Anaesthesia and Intensive Care最新文献

{"title":"Navigating the translational chasm: a scoping review of large language models and hybrid architectures in intensive care.","authors":"Xiaoqian Cui, Hongda Zhang, Bo Wang, Wenbin Luo, Deming Guo, Xiaoning Liu","doi":"10.1177/0310057X261494610","DOIUrl":"https://doi.org/10.1177/0310057X261494610","url":null,"abstract":"<p><p>Foundation models, particularly large language models, can process the unstructured data central to the intensive care record, yet their clinical readiness remains poorly defined. This study aimed to map foundation-model and large language model applications in adult intensive care, characterise their architectural paradigms, and chart their validation and deployment features. Empirical studies applying a large language model or other foundation model to adult intensive care tasks were eligible for inclusion. Traditional machine-learning-only, non-intensive care, and paediatric studies were excluded. PubMed, Web of Science, and Scopus were searched (January 2022-February 2026). A supplementary preprint and conference search through mid-2026 was analysed separately. Data were extracted in duplicate using an operationalised taxonomy (generative large language models, clinical language models, retrieval-augmented generation, and hybrid pipelines). Evidence-maturity mapping was performed without formal risk-of-bias appraisal. Sixty-four studies addressed decision support (51.6%), clinical NLP (23.4%), predictive analytics (20.3%), and ICU operations (4.7%). Standalone configurations predominated (79.7%); retrieval-augmented generation (6.3%) and hybrid (14.1%) architectures concentrated in higher-stakes tasks. Maturity was limited: 46.9% relied solely on retrospective MIMIC data, 6.3% reported external validation, 90.6% remained internally retrospective, and only 3.1% achieved prospective evaluation. Hybrid and retrieval-augmented architectures appear better aligned with high-risk ICU tasks, though no comparative synthesis was performed. Prospective validation and a risk-stratified 'clinical co-pilot' framework are needed.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"310057X261494610"},"PeriodicalIF":1.5,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paediatric anaesthesia research in Australia and New Zealand.","authors":"Brian J Anderson, Ian M Mckenzie","doi":"10.1177/0310057X261491558","DOIUrl":"https://doi.org/10.1177/0310057X261491558","url":null,"abstract":"","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"310057X261491558"},"PeriodicalIF":1.5,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Harm reduction opportunities following ICU admission for prescription opioid overdose: An 8-year comparative audit at the Royal Melbourne Hospital.","authors":"Sarah S Jeyaprakash, Charles C Kim, Malcolm N Hogg","doi":"10.1177/0310057X261491759","DOIUrl":"https://doi.org/10.1177/0310057X261491759","url":null,"abstract":"<p><p>Intensive care unit (ICU) admission following prescription opioid overdose represents an important opportunity for multidisciplinary intervention and harm reduction, yet Australian data describing inpatient management are limited. A retrospective audit was conducted of 70 adults admitted to the ICU at the Royal Melbourne Hospital with prescription opioid overdose between 2021 and 2024. The primary outcome was provision of take-home naloxone (THN) before discharge among patients meeting institutional eligibility criteria. Secondary outcomes included opioid education, multidisciplinary involvement and discharge opioid management, with comparison with the previous institutional audit where comparable data were available. Only five patients (7.5%, 95% confidence interval 3.2-16.3) were supplied with THN despite all meeting institutional eligibility criteria. Polypharmacy overdose was common (77%). Most patients received at least one specialist referral (83%), although 15% received no inpatient specialist referral. Opioid education was documented in 58 patients (87%) compared with 17% previously (<i>P</i> <0.001), although content and documentation were inconsistent. These findings demonstrate persistent gaps in THN provision, structured opioid education and coordinated discharge planning, highlighting ICU admission as an important opportunity for prescription opioid harm reduction. Strengthening guideline-based multidisciplinary interventions during admission may improve patient outcomes and inform harm reduction strategies nationally.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"310057X261491759"},"PeriodicalIF":1.5,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anaesthetic implications and occupational safety considerations of pressurised intraperitoneal aerosol chemotherapy procedures: An Australian 5-year single-centre experience.","authors":"Jellsingh Jeyadoss, Samuel West, Markus Trochsler, Venkatesan Thiruvenkatarajan","doi":"10.1177/0310057X261476712","DOIUrl":"https://doi.org/10.1177/0310057X261476712","url":null,"abstract":"<p><p>Pressurised intraperitoneal aerosol chemotherapy is an emerging treatment for peritoneal carcinomatosis, combining aerosolised chemotherapy delivery with minimally invasive surgical techniques. This study describes anaesthetic practice, perioperative outcomes, and occupational safety considerations associated with the delivery of pressurised intraperitoneal aerosol chemotherapy, based on a 5-year, single-centre experience. A retrospective review was conducted on patients who underwent pressurised intraperitoneal aerosol chemotherapy between December 2019 and April 2025. Data included demographic information, anaesthetic techniques, perioperative complications, and occupational safety measures implemented to protect healthcare staff. The study included 38 patients who underwent a total of 66 pressurised intraperitoneal aerosol chemotherapy procedures. The median age of the patients was 51 years (range 18-88 years). The median anaesthesia duration was 132 min (range 92-235 min). Common anaesthetic techniques utilised included sevoflurane for maintenance, rocuronium for neuromuscular blockade, and sugammadex for reversal of neuromuscular blockade, along with specific monitoring protocols. No notable intraoperative complications related to anaesthesia were observed. The median hospital stay was 1 day (range 0-7 days); prolonged admissions were associated with nausea and vomiting, pain, atelectasis, hypokalaemia, and fever. Occupational safety measures, including the use of personal protective equipment and aerosol containment strategies, were implemented to reduce exposure risks during the procedure, with no reported incidents of chemotherapy exposure among healthcare personnel. Pressurised intraperitoneal aerosol chemotherapy represents a viable treatment option with manageable anaesthetic challenges and significant occupational safety considerations. Ongoing education and adherence to safety protocols, along with collaboration among multiple teams, are crucial in minimising risks to both patients and healthcare workers.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"310057X261476712"},"PeriodicalIF":1.5,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sustainable healthcare: The action that the evidence demands.","authors":"Eugenie Kayak, Rebecca E McIntyre","doi":"10.1177/0310057X261495129","DOIUrl":"https://doi.org/10.1177/0310057X261495129","url":null,"abstract":"","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"310057X261495129"},"PeriodicalIF":1.5,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined intrathecal and epidural morphine for major abdominal surgery: A two-centre feasibility randomised controlled trial.","authors":"Katrina P Pirie, Emily A Traer, Noam B Winter, Wendy A Brown, Bernhard Riedel, Paul S Myles","doi":"10.1177/0310057X261489312","DOIUrl":"https://doi.org/10.1177/0310057X261489312","url":null,"abstract":"<p><p>Epidural analgesia using continuous local anaesthetic infusions has declined in popularity, while single-shot intrathecal hydrophilic opioids are increasingly utilised. However, intrathecal opioids have a finite duration of action, which may be insufficient to provide adequate analgesia following major open abdominal surgery. This two-centre randomised controlled trial aimed to determine the feasibility of a strategy combining a single preoperative intrathecal morphine (ITM) injection with postoperative epidural morphine boluses (intervention), compared to ITM alone (control), in terms of recruitment and protocol adherence. Feasibility criteria were met for both recruitment (68%) and protocol adherence (80%). However, the scalability of this study is limited by its resource requirements. Marginal mean pain scores at rest and with movement (dynamic) were similar between groups at all timepoints. Total opioid consumption was comparable between groups, except on postoperative day 1, when consumption was lower in the intervention group (20 mg (IQR 4-36; range 0-220)) compared with the control group (48 mg (IQR 6-94; range 0-212); <i>P</i>=0.04). The number of pruritus events was similar across groups (<i>n</i> = 46), although a greater proportion of patients in the epidural group required treatment with naloxone (14 vs. 5). One patient in the control group received naloxone for sedation; no patients required naloxone for respiratory depression. Further research is required to improve postoperative analgesia and enhance quality of recovery following major abdominal surgery.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"310057X261489312"},"PeriodicalIF":1.5,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relative contribution of anaesthetists and post-anaesthesia care unit nurses to patient-reported postoperative quality improvement indices.","authors":"Timothy D Starkie, Alice W S Hung, Amy L Gaskell","doi":"10.1177/0310057X261481927","DOIUrl":"https://doi.org/10.1177/0310057X261481927","url":null,"abstract":"<p><p>Patient-reported outcomes in the post-anaesthesia care unit (PACU), such as pain, postoperative nausea and vomiting (PONV) and hypothermia, are often used for quality improvement (QI) purposes and to benchmark hospitals and anaesthetists. However, it is unclear whether variations in these measures reflect differences between clinicians or are driven by factors beyond clinician control. The aim of this study was to quantify how much of the variation in patient outcomes of severe pain, PONV and hypothermia in PACU, was associated with individual anaesthetists and PACU nurses, after adjusting for patient and surgical factors. Data from 71,113 adult surgical cases at a single tertiary institution were analysed. PACU outcomes of pain, PONV and hypothermia were assessed using mixed-effect logistic regression models, where clinicians were random effects, and patient and surgical factors were fixed effects. For each outcome, the proportion of variance associated with PACU nurses, after adjustment for patient and surgical factors, exceeded that associated with anaesthetists (pain 2.9% vs 1.1%; PONV 1.9% vs 1.1%; hypothermia 14.2% vs 1.5%). The majority of variation was explained by patient, surgical and unmeasured factors. These findings indicate that the outcomes examined predominantly reflect case-mix and system factors, with little observable variability attributable to individual anaesthetists. Consequently, these outcomes should not be used as performance indicators for anaesthetists, but rather for focused QI projects in targeted patient and surgical groups.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"310057X261481927"},"PeriodicalIF":1.5,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interventions to reduce desflurane use in hospitals: A systematic review.","authors":"Krista M Verlis, Luise Kazda, Alexandra L Barratt, Philomena Colagiuri, Anthony Hull, Romi Haas, Kristen Pickles","doi":"10.1177/0310057X261484168","DOIUrl":"https://doi.org/10.1177/0310057X261484168","url":null,"abstract":"<p><p>Desflurane is a potent greenhouse gas (GHG) and major contributor to healthcare carbon emissions. Clinician-led interventions to reduce its use have been implemented, but their effectiveness has not been systematically reviewed. We aimed to synthesise available evidence on the effectiveness of hospital-based interventions designed to reduce desflurane use. Four databases were searched from inception to 3 July 2025. Randomised and non-randomised controlled trials (RCTs), interrupted time series (ITS) and controlled or uncontrolled before-and-after studies were included. Outcome measures were desflurane consumption (primary), GHG emissions, costs, alternate anaesthetic consumption and staff outcomes. Paired authors independently screened studies, extracted data, assessed risk of bias and certainty of the evidence. Due to heterogeneity, results were synthesised using a structured summary of intervention effects with no meta-analysis. Twenty-three studies were included: 13 uncontrolled before-after studies, seven ITSs and three RCTs. Common interventions were environmental changes (<i>n</i> = 20) and education (<i>n</i> = 19). No study was rated at low risk of bias across all criteria. All studies that reported impacts on desflurane consumption (17/17), GHG emissions (16/16) and costs (14/14) found reductions. Use of alternative anaesthetics was inconsistent for sevoflurane (<i>n</i> = 15) and isoflurane (<i>n</i> = 7) but increased for propofol (<i>n</i> = 7). Staff knowledge (3/4) and behaviour (3/3) improved; however, attitudes were unfavourable (1/1) and acceptability was inconsistent (1/1). The evidence was very uncertain for all outcomes. Hospital-based interventions targeting desflurane use may reduce consumption, GHG emissions and costs, with inconsistent effects on alternative anaesthetic use and staff outcomes. However, the evidence is very uncertain.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"310057X261484168"},"PeriodicalIF":1.5,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital resources to manage pulmonary embolism and the establishment of pulmonary embolism response teams: Many models of care.","authors":"Rob Boots, Christopher Zappala, Robert Carroll, Hayden White, Adam Simpson, Phillip Masel, Craig Hukins, David Mackintosh, Hervey Lau, Samuel Davis, Oliver Bennett, Ian Yang","doi":"10.1177/0310057X261488851","DOIUrl":"https://doi.org/10.1177/0310057X261488851","url":null,"abstract":"<p><p>Acute pulmonary embolism (PE) management has become increasingly complex, resulting in clinical uncertainty and practice variability. Pulmonary Embolism Response Teams (PERT) are recommended to facilitate timely, consensus-driven management in complex cases. A statewide survey was conducted in 2025 across major public hospitals in Queensland, Australia, with emergency, internal medicine or thoracic services and intensive care units. The survey assessed available resources, the presence of PERTs and the use of management protocols for acute PE. Of 26 eligible hospitals, 80 departmental responses were received (response rate 86%), representing at least one department per hospital. While 96.2% of hospitals could rapidly assess and provide treatment for patients with acute PE, only 10 (38.5%) were able to deliver the full spectrum of medical, surgical and endovascular therapies. Multidisciplinary follow-up was available in 73.1% of hospitals, but only 57.7% routinely collected outcome data. Established PERTs were present in 26.9% of hospitals, predominantly larger academic teaching hospitals. For hospitals with a PERT, all had a single point of contact while only three of seven used a conference calling system. While an intensivist was involved in calls at all participating facilities, a thoracic physician was routinely involved in the PERT call process in five hospitals (71.4%), and a cardiologist in just three (42.9%) hospitals. Considerable variability was identified in protocol awareness, follow-up arrangements, PERT structure and activation processes. Despite widespread capacity for PE management, significant variability exists in resource availability, protocol use, specialist follow-up and PERT implementation.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"310057X261488851"},"PeriodicalIF":1.5,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of tranexamic acid on graft function in liver transplantation: A randomised controlled trial.","authors":"Yajie Zhang, Xiaozhen Wei, Haibei Liu, Yanhua Qiu, Qi Li","doi":"10.1177/0310057X261489609","DOIUrl":"https://doi.org/10.1177/0310057X261489609","url":null,"abstract":"<p><p>Tranexamic acid (TXA) has been reported to reduce transfusion requirements in liver transplantation (LT). However, clinical evidence regarding the impact of TXA on graft function and other outcomes in liver transplant recipients remains limited. This study aimed to evaluate the effect of TXA on early allograft function following LT. In this prospective, single-centre, randomised study, 89 adult participants scheduled for LT were randomised to receive either TXA or placebo. After anaesthesia induction, a continuous infusion of TXA (10 mg/kg/h) was maintained until portal vein unclamping in the TXA group, while the control group received an equivalent volume of 0.9% saline. The anaesthesia protocol was standardised across both groups. Within 7 days post-transplantation, early allograft dysfunction occurred in 12 of 43 patients in the TXA group compared with 6 of 46 patients in the control group (28% vs 13%, <i>P</i>=0.08). Median aspartate transaminase level was significantly higher in the TXA group on post-operative day 1 compared to the control group (841 vs 622 IU/L, <i>P</i>=0.03). No significant differences were observed between the two groups in transfusion volume, acute kidney injury incidence, thromboembolic events, hospital length of stay, total hospitalisation costs, in-hospital mortality and 180-day survival. TXA administration in liver transplant patients failed to demonstrate beneficial effects on incidence of early graft dysfunction, transfusion requirements or other perioperative outcomes compared to placebo. The routine use of TXA must be undertaken with caution.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"310057X261489609"},"PeriodicalIF":1.5,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}