Anaesthesia Critical Care & Pain Medicine最新文献

{"title":"Withdrawal notice to Elevating anesthesia standards for adult congenital heart disease patients: comprehensive guidelines for non-cardiac surgery Anaesthesia Critical Care & Pain Medicine, Volume 44 Issue 4 (2025) / 101528","authors":"Magalie Ladouceur , Tuan-Chen Aw , Michael A. Gatzoulis","doi":"10.1016/j.accpm.2025.101588","DOIUrl":"10.1016/j.accpm.2025.101588","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 4","pages":"Article 101588"},"PeriodicalIF":4.7,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144722669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurodevelopmental impact of prenatal regional or general anaesthesia: An ambidirectional pilot cohort study","authors":"Vanja Courteille ,&nbsp;Côme Sauvage ,&nbsp;Francis Veyckemans ,&nbsp;Shahad Albadri ,&nbsp;Lorna Le Stanc ,&nbsp;Gilles Orliaguet ,&nbsp;Jean-Luc Hanouz ,&nbsp;Denis Vivien ,&nbsp;Nicolas Poirel ,&nbsp;Jean-Philippe Salaün","doi":"10.1016/j.accpm.2025.101592","DOIUrl":"10.1016/j.accpm.2025.101592","url":null,"abstract":"<div><h3>Background</h3><div>Up to 2% of pregnant women undergo non-obstetric surgery, yet literature on the long-term effects of prenatal anaesthesia exposure is scarce and conflicting. This study aimed to assess executive functions in children born to mothers exposed to general anaesthesia (GA) or regional anaesthesia (RA) for non-obstetric surgery during pregnancy, compared with children born to women who did not undergo surgery. The second aim was to assess executive functions, considering potential confounding factors affecting brain development.</div></div><div><h3>Methods</h3><div>This single-centre ambidirectional pilot cohort study included children born between 2011 and 2018 at Caen Normandy University Hospital, with retrospective identification of children born to mothers exposed, or not, to GA or RA during pregnancy. Children with a diagnosed neurodevelopmental disorder were excluded. Neurodevelopmental outcomes were assessed using the Behaviour Rating Inventory of Executive Function (BRIEF) parental questionnaire. Analyses included potential confounding factors. We conducted an analysis of variance (ANOVA) between the three groups for the primary outcome and univariate ANOVAs to study the influence of confounders on BRIEF scoring.</div></div><div><h3>Results</h3><div>Ninety-four children (6.3–10.3 years old) were studied: children born to mothers exposed to GA (<em>n</em> = 40), RA (<em>n</em> = 13), and the control group (<em>n</em> = 41). No difference in BRIEF scores was observed among the groups. No confounding factors influenced this result.</div></div><div><h3>Conclusions</h3><div>This study is the first to compare neurodevelopmental outcomes in children born to mothers exposed, or not, to RA or GA during pregnancy. No difference in BRIEF scores was observed. Larger studies with detailed executive function analyses and daily life habits are needed.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 6","pages":"Article 101592"},"PeriodicalIF":4.7,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144620869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persistent critical illness and long-term survival in cardiac surgery: A multicentre cohort study","authors":"Ashwin Subramaniam ,&nbsp;Ryan Ruiyang Ling ,&nbsp;William Bonavia ,&nbsp;Kollengode Ramanathan ,&nbsp;Mahesh Ramanan ,&nbsp;Kiran Shekar ,&nbsp;David Pilcher","doi":"10.1016/j.accpm.2025.101593","DOIUrl":"10.1016/j.accpm.2025.101593","url":null,"abstract":"<div><h3>Background</h3><div>Persistent critical illness (PerCI) is associated with poorer in-hospital outcomes in patients admitted to an intensive care unit (ICU), and in patients receiving cardiac surgery, yet its association with longer-term survival remains unclear.</div></div><div><h3>Objective</h3><div>We investigated the association between PerCI and long-term survival in patients receiving cardiac surgery.</div></div><div><h3>Methods</h3><div>In this retrospective, multicentre observational cohort study using the Australia and New Zealand Intensive Care Society Adult Patient Database, we included all adults (≥16 years) admitted to 83 ICUs across Australia and New Zealand after cardiac surgery (coronary artery bypass graft, valvular replacement, or both) from January 1^st 2018 to December 31^st 2022 for Australia and 31^st December 2020 for New Zealand. The primary outcome was survival time up to 4 years after ICU admission. We analysed the association between PerCI (defined as ICU length of stay ≥6 days) and survival time up to 4 years from ICU admission using a Cox proportional hazards model.</div></div><div><h3>Results</h3><div>We included 73,462 patients (90.8% elective, 9.2% emergent), of whom 5,087 (6.9%) developed PerCI. PerCI was associated with shorter survival times (hazard ratio [HR]: 3.14, 95%-CI: 2.77–3.55). As ICU stays became progressively longer, survival times progressively decreased (HR by additional day in ICU: 1.02, 95%-CI: 1.01–1.03). PerCI was associated with larger reductions in survival times in patients aged &lt;65 years (HR: 5.61, 95%-CI: 4.72–6.67) compared to patients ≥65 years (HR: 2.83, 95%-CI: 2.48–3.23, p-interaction &lt;0.0001). However, there were no significant differences amongst the various types of surgeries, and between elective and emergent surgeries.</div></div><div><h3>Conclusion</h3><div>PerCI was associated with poorer outcomes, and this persisted during longer-term follow-up. Further study is required to identify potential modifiable risk factors for PerCI.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 6","pages":"Article 101593"},"PeriodicalIF":4.7,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144620854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence in airway management: A systematic review and meta-analysis","authors":"Mohamed F. Abosamak ,&nbsp;Hany A. Zaki ,&nbsp;Eman E. Shaban ,&nbsp;Amira Shaban ,&nbsp;Ahmed Shaban ,&nbsp;Haitham Hodhod ,&nbsp;Benny Ponappan","doi":"10.1016/j.accpm.2025.101589","DOIUrl":"10.1016/j.accpm.2025.101589","url":null,"abstract":"<div><h3>Background</h3><div>Airway management is the cornerstone of anesthesia care. Complications of difficult airways are usually fatal to patients. Artificial intelligence (AI) has shown promising results in enhancing clinicians' performance in various settings. We therefore aimed to summarize the current evidence on the use of AI models in the prediction of a difficult airway.</div></div><div><h3>Methods</h3><div>We searched two databases, PubMed and Science Direct, for all relevant articles published until March 2025. Statistical software R version 4.4.2 was then utilized to meta-analyze the area under receiver operating curves (AUROC) to identify the best-performing models.</div></div><div><h3>Results</h3><div>After the eligibility assessment, 13 studies met the inclusion criteria and were thus included in the review. Only two studies developed models for patients in the ED, and the remaining 11 studies developed models for patients undergoing different surgeries under general anesthesia. The deep learning model with the best discriminative ability for difficult airways was VGG (AUC 0.84; 95% CI [0.83, 0.84] I² = 0%). For the traditional machine learning models, those with good discriminative ability for difficult airways included SVM (AUC 0.80; 95% CI [0.65, 0.96] I² = 99.7%) and NB (AUC 0.81; 95% CI [0.51, 1.10] I² = 99.3%).</div></div><div><h3>Conclusions</h3><div>Our study found that while some AI models have good discriminative ability (AUC ≥ 0.80) for difficult airways, most of them have just average discriminative ability AUC &lt; 0.80. This, therefore, indicates a need to develop models with better discriminative ability and to validate the developed models.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 6","pages":"Article 101589"},"PeriodicalIF":4.7,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144620867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An interpretable machine learning approach for predicting clinically important gastrointestinal bleeding in critically ill patients","authors":"Shohei Ono ,&nbsp;Shigehiko Uchino ,&nbsp;Shinshu Katayama ,&nbsp;Yusuke Iizuka","doi":"10.1016/j.accpm.2025.101590","DOIUrl":"10.1016/j.accpm.2025.101590","url":null,"abstract":"<div><h3>Background</h3><div>Clinically important gastrointestinal bleeding (CIGIB) is a serious complication in critically ill patients, contributing to prolonged ICU stays and increased mortality. Despite efforts to identify high-risk patients, no previous studies have employed machine learning models to predict CIGIB during ICU stay or identify key predictors in this context.</div></div><div><h3>Methods</h3><div>This single-center retrospective study included ICU patients aged 18 years or older admitted between 2017 and 2024. Patients with ICU stays of less than 24 h or GIB within 24 h of admission were excluded. Machine learning models, including XGBoost, Random Forest, and L1-regularized logistic regression, were trained using patient data from the first 24 h of ICU admission. Model performance was assessed using AUROC, precision, recall, and F1 scores. Shapley Additive Explanations (SHAP) were employed to evaluate key predictors.</div></div><div><h3>Results</h3><div>A total of 7357 ICU patients were included, of whom 171 (2.3%) experienced CIGIB. The XGBoost model demonstrated the highest predictive performance with an AUROC of 0.84. Key predictors included APACHE III scores, hematocrit levels, APTT, creatinine and respiratory rate, while invasive mechanical ventilation and stress ulcer prophylaxis within the first 24 h of ICU admission did not rank among the top 20 predictors based on SHAP values.</div></div><div><h3>Conclusions</h3><div>This study represents the first application of machine learning for predicting CIGIB in ICU patients, providing valuable insights into risk stratification. The model demonstrated high predictive accuracy and interpretability, highlighting its potential to guide early intervention and prophylaxis. Further multi-center studies and interventional trials are needed to validate these findings and refine clinical risk prediction strategies.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 6","pages":"Article 101590"},"PeriodicalIF":4.7,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144620866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metabolic alkalosis acquired in intensive care: A retrospective cohort study","authors":"Gordon Goh ,&nbsp;Sebastiaan P. Blank ,&nbsp;Ra’eesa Doola ,&nbsp;Nelson Alder ,&nbsp;Abhilasha Ahuja ,&nbsp;Kevin B. Laupland ,&nbsp;Alexis Tabah ,&nbsp;Kiran Shekar ,&nbsp;Aashish Kumar ,&nbsp;Kyle White ,&nbsp;Antony Attokaran ,&nbsp;Stephen Luke ,&nbsp;Stephen Whebell ,&nbsp;Peter Garrett ,&nbsp;Alexander Nesbitt ,&nbsp;James McCullough ,&nbsp;Philippa McIlroy ,&nbsp;Mahesh Ramanan ,&nbsp;on behalf of the Queensland Critical Care Research Network (QCCRN)","doi":"10.1016/j.accpm.2025.101591","DOIUrl":"10.1016/j.accpm.2025.101591","url":null,"abstract":"<div><h3>Introduction</h3><div>Alkalosis is a common acid-base disturbance in intensive care unit (ICU) patients. We evaluated the epidemiology of metabolic alkalosis developing during admission to the ICU and its relationship with outcome.</div></div><div><h3>Methods</h3><div>Multicentre, retrospective cohort study of admissions to 12 ICUs in Queensland, Australia from January 1st, 2015 to December 31st, 2021. We excluded readmissions, patients with metabolic alkalosis within the first 24 h and those with ICU length of stay (LOS) ≤48 h. The primary outcome was the cumulative incidence of metabolic alkalosis during admission, and secondary outcomes were the frequency of potential underlying causes. Multivariable analyses, including adjustment for immortal time bias, were used to explore its relationship with mortality.</div></div><div><h3>Results</h3><div>Of 24,676 eligible admissions, 8889 (36%) developed metabolic alkalosis during their stay in the ICU. The median time to first development was four days in the ICU (interquartile range 3–6 days). The most common potential causes were diuretics (28%) and steroids (24%), but no cause could be identified in more than 40% of cases. After adjustment for immortal time bias, patients with metabolic alkalosis were seen to have increased mortality rates. However, it was not an independent predictor of outcome after adjusting for disease severity and comorbidities using multivariable analysis.</div></div><div><h3>Conclusion</h3><div>Metabolic alkalosis develops commonly in the ICU, but its association with increased mortality may be attributable to other confounding factors. Further research is required to elucidate its underlying causes and whether treatments to correct alkalosis improve outcomes.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 6","pages":"Article 101591"},"PeriodicalIF":4.7,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144620868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of tolerance of 4 interfaces for preventive non invasive ventilation after abdominal surgery in intensive care units assessed by patients and caregivers: A prospective randomized cross-over study","authors":"Audrey De Jong ,&nbsp;Albert Prades ,&nbsp;Mathieu Capdevila ,&nbsp;Gérald Chanques ,&nbsp;Samir Jaber","doi":"10.1016/j.accpm.2025.101587","DOIUrl":"10.1016/j.accpm.2025.101587","url":null,"abstract":"<div><h3>Introduction</h3><div>Interface selection is one of the major determinants of success for noninvasive ventilation (NIV). The aim of this study was to compare the tolerance of 4 interfaces (auto and hetero-evaluation) used during preventive NIV in Intensive Care Units (ICU).</div></div><div><h3>Methods</h3><div>ICU patients receiving preventive NIV post-extubation after abdominal surgery were included in a prospective, single-center, randomized, crossover study. Four interfaces: two full-face (Helmet®, Bacou®) and two oro-nasal (Respironics®, Intersurgical®) interfaces were evaluated. An auto-evaluation (patients) and an hetero-evaluation (caregivers) were performed at the end of each NIV trial for each interface. Tolerance was evaluated with a visual numeric scale including: comfort (0 = maximum discomfort, 10 = perfect comfort), leaks (0 = maximum leaks, 10 = no leak), and communication (0 = no communication, 10 = optimal communication). A <em>p</em>-value &lt;0.05/6 = 0.008 (Bonferroni correction) was considered significant.</div></div><div><h3>Results</h3><div>Twenty-six consecutive patients were included. For auto-evaluation of comfort and leaks, no significant difference was observed between the interfaces. For hetero-evaluation of comfort, significantly higher scores were observed for Helmet (9 (8–10)) compared to Respironics and Intersurgical (respectively 9 (7–9) <em>p</em> = 0.0073 and 8 (7–8) <em>p</em> = 0.0046), whereas no difference was observed for hetero-evaluation of leaks. Concerning the auto-evaluation of communication, higher scores were observed for Helmet (9 (6–10)), in comparison to the other interfaces (5 (3–7) <em>p</em> = 0.003, 5 (3–8) (<em>p</em> = 0.0017, 2 (0–5) <em>p</em> &lt; 0.0001) for Bacou, Respironics and Intersurgical, respectively). Similar results were observed for hetero-evaluation. The caregivers overestimated comfort scores and communication scores for each interface (<em>p</em> &lt; 0.008), except for Helmet (<em>p</em> = 0.05).</div></div><div><h3>Conclusion</h3><div>The results suggest that none of the interfaces is universally better than the others, with no differences in comfort scores. The choice of interface in NIV should be personalized, and the patient asked for the preferred interface. Auto-evaluation differed from hetero-evaluation.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 5","pages":"Article 101587"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonsteroidal anti-inflammatory drug use and acute kidney injury in nephrectomies: A retrospective propensity score-matched cohort study","authors":"Chun-yan Ye ,&nbsp;Long-yan Li ,&nbsp;Min-jing Yang ,&nbsp;Xing-yang Liu ,&nbsp;Ning Luo ,&nbsp;Jing-han Wu ,&nbsp;Yu-jie Xiao ,&nbsp;Daniel I. Sessler ,&nbsp;E. Wang","doi":"10.1016/j.accpm.2025.101581","DOIUrl":"10.1016/j.accpm.2025.101581","url":null,"abstract":"<div><h3>Introduction</h3><div>Nonsteroidal anti-inflammatory drugs (NSAID) are analgesic and spare opioids, but it remains unclear whether perioperative NSAID use worsens renal function after nephrectomy. We therefore tested the hypothesis that perioperative use of NSAID is associated with acute kidney injury (AKI) after nephrectomy surgery.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included patients ≥18 years old who had partial or radical nephrectomies. Patients who were given intravenous NSAIDs for postoperative analgesia were defined as one group, whereas reference patients did not use any NSAIDs. The primary outcome was the occurrence of postoperative acute kidney injury (AKI), as defined by the Kidney Disease: Improving Global Outcomes criteria. Secondary outcomes included AKI stage, NSAID-related side effects, postoperative hemoglobin, cumulative opioid consumption, and duration of hospitalization.</div></div><div><h3>Results</h3><div>Among 3,359 eligible nephrectomy patients, 78% (2,614) were given NSAIDs. We propensity-score-matched 739 pairs of patients who were or were not given NSAIDs. Patients in the NSAID group did not have more AKI (27.6%<em>vs</em>. 27.9%, HR 0.98 95% CI (0.80–1.19), <em>P</em> =  0.90), nor were their AKI stages worse [OR 0.99 (0.79–1.24), <em>P</em> =  0.91]. No significant differences were detected in NSAID-related side effects [OR 1.50 (0.42, 5.32), <em>P</em> = 0.53]. However, NSAID treatment was associated with shorter postoperative hospitalization: [5 [4,7] <em>vs</em>. 6 [5,7] days, <em>P</em> &lt; 0.001].</div></div><div><h3>Conclusions</h3><div>Perioperative use of NSAIDs in patients having nephrectomies was not associated with a greater risk of AKI, and possibly reduced the duration of hospitalization. Prospective interventional data are needed to guide NSAID use in this high-risk patient subset.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 6","pages":"Article 101581"},"PeriodicalIF":4.7,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of abdominal muscle thickening fraction as a predictor for weaning outcome in patients with sepsis: A prospective observational study","authors":"Mina A. Helmy,&nbsp;Basma Gamal,&nbsp;Ahmed M. Lotfy,&nbsp;Walid I. Hammimy,&nbsp;Maha Mostafa","doi":"10.1016/j.accpm.2025.101580","DOIUrl":"10.1016/j.accpm.2025.101580","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 6","pages":"Article 101580"},"PeriodicalIF":3.7,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of intravenous paracetamol on mean arterial pressure in critically ill patients: A systematic review and meta-analysis with trial sequential analysis","authors":"Simone Messina ,&nbsp;Simona Ferro ,&nbsp;Cristina Santonocito ,&nbsp;Carmelo Minardi ,&nbsp;Mateusz Zawadka ,&nbsp;Filippo Drago ,&nbsp;Alberto Noto ,&nbsp;Filippo Sanfilippo","doi":"10.1016/j.accpm.2025.101579","DOIUrl":"10.1016/j.accpm.2025.101579","url":null,"abstract":"<div><h3>Background</h3><div>Intravenous administration of paracetamol to critically ill patients may have negative hemodynamic effects. However, such effects have not been adequately quantified.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and meta-analysis of observational studies (published in English language in PubMed and/or EMBASE) conducted on intensive care unit (ICU) patients, reporting hemodynamic changes within 30 min of intravenous paracetamol administration for fever and/or analgesia. The primary outcome was the mean difference (MD) with 95% confidence interval [95%CI] in mean arterial pressure (MAP). Secondary outcomes were systolic and diastolic arterial pressure (SAP and DAP), heart rate (HR), and incidence of hypotension. Trial sequential analysis (TSA) was conducted to ascertain the robustness of findings.</div></div><div><h3>Results</h3><div>Eight studies were included. We observed significant reduction after paracetamol of MAP (5 studies, MD: −6.75 mmHg [−10.68; −2.82]; <em>p</em> = 0.0008; I² = 74%), SAP (5 studies, MD: −11.55 mmHg [−20.55; −2.55]; <em>p</em> = 0.01; I² = 78%) and DAP (5 studies, MD: −5.29 mmHg [−8.53; −2.05]; <em>p</em> = 0.001; I² = 42%). No effects were seen for HR (4 studies, MD: −3.08 bpm [−7.09;0.93]; <em>p</em> = 0.13; I² = 0%). Subgroup analyses were hampered by the small number of studies. MAP reduction appeared consistent when paracetamol was administered for fever. TSAs showed that results on MAP and DAP were robust; SAP and HR were not. The grade of evidence was very low. The occurrence of hypotension after intravenous paracetamol was 45.5% (n = 143/314, 4 studies).</div></div><div><h3>Conclusions</h3><div>Hypotension after intravenous paracetamol is frequent in the ICU, with significant reduction in MAP, SAP, and DAP but no effects on HR. Effects seem more pronounced in patients with fever. More advanced hemodynamic studies are needed to understand the mechanisms of paracetamol-induced hypotension.</div></div><div><h3>Registration</h3><div>PROSPERO (CRD number 42024574919).</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 5","pages":"Article 101579"},"PeriodicalIF":3.7,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}