Daily Anesthesiology Research Analysis
Three practice-shaping studies emerged in anesthesiology and critical care. An international Delphi produced a six-item core outcome set for adult ICU trials. A multicenter machine-learning model (iREAD) accurately predicted 48-hour ICU readmission and outperformed traditional scores. An RCT in Anesthesiology showed intravenous dexamethasone alone prolongs supraclavicular block analgesia, with no added benefit from perineural dosing.
Summary
Three practice-shaping studies emerged in anesthesiology and critical care. An international Delphi produced a six-item core outcome set for adult ICU trials. A multicenter machine-learning model (iREAD) accurately predicted 48-hour ICU readmission and outperformed traditional scores. An RCT in Anesthesiology showed intravenous dexamethasone alone prolongs supraclavicular block analgesia, with no added benefit from perineural dosing.
Research Themes
- Standardizing outcome measures in ICU trials
- AI/ML-driven risk stratification for ICU discharge
- Optimization of regional anesthesia adjuncts
Selected Articles
1. A Core Outcome Set for Adult General ICU Patients.
Using a modified Delphi across multi-stakeholder panels, the authors defined and internationally validated a six-item core outcome set for adult general ICU trials: survival, free of life support, free of delirium, out of hospital, health-related quality of life, and cognitive function. This harmonizes endpoints that matter to patients, families, clinicians, and researchers.
Impact: A widely adopted core outcome set can transform trial comparability, meta-analyses, and regulatory/HTA alignment across critical care research.
Clinical Implications: ICU trials should incorporate these six core outcomes to standardize endpoints, enable cross-trial comparisons, and ensure patient-centered relevance.
Key Findings
- Identified 329 published outcomes; 50 advanced to Delphi with 264 participants.
- Six core outcomes finalized after international validation: survival, free of life support, free of delirium, out of hospital, health-related quality of life, cognitive function.
- High participation and consensus across 14 countries and 22 panels (5 Danish, 17 international).
Methodological Strengths
- Modified Delphi with literature review, surveys, interviews, and multi-panel discussions
- International validation across diverse settings
Limitations
- Initial development centered in Denmark may introduce geographic bias
- Operationalization and measurement tools for each outcome still require standard selection
Future Directions: Develop standardized measurement instruments and timing for each core outcome; promote adoption in registries, RCTs, and funder mandates; assess applicability in LMICs.
OBJECTIVES: Randomized clinical trials informing clinical practice (e.g., like large, pragmatic, and late-phase trials) should ideally mostly use harmonized outcomes that are important to patients, family members, clinicians, and researchers. Core outcome sets for specific subsets of ICU patients exist, for example, respiratory failure, delirium, and COVID-19, but not for ICU patients in general. Accordingly, we aimed to develop a core outcome set for adult general ICU patients. DESIGN: We developed a core outcome set in Denmark following the Core Outcome Measures in Effectiveness Trials Handbook. We used a modified Delphi consensus process with multiple methods design, including literature review, survey, semi-structured interviews, and discussions with initially five Danish research panels. The core outcome set was internationally validated and revised based on feedback from research panels in all countries. SETTING: There were five Danish research panels and 17 panels in 13 other countries. Interviews and the three-round Delphi survey was conducted in Denmark, followed by validation of the core outcome set across 14 countries in Europe, Australasia, and India.
2. Multicenter validation of a machine learning model to predict intensive care unit readmission within 48 hours after discharge.
The iREAD ensemble model using 30 discharge-time features predicted ICU readmission within 48 hours with AUROC 0.820 internally and 0.768/0.725 on two external cohorts, outperforming traditional scores and conventional ML baselines. High-risk patients identified by iREAD had over four-fold higher readmission rates in Kaplan–Meier analyses.
Impact: Provides a validated, generalizable tool for objective ICU discharge risk stratification, with potential to improve patient safety and resource allocation.
Clinical Implications: Integrate iREAD into discharge workflows to flag high-risk patients for interventions (e.g., delayed transfer, step-down monitoring). Prospective implementation trials are warranted.
Key Findings
- Internal AUROCs: 0.771 (≤48 h), 0.834 (>48 h), 0.820 (overall).
- External AUROCs: 0.768 (MIMIC-III overall) and 0.725 (eICU-CRD overall), outperforming traditional scores (all P < 0.001).
- Kaplan–Meier: >40% of iREAD high-risk group readmitted within 48 h, >4-fold higher than traditional score-based stratification.
Methodological Strengths
- Large development cohort with dual external validations across heterogeneous ICUs
- Direct comparison against traditional scores and multiple ML baselines
Limitations
- Retrospective model development; performance degradation on external datasets
- Clinical impact untested; prospective implementation and calibration needed
Future Directions: Prospective, cluster-randomized implementation to test outcome impact; fairness auditing; local recalibration; integration with discharge checklists and EHR.
BACKGROUND: Intensive care unit (ICU) readmission is a crucial indicator of patient safety. However, discharge decisions often rely on subjective assessment due to a lack of standardized guidelines. We aimed to develop a machine-learning model to predict ICU readmission within 48 h and compare its performance to traditional scoring systems. METHODS: We developed an ensemble model, iREAD, that generates a probability score at ICU discharge, representing the likelihood of the patient being readmitted to the ICU within 48 h, using data from Seoul National University Hospital (SNUH) and validated it using the MIMIC-III and eICU-CRD datasets. From September 2007 to August 2021, a total of 70,842 patients were included from SNUH. The MIMIC-III datasets comprised 43,237 patients admitted to ICUs between 2001 and 2012 at Beth Israel Deaconess Medical Center, and the eICU-CRD datasets included 90,271 ICU admissions across 208 hospitals between 2014 and 2015.
3. Exploring the Additive or Synergistic Effects of the Systemic and Perineural Routes of Dexamethasone as Adjuncts to Supraclavicular Block: A Randomized Controlled Trial.
Among 104 patients, IV dexamethasone prolonged sensory block versus control by 4.5 h (95% CI, 1.3–7.7) and reduced 24-h pain and opioid use. Adding perineural dexamethasone to IV conferred no incremental benefits across all outcomes, indicating IV dexamethasone alone is sufficient as an adjunct.
Impact: Directly informs regional anesthesia practice by discouraging perineural dexamethasone (off-label) when IV achieves equivalent benefits, simplifying protocols and potentially improving safety.
Clinical Implications: Prefer IV dexamethasone as an adjunct to supraclavicular block; avoid routine perineural dexamethasone given lack of additive benefit.
Key Findings
- Sensory block duration: IV 21.3±7.3 h; IV+perineural 20.6±6.1 h; control 16.8±6.8 h.
- IV vs control prolonged sensory block by 4.5 h (95% CI, 1.3–7.7; P=0.006); IV+perineural vs control by 3.8 h (95% CI, 0.8–6.8; P=0.015).
- No differences between IV and IV+perineural in any outcomes, including pain, opioid consumption, or rebound pain.
Methodological Strengths
- Randomized controlled design with predefined outcomes
- CONSORT-like reporting with effect sizes and confidence intervals
Limitations
- Single block type (supraclavicular) and upper extremity procedures may limit generalizability
- Sample size powered for sensory duration; rarer adverse events may be underdetected
Future Directions: Evaluate dosing strategies and applicability across other peripheral nerve blocks; assess long-term safety and neuropathy risks comparing routes.
BACKGROUND: Both perineural and intravenous dexamethasone have been proposed as effective adjuncts that prolong the duration of peripheral nerve blocks. The authors sought to explore whether combining systemic with perineural dexamethasone yields any additive or synergistic effect on the characteristics and analgesic effects of peripheral nerve blocks. METHODS: Adult patients having distal radius open reduction and internal fixation and/or carpometacarpal arthroplasty under supraclavicular block were randomized to intravenous dexamethasone, a combination of perineural plus intravenous dexamethasone, or no dexamethasone (control). Sensory block duration was set as the primary outcome. Secondary outcomes included motor block duration; postoperative rebound pain scores as well as worst pain at 8, 16, 24, 32, 40, and 48 h; opioid consumption at 0 to 24 and 25 to 48 h; incidence of nausea/vomiting; and presence of burning sensation in the blocked limb at 24 and 48 h.