Daily Anesthesiology Research Analysis
Systems-level reorganization for acute mesenteric ischaemia markedly reduced mortality and improved revascularization. A large-scale, externally validated ICU VTE risk model showed strong calibration but only modest discrimination, underscoring the need for prospective impact studies. In neonates, continuous optical sensor monitoring substantially reduced the severity of peripheral IV infiltration/extravasation events.
Summary
Systems-level reorganization for acute mesenteric ischaemia markedly reduced mortality and improved revascularization. A large-scale, externally validated ICU VTE risk model showed strong calibration but only modest discrimination, underscoring the need for prospective impact studies. In neonates, continuous optical sensor monitoring substantially reduced the severity of peripheral IV infiltration/extravasation events.
Research Themes
- System-of-care redesign in acute mesenteric ischaemia
- Risk prediction for venous thromboembolism in the ICU
- Neonatal patient safety via optical sensor monitoring for IV infiltration
Selected Articles
1. Impact on the prognosis with the creation of a dedicated stroke to mesenteric ischaemia.
In a single-center before–after comparison (100 SOS AMI patients vs 100 historical controls), a dedicated AMI pathway increased revascularization and reduced 30- and 90-day mortality while shortening time from CT to intervention. The findings suggest multidisciplinary, time-critical organization improves AMI outcomes.
Impact: Demonstrates a real-world systems intervention that significantly reduces mortality in AMI, a time-sensitive surgical emergency. Provides a scalable template for regional care pathways.
Clinical Implications: Hospitals should consider dedicated AMI pathways with rapid imaging-to-intervention workflows and defined multidisciplinary roles to increase revascularization and survival.
Key Findings
- More inter-hospital transfers under SOS AMI (41% vs 19%, p=0.001).
- Shorter CT-to-intervention time (median 4 h [1–129] vs 5 h [0–285], p=0.05).
- Higher revascularization rate (61% vs 28%, p=0.02).
- Lower 30-day mortality (32% vs 58%, p<0.001) and 90-day mortality (45% vs 62%, p=0.02).
Methodological Strengths
- Prospective inclusion of the SOS AMI cohort with predefined workflow.
- Multiple clinically relevant endpoints (time metrics, revascularization, mortality).
Limitations
- Before–after single-center design susceptible to secular trends and residual confounding.
- Modest sample size (100 per group) limits precision and subgroup analyses.
Future Directions: Multicenter stepped-wedge or cluster randomized trials to confirm causality, define key pathway components, and assess cost-effectiveness and transfer logistics.
BACKGROUND: Acute mesenteric ischaemia (AMI) is an emergency with a poor prognosis. In France, a structure dedicated to AMI has been created in Paris in 2016 (SURVI), with promising results. A similar organization has been created in Marseille in 2021 (SOS AMI). Our aim was to compare the results of SOS AMI with those of a previous cohort of AMI patients managed without any dedicated structure. METHODS: The first 100 patients with AMI, managed by the SOS AMI, between November 2021 and December 2023 were prospectively included. They were compared with 100 AMI patients from a previous retrospective cohort (from January 2017 to December 2020), managed without any dedicated structure in the same center. RESULTS: The first 100 AMI patients managed by SOS AMI have similar demographic characteristics to those previously managed without SOS. The vascular causes of AMI were also similar between groups: arterial occlusive (61 vs. 56%, p = 0.5), venous occlusive (17 vs. 13%, p = 0.5), or non occlusive (22 vs. 31%, p = 0.2). AMI patients managed by SOS AMI were more frequently transferred from another center (41 vs. 19%, p = 0.001), had a shorter median time between CT scan and intervention (4 [range, 1-129] vs. 5 [0-285] hours, p = 0.05), a higher revascularisation rate (61 vs. 28%, p = 0.02), and lower 30-day (32 vs. 58%, p < 0.001) and 90-day (45 vs. 62%, p = 0.02) mortality rates. CONCLUSION: The creation of SOS AMI has significantly improved the management of AMI patients, by better organizing the role of the various specialties involved, particularly in terms of revascularisation and survival rates. These promising results support the further development and expansion of this dedicated structure.
2. Predicting the risk of venous thromboembolism in critically ill patients (PROVE-IT): a model development and validation study.
The PROVE-IT model for ICU-acquired VTE was developed in 26,218 patients and externally validated in 1,983 patients. It showed acceptable discrimination (C-statistic 0.681 internal; 0.629 external) and excellent calibration, but clinical utility remains uncertain.
Impact: Provides a large-scale, externally validated VTE risk tool tailored to the ICU setting, highlighting calibration strengths and current limitations in discrimination.
Clinical Implications: Risk stratification for ICU VTE could guide intensified thromboprophylaxis and surveillance, but prospective impact and recalibration studies are needed before implementation.
Key Findings
- Model development cohort: 26,218 ICU patients; external validation cohort: 1,983 patients.
- Discrimination acceptable: C-statistic 0.681 (internal) and 0.629 (external).
- Calibration excellent internally (ICI=0.00231); well-calibrated on external validation.
- Decision-curve analysis indicated unclear clinical utility; not recommended for clinical use yet.
Methodological Strengths
- Very large development dataset with predefined prognostic factors and external validation.
- Comprehensive performance assessment including discrimination, calibration, and DCA.
Limitations
- Only acceptable discrimination limits clinical applicability without further refinement.
- Potential unmeasured confounding and variability in thromboprophylaxis practices across cohorts.
Future Directions: Incorporate dynamic physiologic and biomarker data, recalibrate across diverse ICUs, and test impact on VTE and bleeding outcomes in pragmatic trials.
BACKGROUND: Venous thromboembolism (VTE) is a serious complication of critical illness. The persistently high rates of VTE may be the result of thromboprophylaxis failure in critically ill patients at particularly high risk of VTE. A prognostic model may facilitate patient-specific interventions, ultimately lowering the incidence of VTE in critically ill patients. OBJECTIVES: We aimed to develop and externally validate a prognostic model for VTE in critically ill patients: Predicting the Risk of Venous Thromboembolism in Critically Ill Patients model. METHODS: The outcome was in-hospital VTE after intensive care unit admission. Model development was performed using multiple logistic regression with 14 established prognostic factors for VTE in critically ill patients. External validation was conducted in an independent cohort. Model performance was evaluated in terms of discrimination (C-statistic), calibration (integrated calibration index [ICI], E RESULTS: The Predicting the Risk of Venous Thromboembolism in Critically Ill Patients (PROVE-IT) model was developed in 26 218 patients and externally validated in 1983 patients. Discrimination was acceptable with a C-statistic of 0.681 upon internal validation and 0.629 upon external validation. Calibration was excellent internally (ICI = 0.00231; E CONCLUSION: We developed and externally validated a prognostic model for in-hospital VTE in critically ill patients. Our model was well-calibrated upon external validation, although the discrimination was merely acceptable. Additionally, the model's clinical utility, assessed by DCA, is unclear, which precludes its recommendation for clinical implementation at this stage.
3. Evaluation of optical sensor technology for the early detection of peripheral intravenous infiltration in neonates: a retrospective cohort study.
In a sequential, single-center NICU cohort (32,713 catheters), continuous optical sensor monitoring (ivWatch) did not change overall PIV infiltration incidence but significantly reduced severe extravasation events compared with conventional TLC assessments.
Impact: Demonstrates a pragmatic technology-enabled safety intervention that substantially reduces severe IV extravasation in a high-risk neonatal population.
Clinical Implications: Incorporating continuous optical sensor monitoring alongside standard assessments may reduce severe tissue injury from IV extravasation in NICUs, improving safety without increasing insertion burden.
Key Findings
- Analyzed 32,713 neonatal peripheral IV catheters across two practice periods.
- Overall PIV infiltration incidence similar: 29.9% (conventional) vs 30.1% (ivWatch).
- Severe PIVIE events decreased from 4.9% (243 events) to 1.1% (54 events), p<0.001.
- PIVIE was the most common cause of unplanned device removal.
Methodological Strengths
- Large real-world dataset with standardized severity grading (IEGS).
- Sequential cohort design capturing practice change with technology integration.
Limitations
- Single-center retrospective design; potential secular trend and selection bias.
- Overall incidence unchanged; potential confounding from concurrent practice changes.
Future Directions: Conduct multicenter pragmatic trials to assess effectiveness, cost-benefit, alarm thresholds, and workflow impact; evaluate integration with nurse decision-support.
OBJECTIVE: This study aimed to evaluate the utility of optical sensor-based technology in mitigating the frequency and severity of peripheral intravenous infiltration and/or extravasation (PIVIE) in neonates. DESIGN: Single-centre, retrospective, observational cohort study. SETTING: Tertiary-level neonatal intensive care unit (NICU) (112 cots) at the Women's Wellness and Research Centre (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar, January 2019-December 2022. PARTICIPANTS: All neonates admitted to the NICU requiring intravenous therapy via a neonatal short peripheral intravenous catheter (n-SPC) were included. Participants were excluded if the insertion was unsuccessful, if they had incomplete data, or if they received intravenous therapy exclusively through alternative vascular access devices. INTERVENTIONS: The study analysed two cohorts representing different clinical practices over two distinct periods. In the conventional cohort (Phase 1, 2019-2020), PIVIE detection relied solely on periodic 'Touch Look Compare (TLC)' assessments. In the ivWatch cohort (Phase 2, 2021-2022), continuous optical sensor-based monitoring using the ivWatch system was implemented alongside TLC assessments. This sequential design allowed for a comparison of outcomes between the two phases. OUTCOME MEASUREMENTS: The primary outcomes were the occurrence and severity of PIVIE. Secondary outcomes included the influence of patient demographics, vascular access characteristics, and management details on PIVIE incidence and severity. RESULTS: Over the 4-year data collection period, 32 713 peripheral intravenous catheters were analysed across two cohorts. PIVIE was the most common reason for unplanned device removal. In the conventional cohort (Phase 1, 2019-2020), 4941 infiltration events were reported (29.9%), compared with 4872 events (30.1%) in the ivWatch cohort (Phase 2, 2021-2022). However, severity measures using the Intravenous Extravasation Grading Scale (IEGS) revealed a marked reduction in severe PIVIE cases, with severe events decreasing from 243 (4.9%) in the conventional cohort to 54 (1.1%) in the ivWatch cohort (p<0.001). CONCLUSIONS: PIVIE remains a frequent complication in neonatal vascular access. Continuous site monitoring with optical sensor technology was associated with earlier detection of PIVIE events and reduced IEGS severity scores. These findings highlight the potential of integrating sensor-based monitoring with traditional observational methods to improve patient outcomes in neonatal care.