BJA open最新文献

{"title":"Exploring clinician and patient perspectives on choice of general anaesthetic. A report of two U.S. surveys: an anesthesia clinician Multicenter Perioperative Outcomes Group survey and a patient Amazon Mechanical Turk survey","authors":"Katherine J. Holzer ,&nbsp;Rachel M. Hurwitz ,&nbsp;Bethany R. Tellor Pennington ,&nbsp;Mary C. Politi ,&nbsp;Michelle T. Vaughn ,&nbsp;Larry Chu ,&nbsp;Amy Price ,&nbsp;Melissa Hicks ,&nbsp;Michael S. Avidan ,&nbsp;Sachin Kheterpal","doi":"10.1016/j.bjao.2025.100504","DOIUrl":"10.1016/j.bjao.2025.100504","url":null,"abstract":"<div><h3>Background</h3><div>Inhalation anaesthesia or propofol-based TIVA are the two primary options for administering general anaesthesia. Shared decision-making between clinicians and patients is critical. This study explores the perspectives of both anesthesia clinicians and patients on general anaesthesia techniques, aiming to identify gaps in communication and decision-making.</div></div><div><h3>Methods</h3><div>Two surveys were conducted in December 2020: an 18-item clinician survey disseminated through the Multicenter Perioperative Outcomes Group to clinicians who administer general anesthesia and a 33-item patient survey distributed via Amazon Mechanical Turk to individuals who had undergone surgery using general anaesthesia. The clinician survey focused on preferences regarding use of general anaesthesia techniques, discussion practices, and perceived barriers to TIVA use. The patient survey assessed preoperative discussions and preferences for anaesthetic techniques. Data were analysed using descriptive statistics.</div></div><div><h3>Results</h3><div>Of the 1123 anesthesia clinician respondents [comprised mostly of anaesthesiology attendings (47.8%) or Certified Registered Nurse Anesthetists (CRNAs, 34.6%)], when asked if they or a family member required general anaesthesia; 40% preferred TIVA, 13% preferred inhalation anesthesia and 33% indicated no preference. Nearly 80% of clinicians did not routinely discuss general anaesthetic technique options with patients. Among the 509 eligible patients (mean age: 38.1 yr), 65% reported that their anaesthesia team discussed general anaesthesia options, and 63% were offered a choice. Both anesthesia clinicians and patients identified intraoperative awareness risk and recovery quality as important factors influencing preferences.</div></div><div><h3>Conclusions</h3><div>This study highlights discrepancies between patient perceptions of shared decision-making and anesthesia clinicians’ reported practices for general anesthesia techniques in US hospitals. Further comparative studies are needed to address these communication gaps and support evidence-based shared decision-making in anaesthetic care.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"17 ","pages":"Article 100504"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147420137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A quality improvement initiative to improve operating room well-being: the Microaffirmations in Perioperative Personnel Project (The MAPP Project)","authors":"Shanique B. Kilgallon ,&nbsp;Vanessa Olbrecht ,&nbsp;Abigail Storm ,&nbsp;Loren Berman ,&nbsp;William J. Parkes ,&nbsp;Jacqueline L. Crawford ,&nbsp;Holly Antal","doi":"10.1016/j.bjao.2026.100530","DOIUrl":"10.1016/j.bjao.2026.100530","url":null,"abstract":"<div><h3>Background</h3><div>Burnout and lack of professional fulfilment are prevalent among perioperative personnel, often exacerbated by a culture that lacks positive reinforcement. Microaffirmations—small, intentional acts of recognition—may offer a scalable strategy to improve workplace culture and well-being. The primary objective was to evaluate the impact of a microaffirmation-based intervention, the Microaffirmations in Perioperative Personnel Project (MAPP Project), on professional fulfilment and burnout. The secondary objective was to evaluate changes in perceived and experienced microaggressions among perioperative staff.</div></div><div><h3>Methods</h3><div>A toolkit of microaffirmation examples was disseminated to perioperative members, and volunteer peer MAPP coaches modelled affirming behaviours. Surveys were administered at baseline before start of the intervention and at 3 and 6 months after the end of the intervention. The primary outcomes of professional fulfilment and burnout were measured using the validated Professional Fulfillment Index. Secondary outcomes including perceived and experienced microaggressions were assessed via a custom Microaggressions Impact Questionnaire.</div></div><div><h3>Results</h3><div>A total of 388 responses were collected across the three time points. Mean fulfilment scores increased from 2.53 at baseline to 2.67 at 6 months (<em>P</em>=0.222), whereas burnout scores decreased from 1.06 to 0.87 (<em>P</em>=0.029). Perceived microaggressions and their reported impact also declined. Among 67 participants who completed all three surveys, trends were consistent but not statistically significant. Survey response rates were 63%, 40%, and 41% at each time point, respectively.</div></div><div><h3>Conclusions</h3><div>The MAPP Project was associated with improved fulfilment, reduced burnout, and decreased perceived microaggressions among perioperative staff. These findings suggest that microaffirmation-based interventions may be a feasible and effective strategy to enhance workplace culture in health care settings.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"17 ","pages":"Article 100530"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Procalcitonin and interleukin-6 to diagnose infection in cardiac surgery patients with hyperinflammation: a two-centre, prospective cross-sectional study","authors":"Ted Reniers ,&nbsp;Peter Noordzij ,&nbsp;Eline Harding ,&nbsp;Henk Ruven ,&nbsp;Maaike Thio ,&nbsp;Marloes Langelaan ,&nbsp;Ineke Dijkstra ,&nbsp;Lisette Vernooij ,&nbsp;Olaf Cremer ,&nbsp;Thijs C.D. Rettig","doi":"10.1016/j.bjao.2026.100538","DOIUrl":"10.1016/j.bjao.2026.100538","url":null,"abstract":"<div><h3>Background</h3><div>Inflammation after cardiac surgery complicates infection diagnosis. The diagnostic value of procalcitonin (PCT) in patients with suspected infection remains unclear. We studied the diagnostic performance of PCT in elective cardiac surgery patients suspected of early-onset infection. Secondarily, we analysed C-reactive protein (CRP), leucocytes, interleukin-6 (IL-6), and neutrophil/lymphocyte ratio (NLR).</div></div><div><h3>Methods</h3><div>A two-centre, prospective study was conducted. Patients were suspected of infection if they developed abnormal body temperature (&lt;36.0°C or &gt;38.0°C), had blood cultures drawn, or received antibiotic treatment within the first 3 postoperative days. A positive and negative diagnostic threshold was assessed at the time infection was suspected, with a negative likelihood ratio (–LR) &lt;0.2 and a positive likelihood ratio (+LR) &gt;5 deemed clinically relevant for ruling out and ruling in infection, respectively.</div></div><div><h3>Results</h3><div>Infection was confirmed in 21/284 (7%) patients. The area under the curve (AUC) for PCT was 0.59 (95% confidence interval [CI] 0.47–0.71). No PCT threshold met predefined clinical relevance criteria, with a minimum –LR of 0.25 at 0.15 μg L^–1 and maximum +LR of 2.07 at 7.16 μg L^–1. The AUC for IL-6 was 0.70 (95% CI 0.59–0.80), achieving a –LR of 0.15 and a +LR of 5.37 at thresholds of 73 and 531 pg ml^–1, respectively. This enabled infection to be ruled out for 82 (29%) patients and ruled in for three (1%) patients. CRP, leukocytes, and NLR did not differentiate between infected and non-infected patients.</div></div><div><h3>Conclusions</h3><div>PCT did not meet clinically important thresholds, offering no valuable diagnostic information in patients with suspected infection early after cardiac surgery, whereas IL-6 did. IL-6 appears promising for ruling out infection, warranting further investigation.</div></div><div><h3>Trial registration number</h3><div>clinicaltrials.gov, registration number NCT05199025, Open Science Framework (OSF) (https://doi.org/10.17605/OSF.IO/6DGJS.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"17 ","pages":"Article 100538"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of adverse childhood experiences on sensory thresholds in adults living with multimorbidity and chronic pain: an observational feasibility study","authors":"Dhaneesha N.S. Senaratne ,&nbsp;Blair H. Smith ,&nbsp;Tim G. Hales ,&nbsp;Louise Marryat ,&nbsp;Lesley A. Colvin","doi":"10.1016/j.bjao.2026.100545","DOIUrl":"10.1016/j.bjao.2026.100545","url":null,"abstract":"<div><h3>Background</h3><div>Epidemiological studies have linked adverse childhood experiences (ACEs) to multimorbidity and chronic pain. One possible mechanism may be altered sensory processing, which could influence symptom development and persistence, and can be assessed by psychophysical methods such as quantitative sensory testing (QST). In this single-site feasibility study, we evaluated a study protocol to examine these relationships. Our primary aim was to assess the feasibility and acceptability of the study procedures. Our secondary aim was to generate preliminary data exploring relationships between ACE exposure and QST parameters.</div></div><div><h3>Methods</h3><div>This was a single-site feasibility study with a cross-sectional design. Adult participants completed questionnaires (including a 20-item ACE questionnaire), static QST based on the German Research Network on Neuropathic Pain protocol, and dynamic QST (conditioned pain modulation) using pressure and heat test stimuli.</div></div><div><h3>Results</h3><div>Of 101 people directly approached, 60 were recruited (recruitment rate, 59.4%; 73.3% female [<em>n</em>=44]; mean [range] age, 48.8 [19–87] yr). Study completion rate was 100%, and all participants reported that the protocol was either ‘completely acceptable’ (93.3%, <em>n</em>=56) or ‘acceptable’ (6.7%, <em>n</em>=4). In exploratory analyses, higher ACE exposure was associated with higher odds of chronic pain, multimorbidity, greater medication use, and higher pain severity and interference scores. Higher ACE count was also linked to some mechanical static QST parameters, but there was no relationship with dynamic QST parameters.</div></div><div><h3>Conclusions</h3><div>This study demonstrated that assessing sensory processing in relation to ACEs among adults with chronic pain and multimorbidity was both feasible and acceptable. Feasibility metrics and preliminary effect estimates will inform protocol refinement, outcome prioritisation, sample size calculations, and recruitment timelines for a future appropriately powered definitive study.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"17 ","pages":"Article 100545"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147420906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Noninvasive cardiac index estimation under general anaesthesia: comparison between the VenArt® device and transthoracic echocardiography☆","authors":"Catherine Paschoud ,&nbsp;Nicolas Silvestrini ,&nbsp;John Daniels ,&nbsp;Jérémie Koegel ,&nbsp;Stéphanie Mulin ,&nbsp;Florence Gonzalez Ennahdi-Elidrissi ,&nbsp;Laszlo Vutskits ,&nbsp;Nadia Elia ,&nbsp;Georges L. Savoldelli","doi":"10.1016/j.bjao.2025.100516","DOIUrl":"10.1016/j.bjao.2025.100516","url":null,"abstract":"<div><h3>Background</h3><div>VenArt® is a novel noninvasive cardiac output monitoring device which provides beat-by-beat Fick principle-based measurements of stroke volume and cardiac output. The study aim was to determine the accuracy of this device by comparing it with cardiac output measurements using transthoracic echocardiography in patients undergoing anaesthesia.</div></div><div><h3>Methods</h3><div>This prospective observational study included 55 women (ASA physical status classification I–III) undergoing laparoscopic gynaecological procedures. Cardiac output was assessed at five timepoints using the VenArt® device and transthoracic echocardiography. Primary endpoint was the agreement between the two methods regarding cardiac index, evaluated using Bland–Altman analysis to determine bias, precision, mean percentage error, and limits of agreement. Secondary endpoint was the ability of the device to track changes in cardiac index over time compared with echocardiography.</div></div><div><h3>Results</h3><div>We analysed 273 pairs of cardiac index values from 55 patients. Bland–Altman analysis showed a bias of 0.02 (95% confidence interval [CI] 0–0.05) L min⁻¹ m⁻², with a precision of 0.20 and a mean percentage error of 14.7% (95% CI 13.2–16.2%). Limits of agreement ranged from −0.37 (95% CI −0.41 to −0.33) to 0.41 (95% CI 0.37–0.45) L min⁻¹ m⁻². Trending ability demonstrated good agreement: the four-quadrant plot revealed a concordance rate of 95.88%, and the polar plot showed a mean polar angle of 0.75°, with a standard deviation of 13.4° and radial limits of agreement within plus or minus 30°.</div></div><div><h3>Conclusions</h3><div>The VenArt® device showed negligible bias and acceptable differences. Trending ability was favourable, with clinically acceptable agreement and high concordance in tracking haemodynamic changes.</div></div><div><h3>Clinical trial registration</h3><div>ISRCTN92565809.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"17 ","pages":"Article 100516"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145792279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative anaemia: the unseen challenge in cardiac surgery","authors":"Matthew A. Warner ,&nbsp;Jacob Raphael","doi":"10.1016/j.bjao.2025.100514","DOIUrl":"10.1016/j.bjao.2025.100514","url":null,"abstract":"<div><div>Postoperative anaemia is an overlooked complication of cardiac surgery that is associated with adverse clinical outcomes. Although small clinical trials suggest that postoperative treatment with i.v. iron improves haemoglobin recovery and reduces transfusion utilisation, appropriately powered randomised controlled trials are necessary to definitively evaluate the efficacy of treatment on clinical outcomes of importance to patients, clinicians, and healthcare systems. A comprehensive approach to perioperative anaemia management demands a renewed focus on both prevention and treatment to improve patient outcomes.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"17 ","pages":"Article 100514"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145792281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of postoperative haemoglobin with adverse outcomes in patients undergoing cardiac surgery: a retrospective single centre cohort study","authors":"Jamal Alkadri ,&nbsp;Maggie Chen ,&nbsp;Keyvan Karkouti ,&nbsp;Samantha Morais ,&nbsp;Refik Saskin ,&nbsp;Alexa Grudzinski ,&nbsp;Maral Ouzounian ,&nbsp;Jeannie Callum ,&nbsp;Yulia Lin ,&nbsp;Stuart A. McCluskey ,&nbsp;Daniel I. McIsaac ,&nbsp;Justyna Bartoszko","doi":"10.1016/j.bjao.2025.100508","DOIUrl":"10.1016/j.bjao.2025.100508","url":null,"abstract":"<div><h3>Background</h3><div>Preoperative anaemia is an important risk factor for adverse outcomes in cardiac surgery, however data on postoperative anaemia is sparse. The aim of this study is to characterise the association of postoperative haemoglobin with 30-day mortality and morbidity after cardiac surgery.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort study of adults (age ≥18 yr) undergoing coronary revascularisation, valve surgery, or a combination at Toronto General Hospital from 2016 to 2020. We analysed the association between nadir postoperative day 1 (POD1) haemoglobin as a continuous and binary variable (haemoglobin ≤80 g L⁻¹), with a primary composite outcome of 30-day mortality, stroke, myocardial infarction, acute kidney injury, sternal wound infection, or a combination. The secondary outcome was the incidence of adverse events. The primary outcome was analysed using logistic regression, secondary using Poisson regression; adjusted models accounted for clustering and confounders.</div></div><div><h3>Results</h3><div>We included 5960 patients. On POD1, mean haemoglobin was 90.1g L⁻¹ (standard deviation 15.2) and 1794 patients (30%) had haemoglobin ≤80 g L⁻¹. Red blood cells were transfused to 49% of the cohort, and to 90% of patients with POD1 haemoglobin ≤80 g L⁻¹. Each 10 g L⁻¹ decrease in POD1 haemoglobin increased the odds of the primary outcome (adjusted odds ratio [OR] 1.15 [1.05–1.25], <em>P</em>&lt;0.001), as did haemoglobin ≤80 g L⁻¹ (adjusted OR 1.44 [1.19–1.75], <em>P</em>&lt;0.001). For adverse events, each 10 g L⁻¹ decrease in haemoglobin was associated with an increased incidence rate ratio (IRR) (adjusted IRR 1.14 [1.07–1.20], <em>P</em>&lt;0.001), as was haemoglobin &lt;80 g L⁻¹ (adjusted IRR 1.33 [1.16–1.54], <em>P</em>&lt;0.001).</div></div><div><h3>Conclusions</h3><div>In postoperative cardiac surgical patients, progressive decreases in postoperative haemoglobin are associated with increased risk of mortality and major morbidity at 30 days.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"17 ","pages":"Article 100508"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a machine learning model to predict intensive care unit bed demand for adult elective surgical patients at a large United Kingdom National Health Service Trust","authors":"Jennifer Hunter ,&nbsp;Hrisheekesh Vaidya ,&nbsp;Sonya Crowe ,&nbsp;Martin Utley ,&nbsp;Zella King ,&nbsp;Kezhi Li ,&nbsp;Steve Harris","doi":"10.1016/j.bjao.2025.100513","DOIUrl":"10.1016/j.bjao.2025.100513","url":null,"abstract":"<div><h3>Background</h3><div>Elective surgical admissions form a growing share of demand for ICU beds, a constrained resource. Capacity planning for these admissions is feasible, but hospitals often lack reliable systems estimating daily elective surgical ICU bed demand before the day of surgery. Comprehensive clinical review of all elective cases is impractical, so planning relies on subjective preassessment processes of variable reliability. This study aimed to develop a machine learning model predicting elective surgical ICU bed demand using electronic health record data to improve on current electronic bed demand estimation at a large UK National Health Service (NHS) Trust.</div></div><div><h3>Methods</h3><div>Using a retrospective dataset comprising 38 656 elective inpatient surgeries occurring at three sites in a large UK NHS trust between 1 May 2019 and 31 December 2023, we developed two tree-based machine learning models predicting ICU admission after elective surgery: one using only basic, objective clinical data (CoreML) and one using additional preassessment data (FullML). Individual predictions were aggregated to forecast ICU bed demand. Performance was validated retrospectively and prospectively.</div></div><div><h3>Results</h3><div>At our large UK NHS Trust, in a prospective evaluation, only 71.6% of elective surgical cases admitted to ICU after surgery had an ICU bed electronically requested. In this evaluation, the CoreML model predicting ICU admission at an individual level 1 day before surgery achieved an area under the receiver operator curve of 0.88. It outperformed the current electronic indicator of aggregate elective surgical ICU bed demand 1 day before surgery at two sites handling 72% of inpatient elective surgery (root mean square error, 1.28 <em>vs</em> 1.64 at site A; 0.76 <em>vs</em> 1.16 at site C). CoreML outperformed FullML in aggregate prediction at all sites in prospective evaluation; however, importantly in retrospective evaluation, the converse was true.</div></div><div><h3>Conclusions</h3><div>We demonstrate that aggregating individual-level ICU admission predictions for elective surgeries provides a bed demand estimate that improves on the current electronic bed demand indicator 1 day before surgery at two out of three sites conducting the majority of inpatient elective surgery at our large UK NHS Trust. We demonstrate the importance of prospective validation, in which the more parsimonious model was the best performing.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"17 ","pages":"Article 100513"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Selective impairment of auditory discrimination in critically ill patients with delirium: a prospective electroencephalographic observational study","authors":"Fabrice Ferré ,&nbsp;William Buffières ,&nbsp;Lizette Heine ,&nbsp;Beatrice Riu ,&nbsp;Alexandra Corneyllie ,&nbsp;Benjamine Sarton ,&nbsp;Stein Silva ,&nbsp;Fabien Perrin","doi":"10.1016/j.bjao.2025.100517","DOIUrl":"10.1016/j.bjao.2025.100517","url":null,"abstract":"<div><h3>Background</h3><div>Delirium in the ICU is a major and potentially modifiable risk factor for subsequent neurocognitive decline. However, the cerebral dysfunctions underlying its behavioural manifestations remain poorly understood, limiting targeted clinical management. These dysfunctions may reflect impairments in low-level perceptual processes (stimulus detection), higher-order integrative processes (stimulus discrimination), or both. The P3 event-related potential (ERP), a positive deflection in the electroencephalogram occurring approximately 300 ms after stimulus presentation, reflects neural processes involved in attention and cognitive integration and provides an objective measure of auditory detection (P3a) and discrimination (P3b).</div></div><div><h3>Methods</h3><div>In this prospective single-centre observational study conducted between March and October 2021 in the Critical Care Unit of Purpan University Hospital, Toulouse, France, we used a multidimensional P3 ERP battery incorporating auditory paradigms designed to assess stimulus detection (P3a) and discrimination (P3b). The battery included both non-verbal stimuli (local–global paradigm) and verbal stimuli (subject’s own name and arithmetic paradigms). Critically ill COVID-19 patients with delirium (n=18) and without delirium (n=20) were prospectively recruited. The primary outcome was the presence of P3 subcomponents across paradigms. Group differences were assessed using spatial–temporal cluster-based permutation testing, with statistical significance defined at cluster-level P≤0.05.</div></div><div><h3>Results</h3><div>In patients without delirium, both detection-related (P3a) and discrimination-related (P3b) responses were present across verbal and non-verbal paradigms. In contrast, patients with delirium demonstrated preserved P3a responses to non-verbal auditory stimuli but absence of P3b responses, indicating impaired auditory discrimination (cluster-level P≤0.05). Source modelling suggested reduced activation of frontal cortical generators in patients with delirium compared with those without delirium.</div></div><div><h3>Conclusions</h3><div>In critically ill patients with COVID-19, delirium was associated with preserved automatic auditory detection but impaired higher-order auditory discrimination. This dissociation provides neurophysiological evidence of selective impairment in integrative cognitive processing during ICU delirium and contributes to improved mechanistic understanding of delirium-related brain dysfunction.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"17 ","pages":"Article 100517"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case report: intravenous provocation testing clears rocuronium after sugammadex-rocuronium complex-induced anaphylaxis","authors":"Myrthe de Haas ,&nbsp;Mark Vincent Koning ,&nbsp;Matthias H. Busch ,&nbsp;Tessa Langeveld","doi":"10.1016/j.bjao.2026.100541","DOIUrl":"10.1016/j.bjao.2026.100541","url":null,"abstract":"","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"17 ","pages":"Article 100541"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147379725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}