Weekly Anesthesiology Research Analysis
This week’s anesthesiology literature emphasizes precision perioperative care driven by data and simple pragmatic interventions. An AI clinical classifier for ARDS phenotypes offers a path to phenotype-guided corticosteroid use, while a large multicenter RCT shows lateral positioning during sedation markedly reduces hypoxaemia. Regional anesthesia practice is clarified by a high-quality meta-analysis favoring erector spinae plane block over quadratus lumborum block for postoperative analgesia.
Summary
This week’s anesthesiology literature emphasizes precision perioperative care driven by data and simple pragmatic interventions. An AI clinical classifier for ARDS phenotypes offers a path to phenotype-guided corticosteroid use, while a large multicenter RCT shows lateral positioning during sedation markedly reduces hypoxaemia. Regional anesthesia practice is clarified by a high-quality meta-analysis favoring erector spinae plane block over quadratus lumborum block for postoperative analgesia.
Selected Articles
1. Temporal stability of phenotypes of acute respiratory distress syndrome: clinical implications for early corticosteroid therapy and mortality.
An open-source AI Clinical Classifier derived from multicenter RCT data identified hyperinflammatory and hypoinflammatory ARDS phenotypes using routine clinical variables. Phenotypes were dynamic over 30 days, and target trial emulation showed corticosteroids reduced 30-day mortality in hyperinflammatory ARDS but increased mortality in hypoinflammatory ARDS; benefit persisted only if hyperinflammatory status remained at day 3.
Impact: Operationalizes phenotype-guided immunomodulation using routine data and links phenotypes to heterogeneous steroid effects — a practical step toward precision critical care.
Clinical Implications: Deploy bedside phenotype classifiers to guide corticosteroid decisions in ARDS—favor steroids for early hyperinflammatory phenotype, avoid in hypoinflammatory phenotype, and reassess phenotype within ~72 hours to confirm ongoing benefit.
Key Findings
- AI classifier using routine clinical data identified 39% hyperinflammatory and 61% hypoinflammatory ARDS.
- Phenotypes were dynamic: 49% of baseline hyperinflammatory patients transitioned to hypoinflammatory by day 30.
- Corticosteroids reduced 30-day mortality in hyperinflammatory ARDS (IPW-weighted HR 0.81) but increased mortality in hypoinflammatory ARDS (HR 1.26); benefit persisted only if phenotype remained hyperinflammatory at day 3.
2. Effect of lateral versus supine positioning on hypoxaemia in sedated adults: multicentre randomised controlled trial.
A pragmatic multicentre RCT (≈2,143 analyzed adults) found lateral positioning during sedation significantly reduced incidence and severity of hypoxaemia and decreased the need for airway rescue interventions compared with supine positioning, with no observed safety trade-offs. Benefits were consistent across centers.
Impact: A large, pragmatic, low-cost intervention with immediate applicability that meaningfully reduces hypoxaemia during procedural sedation — strong potential to change standard positioning practice.
Clinical Implications: Adopt lateral positioning as a default for adults undergoing procedural sedation when feasible to reduce hypoxaemia risk and lower airway rescue interventions; combine with existing oxygenation and monitoring protocols.
Key Findings
- Lateral positioning significantly reduced incidence and severity of hypoxaemia versus supine during sedation.
- Lateral position decreased need for airway rescue interventions.
- No safety compromises were identified across multiple centers.
3. Comparison of the analgesic effects of ultrasound-guided erector spinae plane block and quadratus lumborum block: a systematic review and meta-analysis.
A PROSPERO-registered meta-analysis of 27 RCTs (n≈1,942) found moderate-to-high quality evidence that ESPB provides superior postoperative analgesia compared with QLB, with lower 24-hour analgesic consumption, faster block performance, and reduced postoperative nausea and vomiting.
Impact: Synthesizes randomized evidence with GRADE appraisal to inform truncal block selection across procedures — directly actionable for regional anesthesia and ERAS pathways.
Clinical Implications: Prefer ESPB over QLB for truncal postoperative analgesia when appropriate, expecting less opioid consumption, faster placement, and lower PONV; tailor choice to surgical site and patient anatomy.
Key Findings
- Across 27 RCTs, ESPB reduced 24-hour postoperative analgesic consumption versus QLB (WMD −4.03; 95% CI −6.25 to −1.82).
- ESPB had faster block performance times and lower incidence of postoperative nausea and vomiting.
- GRADE assessment indicated moderate-to-high quality evidence; sensitivity and subgroup analyses supported robustness.