FALCON II: Input For A European PBS Definition : Review Of Vehicle Legislations And Infrastructure Design Criteria

In Europe, the regulation on weights and dimensions of trucks are complex : European rules are given by EC Directive 96/53/EC as modified by Directive (EU) 2015/719 [1]. These rules apply for international traffic, but countries can decide to add specific national rules. Moreover, these rules are often different from one country to another, due to policy choices and local history. More specifically, the impact of trucks on infrastructure has not always been the primary fact for defining these rules. But in other countries or other research domains, performance based standards (PBS) are used to determine what is allowed, in terms of performance. For example, vehicles may be allowed in terms of their induced damage on bridges (Bridge Formula, see [2]) or dynamic behavior (PBS as in Australia for example). In another context, materials and structures are now often defined in calls for tender in terms of performance (durability, resistance for example). In this context, the work package (WP) C (Fit for purpose road vehicles to influence modal choice) of CEDR project FALCON (Freight And Logistics in a multimodal CONtext) aims at developing Performance Based Standards [3]. For that, the first step is to create a state-of-the art of the European situation concerning vehicle policy and infrastructure. This paper summarizes this work: the first section gives insight on the European vehicle policy. The second section presents the infrastructure catalogue developed within the FALCON project. Finally, these infrastructure elements are characterized in terms of design criteria in Section 3

Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study

Background Results from retrospective studies suggest that use of neuromuscular blocking agents during general anaesthesia might be linked to postoperative pulmonary complications. We therefore aimed to assess whether the use of neuromuscular blocking agents is associated with postoperative pulmonary complications. Methods We did a multicentre, prospective observational cohort study. Patients were recruited from 211 hospitals in 28 European countries. We included patients (aged ≥18 years) who received general anaesthesia for any in-hospital procedure except cardiac surgery. Patient characteristics, surgical and anaesthetic details, and chart review at discharge were prospectively collected over 2 weeks. Additionally, each patient underwent postoperative physical examination within 3 days of surgery to check for adverse pulmonary events. The study outcome was the incidence of postoperative pulmonary complications from the end of surgery up to postoperative day 28. Logistic regression analyses were adjusted for surgical factors and patients’ preoperative physical status, providing adjusted odds ratios (ORadj) and adjusted absolute risk reduction (ARRadj). This study is registered with ClinicalTrials.gov, number NCT01865513. Findings Between June 16, 2014, and April 29, 2015, data from 22803 patients were collected. The use of neuromuscular blocking agents was associated with an increased incidence of postoperative pulmonary complications in patients who had undergone general anaesthesia (1658 [7·6%] of 21694); ORadj 1·86, 95% CI 1·53–2·26; ARRadj –4·4%, 95% CI –5·5 to –3·2). Only 2·3% of high-risk surgical patients and those with adverse respiratory profiles were anaesthetised without neuromuscular blocking agents. The use of neuromuscular monitoring (ORadj 1·31, 95% CI 1·15–1·49; ARRadj –2·6%, 95% CI –3·9 to –1·4) and the administration of reversal agents (1·23, 1·07–1·41; –1·9%, –3·2 to –0·7) were not associated with a decreased risk of postoperative pulmonary complications. Neither the choice of sugammadex instead of neostigmine for reversal (ORadj 1·03, 95% CI 0·85–1·25; ARRadj –0·3%, 95% CI –2·4 to 1·5) nor extubation at a train-of-four ratio of 0·9 or more (1·03, 0·82–1·31; –0·4%, –3·5 to 2·2) was associated with better pulmonary outcomes. Interpretation We showed that the use of neuromuscular blocking drugs in general anaesthesia is associated with an increased risk of postoperative pulmonary complications. Anaesthetists must balance the potential benefits of neuromuscular blockade against the increased risk of postoperative pulmonary complications