Anestesia y reanimación cardiovascular

J Clin Med. 2025 Sep 3;14(17):6236. doi: 10.3390/jcm14176236.

ABSTRACT

Background: Spinal anesthesia is a widely used technique for pain control in surgical procedures, requiring effective drug distribution within the cerebrospinal fluid (CSF) for optimal outcomes. The distribution is influenced by injection parameters such as needle diameter and injection speed, which, if not optimized, can reduce efficacy or cause side effects. This study investigates how these parameters affect drug distribution in the CSF using computational fluid dynamics (CFD). Material Methods: An anatomically accurate three-dimensional model of the CSF space was created using MRI data. Simulations were performed using three needle tips (22 G, 25 G, 27 G) and different injection rates at the L4-L5 vertebral level. The model included physiological CSF oscillations from cardiac and respiratory cycles. Drug dispersion was analyzed in terms of spatial distribution and concentration changes over time. Results: The findings obtained show that the combination of a large-gauge needle (22G) and high injection speed provides wider distribution within the CSF and more effective transport to the cranial regions. On the other hand, with a small-gauge needle (27G) and low injection speed, the drug remained more localized, and access to the upper spinal regions was limited. Additional parameters such as injection duration, direction, and flush applications were also observed to significantly affect distribution. Conclusions: CFD modeling reveals that injection parameters significantly affect drug dispersion patterns in spinal anesthesia. Optimizing these parameters may improve therapeutic outcomes and reduce complications. The model provides a foundation for developing personalized intrathecal injection protocols.

PMID:40943995 | PMC:PMC12429119 | DOI:10.3390/jcm14176236

J Clin Med. 2025 Aug 28;14(17):6080. doi: 10.3390/jcm14176080.

ABSTRACT

Background/Objectives: Perioperative organ injury (POI) is frequently observed following hepatectomy as acute kidney injury (AKI), perioperative myocardial injury (PMI), or both. We aimed to determine the incidences of POI, PMI, and AKI, reveal the risk factors and predictive tools for POI occurrence, and evaluate the relationship between POI and patient outcomes. Methods: This was a single-center historical cohort study of consecutive patients. The primary endpoint was the occurrence of POI within 3 days following hepatectomy. Results: Out of 128 patients, POI, PMI, and AKI occurred in 48 (37.5%), 36 (28.1%), and 23 (18%) patients, respectively. Ten (7.8%) patients suffered from both PMI and AKI. The presence of chronic kidney disease or systolic/valvular heart disease, fluid balance more than 365 mL/h, and intraoperative bleeding more than 950 mL were the risk factors for POI. A tool created by using the intraoperative decline of central venous oxygen saturation and lactate value during skin closure performed well in predicting POI (area under the ROC curve: 0.79, p < 0.001). In patients with POI, the number of those who needed intensive care unit (ICU) follow-up for more than 1 day was significantly higher (21% vs. 6%, p: 0.01). The length of hospital stay for these patients was significantly longer as well (11 (8-18) vs. 9 (7-13) days, p: 0.02). Two patients (20% of 10 patients who suffered from both AKI and PMI) died in the 90-day follow-up. Conclusions: POI is a common complication following hepatectomy and is associated with longer hospital and ICU stays. Patients who suffer from both AKI and PMI have a higher risk of mortality.

PMID:40943838 | PMC:PMC12429616 | DOI:10.3390/jcm14176080

J Cardiothorac Vasc Anesth. 2025 Aug 18:S1053-0770(25)00673-1. doi: 10.1053/j.jvca.2025.08.026. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the impact of perioperative blood pressure variability (BPV) on cardiovascular outcomes and mortality in cardiac surgery patients.

METHODS: Literature searches were performed across scientific databases up to December 31, 2024. Studies reporting perioperative BPV in patients undergoing cardiac surgery and its association with mortality and clinical outcomes were included.

RESULTS: Fifteen studies with 16,407 patients were included. Increased BPV was significantly associated with higher rates of 30-day mortality, acute kidney injury (AKI), prolonged intensive care unit stay, and cognitive dysfunction. Among patients with fewer comorbidities and perioperative risk, 30-day mortality ranged from 0.2% to 0.5%, while in patients with higher risk, it increased from 42.4% to 60.7% (p < 0.001). Elevated BPV was linked to a 23.2% higher risk of AKI per unit increase in blood pressure (BP) standard deviation (SD) and a 15% increased incidence of postoperative delirium. The findings emphasize the critical need for precise perioperative BP control, with advanced metrics like BP fragmentation providing valuable insights into patient risk.

CONCLUSIONS: Perioperative BPV appears to be a crucial factor influencing postoperative outcomes in cardiac surgery patients. Effective management of BPV may help reduce complications and improve patient outcomes, highlighting the potential benefits of tailored hemodynamic strategies. However, further research is needed to establish standardized BPV thresholds and optimal management approaches.

PMID:40940247 | DOI:10.1053/j.jvca.2025.08.026

Turk Gogus Kalp Damar Cerrahisi Derg. 2025 Jul 21;33(3):321-328. doi: 10.5606/tgkdc.dergisi.2025.27656. eCollection 2025 Jul.

ABSTRACT

BACKGROUND: In this review, we discuss the risk factors of intraabdominal hypertension developing after cardiac surgery.

METHODS: We used records from electronic databases (PubMed, Scopus, Web of Science and Ovid) between 1980 and 2025. All studies in which possible pre- and intraoperative risk factors (age, sex, hypertension, diabetes mellitus, lung disease, coronary artery bypass grafting, body mass index and, cardiopulmonary bypass duration) were recorded were included in the analysis. The results of the studies were evaluated with a random or fixed effect model depending on the presence of heterogeneity (I2 >25%).

RESULTS: A total of 4,286 articles were found from the database search. After analyzing the abstract and full texts, six articles which met the inclusion criteria and covered 696 patients were included in the analysis. The overall rate of intraabdominal hypertension was 44.68%. Age (standardized mean difference [SMD]: 0.303, 95% confidence interval [CI]: 0.123-0.484, p<0.001), hypertension (odds ratio [OR]=0.524, 95% CI: 0.087-0.960, p=0.019), body mass index (SMD: 0.532, 95% CI: 0.004-1.061, p=0.048), and cardiopulmonary bypass duration (SMD: 0.545, 95% CI: 0.184-0.907, p=0.003) were preoperative risk factors.

CONCLUSION: The patient's age, hypertension, body mass index, and duration of cardiopulmonary bypass are the risk factors for the development of intraabdominal hypertension after cardiac surgery. However, larger studies are needed to avoid heterogeneity of results.

PMID:40936981 | PMC:PMC12421560 | DOI:10.5606/tgkdc.dergisi.2025.27656

Turk J Med Sci. 2025 Apr 17;55(4):868-876. doi: 10.55730/1300-0144.6039. eCollection 2025.

ABSTRACT

BACKGROUND/AIM: The aim of our study was to determine which preoperative bleeding risk scoring system is more sensitive in predicting perioperative transfusion requirement in patients undergoing open-heart surgery.

MATERIALS AND METHODS: This is a retrospective single-center cohort study. Seven scoring systems (TRACK, PAPWORTH, WILL-BLEED, CRUSADE, ACTION, TRUST, ACTA-PORT) were used to predict the likelihood of perioperative erythrocyte suspension (ES) transfusion requirement.

RESULTS: Four hundred patients were enrolled in the study. Age, creatinine level, and diagnoses of diabetes mellitus and hypertension were significantly higher in patients who required ES (p < 0.05). In addition, ejection fraction percentages and hemoglobin and hematocrit levels were significantly lower (p < 0.05). Except for PAPWORTH; ACTION, ACTA-PORT, WILL-BLEED, TRACK, TRUST, and CRUSADE scores were higher in the ES group (p < 0.05), but the most predictive scoring system for ES use was TRUST.

CONCLUSION: The ACTION and ACTA-PORT systems were also found to significantly predict ES use, but the WILL-BLEED, TRUST, and TRACK systems were found to be more predictive of bleeding and ES transfusion requirement in CABG operations. Furthermore, low EF, Hb, and Hct levels, higher creatinine levels, and the presence of DM were identified as individual risk factors for perioperative bleeding, apart from the scoring systems.

PMID:40933962 | PMC:PMC12419046 | DOI:10.55730/1300-0144.6039

Cardiol Young. 2025 Sep 11:1-7. doi: 10.1017/S1047951125109517. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to evaluate the predictive accuracy of Paediatric Risk of Mortality-III, Paediatric Index of Mortality-II, and Paediatric Logistic Organ Dysfunction scoring systems for major adverse events following congenital heart surgery.

METHODS: This prospective observational study included patients under 18 years of age who were admitted to the ICU for at least 24 hours postoperatively following congenital heart surgery. Major adverse events were defined as a composite of 30-day mortality, ICU readmission, reintubation, acute neurologic events, requirement for extracorporeal membrane oxygenation, cardiac arrest requiring cardiopulmonary resuscitation, need for a permanent pacemaker, acute kidney injury, or unplanned reoperation.

RESULTS: A total of 116 patients, with a median age of 17.5 months (interquartile range: 5.4-60.0) were included in the study. Major adverse events occurred in 34 patients (29.3%). Paediatric Risk of Mortality-III (11.5 [8.0-18.8] vs. 7.0 [2.3-11.0]; p = 0.001), Paediatric Index of Mortality-II (3.8 [2.8-6.6] vs. 2.2 [1.7-2.8]; p < 0.001), and Paediatric Logistic Organ Dysfunction (12.0 [10.0-21.0] vs. 1.0 [1.0-10.0]; p < 0.001) scores were significantly higher in patients with major adverse events than in those without. The Paediatric Logistic Organ Dysfunction score (area under the curve 0.83; 95% confidence interval: 0.74-0.92) demonstrated the highest discrimination capacity compared to Paediatric Risk of Mortality-III (area under the curve 0.70; 95% confidence interval: 0.60-0.81) and Paediatric Index of Mortality-II (area under the curve 0.77; 95% confidence interval: 0.66-0.88) with good calibration (Hosmer-Lemeshow p > 0.05 for all). Based on the logistic regression model evaluation metrics, Paediatric Logistic Organ Dysfunction demonstrated better performance in predicting major adverse events compared with Paediatric Risk of Mortality-III and Paediatric Index of Mortality-II.

CONCLUSIONS: The Paediatric Logistic Organ Dysfunction score outperformed the Paediatric Index of Mortality-II and Paediatric Risk of Mortality-III scores in predicting major adverse events in paediatric patients admitted to the ICU after congenital heart surgery.

PMID:40931679 | DOI:10.1017/S1047951125109517

Can Respir J. 2025 Aug 28;2025:3647362. doi: 10.1155/carj/3647362. eCollection 2025.

ABSTRACT

Background: Chronic obstructive pulmonary disease (COPD) is an increasing cause of morbidity and mortality worldwide, and acute exacerbations are the major health issues in COPD patients. In this study, we aimed to investigate the role of the delta neutrophil index (DNI) with other hematologic parameters in managing and guiding COPD patients admitted with acute exacerbations. Methods: In this retrospective study, COPD patients treated internally in pulmonology clinic, intensive care unit, and anesthesiology and reanimation unit with acute exacerbation between May 2021 and December 2023 were investigated. Records from daily visits were evaluated retrospectively. Patients were divided into two groups according to the causative organism: bacterial or nonbacterial. Results: Patients with cardiac failure were found to have significantly higher median DNI values (p : 0.026), whereas patients with other comorbidities that were not individually recorded have substantially lower median DNI values (p : 0.026). White blood cell (WBC), neutrophil, immature granulocyte values (both absolute value and percent), thrombocyte, platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR), C-reactive protein (CRP), procalcitonin, positive blood culture, positive systemic inflammatory response syndrome (SIRS) criteria, and sepsis were significantly higher in patients with bacterial acute exacerbation. Hospitalization duration was also significantly longer in the same group (p : 0.006). No statistically significant correlation was found between median DNI values and early mortality rate (within 28 days), readmission within 30 days and 6 months. Conclusion: In this study, we have shown that the serum procalcitonin level, WBC, NLR, and PLR measurement can be used to distinguish bacterial and nonbacterial COPD exacerbations. The DNI revealed no prognostic predictive value regarding early mortality, mechanic ventilation need, or readmission in 30 days and 6 months.

PMID:40917823 | PMC:PMC12411038 | DOI:10.1155/carj/3647362

Pathol Res Pract. 2025 Sep 5;275:156193. doi: 10.1016/j.prp.2025.156193. Online ahead of print.

ABSTRACT

AIM: This study aims to evaluate the effects of bupivacaine on acute kidney injury (AKI) through kidney function parameters and cardiac tissue damage via TRPM2, HSP70, TLR4, NF-κB, and TNF-α biomarkers.

MATERIAL AND METHOD: Male Wistar albino rats were divided into 4 groups, with seven rats in each group: Control group, AKI group (kidney damage induced by glycerol), AKI + L group (group treated with bupivacaine), and L group (group treated with bupivacaine alone). At the end of the experiment, kidney and heart tissues were collected for histological analysis, and serum samples were taken for biochemical analysis. In serum samples, urea nitrogen (BUN), creatinine (Cr), troponin t, Creatine Kinase, Creatine Kinase-MB, and total oxidant levels were measured. In histological analysis, changes in heart and kidney tissues were evaluated histopathologically and immunohistochemically through KIM-1, TNF-α, TRPM2, HSP70, NF-κB, and TLR4 parameters.

RESULTS: In the AKI group, a significant increase in blood urea nitrogen (BUN) and creatinine (CR) levels was observed when compared to the control group (p < 0.05). Notably, in the AKI + Local Anesthetic (L) group, these levels were found to be elevated compared to the AKI group. KIM-1 and TNF-α immunoreactivity in kidney tissue were both significantly elevated in the AKI group compared with the Control group, and further increased in the AKI + L group compared with the AKI group. In heart tissues, significant increases in the immunoreactivity levels of TLR4, NF-κB, TNF-α, HSP70, and TRPM2 were observed in the AKI + L group relative to the AKI group (p < 0.05). Moreover, in the AKI + L group, the extent of histopathological damage was found to be more severe compared to the AKI group (p < 0.05).

CONCLUSION: This study demonstrates that bupivacaine exacerbates acute kidney injury and leads to significant histopathological changes in kidney function and heart tissue parameters. It was observed that bupivacaine might affect cardiac conduction, impairing heart functions, and lead to changes in molecular pathways such as KIM-1, TNF- α, TRPM2, HSP70, TLR4, and NF-κB. Furthermore, the increase of oxidant levels and biomarker levels suggest that bupivacaine may induce oxidative stress and inflammation, leading to damage in both kidney and heart tissues.

PMID:40915012 | DOI:10.1016/j.prp.2025.156193

Cardiol Young. 2025 Sep;35(9):1824-1843. doi: 10.1017/S1047951125100565. Epub 2025 Sep 5.

ABSTRACT

OBJECTIVE: Chronic pulmonary regurgitation following tetralogy of Fallot repair burdens the right ventricle. This study evaluated early outcomes of pulmonary valve reconstruction using right atrial tissue versus standard transannular patch repair.

METHODS: A retrospective analysis of 412 tetralogy of Fallot patients (2014-2024) was conducted: Atrial Valve Group (n = 205) underwent valve reconstruction; No-Valve Group (n = 207) received standard repair. Patients were followed for 1 year with echocardiographic assessments. Outcomes included right ventricular insufficiency, ventilation duration, and ICU stay.

RESULTS: Atrial Valve Group had lower right ventricular insufficiency at 12 months (9.3% vs. 19.8%, p = 0.004, OR = 2.39, 95% CI: 1.32-4.33), shorter ventilation times (6.1 vs. 18.0 hours, p < 0.001, Cohen's d = 3.54), and reduced ICU stays (3.0 vs. 5.7 days, p < 0.001, Cohen's d = 1.87), despite longer CPB durations (47.1 vs. 40.5 minutes, p = 0.02).

CONCLUSIONS: Right atrial tissue reconstruction reduces early and intermediate-term right ventricular dysfunction post-tetralogy of Fallot repair. Long-term studies are needed.

PMID:40908924 | DOI:10.1017/S1047951125100565

Biology (Basel). 2025 Aug 1;14(8):973. doi: 10.3390/biology14080973.

ABSTRACT

Systematic reviews are a cornerstone of evidence-based research, providing comprehensive summaries of existing studies to answer specific research questions. This article offers a detailed guide to conducting high-quality systematic reviews in biology, health and social sciences. It outlines key steps, including developing and registering a protocol, designing comprehensive search strategies, and selecting studies through a screening process. The article emphasizes the importance of accurate data extraction and the use of validated tools to assess the risk of bias across different study designs. Both meta-analysis (quantitative approach) and narrative synthesis (qualitative approach) are discussed in detail. The guide also highlights the use of frameworks, such as GRADE, to assess the certainty of evidence and provides recommendations for clear and transparent reporting in line with the PRISMA 2020 guidelines. This paper aims to adapt and translate evidence-based review principles, commonly applied in clinical research, into the context of biological sciences. By highlighting domain-specific methodologies, challenges, and resources, we provide tailored guidance for researchers in ecology, molecular biology, evolutionary biology, and related fields in order to conduct transparent and reproducible evidence syntheses.

PMID:40906182 | PMC:PMC12383630 | DOI:10.3390/biology14080973

Pharmaceuticals (Basel). 2025 Aug 8;18(8):1173. doi: 10.3390/ph18081173.

ABSTRACT

Background: Remifentanil, an ultra-short-acting μ-receptor agonist, is used with propofol or thiopental for tracheal intubation without muscle relaxants. While effective with both, its combination with thiopental provides better hemodynamic stability. Thiopental has long been a standard intravenous agent for anaesthesia induction and remains a cost-effective alternative to propofol in resource-limited settings. To date, no study has directly compared the effects of thiopental-remifentanil and propofol-remifentanil combinations on LMA insertion conditions. This study aims to compare the effects of thiopental or propofol with 2 µg·kg-1 remifentanil on laryngeal mask airway (LMA) insertion conditions and success in a prospective, randomised double-blind study. Method: The study included 80 premedicated ASA I-II patients, aged 18-65, randomised into Group P (propofol) and Group T (thiopental). Anaesthesia induction was with 2 μg·kg-1 remifentanil, followed by 5 mg·kg-1 thiopental or 2.5 mg·kg-1 propofol. LMA insertion occurred 90 s post-induction. LMA insertion conditions were evaluated using a six-variable scale. Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), and bispectral index monitor (BIS) values were recorded at baseline, 1 min pre-insertion, and at 1, 2, 3, 4, and 5 min after insertion. Apnoea duration, loss of eyelash reflex duration, insertion duration, number of attempts, and perioperative complications were also documented. Results: Demographic data were similar. Group P showed significantly shorter eyelash reflex loss and LMA insertion durations, longer apnoea duration, and higher rates of full mouth opening, excellent LMA insertion condition, and hypotension or bradycardia compared to Group T (p < 0.05). Group P had significantly lower HR, SAP, DAP, and MAP at various time points (p < 0.05). There were no significant differences in blood presence on LMA, sore throat, or dysphagia (p > 0.05). Conclusions: In our study, administration of 2 μg·kg-1 remifentanil before induction along with thiopental or propofol was shown to provide acceptable LMA insertion conditions at comparable levels. As hemodynamic parameters were less affected, we believe the remifentanil-thiopental combination may be a suitable alternative.

PMID:40872564 | PMC:PMC12389158 | DOI:10.3390/ph18081173

Life (Basel). 2025 Aug 14;15(8):1292. doi: 10.3390/life15081292.

ABSTRACT

Intubated critically ill patients are susceptible to secretion accumulation because of compromised airway clearance. Various airway clearance interventions are employed to prevent complications arising from mucus retention. This Delphi study aims to collect global opinions in an international expert panel of ICU professionals on the usefulness of these various airway clearance interventions. A steering committee performed a literature search informing the formulation of statements. Statements are grouped into two distinct parts: (1) Humidification and Nebulization, and (2) Suctioning and Mucus mobilization techniques. For each part, a diverse panel of 30-40 experts will be selected, with concerted effort to involve experts from various medical specialties involved in airway clearance methods. Multiple choice questions (MCQs) or 7-point Likert-scale statements will be used in the iterative Delphi rounds to reach consensus on various airway clearance interventions. Rounds will continue until stability is achieved for all statements. Consensus will be deemed achieved when a choice in MCQs or a Likert-scale statement achieves ≥75% agreement or disagreement. Starting from the second round of the Delphi process, stability will be assessed using non-parametric χ2 tests or Kruskal-Wallis tests. Stability will be defined by a p-value of ≥0.05.

PMID:40868940 | PMC:PMC12387527 | DOI:10.3390/life15081292

Medicine (Baltimore). 2025 Aug 22;104(34):e43840. doi: 10.1097/MD.0000000000043840.

ABSTRACT

BACKGROUND: Music therapy has been used in medicine to reduce patient stress and to improve mood. This study aimed to evaluate the effects of music therapy on intraoperative hemodynamics and medication requirement and postoperative pain and side effects.

METHODS: Eighty patients with American Society of Anesthesiologists I to II physical status at the ages of 20 to 60 for whom elective thyroidectomy surgery was planned were included in the study. General anesthesia was induced for patients and demographic data were recorded. The patients were randomly divided into 2 groups. The groups were determined as music group (group M) and control group (group C). The intraoperative vital signs of the patients (heart rate, blood pressure, and oxygen saturation), bispectral index values, train-of-four neuromuscular monitoring values, additional opioid and muscle relaxant requirements, and complications were recorded.At the end of the operation, extubation was performed following standard decurarization using atropine and neostigmine. The 0th hour, 3rd hour and 6th hour visual analogue scale scores of the patients were measured and recorded.

RESULTS: Intraoperative fentanyl and rocuronium consumption were found to be approximately 23% lower in group M compared to group C (P < .05).The bispectral index values of the patients were similar between the groups (P > .05). It was also observed that the postoperative pain levels of the group M were lower (P < .05). Music therapy was determined to not create a difference in terms of the blood pressure, heart rate, and saturation (SpO2) levels during recovery from anesthesia (P > .05).

CONCLUSIONS: Playing music, which is a non-pharmacological intervention, is an effective method without a side effect that not only reduces the intraoperative need for muscle relaxant and analgesic use but also causes positive effects on postoperative visual analogue scale scores.

PMID:40859508 | PMC:PMC12384971 | DOI:10.1097/MD.0000000000043840

Sci Rep. 2025 Aug 26;15(1):31479. doi: 10.1038/s41598-025-12560-z.

ABSTRACT

Neurological disorders are increasingly prevalent in developing countries, particularly in sub-Saharan Africa. However, data regarding the epidemiology of these conditions in Somalia remain limited. This study aims to analyze the patterns of neurological diagnoses among patients admitted to the neurology department of a tertiary referral hospital in Mogadishu, Somalia. We conducted a retrospective cross-sectional study at Somalia's largest referral hospital in Mogadishu between July 2019 and July 2024. Data were extracted from electronic medical records of adult patients admitted with neurological conditions to the neurology ward, emergency department, and general intensive care units. Pediatric and trauma-related admissions were excluded. Descriptive statistics, Pearson chi-square tests, binary logistic regression, and Kaplan-Meier survival analysis were employed to assess the distribution of neurological diagnoses and factors associated with in-hospital mortality. A total of 2,126 patients were included in the study. The mean age was 56.03 ± 19.07 years (range: 18-98 years), and the majority were male (n = 1,274; 60%). Most admissions originated from the emergency department (n = 1,741; 82%). Over half of the patients had at least one comorbidity (n = 1,329; 62.5%), with hypertension being the most common (n = 654; 31%), followed by diabetes mellitus (n = 175; 8.2%), epilepsy (n = 138; 6.5%), heart disease (n = 118; 5.6%), and previous stroke or transient ischemic attack (TIA) (n = 67; 3.2%). The leading neurological diagnoses were ischemic stroke (n = 905; 42.6%), hemorrhagic stroke (n = 552; 26%), epileptic disorders (n = 166; 7.8%), cerebral venous thrombosis (n = 138; 6.5%), non-traumatic subarachnoid hemorrhage (n = 92; 4.2%), and Guillain-Barré syndrome (n = 47; 2.2%). Intrahospital mortality was recorded in 342 patients (23%). Poor survival outcomes were significantly associated with advanced age, comorbidities, multiple diagnoses, low Glasgow Coma Scale (GCS) scores, and ICU admission, underscoring the importance of early detection and targeted interventions to reduce mortality. This study represents the first comprehensive assessment of neurological admissions in Mogadishu, Somalia-a region with limited healthcare resources. Cerebrovascular diseases and epileptic disorders were the most common diagnoses. The high in-hospital mortality rate emphasizes the urgent need to strengthen preventative and therapeutic strategies targeting non-communicable neurological diseases in low-resource settings.

PMID:40858641 | PMC:PMC12381066 | DOI:10.1038/s41598-025-12560-z

JAMA Netw Open. 2025 Aug 1;8(8):e2527443. doi: 10.1001/jamanetworkopen.2025.27443.

ABSTRACT

IMPORTANCE: Posttraumatic growth (PTG) refers to positive psychological changes following adversity, including deeper relationships and a greater appreciation for life.

OBJECTIVE: To assess PTG among intensive care unit (ICU) health care professionals 4 years after the COVID-19 pandemic and explore its association with resilience, anxiety, and depression.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study invited ICU health care professionals (nursing staff, medical staff [residents, interns, clinical fellows, and senior intensivists], and other professionals providing patient care) in ICUs in general or university-affiliated hospitals in France and Belgium to complete online questionnaires between March 15 and May 15, 2024.

EXPOSURES: PTG, resilience, anxiety, and depression.

MAIN OUTCOMES AND MEASURES: The primary outcome was PTG, and secondary outcomes were anxiety, depression, and resilience. Participants completed validated self-reported questionnaires, including the Posttraumatic Growth Inventory (PTGI), Hospital Anxiety and Depression Scale (HADS), and 10-item Connor-Davidson Resilience Scale (CD-RISC 10). Visual analog scales (VASs) assessed professional experiences and psychological impact. Multivariate linear regression identified factors associated with PTG.

RESULTS: Among 1371 health care professionals in 23 ICUs, 850 (62%) responded (median age, 39 years [IQR, 32-46 years]; 574 [68%] women). The median PTGI score was 50 (IQR, 33-64), with nursing staff reporting higher PTG than medical staff (51 [IQR, 34-65] vs 47 [IQR, 28-61]; P = .02), mainly in personal strength, spiritual change, and appreciation of life. Anxiety and depression symptoms were present in 492 respondents (58%) and 219 respondents (26%), respectively. Lower PTG was associated with psychological fatigue (regression coefficient, 1.43; 95% CI, 0.91-1.96; P < .001), ICU conflicts (regression coefficient, 0.62; 95% CI, 0.05-1.19; P = .03), and perceived deterioration in family-centered care (regression coefficient, -7.47; 95% CI, -1.10 to -13.80; P = .02). Higher PTG was correlated with higher resilience (Spearman correlation coefficient, 0.24; 95% CI, 0.17-0.30; P < .001) and was associated with a change in personal life since the pandemic (regression coefficient, 1.80 [95% CI, 1.13-2.47] per VAS point; P < .001).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study performed 4 years after the start of the COVID-19 pandemic, ICU health care professionals, particularly nursing staff, exhibited significant PTG. Resilience, rather than psychological distress, emerged as a key driver of PTG, and deterioration in family-centered care was a major contributing factor, underscoring the need for targeted well-being and resilience-building strategies to enhance health care professionals' mental health and professional fulfillment while also improving patient and family care.

PMID:40853660 | PMC:PMC12379108 | DOI:10.1001/jamanetworkopen.2025.27443

Anesth Analg. 2025 Aug 19. doi: 10.1213/ANE.0000000000007710. Online ahead of print.

NO ABSTRACT

PMID:40853224 | DOI:10.1213/ANE.0000000000007710

J Cardiothorac Vasc Anesth. 2025 Jul 23:S1053-0770(25)00619-6. doi: 10.1053/j.jvca.2025.07.027. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare the analgesic efficacy of anesthesiologist-performed ultrasound-guided superficial parasternal intercostal plane block (SPIPB) and surgeon-performed deep parasternal intercostal plane block (DPIPB) in patients undergoing coronary artery bypass grafting (CABG) via median sternotomy.

DESIGN: A prospective, randomized, single-blind clinical trial.

SETTING: A single, tertiary care university hospital.

PARTICIPANTS: Seventy-five participants (aged 45-80 years, ASA III-IV) scheduled for elective isolated CABG surgery.

INTERVENTIONS: Participants were randomly assigned to the SPIPB, DPIPB, or control groups. Regional blocks were performed either under ultrasound guidance after sternal closure and sterilization of the surgical site (SPIPB) or intraoperatively under direct vision (DPIPB). Postoperative pain was managed with multimodal analgesia protocols.

MEASUREMENTS AND MAIN RESULTS: Outcomes included pain scores and tramadol administration at the 1st, 4th, 12th, and 24th postoperative hours, as well as after extubation. The cumulative 24-hour tramadol administration (primary outcome) was significantly lower in the DPIPB group (95 ± 44 mg) compared with the SPIPB (141 ± 58 mg) and control groups (176 ± 61 mg) (p < 0.001). Compared with the control group, the DPIPB group had a significantly reduced likelihood of requiring high-dose tramadol (odds ratio [OR]: 0.18, 95% confidence interval [CI]: 0.06-0.56, p = 0.003). The SPIPB group showed an intermediate effect compared with control (OR: 0.52, 95% CI: 0.23-1.18, p = 0.095). When directly compared, DPIPB was associated with significantly lower tramadol use than SPIPB (OR: 0.34, 95% CI: 0.16-0.72, p < 0.001). Pain scores at all time points were significantly lower in both block groups compared with control (p < 0.05), with DPIPB showing the most pronounced effect. No block-related complications were observed.

CONCLUSIONS: Both parasternal intercostal blocks improved postoperative analgesia compared with standard care. The SPIPB was performed under ultrasound guidance, whereas the DPIPB was applied under direct vision by the surgeon. The DPIPB demonstrated superior opioid-sparing effects and improved dynamic pain control. These findings support the use of parasternal fascial plane blocks, whether performed under ultrasound guidance or direct vision, as effective components of multimodal analgesia in cardiac surgery.

PMID:40841230 | DOI:10.1053/j.jvca.2025.07.027

Intensive Care Med. 2025 Oct;51(10):1784-1796. doi: 10.1007/s00134-025-08089-4. Epub 2025 Aug 21.

ABSTRACT

PURPOSE: Inflammatory phenotypes of acute respiratory distress syndrome (ARDS) can predict patient outcomes and potentially response to treatment. The aim was to assess whether inflammatory phenotypes can be characterized over time using clinical surrogate data and used to guide therapy with corticosteroids.

METHODS: Individual patient data and biomarkers from six multicenter randomized controlled trials (development, n = 1207; validation, n = 2751) were analyzed to establish an open-source AI Clinical Classifier ( https://bostonmontpelliercare.shinyapps.io/AIClarity ) for inflammatory phenotypes of ARDS using routine clinical data. Then, patients from a retrospective cohort (investigation, n = 5578) underwent classification from baseline to day 30. A discrete-time Bayesian Markov model assessed temporal stability at 3-day intervals. A target trial emulation and longitudinal logistic regression assessed corticosteroid effect on 30-day mortality depending on phenotype.

RESULTS: The AI Clinical Classifier identified 2169 (39%) hyperinflammatory and 3409 (61%) hypoinflammatory patients. 1053 (49%) and 826 (24%) patients died within 30 days, respectively (p < 0.001). Over 30 days, 49%(1072/2169) of hyperinflammatory patients at baseline transitioned to hypoinflammatory, and 7%(229/3409) of hypoinflammatory patients at baseline transitioned to hyperinflammatory (p < 0.001). Phenotypes predicted response to corticosteroids, with lower mortality in hyperinflammatory patients (IPW-weighted hazard ratio [HR]: 0.81 [0.67-0.98], p = 0.033), and higher mortality in hypoinflammatory patients (IPW-weighted HR: 1.26 [1.06-1.50], p = 0.009). At day 3, a positive response to corticosteroids only persisted among patients who remained hyperinflammatory (adjusted odds ratio = 0.51, 95% CI 0.32-0.80, p = 0.004).

CONCLUSION: Characterization of inflammatory ARDS phenotypes using clinical surrogate data allows physicians to monitor patients throughout the course of the disease and guide clinical treatment. Corticosteroids may be beneficial in hyperinflammatory ARDS and harmful in hypoinflammatory ARDS.

PMID:40839098 | DOI:10.1007/s00134-025-08089-4

Intensive Care Med. 2025 Oct;51(10):1749-1763. doi: 10.1007/s00134-025-08058-x. Epub 2025 Aug 19.

ABSTRACT

PURPOSE: This is the third of three parts of the clinical practice guideline from the European Society of Intensive Care Medicine (ESICM) on fluid management in adult critically ill patients. This part addresses fluid removal in the de-escalation phase of shock management.

METHODS: This guideline was formulated by an international panel of clinical experts, methodologists, and patient representatives. A literature search was conducted to identify relevant randomized controlled trials (RCTs) in adults published up to February 2025. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology was applied to evaluate the certainty of evidence and to move from evidence to decision.

RESULTS: Based on data from 13 RCTs, the panel issued three conditional recommendations. The panel suggested de-escalation of fluid therapy over no de-escalation in critically ill adults after the acute phase of fluid resuscitation (low certainty evidence). They suggested protocolized fluid removal by diuretics over usual care in critically ill patients after the acute phase of fluid resuscitation (moderate certainty evidence). A conditional recommendation was issued against the routine use of ultrafiltration or extracorporeal fluid removal in critically ill adults after the acute phase of fluid resuscitation, without other indication for RRT (low certainty evidence). There was limited evidence to comment on fluid removal in specific patient cohorts.

CONCLUSIONS: This ESICM guideline provides three recommendations to inform clinicians on fluid removal during the de-escalation phase in critically ill patients with shock who no longer need fluid resuscitation.

PMID:40828463 | DOI:10.1007/s00134-025-08058-x

Diagnostics (Basel). 2025 Aug 5;15(15):1962. doi: 10.3390/diagnostics15151962.

ABSTRACT

Background/Objectives: Obesity is a major cause of repolarisation defects of the heart. The frontal QRS-T angle is a new parameter used for cardiac evaluation. This study aimed to evaluate the effects of a laparoscopic cholecystectomy and anaesthetic agents on the frontal QRS-T angle in individuals with obesity. Methods: A total of 91 patients who underwent a laparoscopic cholecystectomy surgery were included in this study. The patients were divided into two groups according to body mass index (BMI) < 30 (n = 68) and ≥30 (n = 23). The frontal QRS-T angle (FQRST), QT interval (QT), corrected QT, and other electrocardiography (ECG) findings were recorded at different time points. Results: In the BMI ≥ 30 group, the frontal QRS-T angle and QT interval measured during the intraoperative period were statistically higher than those of the BMI < 30 group (p < 0.001, p < 0.001). Additionally, the frontal QRS-T angle value was statistically higher in all patients postoperatively compared with the preoperative and intraoperative periods (p < 0.001). Furthermore, there was a positive correlation between the BMI and the frontal QRS-T angle. Our study found that the QRS-T angle and the QT interval duration measured during surgery in the BMI ≥ 30 group who underwent a laparoscopic cholecystectomy were significantly higher than in the BMI < 30 group. Conclusions: We recommend close haemodynamic monitoring during and after surgery for patients with obesity undergoing a laparoscopic cholecystectomy.

PMID:40804926 | PMC:PMC12346821 | DOI:10.3390/diagnostics15151962