Daily Anesthesiology Research Analysis

Neonatal prematurity leads to considerable morbidity and mortality, partly because of acquired conditions such as bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), and retinopathy of prematurity (ROP). Standard gestational age and birthweight-based classifications of prematurity inadequately capture the variation in newborns' health outcomes, creating an urgent need to develop risk stratification tools for vulnerable newborn infants to initiate the most appropriate care pathways as early as possible. We hypothesized that the metabolic profiles of newborn infants capture additional risk information beyond current measures. A total of 13,536 newborn screening (NBS) blood spot tests from preterm infants in California with linked clinical outcomes of prematurity were used to develop an NBS-based metabolic health index to stratify preterm infants at risk for BPD, IVH, NEC, and ROP (12,096 cases with one or more conditions and 1440 controls) through a deep learning model that provides a single index score in tandem with subgroup discovery to identify individuals with the strongest metabolite biomarker signals for adverse outcomes of prematurity. This metabolic health index captured risk signals that were distinct from gestational age and birthweight and outperformed other machine learning algorithms and clinical risk variable-based models in stratifying at-risk individuals for adverse outcomes of prematurity. The metabolic health index was externally validated in an independent retrospective cohort of 3299 very premature newborns from Ontario, Canada (2117 cases and 1182 controls), which recapitulated common metabolic risk subgroups. In summary, combining widespread metabolite screening with deep learning established a generalizable biological risk metric of prematurity.

INTRODUCTION: Tracheal intubation is commonly performed during in-hospital cardiac arrest, but the evidence for a survival benefit remains uncertain. METHODS: This was an observational study using data from the Get With The Guidelines registry. Adult patients with an in-hospital cardiac arrest between January 2013 and December 2021 were included. Instrumental variable analyses were conducted using two-stage least squares regression in an attempt to account for unmeasured confounding. Two instrumental variables were predefined as (1) tracheal intubation during the previous cardiac arrest and (2) the proportion of intubated cardiac arrest patients within the past year at a given hospital. The primary outcome was survival to hospital discharge. Secondary outcomes included return of spontaneous circulation and favorable neurological status. RESULTS: A total of 210,115 cardiac arrests were included. The median age was 67 years, 59 % of patients were male, and 85 % of patients had an initial non-shockable rhythm. Intubation was performed in 85 % of patients. For the first and second instrumental variables, tracheal intubation was associated with absolute risk differences in survival of -11 % (95 % CI, -16 % to -5.6 %) and -12 % (95 % CI, -16 % to -8.2 %), respectively. Similar results were observed for the secondary outcomes. CONCLUSIONS: Tracheal intubation during in-hospital cardiac arrest was associated with reduced survival, although point estimates were implausibly large, and the results should be interpreted cautiously. Preference-based instrumental variables may not adequately address confounding in this setting. Randomized clinical trials are needed to inform advanced airway management during in-hospital cardiac arrest.

BACKGROUND: The use of transmuscular quadratus lumborum block (TQLB) offers potent pain relief in surgical interventions; nonetheless, the evidence is inadequate to prove its benefits in treating nausea and vomiting. This meta-analysis aimed to calculate the impact of TQLB on postoperative nausea and vomiting. METHODS: Two investigators carried out investigations for randomized controlled trials from Embase, PubMed, and the Cochrane Library, respectively. We used Review Manager software for the meta-analysis. RESULTS: Twelve trials with 725 patients were included. The incidences of postoperative nausea (risk ratio [RR]: 0.59, 95% confidence interval [CI]: 0.44-0.78) and postoperative vomiting (RR: 0.29, 95% CI: 0.09-0.88) in the TQLB group were notably less than those in the control group without publication bias as high-quality evidence evaluated by Grading of Recommendations Assessment, Development and Evaluation. TQLB could reduce the rest (standardized mean difference [SMD]: -0.53, 95% CI: -0.89 to -0.17) and activity (SMD: -0.48, 95% CI: -0.78 to -0.18). Numeric rating scale at the 6 hours after the operation, the rest and activity visual analogue scale (VAS) at both of the 6 hours (rest VAS: SMD: -1.01, 95% CI: -1.91 to -0.11; activity VAS: SMD: -0.89, 95% CI: -1.48 to -0.30) and 24 hours (rest VAS: SMD: -0.64, 95% CI: -1.15 to -0.12; activity VAS: SMD: -1.74, 95% CI: -2.39 to -1.10) after the surgery. TQLB could shorten the time to first ambulation (SMD: -0.54, 95% CI: -0.96 to -0.11), intestinal movement (SMD: -1.06, 95% CI: -1.43 to -0.69), and length of hospital stay (SMD: -0.89, 95% CI: -1.32 to -0.45). TQLB could notably decrease the incidence of rescue analgesia administration (RR: 0.49, 95% CI: 0.27-0.88) and increase the satisfaction degree (RR: 4.10, 95% CI: 2.41-6.99). The generalizability and interpretation of these results are constrained by the study's limited sample size, the exploratory analysis of secondary endpoints, and potential heterogeneity. CONCLUSION: TQLB may decrease the incidence of postoperative nausea and vomiting, enhance postoperative pain management, accelerate postoperative recovery, and increase the satisfaction degree of patients. These benefits highlight the potential efficacy of TQLB to ensure safer and faster recovery following surgical procedures as high-quality evidence.