Journal of Anesthesia, Analgesia and Critical Care (Online)最新文献

{"title":"Incidence, patterns, and factors associated with postoperative pulmonary complications in an ERAS cardiac surgery program: a 500-patient cohort study.","authors":"Valentina Garelli, Christophe Abellan, Alexandra Othenin-Girard, Ziyad Gunga, Tamila Abdurashidova, Caroline Botteau, Estelle Brahier, Nathalie Parietti, Karima Alouazen, Valentina Rancati, Matthias Kirsch, Zied Ltaief","doi":"10.1186/s44158-026-00402-x","DOIUrl":"https://doi.org/10.1186/s44158-026-00402-x","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pulmonary complications (PPCs) remain the most frequent adverse events after cardiac surgery. Enhanced Recovery After Surgery (ERAS) programs aim to reduce postoperative morbidity, and data describing the incidence, patterns, and protective factors associated with PPCs within cardiac ERAS pathways remain limited.</p><p><strong>Methods: </strong>We analyzed 500 consecutive adult patients undergoing cardiac surgery within a standardized ERAS program at a tertiary center. PPCs included respiratory infection, respiratory failure, pleural effusion, atelectasis, pneumothorax, bronchospasm, or aspiration pneumonitis.</p><p><strong>Results: </strong>PPCs occurred in 130 of 500 patients (26%). The most frequent events were atelectasis (28.5%), respiratory failure (23.8%), and pneumonia (20%). Independent preoperative and intraoperative factors included age ≥ 70 years (OR 1.86, 95% CI 1.14-3.03), BMI ≥ 35 kg/m² (OR 2.37, 95% CI 1.18-4.76), active smoking (OR 1.95, 95% CI 1.13-3.37), frailty (OR 2.21, 95% CI 1.12-4.33), and redo surgery (OR 3.09, 95% CI 1.52-6.26). Patients with PPCs had longer ICU and hospital length of stay, higher ICU readmission rates, and increased postoperative complications, without a significant difference in 30-day mortality. Exploratory analyses identified early extubation and shorter chest drain duration as variables associated with a lower incidence of PPCs, whereas postoperative delirium and transfusion were associated with an increased risk of PPCs.</p><p><strong>Conclusion: </strong>PPCs affected one in four patients in this ERAS cardiac surgery cohort and were associated with significant morbidity. Preoperative factors including age, obesity, frailty, and redo surgery were the main associated factors. Among these, frailty and active smoking emerged as key modifiable associated factors that remain incompletely addressed and represent important targets for optimization. Several postoperative factors, including early extubation, delirium, transfusion, and chest drain management, were potential targets for optimization. Further studies are needed to better clarify their causal role and to guide targeted interventions.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857738","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":"Well-being in intensive care: reflections from a multinational survey.","authors":"Denise Battaglini, Irene Aragao, Ana Veloso, Silvia De Rosa, Joana Conduto Vieira Dos Santos, Sónia P Gonçalves, Brigitta Fazzini, Isabel Soares Silva, Catarina Brandão, Maria Cruz Martin Delgado, Luciana Mascia, Olfa Hamzoui, Francesca Rubulotta","doi":"10.1186/s44158-026-00401-y","DOIUrl":"https://doi.org/10.1186/s44158-026-00401-y","url":null,"abstract":"<p><strong>Background: </strong>Intensive care unit (ICU) professionals face high levels of stress, burnout, and work-related psychological strain. However, comprehensive multinational assessments of their well-being-particularly those exploring gender differences and work-life dynamics-are scarce.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted by the International Women in Intensive and Critical Care Network (iWIN) between October 2023 and June 2024. The 113-item questionnaire assessed well-being using the WHO-5 Well-Being Index and other validated instruments across eight domains. ICU professionals were recruited via email, professional meetings, and the iWIN website. Descriptive statistics, T-tests, chi-square, and Mann-Whitney U tests were used for analysis.</p><p><strong>Results: </strong>One hundred fifty-eight ICU professionals from diverse roles responded (62% female, 37% male, 1% other). The median WHO-5 score was 68 (IQR 52-80); males reported significantly higher scores than females (72 vs. 60; p = 0.0051). Respondents reported high workload, moderate job autonomy, and frequent stress. Temporary employment was common, with 41.1% considering job transfers. Despite generally positive diversity ratings, gender disparities remained in perceptions of hiring, promotion, and career advancement fairness.</p><p><strong>Conclusions: </strong>This exploratory survey found generally positive well-being among ICU professionals, with a gender difference observed in WHO-5 scores. Concerns related to workload, job insecurity, and career development were also reported. Findings should be interpreted with caution and warrant further investigation.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847109","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":"Landiolol in perioperative and critical care: evidence, patient selection, and practical titration for targeted heart rate control: a narrative review.","authors":"Cesare Biuzzi, Giulio Carinci, Lorenzo Sorelli, Benedetta Bidi, Chiara Albizzi, Daniele Marianello, Filippo Annoni, Federico Franchi, Gianluca Paternoster, Fabio Silvio Taccone, Sabino Scolletta","doi":"10.1186/s44158-026-00396-6","DOIUrl":"https://doi.org/10.1186/s44158-026-00396-6","url":null,"abstract":"<p><p>Landiolol enables rapid and titratable heart rate control in perioperative and critically ill patients. In supraventricular tachyarrhythmias and perioperative settings, available studies suggest effective rate control and acceptable hemodynamic tolerance. In sepsis and septic shock with persistent tachycardia, landiolol consistently lowers heart rate without increasing vasopressor requirements; however, randomized evidence does not demonstrate consistent benefits on major clinical outcomes, and current guidelines do not support its routine use. Emerging data on decatecholaminization strategies indicate that combining landiolol with non-adrenergic vasopressors may attenuate catecholamine-related toxicity and improve hemodynamic profiles. Experimental and perioperative studies also suggest potential anti-inflammatory effects through modulation of cytokine release. Overall, current evidence supports landiolol as a potentially useful option for acute heart rate control and selected cases of septic tachycardia. Nevertheless, given the heterogeneity of critically ill populations and the absence of clear outcome benefits in large randomized trials, its use should remain individualized and guided by careful hemodynamic monitoring, with particular attention to appropriate patient selection.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847060","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":"The Ethics Committee of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) - Artificial intelligence in end-of-life decision-making processes: ethical reflections.","authors":"Enrico Furlan, Nereo Zamperetti, Mariassunta Piccinni, Annachiara Marra, Paolo Cotogni, Alberto Giannini","doi":"10.1186/s44158-026-00395-7","DOIUrl":"10.1186/s44158-026-00395-7","url":null,"abstract":"<p><p>Recent proposals to use artificial intelligence (AI) in end-of-life decision-making for incapacitated patients without advance directives have prompted critical reflection by the Ethics Committee of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI). This position paper analyzes both general ethical concerns surrounding AI in clinical practice and specific issues raised by the hypothesis of using AI to reconstruct patients' presumed wishes through recorded clinical conversations or analysis of digital footprints. At a general level, major challenges include lack of explainability (the so-called black box problem), risks of bias linked to non-representative training data, environmental sustainability, and the potential erosion of the clinician-patient relationship. In end-of-life contexts, these concerns are amplified. Systematic recording and retrospective analysis of sensitive conversations raise serious questions regarding privacy, data security, informed consent, and the authenticity of communication. Moreover, algorithmic interpretation may fail to capture the complexity of non-verbal communication and the inherently interpretative nature of moral reasoning. The construction of a \"social portrait\" from digital traces risks oversimplifying personal identity and generating conflicts with family narratives at a particularly vulnerable moment. The Committee further highlights the risk of delegating ethically weighty relational tasks to technological systems, thereby reinforcing a procedural model of medicine and weakening shared decision-making. For these reasons, the proposed use of AI in this domain is considered ethically problematic in its current form. Any future application would require robust governance, transparency, and accountability, ensuring that AI supports rather than undermines authentic care relationships.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"6 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151101/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847092","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":"Precision medicine in sepsis: lessons from the TIGRIS trial and the reawakening of targeted therapy.","authors":"Toshiaki Iba, Julie Helms, Hideshi Okada, Kunihiko Nagakari, Ricard Ferrer","doi":"10.1186/s44158-026-00393-9","DOIUrl":"https://doi.org/10.1186/s44158-026-00393-9","url":null,"abstract":"<p><p>Sepsis remains a leading cause of mortality worldwide, in part because it represents a biologically heterogeneous syndrome rather than a single disease entity. Numerous clinical trials targeting inflammation, coagulation, or immune pathways have failed to improve outcomes, largely due to indiscriminate enrollment of biologically diverse patient populations. Precision medicine has therefore emerged as a necessary paradigm shift in sepsis research and care. Endotoxin is a key driver of sepsis pathobiology through Toll-like receptor 4-mediated inflammatory signaling, endothelial dysfunction, and thromboinflammation. The development of the endotoxin activity assay (EAA) enabled real-time functional assessment of circulating endotoxin activity, revealing marked interindividual variability and dynamic changes during illness. These insights provided a rationale for biologically guided endotoxin-targeted therapy. Polymyxin B hemoperfusion, despite its strong mechanistic plausibility and early clinical promise, yielded inconsistent results in trials that relied on syndromic enrollment criteria. The TIGRIS trial was designed to address this limitation by refining patient selection through the integration of EAA-defined endotoxemia and organ dysfunction severity, assessed by the Sequential Organ Failure Assessment score. By defining a therapeutic window in which endotoxin was both biologically relevant and potentially modifiable, TIGRIS provides preliminary evidence suggesting that polymyxin B hemoperfusion may be effective when applied in an appropriate biological context. Beyond endotoxin removal, TIGRIS may offer insights into broader implications for precision medicine in sepsis, including biomarker-guided trial design, rational combination therapy, and reinterpretation of prior \"negative\" studies. Embracing biological heterogeneity may offer a credible path toward effective, individualized sepsis treatment.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824371","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":"Reply to \"PROVENT-C19 repeated prone positioning analysis\": not everything that differs is inconsistent.","authors":"Nicolò Sella, Emanuele Rezoagli, Tommaso Pettenuzzo, Silvia De Rosa, Paolo Navalesi, Giuseppe Foti, Giacomo Bellani, Annalisa Boscolo","doi":"10.1186/s44158-026-00397-5","DOIUrl":"10.1186/s44158-026-00397-5","url":null,"abstract":"","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"6 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13135697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824327","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":"A prospective multimethod investigation of cancer-related pain integrating clinical data and machine learning: results from the RUGGI Study.","authors":"Marco Cascella, Cosimo Guerra, Rosario De Feo, Flavio Di Lisio, Pierpaolo Giordano, Walter Esposito, Gennaro Cisale, Valentina Cerrone, Dalila Esposito, Maria Pia Bruno, Rossella Tarallo, Martina Lombardi, Jacopo Troisi, Marzio Galdi, Stefano Martina, Adele Zarrella, Enza Della Rocca, Amelia Filippelli, Valeria Conti, Mario Montedoro, Francesco Sabbatino, Giuseppe Polese, Ornella Piazza","doi":"10.1186/s44158-026-00389-5","DOIUrl":"https://doi.org/10.1186/s44158-026-00389-5","url":null,"abstract":"<p><strong>Background: </strong>Cancer-related pain is a multidimensional phenomenon, and key determinants of pain intensity remain unclear. The aim of this study was to identify the clinical determinants of cancer-related pain intensity using a convergent, multimethod analytical framework.</p><p><strong>Methods: </strong>Prospective observational study of patients with cancer-related pain. Pain was assessed using a 0-10 numeric rating scale (NRS), the Douleur Neuropathique 4, and the Brief Pain Inventory (BPI). Clinical variables included Eastern Cooperative Oncology Group Performance Status (ECOG-PS), metastatic status, comorbidities, and treatments. Multivariable regression, unsupervised clustering, and supervised machine-learning (ML) models were applied.</p><p><strong>Results: </strong>Eighty-six patients were included (median age 64 years). In bivariate analyses, higher pain intensity was associated with opioid use and poorer functional status, while neuropathic pain features were prevalent but not independently associated with pain intensity. Spearman correlation analysis demonstrated significant associations between ECOG-PS and pain intensity, BPI severity, and BPI interference. In multivariable regression, ECOG-PS emerged as a key independent predictor of pain intensity, whereas metastatic status and cancer type were not independently associated. Unsupervised clustering identified two clinically meaningful phenotypes primarily distinguished by pain intensity and functional interference, rather than neuropathic mechanisms. In supervised ML models predicting high pain burden (NRS ≥ 7), ECOG-PS consistently ranked as the most influential feature, although overall predictive performance was modest.</p><p><strong>Conclusions: </strong>Functional impairment represents a central determinant of cancer-related pain intensity, surpassing pain phenotype and disease-related variables across complementary analytical approaches. These findings support function-centered pain assessment frameworks and underscore the need to systematically integrate functional evaluation into cancer pain management strategies.</p><p><strong>Trial registration: </strong>The study was prospectively registered on ClinicalTrials.gov (identifier: NCT07038434).</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791202","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":"Correction: Non-invasive ICP monitoring when invasive systems are available in the care of acute brain injured patients: a clinical approach.","authors":"Chiara Robba, Edoardo Picetti, Alessandro Bertuccio, Carla Bittencourt Rynkowski, Gregory W J Hawryluk, Elisa Gouvea Bogossian, Randall M Chesnut, Marek Czosnyka, Andres M Rubiano, Lorenzo Calabro, Walter Videtta, Sergio Brasil, Fabio S Taccone","doi":"10.1186/s44158-026-00388-6","DOIUrl":"10.1186/s44158-026-00388-6","url":null,"abstract":"","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"6 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13126769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791330","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":"Comment on PROVENT-C19 repeated prone positioning analysis.","authors":"Thaïs Walter","doi":"10.1186/s44158-026-00391-x","DOIUrl":"10.1186/s44158-026-00391-x","url":null,"abstract":"","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"6 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13126977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791336","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":"Histological evaluation of fascicular damage following repeated sciatic nerve transfixion: an anatomical study.","authors":"Rafael Boscolo-Berto, Alessandro De Cassai, Martina Contran, Veronica Macchi, Valentina Manzo, Raffaele De Caro, Burhan Dost, Serkan Tulgar, Annalisa Boscolo, Paolo Navalesi, Andrea Porzionato","doi":"10.1186/s44158-026-00383-x","DOIUrl":"https://doi.org/10.1186/s44158-026-00383-x","url":null,"abstract":"<p><strong>Background: </strong>Ultrasound guidance has improved the accuracy and safety of peripheral nerve blocks, yet intraneural and even intrafascicular needle placement remains possible. The true incidence of fascicular injury after direct nerve transfixion is uncertain due to limited histological data. This study aimed to determine the frequency of fascicular damage after needle transfixion of the sciatic nerve using a human anatomical model.</p><p><strong>Methods: </strong>A sciatic nerve segment was harvested from a fresh-frozen male cadaver without neurological disease. One hundred full-thickness transfixions were performed using a 22-gauge sharp needle, simulating accidental intraneural penetration. Each transfixion was replicated using a standardized technique. The nerve was fixed in formalin, sectioned every 5 mm, embedded in paraffin, and stained with hematoxylin and eosin for histological evaluation. The presence of fascicular injury or displacement was assessed microscopically. Descriptive statistics were used to summarize findings, and proportions with 95% confidence intervals were calculated using the Wald method.</p><p><strong>Results: </strong>All 100 needle trajectories were successfully identified histologically. Clear fascicular damage was observed in 30 of 100 transfixions, corresponding to an incidence of 30% (95% confidence interval, 21 to 39%). In four additional cases, the needle passed in close proximity to fascicles, causing their displacement without visible structural injury, yielding an incidence of 4% (95% confidence interval, 0.2 to 7.8%). In the remaining cases, the needle path did not involve any fascicles.</p><p><strong>Conclusions: </strong>One third of simulated sciatic nerve transfixions performed with a sharp needle resulted in direct fascicular injury, while a smaller proportion produced fascicular displacement without structural disruption. These findings suggest that fascicular penetration is more common than previously believed when sharp needles are used and highlight the potential for mechanical nerve injury during regional anesthesia procedures. The use of sharp needles for peripheral nerve blocks should be avoided, and further research should explore how needle design and tip geometry influence the likelihood of fascicular injury.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791222","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}