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Publisher: Elsevier   (Total: 3043 journals)

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Showing 1 - 200 of 3043 Journals sorted alphabetically
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 20, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 18, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 83, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 23, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 27, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 331, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 25, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 1)
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 211, 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: 9, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription   (Followers: 1)
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 23, 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: 4)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 4, SJR: 0.383, h-index: 19)
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Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 4, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 3)
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: 5)
Additive Manufacturing     Hybrid Journal   (Followers: 8, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 20)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 128, 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: 9, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 25, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 3)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 6, 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: 16, 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: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 25, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
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: 24, 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: 18, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 16, SJR: 0.223, h-index: 22)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 4)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 22)
Advances in Ecological Research     Full-text available via subscription   (Followers: 41, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 25, 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: 40, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 8)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 47, 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: 11)
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: 8, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 25)
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: 35, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 5)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 4)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 16, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, 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: 22)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
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: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 3)
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: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, 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: 13)
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: 7, 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: 8)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 4)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 19, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 60)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 5, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 2, SJR: 0.1, h-index: 2)
Advances in Space Research     Full-text available via subscription   (Followers: 343, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 8)
Advances in Surgery     Full-text available via subscription   (Followers: 7, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 30, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 15)
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: 43, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 5, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 307, 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: 5, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 8, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 405, 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: 30, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 38, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 1)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 53, 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: 5, 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: 9, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 6)
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  
Algal Research     Partially Free   (Followers: 8, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 3)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 4, SJR: 0.776, h-index: 35)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 7, 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: 5)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 3)
American Heart J.     Hybrid Journal   (Followers: 48, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 45, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 38, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 6, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 16, 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: 24, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 33, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 46, 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: 191, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 54, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 3)
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: 23, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 26, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 21, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 34, 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: 5)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 55, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 10)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, 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: 2, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 38, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 162, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 8, 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  
Animal Behaviour     Hybrid Journal   (Followers: 157, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)
Animal Reproduction Science     Hybrid Journal   (Followers: 5, SJR: 0.711, h-index: 78)
Annales d'Endocrinologie     Full-text available via subscription   (Followers: 1, SJR: 0.394, h-index: 30)
Annales d'Urologie     Full-text available via subscription  
Annales de Cardiologie et d'Angéiologie     Full-text available via subscription   (SJR: 0.177, h-index: 13)
Annales de Chirurgie de la Main et du Membre Supérieur     Full-text available via subscription  
Annales de Chirurgie Plastique Esthétique     Full-text available via subscription   (Followers: 2, SJR: 0.354, h-index: 22)
Annales de Chirurgie Vasculaire     Full-text available via subscription   (Followers: 1)

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Journal Cover Anaesthesia Critical Care & Pain Medicine
  [10 followers]  Follow
    
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   ISSN (Online) 2352-5568
   Published by Elsevier Homepage  [3043 journals]
  • Postoperative neurosurgery complication in 2017: A new window to take into
           account surgical ischaemic events
    • Authors: C. Bombled; A. André; A. Jacquens; F. Clarençon; V. Degos
      Pages: 203 - 204
      Abstract: Publication date: August 2017
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 36, Issue 4
      Author(s): C. Bombled, A. André, A. Jacquens, F. Clarençon, V. Degos


      PubDate: 2017-08-09T13:18:45Z
      DOI: 10.1016/j.accpm.2017.07.001
       
  • Residual anxiety after high fidelity simulation in anaesthesiology: An
           observational, prospective, pilot study
    • Authors: Jean-Noël Evain; Lana Zoric; Laurent Mattatia; Olivier Picard; Jacques Ripart; Philippe Cuvillon
      Pages: 205 - 212
      Abstract: Publication date: August 2017
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 36, Issue 4
      Author(s): Jean-Noël Evain, Lana Zoric, Laurent Mattatia, Olivier Picard, Jacques Ripart, Philippe Cuvillon
      Background High fidelity simulation (HFS) in anaesthesiology intentionally provides stress on students, but anxiety may be detrimental if it goes on through debriefing. The primary goal of this study was to estimate the proportion of students with significant anxiety remaining after debriefing (residual anxiety [RA]). Secondary goals were to evaluate the instructors’ ability to estimate students’ RA and to identify potential risk factors for high RA. Subjects and methods Following IRB approval and informed consent, data from a cohort of subjects were prospectively collected by an independent expert. State-anxiety after debriefing (RA) was prospectively measured using the State-Trait Anxiety Inventory (a score varying from 20 to 80/80). RA was considered significant when≥36/80. Instructors simultaneously estimated the levels of subjects’ RA via a visual analogue scale. Data about subjects, stress during scenarios (including continuous heart rate monitoring), and debriefings (including DASH© quality scores) were also collected. Results Seventy study subjects (30 residents, 26 nurses and 14 anaesthetists) were enrolled during 52 HFS sessions. As concerns the primary endpoint, RA was≥36/80 in 15 subjects (21%; 95% CI: 13–32). The median RA was 30/80 [25–35]. For secondary endpoints, the instructors’ estimations poorly correlated with measurements: rho=0.36 (P <0.01); limits of agreement: –16 and 22. Subjects with RA≥36/80 had significantly higher trait-anxiety (P <0.01). An easy scenario (P =0.04) and low quality debriefing (P =0.04) were associated with higher RAs. Conclusion Most students experienced low anxiety after debriefing. Instructors seem to be unable to reliably estimate students’ RA. Students with an anxious personality are more likely to be anxious after debriefing.

      PubDate: 2017-08-09T13:18:45Z
      DOI: 10.1016/j.accpm.2016.09.008
       
  • Postoperative complications after craniotomy for brain tumor surgery
    • Authors: Laurent Lonjaret; Marine Guyonnet; Emilie Berard; Marc Vironneau; Françoise Peres; Sandrine Sacrista; Anne Ferrier; Véronique Ramonda; Corine Vuillaume; Franck-Emmanuel Roux; Olivier Fourcade; Thomas Geeraerts
      Pages: 213 - 218
      Abstract: Publication date: August 2017
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 36, Issue 4
      Author(s): Laurent Lonjaret, Marine Guyonnet, Emilie Berard, Marc Vironneau, Françoise Peres, Sandrine Sacrista, Anne Ferrier, Véronique Ramonda, Corine Vuillaume, Franck-Emmanuel Roux, Olivier Fourcade, Thomas Geeraerts
      Introduction After elective craniotomy for brain tumour surgery, patients are usually admitted to an intensive care unit (ICU) for monitoring. Our goal was to evaluate the incidence and timing of neurologic and non-neurologic postoperative complications after brain tumour surgery, to determine factors associated with neurologic events and to evaluate the timing and causes of ICU readmission. Patients and methods This prospective, observational and analytic study enrolled 188 patients admitted to the ICU after brain tumour surgery. All postoperative clinical events during the first 24hours were noted and classified. Readmission causes and timing were also analysed. Results Twenty-one (11%) of the patients were kept sedated after surgery; the remaining 167 patients were studied. Thirty one percent of the patients presented at least one complication (25% with postoperative nausea and vomiting (PONV), 16% with neurologic complications). The occurrence of neurological complications was significantly associated with the absence of preoperative motor deficit and the presence of higher intraoperative bleeding. Seven patients (4%) were readmitted to the ICU after discharge; 43% (n =3) of them had a posterior fossa surgery. Conclusion Postoperative complications, especially PONV, are frequent after brain tumour surgery. Moreover, 16% of patients presented a neurological complication, probably justifying the ICU postoperative stay for early detection. The absence of preoperative motor deficit and intraoperative bleeding seems to predict postoperative neurologic complications. Finally, patients may present complications after ICU discharge, especially patients with fossa posterior surgery, suggesting that ICU hospitalization may be longer in this type of surgery.

      PubDate: 2017-08-09T13:18:45Z
      DOI: 10.1016/j.accpm.2016.06.012
       
  • Bicarbonate-buffered ropivacaine-mepivacaine solution for medial caruncle
           anaesthesia
    • Authors: Gilles Guerrier; David Boutboul; Cédric Chanat; Charles Marc Samama; Christophe Baillard
      Pages: 219 - 221
      Abstract: Publication date: August 2017
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 36, Issue 4
      Author(s): Gilles Guerrier, David Boutboul, Cédric Chanat, Charles Marc Samama, Christophe Baillard
      Background To compare self-reported pain during injection of plain versus alkalinised 0.75% ropivacaine–2% mepivacaine solution for anaesthesia performed at the medial caruncle site for eye surgery. Methods This prospective, monocentric, double blind, randomised, controlled trial involved 40 consecutive patients who received either a standard local anaesthetic solution (0.75% ropivacaine 5ml and 2% mepivacaine 5ml with a pH of 5.9), or an alkalinised solution composed with a pH-adjusted solution of 7.0 through adjunction of 0.15mEq sodium bicarbonate per 10ml of the same mixture. Before anaesthesia, patients received intravenous midazolam (0.03mg/kg) to ease potential anxiety. During injection performed at the medial caruncle site, patients were asked to grade a pain VRS (0 to 10) for the injection using a verbal analogue scale. The primary end point was to investigate pain during injection of local anaesthetics. Results Anxiety levels before anaesthesia were low and similar for both groups. The mean pain score for the alkalinised group was significantly reduced compared to the control group (6 [25–75%, IQR 4–9] versus 3 [25–75%, IQR 1–5]; P =0.02; 95% CI for the difference in median pain scores [1.9–3.3]). Conclusion Buffering local anaesthetics used in caruncular injection for eye surgery significantly reduces pain during injection. This simple strategy should be tested in routine clinical practice to improve patient satisfaction.

      PubDate: 2017-08-09T13:18:45Z
      DOI: 10.1016/j.accpm.2016.09.007
       
  • Burnout syndrome in critical care team members: A monocentric cross
           sectional survey
    • Authors: Stéphanie Malaquin; Yazine Mahjoub; Arianna Musi; Elie Zogheib; Alexis Salomon; Mathieu Guilbart; Hervé Dupont
      Pages: 223 - 228
      Abstract: Publication date: August 2017
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 36, Issue 4
      Author(s): Stéphanie Malaquin, Yazine Mahjoub, Arianna Musi, Elie Zogheib, Alexis Salomon, Mathieu Guilbart, Hervé Dupont
      Introduction There has been a growing interest in evaluating the occurrence of burnout syndrome (BOS) among intensive care units (ICU) team over recent years. The aims of this study were to determine the prevalence of BOS among staff working in the Amiens University Hospital and to assess associated factors. Patients and methods Prospective observational study based on self-administered questionnaires filled in by physicians and non-physicians working in 3 ICUs. Demographic data, well-being assessment, work relationships, level of BOS and depressive symptoms were investigated. Logistic regression analysis was performed to identify variables independently associated with BOS. Results One hundred and sixty-one questionnaires were analysed. Participation rate was 90%. Thirty-two respondents were physicians and 129 were non-physicians. The prevalence of BOS was 51% and was not significantly different between physicians and non-physicians (56% versus 50%; P =0.501). Respondents who reported BOS less frequently had regular leisure activities (54 [66%] versus 70 [87%], P =0.001). In the BOS group, well-being was significantly lower (4.8±2.5/10 versus 6±2/10, P =0.001), a desire to leave the job was more frequently expressed (50 [61%] versus 32 [40%], P =0.009) and depressive symptoms were significantly more frequent (41 [50%] versus 21 [27%], P =0.002). Factors independently associated with BOS were regular leisure activities (OR 0.24 [0.1–0.59]; P =0.002), the presence of depressive symptoms (OR 2.71 [1.26–5.84]; P =0.011) and a well-being visual analogue scale≥5 (OR 0.40 [0.18–0.89]; P =0.024). Conclusions BOS affects all ICU workers and is determined by multiple factors. Leisure activities and measures designed to improve well-being should be promoted.

      PubDate: 2017-08-09T13:18:45Z
      DOI: 10.1016/j.accpm.2016.06.011
       
  • A targeted remifentanil administration protocol based on the analgesia
           nociception index during vascular surgery
    • Authors: Georges Daccache; Edouard Caspersen; Michel Pegoix; Kelly Monthé-Sagan; Ludovic Berger; Dominique Fletcher; Jean-Luc Hanouz
      Pages: 229 - 232
      Abstract: Publication date: August 2017
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 36, Issue 4
      Author(s): Georges Daccache, Edouard Caspersen, Michel Pegoix, Kelly Monthé-Sagan, Ludovic Berger, Dominique Fletcher, Jean-Luc Hanouz
      Background The intraoperative modulation of opioids continues to be based on clinical signs. This may result in adverse events such as sympathetic reactivity or opioid-induced hyperalgesia. Recently, the Analgesia/Nociception Index (ANI), a non-invasive 0–100 index derived from heart rate variability analysis, has been proposed for nociception assessment. However, the ability of the ANI to adequately guide intraoperative opioid administration has never been demonstrated. We designed a prospective study to evaluate the ability of the ANI to guide remifentanil administration in vascular surgery. Methods One hundred and eighty adults presenting for elective surgery were included. All received total intravenous anaesthesia with propofol adjusted to entropy and remifentanil adjusted to the ANI. The primary endpoint was the number of patients without any episode of reactivity defined as a 20% increase in heart rate or arterial pressure or the occurrence of movement. Secondary endpoints included opioid use and maximal pain rate in the first postoperative day. Results Anaesthesia was achieved without any episode of reactivity in 160 (89%) patients. Twenty-five episodes of reactivity occurred in 20 (11%) patients. The median remifentanil dose was 0.042 [0.040–0.044]μg.kg− 1.min−1. At 24hours, the maximal NRS pain score was 2 [2,3]. One hundred and fifty-five patients (86%) did not receive any postoperative opioids, whereas 25 (14%) received a median dose of 5[5–10] mg of oxycodone. Conclusion This prospective study demonstrated that the ANI can be used to adequately guide intraoperative remifentanil administration during vascular surgery. Such guidance resulted in low remifentanil consumption, low postoperative pain rates and low opioid rescue analgesia.

      PubDate: 2017-08-09T13:18:45Z
      DOI: 10.1016/j.accpm.2016.08.006
       
  • Large vein injection alleviates rocuronium-induced pain in gynaecologic
           patients
    • Authors: Xing-Mei Zhang; Qun Wang; Wei-Si Wang; Meng Wang
      Pages: 233 - 235
      Abstract: Publication date: August 2017
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 36, Issue 4
      Author(s): Xing-Mei Zhang, Qun Wang, Wei-Si Wang, Meng Wang
      Background Rocuronium-induced pain upon injection is very common in the clinical setting. Using the antecubital rather than the hand vein can avoid pain due to propofol injection. We aimed to investigate whether the use of the antecubital vein for injection would alleviate rocuronium-induced pain in a similar fashion. Methods Sixty patients (ASA classes I and II) scheduled for gynaecologic laparoscopy were randomised into two groups. Rocuronium (0.6mg/kg) was injected either into the vein on the dorsum of the hand (group D) or a large vein in the antecubital fossa (group A). Pain was assessed and recorded using a four-point scale. Results Compared with group D, the incidence of pain and severe pain was lower in group A patients. The rate of no pain was also higher in group A patients. Conclusion The incidence and severity of rocuronium-induced injection pain were significantly alleviated via use of a large vein for rocuronium injection.

      PubDate: 2017-08-09T13:18:45Z
      DOI: 10.1016/j.accpm.2016.03.010
       
  • A trans-atlantic high-fidelity mannequin based telesimulation experience
    • Authors: Anne Beissel; Marc Lilot; Christian Bauer; Keith Beaulieu; Christopher Hanacek; Olivier Desebbe; Maxime Cannesson; Jean-Jacques Lehot; Cameron Ricks
      Pages: 239 - 241
      Abstract: Publication date: August 2017
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 36, Issue 4
      Author(s): Anne Beissel, Marc Lilot, Christian Bauer, Keith Beaulieu, Christopher Hanacek, Olivier Desebbe, Maxime Cannesson, Jean-Jacques Lehot, Cameron Ricks


      PubDate: 2017-08-09T13:18:45Z
      DOI: 10.1016/j.accpm.2016.09.006
       
  • Comparison of learning outcomes between learning roles (spectator and
           actor) during an immersive simulation
    • Authors: Antonia Blanié; Philippe Roulleau; Claire Mengelle; Dan Benhamou
      Pages: 243 - 244
      Abstract: Publication date: August 2017
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 36, Issue 4
      Author(s): Antonia Blanié, Philippe Roulleau, Claire Mengelle, Dan Benhamou


      PubDate: 2017-08-09T13:18:45Z
      DOI: 10.1016/j.accpm.2016.09.005
       
  • Cheyne-Stokes respiration: Implications for anaesthesiologists
    • Authors: Philippe Ariès; Marc Danguy des Déserts; Ba Vinh Nguyen; Mehdi Ould-Ahmed
      Pages: 245 - 246
      Abstract: Publication date: August 2017
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 36, Issue 4
      Author(s): Philippe Ariès, Marc Danguy des Déserts, Ba Vinh Nguyen, Mehdi Ould-Ahmed


      PubDate: 2017-08-09T13:18:45Z
      DOI: 10.1016/j.accpm.2016.11.004
       
  • Burnout among French anaesthetists and intensivists: Adequate progress is
           still lacking
    • Authors: Georges Mion; Kani Boiguile; Annick Bidou; Marion Limare
      Pages: 247 - 248
      Abstract: Publication date: August 2017
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 36, Issue 4
      Author(s): Georges Mion, Kani Boiguile, Annick Bidou, Marion Limare


      PubDate: 2017-08-09T13:18:45Z
      DOI: 10.1016/j.accpm.2017.02.004
       
  • A pilot study of mechanical chest compression with the LifeLine ARM device
           during simulated cardiopulmonary resuscitation
    • Authors: Jolanta Majer; Jaroslaw Kedziora; Marcin Madziala
      First page: 249
      Abstract: Publication date: August 2017
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 36, Issue 4
      Author(s): Jolanta Majer, Jaroslaw Kedziora, Marcin Madziala


      PubDate: 2017-08-09T13:18:45Z
      DOI: 10.1016/j.accpm.2017.01.007
       
  • Saving money: An ideal driver for improved perioperative care'
    • Authors: T.E.F. Abbott; R.M. Pearse
      Pages: 147 - 148
      Abstract: Publication date: June 2017
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 36, Issue 3
      Author(s): T.E.F. Abbott, R.M. Pearse


      PubDate: 2017-06-24T08:26:51Z
      DOI: 10.1016/j.accpm.2017.01.006
       
  • Are capillary and arterial lactates interchangeable'
    • Authors: François Dépret; Matthieu Legrand
      First page: 149
      Abstract: Publication date: June 2017
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 36, Issue 3
      Author(s): François Dépret, Matthieu Legrand


      PubDate: 2017-06-24T08:26:51Z
      DOI: 10.1016/j.accpm.2017.04.001
       
  • Evaluation of financial burden following complications after major surgery
           in France: Potential return after perioperative goal-directed therapy
    • Authors: Alain Landais; Morgane Morel; Jacques Goldstein; Jerôme Loriau; Annie Fresnel; Corinne Chevalier; Gilles Rejasse; Pascal Alfonsi; Claude Ecoffey
      Pages: 151 - 155
      Abstract: Publication date: June 2017
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 36, Issue 3
      Author(s): Alain Landais, Morgane Morel, Jacques Goldstein, Jerôme Loriau, Annie Fresnel, Corinne Chevalier, Gilles Rejasse, Pascal Alfonsi, Claude Ecoffey
      Objective Perioperative goal-directed therapy (PGDT) has been demonstrated to improve postoperative outcomes and reduce the length of hospital stays. The objective of our analysis was to evaluate the cost of complications, derived from French hospital payments, and calculate the potential cost savings and length of hospital stay reductions. Methods The billing of 2388 patients who underwent scheduled high-risk surgery (i.e. major abdominal, gynaecologic, urological, vascular, and orthopaedic interventions) over three years was retrospectively collected from three French hospitals (one public-teaching, one public, and one private hospital). A relationship between mortality, length of hospital stays, cost/patient, and severity scores, based mainly on postoperative complications but also on preoperative clinical status, were analysed. Statistical analysis was performed using Student's t-tests or Wilcoxon tests. Results Our analyses determined that a severity score of 3 or 4 was associated with complications in 90% of cases and this represented 36% of patients who, compared with those with a score of 1 or 2, were associated with significantly increased costs (€ 8205±3335 to € 22,081±16,090; P <0.001, delta of € 13,876) and a prolonged length of hospital stay (mean of 10 to 27 days; P <0.001, delta of 17 days). According to estimates for complications avoided by PGDT, there was a projected reduction in average healthcare costs of between € 854 and € 1458 per patient and a reduction in total hospital bed days from 1755 to 4423 over three years. Based on French National data (47,000 high risk surgeries per year), the potential financial savings ranged from € 40M to € 68M, not including the costs of PGDT and its implementation. Conclusion Our analysis demonstrates that patients with complications are significantly more expensive to care for than those without complications. In our model, it was projected that implementing PGDT during high-risk surgery may significantly reduce healthcare costs and the length of hospital stays in France while probably improving patient access to care and reducing waiting times for procedures.

      PubDate: 2017-06-24T08:26:51Z
      DOI: 10.1016/j.accpm.2016.11.006
       
  • Comparison of capillary and arterial lactate levels in patients with shock
    • Authors: Olivier Collange; Vincent Garcia; Michel Kindo; Nicolas Meyer; Thomas Lavaux; Paul Michel Mertes; Girish P. Joshi; Pierre Diemunsch
      Pages: 157 - 162
      Abstract: Publication date: June 2017
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 36, Issue 3
      Author(s): Olivier Collange, Vincent Garcia, Michel Kindo, Nicolas Meyer, Thomas Lavaux, Paul Michel Mertes, Girish P. Joshi, Pierre Diemunsch
      Objective Several guidelines recommend point-of-care lactate measurements for therapeutic decision-making in patients with shock. The aim of the study was to validate capillary lactate measurements with a bedside micromethod in patients with shock. Study design Prospective observational study. Patients and measurements Capillary lactate levels measured by a micromethod (CAPI) and arterial lactate levels measured by a standard laboratory method (ARTs) were simultaneously and repeatedly assayed in consecutive ICU patients with shock. The validity and clinical acceptability of the CAPI method was assessed from its reproducibility, the arterio-capillary lactate difference (ACLD) and conventional diagnostic indicators. Main results Lactate measurements were available for 139 time-points in 37 patients. CAPI values correlated well with ARTs values (intraclass coefficient correlation: r2 =0.92, P <0.001). CAPI had a sensitivity of 98%, a specificity of 36%, an accuracy of 88% and a positive predictive value of 89% to detect lactate values≥2mmol/L (P <0.0001). The mean bias between the two methods (ACLD: 0.56±2.21mmol/L) was mainly due to higher lactate concentration in capillary blood. Conclusion CAPI was correctly correlated to ARTs. The bias between the two methods is probably acceptable for triage purpose. Patients with elevated capillary lactate or in shock should be monitored with atrial-based lactate.

      PubDate: 2017-06-24T08:26:51Z
      DOI: 10.1016/j.accpm.2016.08.007
       
  • Postoperative complications following neonatal and infant surgery: Common
           events and predictive factors
    • Authors: Daphné Michelet; Christopher Brasher; Houssam Ben Kaddour; Thierno Diallo; Rachida Abdat; Serge Malbezin; Arnaud Bonnard; Souhayl Dahmani
      Pages: 163 - 169
      Abstract: Publication date: June 2017
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 36, Issue 3
      Author(s): Daphné Michelet, Christopher Brasher, Houssam Ben Kaddour, Thierno Diallo, Rachida Abdat, Serge Malbezin, Arnaud Bonnard, Souhayl Dahmani
      Background Data on major non-surgical postoperative complications following neonatal and infant surgery is lacking. The goal of the present study was to describe common major complications and their predictive factors. Material and methods The study consisted of a retrospective review of medical charts of patients less than 6months of age operated in our institution over one calendar year, excluding herniorraphy surgery. The data collected included demographics, preoperative ICU bed status, ASA status, a history of cardiac malformation, hyaline membrane disease (HMD) or necrotizing enterocolitis (NEC), preoperative haemoglobin, emergent surgery status, surgery type and duration, duration of anaesthesia and the need for intraoperative fluid boluses. Complications were analysed until the 30th postoperative day. Analyses included descriptive statistics and the determination of factors associated with non-surgical complications using univariate and multivariate statistics. Results The study included 168 patients. Their postnatal age was 48±48days. Overall, 37 patients experienced major postoperative non-surgical complications. The most common major complications were haemodynamic compromise (n =19, 11.3%), multiple organ dysfunction syndrome (MODS, n =8, 4.8%) and respiratory failure requiring ventilation (n =3, 1.8%). Surgical complications occurred in 8 cases (4.8%). Four factors were identified as being predictive of non-surgical complications: PCA<40 weeks, a history of cardiac malformation, HMD or NEC, preoperative ICU status and intraoperative fluid bolus administration. Conclusion This study describes common non-surgical postoperative complications in neonates and infants, and their risk factors. They were much more common than surgical complications. Further studies should focus on preventive strategies addressing these complications.

      PubDate: 2017-06-24T08:26:51Z
      DOI: 10.1016/j.accpm.2016.05.012
       
  • What are the factors associated with successful I-gel™ insertion and
           uneventful anaesthesia in children under age two'
    • Authors: Cécile Magne; Vincent Pichenot; Péan Didier; Luc Bérard; Corinne Lejus-Bourdeau
      Pages: 171 - 177
      Abstract: Publication date: June 2017
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 36, Issue 3
      Author(s): Cécile Magne, Vincent Pichenot, Péan Didier, Luc Bérard, Corinne Lejus-Bourdeau
      Background Our purpose was to evaluate I-gel™ sizes 1 and 1.5. Methods I-gel™ insertion was attempted in 60 children<2 years of age undergoing short elective surgery. The main endpoints were the determination of independent factors associated with successful first attempt insertion and those associated with uneventful anaesthesia (i.e. no adverse events during insertion or during the intraoperative period of removal). Results Size 1 and size 1.5 I-gel™ devices were used (intraoperatively) in 33 and 27 cases, respectively. Median age and weight were 3 (1–12) months and 4.97 (4.00–9.00) kg. Ventilation modes were spontaneous breathing (8.3%), pressure support (45%), controlled pressure (15%) or volume (31.7%) ventilation. I-gel™ insertion was successful on the first attempt in 45 cases (75%). A time between induction and insertion>11min (OR: 4.85 [1.08–21.77]) and age<6 months (OR: 5.501 [1.20–16.8]) were identified as the independent factors of successful first attempt insertion (AUC: 0.715). Adverse events were reported in 35 (58.3%) cases, during insertion in 18 (30%) cases, during the intraoperative period in 25 (41.7%) cases and/or during recovery in 3 (5.08%) cases. Age<6 months (OR: 4.497 [1.197–16.89]) and I-gel™ removal in the operating room (OR: 6.034 [1.153–31.577]) were identified as independent factors associated with uneventful anaesthesia (AUC: 0.761). Conclusion I-gel™ sizes 1 and 1.5 were interesting alternatives to intubation with all ventilation modes. However, the high incidence of adverse events calls for careful monitoring. The superiority of removal under anaesthesia must be confirmed.

      PubDate: 2017-06-24T08:26:51Z
      DOI: 10.1016/j.accpm.2016.07.003
       
  • Predicting postoperative morphine consumption in children
    • Authors: Vilnis Silins; Christopher Brasher; Freedom Antus; Daphné Michelet; Julie Hilly; Robert Grace; Souhayl Dahmani
      Pages: 179 - 184
      Abstract: Publication date: June 2017
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 36, Issue 3
      Author(s): Vilnis Silins, Christopher Brasher, Freedom Antus, Daphné Michelet, Julie Hilly, Robert Grace, Souhayl Dahmani
      Background Morphine is the most commonly used postoperative analgesic for moderate to severe pain in paediatric patients, but there is little research into predictive factors correlating with postoperative morphine consumption. Methods All patients undergoing surgery who received morphine postoperatively over eight months were prospectively enrolled. Data analysed included total morphine consumption to day 3, age, weight, type of surgery, ASA status, preoperative opioid administration, predicted postoperative pain intensity (according to French Society of Anaesthesiology and Intensive Care classification) and surgery duration. Two cohorts were constructed: the first over 6months to construct a statistical model and the second over 2months to validate the model. ANOVA univariate analyses and multivariate linear analysis were performed. Results One hundred and fifty-three patients were included in the construct cohort and 40 in the validation cohort. Multivariate analysis demonstrated that total morphine consumption through postoperative day 3 was independently increased by a decreased age, female gender, an increased duration of surgery and an increased morphine titration in PACU. Overall, the model explained 57% of morphine requirement variability. When the model was applied to the validation cohort, a significant correlation was demonstrated between observed and predicted values: r =0.67, P <0.0001. Conclusion Age, gender, duration of surgery and doses of titrated morphine in PACU proved to be strong predictors of postoperative morphine consumption by day 3 during paediatric surgery. Knowledge of such factors may help clinicians to better manage postoperative pain in children.

      PubDate: 2017-06-24T08:26:51Z
      DOI: 10.1016/j.accpm.2016.08.005
       
  • The risk of atrial fibrillation after pneumonectomy is not impaired by
           preoperative administration of dexamethasone. A cohort study
    • Authors: Sacha Rozencwajg; Carole Desthieux; Olga Szymkiewicz; Yacine Ynineb; Jean-Pierre Fulgencio; Francis Bonnet
      Pages: 185 - 189
      Abstract: Publication date: June 2017
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 36, Issue 3
      Author(s): Sacha Rozencwajg, Carole Desthieux, Olga Szymkiewicz, Yacine Ynineb, Jean-Pierre Fulgencio, Francis Bonnet
      Introduction Atrial fibrillation (AF) is one of the most frequent complications occurring after thoracic surgery especially after lung resection. It is associated with an increase in postoperative morbidity and mortality. Recent data having documented the preventive role of corticosteroids on the occurrence of AF in cardiac surgery, we sought to evaluate the effect of preoperative administration of dexamethasone on the incidence of AF after pneumonectomy. Methods We reviewed the files of all consecutive patients who underwent a pneumonectomy in one single centre between July 2004 and July 2012. For each patient, demographics, medical status, the surgical procedure and treatments administered including dexamethasone, were recorded. The data were analysed using a univariate analysis and a multivariate logistic regression. Results Among them, 153 patients were included and analysed; 35 (23%) presented with at least one episode of AF occurring within 48hours after surgery. Mortality was higher in these patients (26.5% versus 12.1%, P =0.06). The univariate analysis indicated that patients who had a postoperative course complicated by the occurrence of AF were older (P =0.003), had a higher SAPS2 score (P =0.002) and a higher CHADS score (P =0.05). Older age (OR=1.08; P =0.048) and preoperative treatment by anti-arrhythmics (OR=3.9; P =0.029) were documented as independent risk factors in the multivariate analysis. Preoperative administration of dexamethasone 8–12mg did not impair the incidence of AF. Discussion AF is a frequent complication after pneumonectomy associated with increased mortality. Whereas corticosteroids have been documented as preventing AF following cardiac surgery, no such effect was found after pneumonectomy.

      PubDate: 2017-06-24T08:26:51Z
      DOI: 10.1016/j.accpm.2016.04.005
       
  • Are pain and PONV so predominant in ambulatory surgery: Survey of call on
           D1 in 11,104 patients'
    • Authors: Eric Bourgeois; Anouchka Cousin; Céline Chatel; Marc Edouard Gentili
      Pages: 193 - 194
      Abstract: Publication date: June 2017
      Source:Anaesthesia Critical Care & Pain Medicine, Volume 36, Issue 3
      Author(s): Eric Bourgeois, Anouchka Cousin, Céline Chatel, Marc Edouard Gentili


      PubDate: 2017-06-24T08:26:51Z
      DOI: 10.1016/j.accpm.2016.10.006
       
  • Eye protection in anaesthesia and intensive care
    • Authors: Hawa Keita; Jean-Michel Devys; Jacques Ripart; Marie Frost; Frédérique Boutin; Claude Guérin; Dominique Fletcher
      Abstract: Publication date: Available online 5 August 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Hawa Keita, Jean-Michel Devys, Jacques Ripart, Marie Frost, Frédérique Boutin, Claude Guérin, Dominique Fletcher


      PubDate: 2017-08-09T13:18:45Z
      DOI: 10.1016/j.accpm.2017.08.001
       
  • Management of septic shock in an intermediate care unit
    • Authors: Eric Meaudre; Cédric Nguyen; Claire Contargyris; Ambroise Montcriol; Erwan d’Aranda; Pierre Esnault; Mourad Bensalah; Bertrand Prunet; Julien Bordes; Philippe Goutorbe
      Abstract: Publication date: Available online 5 August 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Eric Meaudre, Cédric Nguyen, Claire Contargyris, Ambroise Montcriol, Erwan d’Aranda, Pierre Esnault, Mourad Bensalah, Bertrand Prunet, Julien Bordes, Philippe Goutorbe
      Background While guidelines advocate goal-directed resuscitation based on timed bundles, the management of SS outside an ICU setting has been poorly studied in intermediate care units (IMCU). Patients and Method We reviewed all cases of septic shock patients admitted to our IMCU between January 2013 and June 2014. The characteristics of sepsis, compliance of bundles, and outcomes were collected. The IMCU population was compared with the SS patients admitted to the ICU during the same period. The primary objective was to evaluate the feasibility of care in an IMCU. Results We treated 59 patients in the IMCU. Forty-three patients (73%) were fully managed in the IMCU and 16 patients (27%) were secondarily transferred to the ICU. In the first 3hours, the compliance to bundles was: blood cultures (95%), plasma lactate concentration (90%), vascular filling volume (1500ml (1000-2000)) and antibiotics (100%). A central venous line and an arterial catheter were inserted in 85% and 98.3% of the cases. At 24h, patients who were transferred to the ICU had higher lactate concentrations than the other patients (1.4 ± 0.7 versus 2.9 ± 3.4 mmol P = 0.03). A 24 hours-SOFA score >4 was correlated with a transfer in ICU (OR 7,75 (95% CI 2.08-28,81; P = 0.002). Conclusions Our work demonstrated the ability to manage SS patients solely in an IMCU. It showed that the SS resuscitation bundle can be successfully implemented outside the ICU. A lack of improvement at the 24th hour is associated with a transfer to the ICU.

      PubDate: 2017-08-09T13:18:45Z
      DOI: 10.1016/j.accpm.2017.07.004
       
  • Operation and Organization of Ambulatory Surgery in France. Results of a
           Nationwide Survey; The OPERA study
    • Authors: Marc Beaussier; Pierre Albaladejo; Didier Sciard; Laurent Jouffroy; Dan Benhamou; Claude Ecoffey; Frederic Aubrun
      Abstract: Publication date: Available online 5 August 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Marc Beaussier, Pierre Albaladejo, Didier Sciard, Laurent Jouffroy, Dan Benhamou, Claude Ecoffey, Frederic Aubrun
      Operation and organization of ambulatory surgical activity in France remains largely undocumented. Because organizational processes are a major determinant of the quality of care and patient safety, this could appear in contrast with the strong encouragement by French authorities to physicians and hospitals to further develop surgery in an ambulatory setting. This nationwide observational prospective survey, carried out between December 2013 and December 2014, was undertaken to characterize the organizational processes of ambulatory surgery in France. Three hundred centers were randomly chosen from a list of 891 hospitals practicing ambulatory surgery, with stratification according to the type of facility (public general hospital, university hospital, private hospital) and region. An email was sent to the board of the randomly chosen facilities with an attached information letter explaining how the survey worked. Hospitals who did not reply to this email were contacted by phone. Among the 206 hospitals that answered the survey, 92 were private, 78 were public and 36 were university hospitals. Median accommodation capacities of ambulatory units were 8 beds, mostly distinct from conventional surgical ward. Patient pathways dedicated to ambulatory surgery appear as the current predominant practice. 77% of the French ambulatory units have a head nurse in charge of logistics and coordination. Several items have still to be improved, such as the adherence to modern fasting rules and the unnecessary use of stretcher to move the patient. Objective discharge score is used in 77% of ambulatory units. Information was provided on operations (number of beds, dedicated pathways, dedicated staff, governance) and on organizational processes (information, preoperative fasting rules, pre-and postoperative contacts, postoperative care, discharge criteria, follow-up and outcomes). This survey highlights the implementation of some positive organizational parameters corresponding to common good practices recommendations. In contrast, several other recommendations are still insufficiently applied and may hamper the development of safe ambulatory surgery. This brings up new challenges for health regulatory boards, hospitals and ambulatory units managers.

      PubDate: 2017-08-09T13:18:45Z
      DOI: 10.1016/j.accpm.2017.07.003
       
  • Impact of a visual aid on discordance between physicians and family
           members
    • Authors: Gabrielle Burelli; Chloé Berthelier; Hélène Vanacker; Léonard Descaillot; Bénédicte Philippon-Jouve; Xavier Fabre; Mahmoud Kaaki; Jean-Charles Chakarian; Alexandre Domine; Pascal Beuret
      Abstract: Publication date: Available online 5 August 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      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: 2017-08-09T13:18:45Z
      DOI: 10.1016/j.accpm.2017.05.006
       
  • Changes in the availability of bedside ultrasound practice in emergency
           rooms and pre-hospital 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
      Abstract: Publication date: Available online 4 August 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      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, multi-centre 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 328 (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: 2017-08-09T13:18:45Z
      DOI: 10.1016/j.accpm.2017.06.008
       
  • Impact of a stay in the intensive care unit on the preparation of Advance
           Directives: Descriptive, exploratory, qualitative study.
    • Authors: Pascal Andreu; Auguste Dargent; Audrey Large; Nicolas Meunier-Beillard; Sandrine Vinault; Uriel Leiva Rojas; Fiona Ecarnot; Sébastien Prin; Pierre-Emmanuel Charles; Isabelle Fournel; Jean-Philippe Rigaud; Jean-Pierre Quenot
      Abstract: Publication date: Available online 4 August 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Pascal Andreu, Auguste Dargent, Audrey Large, Nicolas Meunier-Beillard, Sandrine Vinault, Uriel Leiva Rojas, Fiona Ecarnot, Sébastien Prin, Pierre-Emmanuel Charles, Isabelle Fournel, Jean-Philippe Rigaud, Jean-Pierre Quenot
      Background Our objective was to assess, through a qualitative, exploratory study, the thought processes of patients regarding the formulation of Advance Directives (AD) after a stay in the ICU. Methods Study performed from May to July 2016 using telephone interviews performed by four senior ICU physicians. Inclusion criteria were: patients discharged from ICU to home >3 months previously. Semi-directive interviews with patients focused on 5 main points surrounding AD. Results In total, among 159 eligible patients, data from 94 (59%) were available for analysis.Among all those interviewed, 83.5% had never heard of “Advance Directives”. Only 2% had executed AD before ICU admission, and 7% expressed a desire to prepare AD further to their ICU stay. Among the barriers to preparation of AD, lack of information was the main reason cited for not executing AD. Patients noted the following in their AD:withdrawal of life-support in case of vegetative/minimally conscious state or when there is no longer any hope, in case of uncontrollable pain, and if impossible to wean from mechanical ventilation. Conclusion The ideal time to engage patients in these discussions is most likely well before an acute health event occurs, although this warrants further investigation both before and after ICU admissions.

      PubDate: 2017-08-09T13:18:45Z
      DOI: 10.1016/j.accpm.2017.05.007
       
  • Does Perfusion Pressure offer more Brain Protection than Hemoglobin
           Level' A case of Aortic Injury during Laparoscopic Bariatric Surgery
    • Authors: Ahed Zeidan; Osamah Al-Sanea; Sameh Baryan
      Abstract: Publication date: Available online 26 July 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Ahed Zeidan, Osamah Al-Sanea, Sameh Baryan


      PubDate: 2017-07-30T12:34:41Z
      DOI: 10.1016/j.accpm.2017.04.008
       
  • Association between augmented renal clearance and clinical failure of
           antibiotic treatment in brain-injured patients with ventilator-acquired
           pneumonia: a preliminary study
    • Authors: Cédric Carrie; Merry Bentejac; Vincent Cottenceau; Françoise Masson; Laurent Petit; Jean François Cochard; François Sztark
      Abstract: Publication date: Available online 26 July 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Cédric Carrie, Merry Bentejac, Vincent Cottenceau, Françoise Masson, Laurent Petit, Jean François Cochard, François Sztark
      OBJECTIVES This preliminary study aimed to determine whether augmented renal clearance (ARC) impacts negatively on the clinical outcome in traumatic brain-injured patients (TBI) treated for a first episode of ventilator-acquired pneumonia (VAP). METHODS During a 5-year period, all TBI patients who had developed VAP were retrospectively reviewed to assess variables associated with clinical failure in multivariate analysis. Clinical failure was defined as an impaired clinical response with a need for escalating antibiotics during treatment and/or within 15 days after the end-of-treatment. Recurrence was considered if at least one of the initial causative bacterial strains was growing at a significant concentration from a second sample. Augmented renal clearance (ARC) was defined by an enhanced creatinine clearance exceeding 130mL/min/1.73m2 calculated from a urinary sample during the first three days of antimicrobial therapy. MAIN RESULTS During the study period, 223 TBI patients with VAP were included and 59 (26%) presented a clinical failure. Factors statistically associated with clinical failure were GSC ≤ 7 (OR = 2.2 [1.1 – 4.4], p = 0.03), early VAP (OR = 3.9 [1.9 – 7.8], p = 0.0001), bacteraemia (OR = 11 [2.2 – 54], p = 0.003) and antimicrobial therapy ≤ 7 days (OR = 3.7 [1.8 – 7.4], p = 0.0003). ARC was statistically associated with recurrent infections with an OR of 4.4 [1.2 – 16], p = 0.03. CONCLUSION ARC was associated with recurrent infection after a first episode of VAP in TBI patients. The optimal administration and dosing of the antimicrobial agents in this context remain to be determined.

      PubDate: 2017-07-30T12:34:41Z
      DOI: 10.1016/j.accpm.2017.06.006
       
  • Axillary nerve block for a wrist fracture in a patient with
           facioscapulohumeral (Landouzy-Dejerine) disease
    • Authors: Mostafa Mazboudi; Samy Figueiredo; Bausard Latrech; Dan Benhamou
      Abstract: Publication date: Available online 26 July 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Mostafa Mazboudi, Samy Figueiredo, Bausard Latrech, Dan Benhamou


      PubDate: 2017-07-30T12:34:41Z
      DOI: 10.1016/j.accpm.2017.05.004
       
  • 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
      Abstract: Publication date: Available online 26 July 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Lucile Picard, Chamsedine cherait, Ophélie constant, Boris boulanger, Amandine dorget, Dominique vodovar, Antonio Fiore, Hakim haouache, Gilles dhonneur, Nicolas mongardon
      Extra-Corporeal Membrane Oxygenation (ECMO) has become increasingly used for rescue therapy of severe cardiac or/and respiratory failures. If a central venous catheter is mandatory for managing these critically ill patients, its insertion during emergent ECMO implantation exposes to unique mechanical complications. We report the case of ECMO implementation for refractory cardiac arrest, complicated with guidewire suctioning into ECMO circuit. Through the analysis of this guidewire embolism, we propose to discuss some technical points regarding the ideal time and site of insertion as well as precautions that should be assessed before inserting the central venous catheter in patients treated with ECMO, in order to limit the potential life-threatening complications.

      PubDate: 2017-07-30T12:34:41Z
      DOI: 10.1016/j.accpm.2017.05.005
       
  • Comparison of three stimulation Sites on the pupillary dilation reflex
           amplitude evoked by a standardized noxious test
    • Authors: Florian Roquet; Laila Guezoulialail; Bozena Wachowska; Iulia Balcan; Philippe Montravers; Dan Longrois; Jean Guglielminotti
      Abstract: Publication date: Available online 26 July 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Florian Roquet, Laila Guezoulialail, Bozena Wachowska, Iulia Balcan, Philippe Montravers, Dan Longrois, Jean Guglielminotti


      PubDate: 2017-07-30T12:34:41Z
      DOI: 10.1016/j.accpm.2017.06.007
       
  • Ventilation for thoracic surgery in the newborn: don’t forget High
           Frequency Oscillatory Ventilation
    • Authors: Charlotte Rémond; Chloé Alliana; Karin Jonckheer; Jean-François Lecompte; François de la Brière
      Abstract: Publication date: Available online 26 July 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Charlotte Rémond, Chloé Alliana, Karin Jonckheer, Jean-François Lecompte, François de la Brière


      PubDate: 2017-07-30T12:34:41Z
      DOI: 10.1016/j.accpm.2017.07.002
       
  • Implementation of an Electronic Checklist in the ICU: Association with
           Improved Outcome
    • Authors: Gary Duclos; Sophie Medam; François Antonini; Djamel Mokart; Véronique Paone; Marie Hélène Po; Coralie Vigne; Emmanuelle Hammad; Frédéric Potié; Claude Martin; Laurent Zieleskiewicz; Marc Leone
      Abstract: Publication date: Available online 10 July 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Gary Duclos, Sophie Medam, François Antonini, Djamel Mokart, Véronique Paone, Marie Hélène Po, Coralie Vigne, Emmanuelle Hammad, Frédéric Potié, Claude Martin, Laurent Zieleskiewicz, Marc Leone
      Objective To assess the impact of an electronic checklist during the morning rounds on ventilator-associated pneumonia (VAP) in the intensive care unit (ICU). Patients and methods We conducted a retrospective, before/after study in a single ICU of a university hospital. A systematic electronic checklist focusing on guidelines adherence was introduced in January 2012. From January 2008 to June 2014, we screened patients with ICU stay durations of at least 48hours. Propensity score-matched analysis with conditional logistic regression was used to compare the rate of VAP and number of days free of invasive devices before and after implementation of the electronic checklist. Results We analyzed 1711 patients (before group, n=761; after group, n=950). The rates of VAP were 21% and 11% in the before and after groups, respectively (p<0.001). In propensity-score matched analysis (n=742 in each group), VAP occurred in 151 patients (21%) during the before period compared with 72 patients (10%) during the after period (odds ratio [OR]=0.38; 95% confidence interval [CI]=0.27–0.53). The after group showed increases in ICU-free days (OR=1.05; 95% CI=1.04–1.07) and mechanical ventilation-free days (OR=1.03; 95% CI=1.01–1.04). Conclusion In this matched before/after study, implementation of an electronic checklist was associated with positive effects on patient outcomes, especially on VAP. Further prospective studies are needed to confirm these observations.

      PubDate: 2017-07-14T03:18:08Z
      DOI: 10.1016/j.accpm.2017.04.006
       
  • Repeated failure with regional blocks: technical problem or resistance to
           local anesthetics'
    • Authors: David Leconte; Romain Lemarchand; Cécile Petitjean; Marc E Gentili
      Abstract: Publication date: Available online 8 July 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): David Leconte, Romain Lemarchand, Cécile Petitjean, Marc E Gentili


      PubDate: 2017-07-14T03:18:08Z
      DOI: 10.1016/j.accpm.2017.06.005
       
  • Impact factor: an assessment tool for journals or for scientists'
    • Authors: Slim Roy
      Abstract: Publication date: Available online 8 July 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): K. Slim, A. Dupré, B. Le Roy


      PubDate: 2017-07-14T03:18:08Z
       
  • Dynamic Arterial Elastance Obtained Using Arterial Signal Does Not Predict
           An Increase In Arterial Pressure After A Volume Expansion in the Operating
           Room
    • Authors: Romain Lanchon; Karine Nouette-Gaulain; Laurent Stecken; Musa Sesay; Jean-Yves Lefrant; Matthieu Biais
      Abstract: Publication date: Available online 8 July 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Romain Lanchon, Karine Nouette-Gaulain, Laurent Stecken, Musa Sesay, Jean-Yves Lefrant, Matthieu Biais
      Introduction Dynamic arterial elastance (Eadyn) is defined as the ratio between pulse pressure variations (PPV) and stroke volume variations (SVV). Eadyn has been proposed to predict an increase in mean arterial pressure (MAP) after volume expansion with conflicting results. The aim of the present study was to test the reliability of Eadyn in hypotensive patients (MAP<65mmHg) in the operating room (OR). Patients and Methods The study pooled data from 51 patients. They were included after the induction of anesthesia and before skin incision. Eadyn, MAP and stroke volume (FloTracTM, VigileoTM, Edwards-Lifesciences, Irvine,CA) were recorded before and after volume expansion (500ml starch 6% given over 10minutes). Pressure-responders were defined as an increase MAP≥15% after volume expansion. Changes in MAP were predicted using the area under the curves (AUC) with their 95%Confidence Interval(95%CI) derived from Receiver Operating Characteristic curves. Results Seventeen patients responded to volume expansion. Heart rate, PPV, SVV and Eadyn were similar between pressure responders and non-responders. Baseline values of stroke volume, cardiac output and MAP were lower in responders. Volume expansion induced significant variations in stroke volume, cardiac output, SVV and PPV, but not in Eadyn. Baseline Eadyn failed to predict MAP increase (AUC=0.53,95%CI=0.36-0.70,P>0.05) and was not correlated with volume expansion-induced changes in MAP (P>0.05). In preload responsive patients (changes in SV≥15% after volume expansion,n=24), the AUC was 0.54(95%CI=0.29-0.78;P>0.05). Conclusion In the present study performed in the OR and in hypotensive patients, Eadyn obtained using arterial signal was unable to predict an increase in MAP after volume expansion.

      PubDate: 2017-07-14T03:18:08Z
      DOI: 10.1016/j.accpm.2017.05.001
       
  • From Universal Postoperative Pain Recommendations to Procedure Specific
           Pain Management
    • Authors: Helene Beloeil; Francis Bonnet
      Abstract: Publication date: Available online 8 July 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Helene Beloeil, Francis Bonnet


      PubDate: 2017-07-14T03:18:08Z
      DOI: 10.1016/j.accpm.2017.05.003
       
  • Management of a cardiac shock in an austere military environment (Northern
           Niger)
    • Authors: S-P. Corcostegui; E. Dulaurent; A. Luft
      Abstract: Publication date: Available online 8 July 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): S-P. Corcostegui, E. Dulaurent, A. Luft


      PubDate: 2017-07-14T03:18:08Z
      DOI: 10.1016/j.accpm.2017.05.002
       
  • Targeted temperature management in the ICU: guidelines from a French
           expert panel
    • Authors: Alain Cariou; Jean-Francois Payen; Karim Asehnoune; Gerard Audibert; Astrid Botte; Olivier Brissaud; Guillaume Debaty; Sandrine Deltour; Nicolas Deye; Nicolas Engrand; Gilles Francony; Stéphane Legriel; Bruno Levy; Philippe Meyer; Jean-Christophe Orban; Sylvain Renolleau; Bernard Vigue; Laure De Saint Blanquat; Cyrille Mathien; Lionel Velly
      Abstract: Publication date: Available online 5 July 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Alain Cariou, Jean-Francois Payen, Karim Asehnoune, Gerard Audibert, Astrid Botte, Olivier Brissaud, Guillaume Debaty, Sandrine Deltour, Nicolas Deye, Nicolas Engrand, Gilles Francony, Stéphane Legriel, Bruno Levy, Philippe Meyer, Jean-Christophe Orban, Sylvain Renolleau, Bernard Vigue, Laure De Saint Blanquat, Cyrille Mathien, Lionel Velly
      Over the recent period, the use of induced hypothermia has gained an increasing interest for critically ill patients, in particular in brain-injured patients. The term “targeted temperature management” (TTM) has now emerged as the most appropriate when referring to interventions used to reach and maintain a specific level temperature for each individual. TTM may be used to prevent fever, to maintain normothermia, or to lower core temperature. This treatment is widely used in intensive care units, mostly as a primary neuroprotective method. Indications 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 TTM in adult and paediatric 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 [SRLF]) and the French Society of Anesthesia and Intensive Care Medicine (Société Francaise d’Anesthésie Réanimation [SFAR]) with the participation of the French Emergency Medicine Association (Société Française de Médecine d’Urgence [SFMU]), the French Group for Pediatric Intensive Care and Emergencies (Groupe Francophone de Réanimation et Urgences Pédiatriques [GFRUP]), the French National Association of Neuro-Anesthesiology and Critical Care (Association Nationale de Neuro-Anesthésie Réanimation Française [ANARLF]), and the French Neurovascular Society (Société Française Neurovasculaire [SFNV]). Fifteen experts and two coordinators agreed to consider questions concerning TTM and its practical implementation in five clinical situations: cardiac arrest, traumatic brain injury, stroke, other brain injuries, and shock. This resulted in 30 recommendations: 3 recommendations were strong (Grade 1), 13 were weak (Grade 2), and 14 were experts’ opinions. After two rounds of rating and various amendments, a strong agreement from voting participants was obtained for all 30 (100%) recommendations, which are exposed in the present article.

      PubDate: 2017-07-14T03:18:08Z
      DOI: 10.1016/j.accpm.2017.06.003
       
  • Physiological and self assessed psychological stress induced by a high
           fidelity simulation course among third year anaesthesia and critical care
           residents: an observational study
    • Authors: Pr Thomas Geeraerts
      Abstract: Publication date: Available online 23 June 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Pr Thomas Geeraerts
      Introduction The use of high-fidelity simulators in Medicine can improve knowledge, behavior and practice but may be associated with significant stress. Our objective was to measure physiological and psychological self-assessed intensity of stress before and after a planned simulation training session among third year anesthesia and critical care residents. Methods A convenience sample of 27 residents participating in a simulation training course was studied. Stress was evaluated by self-assessment using a numerical scale and by salivary amylase concentration before and after the session. Technical and non-technical (using the Aberdeen Anaesthetists’ Non Technical Skills scale) performances were assessed through videotapes analysis. Results The median stress score was 5 [2-8] before and 7 [2-10] after the simulation session (p<0.001). For 48% of residents studied, the stress score after the session was superior or equal to 8/10. Salivary amylase concentration increased significantly after the session compared to before the session, respectively (1 250 440 ± 1 216 667 vs. 727 260 ± 603 787 IU / L, p = 0.008). There was no significant correlation between stress parameters and non-technical performance. Discussion Simulation-induced stress, as measured by self-assessment and biological parameter, is high before the session and increases significantly during the course. While this stress did not seem to impact performance negatively, it should be taken into account.

      PubDate: 2017-06-24T08:26:51Z
      DOI: 10.1016/j.accpm.2017.06.002
       
  • Debriefing values in high-fidelity simulation
    • Authors: Antonia Blanié; Morgan Le Guen
      Abstract: Publication date: Available online 16 June 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Antonia Blanié, Morgan Le Guen


      PubDate: 2017-06-24T08:26:51Z
      DOI: 10.1016/j.accpm.2017.06.001
       
  • A pilot study of mechanical chest compression with the LifeLine ARM device
           during simulated cardiopulmonary resuscitation: Reply
    • Authors: Jean Cotte
      Abstract: Publication date: Available online 17 April 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Jean Cotte


      PubDate: 2017-04-21T14:58:48Z
      DOI: 10.1016/j.accpm.2017.04.005
       
  • Preventing Medication Errors in Anesthesia and Critical Care (abbreviated
           version)
    • Authors: Vincent Piriou; Alexandre Theissen; Ségolène Arzalier-Daret; Marie Marcel; Pierre Trouiller; Stéphanie Parat; Catherine Stamm; Rémy Collomp
      Abstract: Publication date: Available online 10 April 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Vincent Piriou, Alexandre Theissen, Ségolène Arzalier-Daret, Marie Marcel, Pierre Trouiller, Stéphanie Parat, Catherine Stamm, Rémy Collomp


      PubDate: 2017-04-13T14:28:00Z
      DOI: 10.1016/j.accpm.2017.04.002
       
  • Successful management of a neck hematoma following simulation training
    • Authors: Marie-Ève Bélanger; Issam Tanoubi; Mihai Georgescu; Roger Perron; Arnaud Robitaille; Marie-Pierre Charron; Pierre Drolet
      Abstract: Publication date: Available online 10 April 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Marie-Ève Bélanger, Issam Tanoubi, Mihai Georgescu, Roger Perron, Arnaud Robitaille, Marie-Pierre Charron, Pierre Drolet
      Simulation-based education is gaining widespread acceptance in many medical specialties as an effective method to teach technical and non-technical skills. The ultimate goal of simulation is to improve health care and patient safety. Boet et al. [1] published a review on simulation-based crisis resources management (CRM) teaching, looking for evidence that it can lead to improved workplace practices and patient safety. Amongst hundreds of studies pertaining to CRM, he found only nine that were relevant, and only one that showed reduced mortality. Elaborating and putting forward studies designed to measure the impact of simulation on patient safety and outcomes is by no mean an easy task [2]. Indeed, most studies present various problems, such as biases introduced by the use of historical cohorts rather than control groups, and sample sizes based on convenience rather than power analysis. Furthermore, many significant outcomes such as mortality and major morbidity rates need to be measured over an extended period of time, which leaves room for variables other than the introduction of a simulation-based teaching program to play a confounding role [2]. These are some of the reasons why the majority of publications in simulation-based teaching are focusing mostly if not exclusively on measuring participants’ satisfaction and performance in a simulated environment. At the Université de Montréal, we developed surgical high-fidelity simulation-based CRM scenarios focusing on teamwork. The specific simulation based training on CRM, which includes this airway management scenario, is given only once a year, in the beginning of their second year of residency. This highly appreciated training [3] place surgical residents in rare and urgent situations, but within a safe simulated environment. One of these scenarios focuses on the management of neck hematoma after thyroidectomy. It teaches a step-by-step approach that emphasizes, amongst other things, the need for bedside evacuation in the setting of significant and life-threatening airway obstruction (figure 1). The purpose of this case report is to describe how a postgraduate year 3 (PGY 3) surgical residents used and credited the training acquired during a simulation-based CRM scenario for positively influencing a patient's outcome.

      PubDate: 2017-04-13T14:28:00Z
      DOI: 10.1016/j.accpm.2017.04.003
       
  • Hypercarbia complicating endoscopic sphincterotomy
    • Authors: Marc- E Gentili; Aurélien Colleu; Sébastien Lemière; Jean-Robert Robert
      Abstract: Publication date: Available online 18 March 2017
      Source:Anaesthesia Critical Care & Pain Medicine
      Author(s): Marc- E Gentili, Aurélien Colleu, Sébastien Lemière, Jean-Robert Robert


      PubDate: 2017-04-13T14:28:00Z
      DOI: 10.1016/j.accpm.2017.01.009
       
 
 
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