Notice bibliographique
Résumé
Editor, We thank Drs Zilberman and Biro for their interest in our Editorial, and appreciate the opportunity to respond to their comments.1,2 The purpose of our Editorial was to point out where technology has failed us (delivered hypoxic guard systems) and describe how properly applied modern technology could improve overall safety in anaesthesia.2 Although Drs Zilberman and Biro mean well by describing a method to reduce the incidence of hypoxic inspired oxygen fraction (FIO2), it is not a foolproof system because it does not take into account the (remote) possibility that patient oxygen consumption is higher than expected. This could occur in situations such as thyroid storm or malignant hyperthermia. It also does not result in true low-flow anaesthesia, causing unnecessary expenses and pollution. Therefore, in our opinion, we should not continue to rely on ‘home-made regimens’ to prevent hypoxic FIO2; instead we should stimulate all of the anaesthesia machine manufacturers to use state-of-the-art technology to avoid and/or immediately correct such situations; this kind of technology is available today. There are several other issues with the statements by Zilberman and Biro that are based on serious misinterpretations. For example, the Brody formula should not be used in anaesthetised patients; it has been shown that the average oxygen consumption in an adult patient under anaesthesia is about 180 ml min−1, although there is a fairly wide range.3,4 Also, their proposed fresh gas flow of 800 ml min−1 is unnecessarily high, and modern technology allows us to (automatically) reduce agent consumption much more by using lower fresh gas flows. A very important issue is that they only consider the amount of oxygen delivered to the system and patient oxygen uptake, but they do not consider the amount of oxygen that leaves the system through the pop-off valve or ventilator relief valve; just because you add a certain amount of oxygen to the breathing system does not mean that all this oxygen is available to the patient. At the same time, the effects of rebreathing seem to be merely an afterthought. The rebreathed gas, at low flows, determines the final composition of inspired gas, much more than the delivered concentrations. Indeed, the authors fail to differentiate FDO2 (delivered oxygen fraction) from FIO2. These terms are not interchangeable! And finally, the authors use the term ‘low-flow ventilation’, which is really a misnomer. In conclusion, this letter confirms that we need sophisticated technology to help provide the safest possible conditions for our patients. Although we agree that teaching is important, education alone will not suffice. We hope that our reply further illustrates this point. There is no paradox: ‘sophisticated’ machines are needed to improve and maximize patient safety. Acknowledgements related to this article Assistance with the reply: none. Financial support and sponsorship: none. Conflicts of interest: JFAH has received lecture support, travel reimbursements, equipment loans, consulting fees and/or meeting organizational support of basically all companies involved with inhaled agent delivery (in alphabetical order): AbbVie, Acertys, Air Liquide, Allied Healthcare, Armstrong Medical, Baxter, Dräger, GE, Hospithera, Heinen und Lowensein, Intersurgical, Maquet, MDMS, MEDEC, Micropore, Molecular, NWS, Philips, Quantum Medical.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».