Daily Anesthesiology Research Analysis
Three impactful studies for anesthesiology and critical care emerged today: a multicenter cohort defined four phenotypes of post-sepsis recovery with distinct 1-year trajectories; an international observational study linked ventilator settings to mortality in acute brain injury; and a meta-analysis found remimazolam safer than propofol in elderly patients during general anesthesia. Together, they inform ICU survivorship pathways, neurocritical ventilation practices, and geriatric anesthesia safe
Summary
Three impactful studies for anesthesiology and critical care emerged today: a multicenter cohort defined four phenotypes of post-sepsis recovery with distinct 1-year trajectories; an international observational study linked ventilator settings to mortality in acute brain injury; and a meta-analysis found remimazolam safer than propofol in elderly patients during general anesthesia. Together, they inform ICU survivorship pathways, neurocritical ventilation practices, and geriatric anesthesia safety.
Research Themes
- ICU survivorship and post-sepsis phenotyping
- Mechanical ventilation strategies in neurocritical care
- Geriatric anesthesia safety and sedative selection
Selected Articles
1. Phenotypes of Functional Decline or Recovery in Sepsis ICU Survivors: Insights From a 1-Year Follow-Up Multicenter Cohort Analysis.
In a 21-ICU prospective cohort (n=220), four discharge phenotypes of sepsis-associated PICS were identified spanning none, mild, moderate, and severe multi-domain impairments. Mild physical/cognitive deficits improved by 3 months, but moderate and severe phenotypes showed persistent disability at 12 months; severe phenotype had ongoing depression and declining survival.
Impact: This phenotyping provides a pragmatic framework to tailor post-ICU follow-up and rehabilitation resources based on early discharge assessments, potentially improving long-term outcomes for sepsis survivors.
Clinical Implications: Use discharge assessments (Barthel, SMQ, HADS, IES-R, EQ-5D-5L, frailty, grip/MRC) to assign patients to phenotypes and prioritize intensive, multi-domain rehabilitation and mental health support for moderate/severe PICS; monitor severe phenotype closely for mortality risk.
Key Findings
- Four discharge phenotypes identified: no PICS (n=62), mild (physical and cognitive; n=55), moderate (all domains; n=53), severe (all domains; n=50).
- Mild phenotype improved by 3 months; moderate and severe phenotypes showed persistent disability over 12 months.
- Psychiatric PICS improved in moderate/severe groups, but depression persisted at 12 months in the severe group.
- All groups had persistently reduced QoL and low employment (0–50%), with continuously decreasing survival in the severe group.
Methodological Strengths
- Prospective multicenter design across 21 ICUs with standardized assessments
- One-year follow-up capturing functional, psychiatric, QoL, and survival outcomes
Limitations
- Moderate sample size (n=220) with potential selection bias to survivors
- Cluster phenotypes are data-driven and require external validation for generalizability
Future Directions: Validate phenotypes in larger, international cohorts and test phenotype-guided rehabilitation and mental health interventions in pragmatic trials to improve survivorship outcomes.
2. Ventilation practices in acute brain injured patients and association with outcomes: the VENTIBRAIN multicenter observational study.
Across 74 ICUs in 26 countries (n=2095 ABI patients), protective ventilation was common but variable; admission Pplat had a median of 15 cmH2O. Ventilator settings during ICU stay were associated with ICU and 6‑month mortality but not with unfavorable neurological outcomes.
Impact: This large prospective study provides granular, international benchmarks for ventilation in ABI and links modifiable ventilator parameters to mortality, informing practice harmonization and future interventional trials.
Clinical Implications: Adopt protective ventilation while minimizing unnecessary variability; monitor and titrate ventilator settings mindful of their association with mortality. The lack of association with neurological outcome suggests prioritizing systemic safety endpoints alongside neuroprotection.
Key Findings
- International prospective cohort of 2,095 ABI patients across 74 ICUs documented daily ventilator settings through day 14.
- Protective ventilation strategies were common but varied substantially between countries.
- Ventilator settings during ICU stay were associated with increased ICU and 6‑month mortality.
- No association was found between ventilator settings and unfavorable 6‑month neurological outcome.
Methodological Strengths
- Large, prospective, multicenter international design with daily ventilator data
- Hard outcomes assessed at ICU discharge and 6 months
Limitations
- Observational design limits causal inference; residual confounding likely
- Heterogeneity in practice patterns across countries may affect generalizability of specific thresholds
Future Directions: Randomized trials to test ventilator strategies tailored to ABI pathophysiology; development of consensus protocols to reduce harmful variability.
3. Comparison of the safety of remimazolam and propofol during general anesthesia in elderly patients: systematic review and meta-analysis.
Meta-analysis of eight RCTs (n=571) shows remimazolam reduces hypotension, bradycardia, and injection-site pain versus propofol in elderly general anesthesia, with more stable MAP and HR after induction. Results support remimazolam as a safer alternative in geriatric patients.
Impact: Addresses a high-risk population central to anesthetic practice with pooled RCT evidence, informing sedative selection and peri-induction hemodynamic management.
Clinical Implications: Consider remimazolam as first-line or alternative induction/maintenance sedative in elderly where hypotension/bradycardia risk is a concern; maintain individualized dosing and monitoring given study heterogeneity.
Key Findings
- Eight RCTs (571 participants) compared remimazolam vs propofol in elderly general anesthesia.
- Remimazolam lowered incidence of hypotension and bradycardia versus propofol.
- Injection-site pain was less frequent with remimazolam.
- MAP and HR were more stable after induction with remimazolam.
Methodological Strengths
- Systematic review and meta-analysis of randomized controlled trials
- Prospective registration (PROSPERO) and multi-database search
Limitations
- Total sample size moderate; potential heterogeneity in dosing, anesthesia protocols, and outcome definitions
- Limited long-term outcomes; focus primarily on peri-induction safety endpoints
Future Directions: Head-to-head pragmatic trials comparing remimazolam-based vs propofol-based pathways in high-risk geriatric surgery, including recovery profiles and cost-effectiveness.