Weekly Anesthesiology Research Analysis
This week’s anesthesiology literature was dominated by large multicenter trials and high-quality translational work that could change perioperative and critical-care practice. A personalized, capillary refill time–targeted resuscitation strategy improved a hierarchical composite in early septic shock (CRT-guided ANDROMEDA-SHOCK-2). Two major ICU trials — one showing no mortality benefit but ecological concerns with selective digestive decontamination, and a large cluster trial demonstrating a lo
Summary
This week’s anesthesiology literature was dominated by large multicenter trials and high-quality translational work that could change perioperative and critical-care practice. A personalized, capillary refill time–targeted resuscitation strategy improved a hierarchical composite in early septic shock (CRT-guided ANDROMEDA-SHOCK-2). Two major ICU trials — one showing no mortality benefit but ecological concerns with selective digestive decontamination, and a large cluster trial demonstrating a low-cost intervention that reduced ICU staff burnout — have immediate organizational and policy implications. Across perioperative care, there is growing emphasis on individualized hemodynamics, pragmatic prevention bundles (delirium, CPSP), and validated prognostic tools using interpretable machine learning.
Selected Articles
1. Personalized Hemodynamic Resuscitation Targeting Capillary Refill Time in Early Septic Shock: The ANDROMEDA-SHOCK-2 Randomized Clinical Trial.
In a 19-country, multicenter randomized trial, a personalized resuscitation protocol targeting capillary refill time (CRT) improved a 28‑day hierarchical composite outcome (mortality, duration of vital support, length of stay) versus usual care, with the primary benefit coming from reduced duration of life‑support therapies.
Impact: Provides high-level evidence that a simple, bedside perfusion target (CRT) embedded in a personalized algorithm can improve clinically meaningful composite outcomes in early septic shock, shifting focus from uniform MAP targets to individualized assessment.
Clinical Implications: Consider protocolizing CRT assessment (with pulse pressure, diastolic pressure, fluid responsiveness, bedside echo) to tailor fluids, vasopressors, and inotropes in early septic shock; anticipate reductions in days on vasoactives, ventilation, and kidney support but plan implementation and training.
Key Findings
- CRT-guided personalized resuscitation achieved a win ratio of 1.16 (95% CI 1.02–1.33; P=0.04) favoring the intervention on the 28‑day hierarchical composite.
- Benefit was primarily driven by reduced duration of vital support (vasopressors, mechanical ventilation, kidney replacement therapy).
- Trial enrolled 1,467 patients across 86 centers in 19 countries, with stratification by APACHE II to ensure robustness across severities.
2. Positive communication for decreasing burnout in intensive-care-unit staff: a cluster-randomized trial.
A pragmatic, multinational cluster-RCT in 370 ICUs across 60 countries showed that a 4‑week, low-cost positive communication intervention significantly lowered burnout prevalence (52.2% vs 63.3%; adjusted OR 0.56) and improved emotional exhaustion, depersonalization, personal accomplishment, job satisfaction, and perceived workplace safety and ethics.
Impact: One of the largest randomized organizational interventions in critical care demonstrating scalable reductions in burnout with broad secondary benefits for workplace climate and likely downstream effects on patient care and staff retention.
Clinical Implications: ICUs and perioperative services should consider implementing brief, team-focused positive communication programs as part of staff well-being strategies; these are low-cost, pragmatic, and may improve care culture and reduce turnover.
Key Findings
- Burnout prevalence fell from 63.3% (control) to 52.2% (intervention) with adjusted OR 0.56 (95% CI 0.46–0.68; P<0.001).
- Emotional exhaustion and depersonalization scores decreased, and personal accomplishment increased in the intervention arm.
- Secondary benefits included higher job satisfaction, perceived safety, improved ethical climate, and reduced intention to leave.
3. Selective Decontamination of the Digestive Tract during Ventilation in the ICU.
In a large international cluster randomized crossover trial across 26 ICUs including 9,289 randomized patients and an ecologic assessment (10,711 patients), SDD did not reduce 90‑day in‑hospital mortality versus standard care. Patient-level microbiology showed fewer bloodstream infections and fewer cultured resistant organisms, but the ecologic noninferiority margin for new antibiotic‑resistant organisms was not met, leaving ecological safety unresolved.
Impact: Definitive, large-scale randomized evidence addressing a decades-long debate: SDD shows no mortality benefit and raises unresolved ecological concerns, directly informing ICU infection-control and antimicrobial stewardship policies.
Clinical Implications: Routine adoption of SDD to reduce mortality in ventilated patients is not supported; centers must weigh potential reductions in bloodstream infections against uncertain ecological risks and strengthen surveillance if SDD is considered.
Key Findings
- No difference in 90‑day in‑hospital mortality: 27.9% (SDD) vs 29.5% (standard); OR 0.93 (95% CI 0.84–1.05; P=0.27).
- Fewer new bloodstream infections and fewer cultured antibiotic‑resistant organisms at patient level with SDD.
- Ecologic assessment did not confirm noninferiority for new antibiotic‑resistant organisms at the unit level, leaving ecological safety unresolved.