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

{"title":"Which calcium preparation should we use in paediatric resuscitation? A comprehensive review of basic physiology, pharmacokinetics, and clinical evidence.","authors":"Constantinos Kanaris, Swathy Subhash, Anna Camporesi","doi":"10.1186/s44158-026-00369-9","DOIUrl":"10.1186/s44158-026-00369-9","url":null,"abstract":"<p><strong>Background: </strong>The optimal choice between calcium gluconate (CaGN) and calcium chloride (CaCl₂) for hypocalcaemia correction during paediatric critical illness and resuscitation remains debated. This literature review aimed to compare the efficacy and safety profiles of both preparations to determine an evidence-based clinical preference.</p><p><strong>Methods: </strong>A comprehensive review of in vitro, in vivo, and clinical trials involving critically ill patients was conducted, focusing on the pharmacokinetics, therapeutic efficacy (measured by the rise in ionised calcium, iCa²⁺), and comparative adverse event profiles, particularly the risk of extravasation injury.</p><p><strong>Results: </strong>Both CaGN and CaCl₂ effectively correct hypocalcaemia when equivalent elemental calcium doses are administered. CaCl₂ holds a significant dosing advantage in volume-restricted or extreme emergent scenarios due to its higher concentration of elemental calcium (27.2 mg/mL vs. 9.0 mg/mL for 10% solutions). Whilst the hepatic metabolism requirement for CaGN has been widely refuted, limited paediatric data suggest CaCl₂ may yield a greater response in mean arterial pressure (MAP) in critically ill children. Crucially, the safety profile favours CaGN; a substantial body of evidence indicates that the risk and severity of tissue necrosis following extravasation are markedly higher with CaCl₂.</p><p><strong>Conclusion: </strong>The selection of a calcium preparation must be conditional and context-dependent. We recommend reserving CaCl₂ for central venous administration in volume-restricted or extreme emergent settings, whilst CaGN is the preferred choice for peripheral line administration or routine maintenance due to its superior safety profile.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13081568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147373711","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 labor: promise or illusion? A narrative review with expert opinion.","authors":"Antonio Coviello, Dario Cirillo, Maria Grazia Frigo, Filomena Coppola, Giorgio Ranieri, Domenico Pietro Santonastaso, Paolo Scimia, Giuseppe Servillo","doi":"10.1186/s44158-026-00372-0","DOIUrl":"10.1186/s44158-026-00372-0","url":null,"abstract":"<p><strong>Background: </strong>Neuraxial analgesia represents the gold standard for labor pain management, providing superior efficacy and safety for both mother and fetus. However, its use is not always feasible due to medical contraindications, technical difficulties, or patient preference. Fascial Plane Blocks (FPBs) have emerged as potential alternatives, yet evidence regarding their effectiveness in labor remains limited. The purpose of this study was to synthesize the current evidence on FPBs for labor analgesia and to offer expert insight into their potential role, benefits, and limitations within modern obstetric practice.</p><p><strong>Material and methods: </strong>A systematic search of PubMed, EMBASE, and the Cochrane Library (1985-2025) was conducted following PRISMA guidelines. Eligible studies included laboring women aged ≥ 18 years undergoing analgesia with FPBs. Case reports, case series, and letters to the editor were included due to the scarcity of high-level evidence. Outcomes of interest were maternal pain scores, analgesic satisfaction, and maternal-fetal safety. Because of the marked heterogeneity in study designs, interventions, and outcome measures, a meta-analysis was not feasible; therefore, a narrative synthesis was performed, and qualitative methodological assessment was undertaken using validated tools.</p><p><strong>Results: </strong>Eight studies met inclusion criteria. QLB demonstrated promising analgesia in the first stage of labor, while lumbar and thoracic ESPBs yielded variable effects and inconsistent coverage during the second stage. Sacral ESPB showed potential as an adjunct when neuraxial techniques failed or were contraindicated. No major complications were reported; however, methodological limitations, small sample sizes, and inconsistent reporting hindered definitive conclusions. Fetal outcomes were rarely reported, and no long-term follow-up data were available.</p><p><strong>Conclusions: </strong>Current evidence does not support FPBs as replacements for neuraxial analgesia. Their use should be restricted to highly selected cases where neuraxial techniques are not feasible. Importantly, there is no predefined formula for managing labor pain-analgesic strategies must be individualized according to clinical context, patient preference, and available resources. High-quality prospective studies are necessary to clarify the role of FPBs in labor.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13069772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147357947","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 dexmedetomidine versus midazolam for sedation in mechanically ventilated pediatric patients: a randomized clinical trial.","authors":"Majid Sezavar, Hosein Akhavan, Gholamreza Khademi, Maryam Naseri, Tahereh Sadeghi, Atiyeh Kaveh","doi":"10.1186/s44158-026-00370-2","DOIUrl":"10.1186/s44158-026-00370-2","url":null,"abstract":"<p><strong>Aims: </strong>The benefits of Dexmedetomidne in sedation of mechanically ventilated pediatric patients are still challenging. In this study, we compared the efficacy and safety of Dexmedetomidine versus Midazolam for achieving deep sedation in pediatric patients receiving mechanical ventilation.</p><p><strong>Methods: </strong>A randomized clinical trial was conducted across three affiliated hospitals during February 2023 until February 2024. Eligible mechanically ventilated children aged 1 month to 18 years were randomized 1:1 to receive either Dexmedetomidine (0.25-1 mcg/kg/h) or midazolam (1-4 mcg/kg/min) for sedation, alongside fentanyl analgesia. Sedation was assessed using the Ramsey Sedation Scale and target scores set on 5-6. Primary outcomes included success rates in achieving target sedation at the beginning of mechanical ventilation; secondary outcomes encompassed hemodynamic adverse effects (hypotension, bradycardia), follow-up assessment of sedation level of successful patients over the next 6 h, mortality rate, mean arterial blood pressures and heart rates (HR) changes, mechanical ventilation and PICU stay duration.</p><p><strong>Main results: </strong>Among 130 eligible patients, 120 were analyzed after exclusions (60 per group). Demographic characteristics were similar between groups. The primary outcome revealed that Dexmedetomidine was less effective than Midazolam in achieving target sedation levels across all ages (p < 0.001). In infants under one year, there was no significant difference in sedation effectiveness between the two medications (P = 0.157). Notably, Dexmedetomidine patients required higher drug doses to maintain sedation over 6 h, while Midazolam patients experienced fewer adjustments (p < 0.001). Hemodynamic complications were significantly less frequent in the Dexmedetomidine group (3.3% vs. 23.3% for hypotension; p < 0.01). However, the two groups did not differ in terms of MAP and HR changes (P = 0.255; P = 0.063). Mortality, mechanical ventilation duration and length of PICU stay were not different between two groups (P = 0.853; P = 0.076; P = 0.082).</p><p><strong>Conclusion: </strong>Dexmedetomidine is inferior to Midazolam for deep sedation during mechanical ventilation in children aged 1 month to 18 years. However, it can be effective in infants under one year of age. Dexmedetomidine presents a lower risk of hemodynamic side effects compared to Midazolam.</p><p><strong>Trial registration: </strong>IRCT20190522043672N3 on February 16, 2023.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13067651/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147349202","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":"Pregnancy and parenthood among Italian residents in anesthesia and intensive care - a national survey.","authors":"Annalisa Boscolo, Denise Battaglini, Tiziana Bove, Gilda Cinella, Antonello Discenza, Ornella Piazza, Monica Rocco, Giuliana Scarpati, Rosanna Vaschetto, Francesca Rubulotta, Nicolò Sella, Paolo Navalesi","doi":"10.1186/s44158-026-00366-y","DOIUrl":"10.1186/s44158-026-00366-y","url":null,"abstract":"<p><strong>Background: </strong>Parenthood during medical residency is challenging, especially in Anesthesia and Intensive Care Medicine, given the irregular schedules, long working hours, and high levels of stress. Prior studies among surgeons and intensivists reported increased miscarriage and pregnancy complications, while cultural stigma and limited support further increase difficulties. This national survey among Italian Anesthesia and Intensive Care Medicine residents aimed to elucidate the experience of (i) parenthood and pregnancy outcomes, (ii) maternity leave and work arrangements, (iii) breastfeeding support, and (iv) workplace well-being.</p><p><strong>Methods: </strong>A national anonymous online survey (ethical approval no. 0017063), endorsed by the National Board of Anesthesia and Intensive Care Professors (Collegio dei Professori di Anestesia e Rianimazione-CPAR), was systematically distributed via institutional emails to members of the Italian Society of Anaesthesia, Analgesia and Intensive Care Medicine (SAARTI). The questionnaire, designed with the BRUSO model and pretested, targeted Italian residents in Anesthesia and Intensive Care Medicine.</p><p><strong>Results: </strong>A total of 1387 residents completed the survey (national response rate: 33%, 62% female). Most responses (61%, 748/1387) and pregnancies (52%, 151/289) were from Northern Italy. Parenthood was reported by 24% (208/862) female residents and 18% (92/525) males (p = 0.004). Complications during full-term pregnancies were more frequent among female residents than among partners of male colleagues (47% vs 22%, p < 0.001). When healthy residents were pregnant, 34% were reassigned to alternative tasks, 11% lost their tasks with no new assignments, and 44% were declared at high risk regardless of being healthy and remained at home. Breastfeeding was reported in 61% (144/235), and only 33% (48/144) requested leave. Workplace support was inadequate, particularly during work arrangements, breastfeeding, and fertility attempts. Finally, residents from Northern Italy declared to work more than 38 h/week (p < 0.001). Pregnancy-related complications were similar between regions.</p><p><strong>Conclusions: </strong>This first Italian national survey, among anesthesia residents, highlights organizational and cultural barriers to parenthood, as well as significant regional disparities, stressing the need for institutional strategies ensuring equity, safety, and workplace well-being.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13067416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147345985","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":"Postoperative intravenous lidocaine infusion for pain management in pelvic bone tumor surgery patients: a randomized, double-blind, controlled trial.","authors":"Fei Huo, Ran Zhang, Yaqing Wu, Xue Tian, Yi Feng","doi":"10.1186/s44158-026-00348-0","DOIUrl":"10.1186/s44158-026-00348-0","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have demonstrated that perioperative use of lidocaine effectively reduces opioid requirements in various surgical procedures. Our objective was to evaluate the effect of postoperative intravenous lidocaine infusion on opioid consumption following pelvic bone tumor surgery.</p><p><strong>Methods: </strong>This single center randomized controlled trial in a tertiary teaching hospital containing a total of 70 patients, aged 18 to 65 years, with American Society of Anesthesiologists(ASA) physical status classifications of I to III, who were scheduled to undergo pelvic bone tumor surgery. Participants were randomly assigned in a 1:1 ratio to either the lidocaine group(L Group) or the control group(C Group). The L Group received lidocaine for postoperative analgesia, whereas the C Group was administered a placebo saline infusion.The primary outcome was postoperative opioid consumption. Secondary outcomes included the time to first bowel movement, the incidence of postoperative nausea and vomiting(PONV), and pain scores at rest and during movement on postoperative days.</p><p><strong>Results: </strong>A significant difference was observed in the cumulative 72-h morphine equivalent consumption between the L Group (n = 33) and the C Group (n = 33). Patients in the L Group required significantly less morphine equivalent consumption compared to the C Group (13 (0-52) mg vs. 25 (14-85) mg, P = 0.043). Additionally, the proportion of patients experiencing breakthrough pain was significantly lower in the L Group compared to the C Group (33.33% vs. 75.76%, P = 0.001). No significant differences were noted between the groups in secondary outcomes, including the incidence of PONV, numerical pain scores at rest or during movement, time to first bowel evacuation, or time to first oral intake.</p><p><strong>Conclusion: </strong>Postoperative intravenous lidocaine infusion is effective in reducing opioid consumption and the incidence of breakthrough pain following pelvic bone tumor surgery.</p><p><strong>Trial registration: </strong>This single-center, prospective RCT was registered with the Chinese Clinical Trial Registry (ChiCTR2100051207, 15/09/2021). The first research participant was enrolled in September 20, 2021.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13059209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147322724","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 international, prospective COSMOS (CytOSorb® TreatMent Of Critically Ill PatientS) Registry: results from the first 300 patients.","authors":"Ricard Ferrer, Matthias Thielmann, Moritz Unglaube, Thomas Kirschning, Andreas Baumann, Julian Kreutz, Andreas Kribben, Bartosz Tyczynski, Ulf Guenther, Dietrich Henzler, Christina Scharf, Nuno Germano, Martin Bellgardt, Aschraf El-Essawi, Philipp Hohlstein, Thomas Guenther, P Christian Schulze, Filippo Aucella, Mario Marquez Fernandez, Markus Koestenberger, Gabriella Bottari, Jorge Hidalgo, Jean-Louis Teboul, Dana Tomescu, Teresa Klaus, Weihong Fan, Joerg Scheier, Efthymios N Deliargyris, Fabio Silvio Taccone","doi":"10.1186/s44158-026-00362-2","DOIUrl":"10.1186/s44158-026-00362-2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Blood purification techniques are being investigated as adjunctive options in critically ill patients not only to treat severe inflammation but also to remove harmful substances such as myoglobin in rhabdomyolysis. Yet, the available evidence is limited, and further research is needed to clarify their clinical benefits.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The international prospective COSMOS Registry (NCT05146336, 23 Nov 2021) tracks CytoSorb® (CS) utilization patterns and outcomes in critical care settings. Clinical assessment was performed before, during, and after CS treatment, with a 90-day follow-up. Device-related adverse effects were reported by investigators as the safety evaluation. Data were analyzed according to a pre-specified statistical plan using descriptive statistics and paired tests to compare pre- and post-treatment values, with subgroup and safety analyses performed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 300 adult patients (30.3% female, mean age 59 ± 15 years) from 22 sites were included in this analysis. The most common indications for CS therapy (multiple indications possible per patient) were septic shock (48.3%), rhabdomyolysis (12.8%), cardiogenic shock (11.5%), liver failure (11.5%), and acute respiratory distress syndrome (ARDS; 5.0%). On average, each patient received 3.3 ± 3.3 adsorbers, with 27.9% of patients receiving 4 or more adsorbers. CS was integrated in conjunction with kidney replacement therapy (75.6%), standalone hemoperfusion (7.1%), intermittent hemodialysis (IHD; 10.6%), extracorporeal membrane oxygenation (ECMO; 3.9%), and sustained low-efficiency daily dialysis (SLEDD; 4.9%). At baseline, median (interquartile range, IQR) APACHE II and SOFA scores were 24 [18, 30] and 12 [9, 15], respectively. Fluid balance improved from +1675 [141, 3348] mL pre-CS to +115 [-1100, 1495] mL post-CS, and norepinephrine requirements decreased from 0.21 [0.09, 0.40] µg/kg/min to 0.08 [0.02, 0.22] µg/kg/min (p &lt; 0.0001 for both). Ratio of partial pressure of oxygen in arterial blood to the fraction of inspiratory oxygen concentration (P/F ratio) improved from 120 [72, 208] to 176 [115, 255] (p &lt; 0.0001). Platelet counts decreased from 123 [76, 185] to 72 [42, 118] × 10&lt;sup&gt;9&lt;/sup&gt;/L (p &lt; 0.0001), while albumin levels remained stable from 2.6 [2.3, 3.1] to 2.5 [2.3, 3.0] g/dL (p = 0.112). ICU mortality was 33.1%, which was lower than mortality estimates historically associated with comparable APACHE II and SOFA scores. No serious adverse effects related to the device or device deficiencies were reported.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Real-world CytoSorb® use as part of standard care in critically ill patients was associated with improvements in several clinical and laboratory parameters; however, these findings should be interpreted cautiously given the observational design and absence of a control group. Observed mortality was lower than mortality estimates historically associated w","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12980944/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286070","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":"Characterization of lung microbiota in pneumonia: a pilot study in ICU and non-ICU patients.","authors":"Andrea Bruni, Eugenio Garofalo, Alessandro Russo, Corrado Pelaia, Federico Longhini, Elisa Bona, Isabella Aquila, Paolo Navalesi, Annalisa Boscolo","doi":"10.1186/s44158-026-00363-1","DOIUrl":"10.1186/s44158-026-00363-1","url":null,"abstract":"<p><strong>Objective: </strong>To identify potential differences in lung microbiota according to clinical severity, age, and gender in pneumonia patients compared to controls.</p><p><strong>Design: </strong>Pilot study.</p><p><strong>Setting: </strong>Single center (Azienda Ospedaliera Universitaria Dulbecco, Catanzaro, Italy).</p><p><strong>Patients: </strong>Thirty-three individuals-11 ICU patients requiring invasive mechanical ventilation, 11 non-ICU patients, and 11 cadaver controls without lung disease.</p><p><strong>Interventions: </strong>Bronchoalveolar lavage sample collection and analysis via microbiological cultures and metagenomic sequencing.</p><p><strong>Measurements and main results: </strong>Bacteroidota and Verrucomicrobiota phyla were more abundant in older (≥65 years) ICU and non-ICU patients versus controls. Massilia timonae showed a significantly lower relative abundance at the group level in cases compared to controls, potentially increasing infection susceptibility. Higher microbiota diversity was observed in older patients.</p><p><strong>Conclusions: </strong>Alterations in lung microbiota composition were observed in pneumonia patients, with differences that appeared more evident in older patients. Microbiota phenotyping may offer novel insights into pneumonia pathophysiology and pulmonary dysbiosis.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"6 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12930678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286015","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":"Appropriate selection of vascular access devices in the hospitalized patient: a prospective observational pilot study.","authors":"Fulvio Pinelli, Filippo Firenzuoli, Stefano Romagnoli, Barbara Defilippo, Gianluca Villa","doi":"10.1186/s44158-026-00365-z","DOIUrl":"10.1186/s44158-026-00365-z","url":null,"abstract":"<p><strong>Introduction: </strong>Vascular access devices (VADs) play a critical role in clinical practice, facilitating the administration of medications, fluid therapy, and parenteral nutrition. Nevertheless, improper selection of VADs can result in various complications, escalate healthcare costs, and significantly impact patients' experience. This study seeks to evaluate the appropriateness of VAD selection in contemporary clinical practice.</p><p><strong>Methods: </strong>A prospective observational pilot study was conducted between September 1st and December 31st, 2023, in two medical wards at Careggi University Hospital, Florence, Italy. Data on VAD type, insertion, maintenance, and complications were collected. The primary outcome was the appropriate selection of central VADs (CVADs) and peripheral VADs (PVADs) as recommended by the most recent international guidelines and consensus documents.</p><p><strong>Results: </strong>A total of 322 VADs were inserted in the considered period, out of which 23 (7.1%) were CVADs and 299 (92.9%) were PVADs. Peripherally Inserted Central Catheter (PICC, n = 10; 43.5%) was the most represented CVAD, followed by ports (n = 6; 26%), Centrally Inserted Central Catheters (CICC, n = 4; 17.4%), and Femorally Inserted Central Catheters (FICC, n = 3; 13%). Short peripheral cannulas (SPC) were the most represented PVADs (n = 257; 86%), followed by long peripheral cannulas (LPC) (32; 10.7%), and midline (MC) (n = 10; 3.3%). CVADs were appropriate in 82.6% of cases, whereas PVADs' appropriateness fell to 43.1%. Overall, 47 VAD failures were observed: 6 (26.1%) CVADs and 41 (13.7%) PVADs.</p><p><strong>Conclusion: </strong>This study found a high prevalence of inappropriate VAD selection in hospitalised patients, especially among PVADs, although with no increased risk of complications. Further studies are needed to address effective strategies for improving the selection of VADs.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13037174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147277918","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":"High-flow nasal therapy vs conventional oxygen therapy in mild COVID-19 hypoxaemia: a Bayesian reanalysis of the COVID-HIGH Trial.","authors":"Claudia Crimi, Salvatore Sardo, Alberto Noto, Fabiana Madotto, Mariachiara Ippolito, Santi Nolasco, Raffaele Campisi, Giuseppe Fiorentino, Ioannis Pantazopoulos, Athanasios Chalkias, Alessio Mattei, Raffaele Scala, Enrico Clini, Begum Ergan, Manel Lujan, João Carlos Winck, Antonino Giarratano, Annalisa Carlucci, Cesare Gregoretti, Paolo Groff, Andrea Cortegiani","doi":"10.1186/s44158-026-00361-3","DOIUrl":"10.1186/s44158-026-00361-3","url":null,"abstract":"<p><strong>Background: </strong>Clinical effectiveness of high-flow nasal therapy (HFNT) over conventional oxygen therapy (COT) in patients with mild COVID-19-related acute hypoxaemic respiratory failure (AHRF) remains uncertain. The COVID-HIGH trial did not demonstrate statistically significant benefits of HFNT over COT. However, the trial was slightly underpowered, and the event rate lower-than-expected. Bayesian methods provide deeper insight by incorporating prior knowledge and quantifying uncertainty intuitively. This analysis aimed to quantify the probability of benefit or harm associated with HFNT, adopting a Bayesian approach.</p><p><strong>Methods: </strong>We performed a Bayesian reanalysis of the COVID-HIGH trial (NCT, which randomised 364 patients with PaO₂/FiO₂ between 200-300 mmHg to receive HFNT or COT. The primary outcome was escalation of respiratory support (continuous positive airway pressure, noninvasive ventilation or invasive mechanical ventilation) within 28 days. A key secondary outcome was clinical recovery at day 14. Bayesian logistic models with noninformative and informative priors were used to estimate the posterior probability of treatment effects.</p><p><strong>Results: </strong>Escalation of respiratory support occurred in 23.6% (HFNT) versus 30.2% (COT) (risk difference - 6.6%, 95% CI - 15.1 to 2.1; p = 0.14). Across a wide range of priors, the posterior probability mass on the beneficial side remained high, generally > 70%, while the proportion on the harm side remained consistently low at ≤ 6% for all models, underscoring a favourable benefit-risk profile. The acute respiratory failure meta-analysis model (OR 0.76, 95% CrI 0.60-0.97), the COVID-19 randomised evidence model (OR 0.76, 95% CrI 0.60-0.97), the COVID-19 observational evidence model (OR 0.60, 95% CrI 0.45-0.80), and the COVID-19 Bayesian meta-analysis mixed evidence model (OR 0.66, 95% CrI 0.52-0.86) showed posterior probability mass on the beneficial side of 70%-94%. Clinical recovery at day 14 occurred in 61.5% (HFNT) versus 53.3% (COT), with 61-73% of posterior probability mass on the clinical benefit side.</p><p><strong>Conclusions: </strong>This Bayesian re-analysis of the COVID-HIGH trial suggests that HFNT likely reduces escalation of respiratory support and improves clinical recovery in patients with COVID-19 pneumonia and mild hypoxaemia, although the magnitude of benefit remains uncertain and sensitive to prior assumptions.</p><p><strong>Trial registration: </strong>The trial was prospectively registered in ClinicalTrials.gov on December 7, 2020 (NCT04655638).</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13032249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146777049","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":"Transesophageal echocardiography during cardiac arrest: integrating emerging prehospital evidence with practical boundaries for clinical application.","authors":"Ming-Hui Hung, Shu-Yueh Cheng","doi":"10.1186/s44158-026-00367-x","DOIUrl":"10.1186/s44158-026-00367-x","url":null,"abstract":"","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"6 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12925359/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146777026","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}