Acta Anaesthesiologica Scandinavica最新文献

{"title":"Epidural Analgesia Versus Systemic Opioids for Postoperative Pain Management After VATS: A Systematic Review and Meta-Analysis.","authors":"Jimmy H Holm, Mikkel Bak, Anne C Brøchner","doi":"10.1111/aas.70122","DOIUrl":"10.1111/aas.70122","url":null,"abstract":"<p><strong>Background: </strong>Firm consensus on the best perioperative pain management after Video-Assisted Thoracic Surgery (VATS) is lacking. Recommendations often assess different loco-regional techniques as part of a multimodal approach, but few discuss omitting regional analgesia altogether, eliminating any risk of procedural complications. A reasonable prerequisite for this approach would be that the alternative provides comparable pain relief. To compare the efficacy of systemic opioids and epidural analgesia for postoperative pain management, we conducted a systematic review and meta-analysis of current studies.</p><p><strong>Methods: </strong>We did a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies on VATS with the primary objective of examining postoperative pain at rest and during activity at POD1, POD2, and POD3. The secondary objectives were to evaluate the efficacy of the treatments, examining the need for postoperative \"rescue\" opioid, the hospital length of stay, and side effects. We did literature searches of Medline, Embase, and the Cochrane Library from inception to 07 April 2025. Additionally, we searched ClinicalTrials.gov, the EU Clinical Trials Register, the WHO International Clinical Trials Registry Platform, Scopus, and Google Scholar. We included adult patients undergoing VATS receiving either epidural analgesia or systemic opioids for postoperative pain management.</p><p><strong>Results: </strong>We included four randomized controlled trials (RCTs) and four observational studies encompassing 946 patients. The primary meta-analysis of the RCTs found that epidural analgesia reduced pain compared with systemic opioids by a pooled mean difference of 0.8 NRS/VAS points (95% CI 0.2-1.3) at rest and 1.1 points (0.7-1.5) during activity over POD 1 to 3. Heterogeneity was substantial (I² 99% and 98%, respectively) and was largely explained by the presence of baseline multimodal analgesia on POD 2. Rescue-opioid use was lower with epidurals in three of four trials, with no consistent differences in length of stay or adverse effects. Evidence certainty was moderate. The observed difference is below or at the lower bound of the minimal clinically important difference of 1-2 NRS/VAS points.</p><p><strong>Conclusion: </strong>Epidural analgesia offers a small but possibly subclinical reduction in acute postoperative pain after VATS compared with systemic opioids, particularly when combined with baseline multimodal analgesia. High heterogeneity and moderate certainty underscore the need for adequately powered trials.</p><p><strong>Prospero registration: </strong>CRD42024598757.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 9","pages":"e70122"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12427149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145038782","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":"Prehospital Treatment With Dried Plasma in Patients With Major Bleeding-A Prospective Randomised Controlled Multicentre Trial: Statistical Analysis Protocol.","authors":"G Skallsjö, A Wikman, C Wessman, G Sandström","doi":"10.1111/aas.70120","DOIUrl":"10.1111/aas.70120","url":null,"abstract":"<p><strong>Background: </strong>Major haemorrhage remains one of the most preventable causes of early death in prehospital care. While prehospital administration of plasma has shown potential to improve survival, logistical challenges limit its use outside hospitals. Dried plasma offers a practical solution, particularly in rural or remote environments. This statistical analysis protocol (SAP) describes the predefined methods for evaluating the effect of dried plasma versus standard care in bleeding patients treated in the prehospital setting.</p><p><strong>Methods: </strong>This prospective, randomised parallel trial is registered at ClinicalTrials.gov (NCT07012863) and includes adult patients (≥ 18 years) with suspected bleeding requiring fluid resuscitation. Ambulance vehicles are randomised to either carry dried plasma or standard care (crystalloids), stratified by urban and rural regions. Each ambulance will be reassigned to either standard care or dried plasma after each mission. The primary outcome is 24-h survival. Secondary outcomes include markers of coagulopathy, transfusion volume, and impact of transport time. All analyses follow the intention-to-treat principle and utilize Cox regression, linear or quantile regression, with Bonferroni-Holm adjustment for multiplicity. The trial will enrol a total of 650 patients.</p><p><strong>Conclusions: </strong>This SAP ensures transparency and prevents analytical bias in a trial that addresses an urgent need for field-appropriate blood products. The results may inform practice and policy for both civilian and military prehospital care.</p><p><strong>Trial registration: </strong>clinicaltrials.gov (NCT07012863).</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 9","pages":"e70120"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12412280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144999391","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":"Prospective Assessment of Clinically Relevant Fluid Balance Thresholds Associated With Postoperative Complications in Advanced Ovarian Cancer.","authors":"Emma Hasselgren, Nina Groes Kofoed, Henrik Falconer, Håkan Björne, Diana Zach, Daniel Hunde, Hemming Johansson, Mihaela Asp, Karin Thorlacius, Päivi Kannisto, Sahar Salehi","doi":"10.1111/aas.70112","DOIUrl":"10.1111/aas.70112","url":null,"abstract":"<p><strong>Background: </strong>Reliable data on optimal fluid management in the perioperative period for patients with advanced ovarian cancer undergoing cytoreductive surgery is limited. These patients often present with malignant ascites and are prone to significant fluid shifts perioperatively. For this reason, our objective was to define clinical targets for optimal fluid balance and determine whether initial ascites should be included in fluid-loss calculations by examining the association between perioperative fluid balance and major postoperative complications.</p><p><strong>Methods: </strong>This prospective, observational study conducted in a centralized and public healthcare system setting in Sweden between 2020 and 2023 included patients with advanced ovarian cancer, > 18 years of age, scheduled for upfront cytoreductive surgery, an ASA physical status I-III with no speech/language issues. The primary outcome was major postoperative complication within 30 days of surgery. The measurements of fluid input and output, cut-offs for fluid balance, perioperative time, and postoperative complications were defined a priori. The association between fluid balance and major postoperative complications was assessed by multivariable regression, adjusted for predefined covariates, yielding odds ratios (OR) with 95% confidence intervals (CI).</p><p><strong>Results: </strong>Of 175 enrolled patients, 162 were included in the final analysis. In the adjusted analysis, there was a significant association between fluid balance of 1750-2700 mL, OR 3.40 (95% CI 1.06-10.9; p = 0.04) and > 2700 mL, OR 3.91 (95% CI 1.33-11.5; p = 0.01) and major postoperative complications. When including initial ascites as fluid loss, a balance of > 2700 mL was associated with major postoperative complications, OR 2.59 (95% CI 1.01-6.66, p = 0.047).</p><p><strong>Conclusion: </strong>An optimal target for perioperative fluid balance to decrease the odds of major postoperative complications is suggested to be < 1750 mL. If initial ascites is included as loss in the calculation of balance, the optimal target of fluid balance is suggested to be < 2700 mL. These results provide practical clinical reference values that may assist anesthesiologists and surgical teams in optimizing perioperative fluid management in advanced ovarian cancer.</p><p><strong>Editorial comment: </strong>This secondary analysis of a trial ovarian cancer operative cohort assessed the relation of the estimated fluid balance over the operative day 24 h to major postoperative complications. The findings showed that the groups where the fluid balance was in the categories higher and also most positive had higher odds for having a major complication compared to the group with lowest fluid balance. Ascities fluid was an issue in this cohort, which was managed in the analysis.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov: NCT04065009.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 9","pages":"e70112"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12379113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938103","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":"Long-Term Outcomes After Cardiac Arrest: Protocol for the Extended Follow-Up Sub-Study of the STEPCARE Trial.","authors":"Gisela Lilja, Dorit Töniste, Frances Bass, Janus Christian Jakobsen, Niklas Nielsen, Markus B Skrifvars, Susann Ullén, Josef Dankiewicz, Helena Levin, Johanna Hästbacka, Marion Moseby Knappe, Manoj Saxena, Matt P Wise, Paul Young, Anders Aneman, Koen Ameloot, Jade M Cole, Tobias Cronberg, Anthony Delaney, Patrick Druwé, Joachim During, Tobias Graf, Matthias Haenggi, Katarina Heimburg, Manuela Itens, Caroline Kamp Barkholt, Thomas R Keeble, Christoph Leithner, Anna Lybeck, Andreas Lundin, Peter McGuigan, Annerose Mengel, Tuomas Oksanen, John Ridgway, Luis Romundstad, Claudia Schrag, Pascal Stammet, Anna Tippett, Matthew Thomas, Joonas Tirkkonen, Johan Undén, Bala Venkatesh, Marjaana Tiainen, Naomi Hammond","doi":"10.1111/aas.70114","DOIUrl":"10.1111/aas.70114","url":null,"abstract":"<p><strong>Background: </strong>The international multi-center randomized controlled STEPCARE-trial will investigate optimal management of sedation, temperature, and mean arterial pressure (MAP) during intensive care in out-of-hospital cardiac arrest (OHCA) patients due to various etiologies. The primary outcome is mortality at 6 months. This protocol describes an extended follow-up sub-study of the STEPCARE-trial with the main objective to provide detailed long-term outcomes for survivors and caregivers. It will focus on potential neuroprotection and improved recovery for different targets of sedation, temperature, and MAP management at 6 and 12 months post-OHCA.</p><p><strong>Methods: </strong>All survivors and one caregiver per survivor at selected STEPCARE sites will be invited to participate. Randomization is stratified by site. This sub-study extends the main STEPCARE follow-up at 6 months by undertaking detailed assessments, face-to-face meetings, inclusion of a caregiver, and repeating the assessments at 12 months. Our main outcome for survivors is cognitive function measured by the Montreal Cognitive Assessment, and for caregivers, the caregiver burden measured by the Zarit Burden Interview. Additional outcomes include symptoms of anxiety, depression, post-traumatic stress disorder, fatigue, physical function, life satisfaction, and life impact (disability), assessed by psychometrically robust measures. The estimated sample size is 600. Efforts to improve interrater reliability and decrease missing data are integral to the study design.</p><p><strong>Conclusion: </strong>These detailed long-term outcomes will explore the possible benefits or risks of fever, sedation, and blood pressure management in post-OHCA survivors. Additionally, this study will explore survivorship after cardiac arrest from various perspectives, including different causes of arrest.</p><p><strong>Clinicaltrials: </strong>gov: NCT0207942.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 9","pages":"e70114"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12379104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938044","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":"Selected Serious Adverse Events in a Cohort of Adult ICU Patients: Protocol for a Sub-Study of the PATIENCE Cohort.","authors":"Vera Crone, Morten Hylander Møller, Anders Granholm, Anders Perner, Waleed Alhazzani, Abdulrahman Al-Fares, Johanna Hästbacka, Marlies Ostermann, Carmen A Pfortmueller, Ricard Ferrer, Annika Reintam Blaser, Eric Keus, Wojciech Szczeklik, Mette Krag","doi":"10.1111/aas.70125","DOIUrl":"10.1111/aas.70125","url":null,"abstract":"<p><strong>Background: </strong>Serious adverse events (SAEs) are a relevant patient safety concern in critically ill patients, yet epidemiological data on their occurrence in the intensive care unit (ICU) remain limited. This sub-study of the PATIENCE cohort study aims to describe the occurrence of selected SAEs in adult ICU patients with and without prokinetic treatment.</p><p><strong>Methods: </strong>This is a protocol and statistical analysis plan for a post hoc sub-study of the \"Prokinetic agents in adult intensive care unit patients-An international inception cohort study (PATIENCE)\" which has included 1440 acutely admitted adult ICU patients from 11 countries. The primary outcome is the proportion of patients experiencing selected SAEs, assessed according to exposure to prokinetic treatment. Secondary outcomes include the proportion of patients experiencing each specific SAE, their distribution by treatment duration, and timing in relation to ICU admission and prokinetic use. Furthermore, patient characteristics for those with and without the SAEs will be described. Data will be presented descriptively.</p><p><strong>Conclusion: </strong>This sub-study will use data from the international PATIENCE cohort study to provide epidemiological data on the occurrence of SAEs potentially related to prokinetic use in adult ICU patients.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 9","pages":"e70125"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12445326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079452","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":"A Novel Approach to Early Personalized Hemodynamic Resuscitation: Non-Invasive Peripheral Photoplethysmography for Identifying Predominant Vasodilatory Shock in Sepsis.","authors":"Sanne Ter Horst, Anna D Schoonhoven, Raymond J van Wijk, Rick Weitering, Sanne W van Loon, Jan C Ter Maaten, Hjalmar R Bouma","doi":"10.1111/aas.70119","DOIUrl":"10.1111/aas.70119","url":null,"abstract":"<p><strong>Introduction: </strong>Sepsis remains a leading cause of mortality, with mortality from septic shock exceeding 40%. Standardized resuscitation (30 mL/kg) may cause adverse outcomes, including fluid overload or prolonged hypotension, emphasizing the need for individualized strategies. Sepsis-induced shock arises from varying degrees of vasodilation and hypovolemia, yet patients often present with similar clinical signs in the emergency department (ED). Photoplethysmography (PPG), a non-invasive technique reflecting peripheral perfusion, may help identify patients with a predominant vasodilatory profile who could benefit from early vasopressor therapy.</p><p><strong>Methods: </strong>This post hoc analysis used data from the Acutelines biobank at the University Medical Centre Groningen. Adults admitted for non-trauma specialties with suspected infection and hemodynamic instability (MAP < 70 mmHg, SBP < 90 mmHg, shock index > 0.9, or lactate > 4.0 mmol/L) were included. PPG data were pre-processed and features extracted. Principal component analysis (PCA) and K-means clustering enabled dimensionality reduction and hemodynamic profiling. Logistic regression assessed the discriminative performance of PPG-based models for vasopressor therapy initiation within 24 h.</p><p><strong>Results: </strong>Among 325 patients, 16.3% received vasopressors. PCA identified three principal components explaining 80.3% of variance: PC1 (arterial compliance), PC2 (cardiac output and systemic vascular resistance), and PC3 (peripheral vasomotor tone). The PPG-based model showed moderate discriminative power (AUROC: 0.75), improving when combined with MAP and lactate (AUROC: 0.83).</p><p><strong>Conclusion: </strong>PPG enables identification of patients likely to benefit from vasopressor therapy during the first 20 min after ED arrival. By providing additional insight into peripheral perfusion, this proof-of-principle study supports further exploration of PPG as a clinical support tool for personalized hemodynamic resuscitation in sepsis.</p><p><strong>Editorial comment: </strong>This secondary analysis demonstrates early peripheral circulatory patterns in sepsis using photoplethysmography at the start of resuscitation. Distinct PPG-derived profiles were associated with vasopressor initiation within 24 h, supporting PPG as a tool for personalized resuscitation.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 9","pages":"e70119"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12418295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145022590","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":"Translation and Validation of the Canadian ICU Family Satisfaction Questionnaire (FS-ICU-24R) to Danish-A Protocol.","authors":"Anne Højager Nielsen, Anne Sophie Ågård, Marie Oxenbøll Collet, Lone Dragnes Brix","doi":"10.1111/aas.70123","DOIUrl":"10.1111/aas.70123","url":null,"abstract":"<p><strong>Background: </strong>Family-centered care is vital in the intensive care unit, yet families often experience significant distress, increasing risks of anxiety and depression. Flexible presence, open communication, and involvement in care are central to supporting them. Guidelines recommend liberal visitation policies, structured communication, and staff education to strengthen family-centered practices. Measuring family satisfaction offers valuable insights to guide improvements, ensuring care addresses both patient needs and the well-being of families. Family satisfaction can be assessed with the Canadian questionnaire Family Satisfaction with Care in the Intensive Care Unit (FS-ICU-24R), a validated tool available in 24 languages. It consists of 32 items covering care, information, decision making, end-of-life, and open feedback. Psychometric testing has shown high reliability, with distinct subscales for satisfaction with care and satisfaction with information/decision making. However, some evidence suggests that decision making and information could represent separate constructs. The aim of this study is to translate and culturally adapt the FS-ICU-24R into Danish and to test its reliability and validity among family members of intensive care unit patients in Denmark. Furthermore, we will examine whether the questionnaire is best structured into two or three subscales.</p><p><strong>Method: </strong>This prospective study will be conducted in two phases. Phase one will involve translation and cultural adaptation of the FS-ICU-24R into Danish using a standardized multistep approach. Phase two will test psychometric properties, including internal consistency, convergent and construct validity, test-retest reliability, and internal structure. The study will be registered with the Central Denmark Region (D 1-16-02-51-24) and on Clinical Trials (NCT07087132).</p><p><strong>Results: </strong>The study is expected to provide a valid and reliable Danish version of the FS-ICU-24R.</p><p><strong>Conclusion: </strong>A Danish version of the FS-ICU-24R will facilitate national and international research aimed at improving conditions for family members of intensive care unit patients.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 9","pages":"e70123"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145022616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The AI and Automation in Anaesthesia (TRIPLE-A) Perioperative Database in Eastern Denmark 2017-: A Platform for Epidemiology, AI-Driven Prediction, Quality Control and Automated Data Retrieval.","authors":"Anders Peder Højer Karlsen, Marcus Ølgaard Møller, Nikolaj Krebs Pedersen, Mathilde Veje, Jonas Valbjørn Andersen, Christian Sylvest Meyhoff, Ole Mathiesen, Anders Kehlet Nørskov, Markus Harboe Olsen","doi":"10.1111/aas.70116","DOIUrl":"10.1111/aas.70116","url":null,"abstract":"<p><strong>Introduction: </strong>Electronic health records can be used to create high-quality databases if data are structured and well-registered, which is the case for most perioperative data in the Capital and Zealand Regions of Denmark. We present the purpose and development of the AI and Automation in Anaesthesia (TRIPLE-A) database-a platform designed for epidemiology, prediction, quality control, and automated research data collection.</p><p><strong>Methods: </strong>Data collection from the electronic medical record (EPIC Systems Corporation, WI, USA) was approved by the Capital Region, Denmark, and ethical approval was waived. The first TRIPLE-A database version included surgical procedures performed in a public hospital in the Capital and Zealand Regions of Denmark from 2017 to 2024 without age restrictions. We received structured, timestamped raw data including event log, medicine administrations, blood samples, vital parameters, etc. In collaboration with surgical specialists, we classified surgical procedures based on procedure codes and names. Variables were coded and enriched using multiple data sources (e.g., acute kidney injury: increase in creatinine OR new dialysis or ICD-10 codes) to improve quality and mirror the clinical reasoning of physicians. Variable coding, validation and improvement continuous in iterative processes with each project in the database. The database is scheduled for updates every 6 months and as needed, currently approved to December 2030 with plans for future extension. The database is used for multiple purposes in research with broad collaboration.</p><p><strong>Results: </strong>The first version of the TRIPLE-A database consists of 1,142,108 surgeries in 675,790 patients. Data were processed into 17 summary tables (anaesthesia, airway management, complications, etc.) including a total of 1617 variables. The database currently provides data for 34 research projects.</p><p><strong>Conclusion: </strong>TRIPLE-A is a continuously updated, granular, high-quality perioperative database. It will be used for (1) high-quality epidemiological research, (2) automated data retrieval into case report forms in cohort studies and randomized trials, (3) monitoring and evaluation of clinical implementation of interventions, and (4) development of perioperative prediction models for risk stratification and individualized treatment.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 9","pages":"e70116"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12418294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145022536","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":"Pro- and Anti-Inflammatory Responses and Clinical Outcomes in Critically Ill Patients With Endotheliopathy: A Cohort Study.","authors":"Caroline Humble, Martin Schønemann-Lund, Peter Bruun-Rasmussen, Morten H Bestle, Pär I Johansson, Lone M Poulsen, Ole Mathiesen","doi":"10.1111/aas.70117","DOIUrl":"10.1111/aas.70117","url":null,"abstract":"<p><strong>Background: </strong>Multiple organ dysfunction syndrome (MODS) in critical illness involves dysregulated immune and inflammatory responses, endotheliopathy, and coagulation activation. We investigated how three types of endotheliopathy biomarkers relate to pro- and anti-inflammatory responses and clinical outcomes in intensive care unit (ICU) patients.</p><p><strong>Methods: </strong>In this secondary, explorative analysis of a prospective single-centre cohort (n = 459), we assessed associations between endotheliopathy biomarkers (syndecan-1, soluble thrombomodulin (sTM), platelet endothelial cell adhesion molecule-1 (PECAM-1)) and inflammatory biomarkers (pro-inflammatory: IFN-ϒ, IL-1β, IL-2, IL-6, IL-8, IL-12p70, TNF-α; anti-inflammatory: IL-4, IL-10, IL-13) at ICU admission using linear regression. Associations with 30-day clinical outcomes were analysed using linear and Cox regression. All models were adjusted for age, sex, septic shock, pre-ICU surgery and chronic disease.</p><p><strong>Results: </strong>Higher levels of all three endotheliopathy biomarkers were associated with higher levels of inflammatory biomarkers. PECAM-1, however, showed no significant association with IFN-ϒ, IL-1β and IL-12p70. IL-4 was excluded from linear regression due to > 50% imputed values. Higher levels of all three endotheliopathy biomarkers were significantly associated with increased mean and maximum modified Sequential Organ Failure Assessment (mSOFA) scores over 30 days, as well as with renal, hepatic, and coagulation failure, and 30-day all-cause mortality. Only sTM was significantly associated with cardiovascular failure; none were significantly associated with respiratory failure. Higher levels of sTM were associated with the highest levels of inflammatory biomarkers, the largest increases in mean and maximum mSOFA scores, and the highest hazard ratios for organ failure and 30-day all-cause mortality, compared with syndecan-1 and PECAM-1.</p><p><strong>Conclusion: </strong>In this cohort of critically ill ICU patients, endotheliopathy was associated with (1) higher levels of pro- and anti-inflammatory biomarkers at ICU admission and (2) MODS, single organ failure, and 30-day all-cause mortality. Among the three endotheliopathy biomarkers, sTM demonstrated the most consistent and strongest associations with both inflammatory biomarkers and clinical outcomes. These findings are exploratory and should be interpreted as hypothesis-generating.</p><p><strong>Editor's comment: </strong>In this analysis of different biomarkers in a critically ill cohort, associations are demonstrated between markers related to endothelial stress, cytokines related to modulation of inflammation, and severity of illness scores.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 9","pages":"e70117"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12417775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145022586","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":"Cesarean Delivery in Queensland, Australia-A Retrospective Study of Factors Associated With Primary and Secondary General Anesthesia.","authors":"Victoria A Eley, Anita Pelecanos, Sue Lawrence, Suzanne Bertrand, Alka Kothari, Doogie Whitcombe, M Guy Godsall","doi":"10.1111/aas.70093","DOIUrl":"10.1111/aas.70093","url":null,"abstract":"<p><strong>Background: </strong>Queensland maternity services are provided by institutions of varying sizes, that are classified according to the Clinical Services Capability Framework. Obesity is more common in more remote areas. We aimed to identify factors associated primary and secondary general anesthesia in Queensland, Australia.</p><p><strong>Methods: </strong>Data were obtained from the Anaesthesia Benchmarking System and Mater Health Services between January 2019 and July 2022. The Accessibility/Remoteness Index of Australia Plus classification was used to describe remoteness and the institutional Clinical Services Capability Framework level documented. Associations of individual characteristics, cesarean characteristics and remoteness category with the outcomes of primary and secondary GA, were explored using chi-square tests and modelled using binary logistic regression.</p><p><strong>Results: </strong>Of 35,227 cases, 22,780 (64.7%) resided in major cities with a median (IQR) body mass index of 29.0 kg m^-2 (25.0-34.5). Primary general anesthesia occurred in 1562 (4.4%) and secondary general anesthesia in 1336 (3.8%). Primary general anesthesia occurred more commonly in category 1 cesarean (adjusted odds ratio, aOR 31.49, 95% CI 27.00-36.84) and those with a mental health condition (aOR 1.82, 95% CI 1.57-2.10), both p < 0.001. Primary GA occurred less commonly in nulliparous women (aOR 0.56, 95% CI 0.49-0.63, p < 0.001). Secondary general anesthesia was more likely in those with category 1 surgical urgency (aOR 12.62, 95% CI 10.58-15.07), post-partum hemorrhage (aOR 2.74, 95% CI 2.32-3.23), lowest BMI category (aOR 2.13, 95% CI 1.44-3.07), highest BMI category (aOR 1.71, 95% CI 1.41-2.07) and presence of a mental health condition (aOR 1.57, 95% CI 1.35-1.82), all variables p < 0.001. Clinical Services Capability Framework level 4 and 5 institutions cared for significantly more women with body mass index ≥ 40 kg m^-2 however more women with body mass index ≥ 40 kg m^-2 resided in remote/very remote locations.</p><p><strong>Conclusion: </strong>Anesthetists may use these results to anticipate secondary general anesthesia or modify primary techniques. Institutions located in remote areas and with fewer resources cared for more women with obesity, with implications for women and healthcare services.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 9","pages":"e70093"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12435121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145063148","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}