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

{"title":"Interpreting postoperative cognitive outcomes in a trial of bispectral index-guided sedation.","authors":"Hsiao-Liang Cheng, Ming-Hui Hung","doi":"10.1186/s44158-026-00452-1","DOIUrl":"10.1186/s44158-026-00452-1","url":null,"abstract":"","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"6 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13520136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842379","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":"Delirium modifies the prognostic performance of SAPS-II.","authors":"Ignazio De Trizio, Maria Angeliki Komninou, Reto Schüpbach, Giovanna Brandi, Jan Bartussek","doi":"10.1186/s44158-026-00439-y","DOIUrl":"10.1186/s44158-026-00439-y","url":null,"abstract":"","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"6 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13420855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148631950","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":"Development and validation of a proposed rule for estimating central venous pressure from inferior vena cava dynamics: a clinical prediction model study.","authors":"Sameh M Hakim, Nermeen S Ahmed, Sahar M Talaat, Sana F Wasfy, Adham M Haggag","doi":"10.1186/s44158-026-00438-z","DOIUrl":"10.1186/s44158-026-00438-z","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to derive and validate a prediction rule for estimating the central venous pressure (CVP) from the inferior vena cava collapsibility index (IVCCI) in adults.</p><p><strong>Methods: </strong>Five hundred forty paired CVP-IVCCI measures were obtained from 180 adults. The CVP was measured via a central venous catheter connected to a pressure transducer, and the IVCCI was estimated by abdominal ultrasound. The dataset was randomly split at the patient level into training (121 patients, 363 observations) and validation (59 patients, 177 observations) samples. A generalized estimating equation for repeated measures was used to fit a prediction rule from the training sample, which was validated on the validation subset.</p><p><strong>Results: </strong>The model showed promising performance with a mean absolute error of 2.13 mmHg and 75.7% of predictions falling within ± 3 mmHg of the true values. The limits of agreement ranged from -6.0 to + 4.3 mmHg, 85.9% of predictions fell within a prespecified maximum accepted difference of ± 4 mmHg, and the direction of change was correctly predicted in 65.3% of instances. Calibration analysis showed the model tended to systematically underestimate high values and vice versa, but recalibration by applying a shrinkage factor worsened the model's performance.</p><p><strong>Conclusions: </strong>The suggested rule exhibits promising performance for most instances, rendering it useful for non-invasive trend monitoring and triaging purposes. However, single-point estimates carry considerable uncertainty that precludes their use for definitive, high-stakes clinical decisions. Validation on larger cohorts and recalibration utilizing more elaborate modeling methods are recommended before it is adopted for regular use.</p><p><strong>Trial registration: </strong>The trial was prospectively registered at the clinicaltrials.gov registry ( https://register.</p><p><strong>Clinicaltrials: </strong>gov/ , registration number: NCT06166875, registration date: 4 December 2023).</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"6 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13419015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148622904","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":"Peri-operative goal-directed haemodynamic therapy and high-risk patients: what's going on? A narrative review.","authors":"Mariateresa Giglio, Alberto Corriero, Luciano Frassanito, Elena Giovanna Bignami, Filomena Puntillo, Luigi Tritapepe","doi":"10.1186/s44158-026-00431-6","DOIUrl":"10.1186/s44158-026-00431-6","url":null,"abstract":"<p><p>Goal-directed haemodynamic therapy (GDHT) is a comprehensive haemodynamic optimisation strategy rather than simple fluid optimisation. It guides peri-operative haemodynamic management towards predefined physiological targets to reduce post-operative complications in high-risk surgical patients. This review asks whether GDHT retains clinical value in 2026, which patients are most likely to benefit, which targets are most appropriate, and what its relationship to Enhanced Recovery After Surgery (ERAS) programmes should be. The physiological basis of GDHT links surgical injury to an inflammatory cascade that impairs vascular integrity and tissue perfusion and draws on Shoemaker's seminal observation that prompt restoration of oxygen delivery during surgery or in the first post-operative hours predicts survival. RCTs and meta-analyses have reported reductions in post-operative complications, most consistently acute kidney injury, surgical site infections, and gastrointestinal morbidity, with the benefit most consistent in patients at the highest peri-operative risk. Recent evidence has complicated this picture. OPTIMISE II and iPEGASUS, two large pragmatic trials, produced neutral results, and the incorporation of fluid optimisation into ERAS protocols raises a practical question: what does GDHT add when good peri-operative care already includes haemodynamic attention? These uncertainties converge on a single practical difficulty: there is no universally accepted definition of \"high risk\", which limits both trial comparability and clinical uptake. Artificial intelligence tools, in particular closed-loop haemodynamic management systems and machine learning models for preoperative risk stratification, are appraised here as potential means of supporting more individualised implementation. GDHT retains clinical value in 2026, but the benefit appears most evident in patients at the highest peri-operative risk, while in intermediate-risk populations the evidence for added value beyond well-implemented ERAS remains uncertain. The most effective strategy is a multiparameter-based one, combining dynamic preload indices, cardiac output monitoring, and metabolic endpoints rather than fixed single-variable targets. Validated risk stratification is the critical prerequisite for both rational clinical implementation and meaningful future trials.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"6 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198230","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 effect of bispectral index-controlled sedation on postoperative cognitive health in elderly patients with spinal anesthesia undergoing elective total knee arthroplasty: randomized, blinded study.","authors":"Inna Jaremko, Gabrielė Milkintaitė, Arūnas Gelmanas, Alfredas Smailys, Tadas Lenkutis, Andrius Macas","doi":"10.1186/s44158-026-00437-0","DOIUrl":"https://doi.org/10.1186/s44158-026-00437-0","url":null,"abstract":"<p><strong>Background: </strong>Postoperative cognitive dysfunction (POCD) commonly affects elderly patients, but the impact of BIS-guided sedation during elective orthopedic surgery under spinal anesthesia remains unclear. The aim was to compare BIS-controlled versus standard clinically guided sedation on POCD in elderly patients undergoing elective knee arthroplasty.</p><p><strong>Methods: </strong>This was a prospective, patient- and outcome assessor-blinded, randomized controlled clinical study. Participants were randomized into two groups: BIS-targeted sedation (BIS group > 70) and standard clinical sedation (non-BIS group). All patients received the same anesthetic and analgesic. The primary outcome was the change in cognitive function over time. Cognitive function was assessed four times using the Addenbrooke's Cognitive Examination-Revised (ACE-R) questionnaire. Higher scores indicate better cognitive performance. The emotional status was evaluated two times using the Hospital Anxiety and Depression Scale (HADS).</p><p><strong>Results: </strong>Ninety-two patients (46 per group) were included in the final analysis. No statistically significant differences in total ACE-R score were found between the two groups at any time point (p > 0.05). Within the BIS group, total ACE-R scores were significantly higher on postoperative day (POD) 90 than preoperatively (PO) (87 (65-96) vs. 92 (70-98), p = 0.007). In the non-BIS group, total ACE-R scores increased significantly at several time points: from PO to 30 POD (87 (48-96) vs. 90.5 (40-98), p = 0.007), from PO to 90 POD (87 (48-96) vs. (91 (40-99), p < 0.001), and from 2 to 30 POD (88 (45-98) vs. 90.5 (40-98), p = 0.005). Significant decline in the number of patients experiencing probable anxiety at 30 POD compared with PO in both groups (BIS 28.3% to 2.2%, p = 0.004; non-BIS 32.6% to 8.7%, p = 0.015).</p><p><strong>Conclusions: </strong>This study did not demonstrate superiority of BIS-controlled sedation compared to clinically guided sedation with regard to cognitive outcomes. Further studies are needed.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov (NCT06241859, January 28, 2024).</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"6 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225455","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":"Preoperative natremia and AKI after cardiac surgery: an international multicenter prospective cohort study.","authors":"Jose Maria Mora, Pablo Montero-López, Angel Candela, Esther Gómez, David Nagore, Jorge M Núñez-Córdoba, Gemma Echarri, Raquel Callejas, Marc Vives","doi":"10.1186/s44158-026-00436-1","DOIUrl":"10.1186/s44158-026-00436-1","url":null,"abstract":"<p><strong>Background and goal of study: </strong>Whether preoperative natremia levels may play a role in the development of acute kidney injury (AKI) after cardiac surgery is uncertain. We conducted a cohort study to evaluate the influence of preoperative natremia on AKI in high-risk patients undergoing cardiac surgery.</p><p><strong>Materials and methods: </strong>This multicenter prospective cohort study involved 14 British and Spanish hospitals, each under local ethics committee approval. The study population comprised all consecutive patients aged 18 years or older, with a Cleveland Clinic score ≥ 4, undergoing cardiac surgery from July to December 2017. The resultant 241 consecutive patients were classified according to tertiles of preoperative natremia levels (< 139, > 139-141, and > 141 mmol/L).</p><p><strong>Results and discussion: </strong>The AKIN criteria were used to define AKI. Multivariable logistic regression was used to estimate the adjusted association between preoperative natremia and AKI. A potential link was observed between sodium levels ≤ 139 mmol/L and an increased risk of moderate-to-severe AKI relative to levels above 141 mmol/L (OR 2.01, 95% CI 1.02-3.95, p = 0.03), after multivariable adjustment for age and preoperative serum creatinine. No significant associations were observed between sodium levels and RRT or in-hospital mortality. Conclusions The results from this cohort of high-risk cardiac surgery patients lend tentative support to the hypothesis that preoperative natremia levels ≤ 139 mmol/L might be linked to a higher risk of moderate-to-severe AKI compared with levels above 141 mmol/L. These findings warrant further evaluation in a larger cohort.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"6 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149221213","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":"Use of virtual reality to enhance rehabilitation experience in critically ill patients: a pilot feasibility study.","authors":"Ian Buckley, Joanne Dowds, Cristiano Pargana, Seán McEntagart, Emily Naylor, Christopher Soraghan, Ignacio Martin-Loeches","doi":"10.1186/s44158-026-00429-0","DOIUrl":"10.1186/s44158-026-00429-0","url":null,"abstract":"","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"6 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13366675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148451079","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":"Procalcitonin kinetics in critically ill patients: a retrospective analysis of the impact of renal dysfunction and renal replacement therapy.","authors":"Francesco Cipulli, Beatrice Cazzetta, Marco Casarotti, Sara Miori, Eleonora Balzani, Adriano Anesi, Silvia De Rosa, Giacomo Bellani","doi":"10.1186/s44158-026-00405-8","DOIUrl":"10.1186/s44158-026-00405-8","url":null,"abstract":"<p><strong>Background: </strong>Despite its widespread use, several aspects of procalcitonin (PCT) kinetics remain unclear for guiding antibiotic therapy, particularly its behavior in acute kidney injury (AKI) and during renal replacement therapy (RRT). This study aimed to describe PCT kinetics in intensive care unit (ICU) patients with AKI, including those undergoing RRT, compared with patients without AKI.</p><p><strong>Methods: </strong>We conducted a single-center retrospective study including 396 ICU patients. At admission, PCT, C-reactive protein (CRP), and white blood cell (WBC) count were compared across AKI stages. During ICU stay, any subsequent rise in PCT > 2 µg/L was defined as a PCT peak-episode. PCTpeak was the highest value before a sustained decline, PCTvalley the following lowest value, and PCTdecay the average daily reduction from peak to valley. Group comparisons were conducted using ANOVA or Kruskal-Wallis tests, with Bonferroni correction as appropriate. Linear mixed-effects models were applied to account for repeated measures within patients.</p><p><strong>Results: </strong>CRP and WBC did not differ among AKI stages, whereas PCT increased progressively (p = 0.004). PCTpeak correlated with AKI severity (p = 0.001), while PCTdecay decreased progressively (p < 0.001). Among stage 3 patients, RRT was performed in 12.3% of cases and did not significantly affect daily PCT levels compared to non-RRT patients.</p><p><strong>Conclusion: </strong>AKI is associated with higher PCT peaks and reduced PCT decline, whereas RRT does not appear to significantly alter PCT kinetics.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13640271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427034","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":"Reappraising the fascia iliaca compartment block and pericapsular nerve group block for geriatric hip fractures: a narrative review.","authors":"Jun Lu, Jinhua Jiang, Jinjun Bian, Lulong Bo","doi":"10.1186/s44158-026-00434-3","DOIUrl":"10.1186/s44158-026-00434-3","url":null,"abstract":"<p><p>Regional analgesia is a cornerstone of multimodal pain management for hip fractures, yet the optimal choice between the pericapsular nerve group (PENG) block and the fascia iliaca compartment block (FICB) remains a subject of ongoing debate. Current literature often presents conflicting outcomes due to the heterogeneous pathophysiology of hip fractures which complicates a universal approach. This narrative review synthesizes current anatomical and clinical evidence to reconcile these discrepancies. By evaluating the relative strengths and limitations of each technique, we identify three critical dimensions including pathology, patient factors, and performance. Our synthesis indicates that pathology dictates the target. Based on anatomical considerations, intracapsular fractures may benefit from the targeted coverage of the PENG block, whereas extracapsular injuries involve somatic pathways that appear more effectively addressed by the FICB. Patient-centered priorities like delirium prevention in the frail elderly must be balanced against the theoretical benefits of motor sparing. Furthermore, the clinical utility of motor preservation is only realized when coupled with early active rehabilitation. Consequently, the PENG block and FICB should be viewed as complementary rather than competitive strategies. This review offers the 3P framework as an evidence-based synthesis tool to assist clinicians in personalized technique selection. Future research should prioritize defining which technique best suits specific patient phenotypes and functional goals instead of pursuing a universal gold standard.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427042","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":"Prognostic value and organ-specific correlations of admission MR-proADM in critically ill patients: a retrospective exploratory study.","authors":"Roberta Domizi, Elisa Damiani, Andrea Carsetti, Erika Casarotta, Riccardo Antolini, Alessandra Calcinari, Marco Moretti, Vincenzo Gabbanelli, Elisa Compagnucci, Erica Adrario, Abele Donati","doi":"10.1186/s44158-026-00428-1","DOIUrl":"10.1186/s44158-026-00428-1","url":null,"abstract":"<p><strong>Background: </strong>Acute organ dysfunction is a primary driver of ICU mortality. As clinical scores often act as lagging indicators, early recognition of subclinical endothelial stress may be essential for timely intervention. This exploratory study investigated the association of mid-regional pro-adrenomedullin (MR-proADM)-a stable surrogate of the hormone adrenomedullin-as a potential early indicator of early organ failure.</p><p><strong>Methods: </strong>This retrospective, single-center study analyzed a heterogeneous cohort of 26 critically ill patients. Plasma MR-proADM levels were assessed at admission (t0) and daily for 5 days. The primary outcome was the correlation between admission MR-proADM and the 24-h SOFA score. Secondary outcomes included comparisons between septic and non-septic patients and between survivors and non-survivors.</p><p><strong>Results: </strong>Admission MR-proADM showed a moderate correlation with the 24-h SOFA score (rho = 0.488; p = 0.021), with the most prominent associations observed within the cardiovascular and renal SOFA domains. In the septic subgroup, MR-proADM levels were higher than in non-septic patients (10.90 [IQR 5.91-19.00] vs. 1.30 [IQR 0.74-2.53] nmol/L, p < 0.001); ROC analysis yielded an AUC of 0.88 (95% CI 0.73-1.00; p < 0.001), although this estimate should be interpreted descriptively given the small number of septic cases. Despite the low number of mortality events (n = 4), higher admission MR-proADM values were observed in non-survivors than in survivors, although this finding remains preliminary. Furthermore, admission MR-proADM levels showed positive correlations with procalcitonin at each individual timepoint during the first five ICU days (p < 0.001 at each timepoint).</p><p><strong>Conclusions: </strong>Within the limits of this small cohort, MR-proADM might provide a biological window into incipient organ dysfunction. Its possible role in supporting clinical assessment of sepsis and risk stratification-particularly regarding hemodynamic and renal dysfunction-remains strictly hypothesis-generating and requires validation in larger, prospective multicenter studies.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427006","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}