Zawadka M, Czarnik T, Gawda R
… +12 more, Miłobędzka M, Trzebicka J, Królicki T, Owczuk R, Czuczwar M, Białka S, Gola W, Aszkiełowicz A, Latos M, Włudarczyk A, Szczeklik W, Putowski Z
These guidelines provide evidence-based recommendations for central venous cannulation in critically ill patients in the intensive care unit. The document was developed by the Working Group of the Polish Society of Anaes...These guidelines provide evidence-based recommendations for central venous cannulation in critically ill patients in the intensive care unit. The document was developed by the Working Group of the Polish Society of Anaesthesiology and Intensive Therapy (Polskie Towarzystwo Anestezjologii i Intensywnej Terapii - PTAiIT) based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology, which encompasses systematic reviews of the literature, meta-analyses, and - in the absence of sufficient data - expert consensus. These guidelines aim to standardise the approach to central venous cannulation, increase the effectiveness of procedures, and minimise the risk of complications. The guidelines address pre-procedural ultrasound assessment, selection of the optimal vascular access site, comparison of ultrasound-guided versus landmark cannulation at different access sites, confirmation of catheter position after cannulation, and the role of positional manoeuvres.
Arterial cannulation for arterial line placement is a common procedure in critically ill patients. The radial artery is usually cannulated for this purpose, but in excessive vaso-constriction or shock, this approach may...Arterial cannulation for arterial line placement is a common procedure in critically ill patients. The radial artery is usually cannulated for this purpose, but in excessive vaso-constriction or shock, this approach may be inaccessible. In such cases, the femoral artery is frequently selected for the placement of an arterial catheter. Given this, the low number of clinical trials conducted in intensive care concerning femoral artery cannulation is surprising. The femoral approach is particularly useful in patients who require hemodynamic monitoring using transpulmonary thermodilution and fluid responsiveness tests. Arterial catheters inserted through the femoral artery are considered more durable than those placed in the radial artery. In addition, arterial pressure has higher values when measured in the femoral artery than in the radial artery. This narrative review presents current evidence on percutaneous cannulation of the common femoral artery for arterial pressure measurement in critically ill patients. The cannulation techniques are described with their limitations and contraindications. In addition, practical tips that may be useful in daily practice, and some potential pitfalls, are also presented.
Optimal postoperative pain management after caesarean delivery is a fundamental component of perioperative care and enhanced recovery protocols in obstetric anaes-thesia. Although intrathecal morphine (ITM) remains the g...Optimal postoperative pain management after caesarean delivery is a fundamental component of perioperative care and enhanced recovery protocols in obstetric anaes-thesia. Although intrathecal morphine (ITM) remains the gold standard for post-caesarean analgesia, its use is not always feasible or desirable. This narrative review synthesises current evidence regarding ultrasound-guided regional anaesthesia techniques employed for post-caesarean analgesia, with emphasis on anatomical rationale, clinical efficacy, and their role when neuraxial opioids are omitted. Available data indicate that abdominal wall blocks provide effective somatic analgesia and meaningful opioid-sparing benefits, particularly in the absence of ITM. Careful technique selection and integration within multimodal analgesic pathways are essential to optimise postoperative outcomes.
Wong A, Cheah K, Papathanakos G
… +2 more, Stefanini F, Zawadka M
Anaesthesiol Intensive Ther
· 2026 Mar · PMID 41879150
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INTRODUCTION: Fluid management in critically ill patients relies on clinical assessment, fluid balance calculations and, increasingly, point-of-care ultrasound. However, the rela-tionships between these assessment modali...INTRODUCTION: Fluid management in critically ill patients relies on clinical assessment, fluid balance calculations and, increasingly, point-of-care ultrasound. However, the rela-tionships between these assessment modalities remain poorly understood, with conflicting evidence regarding their correlation and clinical utility. The study aimed to eva-luate correlations between clinical indicators of fluid overload, cumulative fluid balance, and comprehensive ultrasound parameters including cardiac function, lung ultrasound, and the venous excess ultrasound (VExUS) protocol in critically ill patients. MATERIAL AND METHODS: We conducted a cross-sectional, observational study in a tertiary intensive care unit. Adults admitted for ≥ 72 hours with clinical evidence of fluid overload but haemodynamic stability were eligible. Assessments included focused echocardiography, six-zone lung ultrasound, and comprehensive VExUS. Correlations between cumulative fluid balance, clinical oedema, and ultrasound parameters were analysed. RESULTS: Of 195 patients screened, 50 were recruited to the study. The study population had a mean age of 59 years. Sepsis and respiratory failure were the most common admission diagnoses. The mean cumulative fluid balance was 7.1 ± 4.8 L at the time of recruitment. Peripheral oedema was present in over 70%. Ultrasound revealed left ventricular dysfunction in 16%, right ventricular dysfunction in 10%, bilateral pleural effusions in 44%, and elevated VExUS scores (> 2) in 20%. Cumulative fluid balance showed no correlation with clinical or ultrasound findings. CONCLUSIONS: Traditional fluid assessment (cumulative fluid balance and clinical signs of oedema) methods show no correlation with ultrasound parameters in critically ill patients. Future research should focus on ultrasound-guided approaches that provide cardiovascular assessment rather than on cumulative fluid balance calculations or clinical signs alone.
Kosiński S, Kluska M, Stachowicz J
… +3 more, Ziętkiewicz M, Darocha T, Szlubowski A
Anaesthesiol Intensive Ther
· 2026 Mar · PMID 41860097
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Flexible bronchoscopy (FB) is an established diagnostic and therapeutic tool for critically ill patients. Technological advances have enabled rapid and convenient bedside availability in the intensive care unit, expandin...Flexible bronchoscopy (FB) is an established diagnostic and therapeutic tool for critically ill patients. Technological advances have enabled rapid and convenient bedside availability in the intensive care unit, expanding the range of therapeutic indications for the procedure outside the endoscopy laboratory. FB in critically ill patients, especially mechanically ventilated patients, is technically challenging and requires appropriate operator qualifications. To avoid serious complications, it is essential to understand the procedure's effects on the respiratory and circulatory systems, as well as the mecha-nisms of complications, including infection transmission. A key challenge is to individually determine the expected benefit-risk balance and implement local protocols for the preparation, implementation, and supervision of the procedure. This narrative review aims to explore the practical and clinical aspects of FB in critically ill, mechanically ventilated patients in the ICU environment, emphasizing the most common interventions and safety issues.
Dos Santos Gomes RA, Malbrain MLNG, Rodrigues AT
… +5 more, De Melo MDCB, Valério FC, Da Fonseca JG, Santos Dutra GC, Ferreira AR
Anaesthesiol Intensive Ther
· 2026 Feb · PMID 41777176
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INTRODUCTION: The study aimed to assess the applicability of the ROSE conceptual framework (Resuscitation, Optimization, Stabilization, Evacuation) for fluid therapy in critically ill pediatric patients, focusing on its...INTRODUCTION: The study aimed to assess the applicability of the ROSE conceptual framework (Resuscitation, Optimization, Stabilization, Evacuation) for fluid therapy in critically ill pediatric patients, focusing on its distinct phases, prevention of fluid accumulation, and clinical outcomes. MATERIAL AND METHODS: A quasi-experimental study was conducted including 122 (retrospective: n = 71; prospective: n = 51) mechanically ventilated and vasoactive-dependent children. A retrospective cohort was compared with a prospective cohort following structured training on ROSE-guided fluid management. Outcomes included fluid accumulation percentage (FA%), duration of mechanical ventilation, pediatric intensive care unit (PICU) length of stay, and need for renal replacement therapy (RRT). Adherence to phase-specific FA% targets was also assessed. RESULTS: FA% was similar between cohorts (retrospective vs. prospective) on PICU days 1, 3, and 10 (median [IQR] 1.8% [0.2-4.3] vs. 1.9% [0.8-3.2], P = 0.934; 5.5% [1.7-10.3] vs. 6.1% [3.8-10.2], P = 0.565; 8.3% [0.8-24.8] vs. 7.2% [2.6-18.7], P = 0.848). By ROSE phase, FA% was comparable in Resuscitation (3.5% [2.0-6.0] vs. 4.7% [2.4-6.9], P = 0.244), Optimization (3.0% [0.1-6.7] vs. 4.2% [1.0-7.9], P = 0.261), and Evacuation (2.5% [-2.6-5.3] vs. 2.4% [-0.0-7.4], P = 0.256), but higher during Stabilization (2.5% [0.0-6.9] vs. 4.2% [2.0-8.9], P = 0.043). Mechanical ventilation, length of PICU stay, RRT, and fluid elimination were similar. No independent predictors emerged in logistic regression. FA% target adherence rose from 67.9% to 72.4% after ROSE. CONCLUSIONS: The ROSE framework in pediatric fluid management is feasible, provides benchmarking for FA% control, and shows promise for individualizing fluid management. Future validation in ROSE-naive centers is warranted.
Romanelli A, Langone A, Calicchio A
… +5 more, Palmese S, Anselmi N, Galardo A, Iovine L, Gammaldi R
Anaesthesiol Intensive Ther
· 2026 Feb · PMID 41777175
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INTRODUCTION: Inflammatory responses induced by percutaneous dilatational tracheo-stomy (PDT) are underexplored in critical patients. We examined trends in laboratory values in patients after undergoing PDT and their ass...INTRODUCTION: Inflammatory responses induced by percutaneous dilatational tracheo-stomy (PDT) are underexplored in critical patients. We examined trends in laboratory values in patients after undergoing PDT and their association with mortality. MATERIAL AND METHODS: An analysis of critical patients who underwent PDT was performed. Laboratory values were collected before PDT and at 24, 48, 72, and 96 hours after. Pre-PDT values were divided into tertiles: Low, Medium, and High. Differences between survivors and non-survivors were assessed using appropriate tests. The Aligned Rank Transform (ART) test was used to analyze the tertile-time interaction by outcome. Post-hoc analyses were conducted as necessary. Tertile-outcome associations were evaluated with univariate and multivariate logistic regression, reporting odds ratios (OR) and 95% confidence intervals (95% CI). Survival differences for significant associations were analyzed with the log-rank test. A P-value < 0.05 was considered significant. RESULTS: 114 patients who underwent PDT were included. ART demonstrated significant interactions with monocytes and the Aggregate Index of Systemic Inflammation (AISI) relating to outcomes. Monocytes in the Low tertile significantly increased over time (P < 0.001). In multivariate analysis, patients in the Medium (OR: 0.323, 95% CI: 0.101-0.937, P = 0.044) and High (OR: 0.287, 95% CI: 0.087-0.847, P = 0.029) tertiles had a lower probability of death compared with the Low tertile. AISI trends in the Low, Medium, and High tertiles were significant (all P < 0.05). The Low tertile consistently increased over time (all pairwise P < 0.05). Multivariate regression indicated that high AISI was associated with outcomes (OR: 0.270, 95% CI: 0.074-0.861, P = 0.034). Log-rank tests for survival were not significant for monocytes or AISI. CONCLUSIONS: Monocyte and AISI trends after PDT may correlate with short-term morta-lity. Routine hematologic indices can be useful for early risk assessment. Further studies are needed to confirm these findings.
Anaesthesiol Intensive Ther
· 2026 Feb · PMID 41777174
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INTRODUCTION: Supraglottic airway devices (SGAs) are essential tools in anesthesia and emergency medicine and are easier to teach than endotracheal intubation. The Singularity Air is a recently introduced second-generati...INTRODUCTION: Supraglottic airway devices (SGAs) are essential tools in anesthesia and emergency medicine and are easier to teach than endotracheal intubation. The Singularity Air is a recently introduced second-generation laryngeal mask featuring an adjustable shaft angle to improve sealing. This study compared its bench performance between medical personnel with and without airway management training. MATERIAL AND METHODS: In this randomized, controlled in-vitro study, medical personnel each performed five consecutive insertions using the Singularity Air and a comparator device. Study Part A included 20 participants without anesthesia training, who used the LMA Unique. Study Part B included 20 anesthesia-trained staff, who used the Ambu AuraGain. The primary endpoint was time to successful ventilation, defined as visible chest movement of the mannequin. Participants rated insertion difficulty on a 0-10 scale. RESULTS: Overall insertion success was 99-100% across all devices. For the Singularity Air, median time to successful ventilation on the first attempt was 17 seconds (IQR 10-22) in the non-anesthesiology group and 12 seconds (IQR 10-14) in the anesthesia-trained group (P = 0.287). By the fifth attempt, both groups achieved 7.5 seconds (IQR 5-10 and 6-8, respectively; P = 0.674). Time to ventilation and difficulty ratings were low and comparable to the established devices. The non-anesthesiology participants improved more between the first and fifth attempts than anesthesia-trained participants (P = 0.152). CONCLUSIONS: The Singularity Air laryngeal mask achieved a high success rate and comparable time to ventilation in an in-vitro study when used by acute care medical personnel, regardless of prior airway management training. Larger clinical studies are warranted to confirm these findings and evaluate performance in real patients.
Anaesthesiol Intensive Ther
· 2026 Jan · PMID 41664907
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BACKGROUND: While patient satisfaction is a major marker of quality in healthcare, predictors of Press Ganey scores for anesthesia survey questions have not been well explored. This study aimed to explore factors associa...BACKGROUND: While patient satisfaction is a major marker of quality in healthcare, predictors of Press Ganey scores for anesthesia survey questions have not been well explored. This study aimed to explore factors associated with anesthesia-specific patient satisfaction scores. MATERIAL AND METHODS: Univariable and multivariable regression analyses were performed to identify predictors of percentile ranking on patient satisfaction questions. We conducted a retrospective analysis of the patient experiences with anesthesia at our institution. Three questions were added to the Press Ganey surveys: (1) rating of anesthesia services, (2) explanations provided by the anesthesiologists, (3) friendliness/courtesy of the anesthesiologist. A total of 3,218, 3,294, and 3,200 patients, respectively, answered the questions on a Likert scale. Covariates included attending anesthesiologist workload, number of comparator healthcare institutions, and season of year. RESULTS: Lower percentile rank with rating of anesthesia services was associated with greater attending anesthesiologist workload (-13.7; 95% CI: -24.8 to -2.6; P = 0.017), season of year (-9.0; 95% CI: -16.2 to -1.8; P = 0.016), and smaller number of comparator healthcare institutions (2.4; 95% CI: 0.5 to 4.3; P = 0.015). Lower percentile rank with explanations provided by the anesthesiologists (0.7; 95% CI: 0.1 to 1.3; P = 0.021) and friendliness/courtesy of the anesthesiologist (0.9; 95% CI: 0.2 to 1.5; P = 0.008) were associated with decreasing number of comparator healthcare institutions. CONCLUSIONS: Improving patient satisfaction may require reduction or redistribution of anesthesiologist workload, improvement in resident communication skills, and increased supervision of junior residents. Anesthesia-specific patient satisfaction scores should be risk-adjusted for contextual factors such as seasonality, workload, and number of comparator institutions before being tied to payment.
Eldemrdash A, Zaher Z, Hammad S
… +3 more, Aly M, Mohamed M, Alazhary M
Anaesthesiol Intensive Ther
· 2026 Jan · PMID 41524122
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INTRODUCTION: Spinal anesthesia (SA) is preferred for hip fracture surgery but can be difficult due to severe preoperative pain. This study compared prespinal analgesic techniques for improving the ease of SA and postope...INTRODUCTION: Spinal anesthesia (SA) is preferred for hip fracture surgery but can be difficult due to severe preoperative pain. This study compared prespinal analgesic techniques for improving the ease of SA and postoperative analgesia in neck of femur fractures. MATERIAL AND METHODS: In a prospective, randomized, double-blind trial, 210 patients aged ≥ 60 years undergoing internal fixation of fractured neck of femur under SA were allocated to three groups. Group A received a femoral nerve block (FNB), Group B a pericapsular nerve group (PENG) block, and Group C intravenous fentanyl 1 µg kg-1 10 minutes before SA. For FNB and PENG, 20 mL of 0.25% bupivacaine was used. RESULTS: The PENG group had the lowest Ease of Spinal Anesthesia (EOSA) score (median 7 [IQR 7-8]) vs. FNB 8 (7-9) and fentanyl 9 (9-10) (P < 0.001). Pain during positioning and puncture was lowest with PENG (P < 0.001). Time to first rescue analgesia was longest with PENG (8.8 ± 2.03 h, 95% CI: 8.3-9.3) compared with FNB (5.9 ± 1.5 h, 95% CI: 5.5-6.4) and fentanyl (4.2 ± 0.7 h, 95% CI: 4.0-4.4) (P < 0.001). Immediate postoperative visual analog scale (VAS) scores at 6 and 12 hours were lower with PENG; differences at 24 hours and 30 days were not significant. Hemodynamics and complication rates were largely similar across groups. CONCLUSIONS: In hip-fracture patients, ultrasound-guided PENG and FNB improved the ease of SA and reduced postoperative opioid use, with PENG showing the greatest benefit.
Gorka J, Putowski Z, Wludarczyk A
… +20 more, Jedrusiak M, Bialka S, Palaczynski P, Borys M, Kutnik P, Czarnik T, Szczepanska A, Wawrzyniak S, Mozanski M, Keska M, Kotfis K, Trzebicki J, Aszkielaniec J, Solek-Pastuszka J, Grudzien P, Mudyna W, Kreczko M, Zhao Z, Devereaux PJ, Szczeklik W
Anaesthesiol Intensive Ther
· 2025 Dec · PMID 41480778
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BACKGROUND: The PREVENT-MINS trial investigated whether perioperative heart rate reduction with ivabradine could prevent myocardial injury after noncardiac surgery (MINS). Although ivabradine modestly reduced heart rate,...BACKGROUND: The PREVENT-MINS trial investigated whether perioperative heart rate reduction with ivabradine could prevent myocardial injury after noncardiac surgery (MINS). Although ivabradine modestly reduced heart rate, it did not reduce the incidence of MINS in the intention-to-treat analysis. This per-protocol analysis of the PREVENT-MINS trial, with a post-hoc biomarker substudy, evaluated whether perioperative iva-bradine modifies postoperative N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations, a marker of perioperative cardiovascular risk. METHODS: This analysis included 2008 participants who received ≥ 1 dose of study drug, underwent surgery, and had NT-proBNP and troponin measured (ivabradine: n = 1,001; placebo: n = 1,007). Postoperative NT-proBNP levels and changes from baseline (ΔNT-proBNP) were compared by treatment allocation. Clinical outcomes and safety endpoints from the parent trial were evaluated. Analysis of covariance (ANCOVA) assessed ivabradine's effect on postoperative NT-proBNP after adjustment for baseline values and clinical covariates. RESULTS: MINS occurred in 17.7% of ivabradine-treated vs. 15.7% of placebo patients (RR 1.13; 95% CI: 0.93-1.37; P = 0.23). Median postoperative NT-proBNP was higher with ivabradine than with placebo (418.0 vs. 333.5 pg mL-1; P < 0.001), as were ΔNT-proBNP values (215.1 vs. 154.0 pg mL; P < 0.001). After adjustment for baseline and relevant clinical covariates, ivabradine was independently associated with an approximately 82% increase in postoperative NT-proBNP (Δlog = 0.59 ± 0.19; 95% CI: 26-164). CONCLUSIONS: Ivabradine did not reduce the incidence of MINS and was associated with greater postoperative NT-proBNP release. Perioperative heart rate reduction with ivabradine may elevate markers of cardiac stress without measurable clinical benefit.
Pérez-Garzón M, Rojas-Arrieta M, Quintero-Altare A
… +1 more, Robayo-Amortegui H
Anaesthesiol Intensive Ther
· 2025 Dec · PMID 41457776
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Compartment syndrome (CS) arises from increased pressure within a confined space, compromising organ function due to reduced blood flow and subsequent tissue hypo-xia and ischemia. Thoracic compartment syndrome (TCS), a...Compartment syndrome (CS) arises from increased pressure within a confined space, compromising organ function due to reduced blood flow and subsequent tissue hypo-xia and ischemia. Thoracic compartment syndrome (TCS), a subset of CS, occurs in diverse surgical and medical conditions, particularly cardiac surgery, chest trauma, and critical care scenarios, significantly contributing to morbidity and mortality. However, the absence of a standardized definition hinders timely diagnosis and treatment. This study systematically explores the clinical presentation, pathophysiology, and causes of TCS, aiming to establish a comprehensive definition to guide diagnosis and research. A multi-stage review process was employed. Two independent reviewers screened titles, abstracts, and full texts of studies identified through databases such as PubMed, Scopus, Embase, Google Scholar, and SpringerLink, complemented by gray literature searches in NTIS and EAGLE. Inclusion criteria focused on adult patients, excluding pediatric and obstetric populations. The search spanned all relevant studies published up to December 20, 2024. TCS remains under-recognized yet poses significant risks in critically ill patients. This article proposes a definition grounded in evidence and pathophysiological insights to aid diagnosis and future investigations into this life-threatening condition.