《加拿大麻醉杂志》2023年3月刊，第70卷第3期

本文由“麻醉新超人”授权转载

翻译：徐祗彪 徐医麻醉2022级硕士研究生

审校：赵林林 徐医附院麻醉科

《加拿大麻醉杂志》2023年3月刊，第70卷第3期

1. 1.“Green anesthesia” in the “Green Journal”  

《绿色杂志》中的“绿色麻醉”

1. 2.Promoting practice change towards environmentally sustainable health care: more than meets the eye  

促进实践变革，实现环境可持续的健康医疗：不仅仅是眼睛看到的

1. 3.A call for immediate climate action in anesthesiology: routine use of minimal or metabolic fresh gas flow reduces our ecological footprint  

呼吁立即在麻醉学中采取气候行动：常规使用最小或代谢的新鲜气体流量可减少我们的生态足迹

1. 4.The perceptions and adoption of environmentally sustainable practices among anesthesiologists—a qualitative study  

麻醉医生对环境可持续实践的看法和采用——定性研究

1. 5.An audit of the carbon footprint of travel for the Canadian Anesthesiologists’ Society International Education Foundation partnerships  

加拿大麻醉医师协会国际教育基金会合作伙伴关系的旅行碳足迹审计

1. 6.Anesthetic drug shortages in Pakistan: a multicentre nationwide survey  

巴基斯坦麻醉药物短缺：多中心全国性调查

1. 7.Remimazolam dose for successful insertion of a supraglottic airway device with opioids: a dose-determination study using Dixon’s up-and-down method  

使用阿片类药物成功插入声门上气道装置的瑞玛唑仑剂量：Dixon 升降法的剂量测定研究

1. 8.Emergency airway management in a tertiary trauma centre (AIRMAN): a one-year prospective longitudinal study  

三级创伤中心 （AIRMAN） 的紧急气道管理：为期一年的前瞻性纵向研究

Abstract Purpose

Emergency airway management can be associated with a range of complications including long-term neurologic injury and death. We studied the first-pass success rate with emergency airway management in a tertiary care trauma centre. Secondary outcomes were to identify factors associated with first-pass success and factors associated with adverse events peri-intubation.

摘要 目的

紧急气道管理可能与一系列并发症有关，包括长期神经损伤和死亡。本试验研究了三级医疗创伤中心急诊气道管理的首过成功率。次要结局是确定与首过成功相关的因素以及与围插管周围不良事件相关的因素。

Methods

We performed a single-centre, prospective, observational study of patients ≥ 17 yr old who were intubated in the emergency department (ED), surgical intensive care unit (SICU), medical intensive care unit (MICU), and inpatient wards at our institution. Ethics approval was obtained from the local research ethics board.

方法

本试验对在本机构的急诊科 （ED）、外科重症监护室 （SICU）、医疗重症监护室 （MICU） 和住院病房插管的≥17 岁的患者进行了一项单中心、前瞻性、观察性研究。伦理学批准已获得当地研究伦理委员会的批准。

Results

In a seven-month period, there were 416 emergency intubations and a first-pass success rate of 73.1%. The first-pass success rates were 57.5% on the ward, 66.1% in the intensive care units (ICUs) and 84.3% in the ED. Equipment also varied by location; videolaryngoscopy use was 65.1% in the ED and only 10.6% on wards. A multivariate regression model using the least absolute shrinkage and selection algorithm (LASSO) showed that the odds ratios for factors associated with two or more intubation attempts were location (wards, 1.23; MICU, 1.24; SICU, 1.19; reference group, ED), physiologic instability (1.19), an anatomically difficult airway (1.05), hypoxemia (1.98), lack of neuromuscular blocker use (2.28), and intubator inexperience (1.41).

结果

在7个月内，有416例紧急插管，首过成功率为73.1%。病房的首次通过成功率为57.5%，重症监护室（ICU）为66.1%，急诊室为84.3%。可视喉镜检查在急诊室的使用率为65.1%，在病房中仅为10.6%。使用最小绝对收敛和选择算子 （LASSO） 的多元回归模型显示，与两次或多次插管尝试相关因素的比值比是位置（病房，1.23;MICU，1.24;SICU，1.19;参考组，ED），生理不稳定（1.19），解剖学困难的气道（1.05），低氧血症（1.98），缺乏肌松药的使用（2.28）和插管器经验不足（1.41）。

Conclusions

First-pass success rates varied widely between locations within the hospital and were less than those published from similar institutions, except for the ED. We are revamping ICU protocols to improve the first-pass success rate.

结论

医院内各地点的首次通过成功率差异很大，低于类似机构的公布，除了急诊科。我们正在改进ICU指南，以提高首过成功率。

1. 9. The association of intraoperative low driving pressure ventilation and nonhome discharge: a historical cohort study  

术中低驱动压力通气与非家庭式出院的关联：历史队列研究 Abstract Purpose To evaluate whether intraoperative ventilation using lower driving pressure decreases the risk of nonhome discharge. 

摘要

目的

评估使用较低驱动压力的术中通气是否能降低非家庭式出院的风险。

Methods

We conducted a historical cohort study of patients aged ≥ 60 yr who were living at home before undergoing elective, noncardiothoracic surgery at two tertiary healthcare networks in Massachusetts between 2007 and 2018. We assessed the association of the median driving pressure during intraoperative mechanical ventilation with nonhome discharge using multivariable logistic regression analysis, adjusted for patient and procedural factors. Contingent on the primary association, we assessed effect modification by patients’ baseline risk and mediation by postoperative respiratory failure.

方法

我们对 2007 年至 2018 年期间在马萨诸塞州的两个三级医疗保健中心接受择期非心胸外科手术之前住在家里的 ≥60 岁患者进行了一项历史队列研究。我们使用多变量logistic回归分析评估术中机械通气期间的中位驱动压力与非家庭式出院的关联，并根据患者和程序因素进行调整。根据主要关联，我们评估了患者基线风险和术后呼吸衰竭介导的效果改变。

Results

Of 87,407 included patients, 12,584 (14.4%) experienced nonhome discharge. In adjusted analyses, a lower driving pressure was associated with a lower risk of nonhome discharge (adjusted odds ratio [aOR], 0.88; 95% confidence interval [CI], 0.83 to 0.93, per 10 cm H2O decrease; P < 0.001). This association was magnified in patients with a high baseline risk (aOR, 0.77; 95% CI, 0.73 to 0.81, per 10 cm H2O decrease, P-for-interaction < 0.001). The findings were confirmed in 19,518 patients matched for their baseline respiratory system compliance (aOR, 0.90; 95% CI, 0.81 to 1.00; P = 0.04 for low [< 15 cm H2O] vs high [≥ 15 cm H2O] driving pressures). A lower risk of respiratory failure mediated the association of a low driving pressure with nonhome discharge (20.8%; 95% CI, 15.0 to 56.8; P < 0.001).

结果

在纳入的87，407名患者中，12，584名（14.4%）经历了非家庭式出院。在调整分析中，较低的驱动压力与较低的非家庭式出院风险相关（调整比值比 [aOR]，0.88;95% 置信区间 [CI]，每降低 10 cm H2O 0.83 至 0.93;P < 0.001）。在基线风险较高的患者中，这种关联被放大（aOR，0.77;95% CI，0.73 至 0.81，每 10 cm H2O 降低，相互作用 P < 0.001）。在19，518名与其基线呼吸系统顺应性相匹配的患者中证实了这一发现（aOR，0.90;95%CI，0.81至1.00;P = 0.04 对于低 [< 15 cm H2O] 与高 [≥ 15 cm H2O] 驱动压力）。较低的呼吸衰竭风险介导了低驱动压力与非家庭式出院的关联（20.8%;95% CI，15.0-56.8;P < 0.001）。

Conclusions

Intraoperative ventilation maintaining lower driving pressure was associated with a lower risk of nonhome discharge, which can be partially explained by lowered rates of postoperative respiratory failure. Future randomized controlled trials should target driving pressure as a potential intervention to decrease nonhome discharge.

结论

术中通气保持较低的驱动压力与较低的非家庭式出院风险有关，这可以部分解释为术后呼吸衰竭率降低。未来的随机对照试验应将驱动压力作为减少非家庭式出院的潜在干预措施。

1. 10. Secondary infections in critically ill patients with viral pneumonia due to COVID-19 and influenza: a historical cohort study  

COVID-19 和流感引起的病毒性肺炎危重患者的继发感染：历史队列研究

1. 11.A qualitative descriptive study of the impact of the COVID-19 pandemic on staff in a Canadian intensive care unit  

关于COVID-19 大流行对加拿大重症监护室工作人员影响的定性描述性研究

1. 12.Propofol misuse in medical professions: a scoping review  

丙泊酚在医学界的滥用：概况性综述

1. 13.Comparison of different delivery modalities of epidural analgesia and intravenous analgesia in labour: a systematic review and network meta-analysis  

分娩中硬膜外镇痛与静脉镇痛不同给药方式的比较：系统评价和网状meta分析

1. 14.Ultrasound mirror-image artifacts during transversus abdominis plane blockade  

横腹平面阻滞期间的超声镜面伪像

1. 15.Greener Gases Starter Pack: a tool for transitioning to more sustainable anesthetic volatile agents  

绿色气体入门包：过渡到更可持续的麻醉挥发剂的工具

1. 16. Let’s implement The Sustainability Moment  

让我们实现可持续发展时刻

1. 17.Shifting from volatile to total intravenous anesthesia is associated with environmental risks of its own  

从挥发性麻醉转变为全静脉麻醉本身就与环境风险有关

1. 18.Postoperative opioid consumption and prescription in major abdominal surgery  

腹部大手术术后阿片类药物消耗和处方

1. 19.Perioperative outcomes of placenta accreta spectrum Cesarean delivery in a hybrid vs labour and delivery operating room  

杂交手术室和分娩手术室中胎盘植入谱的剖宫产围术期结局

1. 20.Prothèses dentaires en période péri-opératoire : sécurité et dignité  

围手术期假牙：安全和尊严

1. 21. Anticoagulation strategies and outcomes during extracorporeal membrane oxygenation support: a single-centre pre-COVID-19 experience  

体外膜肺氧合支持期间的抗凝策略和结果：COVID-19前的单中心实践

1. 22. Prevention of exposure keratitis in Ontario intensive care units: a survey study  

安大略省重症监护室暴露性角膜炎的预防：调查研究

免责声明：

文中所涉及药物使用、疾病诊疗等内容仅供医学专业人士参考。

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编辑：MiLu.米鹭

校对：Michel.米萱

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