Weekly Anesthesiology Research Analysis
This week highlighted practice-changing guideline updates and pragmatic trials in anesthesiology and critical care. SCCM focused guidance supports CCUS to guide hemodynamic and volume management with mortality benefit, PADIS updates nudge ICU sedation toward dexmedetomidine and emphasize mobilization and sleep strategies, and multi-society fungal guidance updates candidiasis care amid rising resistance. Across trials and cohort studies, themes of sustainability, AI diagnostic support, perioperat
Summary
This week highlighted practice-changing guideline updates and pragmatic trials in anesthesiology and critical care. SCCM focused guidance supports CCUS to guide hemodynamic and volume management with mortality benefit, PADIS updates nudge ICU sedation toward dexmedetomidine and emphasize mobilization and sleep strategies, and multi-society fungal guidance updates candidiasis care amid rising resistance. Across trials and cohort studies, themes of sustainability, AI diagnostic support, perioperative neurocognitive risk, and systems-level access to advanced therapies (ECMO) emerged.
Selected Articles
1. Society of Critical Care Medicine Guidelines on Adult Critical Care Ultrasonography: Focused Update 2024.
A multidisciplinary SCCM focused update reviews evidence since 2016 and suggests using CCUS to guide management for septic shock, acute dyspnea/respiratory failure, and cardiogenic shock. Notably, CCUS-guided targeted volume management is associated with improved mortality versus usual care, and the guideline emphasizes training, quality assurance, and targeted research needs.
Impact: This guideline directly links bedside ultrasound to improved hard outcomes and will influence ICU protocols, training priorities, and resourcing for CCUS implementation across hospitals.
Clinical Implications: Incorporate CCUS into shock and respiratory failure pathways to personalize fluid and hemodynamic management, invest in CCUS training/credentialing, and develop quality dashboards to monitor impact and adherence.
Key Findings
- Recommendation to use CCUS to guide management in septic shock, acute dyspnea/respiratory failure, and cardiogenic shock.
- Evidence supports CCUS-guided targeted volume management being associated with improved mortality compared with usual care.
2. A Focused Update to the Clinical Practice Guidelines for the Prevention and Management of Pain, Anxiety, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU.
The PADIS focused update issues conditional recommendations favoring dexmedetomidine over propofol for sedation, endorses enhanced mobilization/rehabilitation and melatonin for sleep support, and refrains from recommending benzodiazepines for anxiety or antipsychotics for delirium. Recommendations are GRADE-based and intended to refine ICU sedation and nonpharmacologic care.
Impact: PINPOINT recommendations on sedation and mobilization will alter ICU prescribing, nursing workflows, and procurement, with downstream effects on delirium and recovery trajectories.
Clinical Implications: When feasible, prefer dexmedetomidine-based sedation strategies, operationalize enhanced mobilization protocols, consider melatonin for sleep, and deprioritize routine benzodiazepines or antipsychotics absent clear indications.
Key Findings
- Conditional recommendation for dexmedetomidine over propofol for ICU sedation.
- Recommendation for enhanced mobilization/rehabilitation and melatonin; no recommendation for benzodiazepines for anxiety or antipsychotics for delirium.
3. Global guideline for the diagnosis and management of candidiasis: an initiative of the ECMM in cooperation with ISHAM and ASM.
An international, multi-society guideline updates diagnostic and treatment recommendations for invasive and mucocutaneous candidiasis in light of rising antifungal resistance and taxonomic changes (e.g., Candida auris and fluconazole-resistant Candida parapsilosis). The guidance consolidates evidence and provides practical recommendations for ICU and perioperative settings.
Impact: Provides timely, globally harmonized recommendations at a moment of rising antifungal resistance and pathogen reclassification, critical for ICU, perioperative prophylaxis, and stewardship programs.
Clinical Implications: Adopt updated diagnostic pathways and antifungal stewardship practices, incorporate guidance on emerging pathogens (C. auris) into ICU protocols, and update perioperative prophylaxis where local resistance patterns warrant.
Key Findings
- Highlights emergence of difficult-to-treat Candida species (e.g., Candida auris) and rising antifungal resistance.
- Provides consolidated, evidence-informed recommendations for invasive and mucocutaneous candidiasis relevant to ICU and perioperative care.