From the Department of Perioperative Medicine, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France.
Genetics, Reproduction and Development, Centre National de la Recherche Scienctifique, Institut National de la Santé et de la Recherche Médicale, Université Clermont Auvergne, Clermont-Ferrand, France.
Anesth Analg. 2021 Sep 1;133(3):723-730. doi: 10.1213/ANE.0000000000005442.
Chest injuries are associated with mortality among patients admitted to the intensive care unit (ICU) and require multimodal pain management strategies, including regional anesthesia (RA). We conducted a survey to determine the current practices of physicians working in ICUs regarding RA for the management of chest trauma in patients with multiple traumas.
An online questionnaire was sent to medical doctors (n = 1230) working in French ICUs, using the Société Française d'Anesthésie Réanimation (SFAR) mailing list of its members. The questionnaire addressed 3 categories: general characteristics, practical aspects of RA, and indications and contraindications.
Among the 333 respondents (response rate = 27%), 78% and 40% of 156 respondents declared that they would consider using thoracic epidural analgesia (TEA) and thoracic paravertebral blockade (TPB), respectively. The main benefits declared for performing RA were the ability to have effective analgesia, a more effective cough, and early rehabilitation. For 70% of the respondents, trauma patients with a theoretical indication of RA did not receive TEA or TPB for the following reasons: the ICU had no experience of RA (62%), no anesthesiologist-intensivist working in the ICU (46%), contraindications (27%), ignorance of the SFAR guidelines (19%), and no RA protocol available (13%). In this survey, 95% of the respondents thought the prognosis of trauma patients could be influenced by the use of RA.
While TEA and TPB are underused because of several limitations related to the patterns of injuries in multitrauma patients, lack of both experience and confidence in combination with the absence of available protocols appear to be the major restraining factors, even if physicians are aware that patients' outcomes could be improved by RA. These results suggest the need to strengthen initial training and provide continuing education about RA in the ICU.
胸部损伤与重症监护病房（ICU）患者的死亡率相关，需要采用多模式疼痛管理策略，包括区域麻醉（RA）。我们进行了一项调查，以确定 ICU 医生在多发伤患者胸部创伤管理中应用 RA 的当前实践情况。
使用法国麻醉复苏学会（SFAR）成员的邮件列表，向法国 ICU 中的医生（n=1230）发送了在线问卷。问卷涉及 3 个类别：一般特征、RA 的实际方面以及适应证和禁忌证。
在 333 名回复者（回复率=27%）中，156 名回复者中的 78%和 40%分别表示他们会考虑使用胸段硬膜外镇痛（TEA）和胸段椎旁阻滞（TPB）。进行 RA 的主要益处是能够实现有效的镇痛、更有效的咳嗽和早期康复。对于 70%的回复者，有理论上 RA 适应证的创伤患者未接受 TEA 或 TPB，原因如下：ICU 无 RA 经验（62%）、ICU 中无麻醉医师-重症医师（46%）、存在禁忌证（27%）、对 SFAR 指南不了解（19%）和缺乏 RA 方案（13%）。在这项调查中，95%的回复者认为 RA 的应用可能会影响创伤患者的预后。
尽管 TEA 和 TPB 的应用不足，这与多发伤患者的损伤模式有关，但缺乏经验和信心以及缺乏可用方案似乎是主要的限制因素，即使医生知道 RA 可以改善患者的结局。这些结果表明，有必要加强 ICU 中 RA 的初始培训和继续教育。
