Acta Anaesthesiologica Scandinavica最新文献

{"title":"APECx-Anaesthesia, Perfusion and Surgical Practices in Cardiac Surgery: Main Study Protocol of a Modular Multiphase Prospective International Multicentre Observational Study.","authors":"Jord C Seegers, Nimrat Grewal, Relin van Vliet, Tim Berger, Bhiraj Bhatia, Crispiana Cozowicz, Martin Czerny, Jacopo D'Andria Ursoleo, Alessandro Della Corte, Stefan Dodic, Jonathon P Fanning, Lukas Gasteiger, Simran Grewal, Lars Grønlykke, Ragnar Huhn, Mohammad Idhrees, Theis Skovsgaard Itenov, Arminder S Jassar, Jae-Woo Ju, Dharshi Karalapillai, Gudrun Kunst, Lukas Lannemyr, D-Yin Lin, Carlo Mariani, Andreas Martinsson, Erin McCabe, Benjamin Milne, Fabrizio Monaco, Peter Hasse Møller-Sørensen, Matthias Neuner, Davide Pacini, Luke A Perry, Jaishankar Raman, A Floriaan Schmidt, Florian Schoenhoff, Reny Segal, Ary Serpa Neto, Douglas C Shook, Carolin Torregroza, Marc Vives, Vasileios Zochios, David M P van Meenen, Anne M Beukers","doi":"10.1111/aas.70214","DOIUrl":"10.1111/aas.70214","url":null,"abstract":"<p><p>The perioperative management in adult cardiac surgery patients remains highly variable across centres and regions. The APECx study (Anaesthesia, Perfusion and surgical practicEs in Cardiac surgery) aims to describe the incidence of key clinical patient outcomes, map global variation in anaesthesia, perfusion and surgical practices in cardiac surgery, identify potential modifiable factors associated with relevant clinical outcomes, and explore global, socioeconomic and sex-based differences within these practices. APECx is a prospective multicentre observational study scheduled to start in 2026 that will be conducted in cardiac surgery centres worldwide. Through a modular design, the research focus will evolve over time by going through multiple study phases during a 10-year period. Participating centres can join or leave each study phase and will be actively recruited over the course of the entire study period. Data collection will occur biannually, including all consecutive eligible cases during two prospectively pre-specified locally defined consecutive weeks within a 3-month window. Data will be collected using a web-based electronic case report form. Collected data will be limited to a clearly delineated minimised dataset. All data are routinely obtained as part of standard clinical care. Overall clinical outcomes include, but are not limited to, intensive care unit (ICU) and hospital length of stay, and in-hospital mortality with a maximum follow-up of 30 days. A pilot study will evaluate the feasibility and quantify the workload for participating sites. This study protocol was approved by the Medical Ethics Review Committee of Amsterdam UMC and will be conducted in accordance with local regulations at each participating centre. APECx is a modular, multiphase, large-scale, international, multicentre cohort study with the potential to contribute to standardised, evidence-based care worldwide. By minimising site burden, APECx will allow centres with varying amounts of resources from various economies to join. The modular design uniquely positions it to provide a broad overview of global perioperative practices in cardiac surgery, while enabling detailed investigation of specific evidence gaps.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 4","pages":"e70214"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12948733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147315982","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":"Activities and Time Spent on Rehabilitation in Scandinavian ICUs: A Cross-Sectional Survey Among Healthcare Professionals.","authors":"Hanne B Alfheim, Helle Svenningsen, Anna Holm, Anne S Ågård, Eva Åkerman, Ranveig Lind, Anne H Nielsen, Marie O Collet","doi":"10.1111/aas.70227","DOIUrl":"10.1111/aas.70227","url":null,"abstract":"<p><strong>Introduction: </strong>Survivors of critical illness commonly experience physical, cognitive, and psychological impairments. Early rehabilitation may mitigate these impairments; however, how rehabilitation practices are perceived and implemented by healthcare professionals in intensive care unit (ICU) remains insufficiently described. This study aimed to describe healthcare professionals' perceptions of rehabilitation activities in the ICU and to explore their self-reported estimates of the time devoted to these activities in Scandinavian ICUs.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted among healthcare professionals working in ICUs in Denmark, Norway, and Sweden. Using convenience sampling, data were collected on rehabilitation activities, time allocation, timing of initiation, and availability of post-ICU rehabilitative services.</p><p><strong>Results: </strong>In total, 518 healthcare professionals participated. Rehabilitation was described as a multidimensional practice encompassing cognitive, sensory stimulation, physical, and social rehabilitation activities, as well as patient participation in personal care. Activities were typically performed daily throughout the ICU stay. Respondents reported spending a median of 40% of their working time on rehabilitation, and most patients were considered eligible. Commonly reported activities included verbal interaction, sitting on the edge of the bed, family visits, and participation in personal care.</p><p><strong>Conclusion: </strong>Rehabilitation is an established component of ICU care in Scandinavia and is integrated into routine clinical practice. Activities span multiple domains, with physical and social rehabilitation activities being most prominent. Further research is needed to clarify optimal timing and prioritisation of rehabilitation activities.</p><p><strong>Editorial comment: </strong>This survey study presents perceptions from ICU personnel of how rehabilitation activities tend to be implemented in their workplace. Through different means, rehabilitation efforts are described as established in ICU practice in the three Scandinavian countries which were sampled.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 4","pages":"e70227"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13002326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147484202","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":"Computed Tomography Yield and Predictors of Pulmonary Embolism in Mechanically Ventilated Patients-A Retrospective Study.","authors":"Erik Bruno, Matilda Kewenter, Angeliki Dimopoulou Creusen, Freyr Einarsson, Gaetano Perchiazzi, Kristina Svennerholm, Christian Rylander","doi":"10.1111/aas.70216","DOIUrl":"10.1111/aas.70216","url":null,"abstract":"<p><strong>Background: </strong>The reported prevalence of pulmonary embolism (PE) detected during intensive care varies substantially. Computed tomography pulmonary angiography (CTPA) is the diagnostic reference method, but assessing pre-test probability and finding distinct indications for CTPA from clinical observations is difficult in mechanically ventilated critically ill patients.</p><p><strong>Aims: </strong>To describe the rate of positive diagnostic outcome (yield) from CTPA exams performed on PE suspicion and to identify predictors in the free text motivational reasons from the referring clinician and among selected patient variables during intensive care for other conditions.</p><p><strong>Methods: </strong>CTPA exams and reports in adult, mechanically ventilated patients referred from two intensive care units during a 5-year period were compared to the radiology order content and to data collected from medical records. The association between a positive exam and five arbitrarily defined reasons for ordering the exam as well as selected patient variables was assessed using multivariable logistic regression.</p><p><strong>Results: </strong>Among 1113 thoracic computed tomography exams, 243 were CTPA ordered on clinical PE suspicion, yielding 52 (21% [95% CI: 17-26]) positives. Reasons \"Elevated D-dimer\" and \"Undefined clinical suspicion\" were significantly associated with a positive exam. However, none of the selected patient variables was significantly associated with a CTPA finding of PE.</p><p><strong>Conclusion: </strong>The diagnostic yield of clinical CTPA exams for suspected PE in mechanically ventilated patients fell within a range commonly cited for suspected acute PE in emergency department populations, but its association with clinical signs described in the CTPA order and with selected patient variables was low.</p><p><strong>Editorial comment: </strong>The report describes a single center experience, including 2 years of the COVID-19 pandemic, with computed tomography pulmonary angiography performed to evaluate suspected pulmonary embolism in mechanically ventilated ICU cases. An elevated D-dimer as well as high degree of clinical suspicion were associated with a positive pulmonary embolism finding on the radiological examination.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 4","pages":"e70216"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12967873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147375680","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":"Anatomical Coordinates for Adductor Canal Block: Targeting Saphenous Nerve and Nerve to Vastus Medialis.","authors":"Tulika Gupta, Rafika Munawara, Neel Kamal, Babita Ghai, Nidhi Bhatia, Devendra Shekhawat","doi":"10.1111/aas.70217","DOIUrl":"10.1111/aas.70217","url":null,"abstract":"<p><strong>Background: </strong>The adductor canal block effectively targets the saphenous nerve and nerve to vastus medialis, providing pain relief after total knee arthroplasty while preserving quadriceps strength. Despite its widespread use, the ideal needle insertion point remains uncertain. This study aims to determine the optimal segment for adductor canal block using anatomical dissections and morphometric analysis.</p><p><strong>Methods: </strong>Cadaveric dissections of 30 limbs measured the morphometric data including the thigh length, adductor canal length, and distances from bony landmarks. The Saphenous nerve and nerve to vastus medialis entry at the beginning of the adductor canal, their lengths and course within it, in relation to the femoral artery and vastoadductor membrane, were measured. A single dye injection was performed in one cadaver to analyze its spread within the adductor canal.</p><p><strong>Results: </strong>From the beginning of the adductor canal, both the saphenous nerve and nerve to vastus medialis were found together for a distance of 3.5 cm. This region is identified as the critical zone. Key findings in the critical zone include: (1) The saphenous nerve and nerve to vastus medialis were closely positioned (3.5-6.9 mm apart). (2) Absence of the vasto-adductor membrane in ~50% of specimens enhancing nerve access. (3) Both nerves were lateral to the femoral artery, possibly minimizing vascular injury risk. In relation to the bony landmarks, the adductor canal begins ~7 cm from intersection of the line across anterior superior iliac spine to adductor tubercle and the line across the mid-inguinal point to superior border of patella (28 ± 3 cm from anterior superior iliac spine). Administering anesthesia here with a spread of 3 cm proximally and distally might ensure coverage of the critical zone. The nerve was 3.5-5 cm deep, with dye injection at this site staining both nerves effectively with a spread of 5 cm.</p><p><strong>Conclusions: </strong>The study identifies the proximal 3.5 cm from the beginning of the adductor canal as the critical zone to target both the saphenous nerve and nerve to vastus medialis, ensuring effective adductor canal block. The aim of the cadaver study is to identify the optimal segment of the adductor canal to facilitate and improve the success of adductor canal blocks. Injecting local anaesthetic 3.5 cm from the beginning of the adductor canal is an effective way of targeting both the saphenous nerve and the nerve to the vastus medialis. Superficial landmarks and ultrasound guidance can be used to identify the injection point.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 4","pages":"e70217"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147429929","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":"Ultrasound Use in Anesthesiology and Intensive Care in the Nordic Countries-An International Survey on Availability, Frequency of Use, Operator Training, and Assessment.","authors":"Martine S Nielsen, Anders M Grejs, Anders B Nielsen, Lars Konge, Anders B Mjelle, Johanna Hästbacka, Katrin Thormar, Olof Wall, Maria Cronhjort, Lene Russell, Anne C Brøchner","doi":"10.1111/aas.70190","DOIUrl":"10.1111/aas.70190","url":null,"abstract":"<p><p>Ultrasound is increasingly used in anesthesia and intensive care medicine for procedural guidance and patient assessment. However, training and formal skills assessment vary, and there is limited knowledge about current ultrasound practices in the Nordic countries. This study aims to survey the availability, daily clinical use, and current state of ultrasound training and skills assessment among anesthesiologists across the Nordic countries. An online cross-sectional survey, designed according to the Consensus-Based Checklist for Reporting of Survey Studies (CROSS) guidelines was distributed as a convenience sample across anesthesiology departments in Denmark, Finland, Iceland, Norway, and Sweden, covering a range of hospital types, including regional and university hospitals. The survey consisted of three sections: demographics, ultrasound availability, and procedural use, including skills development and assessment. Key measures included the frequency of ultrasound use, types of procedures where ultrasound was employed, training methods, self-assessed proficiency, and the frequency of formal skills assessments. An overall response rate of 38% (n = 412) was obtained. Ultrasound was used daily or weekly by 96% of respondents, and procedures where ultrasound was most frequently used were vascular access (97%) and peripheral nerve blocks (83%). Practical training was primarily acquired through clinical use under supervision from colleagues, with limited use of simulation-based training. Few respondents (27% across procedures) reported formal skills assessments, and self-assessed proficiency varied, with intermediate and beginner levels being the most common. Retention of skills was rarely assessed, with an average of 8% across procedures. Ultrasound is used almost daily by most anesthesiologists in the Nordic region, with equipment readily available in the departments. Despite its frequent use, training and skills assessments vary with limited focus on ensuring skills retention. EDITORIAL COMMENT: This article presents the results of a survey on ultrasound availability, usage and training for anesthesiologists working in the Nordic countries. Keeping in mind responder bias, the availability and usage is high, but there is a low level of reported formal training and skills assessment. This highlights a need for structured training and competency assessment for ultrasound, that could be offered via nordic collaboration.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 3","pages":"e70190"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12918840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146028101","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":"Low-Molecular-Weight Heparin for Adult ICU Patients Who Require Thromboprophylaxis: Protocol for the INCEPT-Thromboprophylaxis Platform Trial Domain.","authors":"Ruben Eck, Anders Granholm, Aske Tøgern, Aksel Karl Georg Jensen, Sandra Jonmarker, Fredrik Sjövall, Karina Meijer, Maria Cronhjort, Morten Hylander Møller, Anders Perner, Frederik Keus","doi":"10.1111/aas.70199","DOIUrl":"10.1111/aas.70199","url":null,"abstract":"<p><strong>Background: </strong>Low-molecular-weight heparin (LMWH) is recommended for thromboprophylaxis in adult intensive care unit (ICU) patients. Despite its widespread use, there is insufficient evidence on the optimal dose, and there appears to be practice variation. Determining the LMWH dosing strategy that most effectively balances the risks of venous thromboembolism (VTE) and bleeding may improve outcomes in ICU patients.</p><p><strong>Methods: </strong>The INCEPT-thromboprophylaxis domain is an investigator-initiated, open-label domain with an integrated feasibility phase on the international, pragmatic, parallel-group, randomised, embedded, multifactorial, adaptive Intensive Care Platform Trial (INCEPT). Adult acutely admitted ICU patients with an indication for thromboprophylaxis will be randomised to a fixed low dose, a fixed intermediate dose or a weight-adjusted dose of LMWH while in the ICU for a maximum of 90 days. The primary outcome is days alive out of hospital at 30 days. Secondary outcomes include 30-, 90- and 180-day all-cause mortality; days alive without life support at 30 and 90 days; days alive out of hospital at 90 days; days free of delirium at 30 days; health-related quality of life and cognitive function at 180 days; VTE and major bleeding during hospital stay at 30 and 90 days; and serious adverse reactions at 30 and 90 days. Analyses will primarily be conducted in the intention-to-treat population using Bayesian statistical models with neutral, weakly informative priors. We will assess feasibility after 300 participants and conduct adaptive analyses after follow-up for the primary outcome of 1500 participants and every additional 500 participants to a maximum of 10,000, with adaptive stopping for superiority/inferiority and practical equivalence (mean difference in the primary outcome < 1 day), and adaptive arm-dropping for superiority/inferiority. Allocation will initially be equal, followed by response-adaptive randomisation with a minimum 25% allocation to each arm. Expected sample sizes across different scenarios range from 2265 to 4892 participants, with approximately 100% probabilities of conclusiveness across scenarios.</p><p><strong>Conclusions: </strong>INCEPT-thromboprophylaxis will with high probability provide conclusive results and inform clinical practice regarding the dosing of LMWH for thromboprophylaxis in adult acutely admitted ICU patients.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 3","pages":"e70199"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146083784","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":"Anesthetic Strategies for Closed Reduction of Dislocated Total Hip Arthroplasty: A Scoping Review.","authors":"Rasmus Linnebjerg Knudsen, Rikke Helene Frølund Bjulf, Aurelien-Xuan Rosendal Bahuet, Mathias Therkel Steensbæk, Anne-Sofie Linde Jellestad, Kai Henrik Wiborg Lange, Lars Hyldborg Lundstrøm, Anders Kehlet Nørskov","doi":"10.1111/aas.70189","DOIUrl":"10.1111/aas.70189","url":null,"abstract":"<p><strong>Background: </strong>Total hip arthroplasty (THA) is a frequently performed orthopedic procedure, with dislocation being a common complication, often requiring closed reduction. Anesthetic strategies for this vary, and evidence on the efficacy, safety, and cost-effectiveness of current strategies is limited. The aim of this review was to synthesize the existing literature on anesthetic strategies for closed reduction of dislocated THA to identify best practice, organizational challenges and potential knowledge gaps.</p><p><strong>Methods: </strong>A scoping review was designed and conducted in accordance with current scoping review guidelines. Following a systematic literature search, two independent authors screened studies for eligibility and extracted data on key outcomes including procedural success, anesthetic techniques, hospital setting, intraprocedural complications, and resource use.</p><p><strong>Results: </strong>Fifty-seven studies were included with no randomized controlled trials being identified. Case reports, case letters, literature reviews, group interviews, and survey studies were excluded due to risk of selection bias, resulting in 22 remaining studies. Median closed reduction success rate was 81% (IQR 77%-92%) for sedation and 95% (IQR 60%-96%) for general anesthesia. Sedation in the emergency department with propofol had higher reduction success rates than sedation with other drugs. However, inconsistent definitions, variation in the use of anesthetic drugs and dosing, and small sample sizes limited comparability between studies. Time from admission to procedure was 2.25 h (IQR 2.0-2.95) for sedation and 7.6 h (IQR 5.3-9) for general anesthesia. Length of stay was 1.09 days (IQR 0.84-1.31) for sedation and 3 days (IQR 1.3-3.4) for general anesthesia. Complications were infrequently and inconsistently reported.</p><p><strong>Conclusion: </strong>A wide range of anesthetic strategies for reduction of dislocated THA were evaluated, with success rates varying considerably across studies. This review demonstrates a substantial gap in the literature regarding the anesthetic management of closed reduction of dislocated THA. High-quality evidence is needed to inform and balance patient-relevant outcomes.</p><p><strong>Editorial comment: </strong>This scoping review presents an updated exploration of the considerations and alternatives for anesthetic management of cases for closed reduction of hip arthroplasty dislocation and closed reduction.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 3","pages":"e70189"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12929040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146045879","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":"Albumin for Adult ICU Patients With Shock: Protocol for the INCEPT-Albumin Platform Trial Domain.","authors":"Tine Sylvest Meyhoff, Anders Perner, Praleene Sivapalan, Karen Louise Ellekjær, Aksel Karl Georg Jensen, Rikke Faebo Larsen, Maj-Brit Nørregaard Kjær, Benjamin Skov Kaas-Hansen, Theis Lange, Lasse Grønningsæter, Maria Cronhjort, Carmen Andrea Pfortmueller, Frederik Keus, Martin Ingi Sigurdsson, Erika Wilkman, Morten Hylander Møller, Anders Granholm","doi":"10.1111/aas.70203","DOIUrl":"10.1111/aas.70203","url":null,"abstract":"<p><strong>Background: </strong>Intravenous albumin is used for resuscitation of adult intensive care unit (ICU) patients with shock and substitution in those with hypoalbuminemia, which is common in critically ill patients. There is, however, substantial clinical practice variation as it is uncertain if albumin use improves patient-important outcomes.</p><p><strong>Methods: </strong>The INCEPT-Albumin domain is an investigator-initiated, open-label domain with an integrated feasibility phase on the international, pragmatic, parallel-group, randomised, embedded, multifactorial, adaptive Intensive Care Platform Trial (INCEPT). Adult acutely admitted ICU patients with shock irrespective of its cause will be randomised to albumin versus no albumin use for resuscitation and substitution while in the ICU for a maximum of 90 days. The primary outcome is days alive without life support at 30 days. Secondary outcomes include 30-, 90-, and 180-day all-cause mortality; days alive without life support at 90 days; days alive out of hospital at 30 and 90 days; days free of delirium at 30 days; health-related quality of life and cognitive function at 180 days; and serious adverse reactions at 30 and 90 days. Analyses will primarily be conducted in the intention-to-treat population using Bayesian statistical models with neutral, weakly informative priors. We will assess feasibility after 200 participants and conduct adaptive analyses after follow-up for the primary outcome of 1000 participants and every additional 250 participants to a maximum of 10,000, with adaptive stopping for superiority/inferiority and practical equivalence (mean difference in the primary outcome < 1 day). Allocation will initially be equal, followed by response-adaptive randomisation with minimum 40% allocation to each arm. Expected sample sizes across different scenarios range from 1137 to 3547 participants, with approximately 100% probabilities of conclusiveness across scenarios.</p><p><strong>Conclusions: </strong>INCEPT-Albumin will with high probability provide conclusive results and inform clinical practice regarding albumin versus no albumin use in adult acutely admitted ICU patients with shock.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 3","pages":"e70203"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12909088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146206448","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":"Intraoperative Hypotension and Vasoactive Treatment: An International Survey of Anaesthesiologists.","authors":"Emilie S Bækgaard, Morten Vester-Andersen, Vera Crone, Morten Hylander Møller, Shun Yamanaka, Rakel Palmarsdottir, Panu Uusalo, Felix Haidl, Madeleine Rådestad, Koene van der Sloot, Andrea Corona, Alexander Johnström, Anders Kehlet Nørskov, Anders P H Karlsen, Birgit Isberg Faustad, Christina Borgen Sørensen, Fabian Spies, Hanna Bjarkhamar Krogh, Hayan El-Hallak, Jacqueline Møller Mistry, Julie Kjerulff Mønnich, Karen Grangård Olesen, Karl P D Madsen, Kirsten Lerche Voogd, Laila Mulla Reich, Line Agger Kolstrup, Peter Juhl-Olsen, Luisa Korsgaard Körner, Martin Ingi Sigurdsson, Mathias Bach Jensen-Holm, Julie Anna Slavensky, Mette Helene Toft, Michael Leth Jørgensen, Mikkel Andersen, Mikkel Schiødt Heide Jensen, Mojtaba Saei, Morten Hedetoft, Peter Martin Hansen, Rasmus Tofte Hansen, Rune Sarauw Lundsgaard, Sarah Marie Ivan Krarup, Sebastian Wiberg, Torben Laustrup, Guilia Brizzi, Janett Kreutziger, Ifunanya Onyemuchara, Adebisi Adeniji, Thomas Colville, James A Keitley, Meherunissa Khan, Morven Millar, Iona Lennie, Kieran Kelly, Verity Brooker, Jack Roberts, Gareth Lipton, Jill Keohone, Ryad Chebbout, Oliver Bond, William Milligan, Ciara O'Brien, Edward Wright, Fiona Linton, Charlotte Towell, James Shuttleworth, James Norton, Daniel Butler, Stuart Frankland, Francis Screech, Lucy Charig, Stephanie Walsh, Rhys Davies, Eleanor Jones, Elodia Dalmonte, Matthew Evans, Mette Krag","doi":"10.1111/aas.70197","DOIUrl":"10.1111/aas.70197","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Intraoperative hypotension is a common occurrence in patients undergoing anaesthesia, although there is no standardised definition of hypotension. International consensus statements provide some guidelines for the management of intraoperative hypotension, but general clinical practice is unknown. We aimed to survey anaesthesiologists' values and preferences regarding intraoperative blood pressure management, including whether they would support future research on this topic.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted an international, online survey of routine practice and opinion. The target population was anaesthesiologists who regularly anaesthetise adult patients. Results are reported descriptively and in accordance with the Consensus-Based Checklist for Reporting of Survey Studies (CROSS) checklist.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 1640 anaesthesiologists from 11 European countries participated in the survey. The majority of respondents were specialists (1322 of 1640, 80.6%, 95% CI 78.7-82.6). Almost all respondents worked in public hospitals (1613 of 1640, 98.4%). The overall response rate was 22.7%. Most respondents reported using absolute mean arterial pressure as their main unit of measurement to quantify hypotension (1098 of 1640, 67.0%, 95% CI 64.6-69.2). Respondents were most likely to initiate vasoactive treatment at a mean arterial pressure below 60 or 65 mmHg. Chronic arterial hypertension, traumatic brain injury and surgical procedures involving head-up positioning of the patient were the three most common scenarios where respondents would raise their threshold for treatment. Most respondents considered the establishment of safe intraoperative blood pressure thresholds a critical research question, and almost all respondents (1509 of 1640, 92.0%) indicated a willingness to randomise patients to specific blood pressure targets. For 72.9% (1196 of 1640), the lowest acceptable mean arterial pressure for randomisation was 60 mmHg. Respondents were also interested in the comparison of efficacy and safety of vasoactive agents, and the most sought-after comparison was phenylephrine versus noradrenaline (1252 of 1640, 76.3%). The willingness of respondents to administer these agents in peripheral venous access differed according to geography.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In this international survey, mean arterial pressures of 60 or 65 mmHg were the most commonly reported blood pressure thresholds leading to initiation of treatment with vasoactive agents. Almost all respondents indicated patient groups for whom they would alter their treatment threshold, namely those suffering from chronic arterial hypertension, those undergoing surgery in a head-up position, and patients with traumatic brain injury. The majority of respondents supported future trials establishing optimal mean arterial pressure threshold and choice of vasoactive agent. We noticed a geographical variation in willingness to a","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 3","pages":"e70197"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12895218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146111820","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":"Automated Calculation of Sequential Organ Failure Assessment (SOFA) Score in the Intensive Care Unit: Algorithm Development, Validation, and Association With 30-Day Mortality.","authors":"Johan Helleberg, Anna Sundelin, Navid Soltani, Ragnar Thobaben, Johan Mårtensson, Olav Rooyackers","doi":"10.1111/aas.70205","DOIUrl":"10.1111/aas.70205","url":null,"abstract":"<p><strong>Background: </strong>Sequential Organ Failure Assessment (SOFA) score is routinely used in the intensive care unit (ICU) to describe severity of organ dysfunction, for prognostication and sepsis diagnosis, and in clinical trials. Inter-rater variability and scalability are known challenges in manual assessment. We aimed to develop and validate an algorithm for automatic SOFA calculation and evaluated its predictive abilities on 30-day mortality.</p><p><strong>Methods: </strong>Retrospective multi-center cohort study on all adult patients admitted to four ICUs at the Karolinska University Hospitals in 2015-2018. Data from 2018 collected in one ICU was used for algorithm development. The algorithm was validated by comparing the results of automated SOFA score calculation to those obtained by manual SOFA scoring by experienced intensivists on 300 randomly chosen ICU days from the remaining cohort. Intra-class correlation coefficient (ICC [95% confidence interval (CI)]) was calculated as primary validation outcome. Area under the receiver operating characteristic curve (AUROC [95% CI]) was used for assessment of 30-day mortality prediction on the remaining cohort (excluding only the development cohort).</p><p><strong>Results: </strong>A total of 6953 ICU admissions were included. The algorithm was developed on 613 admissions during 2018. Data from the remaining cohort with 6340 admissions (5076 patients, 36,625 ICU days) were used for mortality prediction. On algorithm validation of the full SOFA score, the ICC was 0.99 (0.98-1.00). For 30-day mortality, the best predictive abilities were found with maximum SOFA score (AUROC 0.79 [0.78-0.81]) and with SOFA score on Day 2 (AUROC 0.79 [0.77-0.80]).</p><p><strong>Conclusion: </strong>A trustworthy automated SOFA score dataset can be produced with comprehensive high-frequency electronic health records curation and rigorous artifact control, with accuracy comparable to manual scoring by senior intensivists. Association between SOFA score and 30-day mortality in a large, real-world clinical cohort aligns with findings from previous clinical trials. The results support the use of automated SOFA scoring as a reliable tool for clinical research, quality monitoring, and potentially real-time clinical decision support.</p><p><strong>Editorial comment: </strong>In this article, the authors report results of a retrospective multicenter study, where they used a large cohort of adult ICU patients for developing and validating an automated algorithm for calculating SOFA scores. In validation, they found that the automatically calculated score was comparable to scores manually calculated by experienced clinicians. The automatically calculated maximum SOFA and Day 2 SOFA scores performed well in predicting 30-day mortality.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 3","pages":"e70205"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12907534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146199869","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}