Acta Anaesthesiologica Scandinavica最新文献

{"title":"Parturients' Perspectives on Labor Pain and Epidural Analgesia: An Explorative Qualitative Study.","authors":"L Højstrup, S Bohart, L Thellesen, K Wildgaard","doi":"10.1111/aas.70195","DOIUrl":"10.1111/aas.70195","url":null,"abstract":"<p><strong>Background: </strong>Labor pain is among the most intense forms of pain, yet its subjective and multidimensional nature makes it challenging to assess and manage. Labor epidural analgesia is the most effective method of relief, but clinical practice often emphasizes physical outcomes while overlooking cognitive and emotional dimensions. This study aimed to explore parturients' perceptions of labor pain and relief with labor epidural analgesia, and to inform more comprehensive, patient-centered approaches to pain management.</p><p><strong>Methods: </strong>Semi-structured interviews were conducted with 14 postpartum women within 24 h of delivery at a Danish university hospital. Data were analyzed using inductive thematic analysis and reported in accordance with the Standards for Reporting Qualitative Research. Written informed consent was obtained from all participants. A study protocol was published before data collection.</p><p><strong>Results: </strong>Four themes were identified: (1) An extreme pain experience, (2) From nightmare to a good experience, (3) The dilemma of choice: social norms and practical realities, and (4) Great trust in staff. Labor pain was described as overwhelming and often beyond expectations. Although many hoped for an unmedicated birth, epidural analgesia provided crucial psychological relief, described as a \"mental break,\" which helped restore energy and mental presence. Despite overall satisfaction, most women did not recall discussing what effective pain relief meant to them, suggesting strong trust in staff but also missed opportunities for individualized care.</p><p><strong>Conclusions: </strong>Psychological relief is a key component of effective labor pain management. Antenatal counseling and intrapartum care could consider addressing not only the physical but also the psychological effects of labor epidural analgesia, while fostering open dialog about women's individual goals. Our findings point to the need for multidimensional, clinically relevant assessment tools that move beyond pain intensity to also capture mental capacity, functionality, and emotional well-being. Existing tools may be modified, or new ones developed, to incorporate items on cognitive abilities (e.g., concentration, communication), and physical functioning (e.g., ability to eat or drink).</p><p><strong>Editorial comment: </strong>This study examined women's experiences of labor pain and pain relief with epidural analgesia at a Danish university hospital. Interviews with 14 women revealed four main themes: extreme pain, a shift from negative to positive birth experiences, the influence of social norms on decision-making, and strong trust in healthcare staff. Epidural analgesia offered both physical and psychological relief, described as a \"mental break\" that restored energy and presence. While satisfaction was high, individualized discussions about pain relief were often lacking. The study emphasizes that effective pain management","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 3","pages":"e70195"},"PeriodicalIF":1.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147809560","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":"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":1.9,"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}

{"title":"Glucose Management in the ICU: The Bi-Centre GEM-ICU Cohort Study.","authors":"Milda Grigonyte-Daraskeviciene, Ruben Julius Eck, Morten Hylander Møller, Benjamin Skov Kaas-Hansen, Morten Heiberg Bestle, Christian Lange Gantzel, Anders Granholm, Anders Perner","doi":"10.1111/aas.70207","DOIUrl":"10.1111/aas.70207","url":null,"abstract":"<p><strong>Introduction: </strong>Dysglycaemia is common in intensive care unit (ICU) patients and has been associated with worse outcomes. Data on glucose management and insulin use from contemporary intensive care units (ICUs) are limited.</p><p><strong>Methods: </strong>We conducted a bi-centre, retrospective cohort study of acutely admitted, adult patients at two Danish ICUs. Patients were included consecutively by backtracking admissions from December 1, 2023, until the target sample size (n = 300) was reached. Data were collected from electronic health records following a predefined protocol. The primary outcome was the occurrence of hypoglycaemia (< 4 mmol/L) during ICU stay. Secondary outcomes included severe hypoglycaemia (< 2.3 mmol/L), hyperglycaemia (> 10 mmol/L), time below blood glucose target range (< 6 mmol/L), time above target range (> 10 mmol/L), mortality at 30 days, days alive without life support at 30 days (DAWOLS) and days alive out of hospital at 30 days (DAOH). Process variables were also assessed.</p><p><strong>Results: </strong>We screened 311 ICU patients and included 300, of whom 285 had at least one blood glucose measurement. Hypoglycaemia was observed in 21 patients (7.4%; 95% CI 4.6-11.0) and severe hypoglycaemia in 3 patients (1.1%; 95% CI 0.2-3.0). Hyperglycaemia was observed in 186 patients (65.3%; 95% CI 59.4-70.8). Mortality at 30 days was 24.3% (95% CI 19.6-29.6). Median DAWOLS at 30 days was 27 days (95% CI 26-28; IQR 8-30) and median DAOH at 30 days was 9 days (95% CI 3-14; IQR 0-21).</p><p><strong>Conclusion: </strong>In this Danish bi-centre cohort of acutely admitted ICU patients, hypoglycaemia was uncommon and severe hypoglycaemia was rare, whereas hyperglycaemia occurred in almost every second patient. Insulin was frequently administered, mostly intravenously, and glucose was monitored often. Patients receiving insulin spent nearly half of the observed time above the target range.</p><p><strong>Editorial comment: </strong>In this retrospective analysis from 2 Danish centres, glucose management and insulin use in the ICU is presented. Rare hypoglycemia and more common hyperglycemia measurement events were counted, along with insulin administration, which was common.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 3","pages":"e70207"},"PeriodicalIF":1.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12921425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146225089","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":"Recommendations for Stress Ulcer Prophylaxis in Critically Ill Adults: A Contextualized Clinical Practice Guideline From the Saudi Critical Care Society and the Scandinavian Society of Anaesthesiology and Intensive Care Medicine, Endorsed by the Kuwait Anesthesia and Critical Care Society.","authors":"Marwa Amer, Waleed Alhazzani, Fayez Alshamsi, Anders Granholm, Yaseen M Arabi, Klaus T Olkkola, Marius Rehn, Abdulrahman Al-Fares, Rakan M Alqahtani, Ahmed Aljedai, Haifa F Alotaibi, Amr Arafat, Shadan AlMuhaidib, Ali Al Bshabshe, Ville Jalkanen, Martin Ingi Sigurðsson, Michelle S Chew, Maija-Liisa Kalliomäki, Hasan M Al-Dorzi, Fawziah Alkhaldi, Haifa Algethamy, Majid A Almadi, Namareq Aldardeer, Abdullah M Alhammad, Awad Al-Omari, Faisal A Al-Suwaidan, Mohammed Alshahrani, Morten Hylander Møller","doi":"10.1111/aas.70201","DOIUrl":"10.1111/aas.70201","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Critically ill adults are at risk for stress-related upper gastrointestinal bleeding (UGIB). Regional variations in gastrointestinal bleeding incidence, infection epidemiology, formulary access, and the relative value placed on bleeding versus infection outcomes by patients and clinicians necessitate contextualized recommendations. This guideline provides regionally adapted, evidence-based recommendations for the use of stress ulcer prophylaxis (SUP) in Saudi Arabia, Kuwait, and the Nordic countries using the GRADE-ADOLOPMENT methodology.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A multidisciplinary panel from both regions prioritized PICO questions and ranked outcomes by patient importance. The 2024 Society of Critical Care Medicine (SCCM) and American Society of Health-System Pharmacists (ASHP) guideline served as the source guideline and was evaluated for credibility; contextual fit in Saudi Arabia, Kuwait, and the Nordic countries; and alignment with the GRADE methodology. Evidence profiles and Evidence-to-Decision frameworks were adapted or developed, incorporating updated data, local epidemiology, drug access, and health system variables such as equity, cost, and feasibility.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The panel adopted the following five recommendations. In critically ill adults with coagulopathy, shock, or chronic liver disease, the panel suggests using SUP over no SUP (conditional recommendation; moderate certainty). In enterally fed patients at high risk of UGIB, the panel suggests using SUP over no SUP (conditional recommendation; very low certainty); in those at low risk, the panel suggests not using SUP (conditional recommendation; very low certainty). For patients receiving SUP, the panel suggests using a proton pump inhibitor (PPI) or a histamine-2 receptor antagonist (H2RA) rather than sucralfate (conditional recommendation; low to moderate certainty) and suggests enteral or intravenous administration based on clinical feasibility (conditional recommendation; very low to low certainty). In critically ill adults receiving SUP, low-dose PPI or H2RA therapy should be used rather than high-dose regimens (best practice statement; not GRADEd). Regarding SUP discontinuation, the panel suggests discontinuing SUP in critically ill adults with resolved risk factors for UGIB (conditional recommendations; very low certainty) and in critically ill adults without UGIB risk factors but receiving SUP prior to intensive care unit (ICU) admission in the absence of an active indication (conditional recommendations; very low certainty). Differences in drug availability, ICU discharge practices, and health equity considerations shaped the panel's judgments and highlighted key implementation challenges.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This guideline offers five context-specific, evidence-informed recommendations for SUP in critically ill adults in Saudi Arabia, Kuwait, and the Nordic countries. While grounded in the health","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 3","pages":"e70201"},"PeriodicalIF":1.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12883282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146140677","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":"The Impact of Early Postoperative Oral Intake on the Length of Hospital Stay: A Meta-Analysis.","authors":"Anne Marie Camilleri Podesta, Marie Adrienne Zerafa Simler, Alexander Nagrebetsky, Ib Jammer, Marta Dias Vaz, Anne Rüggeberg, Ehrenfried Schindler, Barbara Hammer, Federico Bilotta, Jamie Elmawieh","doi":"10.1111/aas.70180","DOIUrl":"10.1111/aas.70180","url":null,"abstract":"<p><strong>Background: </strong>International guidelines regarding the resumption of postoperative intake of liquids are limited. Surgical patients are subjected to unnecessarily prolonged fasting times after surgery, which can lead to increased postoperative complications. Research has shown that a shorter fasting duration can enhance recovery, improve rehabilitation, and reduce the psychological stress associated with major surgeries in these patients. Given these potential benefits, we performed this meta-analysis that aims to explore how the duration of postoperative liquid fasting affects the length of hospital stay.</p><p><strong>Methods: </strong>We systematically searched the literature for papers published in English between 1 January 2010 and 6 January 2023. Meta-analyses were performed using R (version 4.0.2). When means and standard deviations were lacking, these were derived from medians and interquartile ranges if available. For the length of hospital stay (a continuous variable), the standardised mean difference (SMD) and 95% confidence intervals were calculated to summarise the data. We used a random-effects model when high heterogeneity was observed (I² > 50%). To account for potential causes of heterogeneity, we performed subgroup analyses according to the type of papers (dividing papers into randomised controlled trials and observational studies; and papers with or without mean derivation from medians). Risk of publication bias was checked by drawing funnel plots.</p><p><strong>Results: </strong>A total of nine studies were included. The definition of 'early feeding' varied according to the type of procedures included across studies. Shorter postoperative fasting with earlier postoperative intake of liquids was associated with a decrease in the length of hospital stay with a mean difference of 0.9 day (p < 0.05). Results remained similar after sensitivity analysis.</p><p><strong>Conclusions: </strong>Shorter postoperative fasting with earlier postoperative intake of liquids is associated with a decreased length of hospital stay. Future research is needed to explore the relation between postoperative fasting times and length of hospital stay according to the types of surgeries.</p><p><strong>Editorial comment: </strong>This systematic review confirms that successful early postoperative intake of liquids is associated with post-operative benefit defined as shorter hospital stay. This was shown in the selected non-interventional studies as well as the trial results, where all the individual study findings for the chosen outcome were in the same direction.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 3","pages":"e70180"},"PeriodicalIF":1.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146123137","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":"Anesthesia Practices for Preterm Infants: A Survey in the Nordic Countries and Review of the Literature.","authors":"Jaap van der Heijden, Peter Frykholm","doi":"10.1111/aas.70186","DOIUrl":"10.1111/aas.70186","url":null,"abstract":"<p><strong>Background: </strong>Preterm infants are at increased risk of perioperative mortality and are among the most vulnerable patients anesthesiologists can encounter. The literature on anesthesia practice in preterm infants is limited, mainly focusing on their physiological immaturity and related pharmacodynamics and pharmacokinetics.</p><p><strong>Aims: </strong>Our aim was to gather comprehensive data on the current practice of anesthesia management in preterm infants and, when available, to compare these findings with existing literature or guidelines.</p><p><strong>Methods: </strong>A cross-sectional study was conducted using a structured survey distributed to pediatric anesthesiologists across the Nordic countries between June and November 2024. The survey assessed various aspects of anesthesia practice in preterm patients, including agent dosing for induction and maintenance, perioperative monitoring techniques, and respiratory and circulatory management strategies.</p><p><strong>Results: </strong>A total of 57 surveys were collected from 14 hospitals, with an estimated response rate of 30.4%. For induction, 15 different combinations were reported, with the most common being fentanyl and sodium thiopental (31.6%). For maintenance, 13 combinations were identified, primarily fentanyl and sevoflurane (47.4%). Anesthetic doses exhibited considerable variability, with up to a 20-fold difference between the lowest and highest doses. Rocuronium and atracurium were used almost equally as neuromuscular blocking agents, although significant variation in dosing intervals was noted. Targeted mean SpO₂ levels ranged from 90% to 96%, and EtCO₂ levels from 4.5 to 6.5 kPa, with some outliers. Approximately 86% of respondents used gestational age in weeks as the minimum acceptable mean arterial pressure, with noradrenaline being the first-choice vasopressor (59.6%). Notable differences were observed in transfusion thresholds, fluid resuscitation strategies, and monitoring practices among respondents.</p><p><strong>Conclusion: </strong>The substantial heterogeneity in anesthesia practice highlighted the need for high-quality research leading to evidence-based protocols and broader consensus to improve safety and quality of care for this vulnerable population. This survey reports on the breadth of practice details for anesthesia management when preterm infants require surgery, from centers in the 5 Nordic countries.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 3","pages":"e70186"},"PeriodicalIF":1.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12895386/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146163410","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":"Pain Management in Aneurysmatic Subarachnoid Haemorrhage: A Survey of Nordic Physicians.","authors":"Hanna Sariola, Maija-Liisa Kalliomäki, Heikki Kiiski, Essi Raatikainen, Juhana Frösen, Matti Reinikainen, Hanna Savioja, Kirsten Møller, Terhi Lohela, Riikka Takala, Martin Sigurdsson, Luis Romundstad, Stig Dyrskog, Karsten Bülow, Johanna Hästbacka","doi":"10.1111/aas.70194","DOIUrl":"10.1111/aas.70194","url":null,"abstract":"<p><strong>Background: </strong>Headache caused by aneurysmatic subarachnoid hemorrhage (aSAH) is often severe and may persist long after the ictus. Pharmacological pain management can be challenging due to poor efficacy or adverse effects. Multimodal pharmacotherapy is often required. Lack of guidelines and good quality clinical studies on pain management has led to variation in pain management practices. Knowledge of current practice and goals of pain management in Nordic countries is lacking. We aimed to fill these knowledge gaps by conducting a survey targeting Nordic clinicians involved in aSAH treatment.</p><p><strong>Methods: </strong>An electronic survey in English was sent to national coordinators in December 2023. The coordinators distributed the survey to intensivists, neurosurgeons, and other specialists treating aSAH patients in their respective countries. The survey contained 63 questions gathering background information, current aSAH pain management during the hospital stay and at hospital discharge, follow-up, and preferred outcome measures regarding a clinical trial on pain management in aSAH. The results were analysed and presented descriptively.</p><p><strong>Results: </strong>We received 70 responses: 36 from Finland, 11 from Norway, 11 from Denmark, 5 from Sweden and 7 from Iceland. Respondents were intensivists (N = 46), neurosurgeons (N = 20), neurologists (N = 2), and others (N = 2). The most frequently used pain medications at ICUs were paracetamol, opioids, and non-steroidal anti-inflammatory drugs (NSAID). Most neurosurgeons (70%, N = 14) responded that they never prescribe opioids at hospital discharge for aSAH patients. The most preferred outcome for a clinical trial was patients' self-reported quality of life.</p><p><strong>Conclusions: </strong>In the Nordic countries, paracetamol, opioids, and NSAIDs were reported as the most frequently used analgesics in the management of aSAH related pain in the ICU. Use of gabapentinoids was commonly reported by Danish respondents, unlike respondents from other Nordic countries. Neurosurgeons reported that they rarely prescribe opioids at hospital discharge.</p><p><strong>Editorial comment: </strong>This survey of Nordic clinicians involved in ICU and neurosurgical management of subarachnoid bleed (aneurysm) cases presents preferences for pain management in hospital and with discharge, as well as assessing clinician preferences for outcomes by which to assess pain management in these cases.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 3","pages":"e70194"},"PeriodicalIF":1.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12833550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146045897","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":"Vasopressor Use in Acute Burn Resuscitation: A Retrospective Study.","authors":"Kristine Knappskog, Kostiantyn Botnar, Julia Kleinhapl, Juquan Song, Amina El Ayadi, Henning Onarheim, Anne Berit Guttormsen, George Golovko, Steven Wolf, Stian Kreken Almeland","doi":"10.1111/aas.70191","DOIUrl":"10.1111/aas.70191","url":null,"abstract":"<p><strong>Background: </strong>Vasopressors are often introduced in severe burn patients who respond poorly to fluid resuscitation to maintain adequate blood pressure and avoid fluid creep. This study aims to characterise these patients and explore potential correlations between vasopressor use and patient outcomes.</p><p><strong>Methods: </strong>Medical records from 2010 to 2023 for patients aged ≥ 18 years with burns ≥ 20% of the total body surface area (TBSA) were extracted from the TriNetX Research Network, a global federated health research platform aggregating de-identified electronic health records. The patients were divided into two groups: those who received vasopressors within the first 2 days of hospitalisation and those who did not. Statistical analysis included Cramér-von Mises and χ² test, with significance set at p < 0.05. Propensity score matching (PSM) in a 1:1 ratio was applied for the variables age, sex, pre-existing comorbidities (hypertension, diabetes, chronic heart disease, chronic lung disease, chronic kidney disease, and alcohol or opioid addiction), presence of inhalation injury, %TBSA burned, and burn injury year. Odds ratios (OR) for outcomes were calculated, with p-values adjusted for multiple testing using the Benjamini-Hochberg correction.</p><p><strong>Results: </strong>Of 6872 included patients, 17.7% received vasopressors within the first two days of hospitalisation. These patients were older, had more comorbidities and sustained more severe burns. After PSM we included 1206 patients in both cohorts (VP+ and VP-). Acute kidney injury occurred within 3 days in 51.0% of the VP+ group and 28.4% in VP- (OR 2.62, 95% CI: 2.20-3.11). VP+ patients also had higher rates of sepsis (30.8% vs. 22.9%, OR 1.50, 95% CI: 1.25-1.81) and higher mortality (45.1% vs. 32.7%, OR 1.69, 95% CI: 1.43-2.01) within 30 days following hospitalisation.</p><p><strong>Conclusion: </strong>While vasopressors are frequently administered as part of burn resuscitation, their use was associated with higher rates of early acute kidney injury and an increased 30-day mortality rate.</p><p><strong>Editorial comment: </strong>Potent vasopressor use to support the circulation is commonly combined with fluid resuscitation in modern intensive care, and this is a prominent aspect of care in major burn cases. In this retrospective analysis of a commercial, de-identified health care dataset (primarily from US hospitals or health systems), matched cases over 14 recent years were analysed by early vasopressor use (or not) and then for important outcomes including mortality. Vasopressor use was associated with some complications and negative outcomes, though there are likely many factors which may contribute to negative outcomes which were not included in this analysis.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 3","pages":"e70191"},"PeriodicalIF":1.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12848638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146058454","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":"Evaluating Shivering and Hypothermia After Removing Forced-Air Heating From Short-Duration Surgery.","authors":"Anders Peder Højer Karlsen, Thomas Bjerring Enevoldsen, Mette Windeleff Svejstrup, Sine Alette Nogel Eriksen, Markus Harboe Olsen, Theis Skovsgaard Itenov, Christian Sylvest Meyhoff, Troels Haxholdt Lunn","doi":"10.1111/aas.70204","DOIUrl":"10.1111/aas.70204","url":null,"abstract":"<p><strong>Background: </strong>Single-use forced-air heating blankets can prevent intraoperative hypothermia, but their use carries environmental and economic costs. Whether omitting heating blankets for short-duration surgical procedures affects patient outcomes remains unclear.</p><p><strong>Objectives: </strong>To evaluate changes in shivering and hypothermia of removing forced-air heating from short-duration surgical procedures.</p><p><strong>Design: </strong>Pragmatic, prospective before-and-after cohort study.</p><p><strong>Setting: </strong>Surgical ward in a secondary university hospital in 2023.</p><p><strong>Patients: </strong>Adults undergoing orthopaedic or abdominal procedures below 90 min.</p><p><strong>Intervention: </strong>Comparing active forced-air heating to no heating after a guideline change.</p><p><strong>Main outcome measures: </strong>Co-primary outcomes were intraoperative hypothermia (< 35.5°C) and shivering (symptom or need for rescue medication) in the post-anaesthetic care unit. Data were extracted from electronic health records.</p><p><strong>Results: </strong>We included 1059 and 1106 surgeries in the heating and no-heating group, respectively. Baseline characteristics were similar with mean 48 min surgery duration. Intraoperative hypothermia occurred more frequently in the no-heating group with 5.58% versus 2.73% in the heating group (relative risk, 97.5% confidence interval): 2.04, 1.11-3.95, p = 0.011. Shivering occurred more frequently in the no-heating group with 6.1% versus 4.0% in the heating group (relative risk, 97.5% confidence interval): 1.55, 1.02-2.41, p = 0.021. Preventing one shivering event cost $235 and 62.9 kg CO₂ equivalents. There were no differences in anaesthesia emergence time or need for/length of post-anaesthetic care unit stay.</p><p><strong>Conclusion: </strong>Omitting forced-air heating significantly increased hypothermia occurrence by 2.85% and shivering by 2.18%, while reducing costs and carbon emissions. This relationship between beneficial patient-related effects and negative climate/economic costs is controversial. The patients' perspective in terms of thermal comfort outcomes should be investigated.</p><p><strong>Trial registration: </strong>Protocol on Zenodo prior to data analysis.</p><p><strong>Editorial comment: </strong>This retrospective analysis compared cases with shorter surgery times where either active warming or not (simple routine insulating) were compared for risk of intraoperative temperature assessed less than 35.5 or shivering, as well as post anaesthesia unit time. Costs were estimated (for active warming materiel) to prevent a single shivering event.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 3","pages":"e70204"},"PeriodicalIF":1.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12910135/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146206382","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":"Treatment-Limiting Decisions in Neurointensive Care: Withholding or Withdrawal of Life-Sustaining Measures.","authors":"Isabella Carvalho Ankerstjerne, Anne-Sophie Worm Fenger, Markus Harboe Olsen, Ove Bergdal, Daniel Kondziella, Helene Ravnholt Jensen, Gorm Greisen, Tiit Illimar Mathiesen, Kirsten Møller","doi":"10.1111/aas.70202","DOIUrl":"10.1111/aas.70202","url":null,"abstract":"<p><strong>Background: </strong>Treatment-limiting decisions (TLDs) in neurointensive care are frequently reported with no distinction between withholding and withdrawal of treatment. We investigated the proportion of patients subjected to withholding and withdrawal of life-sustaining treatment during neurointensive care, and the association with mortality.</p><p><strong>Methods: </strong>This retrospective observational cohort study included all adult (≥ 18 years) neurocritically ill patients admitted to the neurointensive care unit (neuro-ICU), Rigshospitalet, Denmark, for a primary CNS injury during the period from July 2019 to February 2022. Patients were categorised into the following three groups: full treatment, withholding, or withdrawal of life-sustaining treatment. We compared 30-day all-cause mortality of the three groups by a Cox proportional-hazards model and by calculating the mean restricted survival time at 30 days.</p><p><strong>Results: </strong>Of 694 eligible patients, a decision to withhold or withdraw treatment was made for 50 (7.2%) and 124 (17.9%) patients, respectively. Patients subjected to withholding were older and had a higher Charlson Comorbidity Index, whereas those subjected to withdrawal had a lower Glasgow Coma Score (GCS) and a higher Acute Physiology and Chronic Health Evaluation II score. While the primary neurological injury was the main reason for the treatment-limiting decision, and comorbidity contributed in both groups, a history of cardiac arrest was also stated as a reason for withdrawing, and non-neurological injury as a reason for withholding therapy. The 30-day case fatality ratio was 32%, 98% and 8.1% for patients subjected to withholding, withdrawal and full treatment, respectively, corresponding to a mean restricted survival time at 30 days of 24 (95% CI, 21-27), 10.0 (8.2-12) and 29 (28, 29) days.</p><p><strong>Conclusion: </strong>In this study, TLDs were made in one out of four neuro-ICU patients. Furthermore, neurocritically ill patients subjected to withholding treatment had markedly higher survival than those subjected to withdrawal.</p><p><strong>Editorial comment: </strong>In this assessment of treatment-limiting decisions in neuro-intensive care cases, the authors present how withholding escalating ICU treatment can occur in case conditions that differ from those where active ICU treatment is withdrawn.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 3","pages":"e70202"},"PeriodicalIF":1.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12925652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147269407","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}