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Effect of prone positioning and PEEP on respiratory mechanics in children undergoing scoliosis surgery. 俯卧位和PEEP对脊柱侧凸手术患儿呼吸力学的影响。
IF 3.1 Pub Date : 2025-10-15 DOI: 10.1186/s44158-025-00285-4
Anna Camporesi, Federico Cristiani, Pablo Cruces, Horacio Igarzabal, Giulia Catozzi, Ginevra Bayon, Fernando Fontans, Gimena Falcao, Sofi Odriozola, Jurg Hammer, Sebastiàn Gonzalez-Dambrauskas

Background: Surgery for severe scoliosis (SS) is usually performed in the prone position. Changes in respiratory mechanics related to position and positive end expiratory pressure (PEEP) titration during anesthesia of SS are understudied. We aimed to investigate the effect of prone position and PEEP on the respiratory mechanics of scoliotic children undergoing spine surgery.

Methods: Prospective, crossover study performed in two pediatric hospitals (Montevideo, Uruguay-Centro Hospitalario Pereira Rossell- and Milano, Italy-Vittore Buzzi Children's Hospital). Shortly after intubation, pulmonary mechanics measurements were performed using inspiratory and expiratory breath holds during volume-controlled ventilation with a set tidal volume (TV) of 8 ml/kg and a respiratory rate adjusted to maintain normocapnia. Measurements of peak (PIP), plateau (PPLAT) and total PEEP (tPEEP) were obtained at three levels of applied PEEP: 0 (ZEEP), 5, and 10 cmH2O both in supine (baseline) and prone positions. Driving pressure (∆P: PPLAT-tPEEP) was calculated to obtain static respiratory system compliance (Crs: TV/∆P). Crs and pressures were analyzed using a mixed linear regression model with a random subject effect in their relationship with position and PEEP.

Results: Sixty-nine patients were enrolled. Crs was negatively associated with Cobb angle in all the cohorts. Only in secondary scoliosis, it was positively associated with body mass index. Crs was also negatively correlated with the prone position and positively correlated with increasing PEEP levels. The interaction between PEEP and position was studied and showed no significance.

Conclusions: Crs is influenced by the severity of scoliosis and the nutritional status during spine surgery. The addition of PEEP improves Crs and reduces ∆P in the supine position, but both worsen in the prone position. These changes can be related to the effects of position on chest wall compliance.

背景:重度脊柱侧凸(SS)的手术通常采用俯卧位。呼吸力学的变化与体位和呼气末正压(PEEP)滴定有关。我们的目的是探讨俯卧位和PEEP对脊柱侧凸手术患儿呼吸力学的影响。方法:在两家儿科医院(乌拉圭蒙得维的亚-佩雷拉·罗塞尔中心医院和意大利米兰- vittore Buzzi儿童医院)进行前瞻性交叉研究。插管后不久,在容量控制通气期间使用吸气和呼气屏气进行肺力学测量,设定潮气量(TV)为8 ml/kg,并调整呼吸速率以维持正常呼吸能力。在仰卧位(基线)和俯卧位的三个PEEP水平下测量峰值(PIP)、平台(PPLAT)和总PEEP (tPEEP): 0 (ZEEP)、5和10 cmH2O。计算驱动压力(∆P: pplatt - tpeep),得到静态呼吸系统顺应性(Crs: TV/∆P)。采用随机主体效应的混合线性回归模型分析Crs和压力与体位和PEEP的关系。结果:69例患者入组。在所有队列中,Crs与Cobb角呈负相关。只有在继发性脊柱侧凸中,它与体重指数呈正相关。Crs与俯卧位呈负相关,与PEEP升高呈正相关。研究了PEEP与体位之间的相互作用,没有发现明显的差异。结论:Crs受脊柱侧凸严重程度和脊柱手术期间营养状况的影响。加入PEEP可改善仰卧位Crs,降低∆P,但俯卧位Crs和∆P均恶化。这些变化可能与体位对胸壁顺应性的影响有关。
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引用次数: 0
Dual doppler dynamics: integrating femoral venous doppler and VExUS for predicting organ dysfunction in acute heart failure. 双多普勒动力学:综合股静脉多普勒和VExUS预测急性心力衰竭脏器功能障碍。
IF 3.1 Pub Date : 2025-10-15 DOI: 10.1186/s44158-025-00283-6
Vimal Bhardwaj, Abhishek Samprathi, Kingshuk Saha, Nicolas Orozco, Pramukh Hegde, Mohammed Nizamudin, Jose Chacko, Manu M K Varma, Andre Denault, Vikneswaran G, Philippe Rola, Arjun Alva

Background: Heart failure (HF) leads to venous congestion (VC), leading to organ dysfunction. Traditional VC assessments include pulmonary artery catheterization and IVC ultrasound. Newer tools like venous excess ultrasound (VExUS) and femoral venous doppler (FVD) quantify VC severity. We aimed to compare FVD with VExUS score to predict organ dysfunction and its progression in acute HF patients.

Methods: We conducted a 6-month prospective study in a 36-bed Cardiac ICU, enrolling 111 adults with acute decompensated HF. We evaluated FVD and VExUS to predict organ dysfunction and its progression. Key parameters were recorded on ICU admission and Day 3. We followed up patients at 90-days using the MAKE-90 criteria. Sensitivity, specificity, and predictive values of FVD and VExUS were calculated and compared using McNemar's test.

Results: VC was higher in the organ dysfunction group, with higher VExUS scores (55% vs. 31%, p = 0.018) and FVD-defined congestion (85% vs. 57%, p = 0.002). This group also revealed worse LUS, lower TAPSE:PASP ratios, more severe AKI, higher creatinine, and increased use of non-invasive ventilation (all p < 0.01). Mortality (39% vs. 24%) and MAKE-90 events (56% vs. 39%) were higher but not statistically significant. FVD had higher sensitivity but lower specificity than VExUS in detecting AKI, and lung congestion. VExUS had higher specificity for RV coupling and organ dysfunction; FVD correlated more with organ dysfunction.

Conclusion: FVD and VExUS provide complementary insights into venous congestion, reinforcing the need for an integrated approach rather than reliance on a single modality. A multimodal strategy combining these tools with clinical and biochemical markers may offer a more precise framework for guiding management in acute heart failure.

Trial registration: This trial was registered with Clinical Trial Registry-India ( https://www.ctri.nic.in/ ), Trial No-CTRI/2023/10/058186 on 3/10/2023.

背景:心力衰竭(HF)导致静脉充血(VC),导致器官功能障碍。传统的VC评估包括肺动脉插管和IVC超声。较新的工具,如静脉过量超声(VExUS)和股静脉多普勒(FVD)量化VC的严重程度。我们的目的是比较FVD和VExUS评分来预测急性心衰患者的器官功能障碍及其进展。方法:我们在一家36张床位的心脏ICU进行了一项为期6个月的前瞻性研究,纳入了111例急性失代偿性心衰患者。我们评估FVD和VExUS来预测器官功能障碍及其进展。在ICU入院和第3天记录关键参数。我们使用MAKE-90标准对患者进行90天随访。使用McNemar试验计算并比较FVD和VExUS的敏感性、特异性和预测值。结果:VC在器官功能障碍组较高,有较高的VExUS评分(55%对31%,p = 0.018)和fvd定义的充血(85%对57%,p = 0.002)。该组还显示更差的LUS,更低的TAPSE:PASP比率,更严重的AKI,更高的肌酐,以及增加使用无创通气(所有p结论:FVD和VExUS提供了对静脉充血的补充见解,加强了对综合方法的需求,而不是依赖单一模式。将这些工具与临床和生化标志物相结合的多模式策略可能为指导急性心力衰竭的管理提供更精确的框架。试验注册:本试验于2023年10月3日在印度临床试验注册中心(https://www.ctri.nic.in/)注册,试验No-CTRI/2023/10/058186。
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引用次数: 0
Deciding how to decide the correct double-lumen tube: a narrative review of methods and evidence. 决定如何选择正确的双腔管:方法和证据的叙述性回顾。
IF 3.1 Pub Date : 2025-10-14 DOI: 10.1186/s44158-025-00286-3
M Rispoli, G Calgaro, G Strano, G L Rosboch, D Massullo, F Piccirillo, M R Nespoli, F Coppolino, F Piccioni

The selection of the appropriate size of a double-lumen tube (DLT) is a critical yet often underestimated aspect of thoracic anaesthesia. The present narrative review evaluates traditional and emerging methods for determining DLT size, including anthropometric formulas, chest X-rays, CT scans, and ultrasonography. Despite the prevalence of height- and gender-based predictions, mounting evidence underscores their restricted correlation with airway anatomy. Chest X-rays and CT scans have been shown to offer more accurate estimations of tracheobronchial dimensions, while ultrasound has been identified as a promising bedside tool. Recent meta-analytic evidence and technological advancements, including 3D reconstruction and AI-based modelling, may support a more personalised and safer approach. It is recommended that a pragmatic, image-guided strategy be employed to minimise airway trauma, improve lung isolation, and optimise patient outcomes.

选择合适大小的双腔管(DLT)是胸麻醉的一个关键但往往被低估的方面。本文评估了用于确定DLT大小的传统方法和新兴方法,包括人体测量公式、胸部x光、CT扫描和超声检查。尽管基于身高和性别的预测普遍存在,但越来越多的证据强调它们与气道解剖结构的有限相关性。胸部x光片和CT扫描已被证明可以提供更准确的气管支气管尺寸估计,而超声波已被确定为一种有前途的床边工具。最近的元分析证据和技术进步,包括3D重建和基于人工智能的建模,可能会支持更个性化和更安全的方法。建议采用一种实用的、图像引导的策略来减少气道损伤,改善肺隔离,优化患者预后。
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引用次数: 0
Exploring risk factors for pediatric cancer patients admitted to the Pediatric Intensive Care Unit: insight from a multicenter observational study revealing no association with mechanical ventilation. 探索儿科重症监护病房收治的儿科癌症患者的危险因素:来自一项多中心观察性研究的见解,显示与机械通气无关。
IF 3.1 Pub Date : 2025-10-14 DOI: 10.1186/s44158-025-00275-6
Angela Amigoni, Sara Boscato, Maria Cristina Mondardini, Francesca Cavagnero, Luca Marchetto, Veronica Biassoni, Carolina Birolo, Gabriella Bottari, Manuela Corno, Stefania Ferrario, Giorgia Maiolo, Alessia Montaguti, Emanuele Rossetti, Immacolata Rulli, Raffaella Sagredini, Stefania Spaggiari, Luisa Vatiero, Gianluca Vigna, Matteo Martinato, Dario Gregori, Marta Pillon, Rosanna Irene Comoretto

Background: To analyze risk factors for adverse outcomes in a nationally representative sample of pediatric cancer patients admitted to the PICU.

Methods: An observational study composed of a 2-year retrospective phase and a 2-year prospective phase was conducted before and during PICU admission in Italian PICUs.

Results: We included 518 patients, median age 7.2 years (IQR 2.5-12.6). Main diagnosis: solid tumors (51%) and acute lymphoblastic leukemia (23%). Nineteen percent underwent stem cell transplantation (HSCT). Main causes of admission were respiratory failure (33%) and neurological impairment (24%). In-PICU mortality was 15%, higher in HSCT (41%) and non-solid cancer (25%). Pre-PICU mortality risk factors included HSCT (OR 3.48, 95%CI 1.5-8.11), higher Pediatric Overall Performance Category (POPC) (OR 1.72, 95%CI 1.23-2.42), and Pediatric Index of Mortality 3 (PIM-3) score (OR 1.03, 95%CI 1.01-1.06). In-PICU mortality risk factors included multiple organ failure (MOF) (OR 4.83, 95%CI 1.66-15.71), and cardiac arrest (OR 82.16, 95%CI 14.19-1594.61). The use of MV does not appear to be associated with increased mortality. Longer PICU LOS was associated with pre-admission acute respiratory distress syndrome (p < 0.001), renal failure (p = 0.024), POPC (p = 0.007) and PIM 3 (p < 0.001), and in-PICU use of total parenteral nutrition (p = 0.036), and duration of mechanical ventilation (MV) (p < 0.001).

Conclusions: HSCT, non-solid tumor, higher PIM-3, and POPC on admission, MOF, and history of cardiac arrest were associated with poorer outcome. The use of MV does not appear to be associated with increased mortality.

Trial registration: ClinicalTrials.gov ID NCT04581655, October 7, 2020.

背景:分析PICU收治的具有全国代表性的儿科癌症患者不良结局的危险因素。方法:对意大利PICU患者在PICU入院前和入院期间进行为期2年的回顾性研究和为期2年的前瞻性研究。结果:纳入518例患者,中位年龄7.2岁(IQR 2.5-12.6)。主要诊断:实体瘤(51%)和急性淋巴细胞白血病(23%)。19%接受了干细胞移植(HSCT)。入院的主要原因是呼吸衰竭(33%)和神经功能障碍(24%)。picu内死亡率为15%,HSCT(41%)和非实体癌(25%)的死亡率更高。picu前的死亡危险因素包括HSCT (OR 3.48, 95%CI 1.5-8.11)、较高的儿科整体表现类别(POPC) (OR 1.72, 95%CI 1.23-2.42)和儿科死亡指数3 (PIM-3)评分(OR 1.03, 95%CI 1.01-1.06)。picu内死亡危险因素包括多器官衰竭(MOF) (OR 4.83, 95%CI 1.66-15.71)和心脏骤停(OR 82.16, 95%CI 14.19-1594.61)。MV的使用似乎与死亡率的增加无关。较长的PICU LOS与入院前急性呼吸窘迫综合征相关(p)。结论:HSCT、非实体肿瘤、入院时较高的PIM-3和POPC、MOF和心脏骤停史与较差的预后相关。MV的使用似乎与死亡率的增加无关。试验注册:ClinicalTrials.gov ID NCT04581655, 2020年10月7日。
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引用次数: 0
Wall blocks for breast cancer in pregnant patients: saving general anaesthesia also benefits foetal wellness. 孕妇乳腺癌壁阻滞:节省全身麻醉也有利于胎儿健康。
IF 3.1 Pub Date : 2025-10-09 DOI: 10.1186/s44158-025-00281-8
Cristiano D'Errico, Annamaria Fabozzi, Giuseppe Sepolvere, Martino Trunfio, Michele Liguori, Cristina Manetti, Dario Paolo Anceschi, Raffaella Amato

Although it is uncommon in general, breast cancer is the most commonly diagnosed cancer during pregnancy. Pregnant patients should receive treatment based on nonpregnant guidelines, with special adjustments for diagnosis, staging, oncology, and obstetrics. This situation is particularly concerning for the health of a long-awaited foetus, especially after medical intervention to aid fertilization. To ensure the baby's safety, it is best to conclude the pregnancy as soon as possible in many cases. We know this is not always possible. This case report discusses the application of the pecto-serratus plane block (PSP) in a patient at seven months gestation undergoing breast quadrantectomy due to the abrupt onset of breast cancer. This study is limited as it involves only one patient. However, it highlights the relevance of locoregional anaesthesia in para-physiological states such as pregnancy.

虽然乳腺癌在一般情况下并不常见,但它是怀孕期间最常见的癌症。孕妇应根据非孕妇指南接受治疗,并对诊断、分期、肿瘤和产科进行特殊调整。这种情况对期待已久的胎儿的健康尤其令人担忧,特别是在医疗干预以帮助受精之后。为了保证宝宝的安全,很多情况下最好尽早结束妊娠。我们知道这并不总是可能的。本病例报告讨论了胸锯肌平面阻滞(PSP)在妊娠7个月因乳腺癌突然发作而行乳房四象限切除术的患者中的应用。本研究仅涉及一名患者,因此具有局限性。然而,它强调了局部区域麻醉在超生理状态(如怀孕)中的相关性。
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引用次数: 0
Difficult airway management in adults: Insights from an observational cohort study on the use of videolaryngoscopy and fiberoptic bronchoscopy in a direct laryngoscopy-based practice. 成人气道管理困难:一项观察性队列研究在直接喉镜基础上使用视频喉镜和纤维支气管镜的见解。
IF 3.1 Pub Date : 2025-10-09 DOI: 10.1186/s44158-025-00280-9
Alexander Avidan, Tural Alekberli, Fung H Mua, Charles Weissman, Chloé Mimouni

Background: Videolaryngoscopy has significantly improved the management of unanticipated difficult airways and replaced other intubation techniques. The goal of this study was to identify the indications for using videolaryngoscopy and fiberoptic bronchoscopy for adult patients, where direct laryngoscopy is the standard intubation technique.

Methods: Over a one-year period from January to December 2018, anesthesiologists were surveyed on their reasons for using a videolaryngoscope or fiberoptic bronchoscope for tracheal intubations. Additionally, retrospective data on all direct laryngoscopy intubations were collected for the same period from the anesthesia information management system.

Results: Out of 6251 tracheal intubations with direct laryngoscopy and 502 with videolaryngoscopy or fiberoptic bronchoscopy, data from 450 (89.6%) cases were collected. We excluded 46 cases where videolaryngoscopy and fiberoptic bronchoscopy were used for non-airway management reasons, resulting in 404 cases for analysis. Videolaryngoscopy was initially used in 356 (88.1%) patients. The primary reasons for using videolaryngoscopy or fiberoptic bronchoscopy were anticipated difficult intubation (218, 54.0%) and cervical pathology (109, 27.0%). Among the 42 cases of unanticipated failed direct laryngoscopy, videolaryngoscopy was used in 41 cases and fiberoptic bronchoscopy in 1 case. The overall rate of unanticipated failed direct laryngoscopy was 0.7%.

Conclusions: The routine use of videolaryngoscopy and fiberoptic bronchoscopy for anticipated difficult tracheal intubations led to a very low incidence of unanticipated failed tracheal intubations with direct laryngoscopy. Therefore, routinely using more expensive videolaryngoscopes for all intubations would prevent only very small numbers of unanticipated failed direct laryngoscopic intubations and is not financially justified.

背景:视频喉镜检查显著改善了意外困难气道的处理,并取代了其他插管技术。本研究的目的是确定成人患者使用视频喉镜和纤维支气管镜的适应症,其中直接喉镜是标准的插管技术。方法:于2018年1月至12月对麻醉医师进行气管插管使用视频喉镜或纤维支气管镜的原因调查。此外,从麻醉信息管理系统中收集同期所有直接喉镜插管的回顾性数据。结果:6251例直接喉镜下气管插管,502例视频喉镜或纤维支气管镜下气管插管,共收集450例(89.6%)的数据。我们排除了46例因非气道管理原因使用视频喉镜和纤维支气管镜的病例,共404例进行分析。356例(88.1%)患者最初使用视频喉镜检查。使用视频喉镜或纤维支气管镜检查的主要原因是预期插管困难(218例,54.0%)和颈部病理(109例,27.0%)。42例直接喉镜检查意外失败,41例行视频喉镜检查,1例行纤维支气管镜检查。意外喉镜检查失败的总比率为0.7%。结论:常规使用视频喉镜和纤维支气管镜检查预期气管插管困难,直接喉镜下气管插管意外失败的发生率极低。因此,常规使用更昂贵的视频喉镜进行所有插管只能防止极少数意外的直接喉镜插管失败,并且在经济上是不合理的。
{"title":"Difficult airway management in adults: Insights from an observational cohort study on the use of videolaryngoscopy and fiberoptic bronchoscopy in a direct laryngoscopy-based practice.","authors":"Alexander Avidan, Tural Alekberli, Fung H Mua, Charles Weissman, Chloé Mimouni","doi":"10.1186/s44158-025-00280-9","DOIUrl":"10.1186/s44158-025-00280-9","url":null,"abstract":"<p><strong>Background: </strong>Videolaryngoscopy has significantly improved the management of unanticipated difficult airways and replaced other intubation techniques. The goal of this study was to identify the indications for using videolaryngoscopy and fiberoptic bronchoscopy for adult patients, where direct laryngoscopy is the standard intubation technique.</p><p><strong>Methods: </strong>Over a one-year period from January to December 2018, anesthesiologists were surveyed on their reasons for using a videolaryngoscope or fiberoptic bronchoscope for tracheal intubations. Additionally, retrospective data on all direct laryngoscopy intubations were collected for the same period from the anesthesia information management system.</p><p><strong>Results: </strong>Out of 6251 tracheal intubations with direct laryngoscopy and 502 with videolaryngoscopy or fiberoptic bronchoscopy, data from 450 (89.6%) cases were collected. We excluded 46 cases where videolaryngoscopy and fiberoptic bronchoscopy were used for non-airway management reasons, resulting in 404 cases for analysis. Videolaryngoscopy was initially used in 356 (88.1%) patients. The primary reasons for using videolaryngoscopy or fiberoptic bronchoscopy were anticipated difficult intubation (218, 54.0%) and cervical pathology (109, 27.0%). Among the 42 cases of unanticipated failed direct laryngoscopy, videolaryngoscopy was used in 41 cases and fiberoptic bronchoscopy in 1 case. The overall rate of unanticipated failed direct laryngoscopy was 0.7%.</p><p><strong>Conclusions: </strong>The routine use of videolaryngoscopy and fiberoptic bronchoscopy for anticipated difficult tracheal intubations led to a very low incidence of unanticipated failed tracheal intubations with direct laryngoscopy. Therefore, routinely using more expensive videolaryngoscopes for all intubations would prevent only very small numbers of unanticipated failed direct laryngoscopic intubations and is not financially justified.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"5 1","pages":"61"},"PeriodicalIF":3.1,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12512551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145260165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Understanding organ donation refusal in the next of kin: a fifteen-year retrospective study in ten thousand potential donors. 了解近亲拒绝器官捐赠:一项对1万名潜在捐赠者进行的15年回顾性研究。
IF 3.1 Pub Date : 2025-10-09 DOI: 10.1186/s44158-025-00282-7
Stefano Marelli, Lorenzo Querci, Federico Pozzi, Cristiana Cipolla, Giuseppe Piccolo, Marco Sacchi, Tullia De Feo, Massimo Cardillo, Arturo Chieregato

Introduction: Refusal of organ donation is influenced by a range of interconnected factors spanning donor characteristics, family dynamics, and intensive care unit (ICU) practices. This study explores the impact of donor or centre-related variables on organ donation refusal rates in Italian ICUs, among potential donors without expressed will.

Methods: We conducted a retrospective analysis of 12,930 potential donors registered in the North Italian Transplant Program registry from 01/01/2010 to 31/03/2025. A linear mixed-effects model was applied to account for donor characteristics (age, timing and cause of death, geographic origin) and ICU-level variability with refusal of organ donation.

Results: In multivariate analysis geographic origin was an independent predictor of refusal - particularly for donors from North Africa and Middle East (OR 9.59, IQR 6.25 - 14.72; p-value < 0.001), Asia (OR 7.76, IQR 5.69-10.57; p-value < 0.001), Africa (OR 6.81, IQR 4.44 - 10.45; p-value < 0.001) and eastern European (OR 2.65, IQR 2.17 - 3.23; p-value < 0.001). Also, time from event to death over 48 h was associated with higher refusal rate (OR 3.37, IQR 2.52 - 4.50, p-value < 0.001). In contrast, traumatic brain injury (OR 0.85, IQR 0.74 - 0.98; p-value 0.023) was protective. Finally, inter-ICU variability had a significant impact on refusal rates, as indicated by a Median Odds Ratio of 1.38. However, the multivariate model demonstrated weak predictive ability for organ donation refusal (AUC = 0.66).

Conclusions: This study identifies several factors independently associated with organ donation refusal. However, the overall predictive ability based on available variables remains limited. To enable individualized interventions and effectively reduce refusal rates, more comprehensive and prospective data collection is warranted.

器官捐赠的拒绝受到一系列相互关联的因素的影响,包括捐赠者特征、家庭动态和重症监护病房(ICU)的实践。本研究探讨了在意大利icu中,在没有表达意愿的潜在捐赠者中,捐赠者或中心相关变量对器官捐赠拒绝率的影响。方法:我们对2010年1月1日至2025年3月31日在北意大利移植计划登记处登记的12,930名潜在供体进行了回顾性分析。采用线性混合效应模型来考虑供体特征(年龄、时间和死亡原因、地理来源)和icu水平随器官捐赠拒绝的变异性。结果:在多变量分析中,地理来源是拒绝器官捐献的独立预测因子,尤其是北非和中东地区(OR 9.59, IQR 6.25 - 14.72; p值)。结论:本研究确定了与器官捐献拒绝独立相关的几个因素。然而,基于可用变量的整体预测能力仍然有限。为了实现个性化干预并有效降低拒绝率,需要更全面和前瞻性的数据收集。
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引用次数: 0
Gene expression kinetics in Sepsis After Cardiac Surgery (SACS): a multicentric prospective observational study. 心脏手术后脓毒症(SACS)的基因表达动力学:一项多中心前瞻性观察研究。
IF 3.1 Pub Date : 2025-09-26 DOI: 10.1186/s44158-025-00277-4
Rosa Paola Radice, Giuseppe Martelli, Mauro D'Amora, Pierpaolo Dambruoso, Domenico Paparella, Raffaele Mandarano, Giuseppe Olivo, Massimo Scolaro, Domenico Sarubbi, Alessandro Strumia, Maria Calabrese, Andrea Scapigliati, Francesco Greco, Mary Nardi, Stefano Beccaria, Andrea Costamagna, Luca Brazzi, Domenico Abelardo, Pasquale Raimondo, Gianluca Paternoster

Objectives: Surviving Sepsis Campaign (SSC) defined Sepsis as "life-threatening organ dysfunction caused by a dysregulated host response to infection" (De Backer D et al, Crit Care Med, n.d.). Sepsis remains one of the leading causes of morbidity and mortality (17-65% (De Oliveira DC, Arq Bras Cardiol Sociedade Brasileira de Cardiologia - SBC 94:352-6, 2010)) worldwide and it still remains a challenge to be defined and for which an appropriate treatment is desired (Chiu and Legrand, Curr Opin Anaesthesiol 34:71-6, 2021). Different studies have been conducted on genes coding for inflammatory cytokines whose could predispose to the development of sepsis [e.g., IL-10 PD1 and WT1] (Gupta DL et al, Infectious Process Sepsis, 202).

Design: This multicentric observational prospective study aims to evaluate blinding the genetic expression kinetics of different molecules involved in the inflammatory process, IL10, PD1 and WT1, to search for a possible molecular predictive marker of sepsis.

Setting: Nine University teaching Hospitals in Italy take part in this study in collaboration with the Department of Applied Science (DISBA) of the University of Basilicata.

Participants: One hundred sixty-two patients, under elective cardiac and on pump surgery were enrolled in the study.

Interventions: From each patient 4 blood samples were collected during and at the end of the surgery, following the study design.

Measurements and main results: We observed, 30 min after the start of the surgery, lower gene expression levels of IL10 and PD1 in septic patients compared to non-septic (p < 0.05), but considering all the timepoint there are differences in gene expression modulation between the groups.

Conclusion: These results confirmed the dysregulated immune response in septic patients compared to non-septic, highlight how a measurement of the gene expression could help to optimize procedures and pay attention to more susceptible patients.

目的:生存脓毒症运动(SSC)将脓毒症定义为“由宿主对感染反应失调引起的危及生命的器官功能障碍”(De Backer等人,Crit Care Med, n.d)。脓毒症仍然是世界范围内发病率和死亡率的主要原因之一(17-65% (De Oliveira DC, Arq Bras Cardiol Sociedade Brasileira De Cardiologia - SBC 94:352- 6,2010)),它仍然是一个需要定义的挑战,并需要适当的治疗(Chiu和Legrand, Curr Opin anaessiol 34:71- 6,2021)。对炎症细胞因子编码基因进行了不同的研究,这些基因可导致败血症的发生[例如,IL-10 PD1和WT1] (Gupta DL等,感染性过程败血症,202)。设计:本多中心观察性前瞻性研究旨在评估炎症过程中不同分子IL10、PD1和WT1的遗传表达动力学,以寻找可能的脓毒症分子预测标志物。环境:意大利的九所大学教学医院与巴西利卡塔大学应用科学系(DISBA)合作参与了这项研究。参与者:162例择期心脏和泵手术患者被纳入研究。干预措施:按照研究设计,在手术期间和手术结束时从每位患者采集4份血液样本。测量和主要结果:我们观察到,手术开始后30分钟,脓毒症患者的IL10和PD1基因表达水平低于非脓毒症患者(p结论:这些结果证实了脓毒症患者与非脓毒症患者相比免疫反应失调,强调了基因表达的测量如何有助于优化手术并关注更多易感患者。
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引用次数: 0
AI policy in healthcare: a checklist-based methodology for structured implementation. 医疗保健中的人工智能政策:用于结构化实施的基于检查清单的方法。
IF 3.1 Pub Date : 2025-09-25 DOI: 10.1186/s44158-025-00278-3
Elena Bignami, Luigino Jalale Darhour, Gabriele Franco, Matteo Guarnieri, Valentina Bellini
<p><strong>Introduction: </strong>Artificial Intelligence (AI) is transforming anaesthesia and intensive care medicine, enhancing diagnostic precision, workflow efficiency, and patient safety. However, deploying AI in high-acuity environments involves regulatory, ethical, and operational challenges. The European Union Artificial Intelligence Act (AI Act), effective 2025, imposes binding obligations on healthcare organizations, creating an urgent need for structured, governance-focused AI policies. This work presents a checklist-based methodology for responsible, safe, ethical, and regulation-aligned AI adoption in clinical units.</p><p><strong>The need for a methodology to develop an ai policy: </strong>Effective AI policies must ensure transparency, safety, fairness, and regulatory compliance while remaining adaptable to rapid technological and legislative changes. The proposed methodology employs a domain-specific checklist to generate critical evaluative questions, enabling healthcare professionals to systematically assess AI systems' appropriateness, reliability, and legal implications without relying on rigid, quickly outdated prescriptive rules.</p><p><strong>The ai act and its relevance: </strong>Regulation (EU) 2024/1689 establishes the first comprehensive AI legal framework, introducing risk-based classification, imposing stringent requirements for high-risk AI, often including medical devices. Compliance obligations extend to both AI-system providers and deployers, making operational compliance instruments and AI literacy programmes essential for lawful implementation.</p><p><strong>Ai literacy: </strong>OBLIGATION AND PLANNING: From February 2025, the AI Act mandates AI literacy for all personnel interacting with AI-systems. Training should cover baseline competencies for all staff, advanced modules for specialists, continuous professional development, and integration of ethical, legal, and governance principles. Competency acquisition and updates must be systematically documented to meet institutional and EU compliance standards.</p><p><strong>Operational checklist for the adoption of ai policy: </strong>The checklist has two integrated domains: clinical and technical validation, including evidence-based performance assessment, real-world validation, MDR compliance, GDPR adherence, and post-deployment monitoring; and governance and compliance, covering AI Act conformity, organizational accountability, decision traceability, human oversight, AI literacy, and structured audit and update mechanisms.</p><p><strong>Future perspectives: </strong>The checklist methodology offers a scalable, adaptable, regulation-ready framework for AI policy development. By embedding legal compliance, clinical safety, governance, and continuous staff training, it supports sustainable AI integration. Future updates will incorporate regulatory changes, real-world feedback, and impact metrics, enhancing AI's contribution to quality, safety, and equity in patien
人工智能(AI)正在改变麻醉和重症监护医学,提高诊断精度、工作流程效率和患者安全。然而,在高度敏感的环境中部署人工智能涉及监管、道德和运营方面的挑战。2025年生效的《欧盟人工智能法案》(AI法案)对医疗机构施加了具有约束力的义务,迫切需要制定以治理为重点的结构化人工智能政策。这项工作提出了一种基于清单的方法,用于临床单位中负责任、安全、道德和符合法规的人工智能采用。制定人工智能政策的方法需求:有效的人工智能政策必须确保透明度、安全性、公平性和法规遵从性,同时保持对快速技术和立法变化的适应性。拟议的方法采用特定领域的检查表来生成关键的评估问题,使医疗保健专业人员能够系统地评估人工智能系统的适当性、可靠性和法律含义,而不依赖于僵化的、迅速过时的规范性规则。人工智能法案及其相关性:法规(EU) 2024/1689建立了第一个全面的人工智能法律框架,引入了基于风险的分类,对高风险人工智能(通常包括医疗设备)提出了严格的要求。合规义务延伸到人工智能系统提供商和部署者,使业务合规工具和人工智能扫盲计划对合法实施至关重要。人工智能素养:义务和规划:从2025年2月起,《人工智能法案》要求所有与人工智能系统交互的人员具备人工智能素养。培训应包括所有工作人员的基本能力、专家的高级模块、持续的专业发展以及道德、法律和治理原则的整合。能力获取和更新必须系统地记录,以满足机构和欧盟合规标准。采用人工智能政策的操作清单:该清单有两个综合领域:临床和技术验证,包括循证绩效评估、现实验证、MDR合规性、GDPR遵守性和部署后监测;以及治理和遵从性,包括人工智能法案的一致性、组织责任、决策可追溯性、人类监督、人工智能素养以及结构化的审计和更新机制。未来展望:清单方法为人工智能政策制定提供了一个可扩展、可适应、可监管的框架。通过嵌入法律合规性、临床安全、治理和持续的员工培训,它支持可持续的人工智能集成。未来的更新将纳入监管变化、现实世界的反馈和影响指标,增强人工智能对患者护理质量、安全性和公平性的贡献。
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引用次数: 0
West Nile virus and arboviral threats: a call for integration into critical care preparedness. 西尼罗河病毒和虫媒病毒威胁:呼吁将其纳入重症监护准备工作。
IF 3.1 Pub Date : 2025-08-29 DOI: 10.1186/s44158-025-00276-5
Giancarlo Ceccarelli, Gabriella d'Ettorre, Vlad Cristian Sanda, Marco Ridolfi, Francesco Alessandri
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引用次数: 0
期刊
Journal of Anesthesia, Analgesia and Critical Care (Online)
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