Daily Anesthesiology Research Analysis
Analyzed 52 papers and selected 3 impactful papers.
Summary
Analyzed 52 papers and selected 3 impactful articles.
Selected Articles
1. Integrated immune and endothelial profiling predicts 90-day mortality in postoperative sepsis and septic shock.
In a prospective multicenter cohort of 219 postoperative ICU patients, high-dimensional spectral flow cytometry with unsupervised learning identified immune and endothelial subsets associated with 90-day mortality. A LASSO-Cox–derived cellular risk score outperformed SOFA and APACHE II in ROC and survival analyses and was supported by validation using public single-cell RNA-seq datasets.
Impact: Provides a rigorous, mechanistically anchored prognostic signature that could reshape risk stratification and trial enrichment in postoperative sepsis.
Clinical Implications: Adoption of integrated immune–endothelial cellular risk scoring could enable earlier identification of high-risk postoperative sepsis patients and guide allocation to immuno-endothelial–targeted therapies or intensified monitoring.
Key Findings
- High-dimensional profiling identified immune and endothelial subsets associated with 90-day mortality in postoperative sepsis.
- A LASSO-Cox cellular risk score outperformed SOFA and APACHE II in ROC and survival analyses.
- Findings were supported by validation using publicly available single-cell RNA datasets.
Methodological Strengths
- Prospective multicenter cohort with standardized sampling and follow-up to 90 days.
- Rigorous high-dimensional cytometry with both supervised and unsupervised analyses and LASSO-Cox modeling, with external validation.
Limitations
- Observational design precludes causal inference and may be susceptible to residual confounding.
- Generalizability and batch effects need further assessment across broader centers and platforms.
Future Directions: Prospective external validation and interventional trials testing immune–endothelial–guided therapy allocation; integration with clinical and biochemical markers to build deployable risk tools.
BACKGROUND: Sepsis and septic shock remain major causes of mortality in critically ill postoperative patients, largely because of the lack of reliable biomarkers for early risk stratification. The interplay between immune dysfunction and endothelial activation is key in the progression to multiorgan failure, however phenotypic characterisation of circulating endothelial subpopulations remains limited. METHODS: A Prospective multicentre study included 219 postoperative patients (Non-septic ICU patients, sepsis, septic shock). Peripheral Blood Mononuclear Cells were analysed using high-dimensional spectral flow cytometry. Both supervised gating strategies and high-dimensional unsupervised analyses (UMAP and FlowSOM) were applied to identify immune and endothelial cell subsets. Associations with 90-day mortality were assessed using univariate and multivariate Cox proportional hazards models, refined with LASSO-Cox regression, and integrated into a risk score. The predictive performance of this cellular risk score was compared with SOFA and APACHE II scores using ROC curves and survival analysis. Findings were further validated using publicly available single-cell RNA datasets. FINDINGS: Two B cell subsets (plasmablasts/IgG INTERPRETATION: The combination of immune and endothelial profiling provides a robust cellular signature that improves the prognostic stratification in postoperative sepsis. These biomarkers may support treatment and guide therapeutic strategies aimed at restoring immune-endothelial homoeostasis. FUNDING: This work was supported by the Instituto de Salud Carlos III [grant numbers: PI24/00754, FI25/00242 and CIBERINFEC CB21/13/00051], Junta de Castilla y León [GRS 2782/A2/2023, GRS 2804/A1/2023].
2. Comparison of Esketamine and Remifentanil Combined With Propofol for Painless Fiberoptic Bronchoscopy: A Randomized Controlled Trial.
In 206 adults undergoing flexible bronchoscopy, esketamine plus propofol yielded greater hemodynamic stability (less hypotension/bradycardia) but increased airway adverse events (bronchospasm, secretions), higher propofol use, and longer recovery versus remifentanil plus propofol. Operator satisfaction, procedure duration, and discharge time were similar.
Impact: Directly informs anesthetic selection for bronchoscopy by quantifying clinically meaningful trade-offs between hemodynamic stability and airway safety.
Clinical Implications: Esketamine-based regimens may be preferable in patients at high risk of hypotension/bradycardia but require proactive airway management strategies (e.g., anticholinergics, suction readiness) and acceptance of longer recovery.
Key Findings
- Esketamine group had higher bronchospasm incidence (47.12% vs 29.41%; P=0.003) and more airway secretions (grade 2: 76.92% vs 33.33%).
- Esketamine provided better hemodynamic stability (fewer hypotension and bradycardia events) but caused higher SBP/DBP/HR and airway pressures at specific time points.
- Higher propofol consumption and prolonged recovery time occurred with esketamine; satisfaction, procedure duration, discharge time, and NRS pain were similar.
Methodological Strengths
- Randomized controlled design with adequate sample size (n=206).
- Granular assessment of airway events, hemodynamics, cough/sputum grading, and recovery metrics.
Limitations
- Blinding was not specified; performance/detection bias cannot be excluded.
- Single-procedure context with short-term outcomes; generalizability to other endoscopic settings and long-term recovery is uncertain.
Future Directions: Head-to-head blinded trials incorporating multimodal airway management algorithms and patient-centered outcomes (e.g., time-to-readiness, PACU throughput) to refine selection criteria.
PURPOSE: This randomized controlled trial was designed to compare the efficacy and safety of esketamine versus remifentanil respectively combined with propofol for painless fiberoptic bronchoscopy (FFB). METHODS: A total of 206 patients undergoing elective painless FFB were randomly divided into 2 groups. The experimental group (n = 104) received anesthesia induction with esketamine 0.5 mg/kg, propofol 2 to 3 mg/kg, and rocuronium 0.3 mg/kg, followed by maintenance with esketamine 0.5 to 3 mg·kg FINDINGS: Compared with the control group, the experimental group had a significantly higher incidence of bronchospasm (47.12% vs. 29.41%, P = 0.003), and a significantly higher proportion of patients with grade 2 airway secretions (76.92% vs. 33.33%), higher propofol dosage (300.01 ± 151.81 mg vs. 142.62 ± 66.72 mg), elevated SBP/DBP/HR at T3-T5, increased airway pressure at T4-T5, higher incidences of hypertension, lower incidences of hypotension and bradycardia, reduced grade 0 cough scores, increased grade 5 cough scores, decreased grade 0 to 1 sputum volume, increased grade 4 sputum volume, and prolonged recovery time (all P < 0.05). No significant differences were observed in airway stenosis grade, bronchial mucosal swelling/congestion, other adverse events, NRS pain score, operator/anesthesiologist satisfaction, operation duration, or discharge time (all P > 0.05). IMPLICATIONS: In this study of adult patients undergoing elective painless flexible fiberoptic bronchoscopy, esketamine was associated with better hemodynamic stability but increased risks of airway adverse events and prolonged recovery time, requiring vigilant perioperative management in appropriately selected patients.
3. Outcomes, prognostic factors, and the role of intracranial pressure monitoring in severe community-acquired bacterial meningitis: a multicenter retrospective cohort study.
In 704 mechanically ventilated adults with community-acquired bacterial meningitis across 26 ICUs, 50.3% had unfavorable 90-day outcomes and 31.3% died. Early appropriate antimicrobials and adjunctive dexamethasone correlated with improved outcomes, whereas invasive intracranial pressure monitoring (used in 11.9%) was not associated with better functional outcomes overall or in subgroups.
Impact: Challenges the presumed benefit of invasive ICP monitoring in severe bacterial meningitis and refocuses attention on timely antimicrobial therapy and adjunctive steroids.
Clinical Implications: Routine invasive ICP monitoring may not improve outcomes in mechanically ventilated bacterial meningitis; emphasis should be placed on rapid appropriate antimicrobials and dexamethasone, while reserving ICP monitoring for select cases pending RCT evidence.
Key Findings
- Among 704 patients, 50.3% had unfavorable 90-day outcomes and 31.3% died.
- Independent predictors of poor outcome included older age, septic shock, AKI, coagulopathy, low motor GCS, pupillary abnormalities, and abnormal neuroimaging.
- Appropriate initial antimicrobial therapy and adjunctive dexamethasone were associated with improved outcomes.
- Invasive intracranial pressure monitoring (11.9% of patients) was not associated with improved functional outcomes overall or in prespecified subgroups.
Methodological Strengths
- Large multicenter cohort with contemporary ICU management spanning 2012–2023.
- Robust statistical adjustment using multivariable mixed-effects models and propensity score overlap weighting.
Limitations
- Retrospective design with potential confounding by indication for ICP monitoring.
- Practice heterogeneity across centers and limited granularity on ICP management protocols.
Future Directions: Prospective randomized trials to assess ICP monitoring strategies versus protocolized medical management; enhanced phenotyping to identify subgroups that might benefit.
BACKGROUND: Community-acquired bacterial meningitis remains associated with high mortality and neurological disability in critically ill adults. Contemporary data on outcomes in mechanically ventilated patients and on the role of invasive intracranial pressure monitoring are limited. We aimed to describe 90-day outcomes, identify predictors of unfavorable neurological outcome, and evaluate the association between invasive intracranial pressure monitoring and prognosis in mechanically ventilated adults with community-acquired bacterial meningitis. METHODS: Retrospective multicenter cohort study (2012-2023) across 26 French ICUs. The primary endpoint was unfavorable functional outcome at day 90 (modified Rankin Scale score 3-6), assessed using multivariable mixed-effects regression and propensity score-based overlap weighting. FINDINGS: Among 704 included patients (median age, 66 years [IQR, 48-70 years]; 421 men [59.8%]), 354 (50.3%) had an unfavorable outcome at day 90, including 220 (31.3%) who died. Independent predictors of unfavorable outcome included older age, septic shock, acute kidney injury, coagulation disorders, lower motor score on the Glasgow Coma Scale, pupillary abnormalities, and abnormal brain imaging findings at presentation. Appropriate initial antimicrobial therapy, along with adjunctive dexamethasone, was associated with improved outcomes. Invasive intracranial pressure monitoring was performed in 84/704 patients (11.9%) and was not associated with improved functional outcome in the overall cohort (odds ratio, 0.97; 95% CI, 0.48-1.96) or in prespecified subgroups. INTERPRETATION: In this large real-world cohort, 90-day mortality and disability remain high and are largely driven by initial neurological and systemic severity. Invasive intracranial pressure monitoring was not associated with improved outcomes, and no clear benefit was identified in this observational analysis. FUNDING: None.