Daily Anesthesiology Research Analysis

OBJECTIVES: Postoperative pulmonary complications (PPCs) are common after major head and neck cancer surgery. This trial evaluated whether adding daily lung ultrasonography (LUS) to the current diagnostic strategy (clinical evaluation with on-demand chest X-ray [CXR]) improves PPC detection. METHODS: In this randomized controlled trial, 196 adults at intermediate/high risk for PPCs undergoing head and neck cancer surgery with free-flap reconstruction were assigned to the current strategy alone or a routine strategy (daily LUS plus current strategy). The primary outcome was the detection rate of clinically relevant PPCs. RESULTS: The routine strategy identified significantly more clinically relevant PPCs than the current strategy (92.3% vs. 66.7%, p=0.035) with higher diagnostic accuracy (AUC: 91.9% vs. 80.4%, p=0.035). Detection occurred earlier with the routine strategy (median postoperative day 2 vs. 3, p=0.042). No significant differences were observed in hospital stay or mortality. CONCLUSIONS: Incorporating daily LUS into postoperative care enhances the detection of PPCs in patients on general wards after head and neck cancer surgery, without significantly altering short-term clinical outcomes.

BACKGROUND: Acute kidney injury (AKI) is common in the intensive care unit (ICU) but is often detected only after creatinine rises or oliguria develops. Although novel biomarkers allow earlier detection, their cost limits use. The urine albumin-to-creatinine ratio (uACR) is inexpensive, yet its role in AKI risk stratification remains uncertain. METHODS: In a prospective single-centre cohort of mixed ICU patients, adults with existing AKI or at high risk (modified AKI Risk Based on Creatinine [ARBOC] score ≥ 3) were enrolled. uACR was measured at enrollment (uACR at Time 0) and 24 h (uACR at Time 1). Outcomes included the prevalence and prognostic value of elevated uACR (≥ 3.4 mg/mmol) for incident, progressive, or persistent AKI (> 48 h), and for ≥30% decline in estimated glomerular filtration rate (eGFR) at discharge. Predictive performance was assessed using the area under the receiver operating characteristic curve (AUC), change in AUC, net reclassification improvement (NRI), integrated discrimination improvement (IDI), and decision-curve analysis. RESULTS: Of 1010 patients screened, 203 were analysed (89 with and 114 without AKI at enrollm). Elevated uACR was frequent (72% with AKI; 52% without). In AKI patients, high uACR correlated with longer and more persistent AKI. Discrimination for incident AKI was modest (AUC 0.61 and 0.66 for uACR at Time 0 and uACR at Time 1) but higher for persistent AKI (both AUC 0.68). Adding uACR at Time 0 to ARBOC improved reclassification (NRI 0.48; IDI 0.04) and clinical net benefit. CONCLUSIONS: uACR modestly identified incident AKI and more strongly predicted persistent AKI. As a simple biomarker, uACR may serve as a low-cost adjunct to existing ICU risk stratification tools, but requires further validation before consideration for routine clinical use.

Employing a spectral analysis framework based on Chaos Game Representation (CGR), we investigated the multimer-based dynamics of EEG microstates across broadband and canonical frequency bands during reversible unconsciousness (anesthesia and sleep). Robust periodic components consistently emerged within microstate sequences across theta, alpha, beta, and gamma bands, persisting across distinct states of consciousness. Converging evidence from both deconstruction via surrogate data and reconstruction via a hierarchical generative model demonstrates that the multimer structure, along with the conditional duration distribution, constitutes the underlying mechanism of microstate periodicity. Furthermore, we show that temporal smoothing abolishes these intrinsic periodic components. Most notably, during both deep sedation and N3 sleep, the beta band microstate sequence exhibited a consistent increase in peak power and a decrease in center frequency, resulting in highly characteristic patterns in the CGR spectra. To dissect the structural basis of these periodicities, we developed a data-driven algorithm to extract multimers and calculate their metrics. We identified distinct, frequency-dependent alterations in multimer dynamics during reversible unconsciousness, suggesting that the transition to unconsciousness marks a shift towards specific dynamical regimes. Collectively, our findings confirm that microstate sequences exhibit precise temporal orchestration. By elucidating the generative mechanisms of microstate periodicity and establishing a multimer-based analytical framework, this study provides a solid methodological foundation for investigating higher-order temporal structures, while offering promising neurophysiological biomarkers for consciousness assessment and novel insights into the temporal organization of large-scale neural dynamics.