Anaesthesiology intensive therapy最新文献

{"title":"Overcoming cognitive barriers in a CICO emergency: situational awareness and the lone responder.","authors":"Ubaldo La Brocca, Massimiliano Parlanti Garbero, Michele Grio","doi":"10.5114/ait/235666","DOIUrl":"https://doi.org/10.5114/ait/235666","url":null,"abstract":"","PeriodicalId":7750,"journal":{"name":"Anaesthesiology intensive therapy","volume":"58 1","pages":"209-211"},"PeriodicalIF":2.3,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134889","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":"Disrupted thyroid hormone homeostasis in critical illness: clinical correlates and associations with hormone supplementation in a single-center retrospective observational study.","authors":"Alicja Filipczyk, Szymon Zdanowski, Jan Kasprzyk, Karolina Niedzielska, Artur Rakhatsevich, Magdalena Anna Wujtewicz, Tomasz J Stefaniak, Karol P Steckiewicz","doi":"10.5114/ait/230953","DOIUrl":"10.5114/ait/230953","url":null,"abstract":"<p><strong>Background: </strong>Thyroid hormone disturbances are a hallmark of critical illness and are commonly attributed to non-thyroidal illness syndrome. The clinical relevance of thyroid hormone supplementation in the intensive care unit (ICU) remains uncertain. This study aimed to characterize thyroid hormone concentrations in relation to disease severity in critically ill patients receiving thyroid hormone supplementation.</p><p><strong>Methods: </strong>In this single-center retrospective study, data from 98 ICU patients receiving thyroid hormone supplementation were analyzed. A total of 186 measurements of thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), and free thyroxine (fT4) were evaluated in relation to disease severity, organ dysfunction, and clinical interventions.</p><p><strong>Results: </strong>Lower fT3 and fT4 concentrations were consistently associated with markers of critical illness, including shock, vasopressor use, mechanical ventilation, and higher SOFA scores. TSH showed weaker and less consistent associations but correlated positively with duration of ICU stay. Thyroid hormone concentrations were largely unrelated to most therapeutic interventions, with only weak correlations observed. Notably, hormone concentrations did not differ meaningfully between patients with and without preexisting thyroid disease, apart from higher TSH concentrations and levothyroxine dosing in the former group.</p><p><strong>Conclusions: </strong>Thyroid hormone concentrations in critical illness were closely asso-ciated with disease severity. As all patients received supplementation and no comparator group was available, the independent effect of treatment could not be assessed. Prospective controlled studies are needed.</p>","PeriodicalId":7750,"journal":{"name":"Anaesthesiology intensive therapy","volume":"58 1","pages":"198-208"},"PeriodicalIF":2.3,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863586","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":"CMV and HHV-6 reactivation in immunocompetent patients hospitalised in the ICU - is it a real problem? A case series and narrative review.","authors":"Agnieszka Wieczorek, Krzysztof Fidler, Lidia Łysenko","doi":"10.5114/ait/226448","DOIUrl":"10.5114/ait/226448","url":null,"abstract":"<p><p>Cytomegalovirus (CMV) and human herpesvirus-6 (HHV-6) infections typically follow a benign course in immunocompetent individuals. However, critically ill patients may develop profound immune dysregulation associated with sepsis, trauma, prolonged mechanical ventilation, or immunomodulatory therapy, which may predispose them to reactivation of latent viruses. A growing body of evidence suggests that CMV reactivation in immunocompetent, critically ill patients is associated with adverse clinical outcomes, including prolonged mechanical ventilation, longer ICU stay, and an increased risk of secondary infections. The clinical significance of herpesvirus reactivation in this population remains incompletely defined, and diagnosis may be challenging due to nonspecific clinical presentation and limited availability of molecular diagnostics. The aim of this study was to present a case series of CMV and HHV-6 reactivation in immunocompetent, critically ill patients and to discuss diagnostic and therapeutic challenges in the context of current literature. We describe three critically ill patients who developed herpesvirus reactivation during hospitalisation. One patient presented with clinically significant CMV reactivation suspected to contribute to gastrointestinal and pulmonary manifestations in the setting of rising CMV DNAemia. Another patient was diagnosed with CMV-associated immune thrombocytopaenia. A third patient developed rapidly progressive neurological deterioration with cerebrospinal fluid pleocytosis and HHV-6 DNA detected in cerebrospinal fluid, consistent with suspected HHV-6-associated encephalitis. Herpesvirus reactivation may be considered in critically ill patients with unexplained clinical deterioration despite the absence of classical immunosuppression.</p>","PeriodicalId":7750,"journal":{"name":"Anaesthesiology intensive therapy","volume":"58 1","pages":"189-197"},"PeriodicalIF":2.3,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148811843","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":"Opioid-sparing and opioid-free anaesthesia: concepts, rationale, evidence, and practical implications.","authors":"Justyna Karolina Danel, Maja Magdalena Copik, Szymon Zdanowski, Małgorzata Reysner, Wiktoria Smyła-Gruca, Szymon Białka","doi":"10.5114/ait/226446","DOIUrl":"10.5114/ait/226446","url":null,"abstract":"<p><p>Opioids have long been central to perioperative analgesia, but their well-recognised adverse effects, including postoperative nausea and vomiting, respiratory depression, ileus, and the risk of persistent postoperative use, have increased interest in strategies that reduce perioperative opioid exposure. This narrative review examines two such strategies, opioid-sparing anaesthesia and opioid-free anaesthesia (OFA), and presents them as related points along a continuum of opioid minimisation rather than as opposing approaches. We define each strategy, outline the rationale for opioid reduction, including opioid-induced hyperalgesia, and review the multimodal and regional anaesthesia techniques that support both. Current evidence from mixed surgical populations and procedure-specific analyses, including cardiac, thoracic, orthopaedic, bariatric, and breast surgery, suggests that the most consistent benefit of opioid minimisation is improved tolerability, particularly reduced postoperative nausea and vomiting, rather than a major reduction in postoperative pain intensity. OFA may also shift the adverse-effect profile towards haemodynamic events such as bradycardia and hypotension. We also discuss the practical challenges of implementation, including training requirements, monitoring issues, and the important but often overlooked distinction between opioid-free anaesthesia and opioid-free analgesia. Finally, we consider the main limitations of the current literature, especially inconsistent definitions, a focus on short-term outcomes and the near-exclusive enrolment of opioid-naive patients. We conclude that clinically meaningful outcomes depend more on the quality of the perioperative pathway than on whether intraoperative opioids are reduced or completely avoided.</p>","PeriodicalId":7750,"journal":{"name":"Anaesthesiology intensive therapy","volume":"58 1","pages":"179-188"},"PeriodicalIF":2.3,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148811855","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":"Comparison of kinemyography and electromyography during onset of and recovery from non-depolarising neuromuscular blockade: prospective observational study.","authors":"Michal Kalina, Jan Beneš, Olha Litvina, Vladimír Černý","doi":"10.5114/ait/226447","DOIUrl":"10.5114/ait/226447","url":null,"abstract":"<p><strong>Background: </strong>Quantitative neuromuscular monitoring is essential for the safe management of neuromuscular blockade. Although electromyography (EMG) is increasingly regarded as a reference technique, kinemyography (KMG) remains widely used in clinical practice; however, clinically relevant differences between these modalities during onset and recovery of neuromuscular blockade are not fully understood.</p><p><strong>Methods: </strong>In this prospective observational study, adult patients undergoing general anaesthesia with non-depolarising neuromuscular blocking agents were simultaneously monitored using EMG and KMG applied to opposite hands, and onset and recovery times of neuromuscular block were compared between modalities; additionally, a novel EMG-derived parameter (T1%) was explored as a marker of recovery.</p><p><strong>Results: </strong>In the 137 analysed patients, EMG and KMG differed during onset and recovery, with greater and only statistically significant disagreement during onset (EMG 158 ± 74 s vs. KMG 118 ± 68 s, P < 0.001; recovery: EMG 27 ± 22 min vs. KMG 24 ± 21 min, P = 0.242). T1% tended to be higher with sugammadex than with spontaneous recovery (P = 0.074).</p><p><strong>Conclusions: </strong>KMG and EMG are not interchangeable for perioperative neuromuscular monitoring; the observed disagreement suggests that KMG may overestimate neuromuscular block, whereas EMG-based monitoring may provide a safer approach. The EMG-derived parameter T1% appears promising but requires further validation before routine clinical use.</p>","PeriodicalId":7750,"journal":{"name":"Anaesthesiology intensive therapy","volume":"58 1","pages":"172-178"},"PeriodicalIF":2.3,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148811827","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":"Persistent inflammation, immunosuppression, and catabolism are associated with impaired lymphocytic mitochondrial metabolism during the early phase of sepsis. A single-center, prospective cohort study.","authors":"Wagner Nedel, Afonso Kopczynski de Carvalho, Marcelo S Rodolphi, Vitória Girelli de Oliveira, Bruna Valdameri, Gabriela Soares Herasinczuk, Maria Eduarda Pinko, Luis Valmor Portela","doi":"10.5114/ait/222713","DOIUrl":"10.5114/ait/222713","url":null,"abstract":"<p><strong>Background: </strong>Lymphopenia and lymphocytic metabolism have been individually associated with poor prognosis in sepsis; however, the relationship between these factors remains poorly understood. We evaluated whether lymphocyte count and lymphocytic mitochondrial metabolism are associated with the development of persistent inflammation, immunosuppression, and catabolic syndrome (PICS).</p><p><strong>Methods: </strong>A prospective cohort study was conducted in four clinical-surgical intensive care units (ICUs). We included critically ill patients with sepsis requiring vasopressor support and assessed mitochondrial metabolism in isolated lymphocytes, including Complex I- and II-linked respiration, at sepsis diagnosis (day 1) and on day 3. Absolute lymphocyte counts and derived ratios, e.g., neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), were evaluated at the same time points. The primary outcome was the association between mitochondrial respiratory function and PICS. Secondary outcomes included associations between lymphocyte counts, derived biomarkers, and mitochondrial respiration.</p><p><strong>Results: </strong>We included 64 patients, 10 of whom developed PICS. At sepsis diagnosis, patients who did not develop PICS exhibited significantly higher Complex I and II-linked respiration compared with those who did (mean difference [MD] for Complex I: 115 pmol O₂ s-1 10-6 cells; 95% CI: 13-291; P = 0.01; MD for Complex II: 171 pmol O₂ s-1 10-6 cells; 95% CI: 31-397; P = 0.01). No significant differences were observed in the delta (day 3 minus day 1) mitochondrial respiration or lymphocyte count between the PICS and non-PICS groups. Additionally, lymphocyte counts and derived ratios showed no significant correlation with Complex I or II respiration, even when stratified by quartiles across time points.</p><p><strong>Conclusions: </strong>Our findings suggest that reduced mitochondrial Complex I- and II-linked respiration in lymphocytes at sepsis onset may be associated with the development of PICS. Nevertheless, this association remains exploratory and requires confirmation in larger, adequately powered studies.</p>","PeriodicalId":7750,"journal":{"name":"Anaesthesiology intensive therapy","volume":"58 1","pages":"164-171"},"PeriodicalIF":2.3,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148811832","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":"Effect of evaluation prompt strategies on LLM-as-a-judge reliability in critical care.","authors":"Jia-Yu Yan, Wing-Sum Chan, Ching-Tang Chiu, Anne Chao, Po-Ni Hsiao, Shih-Chi Ku, Yu-Chang Yeh","doi":"10.5114/ait/221943","DOIUrl":"10.5114/ait/221943","url":null,"abstract":"<p><strong>Introduction: </strong>Large language model (LLM)-as-a-judge systems offer scalable evaluation of artificial intelligence (AI)-generated clinical outputs, yet their susceptibility to prompt variability raises concerns regarding reproducibility and alignment with expert judgement. This study examined whether evaluation prompt strategies influence scoring patterns and concordance with clinical raters in critical care.</p><p><strong>Material and methods: </strong>This post-hoc analysis used 90 structured clinical reports generated in a prior study using an XGBoost ICU mortality prediction model trained on the MIMIC-IV database. GPT-4o (Azure AI, version 2024-11-20) produced structured interpretations from risk estimates and SHAP attributions. These outputs were evaluated using the IMPACT framework under three evaluation prompt strategies: baseline (E1), top-down decremental (E2), and bottom-up incremental (E3). Agreement between clinician ratings and the automated o3-mini evaluator (Azure AI, version 2025-01-31) was assessed using intraclass correlation coefficients (ICC), with strategy comparisons by Fisher's z-transformation. Score deviations were examined with repeated-measures ANOVA.</p><p><strong>Results: </strong>Mean IMPACT scores were 79.9 (SD 9.9) for E1, 83.3 (SD 9.6) for E2, 78.7 (SD 9.1) for E3, and 78.6 (SD 8.9) for clinicians. All strategies demonstrated substantial agreement (ICC > 0.80). E2 showed significantly lower agreement with clinicians (ICC = 0.82) than E1 and E3 (both ICC = 0.94, p < 0.001). Score deviations differed significantly across strategies (p < 0.001), with E3 showing the smallest mean deviation (0.1) and E2 the largest (4.7).</p><p><strong>Conclusions: </strong>Prompt design meaningfully affects both IMPACT scoring patterns and the reliability of LLM-based evaluators. Bottom-up incremental scoring showed the closest alignment with human assessment, underscoring the need for standardised prompt architectures in clinical AI evaluation.</p>","PeriodicalId":7750,"journal":{"name":"Anaesthesiology intensive therapy","volume":"58 1","pages":"156-163"},"PeriodicalIF":2.3,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148811766","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":"Consensus statement of the Paediatric Anaesthesiology and Intensive Therapy Section of the Polish Society of Anaesthesiology and Intensive Therapy on the use of VV ECMO in paediatric patients for the treatment of acute respiratory failure.","authors":"Jowita Rosada-Kurasinska, Alicja Bartkowska-Śniatkowska, Marzena Zielińska, Małgorzata Mikaszewska-Sokolewicz, Bartłomiej Kociński, Remigiusz Jaśkiewicz, Izabela Pagowska-Klimek","doi":"10.5114/ait/221596","DOIUrl":"10.5114/ait/221596","url":null,"abstract":"<p><p>Extracorporeal membrane oxygenation (ECMO) is widely used in paediatric cardiac surgery units. Over recent years, interest in ECMO has grown among anaesthesiologists working in paediatric intensive care units. The indication for ECMO therapy is respiratory or cardiopulmonary failure in which, despite high inspired oxygen concentrations, advanced ventilator strategies and optimisation of the patient's condition, persistent hypoxaemia and hypercapnia carry a risk of further deterioration and death. This consensus statement of Paediatric Anaesthesiology and Intensive Therapy Section of the Polish Society of Anaesthesiology and Intensive Therapy provides recommendations on the use of veno-venous ECMO in paediatric patients in Poland, with the aim of improving outcomes in severe respiratory failure and facilitating appropriate selection of patients for ECMO support.</p>","PeriodicalId":7750,"journal":{"name":"Anaesthesiology intensive therapy","volume":"58 1","pages":"137-155"},"PeriodicalIF":2.3,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13384215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403446","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":"Exploration of tracheal tube contact pressure and simplified risk indicators for postoperative laryngopharyngeal discomfort: a prospective pilot study.","authors":"Li Fang Wang, Nan Liang, Meng Tao Zheng, Hao Ning Ma, Jiang Shan Huang, Guo Hui Fan, Jing Zhao, Wei Xia Li","doi":"10.5114/ait/221781","DOIUrl":"10.5114/ait/221781","url":null,"abstract":"<p><strong>Background: </strong>Postoperative laryngopharyngeal discomfort (POLPD) is a common yet undermanaged complication after tracheal extubation. While mechanical pressure from the endotracheal tube is implicated, quantitative data linking tube-tissue contact pressure to POLPD are lacking. This study aimed to establish a quantitative relationship between tracheal tube contact pressure and POLPD, while identifying bedside applicable, simplified clinical risk indicators.</p><p><strong>Methods: </strong>In this prospective observational study, 89 patients undergoing elective surgery (≥ 2 hours) were enrolled. We adapted a T-scan III occlusal analysis system to measure tracheal tube pressure distribution at four intraoperative timepoints. POLPD was defined as a composite endpoint including severe pharyngalgia (NRS ≥ 4), profound dysphagia (bedside water swallow test ≥ 4), or prominent tongue edema.</p><p><strong>Results: </strong>POLPD incidence was 39.1%. Multivariate analysis identified two independent risk profiles: female with narrow pharyngeal cavity (OR 3.26, 95% CI: 2.1-4.87, P < 0.001) and prone position with non-neutral O-C2 angle (OR 1.94, 95% CI: 1.34-2.81, P < 0.001). The POLPD group had significantly higher tracheal tube pressures. A pressure-overload index independently predicted POLPD (OR 1.17, 95% CI: 1.01-1.37, P = 0.041), demonstrating a dose-response relationship.</p><p><strong>Conclusions: </strong>This study provides quantitative evidence linking tracheal tube contact pressure to POLPD. Two simplified clinical risk indicators were identified: \"lady overweight, chin looks short, snore at night, airway's tight\" (female with narrow pharyngeal cavity) and \"neck bent too far\" (prone with non-neutral O-C2 angle). Real-time pressure monitoring is a promising target for future airway protection.</p>","PeriodicalId":7750,"journal":{"name":"Anaesthesiology intensive therapy","volume":"58 1","pages":"127-136"},"PeriodicalIF":2.3,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13384216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403242","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":"N-ethyl-pentedrone poisoning as a cause of serotonin syndrome and gastrointestinal bleeding: a case report and literature review.","authors":"Barbara Potocka-Banaś, Krzysztof Kowalik, Artur Teżyk, Aleksander Budny, Tomasz Janus","doi":"10.5114/ait/221780","DOIUrl":"10.5114/ait/221780","url":null,"abstract":"","PeriodicalId":7750,"journal":{"name":"Anaesthesiology intensive therapy","volume":"58 1","pages":"121-126"},"PeriodicalIF":2.3,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13384222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148209985","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}