Daily Anesthesiology Research Analysis
A first-in-human trial shows intrarectal perfluorodecalin for enteral ventilation is safe and well tolerated, supporting further development of non-pulmonary oxygenation strategies. A dose-stratified meta-analysis of 18 RCTs finds moderate-dose corticosteroids—especially hydrocortisone with fludrocortisone—reduce 28-day mortality in septic shock. The 2025 ERC/ESICM post-resuscitation guidelines synthesize evidence on oxygenation, temperature control, prognostication, and rehabilitation to optimi
Summary
A first-in-human trial shows intrarectal perfluorodecalin for enteral ventilation is safe and well tolerated, supporting further development of non-pulmonary oxygenation strategies. A dose-stratified meta-analysis of 18 RCTs finds moderate-dose corticosteroids—especially hydrocortisone with fludrocortisone—reduce 28-day mortality in septic shock. The 2025 ERC/ESICM post-resuscitation guidelines synthesize evidence on oxygenation, temperature control, prognostication, and rehabilitation to optimize post–cardiac arrest care.
Research Themes
- Novel enteral ventilation as a non-pulmonary oxygenation adjunct
- Dose-stratified corticosteroid therapy in sepsis and septic shock
- Evidence-based optimization of post–cardiac arrest care
Selected Articles
1. Safety and tolerability of intrarectal perfluorodecalin for enteral ventilation in a first-in-human trial.
In a phase 1 dose-escalation study of 27 healthy adults, intrarectal perfluorodecalin was safe and well tolerated, with only transient, dose-related gastrointestinal symptoms and no detectable systemic exposure. Pharmacokinetic modeling and small observed SpO2 increases at higher doses support dose-dependent oxygen transfer, laying the groundwork for trials using oxygenated perfluorodecalin in respiratory failure.
Impact: Introduces a new oxygenation route with first-in-human safety data, potentially transforming support for hypoxemic respiratory failure when pulmonary strategies are limited.
Clinical Implications: If efficacy is confirmed with oxygenated perfluorodecalin, enteral ventilation could serve as an adjunct to reduce ventilator settings, facilitate lung rest, and bridge refractory hypoxemia in ICU and perioperative care.
Key Findings
- No serious adverse events or dose-limiting toxicities across 25–1,500 mL intrarectal perfluorodecalin.
- Systemic perfluorodecalin was undetectable in blood (<1.0 μg/mL).
- Transient, dose-related mild GI symptoms resolved without intervention.
- Pharmacokinetic modeling predicted dose-dependent oxygen transfer; modest SpO2 increases observed at higher doses.
Methodological Strengths
- Prospective dose-escalation phase 1 design with predefined safety endpoints
- Multimodal safety monitoring and pharmacokinetic modeling to infer oxygen transfer potential
Limitations
- Small, single-site, all-male healthy volunteer cohort limits generalizability
- Non-oxygenated perfluorodecalin; efficacy for oxygenation not directly tested
Future Directions: Evaluate oxygenated perfluorodecalin in dose-ranging patient trials (ICU/perioperative hypoxemia), define efficacy endpoints, optimize dosing/retention strategies, and assess compatibility with concurrent ventilatory support.
2. Corticosteroids for sepsis and septic shock: a meta-analysis of 18 RCTs with dose-stratified and fludrocortisone subgroup evaluation.
Across 18 RCTs (7,982 patients), corticosteroids reduced 28-day mortality in sepsis, with the strongest effect observed for hydrocortisone-equivalent 201–300 mg/day and hydrocortisone plus fludrocortisone. Results support moderate-dose regimens and adjunct mineralocorticoid therapy, though regional heterogeneity was noted.
Impact: Provides dose-specific, mechanism-informed evidence that clarifies optimal steroid regimens and the added value of fludrocortisone in septic shock.
Clinical Implications: Adopt moderate-dose hydrocortisone (201–300 mg/day) and consider adjunct fludrocortisone in septic shock protocols, with attention to regional practice patterns and patient heterogeneity.
Key Findings
- Corticosteroids reduced 28-day mortality (RR 0.88; 95% CI 0.79–0.98; I²=39%).
- Greatest benefit with hydrocortisone-equivalent 201–300 mg/day (RR 0.86; I²=0%).
- Hydrocortisone plus fludrocortisone showed additional benefit (RR 0.89).
- Regional heterogeneity: weaker effects in China-based trials.
Methodological Strengths
- PRISMA-guided meta-analysis of randomized controlled trials
- Pre-specified dose and agent stratification with random-effects synthesis
Limitations
- Between-trial heterogeneity and potential publication bias
- Limited adverse event harmonization and regional imbalances
Future Directions: Prospective trials to refine patient selection for steroid plus fludrocortisone, examine long-term outcomes, and assess safety profiles across regions and sepsis phenotypes.
3. European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2025: post-resuscitation care.
The ERC/ESICM 2025 post-resuscitation guideline synthesizes ILCOR CoSTR evidence into pragmatic recommendations across oxygenation/ventilation targets, coronary reperfusion, hemodynamics, seizure control, temperature control, prognostication, and long-term rehabilitation.
Impact: Guidelines directly inform practice across ICUs by integrating current evidence into comprehensive post–cardiac arrest care pathways.
Clinical Implications: Standardize oxygenation/ventilation targets, implement temperature control and structured prognostication, and coordinate reperfusion and rehabilitation strategies to improve outcomes after cardiac arrest.
Key Findings
- Evidence-based targets for oxygenation and ventilation in post–cardiac arrest syndrome.
- Recommendations for coronary reperfusion, hemodynamic monitoring/management, and seizure control.
- Guidance on temperature control, multimodal prognostication, and long-term rehabilitation/organ donation pathways.
Methodological Strengths
- Consensus guideline grounded in ILCOR CoSTR systematic evidence reviews
- Comprehensive, multidisciplinary scope across the post-resuscitation care continuum
Limitations
- Guideline synthesis without new primary data
- Heterogeneity in implementation contexts may affect applicability
Future Directions: Prospective validation of guideline adherence metrics, trials to refine oxygenation/temperature targets, and implementation science studies to optimize prognostication and rehabilitation pathways.