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Curr J Neurol. 2024 Jul 5;23(3):197-198. doi: 10.18502/cjn.v23i3.17629.

NO ABSTRACT

PMID:40231035 | PMC:PMC11994065 | DOI:10.18502/cjn.v23i3.17629

BioTech (Basel). 2025 Mar 19;14(1):23. doi: 10.3390/biotech14010023.

ABSTRACT

Ischemic heart disease (IHD) is the leading cause of mortality worldwide, underscoring the urgent need for innovative therapeutic strategies. The cardiac extracellular matrix (ECM) undergoes extreme transformations during IHD, adversely influencing the heart's structure, mechanics, and cellular signaling. Researchers investigating the regenerative capacity of the diseased heart have turned their attention to exploring the modulation of ECM to improve therapeutic outcomes. In this review, we thoroughly examine the current state of knowledge regarding the cardiac ECM and its therapeutic potential in the ischemic myocardium. We begin by providing an overview of the fundamentals of cardiac ECM, focusing on the structural, functional, and regulatory mechanisms that drive its modulation. Subsequently, we examine the ECM's interactions within both chronically ischemic and acutely infarcted myocardium, emphasizing key ECM components and their roles in modulating angiogenesis. Finally, we discuss recent ECM-based approaches in biomedical engineering, focusing on different types of scaffolds as delivery tools and their compositions, and conclude with future directions for therapeutic research. By harnessing the potential of these emerging ECM-based therapies, we aim to contribute to the development of novel therapeutic modalities for IHD.

PMID:40227326 | PMC:PMC11940646 | DOI:10.3390/biotech14010023

Am J Transl Res. 2025 Mar 15;17(3):1985-1995. doi: 10.62347/HZWL9608. eCollection 2025.

ABSTRACT

OBJECTIVES: In this study, we evaluated perioperative pain management using the Analgesia Nociception Index (ANI) monitoring in high-risk ASA III-IV patients scheduled for hip surgery. Specifically, we examined the lumbar plexus (LP), sacral plexus (SP), and supra-inguinal fascia iliaca compartment blocks (SIFIB), as well as combinations of SP blocks.

METHODS: In this prospective observational study, we included 74 patients who were assigned to one of two groups: Group L, which received LP and SP blocks, and Group F, which received SIFIB and SP blocks. Surgery was performed after confirming the sensory block with the pinprick test and applying the sedation protocol. Sedation levels were evaluated using the BIS monitor whereas analgesic requirements were assessed using the ANI monitor. Demographic data, including age, sex, ASA score, SpO2, heart rate (HR), mean arterial pressure (MAP), duration of sensorimotor block, type and duration of surgery, time to first analgesic use, and total analgesic consumption, were recorded. Visual analog scale (VAS) scores at 0, 6, 12, and 24 h additional analgesic requirements, and satisfaction ratings from patients and surgeons were also evaluated.

RESULTS: Compared to Group F, Group L presented significantly greater ANI values at 30, 60, 90 min intraoperatively, as well as at 6 and 12 h postoperatively. The VAS scores were consistently higher in Group F than in Group L at all measurement times.

CONCLUSION: Group L provided better analgesia, required fewer sedatives during surgery, and had greater satisfaction among patients and surgeons. A negative correlation was found between the VAS score and ANI for assessing patient pain.

PMID:40225986 | PMC:PMC11982881 | DOI:10.62347/HZWL9608

Semin Cell Dev Biol. 2025 Jun;170:103609. doi: 10.1016/j.semcdb.2025.103609. Epub 2025 Apr 11.

ABSTRACT

The limited ability of adult humans to replenish lost heart muscle cells after a heart attack has attracted scientists to explore natural heart regeneration capabilities in the animal kingdom. In particular, research has accelerated since the landmark discovery more than twenty years ago that zebrafish can completely regrow myocardial tissue. In this review, we survey heart regeneration studies in diverse model and non-model animals, aiming to gain insights into both the evolutionary trends in cardiac regenerative potential and the variations among closely related species. Differences in cardiomyogenesis, vasculature formation, and the communication between cardiovascular cells and other players have been investigated to understand the cellular basis, although the precise molecular and genetic causes underlying the stark differences in cardiac regenerative potential among certain close cousins remain largely unknown. By studying cardiovascular regeneration and repair in diverse organisms, we may uncover distinct mechanisms, offering new perspectives for advancing regenerative medicine.

PMID:40220599 | DOI:10.1016/j.semcdb.2025.103609

J Cardiothorac Vasc Anesth. 2025 Jul;39(7):1763-1773. doi: 10.1053/j.jvca.2025.03.023. Epub 2025 Mar 15.

ABSTRACT

OBJECTIVES: To evaluate the utility of high-sensitivity cardiac troponin (hs-cTn) monitoring in thoracic surgery to predict severe postoperative complications (sPOCs) according to the Clavien-Dindo classification.

DESIGN: Retrospective, observational cohort study.

SETTING: Tertiary-level hospital involving multiple departments.

PARTICIPANTS: A total of 220 patients who underwent lung resection surgery between November 2018 and October 2021, with preoperative and postoperative troponin measurements.

INTERVENTIONS: hs-cTnI levels (Abbott Alinity) were measured before surgery and within the first 24 hours postoperatively. Myocardial injury (MI) was defined as hs-cTnI greater than 26.2 ng/L postoperatively. In addition, the impact of a postoperative cTnI elevation greater than 20% or a preoperative value below 1.6 ng/L on the occurrence of sPOCs is analyzed. Postoperative complications were recorded for the first 30 days and classified using the Clavien-Dindo classification.

MAIN MEASUREMENTS AND RESULTS: Patients with sPOCs had higher pre- and postoperative hs-cTnI levels compared to those without complications. Patients with MI had a higher incidence of POCs than those without MI. Additionally, undetectable preoperative hs-cTnI levels were associated with better survival.

CONCLUSIONS: Perioperative troponin elevation is associated with worse short-term postoperative outcomes, including a higher incidence of sPOCs and prolonged hospital stays. Preoperative hs-cTnI levels correlate with preoperative morbidity (frailty) in patients.

PMID:40189451 | DOI:10.1053/j.jvca.2025.03.023

J Crit Care. 2025 Aug;88:155076. doi: 10.1016/j.jcrc.2025.155076. Epub 2025 Apr 3.

ABSTRACT

BACKGROUND AND HYPOTHESIS: Up to 14 % of critically ill patients receive renal replacement therapy (RRT) during their ICU stay and are treated with intermittent hemodialysis (IHD) or one of the continuous renal replacement therapy (CRRT) techniques. The choice of a modality (IHD or CRRT) and technique (continuuous veno-venous -hemodialysis (CVVHD), -hemofiltration (CVVH), or - hemodiafiltration (CVVHDF)), and the way it is delivered, may have an impact on outcomes but only few studies addressed this question. We aimed to survey the availability, settings, and clinicians' preferences regarding RRT modalities and techniques in critically ill patients.

METHODS: Between July 2021 and March 2022, we conducted an open online worldwide survey targeting ICU clinicians and consisting of 31 questions.

RESULTS: Among the 1174 participants from 73 countries, 94 % indicated their ability to initiate RRT at any time. CRRT was more widely available than IHD (97 % vs 85 %). CVVHDF was the most frequently used CRRT technique (59 %), followed by CVVHD (26 %) and CVVH (16 %). Most participants (70 %) reported having access to at least two CRRT techniques in their unit. Preference for IHD or CRRT varied greatly, depending on the clinical situation. Among CRRT techniques, CVVHD was preferred for removal of small-sized molecules, better hemofilter lifespan and reduced nursing workload. The preferential indications for CVVH included septic shock, removal of middle-sized molecules and fluid overload. The technical settings for CVVH and CVVHDF were very heterogeneous.

CONCLUSION: This international survey underscores the large diversity in RRT practices wordlwide, as well as heterogeneity in beliefs and preferences among intensivists. These data highlight the need for robust comparative trials to identify the optimal RRT modality and technique to improve outcomes in specific clinical situations.

PMID:40179459 | DOI:10.1016/j.jcrc.2025.155076

Circ Heart Fail. 2025 May;18(5):e012399. doi: 10.1161/CIRCHEARTFAILURE.124.012399. Epub 2025 Apr 3.

NO ABSTRACT

PMID:40177751 | DOI:10.1161/CIRCHEARTFAILURE.124.012399

Crit Care. 2025 Mar 31;29(1):140. doi: 10.1186/s13054-025-05350-6.

ABSTRACT

BACKGROUND: During the weaning process, the transition from positive to negative pressure ventilation may induce cardiac dysfunction, which may lead to pulmonary oedema. The incidence of weaning-induced pulmonary oedema (WIPO) is poorly documented and shows huge variations. Our study aims to investigate the incidence and risk factors for WIPO during weaning from mechanical ventilation in general critically ill patients.

METHODS: This multicentre study was conducted in France, Italy, and India. Adult critically ill patients receiving invasive ventilation were included once a spontaneous breathing trial (SBT) was performed. The SBT technique could be either T-piece or pressure support mode with (PSV-PEEP) or without positive end expiratory pressure (PEEP) (PSV-ZEEP). A consensual diagnosis of WIPO was made a posteriori by five experts who analysed changes observed during the SBT that were retrospectively recorded.

RESULTS: From July 2019 to February 2021, 634 SBTs were performed in 500 patients from 13 ICUs. Weaning success occurred in 417 patients (66%) and weaning failure in 217 (34%). Weaning was short in 414 (83%) of SBTs, difficult in 47 (9%) SBTs, and prolonged in 39 (8%) SBTs. WIPO was diagnosed in 79 (12%) cases, which accounted for 36% of the 217 weaning failures. WIPO occurred in 54/358 (15%) of T-piece SBT, in 7/84 (8%) of PSV-PEEP SBT (p = 0.072 vs. T-piece), and in 18/192 (9%) of PSV-ZEEP SBT (p = 0.002 vs. T-piece). In multilevel logistic regression analysis including 202 weaning failures from 149 different patients, COPD, and previous cardiomyopathy were identified as independent risk factors associated with WIPO.

CONCLUSION: In general ICU patients, WIPO accounts for 36% of weaning failure cases. Previous heart disease and COPD are two independent risk factors for developing WIPO during the weaning process.

CLINICALTRIALS: gov identifier (retrospectively registered on 2022-03-31): NCT05318261.

PMID:40165223 | PMC:PMC11956494 | DOI:10.1186/s13054-025-05350-6

BMC Anesthesiol. 2025 Mar 31;25(1):142. doi: 10.1186/s12871-025-03022-0.

ABSTRACT

BACKGROUNDS: The benefit of fiberoptic bronchoscopy (FOB) guidance during percutaneous dilatational tracheostomy (PDT) remains unclear. We aimed to compare PDT performed with and without FOB guidance in terms of procedure duration, number of attempts, and perioperative complications.

METHODS: A total of 103 patients were divided into two groups, and the PDT procedure was performed either with or without FOB guidance. The primary outcome of our study was the duration of the tracheostomy procedure (PDT procedure time) and the number of attempts. The secondary outcome was the major/minor complications that might develop during and after tracheostomy.

RESULTS: The mean PDT procedure time was 8 (4-14) minutes in the FOB (-) group and 7 (3-14) minutes in the FOB (+) group, with no statistically significant difference between them (p = 0.081). The mean number of PDT attempts was the same in both the FOB (-) and FOB (+) groups, 1 (1-3) (p = 0.079). Hypoxemia/desaturation occurred in 1 (2%) patient in the FOB (-) group and in 1 (1.9%) patient in the FOB (+) group (p = 0.748). Cardiac arrhythmia occurred in 2 (3.9%) patients in the FOB (-) group and in 2 (3.8%) patients in the FOB (+) group (p = 0.684). No cases of pneumothorax or pneumomediastinum were observed in either group (p > 0.999).

CONCLUSION: No difference was found between the two groups in terms of procedure duration, number of attempts, and perioperative complications when performing PDT in the intensive care unit with or without fiberoptic bronchoscopy guidance. PDT can be performed effectively and safely in critically ill patients using a standardized approach by an experienced team, with or without bronchoscopy guidance. However, further investigation and advanced studies are needed to evaluate both methods in more detail.

TRIAL REGISTRATION: Retrospectively registered. Clinical trial number was not applicable.

PMID:40165086 | PMC:PMC11956419 | DOI:10.1186/s12871-025-03022-0

Rev Cardiovasc Med. 2025 Mar 19;26(3):26587. doi: 10.31083/RCM26587. eCollection 2025 Mar.

ABSTRACT

Acute myocardial infarction is myocardial necrosis caused by acute and persistent ischemia and hypoxia in the coronary artery and severely affects public health. Recently, stem cell research has presented transformational developments in treating myocardial infarction. The Notch signaling pathway plays a crucial role in the post-myocardial infarction repair process and cardiac regenerative medicine. Additionally, the Notch signaling pathway can be involved in regulating the inflammatory response, myocardial fibrosis, oxidative stress, cardiomyocyte apoptosis, and cardiomyocyte regeneration after myocardial infarction. Moreover, the Notch signaling pathway is applied in cardiac tissue engineering. This review mainly elaborates on the research on the Notch signaling pathway in repairing myocardial infarction and cardiac regenerative medicine, aiming to provide a reference for treating acute myocardial infarction.

PMID:40160574 | PMC:PMC11951485 | DOI:10.31083/RCM26587

Biomolecules. 2025 Mar 4;15(3):371. doi: 10.3390/biom15030371.

ABSTRACT

Cardiovascular diseases are a leading cause of morbidity and mortality in dogs, with limited options available for reversing myocardial damage. Stem cell therapies have shown significant potential for cardiac repair, owing to their immunomodulatory, antifibrotic, and regenerative properties. This review evaluates the therapeutic applications of mesenchymal stem cells (MSCs) derived from bone marrow, adipose tissue, and Wharton's jelly with a focus on their role in canine cardiology and their immunoregulatory properties. Preclinical studies have highlighted their efficacy in enhancing cardiac function, reducing fibrosis, and promoting angiogenesis. Various delivery methods, including intracoronary and intramyocardial injections, are assessed for their safety and efficacy. Challenges such as low cell retention, differentiation efficiency, and variability in therapeutic responses are also discussed. Emerging strategies, including genetic modifications and combination therapies, aim to enhance the efficacy of MSCs. Additionally, advances in delivery systems and regulatory frameworks are reviewed to support clinical translation. This comprehensive evaluation underscores the potential of stem cell therapies to revolutionize canine cardiovascular disease management while identifying critical areas for future research and clinical integration.

PMID:40149907 | PMC:PMC11940628 | DOI:10.3390/biom15030371

Nat Commun. 2025 Mar 27;16(1):3012. doi: 10.1038/s41467-025-58301-8.

ABSTRACT

Heart injury has been characterized by the irreversible loss of cardiomyocytes comprising the contractile tissues of the heart and thus strategies enabling adult cardiomyocyte proliferation are highly desired for treating various heart diseases. Here, we test the ability of human induced pluripotent stem cell-derived primitive macrophages (hiPMs) and their conditioned medium (hiPM-cm) to promote human cardiomyocyte proliferation and enhance cardiac regeneration in adult mice. We find that hiPMs promote human cardiomyocyte proliferation, which is recapitulated by hiPM-cm through the activation of multiple pro-proliferative pathways, and a secreted proteome analysis identifies five proteins participating in this activation. Subsequent in vivo experiments show that hiPM-cm promotes adult cardiomyocyte proliferation in mice. Lastly, hiPM-cm enhances cardiac regeneration and improves contractile function in injured adult mouse hearts. Together, our study demonstrates the efficacy of using hiPM-cm in promoting adult cardiomyocyte proliferation and cardiac regeneration to serve as an innovative treatment for heart disease.

PMID:40148355 | PMC:PMC11950653 | DOI:10.1038/s41467-025-58301-8

J Surg Res. 2025 May;309:8-18. doi: 10.1016/j.jss.2025.02.041. Epub 2025 Mar 27.

ABSTRACT

INTRODUCTION: This study aimed to compare long-term outcomes in patients undergoing off-pump coronary artery bypass grafting (OPCAB) versus on-pump coronary artery bypass grafting (ONCAB) in a single-center propensity-matched population.

METHODS: Between January 2010 and June 2022, 2964 patients were analyzed and divided into two groups: 1671 (56.3%) patients receiving OPCAB and 1293 (43.7%) patients receiving ONCAB. Propensity score matching was performed resulting in 842 pairs.

RESULTS: In the matched cohort, OPCAB was associated with a reduced incidence of early stroke (odds ratio: 0.40; 95% confidence interval [0.17-0.90], P = 0.02) as well as a reduced incidence of reoperation for bleeding and blood transfusion. The median follow-up time was 6.69 y (interquartile range: 3.47-9.83-y). OPCAB and ONCAB had comparable long-term mortality, myocardial infarction, repeat revascularization, and major adverse cardiac and cerebral events. However, OPCAB was associated with higher freedom from stroke at follow-up compared to ONCAB (hazard ratios stratified on matched pairs: 0.61; 95% confidence interval [0.39-0.95]; P = 0.015). A landmark analysis in the matched cohort was performed excluding the first 30 ds of follow-up to exclude the effect of early stroke. In the landmark analysis, OPCAB and ONCAB had comparable freedom from stroke at follow-up. Briefly, 821 patients with 2055 grafts were analyzed. The overall median time to angiogram was 3.68 y (interquartile range: 1.76-6.61). No difference was observed between OPCAB and ONCAB in the patency rates (Fitzgibbon A) of arterial grafts. However, the patency rate of saphenous vein graft was higher in the OPCAB group than in the ONCAB group (77.4% versus 71.7%, P = 0.04).

CONCLUSIONS: OPCAB was associated with lower rates of stroke, reoperation for bleeding, and blood product transfusion. Meanwhile, at long-term follow-up, OPCAB and ONCAB were associated with comparable outcomes, including all-cause mortality, myocardial infarction, repeat revascularization, major adverse cardiac and cerebral events, and stroke.

PMID:40153915 | DOI:10.1016/j.jss.2025.02.041

Turk J Anaesthesiol Reanim. 2025 May 30;53(3):87-97. doi: 10.4274/TJAR.2025.251925. Epub 2025 Mar 27.

ABSTRACT

Standard monitoring guidelines by the American Society of Anesthesiologists and European Society of Anaesthesiology and Intensive Care have not been updated for over a decade, despite rapid advancements in monitoring technology and the growing complexity of surgical patients. Traditional parameters such as blood pressure and pulse oximetry often fail to detect critical intraoperative conditions, emphasizing the need for comprehensive hemodynamic assessment. This review, the first of a two-part series, explores the fundamental elements of hemodynamics, including cardiac output, stroke volume, blood pressure, and oxygen delivery, with a focus on their physiological basis, clinical significance, and perioperative applications. This article provides a detailed foundation for understanding hemodynamic monitoring, setting the stage for the second article, which addresses advanced monitoring tools and their applications in contemporary anaesthesia practice.

PMID:40150830 | PMC:PMC12123657 | DOI:10.4274/TJAR.2025.251925

J Clin Med. 2025 Mar 13;14(6):1957. doi: 10.3390/jcm14061957.

ABSTRACT

Background: In this study, we present our early and mid-term results using two different types of handmade polytetrafluoroethylene (PTFE) valved conduits in patients who require right ventricular outflow reconstruction. Methods: Between March 2021 and May 2024, 72 patients (30 males and 42 females; median age: 69 (IQR: 26-123) months) who underwent implantation of a handmade bicuspid or tricuspid valve PTFE conduit for right ventricular outflow reconstruction were retrospectively analyzed. Preoperative, postoperative, and follow-up echocardiograms were also evaluated. Results: The first postoperative echocardiography revealed that 11 (36.7%) patients had mild regurgitation, and 3 (10%) patients had moderate regurgitation in the bicuspid group initially, while only 7 (16.7%) of the patients in the tricuspid group had mild regurgitation (p = 0.004). None of the patients required reintervention in the early postoperative period because of conduit dysfunction. In the mid-term follow-up, the mean follow-up duration was 22.4 ± 11 months. PTFE-valved conduit dysfunction was observed in three patients in the bicuspid group, while no dysfunction was observed in the tricuspid group (p = 0.049). Even if the median peak gradient was found to be slightly higher in the tricuspid group [15 (IQR: 0-25) vs. 0 (IQR: 0-15)] (p = 0.032), no conduit dysfunction was reported during follow-up. Kaplan-Meier analysis demonstrated that the tricuspid conduit group maintained 100% freedom from dysfunction during the 24-month follow-up period. In contrast, the bicuspid group had rates of 90%, 87%, and 83% at 6, 12, and 24 months, respectively (log-rank p = 0.016). Conclusions: The ePTFE valved conduits provide significant advantages in terms of durability, biocompatibility, cost-effectiveness, and hemodynamic performance for right ventricular outflow tract reconstruction in pediatric cardiac surgery. The findings of our study suggest that tricuspid valve design offers better potential for preventing conduit dysfunction.

PMID:40142765 | PMC:PMC11942932 | DOI:10.3390/jcm14061957

Turk Gogus Kalp Damar Cerrahisi Derg. 2025 Jan 31;33(1):27-35. doi: 10.5606/tgkdc.dergisi.2025.26627. eCollection 2025 Jan.

ABSTRACT

BACKGROUND: This study aimed to investigate the effect of operative and postoperative parameters on late-onset hyperlactatemia (LOHL) after cardiac surgery in the pediatric patient population.

METHODS: One hundred fifty-nine ventricular septal defect patients (77 males, 82 females; mean age: 8.0±8.6 years; range, 1 to 48 years) were retrospectively examined between August 2020 and February 2023. Patients with the highest lactate value measured between 6 to 12 h postoperatively <3 mmol/L were defined as Group 1, and those with lactate values ≥3 mmol/L (LOHL) were included in Group 2.

RESULTS: Cardiopulmonary bypass (CPB) time, aortic cross-clamp time, and CPB flow did not differ between groups (p=0.916, p=0.729, and p=0.699, respectively). The difference between partial oxygen pressure (PaO2) in the first blood gas obtained after CPB was statistically significant (p=0.017). The lactate level measured in the first arterial blood gas obtained after CPB was 1.74±0.61 mmol/L in Group 1 and 3.01±1.63 mmol/L in Group 2 (p<0.001). The PaO2 in the arterial blood gas measured at 6 h postoperatively was 129.22±61.20 mmHg in Group 1 and 156.07±64.49 mmHg in Group 2 (p=0.046).

CONCLUSION: The development of hyperlactatemia due to ischemia in the early post-CPB period may affect the development of LOHL. Microcirculatory changes at the tissue level may play a role in the etiology of LOHL.

PMID:40135081 | PMC:PMC11931366 | DOI:10.5606/tgkdc.dergisi.2025.26627

JAMA Netw Open. 2025 Mar 3;8(3):e251714. doi: 10.1001/jamanetworkopen.2025.1714.

ABSTRACT

IMPORTANCE: Understanding the relationship between patients' clinical characteristics and outcomes is fundamental to medicine. When critically ill patients die after withdrawal of life-sustaining therapy (WLST), the inability to observe the potential for recovery with continued aggressive care could bias future clinical decisions and research.

OBJECTIVE: To quantify the frequency with which experts consider patients who died after WLST following resuscitated cardiac arrest to have had recovery potential if life-sustaining therapy had been continued.

DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study included comatose adult patients (aged ≥18 years) treated following resuscitation from cardiac arrest at a single academic medical center between January 1, 2010, and July 31, 2022. Patients with advanced directives limiting critical care or who experienced cardiac arrest of traumatic or neurologic etiology were excluded. An international cohort of experts in post-arrest care based on clinical experience and academic productivity was identified. Experts reviewed the cases between August 24, 2022, and February 11, 2024.

EXPOSURE: Patients who died after WLST.

MAIN OUTCOME AND MEASURES: Three or more experts independently estimated recovery potential for each patient had life-sustaining treatment been continued, using a 7-point numerical ordinal scale. In the primary analysis, which involved the patient cases with death after WLST, a 1% or greater estimated recovery potential was considered to be clinically meaningful. In secondary analyses, thresholds of 5% and 10% estimated recovery probability were explored.

RESULTS: A total of 2391 patients (median [IQR] age, 59 [48-69] years; 1455 men [60.9%]) were included, of whom 714 (29.9%) survived to discharge. Cases of uncertain outcome (1431 patients [59.8%]) in which WLST preceded death were reviewed by 38 experts who rendered 4381 estimates of recovery potential. In 518 cases (36.2%; 95% CI, 33.7%-38.7%), all experts believed that recovery potential was less than 1% if life-sustaining therapies had been continued. In the remaining 913 cases (63.8%; 95% CI, 61.3%-66.3%), at least 1 expert believed that recovery potential was at least 1%. In 227 cases (15.9%; 95% CI, 14.0%-17.9%), all experts agreed that recovery potential was at least 1%, and in 686 cases (47.9%; 95% CI, 45.3%-50.6%), expert estimates differed at this threshold.

CONCLUSIONS AND RELEVANCE: In this cohort study of comatose patients resuscitated from cardiac arrest, most who died after WLST were considered by experts to have had recovery potential. These findings suggest that novel solutions to avoiding deaths based on biased prognostication or incomplete information are needed.

PMID:40131275 | PMC:PMC11937936 | DOI:10.1001/jamanetworkopen.2025.1714

Med Sci Monit. 2025 Mar 23;31:e947462. doi: 10.12659/MSM.947462.

ABSTRACT

BACKGROUND Acute renal failure (ARF) is a critical complication following open-heart surgery, significantly impacting morbidity and mortality. This study aimed to evaluate the association between intraoperative renal near-infrared spectroscopy (NIRS) findings and postoperative ARF in 357 patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). MATERIAL AND METHODS This prospective study included 357 patients undergoing open-heart surgery with CPB. ARF diagnosis was based on KDIGO criteria. NIRS sensors were placed bilaterally at the T12/L2 level under ultrasound guidance, and renal oxygenation (rSO2) values were continuously monitored intraoperatively. Patients were categorized into ARF and non-ARF groups for comparative analysis. RESULTS ARF developed in 12.3% (n=44) of patients. ARF patients were older (p=0.024) and had longer surgery (p<0.001), CPB (p=0.004), and aortic cross-clamping durations (p=0.013). They required more blood products (p<0.001) and intra-aortic balloon pump support (p=0.027). Intensive care unit stays were significantly longer in ARF patients (p=0.036). NIRS analysis showed significant rSO2 reductions in ARF patients. Time spent with rSO2 below 80%, 70%, and 60% was a strong predictor of ARF. Receiver operating characteristic (ROC) analyses demonstrated that time exceeding 30 minutes below the 60% threshold predicted ARF with 96.5% specificity and 86.4% sensitivity. CONCLUSIONS Intraoperative NIRS monitoring is crucial for detecting renal perfusion abnormalities during high-risk surgeries. Declines below 80%, 70%, and 60% thresholds strongly predict ARF. Timely interventions, such as fluid resuscitation and hemodynamic support, can mitigate risks. ARF patients require intensive postoperative monitoring due to prolonged ICU stays and complications.

PMID:40121520 | PMC:PMC11948832 | DOI:10.12659/MSM.947462

BMC Anesthesiol. 2025 Mar 22;25(1):138. doi: 10.1186/s12871-025-03007-z.

ABSTRACT

INTRODUCTION: Caudal epidural block is a widely performed procedure for postoperative pain control of pediatric patients. As the local anesthetic acts by spreading cranially after caudal block, it may lead to several effects on the cerebrospinal fluid and intracranial region.

METHOD: Children aged 1-7, ASA I-II were included in this study. The patient population was assigned into two groups as the Caudal Block Group (Group CB) and the Control Group (Group C) Caudal block with 0.25% bupivacaine 1 ml/kg was performed on patients in Group CB. Optic nerve sheath diameter was measured at the following timeline: T0: Following laryngeal mask placement, T1: Following caudal block. T15:15. min, T30:30. min. Heart rate, non-invasive blood pressure, SpO2 and PCO2 values were also recorded at every time point.

RESULTS: There was no significant difference between two groups considering demographic data, intraoperative hemodynamic parameters, intraoperative SpO2 and PCO2 values. While optic nerve sheath diameter findings were not significantly different between the groups at T0 and T1 points(P > 0.05), the measurements at T15(4.18 ± 0.56 for Group C and 4.62 ± 0.47 for Group CB, P = 0.006) and T30(4.20 ± 0.53 for Group C and 4.76 ± 0.52 for Group CB) were statistically higher in the Caudal Group.

CONCLUSION: Evaluation of optic nerve sheath diameter has high diagnostic precision for detecting increased intracranial pressure in children. The findings in this study display that local anesthetic applied for caudal block in pediatric surgeries spread cranially resulting in an increase in the intracranial pressure and optic nerve sheath diameter. However, this increase does not cause intraoperative hemodynamic changes.

PMID:40119299 | PMC:PMC11929278 | DOI:10.1186/s12871-025-03007-z

Turk J Anaesthesiol Reanim. 2025 Mar 21;53(2):53-61. doi: 10.4274/TJAR.2025.241830.

ABSTRACT

OBJECTIVE: To evaluate the cardiopulmonary effect during prone position (PP) on right ventricular (RV) recovery in coronavirus disease-2019 related acute respiratory distress syndrome (C-ARDS) through transesophageal echocardiography (TEE).

METHODS: This prospective study included 30 moderate-to-severe C-ARDS patients who were treated with PP in the first 48 h of invasive mechanical ventilation support. It was evaluated with TEE three times: before PP (T0f), the first hour of PP (T1), and the first hour of returning to the supine position (T0 + 24 h) (T2) after 23 hours of PP treatment. RV end-diastolic area/left ventricular (LV) end-diastolic area (RVEDA/LVEDA), tricuspid annular plane systolic excursion (TAPSE) and LV end-systolic eccentricity index were preferred RV evaluations as primary outcomes. Pulmonary effects of PP were evaluated as a secondary outcome, including PaO2/FiO2, driving pressure (dP), static compliance (Cstat), mechanical ventilation parameters, and their association with 28-day survival. Tissue DO2 was examined as a secondary outcome, and it was calculated using the measured cardiac output through TEE.

RESULTS: With the cardiopulmonary effect of PP, the decrease in RVEDA/LVEDA, the increase in TAPSE, PaO2/FiO2, and Cstat, and the decrease in dP were statistically significant (P < 0.05). The Cstat value associated with 28-day survival showed decreased mortality for each unit increase. The Cstat cut-off value, which was statistically significant for survival, was 37.

CONCLUSION: PP can improve RV recovery and oxygenation, but it isn't always accompanied by increased survival. An increase in the Cstat may improve survival without the development of RV dysfunction while maintaining heart-lung interaction.

PMID:40116456 | PMC:PMC11931261 | DOI:10.4274/TJAR.2025.241830