Acta Anaesthesiologica Scandinavica最新文献

{"title":"Agreement Between Methods Assessing Changes in Plasma Volume During Fluid Therapy-A Post Hoc Analysis of a Randomized Trial.","authors":"David Grubb, Svajunas Statkevicius, Johan Bonnevier, Björn Bark, Peter Bentzer","doi":"10.1111/aas.70271","DOIUrl":"10.1111/aas.70271","url":null,"abstract":"<p><p>Volume status of a patient is difficult to assess clinically. Methods to measure plasma volume as well as changes in plasma volume in connection with fluid therapy are therefore valuable for research purposes and could potentially be used bedside to guide fluid therapy in individual patients. The objective of the present study was to evaluate hematocrit as a marker of changes in plasma volume and an anthropometric formula to estimate absolute plasma volume against the reference method, plasma volume measurements using radiolabeled albumin. A total of 64 postoperative patients received 10 mL/kg of albumin. The plasma volumes were measured with the reference method (radiolabeled albumin) at baseline, after 30 and 180 min. Plasma volumes were compared with plasma volumes derived from either the baseline measurements and subsequent changes in hematocrit (calibrated method) or from an anthropometric formula and subsequent hematocrit changes (anthropometric method). Bland-Altman plots were used to test agreements between methods. The mean difference in plasma volume between the anthropometric and the reference method at baseline was -0.1 mL/kg (95% CI -2.1 to 1.8) with lower and upper LOA of -18.0 and 17.0 mL/kg. The agreement remained essentially unchanged after fluid therapy (mean difference -0.1 mL/kg (95% CI -1.8 to 1.5) with LOAs of -18.0 and 17.0 mL/kg). The mean difference between the calibrated and reference methods was -0.1 mL/kg (95% CI -0.9 to 0.7) with LOAs of -9.4 and 9.2 mL/kg. The anthropometric formula yields low precision in predicting plasma volumes in postsurgical patients. Changes in hematocrit during fluid therapy cannot replace the reference method to assess changes in plasma volume in the individual patient because of the imprecision. EDITORIAL COMMENT: Clinical appreciation of plasma volume is relevant for assessing treatment where intravenous fluid resuscitation is involved. This analysis, using a reference method for plasma volume assessment, and comparing to simpler methods to estimate the same, demonstrates that there are important limitations with some simpler and readily acceptable methods to perform this estimation.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 6","pages":"e70271"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13238360/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148161590","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 Systematic Review and Expert Evaluation of Perioperative SGLT2 Inhibitor-Associated Ketoacidosis Case Reports.","authors":"L I P Snel, X Li, F Jamaludin, S E Siegelaar, F Holleman, T M Vriesendorp, J H DeVries, J B L Hoekstra, B Preckel, D H van Raalte, J Hermanides, A H Hulst","doi":"10.1111/aas.70254","DOIUrl":"10.1111/aas.70254","url":null,"abstract":"<p><strong>Introduction: </strong>The use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in the perioperative setting may lead to SGLT2i-associated postoperative ketoacidosis (SAPKA) in patients with type 2 diabetes (T2D). Therefore, cessation of this drug is recommended before surgery. We aimed to study reported cases to assess the causality of SGLT2i, identify common characteristics, potential risk factors, treatment and outcomes of SAPKA.</p><p><strong>Methods: </strong>We conducted a systematic literature search to identify case reports of patients with metabolic acidosis and the presence of ketones who used SGLT2i in the perioperative setting. Case reports were summarised for common characteristics, assessed for quality and distributed to a panel of diabetes experts, who evaluated the likelihood of SAPKA using a questionnaire.</p><p><strong>Results: </strong>Ninety-three papers containing 128 case reports fulfilled the inclusion criteria. The expert panel found SAPKA to be 'likely' in 53 (41%), 'possible' in 38 (30%) and 'unlikely' in 27 (21%) cases; 10 cases (8%) could not be validated due to insufficient data or implausible timing. SAPKA was therefore considered likely or possible in 71% (91/128) of cases. Common factors identified in the SAPKA reports included a diagnosis of T2D mellitus (n = 115), impaired perioperative intake (n = 30) and insufficient insulin supplementation (n = 10). Treatment with insulin was effective, and ketoacidosis resolved in all surviving patients, although significant morbidity, including ICU admission, was reported in a substantial proportion of cases.</p><p><strong>Discussion: </strong>Confirming a SAPKA diagnosis is challenging due to the variable reporting quality and numerous confounding factors present during the perioperative period. Clinicians should remain aware of SAPKA given the increasing prevalence of SGLT2i use. Focusing on early recognition and treatment represents a potential alternative strategy to routine preoperative SGLT2i discontinuation, though this requires further prospective evaluation.</p><p><strong>Editorial comment: </strong>This systematic review presents an overview and discussion of the many, to date, case reports of ketoacidosis thought to be associated with perioperative SGLT2 inhibitor treatment.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 6","pages":"e70254"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13172662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147925387","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":"Glucocorticoids for Patients With Acute Decompensated Heart Failure: A Protocol for a Systematic Review With Meta-Analysis and Trial Sequential Analysis.","authors":"Laura Wrisberg Kæstel, Isak Mazanti Cold, Danni Herman Andersen, Emilie Melgaard, Amina Sarwar, Janus C Jakobsen, Jasmin Dam Lukoschewitz, Anne Sophie Overgaard Olesen, Laust Obling, Jens Jakob Thune, Jens Dahlgaard Hove, Johannes Grand","doi":"10.1111/aas.70264","DOIUrl":"10.1111/aas.70264","url":null,"abstract":"<p><strong>Background: </strong>Acute decompensated heart failure (ADHF) is associated with inflammation. Inflammatory biomarkers in patients with ADHF are associated with increased mortality. Glucocorticoids mitigate systemic inflammation and may therefore have a therapeutic role in ADHF. We aim to investigate the effects of adding glucocorticoids to standard of care in the treatment of ADHF.</p><p><strong>Method: </strong>This protocol for a systematic review with meta-analysis is conducted according to the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. We will conduct a systematic review of randomized clinical trials comparing glucocorticoids with placebo or any other control in patients hospitalized with ADHF. The primary outcome is all-cause mortality. Secondary outcomes include length of hospitalization, all-cause hospitalizations and rehospitalization for heart failure. A comprehensive search will be conducted across Medline, Embase, the Cochrane Central Register of Controlled Trials, the Latin American and Caribbean Literature on Health Sciences, and Web of Science, and Covidence will be used to independently screen all results by two authors. The search is planned to begin in April 2026. A meta-analysis and Trial Sequential Analysis will be conducted on eligible trials. Risk of bias will be evaluated using the Cochrane Risk of Bias tool-version 2. The certainty of the evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE).</p><p><strong>Conclusion: </strong>This systematic review and meta-analysis will synthesize the available randomized evidence on glucocorticoids as an adjunct to standard care in patients hospitalized with ADHF, with the aim of assessing their therapeutic potential in this population and identifying gaps to inform future research.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 6","pages":"e70264"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147986163","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":"Pre- and Postoperative N-Terminal Pro B-Type Natriuretic Peptide Dynamics and Outcomes After Emergency Laparotomy.","authors":"Frederik F Lau, Simon Brøkmann, Mirjana Cihoric, Morten Laksáfoss Lauritsen, Nicolai Bang Foss","doi":"10.1111/aas.70252","DOIUrl":"10.1111/aas.70252","url":null,"abstract":"<p><strong>Background: </strong>The prognostic value of N-terminal pro B-type natriuretic peptide has only been sparsely studied in patients undergoing emergency laparotomy, where acute systemic inflammation and physiological derangement may affect perioperative N-terminal pro B-type natriuretic peptide dynamics. Our objective was to assess the prognostic association of preoperative and postoperative N-terminal pro B-type natriuretic peptide concentrations in patients undergoing emergency laparotomy.</p><p><strong>Methods: </strong>We conducted an exploratory retrospective cohort study using prospectively registered data. The association between preoperative and postoperative N-terminal pro B-type natriuretic peptide concentrations and 90-day mortality was analysed using logistic regression after logarithmic transformation, with effect estimates expressed as odds ratios per doubling in biomarker concentration. Secondary exploratory analyses included internally derived threshold-based analyses and assessment of perioperative N-terminal pro B-type natriuretic peptide patterns.</p><p><strong>Results: </strong>In total, we included 249 patients. Each doubling of preoperative and postoperative N-terminal pro B-type natriuretic peptide concentrations was associated with increased unadjusted odds of 90-day mortality (preoperative OR 1.89, 95% CI 1.49-2.40; postoperative OR 2.29, 95% CI 1.71-3.06). Secondary exploratory analyses using internally derived thresholds showed a similar directional pattern. Patients with elevated preoperative but lower postoperative N-terminal pro B-type natriuretic peptide concentrations displayed lower observed mortality compared to those with persistently elevated concentrations.</p><p><strong>Discussion: </strong>Preoperative and postoperative N-terminal pro B-type natriuretic peptide concentrations were associated with 90-day mortality in patients undergoing emergency laparotomy. The prognostic relevance of N-terminal pro B-type natriuretic peptide trajectories warrants further study.</p><p><strong>Editorial comment: </strong>This study examines perioperative NT-proBNP dynamics in emergency laparotomy patients, showing higher pre- and postoperative levels predict increased 90-day mortality. It suggests biomarker trajectories, not just absolute values, may refine risk stratification, as declining postoperative levels were associated with lower mortality than persistently elevated concentrations, highlighting potential clinical value while emphasising need for prospective validation.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 6","pages":"e70252"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147925424","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":"Digital Versus in-Person Pre-Anaesthetic Assessment and Postoperative Outcomes in Low-Risk Patients: A Protocol for a Single-Centre Cohort Study.","authors":"Mathilde Nellemann, Moritz Kilian German Denneborg, Sofie Amalie Bosholdt, Camilla Meno Kristensen, Constance Thyra Giertz Christiansen, Janus Christian Jakobsen, Rasmus Hesselfeldt, Morten Hylander Møller, Andreas Møgelmose, Markus Harboe Olsen, Katrine Bredahl Buggeskov","doi":"10.1111/aas.70266","DOIUrl":"10.1111/aas.70266","url":null,"abstract":"<p><p>Pre-anaesthetic assessment is essential for identifying perioperative risk and optimising patient safety. Digital alternatives, including video consultation and structured electronic health record (EHR) review, may improve efficiency, but comparative evidence regarding postoperative safety remains limited. We hypothesise that digital pre-anaesthetic assessment modalities will be associated with low rates of major postoperative complications in selected low-risk patients. This protocol describes a single-centre study with retrospective data collection including adult patients scheduled for elective otorhinolaryngologic, oral or maxillofacial surgery at Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark. Patients underwent preoperative assessment using one of three modalities: in-person consultation (2019-2020), EHR review (2021-2022) or video consultation (2024-2025). The primary outcome is a composite of major postoperative complications within 30 days, including all-cause mortality, admission to the intensive care unit, bleeding requiring transfusion, infection requiring antibiotics, or hospital readmission. Secondary outcomes include number of days spent hospitalised within 30 days after surgery, changes in anaesthesia plan, airway management modifications, delay in surgical start time, intubation attempts and same-day cancellations. Associations between assessment modality and dichotomous outcomes will be examined using multivariable generalised linear models with a log-link function, adjusted for prespecified covariates. Sensitivity analyses will include inverse probability weighting and win ratio analysis. This single-centre cohort study will examine whether digital pre-anaesthetic assessment strategies, such as video consultation and EHR review, are associated with differences in major postoperative complications compared with in-person assessment. The findings may inform the implementation of patient-centred, resource-efficient preoperative assessment strategies within the Danish healthcare system and similar international settings.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 6","pages":"e70266"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147986180","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":"Establishing Expert Consensus on Competencies for Safe Ward-Based Postoperative Epidural Analgesia Management: Protocol for a Modified Delphi Study.","authors":"Cornelia Charlotte Lamprecht, Søs Bohart, Kim Wildgaard, Morten Vester-Andersen, Anne Mørup-Petersen, Thordis Thomsen","doi":"10.1111/aas.70275","DOIUrl":"10.1111/aas.70275","url":null,"abstract":"<p><p>Postoperative epidural analgesia (EA) is an important analgesic strategy for selected surgical procedures. However, clinical practice and training vary across settings, and no consensus-based framework currently defines the competencies required for safe ward-based EA management. A modified Delphi study will establish expert consensus on competencies for ward-based postoperative EA management. Items derived from prior empirical work will be rated by experts across three Delphi rounds: two rounds in which experts rate the relevance of each item on a seven-point Likert scale with controlled feedback between rounds, followed by a third round in which experts rate the required competence level for included items using Miller's pyramid. The study is expected to generate consensus on essential competencies and their required level for safe ward-based postoperative EA management. The findings will inform the development of a competency-based training framework and may contribute to more consistent practice and improved patient safety.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 6","pages":"e70275"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13272755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148262789","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":"Initiation of High-Potency Benzodiazepine Prescriptions Among Survivors of Severe Trauma.","authors":"Anders Oldner, Mikael Eriksson, Emma Larsson, Jesper Eriksson, Erik von Oelreich","doi":"10.1111/aas.70245","DOIUrl":"10.1111/aas.70245","url":null,"abstract":"<p><strong>Background: </strong>Trauma is a major public health concern that often leads to long-term psychological distress and chronic pain. Benzodiazepines (BZDs) are sometimes prescribed for anxiety, insomnia, or acute stress-related symptoms, but long-term use is associated with dependence and adverse outcomes. The extent to which BZDs are initiated after trauma, and their implications for long-term health, remain poorly understood. This study aimed to assess the association between trauma exposure and initiation of high-potency BZDs, identify risk factors within the trauma cohort and examine the association between new BZD use and long-term mortality.</p><p><strong>Methods: </strong>We conducted a population-based cohort study using data from a regional trauma registry linked to Swedish national health registers. New initiation of BZD prescriptions was defined as filling at least one prescription within 6 months after trauma. Multivariable logistic regression was used to assess associations between trauma exposure and BZD initiation and to identify risk factors within the trauma cohort. Cox proportional hazards regression evaluated the association between new BZD use and 6-18-month mortality.</p><p><strong>Results: </strong>The study included 12,206 BZD-naive trauma patients and 66,801 matched controls. Trauma exposure was independently associated with new high-potency BZD use. Within the trauma cohort, risk factors included older age, psychiatric comorbidity, substance abuse, pre-traumatic opioid or sedative-hypnotic drug use, penetrating trauma, and higher injury severity. New BZD use was associated with markedly elevated 6-18-month mortality (adjusted HR 2.9, 95% CI 2.0-4.2, p < 0.001), a finding that reflects the complex clinical and psychosocial vulnerability of this group.</p><p><strong>Conclusions: </strong>Trauma exposure independently predicted initiation of high-potency BZDs among previously BZD-naive patients. Psychiatric comorbidity, substance use, and greater injury severity were important risk factors. The association between new BZD use and increased long-term mortality underscores the need for cautious prescribing and structured follow-up after trauma.</p><p><strong>Editorial comment: </strong>This study examines initiation of high-potency benzodiazepines among previously naive survivors of severe trauma using linked registry data. It shows that trauma exposure is strongly associated with new benzodiazepine use, particularly in older, comorbid, and vulnerable patients. Initiation is also associated with higher subsequent mortality, likely reflecting underlying clinical and psychosocial risk rather than a causal drug effect.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 6","pages":"e70245"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13133234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147809526","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 Use of Non-Invasive Ventilation for Acute Respiratory Failure due to Acute Exacerbation of Chronic Obstructive Pulmonary Disease. A Randomised Trial.","authors":"Jesper H Brendel, Lars W Andersen, Søren H Skaarup, Thomas Dissing, Anders Gunnar Nielsen, Nikolaj F Milandt, Ulrick S Espelund, Lisa F Irion, Lone R Mortensen, Kim M Larsen, Jens Aage K Petersen","doi":"10.1111/aas.70269","DOIUrl":"10.1111/aas.70269","url":null,"abstract":"<p><strong>Background: </strong>In-hospital use of non-invasive ventilation improves outcomes in patients with acute respiratory failure caused by acute exacerbation of chronic obstructive pulmonary disease. Prehospital use of non-invasive ventilation is uncommon due to diagnostic uncertainty and logistical constraints. We hypothesised that prehospital non-invasive ventilation guided by arterial blood gas analysis would improve early physiological outcomes compared with standard medical treatment alone.</p><p><strong>Methods: </strong>This investigator-initiated, multicentre trial randomised patients with suspected acute respiratory failure due to acute exacerbation of chronic obstructive pulmonary disease with respiratory acidosis defined as pH < 7.30 and PaCO₂ > 6.0 kPa to standard medical treatment alone or standard medical treatment plus non-invasive ventilation. Patients were attended by prehospital physician-manned emergency care units and enrolled without prior consent under emergency trial approval. The primary outcome was the change in arterial pH from enrolment to hospital arrival.</p><p><strong>Results: </strong>The trial was terminated early due to low recruitment. Out of 111 screened patients, 16 were randomised and 14 were included in the analysis. The median prehospital pH change was 0.09 (interquartile range 0.02-0.12) in the non-invasive ventilation + standard medical treatment group and 0.02 (0.01-0.03) in the standard medical treatment alone group. Median on-scene time was 32 min in the non-invasive ventilation + standard medical treatment group versus 28 min in the standard medical treatment alone group. Recruitment was limited by strict inclusion criteria, procedural complexity and challenges related to the implementation of prehospital arterial blood gas analysis and trial procedures. Missing data further limited the assessment of in-hospital outcomes.</p><p><strong>Conclusion: </strong>The clinical effect of prehospital non-invasive ventilation could not be determined due to early termination. This trial highlights important challenges relevant to future clinical trials in the prehospital setting, including patient selection, diagnostic requirements and implementation of complex interventions.</p><p><strong>Trial registration: </strong>NCT06211920.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 6","pages":"e70269"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148136413","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":"Cognitive Rehabilitation Interventions in the Intensive Care Unit: A Systematic Integrative Review.","authors":"Kamila C Lassen, Eva Laerkner, Janet F Jensen, Ingrid Egerod, Jan Christensen, Kasper Jørgensen, Rikke S Kjærgaard, Sepideh Olausson, Hilde Wøien, Anne H Nielsen, Maj-Brit N Kjær, Camilla R L Bruun, Hejdi Gamst-Jensen, Anders Perner, Marie O Collet","doi":"10.1111/aas.70240","DOIUrl":"10.1111/aas.70240","url":null,"abstract":"<p><strong>Background: </strong>Because critical illness, sedation, and ICU treatment commonly disrupt attention, memory, and executive function, early cognitive rehabilitation during the ICU stay may preserve or restore these capacities, reduce the delirium burden, and support engagement and recovery. Our primary aim was to identify and describe cognitive rehabilitation interventions delivered during the ICU stay and describe the healthcare professionals providing them. Secondarily, we summarized patient-important outcomes associated with these interventions and appraised study quality to inform future research.</p><p><strong>Method: </strong>We performed a systematic integrative review with searches in Medline, EMBASE, CINAHL, and CENTRAL. Eligible studies included adult ICU patients receiving or healthcare professionals delivering early cognitive rehabilitation initiated in the ICU. Data synthesis followed PRISMA guidelines, and risk of bias was assessed using RoB2 and ROBINS-I and narratively described.</p><p><strong>Results: </strong>We included 27 studies: 10 randomized clinical trials, six cross-sectional studies, five cohort studies, three qualitative studies, three non-randomized trials, and one mixed-methods study. Four categories of interventions were identified: (1) orientation and multisensory stimulation, (2) activities of daily living (ADL)-focused functional occupational therapy, (3) early mobilization and physical rehabilitation, and (4) technology-based sensory and affective stimulation (music or virtual reality). Interventions were provided by nurses, physiotherapists, occupational therapists, research staff, and family members. Multi-component programs combining cognitive and physical elements indicated possible benefits for selected cognitive measures. Effects estimates on delirium and ADL were inconsistent and, in several studies, were based on secondary or exploratory outcomes analyses. Outcomes related to ventilator-free days, health-related quality of life, and survival were also inconsistent, with substantial heterogeneity in outcome definitions, measurement tools, and assessment time points.</p><p><strong>Conclusion: </strong>Multi-component cognitive rehabilitation appeared clinically applicable, but effects on patient-important outcomes were uncertain. High-quality research is needed to assess whether interventions targeting the improvement of cognitive function benefit ICU patients.</p><p><strong>Editorial comment: </strong>This systematic review presents and update of published work on cognitive rehabilitation performed during ICU care and then also with assessments after critical illness in ICU survivors. The findings support the idea that this field need more robust clinical research to assess these different interventions in the ICU and their possible benefit and cost.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 6","pages":"e70240"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13109030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147758280","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":"Severity of Illness and Mortality According to Time of Admission to Intensive Care.","authors":"Ville Ihalainen, Anssi Pölkki, Stepani Bendel, Johanna Hästbacka, Sirkku Heino, Matti Reinikainen","doi":"10.1111/aas.70229","DOIUrl":"10.1111/aas.70229","url":null,"abstract":"<p><strong>Introduction: </strong>Staffing at hospital wards is at its lowest during nighttime, which may endanger prompt recognition of the need for intensive care. High severity of illness of patients admitted to the intensive care unit (ICU) in the morning may reflect delayed referral for intensive care during the night. We investigated whether severity of illness at ICU admission is dependent on admission time.</p><p><strong>Methods: </strong>We analysed data from 25 Finnish ICUs between 2005 and 2022, utilising the national ICU registry. We excluded readmissions, children, non-emergency admissions, cardiac surgery patients and patients admitted for the purpose of organ donation. We explored the severity of illness, as quantified with the Simplified Acute Physiology Score (SAPS) II score, and in-hospital mortality according to admission hours. We also conducted linear and logistic regression analyses adjusting for age, sex, admission type, source of admission, diagnosis category and severity of illness.</p><p><strong>Results: </strong>The study population comprised 131,175 ICU patients. The mean (± SD) SAPS II score at admission was 37.9 ± 17.4, and overall in-hospital mortality was 14.7%. The mean SAPS II score was 39.0 ± 17.9 for morning admissions (6-12 a.m.) and 37.6 ± 17.2 during other times (p < 0.001). The corresponding in-hospital mortalities were 17.5% and 13.9%, respectively (p < 0.001). After adjusting for differences in patient characteristics, morning admissions remained independently associated with higher SAPS II score (mean difference 0.87 points, 95% CI, 0.65-1.09) and in-hospital mortality (OR 1.17, 95% CI, 1.13-1.21).</p><p><strong>Conclusions: </strong>Patients admitted to intensive care during morning hours experienced higher severity of illness and higher in-hospital mortality.</p><p><strong>Editorial comment: </strong>This analysis, from the national ICU database in Finland, shows that cases with morning admission to the ICU appear to have more severe illness compared to those admitted at other times of day. The authors consider if there might be some nighttime delay for recognition of ICU need which could contribute to this observation.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 5","pages":"e70229"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13021569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147519901","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}