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Introduction: In clinical practice, the administration of opioid analgesics depends on pain intensity records from nurses because they are responsible for determining the severity of the patient's complaints; however, discrepancies regarding pain measurement are often observed between physicians and nurses, which can lead to an inadequate use of analgesics. Objective: To carry out a comparison of pain intensity measurements made by staff physicians and nurses in a teaching hospital during the first 24 hours of hospital stay of patients with movement-related pain. Methods: Retrospective, cross-sectional study. Data were obtained from the pharmacy database and medical records (opioids prescribed for 1 month, pain intensity, and medication management). The medical records of 634 in patients who were prescribed at least 1 dose of an opioid analgesic were reviewed. Results: The average pain score provided by physicians (5.4/10; SEM=0.17) was significantly higher than the average pain score reported by nurses (3.5/10; SEM=0.15) (p

Tereza Romanová,1,2 Filip Burša,1,2 Peter Sklienka,1,2 Jiří Sagan,3 Michelle Vaňková,1 Denis Buršík,1,2 Markéta Bílená,1,2 Martin Pulcer,4 Michal Burda,5 Jan Máca1,2,6 1Department of Anesthesiology and Intensive Care Medicine, University Hospital, Ostrava, Czech Republic; 2Department of Intensive Medicine, Emergency Medicine and Forensic Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic; 3Department of Infectious Diseases, University Hospital Ostrava, Ostrava, Czech Republic; 4Institute of Laboratory Medicine, University Hospital Ostrava, Ostrava, Czech Republic; 5Institute for Research and Applications of Fuzzy Modeling, CE IT4Innovations, University of Ostrava, Ostrava, Czech Republic; 6Institute of Physiology and Pathophysiology, Faculty of Medicine, University of Ostrava, Ostrava, Czech RepublicCorrespondence: Jan Máca, Department of Anesthesiology and Intensive Care Medicine, University Hospital Ostrava, 17. listopadu 1790/5, Ostrava, 708 52, Czech Republic, Tel +420597371111, Email jan.maca@fno.czPurpose: Anticoagulation therapy aims to improve the outcome of critically ill patients with severe COVID-19-associated pneumonia. Activated partial thromboplastin time (aPTT) is commonly used to maintain the target therapeutic range of continuous infusion of unfractionated heparin (UFH). The UFH infusion efficacy can be evaluated by determining the time in therapeutic range (TTR) using a modified Rosendaal method. The present study’s primary aim was to evaluate TTR based on the aPTT in critically ill patients with severe forms of COVID-19 pneumonia and its influence on survival. The secondary aim was to evaluate the time spent above (TATR) and below the therapeutic range (TBTR).Patients and Methods: We performed a retrospective analysis of critically ill patients with COVID-19-associated pneumonia. All patients received a continuous infusion of UFH from the 2nd to 8th day since admission to the ICU. TTR, TATR, and TBTR were calculated using the modified Rosendaal method, and survival days were analyzed by regression (censored after 60 days).Results: Of 103 patients, the median TTR was 49% (IQR 38– 63%), TATR 11% (IQR 5– 20%), and TBTR 33% (IQR 22– 51%). The regression analysis indicated a positive impact of higher TTR and TATR on the number of survival days [β=0.598 (p=0.0367) and β=1.032 (p=0.0208), respectively] and a negative impact of higher TBTR [β=− 0.681 (p=0.0033)] on the number of survival days.Conclusion: Higher TTR and TATR were associated with better survival of critically ill patients with a severe course of COVID-19-associated pneumonia. Higher TBTR was associated with worse survival in these patients.Keywords: unfractionated heparin, COVID-19, pneumonia, critical care

Los analgésicos opioides son esenciales para control del dolor moderado a severo, que es un parámetro de calidad en atención hospitalaria. Objetivo: describir el uso e indicación de analgésicos opioides en la población hospitalizada del Hospital de San José de Bogotá DC en febrero de 2014. Materiales y métodos: estudio retrospectivo de utilización de medicamentos (EUM) en 559 pacientes mayores de 16 años, midiendo dosis hospitalaria definida (DDD/DHD) y patrón de distribución opioide según especialidad, diagnóstico CIE10, utilización de herramientas validadas de valoración del dolor, concomitancia opioide e interconsulta a la unidad de dolor. Resultados: los principales motivos de hospitalización fueron la patología quirúrgica no oncológica y oncológica con 73,7%, y 8,4%. El opioide de mayor utilización fue tramadol con 15,4 DDD/100 camas/día. El consumo de morfina e hidromorfona parenteral es bajo con 2 y 1,3 DDD/100 camas/día. De los opioides fuertes, morfina es el más utilizado, siendo cirugía general, hematología y ortopedia los principales prescriptores con 27,4%, 20,4% y 20,4%. La distribución de morfina en los grupos poblacionales de cada especialidad es heterogénea, presentando mayor uso en pacientes hematológicos con 39,1%. Se utilizaron las escalas de valoración del dolor al ingreso y egreso hospitalario en el 48,6% y 5,1%. Conclusión: se deben fortalecer las guías de manejo de dolor institucionales. Hay poca adherencia al uso de escalas de dolor cómo parámetro de seguimiento de la terapia analgésica. Se crearán estrategias educativas para el adecuado manejo del dolor.

Background: Postoperative nausea and vomiting (PONV) is a significant problem following paediatric surgery, and volatile anaesthetics are an important cause of this phenomenon. BIS-guided anaesthesia, by reducing the consumption of anaesthetics, leads to a decrease in PONV in adult patients., Study Objective: Evaluate the role of BIS-guided anaesthesia in reducing the incidence of paediatric PONV., Design: Prospective, randomized, double-blind study., Setting: A single center study in university hospital in Czech republic, from June 2021 to November 2022., Patients: A total of 163 children, aged 3-8 years with ASA I-II who underwent endoscopic adenoidectomy under general anaesthesia were included., Interventions: In the intervention group, the depth of anaesthesia was maintained to values between 40 and 60 of BIS., Main Outcome Measure: The primary outcome was the incidence of postoperative nausea and vomiting during 24 h after surgery., Results: The use of BIS-guided anaesthesia led to a significant decrease in the incidence of nausea and vomiting compared to the control group [17% vs. 53%; RR (95%CI) 0.48 (0.27-0.86); p < 0.001and 16% vs. 34%; RR (95%CI) 0.33 (0.20-0.54); p = 0.01, respectively]., Conclusions: BIS-guided anaesthesia decreases the incidence of postoperative nausea and vomiting in children undergoing adenoidectomy., Trial Registration: Clinicaltrials.gov identifier: NCT04466579., (© 2024. The Author(s).)

Objective: Emergence delirium (ED) is a postoperative complication in pediatric anesthesia characterized by a perception and psychomotor disorder, with a negative impact on postoperative recovery. As the use of inhalation anesthesia is associated with a higher incidence of ED, we investigated whether titrating the depth of general anesthesia with BIS monitor can reduce the incidence of ED., Design: Randomized, prospective, and double-blind., Setting: Patients undergoing endoscopic adenoidectomy under general anesthesia according to a uniform protocol., Patients: A total of 163 patients of both sexes aged 3-8 years were enrolled over 18 months., Interventions: Immediately after the induction of general anesthesia, a bispectral index (BIS) electrode was placed on the patient's forehead. In the study group, the depth of general anesthesia was monitored with the aim of achieving BIS values of 40-60. In the control group, the dose of sevoflurane was determined by the anaesthesiologist based on MAC (minimum alveolar concentration) and the end-tidal concentration., Measurements: The primary objective was to compare the occurrence of ED during the PACU (post-anesthesia care unit) stay in both arms of the study. The secondary objective was to determine the PAED score at 10 and 30 min in the PACU and the need for rescue treatment of ED., Main Results: 86 children were randomized in the intervention group and 77 children in the control group. During the entire PACU stay, 23.3% (38/163) of patients developed ED with PAED score >10: 35.1% (27/77) in the control group and 12.8% (11/86) in the intervention group (p = 0.001). Lower PAED scores were also found in the intervention group at 10 (p < 0.001) and 30 (p < 0.001) minutes compared to the control group. The need for rescue treatment did not differ between groups (p = 0.067)., Conclusion: Individualization of the depth of general anesthesia with BIS monitoring is an effective method of preventing ED in children., Clinical Trial Registration: NCT04466579., (Copyright © 2023 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Background: Maintaining the patient awake and not intubated during the venovenous extracorporeal membrane oxygenation (VV ECMO) reduces the risk of ventilation-induced lung injury in patients with ARDS. Currently, there is a lack of data on outcomes and complications associated with the awake ECMO approach., Objectives: To evaluate outcomes and the occurrence of complications of awake ECMO approach guided by local safety protocol comprising ultrasound-guided cannulation, argatroban-based anticoagulation, respiratory support, and routine sedation targeted to reduce respiratory effort and keeping nurse-to-patient ratio of 1:1., Design: A single-center retrospective case series analysis., Methods: Consecutive patients with COVID-19-related acute respiratory distress syndrome (ARDS) (CARDS) treated by full awake VV ECMO approach from April 2019 to December 2023 were eligible., Results: Our center treated 10 patients (mean age 54.7 ± 11.6 years) with CARDS with an awake ECMO approach. The reasons for awake ECMO included the presence of barotrauma in six patients, a team consensus to prefer awake ECMO instead of mechanical ventilation in three patients, and the patient's refusal to be intubated in one case. Before ECMO, patients were severely hypoxemic, with a mean value of Horowitz index of 48.9 ± 9.1 mmHg and a mean respiratory rate of 28.8 ± 7.3 breaths per minute on high-flow nasal cannula or noninvasive ventilation support. The mean duration of awake VV ECMO was 558.0 ± 173.6 h. Seven patients (70%) were successfully disconnected from ECMO and fully recovered. Intubation from respiratory causes was needed in three patients (30%), all of whom died eventually. In total, three episodes of delirium, two episodes of significant bleeding, one pneumothorax requiring chest tube insertion, and one oxygenator acute exchange occurred throughout the 5580 h of awake ECMO. No complications related to cannula displacement or malposition occurred., Conclusion: The awake ECMO strategy guided by safety protocol appears to be a safe approach in conscious, severely hypoxemic, non-intubated patients with COVID-19-related ARDS.