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{"title":"The 3-Minute Diagnostic Confusion Assessment Method severity score correlates with the Delirium Rating Scale–Revised–98 and with biomarkers of delirium","authors":"Cameron Rivera ,&nbsp;David Kunkel ,&nbsp;Maihlee Her ,&nbsp;Simran Qureshi ,&nbsp;Robert A. Pearce ,&nbsp;Robert D. Sanders ,&nbsp;Richard Lennertz","doi":"10.1016/j.bjao.2025.100398","DOIUrl":"10.1016/j.bjao.2025.100398","url":null,"abstract":"<div><h3>Background</h3><div>Several methods are used to measure delirium severity in the postoperative period. Here, we compare severity scores from two common assessment methods: the 3-Minute Diagnostic Confusion Assessment Method (3D-CAM) and the Delirium Rating Scale–Revised–98 (DRS).</div></div><div><h3>Methods</h3><div>Data were collected as part of an ongoing observational cohort study of perioperative delirium in patients &gt;65 yr old undergoing major elective surgery with an anticipated hospital stay of at least 2 days. Patients were excluded if they had a documented history of dementia, resided in a nursing home, underwent neurosurgery, or could not complete neurocognitive testing. Patients underwent paired 3D-CAM and DRS assessments before and after operation along with EEG, cognitive testing, and plasma biomarker analysis.</div></div><div><h3>Results</h3><div>Of 226 subjects enrolled, 204 completed both the 3D-CAM and DRS assessments. Peak 3D-CAM severity (3D-CAM-S) scores correlated with peak DRS severity scores, for both the raw (ρ=0.74, <em>P</em>&lt;0.001) and short form method (ρ=0.66, <em>P</em>&lt;0.001). Peak 3D-CAM-S raw scores also correlated with delirium duration and severity duration area under the curve measures (ρ=0.71, <em>P</em>&lt;0.001 and ρ=0.91, <em>P</em>&lt;0.001, respectively). Similar to prior reports with the DRS, 3D-CAM-S raw scores correlated with worse performance on the Trail Making Test B (ρ=0.37, <em>P</em>&lt;0.001, <em>n</em>=177), slow-wave electroencephalogram power (ρ=0.3, <em>P</em>=0.001, <em>n</em>=73), and plasma neurofilament light (ρ=0.26, <em>P</em>&lt;0.05, <em>n</em>=61) and tau (ρ=0.41, <em>P</em>&lt;0.001, <em>n</em>=63).</div></div><div><h3>Conclusions</h3><div>The 3D-CAM-S severity scores correlated with DRS, delirium duration, and biomarkers of delirium. The 3D-CAM, which is easier to implement than the DRS in postoperative patients, may provide a comparable assessment of delirium severity in this population.</div></div><div><h3>Clinical trial registration</h3><div>NCT03124303.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"14 ","pages":"Article 100398"},"PeriodicalIF":0.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143851760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in paediatric anaesthesia research publications and the impact of author sex, country of origin, topic, and external funding","authors":"Andy Jeon ,&nbsp;Aine Sommerfield ,&nbsp;Britta S. von Ungern-Sternberg","doi":"10.1016/j.bjao.2025.100397","DOIUrl":"10.1016/j.bjao.2025.100397","url":null,"abstract":"<div><h3>Background</h3><div>The current research landscape has become increasingly competitive with approximately 35% of submitted manuscripts accepted for publication by peer-review journals. It is known that studies with certain ‘favourable characteristics’ have an increased likelihood of acceptance for publication, such as prospective study design, multiple sites, and notable authors.</div><div>We aimed to identify the characteristics of original research publications in paediatric anaesthesiology and the impact of these characteristics on citations. The characteristics selected were study design, topic choice, region of origin, sex of authors (as defined by first name), and presence of external funding.</div></div><div><h3>Methods</h3><div>This bibliometric study reviewed all paediatric anaesthesiology original research articles published between 2012 and 2021 from five high-impact general anaesthesiology journals and from the subspecialty's top-ranking specialist journal, <em>Pediatric Anaesthesia</em>. Original research articles (<em>n</em>=1119) were independently assessed by two investigators for the following characteristics: primary research topic, study design, region of origin, number of sites involved, external funding status, sex of first and last author, and number of citations.</div></div><div><h3>Results</h3><div>The principal findings in our study showed that highly cited articles in paediatric anaesthesiology were more likely to display publication characteristics such as prospective study design (66% <em>vs</em> 61%), multi-site (23%% <em>vs</em> 14%), and being externally funded (53% <em>vs</em> 46%).</div></div><div><h3>Conclusions</h3><div>Our report highlights the need to consider consumer priorities for research, to encourage collaboration across institutions, and to generally improve access to funding for paediatric anaesthesiology research. In addition, the findings underline the already recognised need to reach better sex equality in academic paediatric anaesthesiology publications.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"14 ","pages":"Article 100397"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143830121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploratory randomised trial of tranexamic acid to decrease postoperative delirium in adults undergoing lumbar fusion—a trial stopped early","authors":"Bradley J. Hindman ,&nbsp;Catherine R. Olinger ,&nbsp;Royce W. Woodroffe ,&nbsp;Mario Zanaty ,&nbsp;Carolina Deifelt Streese ,&nbsp;Zeb R. Zacharias ,&nbsp;Jon C.D. Houtman ,&nbsp;Linder H. Wendt ,&nbsp;Patrick P. Ten Eyck ,&nbsp;Debra J. O'Connell-Moore ,&nbsp;Emanuel J. Ray ,&nbsp;Sarah J. Lee ,&nbsp;Daniel F. Waldschmidt ,&nbsp;Lauren G. Havertape ,&nbsp;Lanchi B. Nguyen ,&nbsp;Pei-fu Chen ,&nbsp;Matthew I. Banks ,&nbsp;Robert D. Sanders ,&nbsp;Matthew A. Howard III","doi":"10.1016/j.bjao.2025.100403","DOIUrl":"10.1016/j.bjao.2025.100403","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative delirium may be mediated by systemic inflammation and neuroinflammation. By inhibiting the proinflammatory actions of plasmin, tranexamic acid (TXA) may decrease postoperative delirium. To explore this hypothesis, we modified an ongoing randomised trial of TXA on blood loss, adding measures of delirium, cognition, systemic inflammation, and astrocyte activation.</div></div><div><h3>Methods</h3><div>Adults undergoing elective posterior lumbar fusion randomly received intraoperative i.v. TXA (<em>n</em>=43: 10 mg kg⁻¹ loading dose, 2 mg kg⁻¹ h⁻¹ infusion) or placebo (<em>n</em>=40). Blood was collected before surgery and 24 h after surgery (<em>n</em>=32) for biomarkers (cytokines and S100B). Participants had twice daily delirium assessments (<em>n</em>=65). Participants underwent four measures of cognitive function before surgery and during post-discharge follow-up.</div></div><div><h3>Results</h3><div>Postoperative blood loss was ∼38% less in the TXA group compared with the placebo group with medians of 128 and 207 ml level⁻¹, respectively, <em>P</em>=0.013. Total blood loss in the TXA and placebo groups did not differ with medians of 305 and 333 ml level⁻¹, respectively, <em>P</em>=0.472. Delirium incidence in the TXA group (7/32=22%) was not significantly less than in the placebo group (11/33=33%); <em>P</em>=0.408, effect size =–0.258 (95% confidence interval –0.744 to 0.229).</div></div><div><h3>Conclusions</h3><div>A potential 33% relative decrease in postoperative delirium incidence justifies an adequately powered clinical trial to determine if intraoperative TXA decreases delirium in adults undergoing lumbar fusion.</div></div><div><h3>Clinical trial registration</h3><div>NCT04272606.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"14 ","pages":"Article 100403"},"PeriodicalIF":0.0,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143825970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A bundle to prevent postinduction hypotension in high-risk noncardiac surgery patients: the ZERO-HYPOTENSION single-arm interventional proof-of-concept study","authors":"Kristen K. Thomsen ,&nbsp;Alina Kröker ,&nbsp;Linda Krause ,&nbsp;Karim Kouz ,&nbsp;Christian Zöllner ,&nbsp;Daniel I. Sessler ,&nbsp;Bernd Saugel ,&nbsp;Moritz Flick","doi":"10.1016/j.bjao.2025.100392","DOIUrl":"10.1016/j.bjao.2025.100392","url":null,"abstract":"<div><h3>Background</h3><div>Postinduction hypotension is common and associated with organ injury but might be largely preventable by careful anaesthetic management. We thus aimed to quantify the severity and duration of postinduction hypotension in high-risk noncardiac surgery patients treated with a hypotension prevention bundle.</div></div><div><h3>Methods</h3><div>In this prospective single-arm interventional proof-of-concept study, 107 high-risk noncardiac surgery patients were treated with a hypotension prevention bundle. The bundle included continuous intra-arterial blood pressure monitoring, a hypotension alarm set at a mean arterial pressure (MAP) of 75 mm Hg, careful administration of anaesthetic drugs, and continuous administration of norepinephrine when MAP decreased below 75 mm Hg. The primary endpoint, AUC65, was derived from a plot of MAP over time for the first 15 min after induction of general anaesthesia as the area of the plot under a MAP of 65 mm Hg .</div></div><div><h3>Results</h3><div>Of 107 patients, 55 (51%) had at least one MAP reading &lt;65 mm Hg, but only 16/107 patients (15%) had a MAP &lt;65 mm Hg for at least one continuous minute. Patients had a MAP &lt;65 mm Hg for a median (25% percentile, 75% percentile; minimum–maximum) of 0.2 min (0.0, 0.8; 0.0–5.2 min). The median AUC65 was 0.1 mm Hg . min (0.0, 4.1; 0.0–40.6 mm Hg min).</div></div><div><h3>Conclusions</h3><div>We observed minimal postinduction hypotension in high-risk noncardiac surgery patients treated with a hypotension prevention bundle. However, randomised trials are needed to confirm that using the hypotension prevention bundle helps reduce postinduction hypotension.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"14 ","pages":"Article 100392"},"PeriodicalIF":0.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143817607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PErioperative respiratory care aNd outcomes for patients underGoing hIgh risk abdomiNal surgery (PENGUIN): a randomised international internal pilot trial","authors":"PENGUIN Trial Management Group","doi":"10.1016/j.bjao.2025.100396","DOIUrl":"10.1016/j.bjao.2025.100396","url":null,"abstract":"<div><h3>Background</h3><div>Infections are a common complication of abdominal surgery in low- and middle-income countries (LMICs). The role of a high fraction of inspired oxygen (FiO₂) and chlorhexidine mouthwash in preventing post-operative infections is unconfirmed.</div></div><div><h3>Methods</h3><div>Internal pilot phase of an international outcome assessor-blinded, 2x2 factorial randomised trial of patients aged ≥10-years undergoing midline laparotomy in LMIC hospitals. The main trial objectives are to compare the clinical effectiveness of preoperative 0.2% chlorhexidine mouthwash in preventing pneumonia versus no mouthwash, and 80–100% perioperative FiO₂ to prevent surgical site infection (SSI) versus 21–35% FiO₂. This 12-month internal pilot assessed feasibility of hospital site opening, patient recruitment, intervention adherence, patient follow-up and safety. Patients were randomised in a 1:1:1:1 ratio to the four intervention group combinations and followed up for 30 days.</div></div><div><h3>Results</h3><div>We recruited 927 patients from seven hospitals in India and South Africa over 12 months from November 2020. There were 907 adults (97.8%) and 20 children aged ten or over (2.2%): 89/927 (9.6%) patients died. Site opening reached 70% of our target (7/10) hospitals, and patient recruitment 107% (927/870). 917/927 (99%) patients in the mouthwash arm, and 840/927 (91%) patients in the oxygen arm received the allocated intervention. Lower adherence to the oxygen intervention related mainly to clinically necessary FiO₂ increases in the 21–35% FiO₂ arm. 30-day follow-up was completed appropriately for 924/927 (99%) patients. and was performed by a masked assessor for all patients. There were no reported safety events.</div></div><div><h3>Conclusion</h3><div>This pilot showed the feasibility and safety of a major phase III trial in post-operative infection prevention in LMICs.</div></div><div><h3>Trial registration</h3><div>ClinicalTrials.gov NCT04256798.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"14 ","pages":"Article 100396"},"PeriodicalIF":0.0,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143808144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the accuracy of Seismofit® as an estimate of preoperative maximal oxygen consumption in patients with hepato-pancreato-biliary, colorectal, and gastro-oesophageal cancer","authors":"Nicholas Tetlow ,&nbsp;Philip Devendra ,&nbsp;James Waiting ,&nbsp;Maria Aresu ,&nbsp;Abena Glover ,&nbsp;Martin Rooms ,&nbsp;Shaman Jhanji ,&nbsp;Don Milliken","doi":"10.1016/j.bjao.2025.100395","DOIUrl":"10.1016/j.bjao.2025.100395","url":null,"abstract":"<div><h3>Background</h3><div>Peak oxygen uptake (VO₂ peak) measured during cardiopulmonary exercise testing (CPET) is commonly used to objectively assess fitness and inform risk stratification. Preoperative CPET is not always universally available. Seismofit® offers a noninvasive, non-exercise alternative for estimating VO₂ peak, though it has not been validated in patients awaiting major abdominal cancer surgery.</div></div><div><h3>Methods</h3><div>Prospective single-centre blinded observational study in patients with hepato-pancreato-biliary, colorectal, or gastro-oesophageal cancer undergoing preoperative assessment. Patients underwent Seismofit® assessment before routine CPET. Primary outcome was the relationship between Seismofit<em>®-</em>estimated VO₂ peak and CPET-measured VO₂ peak. Secondary outcomes explored the relationship between Seismofit® and CPET for (i) bias and agreement limits; (ii) surgical subgroup; (iii) commonly reported CPET variables; (iv) patient acceptance.</div></div><div><h3>Results</h3><div>Thirty-three participants (median [interquartile range] age: 67 yr [58–75 yr]; 20 [61%] males) completed both CPET and Seismofit®. No linear association was found between Seismofit<em>®-</em>estimated VO₂ peak and CPET-measured VO₂ peak: Pearson <em>r</em>=0.111 (95% confidence interval −0.242 to 0.437), <em>R</em>²=0.012, <em>P</em>=0.539. Compared with CPET, Seismofit® demonstrated a large bias (standard deviation) 12.8 (8.8); 95% limits of agreement (−4.5 to 30.0). No association existed between Seismofit<em>®-</em>estimated VO₂ peak and CPET-measured VO₂ peak in the hepato-pancreato-biliary or gastro-oesophageal subgroup or between Seismofit®-estimated VO₂ peak and commonly reported CPET variables.</div></div><div><h3>Conclusions</h3><div>There was no evidence of linear association between Seismofit®-estimated VO₂ peak and objectively measured VO₂ peak by CPET in patients undergoing assessment for major abdominal cancer surgery. This finding was consistent across all subgroup and exploratory analyses. Seismofit® tended to overestimate VO₂ peak with a high degree of bias.</div></div><div><h3>Clinical trial registration</h3><div>NCT05831488.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"14 ","pages":"Article 100395"},"PeriodicalIF":0.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional coupling between chronic pain and the autonomic nervous system revealed by neuromodulation techniques. Comment on ‘Effect of neuromodulation for chronic pain on the autonomic nervous system: a systematic review’ (BJA Open 2024; 11: 100305)","authors":"Jean-Pascal Lefaucheur ,&nbsp;Chantal Delon-Martin ,&nbsp;Hasan Hodaj","doi":"10.1016/j.bjao.2025.100393","DOIUrl":"10.1016/j.bjao.2025.100393","url":null,"abstract":"","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"14 ","pages":"Article 100393"},"PeriodicalIF":0.0,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143734601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The readability of online English and Spanish patient education materials on anaesthesia for orthopaedic surgery","authors":"Mariana Restrepo ,&nbsp;Brocha Z. Stern ,&nbsp;Garrett W. Burnett ,&nbsp;Chang Park ,&nbsp;Jashvant Poeran","doi":"10.1016/j.bjao.2025.100388","DOIUrl":"10.1016/j.bjao.2025.100388","url":null,"abstract":"<div><h3>Background</h3><div>With the increasing utilisation of regional anaesthesia for orthopaedic procedures, it is imperative that related online patient education materials (PEMs) be easily retrievable, comprehensive, and readable by the general population, irrespective of the language they are written in. Therefore, we compared the readability levels of online PEMs available in English and Spanish for anaesthesia related to total hip, knee, and shoulder joint replacements.</div></div><div><h3>Methods</h3><div>Six pairs (English and Spanish) of search terms were entered into Google and used to identify relevant online PEMs. Results for English search terms were analysed for readability using the Flesch Reading Ease (FRE), Fry Graph (FG), Simple Measures of Gobbledygook (SMOG) Index, and Gunning Fog Index scores, and for Spanish search terms using the Fernandez-Huerta Reading Ease (FHRE), the Gilliam-Peña-Mountain Grade Level (GPMGL), the Spanish SMOG (SOL), and Indice de Legibilidad de Flesch-Szigriszt (INFLESZ) scores. Scores were compared between languages if the Spanish-language calculator was a validated adaptation of the English one (FRE <em>vs</em> FHRE; FG <em>vs</em> GPMGL; SMOG <em>vs</em> SOL).</div></div><div><h3>Results</h3><div>Overall, 180 and 146 relevant websites were retrieved across all six English language and Spanish-language search terms, respectively. Generally, the FRE and FG scores for the English search results corresponded to college-level material and the SMOG score reflected a 10th grade reading level. In contrast, the FHRE, GPMGL, and SOL scores for Spanish search results corresponded to 10th–12th grade reading levels, and the INFLESZ to ‘Difficult’/‘Normal’ levels.</div></div><div><h3>Conclusions</h3><div>These findings reinforce past literature describing English and Spanish-language orthopaedic anaesthesia PEMs being written at far higher reading levels than the recommended 5th to 8th grade reading level. Interestingly, English PEMs were less readable than their Spanish counterparts, yet, they were more available than related Spanish PEMs overall.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"14 ","pages":"Article 100388"},"PeriodicalIF":0.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143715170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond body mass index: exploring the role of visceral adipose tissue in intensive care unit outcomes","authors":"Maximilian R. Ralston ,&nbsp;Gordan McCreath ,&nbsp;Zoe J. Lees ,&nbsp;Ian P. Salt ,&nbsp;Malcolm A.B. Sim ,&nbsp;Malcolm J. Watson ,&nbsp;Dilys J. Freeman","doi":"10.1016/j.bjao.2025.100391","DOIUrl":"10.1016/j.bjao.2025.100391","url":null,"abstract":"<div><div>Obesity is a worldwide health crisis and poses significant challenges in critical care. Many studies suggest an ‘obesity paradox’, in which obesity, defined by body mass index (BMI), is associated with better outcomes. However, the inability of BMI to discriminate between fat and muscle or between visceral adipose tissue and subcutaneous adipose tissue, limits its prediction of metabolic ill health. We suggest that the ‘obesity paradox’ may be more reflective of the limitations of BMI than the protective effect of obesity.</div><div>We explore the biological processes leading to visceral fat accumulation, and the evidence linking it to outcomes in critical illness. In the ‘spillover’ hypothesis of adipose tissue expansion, caloric excess and impaired expansion of storage capacity in the subcutaneous adipose tissue lead to accumulation of visceral adipose tissue. This is associated with a chronic inflammatory state, which is integral to the link between visceral adiposity, type 2 diabetes mellitus, and ischaemic heart disease.</div><div>We review the current evidence on visceral adiposity and critical illness outcomes. In COVID-19, increased visceral adipose tissue, irrespective of BMI, is associated with more severe disease. This is mirrored in acute pancreatitis, suggesting visceral adiposity is linked to poorer outcomes in some hyperinflammatory conditions. We suggest that visceral adiposity's chronic inflammatory state may potentiate acute inflammation in conditions such as COVID-19 and acute pancreatitis. Further work is required to investigate other critical illnesses, especially sepsis and acute respiratory distress syndrome, in which current evidence is scarce. This may give further insights into pathophysiology and inform tailored treatment and nutrition strategies based on body fat distribution.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"14 ","pages":"Article 100391"},"PeriodicalIF":0.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143706352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strategies to reduce the risk of unrecognised oesophageal intubation: a survey of Difficult Airway Society members","authors":"Moon-Moon Majumdar ,&nbsp;Natalie Silvey ,&nbsp;Abhijoy Chakladar ,&nbsp;Barry McGuire ,&nbsp;Ellen O’Sullivan ,&nbsp;Alistair F. McNarry","doi":"10.1016/j.bjao.2025.100390","DOIUrl":"10.1016/j.bjao.2025.100390","url":null,"abstract":"<div><h3>Background</h3><div>Despite multiple initiatives and consensus guidelines, preventable deaths from unrecognised oesophageal intubation continue worldwide. We aimed to establish what different organisations are doing to reduce the risk of unrecognised oesophageal intubation.</div></div><div><h3>Methods</h3><div>This was a cross-sectional survey of Difficult Airway Society (DAS) members using an internet-based survey platform. Members were invited to participate via e-mail over a period of 10 weeks (28 March to 07 June 2023). Results were reported according to the CROSS checklist.</div></div><div><h3>Results</h3><div>The response rate was 39% (819/2125). About 50% (402/799) of respondents were providing training to reduce the risk of unrecognised oesophageal intubation and 9% (69/799) were planning to. Most of the training (69%; 310/449) is multidisciplinary. However, almost one-third of respondents (31%; 246/799) were from departments that were not planning any training. Non-training-related strategies (including but not limited to increased use of videolaryngoscopy, increased use or improving the interpretability of waveform capnography) were implemented in 39% (297/765) of respondents' departments and planned in 8% (60/765). Nearly one-third (31%; 237/765) were not planning any non-training interventions to reduce risk. Of those who responded, 17% (130/765) were from departments not planning <em>any</em> strategies to reduce the risk of unrecognised oesophageal intubation. <em>Two-person verbal confirmation of capnography</em> was considered ‘extremely’ or ‘very’ helpful by 59% (411/702) of respondents.</div></div><div><h3>Conclusions</h3><div>Our study suggests that uptake of preventative strategies to reduce the risk of unrecognised oesophageal intubation remains inadequate. The authors suggest it is now time for the Royal College of Anaesthetists, DAS, and the General Medical Council to mandate strategies to reduce the risk of unrecognised oesophageal intubation.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"14 ","pages":"Article 100390"},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143685750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}