INTRODUCTION:Therapeutic advances in the treatment of hematologic malignancies have significantly improved patients survival. An increasing number of these patients become eligible for major surgical procedures that may require postoperative admission to intensive care unit (ICU). While several factors associated with ICU mortality in this population have been identified in the medical setting, little is known about prognostic factors in the postoperative setting. The aim of this study was to identify factors associated with poor postoperative outcomes in patients with hematologic malignancies admitted to surgical ICU. METHOD:We conducted a retrospective study at two French referral centers from 2010 to 2021. Primary outcome was the 90-day mortality rate. RESULTS:We included 122 patients, of whom 27 (22%) died within 90 days of ICU admission. In multivariate logistic regression analysis, higher SAPS II score (OR 1.06 [1.03-1.11]; p< 0.001), presence of sepsis (OR 5.16 [1.36-26.3]; p = 0.026), and need for mechanical ventilation (OR 9.79 [2.67-45.8]; p = 0.001) were independently associated with 90-day mortality. DISCUSSION:SAPS II score, sepsis, and the need for mechanical ventilation were independently associated with poor prognosis in patients with hematologic malignancies admitted to the surgical ICU. Prospective studies are warranted to better personalize perioperative management in this high-risk population.

OBJECTIVE:To provide guidelines for guidelines on adult patient intubation in emergency settings outside the operating room and intensive care unit. DESIGN:A consensus committee of 24 experts from the French Society of Anaesthesia and Intensive Care Medicine (Société Française d'Anesthésie et de Réanimation, SFAR) and the French Society of Emergency Medicine (Société Française de Médecine d'Urgence, SFMU) was convened. A formal conflict-of-interest (COI) policy was developed at the beginning of the process and enforced throughout. The entire guideline developpement process was conducted independently of any industrial funding (e.g., pharmaceutical or medical device companies). The authors were required to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide the assessment of the quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. METHODS:The aim of these expert panel guidelines is to evaluate adult patient intubation in emergency settings outside the operating room and intensive care unit. The experts studied questions within 5 domains. Each question was formulated according to the PICO (Population, Intervention, Comparison, Outcome) model, and the evidence profiles were produced. An extensive literature review and recommendations were carried out and analysed according to the GRADE® methodology. RESULTS:The experts' synthesis and the application of the GRADE® method yielded 32 recommendations for adult patient intubation in emergency settings outside the operating room and intensive care unit. Among the formalised recommendations, 5 have high levels of evidence (GRADE 1), and 12 have low levels of evidence (GRADE 2). For 15 recommendations, the GRADE method could not be applied, resulting in expert opinions. 4 questions did not find any response in the literature. After 4 rounds of scoring and amendment, strong agreement was reached for all the recommendations. CONCLUSIONS:There was strong agreement among experts for 36 recommendations to improve practices for adult patient intubation in emergency settings outside the operating room and intensive care unit.

INTRODUCTION:Tramadol is widely used in post-operative pain management. Concentrations of tramadol and its active metabolite O-demethyl tramadol (O-dT) are influenced by cytochrome P450 2D6 (CYP2D6) genotype. OBJECTIVES:The objectives of this study were to investigate the relationships between CYP2D6 phenotype and tramadol pharmacokinetics/ pharmacodynamics (PK/PD) in real life setting. METHODS:CYTRAM was a prospective multicenter study conducted in patients who received post-operative intravenous (IV) tramadol. Patients underwent CYP2D6 genotyping and phenotyping as well as tramadol and O-dT concentration measurements at 24 h and 48 h of therapy. A PK model was used to estimate tramadol and O-dT area under the concentration-time curve (AUC). Pain rating was performed at 24 h and 48 h and evaluated by Numeric Rating Scale (NRS). Patients with NRS < 4 were classified as responders. Variables associated with analgesic response were examined. RESULTS:PK data from 285 patients and pain scores from 273 and 204 patients were available at 24 h and 48 h, respectively. Mean AUC of O-dT was two-fold lower in CYP2D6 poor metabolizers (PM) compared with subjects with other phenotypes (non-PM). At 48 h, pain scores were significantly higher in PM than in non-PM patients. In addition, PM subjects exhibited a significantly lower rate of response (50% versus 78%) and a higher rate of morphine use (47% versus 17%) at 48 h compared with non-PM subjects. However, CYP2D6 phenotype was not an independent predictor of response in the entire population. CONCLUSION:Our results support current pharmacogenetic guidelines and suggest avoiding tramadol for postoperative management in patients with known CYP2D6 PM phenotype. REGISTRATION:ClinicalTrials.gov (NCT00952159).

Invasive fungal diseases (IFDs) are common and often fatal in severe burn patients due to skin barrier loss and immune dysfunction. However, current definitions of invasive mold infections are poorly adapted to this population. This study evaluated the characteristics of various diagnostic criteria and their combinations in relation to clinical outcomes in burn patients. We conducted a retrospective cohort study of all patients admitted to the Burn ICU from 2014 to 2023 with ≥15% total burn surface area and at least one sample sent to the mycology lab. Criteria included direct microscopy, culture (respiratory, skin, or tissue), species-specific quantitative PCR (qPCR) (Aspergillus, Mucorales, and Fusarium) on plasma/tissue/bronchoalveolar lavage fluid, and serum galactomannan. Among 276 patients, 489/6,184 samples were positive, including 281 skin biopsies (direct examination and conventional culture) and 132 plasma specimens (qPCR). Positive diagnostic criteria ≥1 was found in 93 patients (33.7%): Aspergillus (25.7%), Mucorales (10.9%), and Fusarium (9.8%). Twenty-seven patients (9.8%) had ≥2 criteria involving ≥2 mold types. Mortality rose with the number of positive criteria: 12.7% (0), 10.7% (1, 2), 27.3% (3, 4), and 46.7% (≥5) (P < 0.001). Plasma qPCR was positive in 81.3% of Mucorales, 40% of Aspergillus, and 15.4% of Fusarium cases with skin involvement. Skin biopsies (direct examination and conventional culture) combined with species-specific plasma qPCR enhance timely and reliable IFD diagnosis in burn patients. Mortality correlated with the number of positive criteria and coexistence of multiple mold species, underscoring the need for broad antifungal coverage and the value of multi-criteria diagnostics to guide treatment.IMPORTANCEInvasive mold infections are frequent and often fatal complications in patients with severe burns, occurring in up to 20% of cases with a total burn surface area exceeding 15%. Despite their severity, no standardized case definition currently exists to guide research or clinical management in this population. The performance of existing mycological diagnostic criteria remains unknown in burn patients. In this 10-year retrospective study, we evaluated the diagnostic performance of individual and combined mold-related criteria in relation to patient outcomes, analyzing more than 6,000 clinical samples. These findings provide a first comprehensive assessment of mold diagnostic markers in the burn population.

Chaque année, le Conseil national des universités (CNU Santé) organise, sur instruction du ministère de l’Enseignement supérieur et de la Recherche, les concours de mise sur liste d’aptitude aux fonctions de maîtres de conférences et professeurs des universités – praticiens hospitaliers (MCU-PH, PU-PH). En 2025, la sous-section 48-01 « Anesthésiologie-Réanimation et Médecine Périopératoire » (ARMPO) a auditionné quinze candidats (3 MCU-PH, 12 PU-PH). Le concours est précédé d’une visite sur site par deux rapporteurs désignés, qui évaluent l’intégration au sein de l’établissement, les aptitudes scientifiques, pédagogiques et dans la conduite d’équipe du candidat. Le jour du concours, l’audition se déroule en deux étapes : présentation du parcours et du projet hospitalo-universitaire du candidat, puis échange avec le jury du CNU. Une épreuve de pédagogie (leçon de 20minutes) et la rédaction préalable d’une station d’Examen clinique objectif structuré (ECOS) complètent l’évaluation. La promotion 2025 illustre la diversité et la richesse des profils : anesthésie spécialisée, réanimation chirurgicale et polyvalente, innovations pédagogiques, recherche translationnelle, intelligence artificielle, éthique clinique, organisation des soins et développement durable. Les projets couvrent des thématiques variées : optimisation hémodynamique, médecine personnalisée cardiovasculaire, prévention des dysfonctions d’organes, soins périopératoires intégrés, simulation haute-fidélité, neurosciences, allergo-anesthésie, traumatologie, transplantation, ischémie-reperfusion pulmonaire, immunologie du sepsis. À travers la présentation de ces parcours, la sous-section 48-01 témoigne de la vitalité scientifique, pédagogique et hospitalière de l’ARMPO en France, discipline à l’interface de multiples expertises et résolument tournée vers l’innovation, la collaboration interdisciplinaire et la formation des générations futures.

The National Council of Universities (CNU) for Health, under the Ministry of Higher Education and Research, annually conducts competitive examinations to appoint associate professors (MCU-PH) and full professors (PU-PH) in medicine. In 2025, subsection 48-01 "Anesthesiology, Critical Care, and Perioperative Medicine" (ACCPM) evaluated 15 candidates (3 MCU-PH, 12 PU-PH) through a rigorous process. The selection includes an on-site visit by two appointed reviewers-assessing integration within the institution, scientific and educational contributions, and leadership, followed by a two-stage audition: presentation of the candidate's career and academic project, and an interactive discussion with the CNU panel. On the day of the examination, candidates also deliver a 20-minute teaching session and submit a previously prepared Objective Structured Clinical Examination (OSCE) station. The 2025 cohort reflects the breadth of ACCPM expertise: specialized anesthesia, surgical and general intensive care, perioperative medicine, and multidisciplinary leadership. Research themes span hemodynamic optimization, personalized cardiovascular medicine, prevention of organ dysfunction, translational and clinical neurosciences, high-fidelity simulation, allergo-anesthesia, trauma care, transplantation, pulmonary ischemia-reperfusion, sepsis immunology, and applications of artificial intelligence in critical care. These profiles also demonstrate a commitment to innovation in medical education, ethical practice, sustainable healthcare, and integrated care pathways. Collectively, they highlight the scientific vitality and strategic vision of ACCPM in France, an inherently interdisciplinary field dedicated to improving patient outcomes, advancing research, and training the next generation of perioperative and critical care specialists.

PURPOSE OF THE REVIEW:Magnesium sulfate (MgSO4) enhances neuromuscular blockade; it may accelerate onset, prolong clinical duration, and delay neuromuscular recovery. In addition, MgSO4 administration shortly after neuromuscular recovery may lead to the recurrence of neuromuscular blockade. This review aimed to assess the efficacy and safety of sugammadex in both scenarios. RECENT FINDINGS:Compelling evidence suggests that the dosing and timing of sugammadex administration remain unchanged whether the neuromuscular blockade is induced by rocuronium alone or results from magnesium pretreatment before rocuronium administration. Furthermore, particular caution is required when MgSO4 is administered shortly after recovery from neuromuscular blockade, as the reduced safety margin may lead to the reappearance of neuromuscular blockade. Sugammadex may also counteract this recurrence, provided that the initial neuromuscular blockade was induced by a steroidal neuromuscular blocking agent such as rocuronium or vecuronium. SUMMARY:In both clinical scenarios, sugammadex-induced reversal is rapid and reliable.

Introduction:Latex allergy is a leading cause of perioperative anaphylaxis, yet the risk of graft-mediated exposure during solid organ transplantation is poorly characterised. Case Presentation:We report the case of a 45-year-old man with end-stage renal disease and confirmed latex allergy who underwent kidney transplantation with a graft that had been handled with latex gloves during procurement. Following multidisciplinary discussion, the graft was repeatedly rinsed with preservation solution to reduce antigenic load. The operating theatre was prepared as latex-free, and the anaesthesia team implemented enhanced readiness for anaphylaxis. The surgery and perioperative course were uneventful, and the patient was extubated in theatre and transferred to intensive care without complication. Conclusion:This case underscores the potential for graft-mediated anaphylaxis due to latex contamination during procurement. Systematic latex avoidance from organ retrieval to implantation, along with communication between procurement and implant teams, is crucial to mitigate risk in sensitised recipients.

IntroductionDelayed graft function (DGF) is a frequent complication following kidney transplant. This study aimed to assess the association between early post-operative lactate variation and DGF.MethodsThis was a single center, retrospective cohort study between February 2021 and December 2022 in Saint-Louis Hospital (APHP, France). Venous lactate levels were measured immediately (H0) and 4 h (H4) after kidney transplant. The primary outcome was the occurrence of DGF (need for renal replacement therapy between transplantation and day 7). Secondary outcome was the occurrence of complications (i.e., death, vascular thrombosis, hemorrhagic shock, urological complications (hematoma, urinoma), local or systemic infection) between transplant and day 7.ResultsTwo hundred 12 patients were included, and 38 (17.9%) developed DGF. Venous lactate variation between H0 and H4 was higher in patients who developed DGF (-30 (IQR -83, -6)% vs. -15 (IQR -62, -11)%, p = .037), but the variation of level was more often positive (corresponding to an increased lactate production over time between H0 and H4) in patients who developed DGF ((28(85%) vs. 94(62%), p = .011). In multivariate logistic regression, positive venous lactate level variation between H0 and H4 was strongly associated with a reduced risk of developing DGF (OR .30 [.09-.79], p = .024). We did not find any association between post-operative hyperlactatemia and occurrence of complications between transplant and day 7.DiscussionDGF is a frequent complication following kidney transplantation. Its early prediction could help physicians optimize treatment and protect the kidney. Early venous lactate variation after kidney transplant could help to predict the occurrence of DGF.

La notion de risque est inséparable de l’exercice de l’anesthésie-réanimation et sa maîtrise une préoccupation centrale. Les progrès accomplis en matière de sécurité ces trente dernières années ont rendu possible une réduction d’un facteur dix de la morbi-mortalité directement ou indirectement liée à l’anesthésie. La formation des professionnels de l’anesthésie-réanimation s’est améliorée (allongement à cinq ans de la durée du troisième cycle de spécialité). Une attention particulière a été portée à l’évaluation préopératoire du patient (obligation réglementaire de la consultation d’anesthésie), au contrôle des voies aériennes (prévention de l’inhalation du contenu gastrique) et de l’hémodynamique (stratégie transfusionnelle), à la surveillance et à la gestion des complications en post opératoire (obligation de passage en salle de surveillance postinterventionnelle). Des techniques d’anesthésie plus sûres et plus efficaces ont également joué un rôle. La mise en place de protocoles standardisés pour la gestion des patients en période périopératoire (homogénéisation des pratiques médicales) a permis de minimiser les risques de complications, notamment les infections et les événements thromboemboliques. Enfin, les progrès technologiques tels que les équipements de surveillance et de ventilation, leur vérification et leur maintenance rendues obligatoires, la mise à disposition de médicaments anesthésiques plus sûrs et la disponibilité continue des équipes d’anesthésie-réanimation durant la période opératoire, permettant l’intervention sans délai, à tout instant de la prise en charge, ont également contribué à diminuer la morbi-mortalité anesthésique. Ces avancées ont permis de réduire le risque de complications liées totalement ou partiellement à l’anesthésie contribuant à une amélioration significative de la sécurité des patients bénéficiant d’un acte interventionnel, chirurgical ou non.

BACKGROUND Drug challenge is the gold standard for identifying causative agents of drug allergies. Although clinical guidelines have recently been published, they do not recommend neuromuscular blocking agent (NMBA) drug challenges. NMBA challenges are rendered difficult by the lack of homogeneity of routine allergy work-ups and the necessity of a specialised setting. Several scenarios support NMBA challenges, such as an ambiguous allergy work-up, a high suspicion of a false-positive skin test or identification of a well tolerated alternative NMBA strategy. Furthermore, routine allergy work-ups may not recognise non-IgE mechanisms, such as IgG or MRGPRX2, whereas drug challenges may reveal them. Finally, if the culprit NMBA is not identified, subsequent anaesthesia regimens will be challenging to implement, resulting in increased risk. OBJECTIVE(S) This literature review discusses the indications, strategies, doses, monitoring methods, limitations, and unresolved issues related to drug challenges for NMBAs. DESIGN The literature review included randomised controlled trials, observational studies, reviews, case reports, series, and comments on humans. DATA SOURCES Studies were retrieved from databases (PubMed) and electronic libraries (OVID, EMBASE, Scopus, etc.). ELIGIBILITY CRITERIA All studies that referred to the NMBA challenge were included without publication date limitations. RESULTS NMBA challenge may be considered in NMBA anaphylaxis patients with inconclusive or ambivalent IgE diagnostic work-up under controlled conditions (presence of anaesthetists and allergists with continuous monitoring in a secured environment). To illustrate its utility, a case report of a double NMBA challenge in a patient with NMBA cross-reactivity is presented, along with biological explorations to detect subclinical cellular activation, a novel aspect of this procedure. CONCLUSION Drug challenges could be implemented during the NMBA allergy work-up under strict safety conditions at specialised centres with close collaboration between anaesthetists and allergists. This could decrease uncertainty and contribute to defining a safer strategy for subsequent anaesthetic drug regimens.

The concept of risk is inseparable from the practice of anaesthesia and its control is a major concern. The progress made in safety over the last thirty years has made it possible to reduce morbidity and mortality directly or partially linked to anaesthesia by a factor of ten. The training of anaesthesia and intensive care professionals has been improved (the length of the postgraduate course has been extended to five years). Particular attention has been paid to pre-operative patient assessment (a legal requirement for an anaesthetic consultation), airway control (prevention of inhalation of gastric contents) and haemodynamics (transfusion strategy), as well as the monitoring and management of post-operative complications (mandatory followup in the post-anaesthesia care unit). Safer and more effective anaesthesia techniques have also played a role. The introduction of standardized protocols for managing patients during the perioperative period (standardization of medical practices) has helped to minimise the risk of complications, particularly infections and thromboembolic events. Lastly, technological advances such as monitoring and ventilation equipment, which are now compulsorily checked and maintained, the availability of safer anaesthetic drugs and the continuous availability of anaesthesia and intensive care teams during the operating period, enabling them to intervene without delay in the event of an emergency, have also helped to reduce anaesthetic morbidity and mortality. These advances have made it possible to reduce the risk of complications directly or partially linked to anaesthesia, contributing to a significant improvement of patient safety undergoing interventional procedures, whether surgical or not. (c) 2024 l'Academie nationale de medecine. Published by Elsevier Masson SAS. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

We present our findings on interpatient transmission, epidemic control measures, and the outcomes of a series of ten critically ill burn patients who were either colonized or infected with carbapenem-resistant Acinetobacter baumannii (CRAB). None of the five infected patients achieved clinical cure, and all experienced relapses. Microbiological failure was observed in 40% of the infected patients. The isolated CRAB strains were found to carry blaOXA-23 and armA resistance genes. Despite the lack of clinical cure, all five infected patients survived and were discharged from the Burn Intensive Care Unit.

Background. In burn patients, skin barrier disruption and immune dysfunctions increase susceptibility to invasive fungal diseases (IFDs) like invasive candidiasis (IC) and invasive mold infections (IMI). We provide an in-depth analysis of IFD-related factors and outcomes in a 10-year cohort of severe burn patients. Methods. This retrospective cohort study includes adult patients admitted to the burn intensive care unit (BICU) between April 2014 and May 2023 with total burn surface area (TBSA) >= 15%. Patients were classified as proven IFD according to EORTC/MSGERC criteria applicable for IC. Putative IMIs were defined with: >= 2 positive cultures from a skin biopsy/bronchoalveolar lavage or >= 2 positive blood specific-quantitative polymerase chain reactions (qPCRs) or a combination of both. Results. Among 1381 patients admitted, 276 consecutive patients with TBSA >= 15% were included. Eighty-seven (31.5%; IC n = 30; IMI n = 43; both n = 14) patients fulfilled the criteria for probable/putative IFD. At Day 30 after the burn injury, the estimated cumulative incidence proven/putative (pr/pu) IFD was 26.4% (95% confidence interval [CI], 21.4%-31.8%). Factors independently associated with IFDs were TBSA, severity scores and indoor burn injury (ie, from confined space fire). Overall mortality was 15.3% and 36.8% in the no IFD, pr/pu IFD groups respectively (P < .0001). IFD was independently associated with a risk of death (hazard ratio [HR]: 1.94 for pr/pu IFD; 95% CI, 1.12-3.36; P = .019). Conclusions. This study describes twenty-first-century characteristics of IFDs in severe burn patients confirming known risk factors with thresholds and identifying the indoor injury as an independent factor associated to IFDs. This suggests a link to contamination caused by fire damage, which is highly susceptible to aerosolizing spores.

Introduction: Perioperative immediate hypersensitivity (POH) is a rare complication estimated at 1/10,000 anaesthesia. The objective of our study was to investigate the risk factors of POH over a 6-year period in a French teaching hospital. Materials and Methods: A single-centre retrospective descriptive epidemiological study of patients treated in the operating room from January 2016 to December 2021 with and without POH. Results: 111 POH were identified out of 47,585 surgeries, mainly women (71%) with a history of asthma (16% vs. 6%, p < 0.001) undergoing plastic surgery (49% vs. 32%, p < 0.001). POH patients were more likely to receive neuromuscular blocking agents and antibiotics (respectively, 88% vs. 59%, p < 0.001 and 59% vs. 24%, p < 0.001). 92% of patients underwent intraoperative sampling, only 31% benefited from an allergy consultation. 14% had positive skin test (ST). The culprit agent were neuromuscular blocking agents (47% of which 57% rocuronium, 29% suxamethonium, and 14% atracurium), antibiotics (33%, of which 80% cefazolin and 20% cefoxitin), and gelatin (7%). Conclusion: Our study reported a POH incidence of 23/10,000 anaesthesia, with identified allergens aligning with existing literature. These findings underscore the critical need for enhanced patient follow-up to monitor potential hypersensitivity and mitigate future risks. (c) 2024 S. Karger AG, Basel

Purpose The present study aimed at assessing the prevalences of post-traumatic stress disorder (PTSD) (main objective), anxiety, depression, and burnout syndrome (BOS) and their associated factors in intensive care unit (ICU) staff workers in the second year of the COVID-19 pandemic. Materials and methods An international cross-sectional multicenter ICU-based online survey was carried out among the ICU staff workers in 20 ICUs across 3 continents. ICUs staff workers (both caregivers and non-caregivers) were invited to complete PCL-5, HADS, and MBI questionnaires for assessing PTSD, anxiety, depression, and the different components of BOS, respectively. A personal questionnaire was used to isolate independent associated factors with these disorders. Results PCL-5, HADS, and MBI questionnaires were completed by 585, 570, and 539 responders, respectively (525 completed all questionnaires). PTSD was diagnosed in 98/585 responders (16.8%). Changing familial environment, being a non-caregiver staff worker, having not being involved in a COVID-19 patient admission, having not been provided with COVID-19-related information were associated with PTSD. Anxiety was reported in 130/570 responders (22.8%). Working in a public hospital, being a woman, being financially impacted, being a non-clinical healthcare staff member, having no theoretical or practical training on individual preventive measures, and fear of managing COVID-19 patients were associated with anxiety. Depression was reported in 50/570 responders (8.8%). Comorbidity at risk of severe COVID-19, working in a public hospital, looking after a child, being a non-caregiver staff member, having no information, and a request for moving from the unit were associated with depression. Having received no information and no adequate training for COVID-19 patient management were associated with all 3 dimensions of BOS. Conclusion The present study confirmed that ICU staff workers, whether they treated COVID-19 patients or not, have a substantial prevalence of psychological disorders.