British journal of anaesthesia
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Peripheral and truncal nerve blocks provide effective analgesia facilitating perioperative care. However, thresholds for clinically relevant effects remain undetermined and are left for clinicians to choose. These choices are fundamental for sample size calculations and interpretation of study results. This systematic scoping review aimed to create an overview of primary outcomes and anticipated effect sizes in randomised clinical trials assessing peripheral and truncal nerve blocks. ⋯ The presented outcomes and effect sizes from published trials on peripheral and truncal nerve block literature can be used in future trials to increase homogeneity in regional anaesthesia research.
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Randomized Controlled Trial Multicenter Study
Early noninvasive ventilation in general wards for acute respiratory failure: an international, multicentre, open-label, randomised trial.
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Editorial Review
Improving lung protective mechanical ventilation: the individualised intraoperative open-lung approach.
Despite the maturity and sophistication of anaesthesia workstations, improvements in our understanding of intraoperative mechanical ventilation, and use of less invasive surgical techniques, postoperative pulmonary complications (PPCs) are still a common problem in surgical patients of all ages. PPCs are associated with a higher incidence of perioperative morbidity and mortality, longer hospital stays, and higher healthcare costs. PPCs are strongly associated with anaesthesia-induced atelectasis, which predisposes to lung damage when partially collapsed lungs are subjected to mechanical ventilation. ⋯ Intraoperative protective ventilation strategies have been based on two main but intrinsically different hypotheses: one based on sole reduction of tidal volume and pressures, using minimal positive end-expiratory pressure (PEEP), tolerating the presence of lung collapse, and the other also limiting tidal volume and pressures after actively resolving atelectasis by lung recruitment and PEEP individualisation, the individualised open-lung approach. We review the concepts of the individualised open-lung approach, its potential benefits, and outstanding questions. We conclude with a proposal for personalised lung protective ventilation.
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This narrative review evaluates the evidence regarding the protection offered by isolation gowns, approaches to imparting antimicrobial activity to gowns, and the environmental impacts of gown use, particularly during the COVID-19 pandemic. We conducted a search of the Medline, PubMed, and Google Scholar databases for articles published between January 1, 2019 to February 20, 2024. We found that current standards pertaining to isolation gowns might be irrelevant to the protection of healthcare workers from pathogen transmission, as they focus primarily on fluid barrier resistance values that are not reflective of all transmission conditions in hospitals. ⋯ However, evidence of the effectiveness of such techniques in clinical settings is scarce. We advocate for standardised guidelines inclusive of common pathogen survival tests, comfort, and durability, which reflect the actual infection risks encountered by healthcare workers, to improve the safety and efficacy of isolation gowns in hospital settings. Further research into the clinical effectiveness of antimicrobial gowns and their long-term implications on the environment is also warranted.