditional cooling for inducing
           and maintaining temperature control in patients following cardiac arrest
    • Authors: Jérémy Rosman; Maxime Hentzien; Moustapha Dramé; Vincent Roussel; Bernard Just; Damien Jolly; Philippe Mateu
      Pages: 129 - 134
      Abstract: Publication date: April 2018
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 2
      Author(s): Jérémy Rosman, Maxime Hentzien, Moustapha Dramé, Vincent Roussel, Bernard Just, Damien Jolly, Philippe Mateu
      Therapeutic temperature control has been widely used during the last decade to improve clinical outcomes. We conducted this retrospective observational study to compare traditional cooling with endovascular cooling in post-cardiac arrest comatose survivors and to compare results with current guidelines. Patients and methods All patients admitted to our ICU for cardiac arrest and for whom temperature control was performed were included. Traditional cooling included cold infusions, ice packs and cooling blankets. Endovascular cooling consisted in the insertion of a catheter in which cold fluid circulates in a closed circuit provided by a heat exchanger. Temperature control was started at a target temperature of 32°C to 34°C. Rewarming was performed passively in the traditional group and via computer-assistance in endovascular group. We evaluated the delay prior to and speed of cooling, thermic stability during the maintenance phase and the speed of rewarming. Results Thirty-four patients were included. The speed of cooling was faster with the endovascular (−0.66±0.35°C/h) compared to the traditional (−0.35±0.38°C/h, P =0.006) technique, with target temperatures reached in 4.0 and 6.0h, respectively (P =0.14). Temperatures were more stable with the endovascular technique (0.03±0.05°C2) than with the traditional technique (0.26±0.16°C2, P <10−4). There were more deviations from the guideline target range in the traditional group (64.7% versus 17.6%, P =0.008). Rewarming was faster in the traditional group (+0.64±0.33°C/h, versus +0.36±0.12°C/h, P =0.01). No significant difference was found concerning mortality or length of stay in the ICU. Conclusion Temperature control with a cooling catheter was associated with faster cooling, improved thermic stability in the target range, less overcooling or overheating and slower rewarming in comparison with traditional techniques.

      PubDate: 2018-04-15T09:23:53Z
      DOI: 10.1016/j.accpm.2016.08.009
       
  • Short-term effects of low-volume resuscitation with hypertonic saline and
           hydroxyethylstarch in an experimental model of lung contusion and
           haemorrhagic shock
    • Authors: Bertrand Prunet; Pierre-Yves Cordier; Nicolas Prat; Sophie De Bourmont; David Couret; Dominique Lambert; Pierre Michelet
      Pages: 135 - 140
      Abstract: Publication date: April 2018
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 2
      Author(s): Bertrand Prunet, Pierre-Yves Cordier, Nicolas Prat, Sophie De Bourmont, David Couret, Dominique Lambert, Pierre Michelet
      Objectives This study aimed to assess the short-term respiratory tolerance and haemodynamic efficiency of low-volume resuscitation with hypertonic saline and hydroxyethylstarch (HS/HES) in a pig model of lung contusion and controlled haemorrhagic shock. We hypothesised that a low-volume of HS/HES after haemorrhagic shock did not impact contused lungs in terms of extravascular lung water 3hours after trauma. Methods A lung contusion resulting from blunt chest trauma was induced in 28 anaesthetised female pigs with five bolt-shots to the right thoracic cage, followed by haemorrhagic shock and fluid resuscitation. Pigs were randomly allocated into two groups: fluid resuscitation by 4ml/kg of HS/HES, or fluid resuscitation by 10ml/kg of normal saline (NS). Monitoring was based on transpulmonary thermodilution and a pulmonary artery catheter. After 3h, animals were euthanized to measure extravascular lung water (EVLW) by gravimetry. Results Blunt chest trauma was followed by a transient collapse and hypoxaemia in both groups. Post-mortem gravimetric assessment demonstrated a significant difference between EVLW in the NS-group (8.1±0.7ml/kg) and in the HS/HES-group (6.2±0.6ml/kg, P =0.038). Based on a pathological EVLW threshold of > 7ml/kg, results indicated that only the NS-group experienced moderate pulmonary oedema, contrary to the HS/HES-group. After haemorrhagic shock, HS/HES infusion enabled the restoration of effective mean arterial pressure and cardiac index. Intrapulmonary shunting increased transiently after fluid resuscitation but there was no significant impairment of oxygenation. Conclusion In this pig model of lung contusion, the short-term assessment of fluid resuscitation after haemorrhagic shock with 4ml/kg of HS/HES showed that pulmonary oedema was avoided compared to fluid resuscitation with 10ml/kg of NS.

      PubDate: 2018-04-15T09:23:53Z
      DOI: 10.1016/j.accpm.2016.05.010
       
  • Predictive factors of intraoperative cell salvage during pediatric
           scoliosis surgery. Cell saver during scoliosis surgery in children
    • Authors: Daphné Michelet; Florence Julien-Marsollier; Julie Hilly; Thierno Diallo; Christophe Vidal; Souhayl Dahmani
      Pages: 141 - 146
      Abstract: Publication date: April 2018
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 2
      Author(s): Daphné Michelet, Florence Julien-Marsollier, Julie Hilly, Thierno Diallo, Christophe Vidal, Souhayl Dahmani
      Introduction Blood-saving strategy during spinal surgery in children often includes recombinant erythropoietin (rEPO) and antifibrinolytic therapapy (AFT). The aim of this study was to investigate the efficacy of intraoperative blood salvage in decreasing homologous blood transfusion. Material and methods Using the prospective data from patients operated during a one year period for scoliosis correction, we calculate the predictable hematocrit at day postoperative 1 without the use of blood salvage and compare it to the target hematocrit transfusion according to patient's status. Predictors analyzed were: age, weight, surgical indication, Cobb's angle, ASA status, preoperative hemoglobin, number of level fused, sacral fusion and thoracoplasty. Statistical analyses were performed using a classification tree analysis. Results This study included 147 patients. Blood salvage was estimated avoiding homologous blood transfusion in 17 patients. Predictors of the efficacy of blood salvage were: neuromuscular indications, number of level fused and BMI. Blood salvage was found totally ineffective in: patients with no neuromuscular diseases with either: surgeries interesting<13 levels fused or surgeries interesting>13 levels with a preoperative BMI ≥ 21. In all other cases, blood salvage can decrease homologous transfusion. The model exhibited 97% of accurate for the prediction if the inefficacy of blood salvage. The AUCROC of the model was 0.93 [95% confidence interval 0.9 to 0.99] and the overall validation was 60.1% of explained variability. Conclusion The present study indicates that blood salvage is ineffective under certain circumstances. More studies are mandatory to confirm these results.

      PubDate: 2018-04-15T09:23:53Z
      DOI: 10.1016/j.accpm.2017.03.003
       
  • Tracheal extubation with suction vs. positive pressure during emergence
           from general anaesthesia in adults: A randomised controlled trial
    • Authors: Joël L’Hermite; Olivier Wira; Chritel Castelli; Jean-Emmanuel de La Coussaye; Jacques Ripart; Philippe Cuvillon
      Pages: 147 - 153
      Abstract: Publication date: April 2018
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 2
      Author(s): Joël L’Hermite, Olivier Wira, Chritel Castelli, Jean-Emmanuel de La Coussaye, Jacques Ripart, Philippe Cuvillon
      Background After general anaesthesia (GA) in adults, the optimal tracheal extubation technique (positive pressure or suctioning) remains debated. The primary endpoint of this study was to assess the effects of these techniques on onset time of desaturation (SpO2 <92%). Methods Sixty-nine patients with a body mass index<30 scheduled for elective orthopaedic surgery were allocated to positive pressure (PP) or suctioning (SUC) group. GA was standardised with propofol and remifentanil via target-controlled infusion. A morphine bolus of 0.15mg/kg was administered 20–30mins before the end of surgery. The effect of extubation technique on onset time of desaturation (T92) was assessed during the first 10mins after extubation during the spontaneous air breathing. Secondary endpoints included: frequency of desaturation, respiratory complications, need to use oxygen therapy and SpO2 at the end of the first hour while breathing in air (ClinicalTrials.gov identifier: NCT01323049). Results Baseline patient characteristics and intraoperative management data for the 68 patients included had no relevant clinical difference between groups. T92 (sec) after tracheal extubation was 214 (168) vs. 248 (148) in the PP and SUC groups, respectively (P =0.44). In the PP and SUC groups, 50 and 43% reached a SpO2 <92% within the first 10mins after extubation respectively (P =0.73). There were no statistically significant differences between groups for any secondary endpoints. Conclusions Positive pressure extubation as compared with suctioning extubation did not seem to delay onset time of desaturation after GA in standard weight adult patients.

      PubDate: 2018-04-15T09:23:53Z
      DOI: 10.1016/j.accpm.2017.07.005
       
  • The evolution of diastolic function during liver transplantation
    • Authors: Pauline Devauchelle; Zoé Schmitt; Aurélie Bonnet; Serge Duperret; Jean-Paul Viale; Jean-Yves Mabrut; Frédéric Aubrun; Mathieu Gazon
      Pages: 155 - 160
      Abstract: Publication date: April 2018
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 2
      Author(s): Pauline Devauchelle, Zoé Schmitt, Aurélie Bonnet, Serge Duperret, Jean-Paul Viale, Jean-Yves Mabrut, Frédéric Aubrun, Mathieu Gazon
      Introduction The peroperative management of liver transplantation is still associated with many cardiocirculatory complications in which diastolic dysfunction may play a contributive role. Transoesophageal echocardiography is a monitoring device commonly used in liver transplantation allowing diastolic function assessment. Methods We prospectively analysed the peroperative transoesophageal echocardiography recordings of 40 patients undergoing liver transplantation in order to describe changes in diastolic function at different steps of the surgery. The diastolic function marker we used was the lateral mitral annulus motion (E’ wave velocity) obtained by tissue-Doppler imaging. In addition, we also studied the left ventricular filling pressure indices and systolic function. Results As a whole, there was no global change in E’ wave velocity throughout the surgery. However, 11 patients (27.5%) presented a decrease in E’ wave velocity up to 15% that identified an occurrence of diastolic function alteration. In this group, other peroperative data were not different from other patients (amount of bleeding, fluid administration or vasopressive support). Conversely, this group experienced lower preoperative E’ wave velocity values (9cm·s−1 versus 12cm·s−1, P =0.05) and an increased incidence of postoperative cardiorespiratory complications (OR=6 [1–56], P =0.02). Considering all patients, 18 patients had an E’ wave velocity under 10cm·s−1 at unclamping, characterizing a diastolic dysfunction according to the usual criteria. This dysfunction was not associated with cardiorespiratory complications. Conclusion This work investigated peroperative systematic echocardiographic evaluation of diastolic function during liver transplantation. Diastolic dysfunction occurs frequently during liver transplantation and could lead to postoperative cardiorespiratory complications.

      PubDate: 2018-04-15T09:23:53Z
      DOI: 10.1016/j.accpm.2016.09.009
       
  • Effect of sleep deprivation after a night shift duty on simulated crisis
           management by residents in anaesthesia. A randomised crossover study
    • Authors: Ségolène Arzalier-Daret; Clément Buléon; Marie-Laure Bocca; Pierre Denise; Jean-Louis Gérard; Jean-Luc Hanouz
      Pages: 161 - 166
      Abstract: Publication date: April 2018
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 37, Issue 2
      Author(s): Ségolène Arzalier-Daret, Clément Buléon, Marie-Laure Bocca, Pierre Denise, Jean-Louis Gérard, Jean-Luc Hanouz
      Background Sleep deprivation has been associated with an increased incidence of medical errors and can jeopardise patients’ safety during medical crisis management. The aim of the study was to assess the effect of sleep deprivation on the management of simulated anaesthesia crisis by residents in anaesthesiology. Methods A randomised, comparative, monocentric crossover study involving 48 residents in anaesthesia was performed on a high fidelity patient simulator. Each resident was evaluated in a sleep-deprived state (deprived group, after a night shift duty) and control state (control group, after a night of sleep). Performance was assessed through points obtained during crisis scenario 1 (oesophageal intubation followed by anaphylactic shock) and scenario 2 (anaesthesia-related bronchospasm followed by ventricular tachycardia). Sleep periods were recorded by actigraphy. Two independent observers assessed the performances. The primary endpoint of the study was the score obtained for each scenario. Results Resident's crisis management performance is associated with sleep deprivation (scenario 1: control=39 [33–42] points vs. deprived=26 [19–40] points, P =0.02; scenario 2: control=21 [17–24] vs. deprived=14 [12–19], P =0.01). The main errors observed were: error in drug administration and dose, delay in identification of hypotension, and missing communication with the surgical team about situation. Conclusions The present study showed that sleep deprivation is associated with impairment of performance to manage crisis situations by residents in anaesthesia.

      PubDate: 2018-04-15T09:23:53Z
      DOI: 10.1016/j.accpm.2017.05.010
       
  • Effect of fluid challenge on renal resistive index after major orthopaedic
           surgery: a prospective observational study using Doppler ultrasonography
    • Authors: Fabrice Ferré; Philippe Marty; Cédric Folcher; Matt Kurrek; Vincent Minville
      Abstract: Publication date: Available online 21 April 2018
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Fabrice Ferré, Philippe Marty, Cédric Folcher, Matt Kurrek, Vincent Minville
      Background A postoperative renal resistive index (RRI) > 0.70 has the best threshold to early predict acute kidney injury (AKI). The response of RRI to a postoperative fluid challenge (FC) is unknown. The aim of our study was to assess the impact of a FC on RRI in suspected hypovolaemia patients after orthopaedic surgery. Design In this single-centre observational study, we prospectively screened 156 patients in the recovery room after having undergone a hip or knee replacement. Interventions: Forty-six patients with a RRI > 0.70 and requiring FC were included. RRI and cardiac output (CO) were measured before and immediately after a fluid challenge with 500mL of isotonic saline. A decrease in RRI > 5% was considered significant (renal responders). Results Overall, FC resulted in a consistent decrease in RRI (from 0.74 [0.72 – 0.79] to 0.70 [0.68 – 0.73], p<0.01). Thirty-four patients (74%) showed a significant decrease in their RRI (from 0.74 [0.73 – 0.79] to 0.69 [0.67 – 0.72], p<0.05, versus non-responders: from 0.73 [0.72 – 0.75] to 0.72 [0.71 – 0.79], p=NS). CO increased equally among renal responders and non-responders (p=0.56). No correlation was found between changes in RRI and CO (r2=0.04; p=0.064). AKI was more common in renal non-responders (7/12) than in responders (3/34, p=0.001). Conclusions After major orthopaedic surgery, a FC can decrease RRI in suspected hypovolaemia patients at risk of postoperative AKI, but the changes are not correlated to changes in CO. Decreases in RRI were associated with better renal outcome.

      PubDate: 2018-04-25T08:19:52Z
      DOI: 10.1016/j.accpm.2018.04.008
       
  • Evaluation of locum tenens activity by young anaesthesiologists and
           intensivists: a national survey
    • Authors: Michael Thy; Jean Bardon; Hélène Carbonne
      Abstract: Publication date: Available online 20 April 2018
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Michael Thy, Jean Bardon, Hélène Carbonne


      PubDate: 2018-04-25T08:19:52Z
      DOI: 10.1016/j.accpm.2018.04.005
       
  • Brain death: bilateral pneumothorax and pneumoperitoneum after an apnOea
           test.
    • Authors: G. Thery; J. Rosman; G. Julien; F. Chaix; P. Mateu
      Abstract: Publication date: Available online 20 April 2018
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): G. Thery, J. Rosman, G. Julien, F. Chaix, P. Mateu


      PubDate: 2018-04-25T08:19:52Z
      DOI: 10.1016/j.accpm.2018.04.004
       
  • Clinical implications of intravenous drug incompatibilities in critically
           ill patients
    • Authors: Malik Benlabed; Maxime Perez; Romain Gaudy; Stéphanie Genay; Damien Lannoy; Christine Barthélémy; Pascal Odou; Gilles Lebuffe; Bertrand Décaudin
      Abstract: Publication date: Available online 19 April 2018
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Malik Benlabed, Maxime Perez, Romain Gaudy, Stéphanie Genay, Damien Lannoy, Christine Barthélémy, Pascal Odou, Gilles Lebuffe, Bertrand Décaudin
      Objective The aim of this review is to analyse the clinical consequences of intravenous drug incompatibilities in critically ill patients, especially the incidence of organ dysfunctions and mortality. Methods A review of literature was conducted according to the PRISMA statement in June 2017, using Medline, ISI Web of Science and Clinicaltrials.gov. Data extraction Eligible studies were case reports and randomised controlled trials (RCTs) that evaluated the effects of drug incompatibilities in critically ill patients on morbidity or mortality as primary or secondary outcomes, or adverse events. Two investigators independently reviewed the eligibility of the study from abstracts or manuscript data. Data synthesis Twelve articles met the selection criteria. The six articles reporting RCTs concern only four RCTs. RCTs were single-centre studies comparing infusion with or without filter. Two of them included adult patients. The others included paediatric and neonatal intensive care unit patients. Primary endpoints were SIRS, organ failure, overall complication rate, bacteraemia, sepsis, phlebitis and length of stay. The results are mixed with one RCT reporting a reduction in SIRS, organ failure and overall complication rate, two studies in disagreement over the occurrence of sepsis and one study reporting no impact on length of hospital stay. The six articles on case reports show different drug incompatibility situations. They report pulmonary toxicity. Conclusion Little data is available on this topic. Infused particles may induce organ failure, in particular pulmonary toxicity and SIRS. Further studies are needed to establish a link between the level of exposure to drug incompatibilities and clinical implication.

      PubDate: 2018-04-25T08:19:52Z
      DOI: 10.1016/j.accpm.2018.04.003
       
  • Comparison of Proaqt/Pulsioflex® and oesophageal Doppler for
           intraoperative haemodynamic monitoring during intermediate risk abdominal
           surgery
    • Authors: Grégoire Weil; Cyrus Motamed; Alexandre Eghiaian; Xavier Monnet; Stéphanie Suria
      Abstract: Publication date: Available online 18 April 2018
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Grégoire Weil, Cyrus Motamed, Alexandre Eghiaian, Xavier Monnet, Stéphanie Suria
      Objective To compare cardiac index (CI) between Proaqt/PulsioFlex® and esophageal Doppler (OD) and the ability of the PulsioFlex® to track CI changes induced by fluid challenge and secondly to assess the impact of the time interval between two auto-calibrations of PulsioFlex® on the accuracy of the measured CI. Methods In a single hospital, 49 intermediate-risk oncologic abdominal surgery patients were included in an observational study. We measured the cardiac Index (CI) provided by OD and by the Proaqt/PulsioFlex® before and after internal calibration, which were performed randomly at specific intervals after the initial one (30, 60, 90 and 120min). The ability to track fluid responsiveness was evaluated by measuring stroke volume variation, pulse pressure variation (PPV) and CI before and after a 250ml fluid challenge and assessed by a receiver operating characteristic curve analysis. Results The percentage of error before calibration was 51, 58, 82, 81% for 30, 60, 90 and 120min, they were 39, 57, 65, and 54% after calibration. Trending ability is assumed by a 93% concordance rate after applying a 15% exclusion zone. The trend interchangeability rate was 13.75%. The area under the curve for fluid responsiveness measured by PPV and SVV PulsioFlex were respectively 0.67 [0.57 – 0.77], P<0.01 and 0.75 [0.47 – 0.66], which was not clinically relevant. Conclusions The Proaqt/Pulsioflex® system is not equivalent to OD for haemodynamic monitoring during non-vascular abdominal surgery in intermediate-risk patients. More studies are required to define the effect of the auto-calibration on the system.

      PubDate: 2018-04-25T08:19:52Z
      DOI: 10.1016/j.accpm.2018.03.011
       
  • Perioperative glycaemic control
    • Authors: Jean-Charles Preiser
      Abstract: Publication date: Available online 18 April 2018
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Jean-Charles Preiser


      PubDate: 2018-04-25T08:19:52Z
      DOI: 10.1016/j.accpm.2018.04.007
       
  • The place of fibrinogen concentrates in the management of perioperative
           bleeding: a position paper from the Francophone Working Group on
           Perioperative Hemostasis (GIHP)
    • Authors: Charles Marc Samama; Brigitte Ickx; Yves Ozier; Annick Steib; Sophie Susen; Anne Godier
      Abstract: Publication date: Available online 13 April 2018
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Charles Marc Samama, Brigitte Ickx, Yves Ozier, Annick Steib, Sophie Susen, Anne Godier
      The consumption of fibrinogen concentrates has been increasing steadily for several years in surgery, trauma and obstetrics. However, data from the literature are conflicting. The French Working Group on Perioperative Haemostasis (GIHP) proposes a position paper based on a narrative review of the literature, and addresses the following questions: - What is the exact role of fibrinogen in haemostasis' - Which rational support for the use of perioperative fibrinogen' - Which thrombotic risk' - What are the most recent professional recommendations on the use of fibrinogen concentrates' Then, evidence-based recommendations are proposed: 1 - It is suggested not to administer prophylactic FC to prevent haemorrhage. 2 - It is suggested not to use FC alone. Haemostatic treatment must be comprehensive, include other haemostatic treatments and must be limited in cases of severe active haemorrhage. 3 - The GIHP suggests urgent measurement of fibrinogen plasma concentration in a biology laboratory or functional fibrinogen by viscoelastic methods. The choice between the two methods must be guided by the time to receive the results from a certified organisation with, in particular, authorisation to perform delocalised biologic examinations. 4 - It is suggested not to administer FC when the fibrinogen concentration is superior to 1.5g/L or when there is a functional fibrinogen deficit (with the possible exception in obstetrics where the threshold could be 2.0g/L). 5 - If FC are administered, an initial dose of 25-50mg/kg is proposed.

      PubDate: 2018-04-15T09:23:53Z
      DOI: 10.1016/j.accpm.2018.04.002
       
  • Ultrasound-guided bilateral erector spinae block could provide effective
           postoperative analgesia in laparoscopic cholecystectomy in paediatric
           patients
    • Authors: Can Aksu; Yavuz Gürkan
      Abstract: Publication date: Available online 6 April 2018
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Can Aksu, Yavuz Gürkan


      PubDate: 2018-04-15T09:23:53Z
      DOI: 10.1016/j.accpm.2018.03.008
       
  • The Efficacy of Ultrasound-guided Type-I and Type-II Pectoral Nerve Blocks
           for Postoperative Analgesia after Breast Augmentation: A Prospective,
           Randomised Study
    • Authors: Omer Karaca; Huseyin U. Pınar; Enver Arpacı; Rafi Dogan; Oya Y. Cok; Ali Ahiskalioglu
      Abstract: Publication date: Available online 5 April 2018
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Omer Karaca, Huseyin U. Pınar, Enver Arpacı, Rafi Dogan, Oya Y. Cok, Ali Ahiskalioglu
      Purpose The present study was planned to evaluate the efficacy and safety of ultrasound-guided Pecs I and II blocks for postoperative analgesia after sub-pectoral breast augmentation. Methods Fifty-four adult female patients undergoing breast augmentation were randomly divided into two groups: the control group (Group C, n = 27) who were not subjected to block treatment and Pecs group (Group P, n = 27) who received Pecs I (bupivacain 0.25%, 10mL) and Pecs II (bupivacain 0.25%, 20mL) block. Patient-controlled fentanyl analgesia was used for postoperative pain relief in both groups, and the patients were observed for the presence of any block-related complications. Results The 24-h fentanyl consumption was lesser in Group P [mean ± SD,378.7±54.0μg and 115.7±98.1μg, respectively; p < 0.001]. VAS scores in Group P were significantly lower at the time of admission to the post-anaesthetic care unit and at 1,2,4,8,12, and 24h (p< 0.001). The rates of nausea and vomiting were higher in Group C than in Group P (9 vs 2, p= 0.018). Hospital stay duration was shorter in Group P than in Group C (24.4±1.2h vs 27.0±3.1h, p< 0.001). No block-related complications were recorded. Conclusions Combine used of Pecs I and II blocks provide superior postoperative analgesia in patients undergoing breast augmentation and shortens hospital stay.

      PubDate: 2018-04-15T09:23:53Z
      DOI: 10.1016/j.accpm.2018.03.009
       
  • Transverse subglottic diameter assessment in the third gestation
           trimester: preeclampsia versus control
    • Authors: Olivier Belin; Fabien Espitalier; Francis Remerand; Franck Perrotin; Marc Laffon
      Abstract: Publication date: Available online 5 April 2018
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Olivier Belin, Fabien Espitalier, Francis Remerand, Franck Perrotin, Marc Laffon


      PubDate: 2018-04-15T09:23:53Z
      DOI: 10.1016/j.accpm.2018.03.010
       
  • How can we best organise communication with patients’ families'
    • Authors: Jean-Pierre Quenot; Nicolas Meunier-Beillard; Fiona Ecarnot; Auguste Dargent; Jean-Philippe Rigaud
      Abstract: Publication date: Available online 22 March 2018
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Jean-Pierre Quenot, Nicolas Meunier-Beillard, Fiona Ecarnot, Auguste Dargent, Jean-Philippe Rigaud


      PubDate: 2018-04-15T09:23:53Z
      DOI: 10.1016/j.accpm.2018.03.003
       
  • ExtraCorporeal Life support for refractory cardiogenic shock: “An
           efficient system support of peripheral organs more than real ventricular
           assist device…”
    • Authors: Alexandre Ouattara; Alain Rémy; Astrid Quessard
      Abstract: Publication date: Available online 22 March 2018
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Alexandre Ouattara, Alain Rémy, Astrid Quessard


      PubDate: 2018-04-15T09:23:53Z
      DOI: 10.1016/j.accpm.2018.03.004
       
  • Spinal anaesthesia: What is old' What are the new trends'
    • Authors: Philippe Cuvillon; Issam Tanoubi
      Abstract: Publication date: Available online 22 March 2018
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Philippe Cuvillon, Issam Tanoubi


      PubDate: 2018-04-15T09:23:53Z
      DOI: 10.1016/j.accpm.2018.03.006
       
  • Tracheotomy in the intensive care unit: Guidelines from a French expert
           panel: The French Intensive Care Society and the French Society of
           Anaesthesia and Intensive Care Medicine
    • Authors: Jean-Louis Trouillet; Olivier Collange; Fouad Belafia; François Blot; Gilles Capellier; Eric Cesareo; Jean-Michel Constantin; Alexandre Demoule; Jean-Luc Diehl; Pierre-Grégoire Guinot; Franck Jegoux; Erwan L’Her; Charles-Edouard Luyt; Yazine Mahjoub; Julien Mayaux; Hervé Quintard; François Ravat; Sébastien Vergez; Julien Amour; Max Guillot; Max Quillot; Olivier Collange
      Abstract: Publication date: Available online 17 March 2018
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Jean-Louis Trouillet, Olivier Collange, Fouad Belafia, François Blot, Gilles Capellier, Eric Cesareo, Jean-Michel Constantin, Alexandre Demoule, Jean-Luc Diehl, Pierre-Grégoire Guinot, Franck Jegoux, Erwan L’Her, Charles-Edouard Luyt, Yazine Mahjoub, Julien Mayaux, Hervé Quintard, François Ravat, Sébastien Vergez, Julien Amour, Max Guillot
      Tracheotomy is widely used in intensive care units, albeit with great disparities between medical teams in terms of frequency and modality. Indications and techniques are, however, associated with variable levels of evidence based on inhomogeneous or even contradictory literature. Our aim was to conduct a systematic analysis of the published data in order to provide guidelines. We present herein recommendations for the use of tracheotomy in adult critically ill patients developed using the grading of recommendations assessment, development and evaluation (GRADE) method. These guidelines were conducted by a group of experts from the French Intensive Care Society (Société de réanimation de langue française) and the French Society of Anesthesia and Intensive Care Medicine (Société francaise d’anesthésie réanimation) with the participation of the French Emergency Medicine Association (Société française de médecine d’urgence), the French Society of Otorhinolaryngology. Sixteen experts and two coordinators agreed to consider questions concerning tracheotomy and its practical implementation. Five topics were defined: indications and contraindications for tracheotomy in intensive care, tracheotomy techniques in intensive care, modalities of tracheotomy in intensive care, management of patients undergoing tracheotomy in intensive care, and decannulation in intensive care. The summary made by the experts and the application of GRADE methodology led to the drawing up of 8 formal guidelines, 10 recommendations, and 3 treatment protocols. Among the 8 formal guidelines, 2 have a high level of proof (Grade 1±) and 6 a low level of proof (Grade 2±). For the 10 recommendations, GRADE methodology was not applicable and instead 10 expert opinions were produced.

      PubDate: 2018-03-19T14:30:43Z
      DOI: 10.1016/j.accpm.2018.02.012
       
 
 
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