Daily Anesthesiology Research Analysis
Three high-impact critical care and anesthesiology-relevant studies refined practice. A meta-analysis shows adjunct systemic corticosteroids likely reduce short-term mortality in severe non-COVID pneumonia and ARDS without increasing hospital-acquired infections. Two randomized trials report no benefit from levosimendan for VA-ECMO weaning and no infection or long-term outcome advantage using polyurethane-cuffed subglottic suction endotracheal tubes after emergency intubation.
Summary
Three high-impact critical care and anesthesiology-relevant studies refined practice. A meta-analysis shows adjunct systemic corticosteroids likely reduce short-term mortality in severe non-COVID pneumonia and ARDS without increasing hospital-acquired infections. Two randomized trials report no benefit from levosimendan for VA-ECMO weaning and no infection or long-term outcome advantage using polyurethane-cuffed subglottic suction endotracheal tubes after emergency intubation.
Research Themes
- Adjunct corticosteroids in severe pneumonia and ARDS
- Pharmacologic facilitation of VA-ECMO weaning
- Airway device design and prevention of microaspiration/VAP
Selected Articles
1. Systemic Corticosteroids, Mortality, and Infections in Pneumonia and Acute Respiratory Distress Syndrome : A Systematic Review and Meta-analysis.
Across 20 RCTs (n=3459), adjunct systemic corticosteroids probably reduce short-term mortality in severe pneumonia (RR 0.73) and ARDS, and may reduce secondary shock in severe pneumonia, with little to no increase in hospital-acquired infections. Heterogeneity in pneumonia severity classifications limits subgroup precision.
Impact: This synthesis provides high-level evidence resolving a long-standing controversy on corticosteroid use in non-COVID severe pneumonia and ARDS, directly informing guidelines and ICU practice.
Clinical Implications: Consider low-dose, short-course systemic corticosteroids as adjunct therapy in severe pneumonia and ARDS to reduce short-term mortality and possibly secondary shock, with vigilance for infections though risk appears minimal.
Key Findings
- 20 RCTs (n=3459) met inclusion; 15 severe pneumonia, 5 ARDS.
- Low-dose, short-course corticosteroids probably reduce short-term mortality in severe pneumonia (RR 0.73, 95% CI 0.57–0.93).
- Adjunct steroids may reduce secondary shock in severe pneumonia.
- Across severe pneumonia and ARDS, steroids had little or no effect on hospital-acquired infections.
Methodological Strengths
- Comprehensive multi-database search with trial registry coverage through September 2025 and PROSPERO registration.
- Restriction to randomized controlled trials with paired reviewer processes and consensus.
Limitations
- Heterogeneous severity classifications and dosing regimens limited subgroup analyses.
- Relatively few ARDS trials reduce precision for ARDS-specific effects.
Future Directions: Prospective, adequately powered RCTs in ARDS with standardized severity definitions and dosing/duration protocols, and stratification by etiology and infection risk.
2. Levosimendan to Facilitate Weaning From ECMO in Patients With Severe Cardiogenic Shock: The LEVOECMO Randomized Clinical Trial.
In a multicenter double-blind RCT (n=205), levosimendan did not shorten time to successful VA-ECMO weaning within 30 days versus placebo and did not improve ECMO duration, ICU stay, or 60-day mortality. Ventricular arrhythmias were more frequent with levosimendan.
Impact: A rigorous negative RCT clarifies that routine levosimendan to facilitate VA-ECMO weaning is not beneficial and may pose arrhythmic risk, steering practice and future trials.
Clinical Implications: Avoid routine levosimendan for VA-ECMO weaning; consider arrhythmia risk. Resource allocation and protocols should not include levosimendan for this indication outside trials.
Key Findings
- No difference in 30-day successful VA-ECMO weaning (68.3% vs 68.3%; sHR 1.02, P=0.92).
- No significant differences in ECMO duration, ICU length of stay, or 60-day mortality.
- Higher ventricular arrhythmias with levosimendan (17.8% vs 8.7%).
Methodological Strengths
- Multicenter, randomized, double-blind, placebo-controlled design across 11 ICUs.
- Pre-specified outcomes with robust statistical analysis including subdistribution hazard ratios.
Limitations
- Single-country study; generalizability may be limited.
- Sample may be underpowered for mortality differences; heterogeneous etiologies of shock.
Future Directions: Targeted trials in specific cardiogenic shock phenotypes, timing strategies (pre-weaning vs peri-decannulation), and comparative inotrope studies with arrhythmia monitoring.
3. Hospital and long-term outcomes for subglottic suction and polyurethane cuff versus standard endotracheal tubes in emergency intubation (PreVent 2): a randomised controlled phase 2 trial.
In 1068 emergency intubations, polyurethane-cuffed subglottic suction ETTs did not reduce IVAC or possible VAP compared with standard PVC ETTs, nor improve 6-month laryngeal injury, quality of life, or cognition. Findings challenge routine adoption for infection prevention after emergency intubation.
Impact: This large, randomized device trial undermines the presumed clinical benefit of specialized subglottic suction polyurethane ETTs in emergency settings, informing procurement and ICU prevention bundles.
Clinical Implications: Do not expect reductions in IVAC/VAP or improved long-term outcomes solely from using PU-EVAC tubes after emergency intubation; prioritize proven VAP prevention measures (e.g., bundles, oral care, positioning).
Key Findings
- No reduction in IVAC (8% vs 6%) or possible VAP (6% vs 5%) with PU-EVAC vs PVC.
- At 6 months, no significant differences in laryngeal injury, SF-36 PCS/MCS, or cognitive impairment.
- High overall 6-month mortality (~52%) with similar rates across groups.
Methodological Strengths
- Large randomized allocation with pragmatic emergency/intake population across two academic centers.
- Co-primary long-term patient-centered outcomes and adjudicated infection endpoints.
Limitations
- Only two centers; device performance and care practices may vary elsewhere.
- Long-term conclusions limited by survivor sample size completing follow-up assessments.
Future Directions: Head-to-head device trials integrated within standardized VAP bundles, cost-effectiveness analyses, and subgroup analyses (e.g., prolonged ventilation, aspiration risk) to refine indications.