Daily Anesthesiology Research Analysis
A multicenter randomized trial (BigpAK-2) showed that a biomarker-guided perioperative prevention bundle significantly reduced moderate-to-severe acute kidney injury after major surgery. A single-center RCT in Anesthesiology found that individualized flow-controlled ventilation cut mechanical power by 55% and signaled fewer complications despite a neutral primary biomarker endpoint. A meta-analysis in neurosurgical anesthesiology demonstrated that infection-prevention bundles nearly halved exter
Summary
A multicenter randomized trial (BigpAK-2) showed that a biomarker-guided perioperative prevention bundle significantly reduced moderate-to-severe acute kidney injury after major surgery. A single-center RCT in Anesthesiology found that individualized flow-controlled ventilation cut mechanical power by 55% and signaled fewer complications despite a neutral primary biomarker endpoint. A meta-analysis in neurosurgical anesthesiology demonstrated that infection-prevention bundles nearly halved external ventricular drain infections.
Research Themes
- Perioperative kidney protection and biomarker-guided prevention
- Lung-protective intraoperative ventilation strategies
- Infection prevention bundles in neurocritical care
Selected Articles
1. A preventive care strategy to reduce moderate or severe acute kidney injury after major surgery (BigpAK-2); a multinational, randomised clinical trial.
In high-risk major surgical patients identified by clinical factors and urinary tubular stress biomarkers, a KDIGO-aligned preventive bundle reduced moderate-to-severe AKI within 72 hours (14.4% vs 22.3%; OR 0.57; NNT ≈12) without increasing adverse events. The pragmatic strategy focused on hemodynamic optimization, nephrotoxin avoidance, and glycemic control.
Impact: This large, multinational RCT demonstrates that a biomarker-guided prevention bundle can meaningfully reduce clinically significant AKI after major surgery, a frequent and serious perioperative complication.
Clinical Implications: Perioperative teams should consider implementing biomarker-enriched risk stratification and standardized kidney-protection bundles (advanced hemodynamic monitoring, volume and pressure targets, nephrotoxin/contrast avoidance, hyperglycemia prevention) to reduce moderate-to-severe AKI.
Key Findings
- Moderate/severe AKI within 72 hours was reduced from 22.3% to 14.4% (OR 0.57; NNT ≈12).
- No increase in adverse events including atrial fibrillation, significant bleeding, or reoperation.
- Biomarker-enriched selection plus KDIGO-based supportive care bundle achieved clinically meaningful benefit.
Methodological Strengths
- Multicenter randomized design with trial registration (NCT04647396).
- Biomarker-enriched risk stratification and intention-to-treat analysis.
Limitations
- Short primary outcome window (72 hours) may not capture longer-term kidney outcomes.
- Open-label pragmatic implementation could introduce performance bias; industry funding (BioMérieux).
Future Directions: Evaluate durability of kidney protection (e.g., MAKE90), cost-effectiveness, and implementation strategies across diverse health systems; assess additive value of specific biomarker thresholds and automated clinical decision support.
2. Individualized Flow-Controlled versus Pressure-Controlled Ventilation in Cardiac Surgery: A Randomized Controlled Trial.
In 140 adults undergoing on-pump cardiac surgery, flow-controlled ventilation did not reduce IL-8 at 6 hours versus pressure-controlled ventilation but reduced mechanical power by 55% and signaled fewer postoperative complications and shorter hospital stay. FCV achieved normocapnia with lower respiratory rates and minute ventilation.
Impact: FCV is an emerging ventilation mode that substantially lowers mechanical power, a key driver of ventilator-induced lung injury, with encouraging signals in clinical outcomes.
Clinical Implications: Anesthesiologists may consider FCV as a lung-protective strategy in cardiac surgery, recognizing that definitive clinical benefit requires larger multicenter trials and that primary biomarker endpoints were neutral.
Key Findings
- No significant difference in IL-8 at 6 hours post-CPB between FCV and PCV.
- FCV reduced perioperative mechanical power by 55% with lower respiratory rates and minute ventilation.
- Exploratory secondary outcomes favored FCV: fewer pulmonary/extrapulmonary complications and shorter hospital stay.
Methodological Strengths
- Prospective randomized controlled design with protocolized ventilation targets.
- Clinically relevant endpoints including mechanical power and postoperative complications.
Limitations
- Single-center design; primary endpoint neutral, with secondary outcomes exploratory.
- Higher driving pressures and tidal volumes in FCV may confound mechanistic interpretation.
Future Directions: Conduct multicenter, adequately powered RCTs with hard clinical endpoints (e.g., pneumonia, hypoxemia, ventilator days) and standardized FCV protocols; evaluate long-term pulmonary outcomes and cost-effectiveness.
3. Effect of Bundled Care on External VentricularDrain Infections: A Systematic Review and Meta-analysis.
Across 22 studies including 6,330 patients, infection-prevention bundles for external ventricular drains halved infection risk (pooled RR 0.46, 95% CI 0.33–0.65). Core elements were hand hygiene and preinsertion antibiotics, with added benefits suggested for antimicrobial-impregnated catheters, tunneled placement, and structured education.
Impact: This synthesis provides quantitative evidence supporting bundled EVD infection-prevention practices and highlights components associated with achieving low infection rates.
Clinical Implications: Neurocritical care teams should standardize EVD bundles emphasizing hand hygiene and preinsertion antibiotics, and consider antimicrobial-impregnated/tunneled catheters and staff education to achieve infection rates below 5%.
Key Findings
- Bundle implementation reduced EVD infection risk (pooled RR 0.46; 95% CI 0.33–0.65) with moderate heterogeneity (I²=50.9%).
- Hand hygiene (100%) and preinsertion antibiotics (91%) were most commonly implemented elements.
- In studies with <5% infection, antimicrobial-impregnated catheters, tunneled placement, and structured education were more frequently used.
Methodological Strengths
- Registered protocol (PROSPERO) with comprehensive database search and dual independent review.
- Random-effects meta-analysis with Hartung-Knapp adjustment and heterogeneity assessment.
Limitations
- Predominantly observational studies with variability in bundle components and definitions.
- Moderate heterogeneity; potential publication bias not fully excluded.
Future Directions: Prospective multicenter studies/RCTs testing standardized EVD bundles and specific components; evaluate sustainability, cost-effectiveness, and microbiological outcomes.