Background: Sedation of ventilated critically ill trauma patients requires high doses of opioids and hypnotics. We aimed to compare the consumption of opioids and hypnotics, and patient outcomes using sedation with or without continuous regional analgesia (CRA).Methods: Multiple trauma-ventilated patients were included. The patients were randomized to receive an intravenous analgesia (control group) or an addition of CRA within 24h of admission. A traumatic brain injury (TBI) patients group was analyzed. The primary endpoint was the cumulative consumption of sufentanil at 2 days of admission. Secondary endpoints were cumulative and daily consumption of sufentanil and midazolam, duration of mechanical ventilation, intensive care unit (ICU) stay, and safety of CRA management.Results: Seventy six patients were analyzed: 40 (67.5% males) in the control group and 36 (72% males) in the CRA group, respectively. The median [IQR] Injury Severity Score was 30.5 [23.5-38.5] and 26.0 [22.0- 41.0]. The consumption of sufentanil at 48h was 725 [465-960] mu g/48h versus 670 [510-940] mu g/48h (p = 0.16). Daily consumption did not differ between the groups except on day 1 when consumption of sufentanil was 360 [270-480] mu g vs. 480 [352-535] mu g (p = 0.03). Consumptions of midazolam did not differ between the groups. No difference was noted between the groups according to the secondary endpoints.Conclusions: CRA does not decrease significantly sufentanil and midazolam consumption within the first 5 days after ICU admission in multiple trauma-ventilated patients. The use of peripheral nerve blocks in heavily sedated and ventilated trauma patients in the ICU seems safe.(c) 2022 Published by Elsevier Masson SAS on behalf of Socie acute accent te acute accent franc , aise d'anesthe acute accent sie et de re acute accent animation (Sfar).

Objective: To compare the area of the lumen of the axillary and subclavian veins using ultrasound (US) in 50 healthy volunteers.Methods: Using an ultrasound device, depth, area, short axis vein length and long axis vein, vein-artery and vein-pleura distances were measured for axillary and subclavian approaches.Results: The mean cross-sectional area of the axillary vein was greater than the mean cross-sectional area of the subclavian vein (327 +/- 89 mm(2) versus 124 +/- 46 mm(2), P < 0.001). Both the mean transverse (10 +/- 2 mm versus 9 +/- 2 mm) and longitudinal axes (39 +/- 8 mm versus 17 +/- 7 mm) of the axillary vein were greater than those of subclavian vein (P < 0.01, P < 0.001, respectively). The depths of the axillary and subclavian veins were similar (21 +/- 6 mm versus 20 +/- 6 mm, P = 0.43). The axillary and subclavian arteries were visualised in 3 and 45 volunteers, respectively (P < 0.001). The pleura was seen in 25 and 37 volunteers with the axillary and subclavian approaches, respectively (P = 0.01). The distance between the pleura and the subclavian vein was smaller (6 +/- 2 mm versus 8 +/- 3 mm, P < 0.04).Conclusion: The present US study shows that visualisation of the axillary vein under US is greater than that for the subclavian vein, mainly due to a better alignment with the long axis of the axillary vein leading to a greater cross-sectional area of the axillary vein. (C) 2016 Societe francaise d'anesthesie et de reanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

We hypothesized that placing the arm in 90° abduction, through 90° flexion and 90° external rotation, could improve ultrasound visualization of the subclavian vein. In 49 healthy volunteers, a single operator performed a view of the subclavian vein in neutral position and abduction position. A second blinded operator measured the cross-sectional area of the subclavian vein. Abduction position increased the cross-sectional area of the subclavian vein from 124 ± 46 (mean ± SD) to 162 ± 58 mm 2 ( P = 0.001). An increase of the cross-sectional area of ≥50% was observed in 41% volunteers (95% confidence interval, 27%–56%, n = 20); this technique offers an alternative approach (maybe safer) for ultrasound-guided catheterization of the subclavian vein.

L’abord veineux central axillaire [1] semble être une alternative intéressante à l’abord sous-clavier [2] échoguidé. Le but de cet essai était de comparer ces deux approches. Il s’agissait d’un essai randomisé de non-infériorité monocentrique. Tous les patients requérant un accès veineux central admis en réanimation ou au bloc opératoire et ne présentant aucune contre-indication à un abord sous-clavier ont été aléatoirement assignés au groupe sous-clavier ou axillaire. Le critère de jugement principal était le taux de succès de chaque approche. Les critères de jugement secondaires étaient : le taux de succès des stratégies, les positions aberrantes des cathéters et les complications immédiates. La stratégie consistait à employer l’approche allouée et à changer pour l’approche non-allouée après deux échecs de ponction. Au total, 122/132 patients inclus ont été analysés (60 et 62 dans les groupes sous-claviers et axillaire). Les taux de succès des approches pour les sites sous-clavier et axillaire étaient de 88 % et 86 %, respectivement (différence –2,8 %, 95 % IC[–15 %–9 %], non-infériorité p = 0,20). Les taux de succès des stratégies pour les sites sous-clavier et axillaire étaient de 97 % et 98 %, respectivement (différence –1,7 %, 95 % IC [–4 %–7 %], non-infériorité p < 0,01). Dix-neuf cathéters (31,7 %) étaient en position thrombogénique [3] dans le groupe axillaire contre 7 (12,3 %) dans le groupe sous-clavier (p = 0,01). Les taux de complication étaient comparable dans les deux groupes [4 (6,5 %) vs 2 (3,3 %), p = 0,68] (Tableau 1). En termes de taux de succès absolu, l’approche axillaire (AA) n’est pas non-inférieure à l’approche sous-clavière (ASC). En termes de stratégie, l’AA est non-inférieur à l’ASC. Après deux échecs de ponction sous-clavière, changer pour un AA permet un taux de succès de 98 %. L’AA peut être considéré comme une alternative à l’ASC après deux échecs de cette dernière. L’AA était associé à plus de position thrombogénique des cathéters.