Anaesthesiology intensive therapy最新文献

These guidelines provide evidence-based recommendations for central venous cannulation in critically ill patients in the intensive care unit. The document was developed by the Working Group of the Polish Society of Anaesthesiology and Intensive Therapy (Polskie Towarzystwo Anestezjologii i Intensywnej Terapii - PTAiIT) based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology, which encompasses systematic reviews of the literature, meta-analyses, and - in the absence of sufficient data - expert consensus. These guidelines aim to standardise the approach to central venous cannulation, increase the effectiveness of procedures, and minimise the risk of complications. The guidelines address pre-procedural ultrasound assessment, selection of the optimal vascular access site, comparison of ultrasound-guided versus landmark cannulation at different access sites, confirmation of catheter position after cannulation, and the role of positional manoeuvres.

Optimal postoperative pain management after caesarean delivery is a fundamental component of perioperative care and enhanced recovery protocols in obstetric anaes-thesia. Although intrathecal morphine (ITM) remains the gold standard for post-caesarean analgesia, its use is not always feasible or desirable. This narrative review synthesises current evidence regarding ultrasound-guided regional anaesthesia techniques employed for post-caesarean analgesia, with emphasis on anatomical rationale, clinical efficacy, and their role when neuraxial opioids are omitted. Available data indicate that abdominal wall blocks provide effective somatic analgesia and meaningful opioid-sparing benefits, particularly in the absence of ITM. Careful technique selection and integration within multimodal analgesic pathways are essential to optimise postoperative outcomes.

Introduction: Fluid management in critically ill patients relies on clinical assessment, fluid balance calculations and, increasingly, point-of-care ultrasound. However, the rela-tionships between these assessment modalities remain poorly understood, with conflicting evidence regarding their correlation and clinical utility. The study aimed to eva-luate correlations between clinical indicators of fluid overload, cumulative fluid balance, and comprehensive ultrasound parameters including cardiac function, lung ultrasound, and the venous excess ultrasound (VExUS) protocol in critically ill patients.

Material and methods: We conducted a cross-sectional, observational study in a tertiary intensive care unit. Adults admitted for ≥ 72 hours with clinical evidence of fluid overload but haemodynamic stability were eligible. Assessments included focused echocardiography, six-zone lung ultrasound, and comprehensive VExUS. Correlations between cumulative fluid balance, clinical oedema, and ultrasound parameters were analysed.

Results: Of 195 patients screened, 50 were recruited to the study. The study population had a mean age of 59 years. Sepsis and respiratory failure were the most common admission diagnoses. The mean cumulative fluid balance was 7.1 ± 4.8 L at the time of recruitment. Peripheral oedema was present in over 70%. Ultrasound revealed left ventricular dysfunction in 16%, right ventricular dysfunction in 10%, bilateral pleural effusions in 44%, and elevated VExUS scores (> 2) in 20%. Cumulative fluid balance showed no correlation with clinical or ultrasound findings.

Conclusions: Traditional fluid assessment (cumulative fluid balance and clinical signs of oedema) methods show no correlation with ultrasound parameters in critically ill patients. Future research should focus on ultrasound-guided approaches that provide cardiovascular assessment rather than on cumulative fluid balance calculations or clinical signs alone.

Flexible bronchoscopy (FB) is an established diagnostic and therapeutic tool for critically ill patients. Technological advances have enabled rapid and convenient bedside availability in the intensive care unit, expanding the range of therapeutic indications for the procedure outside the endoscopy laboratory. FB in critically ill patients, especially mechanically ventilated patients, is technically challenging and requires appropriate operator qualifications. To avoid serious complications, it is essential to understand the procedure's effects on the respiratory and circulatory systems, as well as the mecha-nisms of complications, including infection transmission. A key challenge is to individually determine the expected benefit-risk balance and implement local protocols for the preparation, implementation, and supervision of the procedure. This narrative review aims to explore the practical and clinical aspects of FB in critically ill, mechanically ventilated patients in the ICU environment, emphasizing the most common interventions and safety issues.