Daily Anesthesiology Research Analysis

Endotracheal intubation is a critical medical procedure for protecting a patient's airway. Current intubation technology requires extensive anatomical knowledge, training, technical skill, and a clear view of the glottic opening. However, all of these may be limited during emergency care for trauma and cardiac arrest outside the hospital, where first-pass failure is nearly 35%. To address this challenge, we designed a soft robotic device to autonomously guide a breathing tube into the trachea with the goal of allowing rapid, repeatable, and safe intubation without the need for extensive training, skill, anatomical knowledge, or a glottic view. During initial device testing with highly trained users in a mannequin and a cadaver, we found a 100% success rate and an average intubation duration of under 8 s. We then conducted a preliminary study comparing the device with video laryngoscopy, in which prehospital medical providers with 5 min of device training intubated cadavers. When using the device, users achieved an 87% first-pass success rate and a 96% overall success rate, requiring an average of 1.1 attempts and 21 s for successful intubation, significantly (

BACKGROUND: Cardiovascular complications are the leading cause of mortality after liver transplant in patients with acute-on-chronic liver failure (ACLF). However, the extent of cardiac impairment in these patients remains unclear. Current risk models, including the Chronic Liver Failure Consortium-Organ Failure, the North American Consortium for the Study of End-stage Liver Disease (NACSELD)-ACLF, and the novel Sundaram ACLF-Liver Transplant-Mortality (SALT-M) scores primarily focus on blood pressure and the use of cardiovascular drugs, without directly assessing biomarkers of cardiac injury. To address the role of cardiac dysfunction, the authors assessed the severity of cardiac impairments with cardiac biomarkers and modified the SALT-M score, developing the SALT-M_ CARDIAC score to better predict mortality after liver transplant. METHODS: In the ASAN-Liver Transplant Registry from 2008 to 2019, 710 consecutive patients with ACLF (ACLF grade 3 [27.3%] and NACSELD-ACLF-positive [26.3%]) were evaluated for heart failure and myocardial injury, using prospective measurements of B-type natriuretic peptide (BNP) and high-sensitivity troponin I (hsTnI), respectively. The authors assessed model performance using C-statistics, optimism-corrected C-statistics, and calibration metrics. Feature importance was assessed using Shapley Additive exPlanations analysis, and a nomogram was constructed. RESULTS: Among patients with ACLF grade 3 and who were NACSELD-ACLF-positive, 32.5% and 34.8% had BNP greater than 400 pg/ml, suggestive of acute heart failure, while 12.9% and 12.3% had hsTnI levels greater than 10-fold the upper limit, respectively. Shapley Additive exPlanations analysis identified BNP and hsTnI as important predictors of mortality after liver transplant. Incorporating cardiac biomarkers into NACSELD-ACLF and Chronic Liver Failure Consortium-Organ Failure scores increased the C-index for 30-day mortality from 0.68 to 0.75 and 0.72 to 0.75, respectively. Compared to the original SALT-M score, the SALT-M_ CARDIAC score improved the optimism-corrected C-index for 30-day mortality from 0.73 to 0.76 ( P < 0.001). A nomogram using the SALT-M_ CARDIAC score was constructed to predict survival after transplant. CONCLUSIONS: Cardiac impairment is prevalent in patients with ACLF and crucial for risk stratification. Integrating cardiac biomarkers into ACLF risk models improves survival predictions after liver transplant and emphasizes the importance of addressing cardiac impairments before liver transplant for better outcomes.

OBJECTIVE: To evaluate the impact of reported β-lactam allergy on the risk of surgical site infections (SSIs), given that most reported cases are unverified and may lead to suboptimal antibiotic prophylaxis. DESIGN: Systematic review and meta-analysis. METHODS: Four databases were systematically searched for studies reporting SSI rates in patients with and without β-lactam allergy. The primary outcome was SSI incidence; secondary outcomes included mortality, length of hospital stay (LOS) and adverse events. Subgroup analyses were conducted to explore potential sources of heterogeneity. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Risk of bias was assessed using the ROBINS-I tool. RESULTS: Twenty-five retrospective observational studies comprising 460,284 patients were included. Reported β-lactam allergy was associated with a significantly increased risk of SSI (RR = 1.55, 95% CI = 1.24-1.94). This association remained consistent across sensitivity and subgroup analyses, particularly in studies relying on self-reported allergies. Patients receiving β-lactam antibiotics had a significantly lower SSI risk than that of patients receiving non-β-lactam alternatives (RR = 0.63, 95% CI = 0.42-0.94). No significant differences were found in LOS or hypersensitivity reaction rates. Mortality was not reported in any of the included studies. CONCLUSIONS: Reported β-lactam allergy is associated with an increased risk of SSI, highlighting the importance of accurate allergy assessment. Selective administration of β-lactam agents, such as cefazolin, may offer a safe and effective option for preoperative prophylaxis in patients without a history of severe hypersensitivity.