Brazilian Journal of Anesthesiology最新文献

{"title":"Preoperative angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use and acute kidney injury after high-risk cardiac surgery: a multicenter prospective cohort study","authors":"Iñigo Rubio,&nbsp;Angel Candela,&nbsp;Gemma Echarri,&nbsp;Raquel Callejas,&nbsp;Eduardo Tamayo,&nbsp;David Nagore,&nbsp;Jorge M. Núñez-Córdoba,&nbsp;Marc Vives","doi":"10.1016/j.bjane.2026.844786","DOIUrl":"10.1016/j.bjane.2026.844786","url":null,"abstract":"<div><h3>Background</h3><div>The impact of preoperative Angiotensin-Converting Enzyme Inhibitors or Angiotensin Receptor Blockers (ACEI/ARB) on cardiac surgery-associated Acute Kidney Injury (AKI) remains elusive. We sought to evaluate the association of ACEI/ARB use with stage 2 or 3 AKI and in-hospital mortality, while evaluating whether preoperative withholding versus continuation strategies modulate clinical outcomes.</div></div><div><h3>Methods</h3><div>Multicenter prospective cohort study involving 14 Spanish and British hospitals. The study population comprised high-risk cardiac surgery patients (Cleveland Clinic Score ≥ 4).</div></div><div><h3>Results</h3><div>Among 249 patients (mean age: 69.5 years; 39% women; 53.8% ACEI/ARB users), the overall incidence of stage 2 or 3 AKI was 32.9%. ACEI/ARB use was associated with a significantly higher likelihood of stage 2 to 3 AKI (38.8% vs. 26.1%; adjusted OR = 2.79; 95% CI 1.47–5.30; p = 0.002). The adjusted risk difference was 0.188 (95% CI 0.079–0.298; p = 0.001), yielding a number needed to harm of 5.3. Sensitivity analyses confirmed the robustness of these findings, with an E-value of 2.73 (lower limit: 1.72) and consistent results using augmented inverse probability weighting (average treatment effect: 0.191; 95% CI 0.081–0.300; p = 0.001). No statistically significant associations were observed in in-hospital mortality or the impact of preoperative withholding versus continuation strategies on clinical outcomes.</div></div><div><h3>Conclusion</h3><div>This study suggests preoperative ACEI/ARB use may be associated with an increased incidence of stage 2 or 3 AKI. While differences in in-hospital mortality and preoperative withholding versus continuation strategies did not reach statistical significance, these findings reveal clinical trends that warrant further investigation.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 4","pages":"Article 844786"},"PeriodicalIF":2.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13380198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychotropic medication use during preanesthetic evaluation at a Brazilian university hospital: a retrospective cross-sectional analysis","authors":"Matheus Salera Gordim,&nbsp;Vitor Yan Bezerra de Araújo,&nbsp;Danilo de Oliveira da Câmara Filho,&nbsp;Luzinelson Muniz da Silva Júnior,&nbsp;Emerson Arcoverde Nunes,&nbsp;Heleno Paiva Oliveira,&nbsp;Wallace Andrino da Silva","doi":"10.1016/j.bjane.2026.844783","DOIUrl":"10.1016/j.bjane.2026.844783","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 4","pages":"Article 844783"},"PeriodicalIF":2.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13351402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148304116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous erector spinae plane block for robotic-assisted thoracic surgery in lung cancer: a dual-center retrospective propensity-score weighted cohort study","authors":"Matheus Arraes,&nbsp;Sara Amaral,&nbsp;Saullo Queiroz Silveira,&nbsp;Leopoldo Muniz da Silva,&nbsp;Rafael Sousa Fava Nersessian,&nbsp;Francisco Jose Lucena Bezerra,&nbsp;Manoel de Souza Neto,&nbsp;Caroline Machado Nunes,&nbsp;Helidea de Oliveira Lima,&nbsp;Fernando Nardy Bellicieri,&nbsp;Glenio B. Mizubuti,&nbsp;Rafael Lombardi","doi":"10.1016/j.bjane.2026.844770","DOIUrl":"10.1016/j.bjane.2026.844770","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative analgesia remains challenging in thoracic surgery, particularly with the rise of Robotic-Assisted Thoracoscopic Surgery (RATS). The Erector Spinae Plane Block (ESPB) is a promising opioid-sparing technique, but its role in RATS is unclear.</div></div><div><h3>Methods</h3><div>In this retrospective dual-center cohort study, we included 78 patients with lung cancer undergoing RATS, who received general anesthesia with or without ESPB. ESPB involved a single shot of 30 mL of 0.5% ropivacaine injection at T7, followed by a 24-hour infusion of 0.2% ropivacaine (7 mL.h⁻¹). The primary outcome was opioid rescue within 36 hours. Secondary outcomes included hospital length of stay and chest tube duration. Confounders were balanced with Inverse Probability Treatment Weighting (IPTW).</div></div><div><h3>Results</h3><div>In unadjusted analyses, there was no significant difference in rescue opioid consumption between groups (ESPB 37.8% vs. GA 27.3%; p = 0.46). After propensity score weighting to improve covariate balance, ESPB use was associated with lower postoperative opioid requirements (OR = 0.57; 95% CI 0.32–0.79; p = 0.01). This finding may reflect improved adjustment for measured confounders, although residual confounding cannot be excluded. In contrast, chest tube presence within 24-hours was associated with higher opioid requirements (OR = 2.32; 95% CI 1.22–4.20; p = 0.04). ESPB patients also required fewer scheduled opioids during the first 24–36h postoperatively (p = 0.03).</div></div><div><h3>Conclusion</h3><div>In this observational cohort, ESPB use was associated with lower postoperative opioid requirements in RATS. These findings suggest a potential role for ESPB within ERAS pathways, although randomized studies are needed to confirm efficacy and define its role in minimally invasive thoracic surgery.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 4","pages":"Article 844770"},"PeriodicalIF":2.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148201339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and factors associated with burnout syndrome among anesthesiology residents in Rio Grande do Sul, Brazil: a multicenter cross-sectional study","authors":"Airton Bagatini,&nbsp;Felipe de Sousa Junqueira,&nbsp;Eduarda Druck Magadan,&nbsp;Silvia Ramos Hecktheuer,&nbsp;Regis Borges Aquino,&nbsp;Florentino Fernandes Mendes,&nbsp;Eduardo Francisco Mafassioli Corrêa,&nbsp;Cleiton da Silva Pando,&nbsp;Daniela Benzano Bumaguin,&nbsp;Cassiana Gil Prates","doi":"10.1016/j.bjane.2026.844771","DOIUrl":"10.1016/j.bjane.2026.844771","url":null,"abstract":"<div><h3>Background</h3><div>Burnout syndrome is characterized by emotional exhaustion, depersonalization, and low personal accomplishment. Anesthesiology residents are particularly vulnerable due to prolonged working hours, cognitive overload, and exposure to stressful clinical situations. This study aimed to estimate the prevalence of burnout and explore associated occupational and psychosocial factors among anesthesiology residents in Rio Grande do Sul, Brazil.</div></div><div><h3>Methods</h3><div>This multicenter cross-sectional study included residents from 6 training centers accredited by the Brazilian Society of Anesthesiology. Data were collected using an anonymous online questionnaire and the Portuguese-validated Maslach Burnout Inventory-Human Services Survey (MBI-HSS). Burnout was defined by high emotional exhaustion (≥ 25), high depersonalization (≥ 10), and low personal accomplishment (≤ 32). Associations were analyzed using Fisher’s exact test (p &lt; 0.05).</div></div><div><h3>Results</h3><div>Ninety-two residents participated (response rate, 84.4%). The overall prevalence of burnout was 26.1% (95% CI 17.5%–36.3%). High emotional exhaustion occurred in 72.8%, depersonalization in 42.4%, and low personal accomplishment in 43.5%. Burnout was significantly associated with living alone (p <em>=</em> 0.036) and psychotropic medication use (p = 0.017). A weekly workload of 60 hours or more (p = 0.068) was not significantly associated with burnout. Female residents showed higher emotional exhaustion (p = 0.039).</div></div><div><h3>Conclusion</h3><div>Burnout prevalence among anesthesiology residents in Rio Grande do Sul was high, predominantly characterized by emotional exhaustion. Institutional strategies focusing on psychosocial support, workload management, and mental health promotion may improve residents’ well-being and professional performance.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 4","pages":"Article 844771"},"PeriodicalIF":2.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148145560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Letter to the Editor: “Erector spinae plane block versus caudal block in children: similar analgesia, different stories beneath the surface”","authors":"Barbara Bombassaro Masiero,&nbsp;Rafael Arsky Lombardi","doi":"10.1016/j.bjane.2026.844784","DOIUrl":"10.1016/j.bjane.2026.844784","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 4","pages":"Article 844784"},"PeriodicalIF":2.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13381984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148304195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence in the prediction of intraoperative red blood cell transfusion in cardiac surgery: a systematic review and diagnostic test accuracy meta-analysis","authors":"Filipe Giordano Valério,&nbsp;Amanda Carneiro Rodrigues,&nbsp;Davi Ricardo Soares Gama de Amorim,&nbsp;Roberta Esterque Cantarino,&nbsp;Glauco Martins de Araujo,&nbsp;Jimmy Yusuf,&nbsp;Lecticia Vianna Leal Soares Bessa,&nbsp;Millena Mendonça Andrade Paes Leme,&nbsp;Marcella Freire de Campos Euzebio,&nbsp;Flávio Luiz Seixas,&nbsp;Alexandra Rezende Assad,&nbsp;Luis Antonio dos Santos Diego","doi":"10.1016/j.bjane.2026.844782","DOIUrl":"10.1016/j.bjane.2026.844782","url":null,"abstract":"<div><h3>Background</h3><div>Red Blood Cell (RBC) transfusion in cardiac surgery is associated with risks. Conventional prediction scores lack accuracy, conflicting with Patient Blood Management (PBM) principles. Artificial Intelligence (AI) offers a potential avenue for developing precise, data-driven predictive models to enhance clinical decision-making and optimize patient outcomes.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis of diagnostic test accuracy studies was conducted following PRISMA guidelines, searching PubMed, Embase, and Cochrane Library databases until April 2025. Studies developing AI models to predict intraoperative Red Blood Cell (RBC) transfusions in adult cardiac surgery were included. Pooled sensitivity, specificity, and Area Under the receiver operating Characteristic Curve (AUC) were calculated using a bivariate random-effects model. To summarize overall diagnostic performance, Summary Receiver Operating Characteristic curves were generated.</div></div><div><h3>Results</h3><div>Five studies encompassing 3,063 patients were analyzed in the meta-analysis. AI models demonstrated high pooled specificity, ranging from 86.3% (95% CI 82.8%‒89.1%) to 93.6% (95% CI 84.3%‒97.6%), whereas pooled sensitivity ranged from 50.3% (95% CI 20.9%‒79.6%) to 55.7% (95% CI 33.8%‒75.6%). AUC values ranged between 0.793 (95% CI 0.634‒0.899) and 0.892 (95% CI 0.740‒0.943). Preoperative hemoglobin levels and patient age were consistently identified as clinical predictors for intraoperative RBC transfusion.</div></div><div><h3>Conclusion</h3><div>This systematic review and meta-analysis suggests that AI models may have potential for predicting intraoperative RBC transfusion in cardiac surgery, with consistently high specificity but only moderate sensitivity. However, given the low certainty of evidence, substantial heterogeneity, and reliance on non-standardized transfusion practices, these findings should be interpreted cautiously.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 4","pages":"Article 844782"},"PeriodicalIF":2.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13379987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148335117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Airway Management: why training, judgement, and competence remain the most important technologies","authors":"Daniel Perin,&nbsp;Rodrigo Leal Alves","doi":"10.1016/j.bjane.2026.844781","DOIUrl":"10.1016/j.bjane.2026.844781","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 4","pages":"Article 844781"},"PeriodicalIF":2.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148260724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronary artery bypass grafting in Jehovah’s Witness patients: a retrospective propensity matched cohort study","authors":"Henrique Ryu Yamanaka Nakano,&nbsp;Guilherme Mota Filho,&nbsp;Bruno Camargo Calabria Araújo,&nbsp;Heloísa Zogheib,&nbsp;Enzo Camargo Calabria Araújo,&nbsp;Leonardo Cardoso Saraiva,&nbsp;Jessica Silva Nicolau,&nbsp;Suely Pereira Zeferino,&nbsp;José Otávio Costa Auler Junior","doi":"10.1016/j.bjane.2026.844765","DOIUrl":"10.1016/j.bjane.2026.844765","url":null,"abstract":"<div><h3>Background</h3><div>Coronary Artery Bypass Grafting (CABG) in Jehovah’s Witness (JW) patients raises concerns regarding perioperative safety because of refusal of allogeneic blood transfusions. This study evaluated the feasibility and short-term outcomes of CABG in JW patients and described perioperative blood management practices.</div></div><div><h3>Methods</h3><div>This retrospective observational study included 26 JW patients and 78 matched non-Jehovah’s Witness (non-JW) patients who underwent CABG at InCor HC-FMUSP between 2015 and 2023. Propensity score matching at a 3:1 ratio based on age, sex, and preoperative hemoglobin was used to improve comparability. The primary outcome was 30-day all-cause mortality. Secondary outcomes included 30-day stroke, myocardial infarction, and acute kidney injury; ICU length of stay; perioperative red blood cell transfusion rates; postoperative hemoglobin and hematocrit; intraoperative blood loss; and cardiopulmonary bypass time.</div></div><div><h3>Results</h3><div>No 30-day deaths occurred among JW patients, whereas three deaths occurred in the non-JW group (OR = 0.45; 95% CI 0.003–5.09; p = 0.575). No JW patient experienced stroke, and one myocardial infarction occurred. JW patients had higher postoperative hemoglobin (OR = 1.50; 95% CI 1.03–2.28; p = 0.032) and lower intraoperative blood loss (OR = 0.55; 95% CI 0.27–0.98; p = 0.046). No JW patient received transfusion, whereas 17.9% and 12.8% of non-JW patients required intraoperative and postoperative transfusions, respectively. ICU length of stay was similar between groups.</div></div><div><h3>Conclusion</h3><div>In this cohort, CABG in JW patients was feasible with acceptable short-term outcomes. Outcomes were generally comparable between groups, acknowledging imprecision related to the small JW sample.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 4","pages":"Article 844765"},"PeriodicalIF":2.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Programmed intermittent epidural bolus versus continuous epidural infusion combined with patient-controlled epidural analgesia for postoperative analgesia: a meta-analysis of randomized controlled trials","authors":"Gabriel Lemos González,&nbsp;Vinícius Fernandes Sarmento,&nbsp;Bruno Francisco Minetto Wegner,&nbsp;Gustavo Roberto Minetto Wegner,&nbsp;Alesson Marinho Miranda,&nbsp;Iaci Luisa Lopes de Mattos,&nbsp;Tatiana Souza do Nascimento","doi":"10.1016/j.bjane.2026.844766","DOIUrl":"10.1016/j.bjane.2026.844766","url":null,"abstract":"<div><h3>Background</h3><div>Programmed Intermittent Epidural Bolus (PIEB) and Continuous Epidural Infusion (CEI) are widely used strategies for maintaining postoperative analgesia, typically combined with Patient-Controlled Epidural Analgesia (PCEA). Although PIEB is theorized to enhance epidural drug distribution and analgesic effectiveness through intermittent high-pressure boluses, evidence supporting its superiority over CEI in the postoperative setting remains inconsistent.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and meta-analysis of Randomized Controlled Trials (RCTs) comparing PIEB and CEI, both with PCEA, in adult postoperative patients (PROSPERO CRD420251046001). PubMed, Embase, and Cochrane were searched until May 1, 2025. Primary outcome: pain at 24 hours. Secondary outcomes: pain at other intervals, anesthetic consumption, and adverse events. Data were synthesized using a random-effects model; Risk of Bias (RoB-2) and small-study effects were assessed.</div></div><div><h3>Results</h3><div>Ten RCTs comprising 692 patients were included. No significant difference was found in 24-hour pain scores at rest (MD = -0.45; 95% CI -0.99 to 0.10) or movement (MD = -0.88; 95% CI -2.07 to 0.32). PIEB showed mildly lower pain at other time points and reduced total epidural volume (MD = -7.31 mL; 95% CI -13.7 to -0.92 mL). However, PIEB was associated with higher hypotension risk (RR = 1.71; 95% CI 1.05 to 2.78). No differences were found in opioid consumption, PCEA demands, or other adverse events.</div></div><div><h3>Conclusion</h3><div>PIEB offers no significant analgesic advantage and increases hypotension risk compared to CEI in postoperative settings, when both are combined with PCEA. These findings should be interpreted with caution due to the limited number of studies and substantial heterogeneity.</div></div><div><h3>PROSPERO registry</h3><div><span><span>https://www.crd.york.ac.uk/PROSPERO/view/CRD420251046001</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 4","pages":"Article 844766"},"PeriodicalIF":2.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148019104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of two large language models for intensive care unit discharge decisions: a prospective observational cohort study","authors":"Engin İhsan Turan,&nbsp;Abdurrahman Engin Baydemir,&nbsp;Ebru Kaya,&nbsp;Zehra Polat Turan,&nbsp;Ayça Sultan Şahin","doi":"10.1016/j.bjane.2026.844768","DOIUrl":"10.1016/j.bjane.2026.844768","url":null,"abstract":"<div><h3>Background</h3><div>The aim of this study was to evaluate the effectiveness of two general-purpose Large Language Models (LLMs), ChatGPT and Gemini, in predicting Intensive Care Unit (ICU) discharge decisions (discharge vs. non-discharge). By comparing their outputs with decisions made by ICU physicians, we sought to determine the alignment of AI-generated recommendations with expert clinical judgment and assess their potential as decision-support tools in critical care.</div></div><div><h3>Methods</h3><div>This prospective observational cohort study was conducted in a tertiary ICU between September 2024 and May 2025. Adult patients (≥ 18 years) requiring ICU discharge decisions were included. Standardized clinical prompts were generated from electronic health records and input into ChatGPT and Gemini. The models’ binary discharge decisions were compared to those of ICU physicians. Model performance was assessed using accuracy, sensitivity, specificity, F1 score, Cohen’s kappa, and McNemar’s test. Discharge was defined as the positive class for all diagnostic performance analyses.</div></div><div><h3>Results</h3><div>A total of 398 patients were analyzed. ChatGPT demonstrated higher accuracy than Gemini (87.2% vs. 66.3%), with higher sensitivity (85.9% vs. 46.9%) and F1 score (0.890 vs. 0.628), whereas Gemini showed higher specificity (96.2% vs. 89.2%). Agreement with clinician decisions was substantial for ChatGPT (κ = 0.737, p = 0.024) and fair for Gemini (κ = 0.379, p &lt; 0.001). Laboratory markers such as lactate, hemoglobin, and procalcitonin significantly differed between discharged and non-discharged patients.</div></div><div><h3>Conclusion</h3><div>Large language models may support ICU discharge decisions when guided by structured, guideline-informed prompting. ChatGPT achieved higher overall accuracy, sensitivity, and F1 score, whereas Gemini demonstrated higher specificity.</div></div><div><h3>Trial registration</h3><div>Externation (Discharge) of ICU, NCT06584890, registered 03 September 2024, prospectively registered, <span><span>https://register.clinicaltrials.gov/prs/beta/studies/S000EVXZ00000029/recordSummary</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 4","pages":"Article 844768"},"PeriodicalIF":2.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148102383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}