| 1. |
- De Hert, Stefan, et al.
(författare)
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Pre-operative evaluation of adults undergoing elective noncardiac surgery Updated guideline from the European Society of Anaesthesiology
- 2018
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Ingår i: European Journal of Anaesthesiology. - : LIPPINCOTT WILLIAMS & WILKINS. - 0265-0215 .- 1365-2346. ; 35:6, s. 407-465
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this update of the European Society of Anaesthesiology (ESA) guidelines on the pre-operative evaluation of the adult undergoing noncardiac surgery is to present recommendations based on the available relevant clinical evidence. Well performed randomised studies on the topic are limited and therefore many recommendations rely to a large extent on expert opinion and may need to be adapted specifically to the healthcare systems of individual countries. This article aims to provide an overview of current knowledge on the subject with an assessment of the quality of the evidence in order to allow anaesthesiologists all over Europe to integrate - wherever possible - this knowledge into daily patient care. The Guidelines Committee of the ESA formed a task force comprising members of the previous task force, members of ESA scientific subcommittees and an open call for volunteers was made to all individual active members of the ESA and national societies. Electronic databases were searched from July 2010 (end of the literature search of the previous ESA guidelines on pre-operative evaluation) to May 2016 without language restrictions. A total of 34066 abtracts were screened from which 2536 were included for further analysis. Relevant systematic reviews with meta-analyses, randomised controlled trials, cohort studies, case-control studies and cross-sectional surveys were selected. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the level of evidence and to grade recommendations. The final draft guideline was posted on the ESA website for 4 weeks and the link was sent to all ESA members, individual or national (thus including most European national anaesthesia societies). Comments were collated and the guidelines amended as appropriate. When the final draft was complete, the Guidelines Committee and ESA Board ratified the guidelines.
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| 2. |
- De Robertis, Edoardo, et al.
(författare)
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Re-inspiration of CO2 from ventilator circuit: effects of circuit flushing and aspiration of dead space up to high respiratory rate
- 2010
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Ingår i: Critical Care. - : Springer Science and Business Media LLC. - 1364-8535. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Dead space negatively influences carbon dioxide (CO2) elimination, particularly at high respiratory rates (RR) used at low tidal volume ventilation in acute respiratory distress syndrome (ARDS). Aspiration of dead space (ASPIDS), a known method for dead space reduction, comprises two mechanisms activated during late expiration: aspiration of gas from the tip of the tracheal tube and gas injection through the inspiratory line - circuit flushing. The objective was to study the efficiency of circuit flushing alone and of ASPIDS at wide combinations of RR and tidal volume (V-T) in anaesthetized pigs. The hypothesis was tested that circuit flushing and ASPIDS are particularly efficient at high RR. Methods: In Part 1 of the study, RR and V-T were, with a computer-controlled ventilator, modified for one breath at a time without changing minute ventilation. Proximal dead space in a y-piece and ventilator tubing (VDaw, prox) was measured. In part two, changes in CO2 partial pressure (PaCO2) during prolonged periods of circuit flushing and ASPIDS were studied at RR 20, 40 and 60 minutes(-1). Results: In Part 1, VDaw, prox was 7.6 +/- 0.5% of V-T at RR 10 minutes(-1) and 16 +/- 2.5% at RR 60 minutes(-1). In Part 2, circuit flushing reduced PaCO2 by 20% at RR 40 minutes(-1) and by 26% at RR 60 minutes(-1). ASPIDS reduced PaCO2 by 33% at RR 40 minutes(-1) and by 41% at RR 60 minutes(-1). Conclusions: At high RR, re-breathing of CO2 from the y-piece and tubing becomes important. Circuit flushing and ASPIDS, which significantly reduce tubing dead space and PaCO2, merit further clinical studies.
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| 3. |
- De Robertis, Edoardo
(författare)
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Tools for protective lung ventilation. The elastic pressure-volume curve and aspiration of dead space
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Ventilator-induced lung injury (VILI) may contribute to morbidity and mortality of acute lung injury (ALI). Lung protective ventilation (LPV), that reduces VILI, may involve low tidal volume (Vt). Particularly low Vt is possible if dead space ventilation is reduced e.g. by aspiration of dead space gas (ASPIDS). ASPIDS implies that gas rich in CO2 during expiration is aspirated through a separate channel from the tracheal tube and replaced by fresh gas injected in the inspiratory line. The elastic pressure volume (Pel/V) curve of the respiratory system is recommended as a guideline to set the ventilator so as to reduce VILI. The Vt should be confined to the linear segment of the Pel/V curve, to avoid lung collapse below this zone, and hyperinflation above it. However, the understanding of physiological phenomena behind the Pel/V curve is limited. The objectives were to increase our comprehension of the Pel/V curve, to enhance its potential clinical usefulness, and to develop and test ASPIDS, in an approach aiming at LPV. A computer controlled Servo Ventilator 900 C allowed accurate recording of the Pel/V curve and control of the ASPIDS system. ASPIDS allowed isocapnic ventilation of pigs and humans with low Vt, and higher PEEP levels in ALI patients. In pigs and humans recruitment was shown to start below the lower inflection point and to continue far above it. Pel/V curves recorded from different PEEP levels allowed evaluation of lung collapse and guidance in setting PEEP. New concepts will hopefully increase the feasibility of LPV.
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| 4. |
- Hinkelbein, Jochen, et al.
(författare)
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European Society of Anaesthesiology and European Board of Anaesthesiology guidelines for procedural sedation and analgesia in adults
- 2018
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Ingår i: European Journal of Anaesthesiology. - 0265-0215. ; 35:1, s. 6-24
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Forskningsöversikt (refereegranskat)abstract
- Procedural sedation and analgesia (PSA) has become a widespread practice given the increasing demand to relieve anxiety, discomfort and pain during invasive diagnostic and therapeutic procedures. The role of, and credentialing required by, anaesthesiologists and practitioners performing PSA has been debated for years in different guidelines. For this reason, the European Society of Anaesthesiology (ESA) and the European Board of Anaesthesiology have created a taskforce of experts that has been assigned to create an evidence-based guideline and, whenever the evidence was weak, a consensus amongst experts on: The evaluation of adult patients undergoing PSA, the role and competences required for the clinicians to safely perform PSA, the commonly used drugs for PSA, the adverse events that PSA can lead to, the minimum monitoring requirements and post-procedure discharge criteria. A search of the literature from 2003 to 2016 was performed by a professional librarian and the retrieved articles were analysed to allow a critical appraisal according to the Grading of Recommendations Assessment, Development and Evaluation method. The Taskforce selected 2248 articles. Where there was insufficiently clear and concordant evidence on a topic, the Rand Appropriateness Method with three rounds of Delphi voting was used to obtain the highest level of consensus among the taskforce experts. These guidelines contain recommendations on PSA in the adult population. It does not address sedation performed in the ICU or in children and it does not aim to provide a legal statement on how PSA should be performed and by whom. The National Societies of Anaesthesiology and Ministries of Health should use this evidence-based document to help decision-making on how PSA should be performed in their countries. The final draft of the document was available to ESA members via the website for 4 weeks with the facility for them to upload their comments. Comments and suggestions of individual members and national Societies were considered and the guidelines were amended accordingly. The ESA guidelines Committee and ESA board finally approved and ratified it before publication.
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| 5. |
- Zacharowski, Kai, et al.
(författare)
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Intensive care medicine in Europe : Perspectives from the European Society of Anaesthesiology and Intensive Care
- 2022
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Ingår i: European Journal of Anaesthesiology. - 0265-0215. ; 39:10, s. 795-800
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND Anaesthesiology represents a rapidly evolving medical specialty in global healthcare, currently covering advanced peri-operative, pre-hospital and in-hospital critical emergency management (CREM), intensive care medicine (ICM) and pain management. The aim of the European Society of Anaesthesiology and Intensive Care (ESAIC) is to develop and promote a coordinated interdisciplinary and multidisciplinary European network of Anaesthesiology and Intensive Care Medicine (AICM) societies for improvement of patient safety and outcome, and to enhance political and public awareness of the role of anaesthesiologists all over Europe. The ESAIC promotes coordinated interdisciplinary and multidisciplinary care for severely compromised patients, based on the European training requirements (ETR) within the European Union of Medical Specialists (UEMS).METHODSTo define the current situation of AICM in Europe, a survey was sent in April 2019 to the ESAIC Council and the ESAIC National Anaesthesiologists Societies Committee (NASC) members. The survey posed questions regarding the year of foundation, the inclusion of ICM in the society name, and if, and to what extent, various kinds (postoperative, general, specific, mixed) of national ICUs are being run by differing medical specialties. The study data were compiled and analysed by the ESAIC Board, Council and NASC in December 2019.RESULTS AND CONCLUSIONAmongst the 42 European national societies surveyed (41 members of ESAIC-NASC plus Luxembourg), nineteen (45%) also include terms related to critical care medicine or ICM in their names, seven (17%) include terms related to reanimation and three (7%) to resuscitation. In recent years, several national societies revised their names to better reflect their gradual embrace of peri-operative medicine, ICM, CREM and pain management. Approximately 70% of ICU beds in Europe, and 100% in Scandinavia, are being run by anaesthesiologists, the remaining 30% being managed by physicians from other surgical or medical specialties. To emphasise future needs and resources of European AICM, the ESAIC drafted an ICM roadmap in terms of clinical practice, organisation of healthcare, interprofessional and interdisciplinary collaboration, patient safety, outcome and empowerment, professional working conditions, and changes in research, teaching and training required to meet future challenges and expectations.
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