Pub Date : 2026-01-27DOI: 10.1016/j.bja.2025.12.048
Adriano Servetti, Denise Battaglini, Nicolò A. Patroniti, Sarah Al Sharie, Basil Jouryyeh, Loui Al-Husinat, John J. Marini, Patricia R.M. Rocco
Positive end-expiratory pressure (PEEP) is a fundamental component of mechanical ventilation in patients with acute respiratory distress syndrome (ARDS). However, identifying the optimal PEEP remains a clinical challenge owing to the heterogeneity of lung injury and the resulting regional variability in mechanical properties. A variety of techniques have been proposed to guide individualised PEEP titration, each based on distinct physiological principles and associated with specific advantages and limitations. Among these, oxygenation-based titration remains the most commonly applied method, although its limitations are well recognised. Alternative strategies, including compliance-guided methods, driving pressure (ΔP) minimisation, and oesophageal pressure-guided ventilation, are gaining attention but require further validation. Imaging modalities, ranging from conventional chest radiography to advanced tools such as chest CT, electrical impedance tomography, and lung ultrasound, provide valuable insights into alveolar recruitment and can support more precise PEEP adjustment. This narrative review critically evaluates current approaches to PEEP titration in ARDS, emphasising the integration of physiological and imaging-based strategies to optimise lung recruitment while minimising ventilator-induced lung injury. An integrative strategy that combines physiological assessment, imaging, and continuous monitoring offers the greatest potential to individualise PEEP. Ongoing technological and clinical advances are likely to further improve the feasibility and effectiveness of personalised PEEP titration in critical care.
{"title":"Optimising positive end-expiratory pressure in acute respiratory distress syndrome: a narrative review of approaches to titration","authors":"Adriano Servetti, Denise Battaglini, Nicolò A. Patroniti, Sarah Al Sharie, Basil Jouryyeh, Loui Al-Husinat, John J. Marini, Patricia R.M. Rocco","doi":"10.1016/j.bja.2025.12.048","DOIUrl":"https://doi.org/10.1016/j.bja.2025.12.048","url":null,"abstract":"Positive end-expiratory pressure (PEEP) is a fundamental component of mechanical ventilation in patients with acute respiratory distress syndrome (ARDS). However, identifying the optimal PEEP remains a clinical challenge owing to the heterogeneity of lung injury and the resulting regional variability in mechanical properties. A variety of techniques have been proposed to guide individualised PEEP titration, each based on distinct physiological principles and associated with specific advantages and limitations. Among these, oxygenation-based titration remains the most commonly applied method, although its limitations are well recognised. Alternative strategies, including compliance-guided methods, driving pressure (ΔP) minimisation, and oesophageal pressure-guided ventilation, are gaining attention but require further validation. Imaging modalities, ranging from conventional chest radiography to advanced tools such as chest CT, electrical impedance tomography, and lung ultrasound, provide valuable insights into alveolar recruitment and can support more precise PEEP adjustment. This narrative review critically evaluates current approaches to PEEP titration in ARDS, emphasising the integration of physiological and imaging-based strategies to optimise lung recruitment while minimising ventilator-induced lung injury. An integrative strategy that combines physiological assessment, imaging, and continuous monitoring offers the greatest potential to individualise PEEP. Ongoing technological and clinical advances are likely to further improve the feasibility and effectiveness of personalised PEEP titration in critical care.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"33 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146056082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-27DOI: 10.1016/j.bja.2025.12.023
Alfie Lloyd
{"title":"Social deprivation and morbidity and mortality after surgery: national differences in deprivation measures across the UK. Comment on Br J Anaesth 2025; 135: 1193–202","authors":"Alfie Lloyd","doi":"10.1016/j.bja.2025.12.023","DOIUrl":"https://doi.org/10.1016/j.bja.2025.12.023","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"102 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146056083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-27DOI: 10.1016/j.bja.2026.01.005
Yuan Sun, Xiao Huang
{"title":"Association of nociplastic pain with executive function decline in a longitudinal cohort of middle-age adults. Comment on Br J Anaesth 2025; 135: 1717–29","authors":"Yuan Sun, Xiao Huang","doi":"10.1016/j.bja.2026.01.005","DOIUrl":"https://doi.org/10.1016/j.bja.2026.01.005","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"16 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146056079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-27DOI: 10.1016/j.bja.2025.12.050
Lingling Jiang, Liu Ping
{"title":"Use of smart glasses imaging for interscalene brachial plexus block: adopting new technology into the workplace. Response to Br J Anaesth 2026; 136: 750-1","authors":"Lingling Jiang, Liu Ping","doi":"10.1016/j.bja.2025.12.050","DOIUrl":"https://doi.org/10.1016/j.bja.2025.12.050","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"219 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146056081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sevoflurane increases surface expression of α5 subunit-containing γ-aminobutyric acid type A receptors (GABAAR-α5) and tonic currents in the hippocampus, contributing to postoperative memory decline. We investigated sevoflurane modulation of the phosphorylation of the β3 subunit which co-assembles with α5 subunits following Ca2+/calmodulin-dependent protein kinase II (CaMKII) activation to alter receptor trafficking and exacerbate cognitive dysfunction.
{"title":"Sevoflurane alters α5β3GABAA receptor trafficking via calcium/calmodulin-dependent protein kinase II-dependent β3 subunit phosphorylation to produce cognitive impairment in aged mice","authors":"Tiantian Wan, Mengxue Zhang, Jianjun Li, Zhun Wang, Jinpeng Dong, Xiaokun Wang, Zhonglan Dong, Qiangwei Liu, Ying Dong, Sixuan Wang, Lu Chen, Yiqin Yin","doi":"10.1016/j.bja.2025.11.058","DOIUrl":"https://doi.org/10.1016/j.bja.2025.11.058","url":null,"abstract":"Sevoflurane increases surface expression of α5 subunit-containing γ-aminobutyric acid type A receptors (GABA<ce:inf loc=\"post\">A</ce:inf>R-α5) and tonic currents in the hippocampus, contributing to postoperative memory decline. We investigated sevoflurane modulation of the phosphorylation of the β3 subunit which co-assembles with α5 subunits following Ca<ce:sup loc=\"post\">2+</ce:sup>/calmodulin-dependent protein kinase II (CaMKII) activation to alter receptor trafficking and exacerbate cognitive dysfunction.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"22 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146056084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-23DOI: 10.1016/j.bja.2025.12.038
Mariateresa Giglio, Alberto Corriero, Filomena Puntillo, Luigi Tritapepe
{"title":"Perioperative Quality Initiative consensus statement on goal-directed haemodynamic therapy: grading recommendations in the era of evidence-based medicine, enhanced recovery after surgery programmes and precision medicine. Comment on Br J Anaesth 2025; 135: 547–60","authors":"Mariateresa Giglio, Alberto Corriero, Filomena Puntillo, Luigi Tritapepe","doi":"10.1016/j.bja.2025.12.038","DOIUrl":"https://doi.org/10.1016/j.bja.2025.12.038","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"86 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146032857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-23DOI: 10.1016/j.bja.2025.12.041
Zhihe Zeng, Ye Sun, Zhaoyang Xiao
{"title":"Risk factors, outcomes, and early prediction of cardiac surgery-associated acute kidney injury: cell salvage as a risk factor. Comment on Br J Anaesth 2026; 136: 34–42","authors":"Zhihe Zeng, Ye Sun, Zhaoyang Xiao","doi":"10.1016/j.bja.2025.12.041","DOIUrl":"https://doi.org/10.1016/j.bja.2025.12.041","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"32 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146032856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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