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

{"title":"Obstetric anaesthesia for caesarean section in Central Europe: a prospective population-weighted binational audit (OBAAMA-COV Study).","authors":"Jan Bláha, Pavlína Nosková, Dagmar Seidlová, Monika Grochová, Radka Klozová, Josef Firment, Hana Harazim, Kateřina Kusalová, Michal Svoboda, Deana Slovjaková, Nela Rezbáriková, Quynh Giang Nguyenová, Petr Štourač","doi":"10.1186/s44158-026-00435-2","DOIUrl":"10.1186/s44158-026-00435-2","url":null,"abstract":"<p><strong>Background: </strong>Neuraxial anaesthesia is recommended as the preferred technique for caesarean section, and the proportion performed under general anaesthesia is increasingly regarded as a quality indicator. Previous national audits in the Czech Republic and Slovakia demonstrated a reduction in general anaesthesia rates between 2011 and 2015; however, contemporary population-level data are lacking.</p><p><strong>Methods: </strong>OBAAMA-COV was a prospective, cross-sectional national audit conducted in November 2022 across maternity units in the Czech Republic and Slovakia. Consecutive caesarean sections were recorded using a structured electronic registry. Population weighting based on official national statistics was applied to generate representative estimates of anaesthetic technique distributions and reported indications. The analyses were descriptive.</p><p><strong>Results: </strong>A total of 2,270 caesarean sections were recorded from 94 centres. Population-weighted estimates corresponded to 2,068 procedures in the Czech Republic and 1,205 in Slovakia. Overall general anaesthesia rates were 33.9% and 31.3%, respectively. In elective procedures, general anaesthesia was used in 23.0% (95% CI 19.9-26.4) in the Czech Republic and 24.9% (20.6-29.7) in Slovakia; in emergency procedures, rates were 45.4% (42.1-48.8) and 36.8% (31.8-42.1), respectively. Maternal preference was the leading reported indication in elective cases (approximately 60-63% across audit cycles), whereas urgency predominated in emergency settings. Rapid sequence induction with tracheal intubation was used in most cases; difficult intubation occurred in approximately 2% of cases, and no aspiration was recorded. Umbilical arterial pH values were comparable between general anaesthesia and neuraxial techniques.</p><p><strong>Conclusions: </strong>These population-weighted data demonstrate a persistent divergence from contemporary European standards. General anaesthesia for caesarean section remains common in both countries, plateauing rather than declining since 2015. The continued reliance on general anaesthesia-driven by maternal preference in elective procedures and by urgency in acute settings-suggests an important contribution of organisational and sociocultural factors beyond strictly clinical indications.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov (NCT04912791), registered June 2, 2021.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148414058","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 prevent ventilator-associated pneumonia in critically ill mechanically ventilated patients: a SIAARTI consensus statement.","authors":"Gennaro De Pascale, Andrea Cortegiani, Stefano Busani, Alberto Corona, Andrea Carsetti, Giulia Catalisano, Salvatore Lucio Cutuli, Francesco Forfori, Massimo Girardis, Jessica Giuseppina Maugeri, Daniela Pasero, Marco Tescione, Bruno Viaggi, Rosanna Vaschetto, Carlo Alberto Volta, Massimo Antonelli","doi":"10.1186/s44158-026-00432-5","DOIUrl":"10.1186/s44158-026-00432-5","url":null,"abstract":"<p><strong>Background: </strong>Ventilator-associated pneumonia (VAP) remains a major complication in mechanically ventilated critically ill patients. Although several preventive strategies have been proposed and incorporated into international guidelines, emerging evidence and evolving epidemiology warrant updated statements. The Italian Society of Anaesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) developed an expert consensus statement to provide pragmatic guidance for VAP prevention.</p><p><strong>Methods: </strong>This consensus statement was developed in accordance with SIAARTI methodology for consensus-based documents. A multidisciplinary panel of 10 experts was appointed and identified key items through a modified Delphi process. Consensus was defined as ≥ 75% agreement within the same Likert scale range. A structured literature search was conducted. Statements and supporting rationales were drafted by multidisciplinary subgroups and subjected to blinded voting. External peer review was performed prior to final approval.</p><p><strong>Results: </strong>Of ten proposed items, four achieved consensus in agreement and were included in the final document. Individual statements address: (1) subglottic secretion drainage, (2) endotracheal cuff pressure control, (3) chlorhexidine for oral hygiene, and (4) selective digestive decontamination (SDD). Subglottic secretions drainage and appropriate cuff pressure control are supported as preventive measures, while routine chlorhexidine use is not recommended outside selected cardiac surgery populations, and SDD was demonstrated effective to reduce VAP and mortality in low multidrug-resistant (MDR) settings.</p><p><strong>Conclusions: </strong>This consensus statement provides updated, pragmatic guidance for VAP prevention. Implementation should consider local epidemiology, particularly MDR prevalence, and patient-specific risk profiles.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628800/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148407231","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 role of cytokine adsorption in post-cardiac arrest syndrome (PCAS): a 10-year literature narrative review.","authors":"Pasquale Raimondo, Ignazio Condello, Pierpaolo Dambruoso, Antonia Nompleggio, Salvatore Grasso","doi":"10.1186/s44158-025-00309-z","DOIUrl":"10.1186/s44158-025-00309-z","url":null,"abstract":"<p><strong>Background: </strong>Post-cardiac arrest syndrome (PCAS) is a critical condition arising from systemic inflammation and ischemia-reperfusion injury, often leading to poor outcomes despite advanced supportive therapies. Cytokine adsorption has been proposed as a therapeutic approach to mitigate the inflammatory response and improve survival and recovery in PCAS patients.</p><p><strong>Materials and methods: </strong>This narrative review aims to synthesize and critically evaluate recent literature (2013-2024) on the role of cytokine adsorption in PCAS management, focusing on inflammatory modulation, clinical outcomes, and safety. A comprehensive search of PubMed, Cochrane Library, Embase, Medline Complete, Scopus and Web of Science identified 17 studies investigating cytokine adsorption in PCAS. Inclusion criteria encompassed clinical trials, observational studies, and preclinical investigations.</p><p><strong>Results: </strong>Cytokine adsorption reduces inflammatory markers, particularly interleukin-6 (IL-6), in patients with PCAS. While some studies report modest improvements in hemodynamic stability and reduced vasopressor requirements, survival benefits remain inconsistent across the literature.</p><p><strong>Conclusions: </strong>Cytokine adsorption appears to be a safe and feasible intervention in PCAS, with potential benefits in inflammatory modulation and hemodynamic support. However, its impact on long-term survival and neurological recovery remains unclear. Future large-scale randomized controlled trials are needed to establish definitive clinical guidelines for its use in PCAS management.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13617889/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392669","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 \"an interpretable machine learning tool for predicting perioperative cardiac events in patients scheduled for hip fracture surgery: insights from the multicenter LUSHIP study\".","authors":"Parthasaradhi Mayasala, G Sunil Kumar, Lalband Neelu","doi":"10.1186/s44158-026-00380-0","DOIUrl":"10.1186/s44158-026-00380-0","url":null,"abstract":"","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"6 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13317273/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148364240","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":"Diurnal vasopressor variation in critically ill adults.","authors":"Michael R Kahn, Chanidapa Klinhom, Amila Adili, Melissa L Wilson, Dong W Chang, Luis E Huerta","doi":"10.1186/s44158-026-00416-5","DOIUrl":"10.1186/s44158-026-00416-5","url":null,"abstract":"","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"6 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13289050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148310824","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":"Efficacy and safety of intrathecal adjuvants in lower limb orthopaedic surgery: a systematic review and network meta-analysis of randomised controlled trials.","authors":"Martina Ollosu, Vincenzo Francesco Tripodi, Claudio Cardia, Debora Fois, Renata Demeglio, Gabriele Finco, Mario Musu, Mariachiara Ippolito, Andrea Cortegiani, Salvatore Sardo","doi":"10.1186/s44158-026-00427-2","DOIUrl":"10.1186/s44158-026-00427-2","url":null,"abstract":"<p><strong>Background: </strong>Intrathecal adjuvants are frequently used in spinal anaesthesia for lower-limb surgery to enhance block quality and prolong postoperative analgesia. However, evidence remains fragmented across individual agents. This systematic review with frequentist network meta-analysis aimed to compare the efficacy and safety of intrathecal adjuvants in patients undergoing lower limb orthopaedic surgery to evaluate the effectiveness and safety of intrathecal adjuvants combined with long-acting local anaesthetics for lower limb orthopaedic surgery.</p><p><strong>Methods: </strong>A systematic search of PubMed, CENTRAL, and Embase was conducted to retrieve English-language RCTs involving adult patients undergoing lower limb orthopaedic surgery under single-shot spinal anaesthesia. We included trials evaluating any intrathecal drug or placebo added to a long-acting local anaesthetic. Our primary outcome was the duration of effective analgesia, defined as the time to the first analgesic requirement, in hours. We selected randomised controlled trials (RCTs) reported in English.</p><p><strong>Results: </strong>We included 183 RCTs, for a total of 14,431 patients and 27 interventions. Morphine combined with ketorolac, morphine alone followed by diamorphine, clonidine combined with morphine and ketamine combined with midazolam provided the greatest prolongation of effective analgesia. Morphine also significantly reduced pain at 12 h and postoperative opioid consumption with no impact on motor block duration. Dexmedetomidine reduced pain intensity at 12 h but substantially prolonged motor block duration and increased the incidence of bradycardia. Morphine and neostigmine showed an increased risk of postoperative nausea and vomiting, while several interventions increased the risk of pruritus. The certainty of evidence ranged from low to very low due to within-study bias, reporting bias, high heterogeneity, imprecision and incoherence.</p><p><strong>Conclusions: </strong>Considering the body of evidence in an NMA framework, intrathecal morphine appears to offer a potentially favourable efficacy-safety balance. Dexmedetomidine may prolong motor block and increase the risk of bradycardia. The certainty of the evidence was low to very low and needs caution interpretation.</p><p><strong>Systematic review registration: </strong>PROSPERO CRD42024557751.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13523280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148284965","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":"Improving bedside airway tests accuracy for predicting difficult laryngoscopy using ultrasound-measured skin-to-epiglottis distance.","authors":"Haytham Eltrabily, Maha Mostafa, Esraa Gamal Hamad, Ahmed Hasanin, Sherin Refaat, Mohamed Mansour, Sherif Alaa Embaby, Mostafa Nagy","doi":"10.1186/s44158-026-00426-3","DOIUrl":"10.1186/s44158-026-00426-3","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to assess the accuracy of a composite score combining ultrasound-measured skin-to-epiglottis distance (DSE), Upper Lip Bite Test (ULBT), and Modified Mallampati Test (MMT) in predicting difficult airway.</p><p><strong>Methods: </strong>In this prospective observational study, 250 adults scheduled for elective surgery were assessed preoperatively using ULBT, MMT, and ultrasound measurement of DSE. A composite airway score was calculated by assigning one point for each of the following: DSE > 2.0 cm, ULBT class > I, and MMT grade > II. Difficult laryngoscopy was defined as Cormack-Lehane grade > 2, and difficult intubation as an Intubation Difficulty Scale > 5. The outcomes were the ability of the score and individual tests to predict difficult airway using area under the receiver operating characteristic curve (AUC).</p><p><strong>Results: </strong>The incidence of difficult laryngoscopy and intubation was 12.8% and 6.8%, respectively. The composite score showed superior predictive accuracy compared to individual tests, with AUCs (95% confidence interval) of 0.77 (0.72-0.82) for difficult laryngoscopy and 0.83 (0.78-0.88) for difficult intubation. A score > 1 had negative predictive values of 93% for difficult laryngoscopy and 97% for difficult intubation. When all three tests were negative, the composite score had a sensitivity and negative predictive value of 100% for predicting difficult intubation.</p><p><strong>Conclusion: </strong>A composite airway score combining DSE, ULBT, and MMT can accurately predict difficult laryngoscopy and intubation. When all three parameters are negative, difficult intubation is very unlikely. Additionally, a score of < 2 rules out difficult laryngoscopy and intubation with 93% and 97% accuracy, respectively.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"6 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13274189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148274051","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":"Fascial plane blocks in pediatric patients.","authors":"Cooper Quiroz, Mackenzie Jacoby, Alparslan Turan","doi":"10.1186/s44158-026-00421-8","DOIUrl":"10.1186/s44158-026-00421-8","url":null,"abstract":"<p><p>Pediatric perioperative pain management remains challenging, and opioid-related adverse effects have driven interest in opioid-sparing strategies. Thus, regional anesthesia techniques are an increasingly important component of multimodal analgesia and may contribute to improved pain control and reduced opioid-related systemic effects. The rapid advancement of ultrasound-guided regional anesthesia has broadened the use of pediatric fascial plane blocks. These approaches offer technically straightforward, safe, and effective analgesia across a range of thoracic and abdominal procedures. However, these developments have not translated uniformly into clinical adoption. The practice of pediatric regional anesthesiology is variable and institution dependent. The lack of standardized recommendations raises safety concerns as the current evidence is limited by heterogeneity in study design and procedural variability. Age-related differences in anatomy, physiology, and pharmacokinetics limit extrapolation from adult data and present challenges in clinical application. Although complication rates are low, the risk of local anesthetic systemic toxicity and conservative dosing practices are important considerations. This narrative review discusses the mechanisms, indications, and clinical applications of fascial plane blocks in pediatric patients and highlights key factors for their safe and effective implementation.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13393914/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148254850","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":"Radial versus femoral access for coronary angiography and percutaneous coronary interventions in critically ill patients.","authors":"Alexis Devaux, Alexandre Gamet, Maxime Desgrouas, Piotr Szychowiak, Marc Goralski, Jean-Baptiste Brillant, Thierry Boulain, François Barbier","doi":"10.1186/s44158-026-00424-5","DOIUrl":"10.1186/s44158-026-00424-5","url":null,"abstract":"<p><strong>Background: </strong>Evidence is lacking to appraise whether radial access should be preferred to femoral access for coronary angiography (CAG) in critically ill patients.</p><p><strong>Methods: </strong>Patients admitted to the medical intensive care unit (ICU) of a university hospital over a 5-year period and requiring CAG immediately before or during the ICU stay were retrospectively included. The average treatment effect of the arterial route used for CAG was assessed through a win-ratio methodology with propensity score (PS)-based inverse probability of treatment weighting (IPTW). The primary endpoint was a hierarchical composite outcome of (i) all-cause death, (ii) resuscitated cardiac arrest, (iii) stroke, (iv) myocardial infarction, (v) acute limb ischemia and/or need for vascular surgery on CAG access site and (vi) Bleeding Academic Research Consortium (BARC) type 3 major bleeding, all assessed at day 28. The relationship between access site and the likelihood of all-cause death at day 28 was investigated with a Cox proportional hazard model stratified on the occurrence of cardiac arrest before CAG and adjusted through PS-based IPTW.</p><p><strong>Results: </strong>Among the 235 included patients (116 with femoral access and 119 with radial access), 145 (61.7%) were admitted following cardiac arrest and 116 (49.4%) presented with cardiogenic shock at the time of CAG. The primary composite endpoint occurred in 63.4% of patients with femoral access and 47.7% of patients with radial access in IPT-weighted populations (absolute risk difference 15.6%, 95% confidence interval [CI] 1.4% to 29.8%, P = 0.03; win ratio for femoral versus radial access 0.62, 95% CI 0.40 to 0.98, P = 0.04). Access site complications were more frequent in patients with femoral access while major bleedings were similarly observed in both groups. Femoral access was not associated with day-28 mortality (adjusted hazard ratio 1.43, 95% CI 0.90 to 2.26, P = 0.13). Percutaneous coronary revascularisation and implantation of veno-arterial extra-corporeal membrane oxygenation, when required, were not hastened with femoral access.</p><p><strong>Conclusion: </strong>In this study, the use of a femoral rather than radial approach for CAG in critically ill patients was associated with a higher incidence of access site complications but did not correlate with the hazard of major bleeding or all-cause death at day 28.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13471660/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148207138","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":"Relationship between norepinephrine dose and outcome in septic shock: a retrospective study.","authors":"Lorenzo Antonino Calabrò, Marco Pasetto, Stefano Zorzi, Martina Polato, Eva Vitali, Chiara Faso, Sofia Castellani, Hassane Njimi, Katia Donadello, Leonardo Gottin, Filippo Annoni, Fabio Silvio Taccone","doi":"10.1186/s44158-026-00425-4","DOIUrl":"10.1186/s44158-026-00425-4","url":null,"abstract":"<p><strong>Background: </strong>High-dose norepinephrine (NE) is frequently required in septic shock, but the association of NE dose with outcome remains incompletely characterised. We aimed to evaluate the relationship between NE dosing, mortality and ischemic complications, and to identify clinically relevant NE dose ranges.</p><p><strong>Methods: </strong>This retrospective single-centre cohort study included adult patients (≥ 18 years) admitted to the Intensive Care Unit (ICU) between 2016 and 2022 with septic shock on admission, complete data on NE dosing and ICU mortality; patients receiving mechanical circulatory support were excluded. NE dosing variables (initial-dose, highest dose within 24 h, and peak ICU-dose) were collected. Adjusted optimal binning was used to identify NE peak-dose ranges associated with ICU and in-hospital mortality. Multivariable logistic regression was adjusted for age, APACHE II, and SOFA score, and time-dependent Cox models assessed associations with secondary ischemic outcomes.</p><p><strong>Results: </strong>A total of 506 patients were included. Median NE peak-dose was 0.5 [0.2-1.2] µg/kg*min. Four NE peak-dose ranges were identified: 0.05-0.6, 0.61-1.2, 1.2-3.0, and > 3.0 µg/kg*min. ICU and in-hospital mortality increased stepwise across these ranges, from 20.7 and 32.4% in the lowest group to 100% in patients receiving > 3.0 µg/kg*min. This association persisted after exclusion of patients with withdrawal of life-sustaining therapies. Adjusted odds ratios for ICU mortality were 1.88 [0.97-3.64] and 2.55 [1.38-5.57] in the 0.61-1.2 and 1.2-3.0 µg/kg*min groups, respectively. NE peak-dose showed fair discrimination for ICU mortality (AUROC of 0.75), with an optimal Youden threshold of 0.78 µg/kg*min. Most ischemic complications were infrequent and not dose dependent, except for myocardial ischemia and unexpected cardiac arrest, which were significantly associated with higher NE doses.</p><p><strong>Conclusions: </strong>In septic shock, increasing NE peak-doses are associated with a significant stepwise increase in ICU and in-hospital mortality across four distinct dose ranges. Ischemic complications are uncommon and largely independent of NE dose.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13465870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148201445","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}