搜索结果：Acta anaesthesiologica Scandinavica

Trauma is a leading cause of death and disability in young adults. Although supplemental oxygen is recommended early after trauma to prevent hypoxemia, evidence regarding the occurrence and distribution of hypoxemic episodes, to raise awareness on potential clinical implications, is sparse. The aim of this study was to investigate the occurrence and daily distribution of hypoxemia within the first day of admission after trauma using continuous pulse oximetry. Adult trauma patients admitted through the trauma centre at Rigshospitalet, Denmark, between February 20 and August 24, 2024, were included in this observational study irrespective of subsequent admission department. Arterial oxygen saturation measured by pulse oximetry (SpO2) was continuously monitored for 24&#x2009;h to identify clinically relevant hypoxemic episodes, defined as SpO2&#x2009;<&#x2009;90%, for >&#x2009;5&#x2009;min. The incidence of episodes was compared regarding the occurrence between daytime and nighttime. Hypoxemic episodes were hypothesized to be more frequent during nighttime. Among 165 included participants, data from 155 were analyzed. Median age was 49&#x2009;years (IQR 31-62), 74.8% were male, and median Injury Severity Score was 13 (IQR 9-19). In total 146 episodes were recorded, and both daytime and nighttime periods showed incidence rates of 5.1 episodes per 100 participant-hours, yielding an incidence rate ratio (IRR) of 1.01 (95% CI, 0.73-1.4; p&#x2009;=&#x2009;0.95) between daytime and nighttime. No differences between daytime and nighttime were found in cumulative hypoxemia duration, prolonged hypoxemic episodes, or across hospital locations. On average, 5.1 clinically relevant hypoxemic episodes occurred per 100 participant-hours of continuous SpO2 monitoring during the first 24&#x2009;h of hospitalization following trauma. The study found similar incidence rates of clinically relevant hypoxemic episodes at daytime and nighttime. Supplementary oxygen is recommended in the early phase after trauma to prevent hypoxaemia. This single center study confirmed that clinically relevant hypoxaemic episodes occur on average five times per 100 participant-hours during the first 24&#x2009;h of hospitalization following trauma, with similar incidences during both day and night. The study highligths the importance of continuous monitoring of peripheral oxygenation including if trauma patients are transferred from high-depency units to the wards. ClinicalTrials.gov: NCT06256692.

Core outcome measurement sets (COMS) enhance the consistency and comparability of outcome reporting in clinical research. However, their effectiveness depends on the selection of valid, reliable, and feasible measurement instruments. Core outcome sets (COS) and COMS have been developed for specific intensive care unit (ICU) patient subgroups. The aim of this study is to establish a standardised approach to outcome measurement and operationalisation for adults acutely admitted to the ICU who are participating in clinical trials and other clinical research. This protocol describes the development of a COMS for adults acutely admitted to the ICU, the CoreMS-ICU, consisting of six core outcomes: survival, free of life support, free of delirium, out of hospital, health-related quality of life, and cognitive function. We will follow the Consensus-based Standards for the Selection of Health Measurement Instruments guideline and report according to the Core Outcome Set-STAndardised Protocol Items guideline. The development of the CoreMS-ICU will follow five predefined steps: (1) conceptual considerations for the six core outcomes; (2) systematic searches for outcome measurement instruments, including consideration of existing COMS; (3) quality assessment of relevant outcome measurement instruments; (4) consensus-based selection of outcome measurement instruments; and (5) recommendations and guidance on how to operationalise and report the measurement of the six core outcomes. We will involve research panels consisting of key stakeholders: patients, family members, healthcare professionals, and researchers in steps 1 and 4. We aim to develop a COMS for adults acutely admitted to ICU patients to facilitate the consistent use of outcomes in trials and enhance the translation of research findings into clinical practice.

Cognitive impairment in intensive care unit (ICU) survivors is multifactorial and can affect especially memory, attention, and executive functions. This study aimed to determine the cognitive functioning of patients with circulatory shock immediately after ICU discharge and 3&#x2009;months later. This study, ASSESS-SHOCK 2, is a preplanned sub-study of the observational ASSESS-SHOCK study conducted at Helsinki University Hospital ICU. We included adults with circulatory shock, defined as hypotension requiring vasopressor infusion and concomitant signs of hypoperfusion. We excluded patients with severe neurological or psychiatric diagnoses, impairment of hearing or vision, developmental disability, and language barriers. Cognitive functioning of patients was assessed within 3&#x2009;days of ICU discharge and 3&#x2009;months thereafter with the Montreal Cognitive Assessment (MoCA) test. We defined cognitive impairment as MoCA score&#x2009;<&#x2009;26 points. We also included data of 48 volunteer controls, tested once, to analyses. Fifty-five patients underwent an assessment within 3&#x2009;days of ICU discharge, and 36 of them completed a follow-up assessment at 3&#x2009;months. At discharge median MoCA-score was 22 (IQR 17-25). At the 3&#x2009;months follow-up, the median MoCA-score was 26.5 points (IQR 24.25-28) showing improvement from discharge to follow-up (p&#x2009;<&#x2009;0.001). The prevalence of cognitive impairment at discharge was 78.2%, and, at the 3-month follow-up 44.4%. In the control group, the median MoCA score was 27 points (IQR 25-28) and the prevalence of cognitive impairment 33%. We found cognitive impairment in more than three out of four ICU survivors immediately after ICU treatment for circulatory shock. We observed an improvement in cognitive functioning between ICU discharge and 3&#x2009;months follow-up. These results have importance considering the optimal timing of information given to patients and when involving patients in decision-making. This study used the MoCA score to investigate the change in cognitive impairment in patients who survived circulatory shock, from the time of discharge from intensive care to 3&#x2009;months after discharge. Scores indicated more severe cognitive dysfunction compared to controls at the time of discharge, but these improved to match control scores 3&#x2009;months later. The findings have important implications for strategies to inform and support newly discharged ICU survivors who have experienced circulatory shock.

Neuromuscular blocking agents (NMBA) provide optimal conditions for tracheal intubation. A high dose of opioid can be used as an alternative but may give suboptimal conditions for intubation. The use of a video laryngoscope for intubation might eliminate this potential difference. A survey examining clinical practice regarding tracheal intubation with and without NMBA and use of video laryngoscopes was conducted in Sweden and Denmark. 1771 out of 3181 (56%) of invited anaesthetists responded. Overall, 1365/1771 (77%) preferred using NMBAs for non-acute tracheal intubation with a considerably higher NMBA preference in Sweden 1011/1073 (94%) than in Denmark 354/700 (51%). A high proportion of Danish anaesthetists 327/700 (47%) compared to 40/1071 (4%) of Swedish anaesthetists reported primarily using opioids without NMBA. Remifentanil was the preferred opioid (1158/1361 (85%)) for intubation without NMBA. The reasons for using NMBA were improved intubating conditions (948/1771 (54%)), departmental tradition (285/1771 (16%)), adherence to local guidelines (264/1771 (15%)), and adherence to national/international guidelines (143/1771 (8%)). Video laryngoscopes were present in every operating theatre for 349/700 (50%) of Danish anaesthetists and 131/1071 (12%) of Swedish anaesthetists. Video laryngoscopes were easily accessible outside the operating room for 350/700 (50%) of Danish anaesthetists and 940/1071 (88%) of Swedish anaesthetists. NMBA use remains the standard for non-acute tracheal intubation. However, a substantial number of anaesthetists regularly employ a NMBA-free approach facilitated by high-potency opioids and video laryngoscopy, particularly in Denmark. These findings emphasise the need for further research and subsequently updated evidence-based guidance to support safe and effective intubation practices. This study, reporting a survey of anesthesia practitioners in Sweden and Denmark assessed preferences concerning how the respondents would manage a series of case scenarios concerning anesthetic drug choices for facilitation of intubation and employment of video laryngoscopy. Quite a bit of variation for preferences is presented by the responses concerning neuromuscular blockade or not to facilitate intubation.

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Continuous vital sign monitoring with wearable biosensors enables earlier detection of clinical deterioration and improves patient safety. This study validated an integrated wireless photoplethysmography-based chest patch biosensor (Biobeat technology Ltd) capable of measuring five vital signs relevant for Early Warning Score calculation, by comparison with standard continuous bedside monitoring in the intensive care unit. Agreement between the wearable biosensor and the reference monitor was assessed using Bland-Altman analysis for repeated measurements. Bias and limits of agreement were calculated for all vital signs. Measurement differences were compared with predefined accuracy limits. Data were aligned at 5- and 15-min intervals using median reference values. Deming regression, Pearson correlation, and Clarke Error Grid analyses were performed. A total of 1931.8 monitoring hours were collected from 32 intensive care patients (mean 60.4&#x2009;&#xb1;&#x2009;28.5&#x2009;h). Heart rate showed a bias of 0.16 beats per minute (LoA -17.06 to 17.38), with 18.8% exceeding the 10% threshold and 0.42% in Clarke Error Grid zones D-E. Respiratory rate showed a bias of 3.77 breaths per minute (LoA -6.78 to 14.31), with 61.4% exceeding the 10% threshold and 18.6% in zones D-E. Systolic blood pressure, oxygen saturation, and temperature showed biases of -4.69&#x2009;mmHg, -1.34%, and -0.29&#xb0;C, respectively. Agreement between a wearable chest-patch biosensor and standard bedside monitoring was evaluated in intensive care patients. Overall agreement was variable, with wide limits of agreement and a substantial proportion of measurements outside predefined thresholds. Further optimisation and validation are required before broader clinical application. In this article, limitations in agreement between signals from wearable wireless sensors for vital signs and usual vital signs monitor values in intensive care cases are described for data collected from a practical and pragmatic setting where the study participants were in early phase of their illness with some expected clinical deterioration. There were enough test device values outside of predefined limits of agreement based on clinically relevant differences, that the authors interpret this as a need for further improvement in device performance.

Staffing at hospital wards is at its lowest during nighttime, which may endanger prompt recognition of the need for intensive care. High severity of illness of patients admitted to the intensive care unit (ICU) in the morning may reflect delayed referral for intensive care during the night. We investigated whether severity of illness at ICU admission is dependent on admission time. We analysed data from 25 Finnish ICUs between 2005 and 2022, utilising the national ICU registry. We excluded readmissions, children, non-emergency admissions, cardiac surgery patients and patients admitted for the purpose of organ donation. We explored the severity of illness, as quantified with the Simplified Acute Physiology Score (SAPS) II score, and in-hospital mortality according to admission hours. We also conducted linear and logistic regression analyses adjusting for age, sex, admission type, source of admission, diagnosis category and severity of illness. The study population comprised 131,175 ICU patients. The mean (&#xb1; SD) SAPS II score at admission was 37.9&#x2009;&#xb1;&#x2009;17.4, and overall in-hospital mortality was 14.7%. The mean SAPS II score was 39.0&#x2009;&#xb1;&#x2009;17.9 for morning admissions (6-12&#x2009;a.m.) and 37.6&#x2009;&#xb1;&#x2009;17.2 during other times (p&#x2009;<&#x2009;0.001). The corresponding in-hospital mortalities were 17.5% and 13.9%, respectively (p&#x2009;<&#x2009;0.001). After adjusting for differences in patient characteristics, morning admissions remained independently associated with higher SAPS II score (mean difference 0.87 points, 95% CI, 0.65-1.09) and in-hospital mortality (OR 1.17, 95% CI, 1.13-1.21). Patients admitted to intensive care during morning hours experienced higher severity of illness and higher in-hospital mortality. This analysis, from the national ICU database in Finland, shows that cases with morning admission to the ICU appear to have more severe illness compared to those admitted at other times of day. The authors consider if there might be some nighttime delay for recognition of ICU need which could contribute to this observation.

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Sternotomy causes substantial postoperative pain. Recently, several less invasive nerve blocks have been described that are safer to use even on anticoagulated patients. This study aims to evaluate early pain management using ultrasound-guided superficial parasternal intercostal plane block (SPIP) in patients undergoing aortic valve replacement via full sternotomy. This was a randomized, placebo-controlled trial performed in a tertiary referral hospital. Seventy-four elective patients scheduled for aortic valve replacement via full sternotomy were included. Patients were randomized to receive a preoperative SPIP block using either 40&#x2009;mL of ropivacaine 7.5&#x2009;mg/mL or 40&#x2009;mL of 0.9% saline. Cumulative oxycodone consumption during the first 24 postoperative hours was recorded and analyzed as the primary outcome. Pain at rest was assessed using the numerical rating scale (NRS) scores 48&#x2009;h postoperatively. Additional secondary outcomes included the need for vasopressors and antiemetics, recovery of bowel function, time spent in the intensive care unit (ICU), and nerve block-related complications. The 24-h cumulative consumption was not significantly different between groups (93.8&#x2009;mg&#x2009;&#xb1;&#x2009;33.3 vs. 109.4&#x2009;mg&#x2009;&#xb1;&#x2009;37.9, p&#x2009;=&#x2009;0.066). NRS pain scores at rest were reduced in the patients with SPIP at 4 (5.0&#x2009;&#xb1;&#x2009;1.8 vs. 3.3&#x2009;&#xb1;&#x2009;2.4, p&#x2009;=&#x2009;0.002). No differences were found in additional secondary outcomes. In this randomized controlled trial a single-shot SPIP block did not reduce the 24-h cumulative opioid consumption after cardiac surgery. This trial in a cardiac surgical cohort tested for possible benefit of a single injection superficial parasternal intercostal plane block for post-operative analgesia for post-sternotomy pain. The study found no post-op opioid treatment reduction with the treatment, but some analgesia effect cannot be ruled out.

Manual removal of placenta (MRP) is required in 0.1%-3.3% of vaginal births. For patients who give birth without labor epidural analgesia, the choice between neuraxial or general anesthesia (GA) with or without tracheal intubation presents unique challenges. This study describes anesthetic management practices for these cases. This multicenter retrospective cohort study analyzed 423 patients undergoing MRP at two tertiary centers in Israel (Soroka and Rabin Medical Centers) from 2016 to 2022. We collected data on anesthetic techniques, patient characteristics, and clinical outcomes, comparing patients managed with and without tracheal intubation during GA. GA was used in 409 (96.7%) cases, with 269 (65.8%) patients managed with tracheal intubation and 140 (34.2%) receiving tubeless GA. Patients who received tubeless GA had lower rates of intraoperative complications, including hypotension (16.4% vs. 26.0%, p&#x2009;=&#x2009;0.034), vasopressor use (10.0% vs. 20.8%, p&#x2009;=&#x2009;0.006), and blood product transfusions (3.6% vs. 11.9%, p&#x2009;=&#x2009;0.006). Multivariable analysis revealed associations between higher body mass index (aOR&#x2009;=&#x2009;2.19), elevated heart rate (aOR&#x2009;=&#x2009;1.86), and tracheal intubation. Tracheal intubation rates significantly declined from 2016 to 2022 following the introduction of gastric ultrasound in our practice. Anesthetic management for MRP should be individualized based on clinical factors. In our cohort, tubeless GA was preferred for fasted, lower BMI, and hemodynamically stable patients, with tracheal intubation typically reserved for more complex cases, reflecting inherent selection bias. This study was descriptive in nature and was not designed to establish the safety of any particular technique. Further high-quality research is needed to validate these findings and refine anesthetic guidelines for MRP. MRP is a rare obstetric procedure that can be challenging to manage without prior epidural analgesia. A retrospective study of 423 patients in two Israeli hospitals (2016-2022) found that most cases (96.7%) used GA, with about two-thirds involving tracheal intubation and one-third using tubeless techniques. Tubeless anesthesia was associated with less hypotension, reduced need for vasopressors, and fewer blood transfusions. Patients with higher BMI and heart rate were more likely to be intubated. Intubation rates decreased over time after gastric ultrasound was introduced in this cohort. Overall, the study suggests tailoring anesthesia choice to the patient, with no endotracheal intubation approaches safe for selected stable cases, though more research is needed.

Routine use of neuromuscular blocking agents (NMBAs) is widely recommended to facilitate tracheal intubation. However, NMBA use is associated with potential adverse effects, including postoperative respiratory complications, intraoperative awareness and anaphylaxis. Bolus remifentanil is an alternative, but evidence supporting its effectiveness on first-pass success when using video laryngoscopy is sparse. We hypothesise that rocuronium reduces failed first-pass and the risk of induction- or airway-management-related complications compared with bolus remifentanil when using a video laryngoscope. ROCVIDEO is a Danish-Swedish, blinded, randomised, controlled trial comparing rocuronium (0.6&#x2009;mg/kg) with remifentanil (4&#x2009;&#x3bc;g/kg) at anaesthesia induction for facilitating orotracheal intubation using video laryngoscopy. Eligible adult participants (ASA-class I-III) undergoing general anaesthesia with video laryngoscopy-assisted orotracheal intubation will be randomised to rocuronium or remifentanil in a ratio of 1:1. Anaesthesia will be induced with propofol and optional fentanyl or sufentanil. Intubation will be initiated 120&#x2009;s after administration of trial medicine. The two co-primary outcomes are: (I) anaesthesia-related adverse events and (II) failed first-pass intubation. Secondary outcomes include patient satisfaction, length of stay in the post anaesthesia care unit and serious adverse events. The trial will randomise 2684 participants to be able to detect a 30% relative risk reduction in failed first pass intubation and anaesthesia-related adverse events, with corresponding power of 80% and 99%, respectively, using a two-sided &#x3b1; of 0.025. Given the global volume of tracheal intubation, even small differences may have substantial clinical implications. ROCVIDEO will generate high-quality evidence to inform future guidelines aiming to improve global clinical practice. As of 15 June 2026, the trial has randomised 707 participants across 15 sites. Recruitment is expected to be completed in the third quarter of 2027. ClinicalTrials.gov: NCT06564857; EUClinicalTrials.eu: 2025-521405-40-01.

Remimazolam is a recently introduced benzodiazepine used for procedural sedation and general anaesthesia. Its pharmacokinetic profile, including rapid metabolism and predictable recovery, has generated interest in its potential advantages compared with traditional sedatives such as midazolam and propofol. This protocol follows established methodological guidance for scoping reviews. The review will map the available evidence on the clinical use of remimazolam and identify gaps in the current literature. Specifically, it will examine studied patient populations, the reported pharmacokinetic profile of remimazolam and the clinical settings in which the drug has been investigated. The review will provide an overview of the existing literature on remimazolam, with particular focus on underrepresented patient populations, its current clinical applications, and reported short- and long-term adverse effects. The planned review will map the current evidence regarding remimazolam, identify underrepresented populations, the clinical contexts in which remimazolam is used, and gaps for future research.

Non-invasive blood pressure (NIBP) measurement can be challenging in patients with obesity. We aimed to determine if arm conicity, mid arm circumference or body mass index (BMI) could be used to predict pre-operative and intra-operative NIBP measurement error. Eligible patients had elective surgery and BMI &#x2265;&#x2009;35&#x2009;kg/m2. Mid-arm circumference and arm slant angle (a measure of arm conicity) were measured according to standardised methods. Systolic (SBP) and diastolic (DBP) blood pressure were obtained using invasive (INV) and non-invasive methods at pre-induction (T0) and 20&#x2009;min post-induction. NIBP accuracy was defined as &#x2264;&#x2009;10&#x2009;mmHg difference from invasive measurement. Post hoc analyses evaluated under and over-estimation. Receiver operating characteristic (ROC) curves were calculated. The 141 participants had a mean (SD) BMI of 46.9 (8.9)&#x2009;kg/m2. There were 531 measurements at T0 and T20 with INV and NIBP available. Of 265 for SBP, 150 (56.7%) were inaccurate and of 266 for DBP, 113 (42.5%) were inaccurate. All ROC curves for right arm slant angle, right mid-arm circumference and BMI for SBP and DBP at T0 and T20 approached a 45&#xb0; line. Area under ROC curves (AUROCs) ranged from 0.47 (0.36, 0.57) to 0.64 (0.54, 0.74), suggesting poor diagnostic performance. The best performer was right arm slant angle, with AUROCs 0.63 (0.51, 0.75) for DBP and 0.69 (0.59, 0.78) for SBP for underestimation at T0. Inaccurate measurements were common. Right arm conicity, mid-arm circumference and BMI were poor classifiers of NIBP measurement error at the pre-induction and intraoperative time points. EDITORIAL COMMENT: Accuracy of NIBP measurements in obese patients is uncertain. This clinical study compared routine oscillometric clinical blood pressure methods to a reference invasive blood pressure measure in an obese cohort. Significant disagreement between these is described, demonstrating reliability problems for some of the common arm oscillometric cuff implementations.

Closed reduction of distal radius fractures is painful, and current analgesic strategies may be inadequate. Ultrasound-guided lateral infraclavicular brachial plexus block may offer complete analgesia and muscle relaxation, potentially improving patient comfort and reduction quality. However, benefits and challenges regarding anesthetic agents for this procedure remain unclear. In this randomized, controlled, blinded, noninferiority trial, 63 adults with distal radius fractures requiring closed reduction received a lateral infraclavicular block with either 30&#x2009;mL of ropivacaine 0.5%, lidocaine 1% with epinephrine, or ropivacaine 0.2%. The primary outcome was block success at 45&#x2009;min, defined as complete sensory and extensive motor block of the radial, musculocutaneous, ulnar, and median nerves. Noninferiority was assessed using a margin of 20%. Exploratory outcomes included sensory and motor block assessments, time to pain relief, block duration, pain during reduction, patient satisfaction, quality of closed reduction, fracture treatments, and safety. Ropivacaine 0.2% was statistically inferior to ropivacaine 0.5% in achieving block success at 45&#x2009;min (risk ratio (RR) 0.63, 97.5% CI 0.40-0.99). Lidocaine 1% with epinephrine did not meet the predefined noninferiority criteria for block success (RR 0.95, 97.5% CI 0.73-1.22) but did provide comparable analgesia with a shorter block duration. Pain scores during reduction were low across all groups, with a significant decrease in pain from baseline. Patient satisfaction was high in all groups. No significant differences were found in the quality of closed reduction, safety, or fracture treatments. Lateral infraclavicular block with ropivacaine 0.2% failed to demonstrate noninferiority for block success and was statistically inferior to ropivacaine 0.5%. Inferiority testing should be interpreted cautiously within the context of a noninferiority design, although the results suggest reduced effectiveness for distal radius fracture reduction. Lidocaine 1% with epinephrine yielded inconclusive results for noninferiority on block success, but provided a shorter block duration without compromising analgesia, patient satisfaction, or quality of reduction. ClinicalTrials.gov Identifier NCT06379490 (released April 23, 2024); https://clinicaltrials.gov/study/NCT06379490; EUCT Identifier 2024-510,572-20-00; https://euclinicaltrials.eu/ctis-public/view/2024-510572-20-00.

Non-steroidal anti-inflammatory drugs (NSAIDs) are recommended for perioperative analgesic treatment. However, NSAID treatment may be associated with increased risk of adverse events. We investigated the risks of serious adverse events with perioperative NSAID treatment in patients undergoing orthopaedic surgery. We conducted a systematic review (PROSPERO: CRD42022342003) of randomised clinical trials assessing the harmful effects associated with the use of NSAIDs versus placebo, usual care, or no intervention in patients undergoing orthopaedic surgery. The primary outcome was the incidence of serious adverse events. We systematically searched for eligible trials up to October 13, 2025. We performed risk of bias assessments to account for systematic errors, Trial Sequential Analysis to account for the risks of random errors, performed meta-analyses using R, and used The Grading of Recommendations Assessment, Development and Evaluation framework to assess the certainty of the evidence. We included 38 trials enrolling 6593 patients for our primary outcome. Most trials were of high risk of bias. Meta-analysis showed no statistically significant difference between NSAID and placebo for risk of serious adverse events, RR 0.83; 95% CI, 0.61 to 1.14; p&#x2009;=&#x2009;0.26; very low certainty of evidence. Post hoc beta-binomial regression sensitivity analyses, including trials with zero events, indicated no difference in risks of serious adverse events between NSAID and placebo (OR 0.89; 95% CI, 0.76 to 1.06; p&#x2009;=&#x2009;0.19). Trial Sequential Analysis showed that insufficient information was obtained to confirm or reject a relative risk change of 25%. In adult patients undergoing orthopaedic surgery, we found no evidence of a difference between NSAID and placebo regarding risk of serious adverse events. However, the available data were insufficient to draw firm conclusions, and the certainty of evidence was generally very low. This systematic review with meta-analysis was aimed at assessing non-steroidal anti-inflammatory drug treatments for reported serious adverse effects in post-operative analgesia trials in orthopedic surgical cohorts. These drugs are routinely part of modern multimodal or pre-emptive analgesia treatment routines. The published evidence was generelly assessed to have a high risk of bias or low certainty for this specific question. No clear difference in reported event risk between this type of drug and placebo was found, though it is not clear that this is conclusive.

Glucose management in intensive care unit (ICU) patients often relies on point of care (POC) blood glucose measurements. An increasing number of randomized clinical trials (RCTs) have investigated continuous glucose monitoring (CGM) compared to POC, but effects on patient-important outcomes are uncertain. We systematically searched PubMed, Embase, CENTRAL, CINAHL and Web of Science. All reporting was done according to the PRISMA guideline. We included RCTs in ICU patients comparing the effects of CGM versus POC on glycemic and clinical outcomes. We performed meta-analyses, Trial Sequential Analysis, and assessed the certainty of the evidence using GRADE. We identified 1271 records and included 18 RCTs comparing CGM versus POC with a total of 2027 participants; 15 trials with 1600 participants reported on mortality (relative risk 0.61, 95% CI 0.35-1.04; very low certainty evidence) and 14 trials with 1515 participants on hypoglycemia (relative risk 0.44, 95% CI 0.23 to 0.82; very low certainty evidence). None of our remaining secondary outcomes were reported in the trials. We identified potential benefits of CGM versus POC on glycemic process outcomes; however, we did not evaluate certainty of evidence. CGM used for glucose management in ICU patients may reduce mortality and hypoglycemia, but the evidence is very uncertain. Sufficiently powered trials at low risk of bias are needed to confirm potential beneficial effects. This meta-analysis reports the available literature on continuous versus intermittent monitoring of blood glucose in critically ill patients. The authors found that the available evidence was very uncertain, although continuous monitoring might improve outcomes. It is likely that this is partially due to lack of standardization of measurements and different management strategies. It is possible that the question is best answered with a larger trial with a well-defined treatment protocol.

Pre-admission functional status affects patients' ability to overcome the deteriorating effects of acute critical illness. We aimed to develop a clinical prediction model for 90-day and 1-year mortality based on pre-admission data, including functional status, in adult delirious ICU patients. We included participants randomized to the three highest-enrolling hospitals in the Agents Intervening against Delirium in the Intensive Care Unit (AID-ICU) trial, with pre-admission data on the Clinical Frailty Scale, Comorbidity-Polypharmacy Score, and Barthel-20 score. Ten candidate models were evaluated using multiple modeling approaches. Final models were chosen based on the hyperparameter setting maximizing the Cox-Snell pseudo R2. All baseline variables and trial allocation were included. Final models were retrained on the full dataset, with internal validation performed using bootstrapping validation adjusting for optimism. Of 1000 participants in AID-ICU, 632 were included: 630 provided data on 90-day mortality, and 610 on 1-year mortality. The elastic net regression models demonstrated stable, robust performance. The optimism-adjusted areas under the receiver operating characteristic curves were 0.74 (95% confidence interval [CI]: 0.70-0.78) and 0.74 (95% CI: 0.70-0.77) for the 90-day and 1-year mortality models, respectively. Calibration was good across the risk spectrum. Frailty, age, the Simplified Mortality Score for the Intensive Care Unit (SMS-ICU), advanced cancer, and surgical admission contributed most to the prediction models. We developed models to predict 90-day and 1-year mortality at ICU admission in patients enrolled in the AID-ICU trial, using baseline variables, including functional status measures. The models showed fair discrimination and good calibration, with frailty, age, SMS-ICU, advanced cancer, and surgical admission as key predictors. Future studies are needed to test whether the model is valid in other ICU settings and whether its performance is sufficient to have clinical value. This article presents mortality prediction models for ICU patients with delirium that incorporate pre-admission functional status and apply several modern statistical learning approaches, providing an instructive and transparent example of contemporary prediction modeling. The resulting elastic net regression models showed fair discrimination and good calibration for predicting 90-day and 1-year mortality, with frailty, age, and illness severity emerging as the strongest predictors. However, such models should be interpreted cautiously at the individual patient level and may be most useful for identifying patients at increased risk who may benefit from careful clinical assessment, individualized treatment, and close follow-up.

Guidelines discourage prediction of neurological outcome in comatose patients within the first 72&#x2009;h after cardiac arrest. Increasing evidence suggests that patients with the most severe brain injury and those with no or minimal brain injury may be identified before 72&#x2009;h using novel methods. We present a protocol for the EARLY-NEURO study, which aims to evaluate whether good and poor outcomes can be reliably predicted already from 24&#x2009;h after cardiac arrest using the most commonly available methods. Protocol for a prospective international multicenter substudy within the Sedation, TEmperature and Pressure after Cardiac Arrest and REsuscitation (STEPCARE) trial where adults post-arrest are randomized to minimal or deep sedation, fever treatment with or without a temperature management device and to two different targets of mean arterial blood pressure. Patients sedated or still unconscious at 24&#x2009;h are examined with head computed tomography (CT) and electroencephalogram (EEG). Blood samples are collected at 24&#x2009;h after randomization, and stored for analysis of the brain injury marker neurofilament light. CT and EEG examinations will be centrally evaluated for signs of a likely poor or good outcome applying standardized criteria by raters blinded to treatment allocations and patient outcomes. Intensive care treatment, neurological prognostication, and criteria for withdrawal of care will be according to the STEPCARE protocol. Timepoint and reasons for withdrawal of life-sustaining therapy (WLST) will be recorded. WLST prior to 72&#x2009;h after randomization based on a presumed futile neurological prognosis is strongly discouraged. Primary outcome will be good or poor functional outcome, assessed by the modified Rankin Scale (dichotomized as 0-3 versus 4-6) at 6&#x2009;months. Results will be reported in accordance with the Standards for Reporting Diagnostic Accuracy (STARD). Earlier prognostication aims to balance the avoidance of premature treatment withdrawal in patients with favorable potential against the prevention of unnecessary intervention in patients with a definitely poor prognosis.

Perioperative glucose monitoring traditionally relies on intermittent point-of-care (POC) testing, whereas continuous glucose monitoring (CGM) enables real-time glucose assessment with automated alerts for dysglycaemia. CGM remains understudied in hospitalised surgical patients with diabetes. This protocol outlines a clinical trial designed to evaluate the effect of CGM on achieving normoglycaemia in surgical patients with diabetes. A multicentre, two-group, randomised controlled trial (NCT06314061). Eligible patients are adults with Type 1 or Type 2 diabetes undergoing surgery lasting more than 45&#x2009;min with an expected hospital stay of at least one night. Patients in the intervention group will be monitored using CGM (Dexcom G7, Dexcom Inc., CA, USA) with active alerts for hyperglycaemia and hypoglycaemia for up to 10&#x2009;days after surgery during hospitalisation. Patients in the control group will wear a CGM device with glucose values and alerts concealed from the patient and clinical staff. All patients will receive routine diabetes care, including intermittent POC glucose testing, in addition to CGM. The primary outcome is CGM time-in-range between 6.0 and 10.0&#x2009;mmol/L. Secondary outcomes include the frequency and cumulative duration of hypoglycaemia and hyperglycaemia as well as postoperative complications. A sample size of 200 patients will allow 90% power to detect a 15% relative difference in the primary outcome between groups, with an expected 10% dropout. To ensure standardised use of CGM and to support clinical decision-making during the trial, a trial-specific guideline has been developed, integrating CGM with insulin treatment and POC tests. The guideline recommends intervention for glucose levels <&#x2009;5.0&#x2009;mmol/L when trending downward. For CGM glucose levels >&#x2009;10.0&#x2009;mmol/L, rapid-acting insulin may be administered according to a sliding scale regimen rather than delaying treatment until the next scheduled POC test. This randomised controlled trial will provide clinical evidence for CGM use by clinical staff to enhance perioperative glycaemic control in surgical patients with diabetes. NCT06314061.