Review: avoid severe hypotension, but trials do not show higher blood pressure targets protect the kidneys

This narrative review finds a consistent, roughly dose-response association between intraoperative hypotension (especially MAP below 60-65 mmHg) and postoperative AKI in observational studies. Randomized trials of individualized or higher blood pressure targets have generally not confirmed kidney protection, and IOH definitions vary widely.

Why it matters. Explains why current evidence supports avoiding severe, sustained hypotension without endorsing higher targets for renal protection.

Limitation. Narrative review; the authors describe their conclusion as provisional.

Serratus anterior plane catheters after sternotomy linked to more pneumothoraces (12% vs 3%)

Comparing 50 trial patients who received continuous serratus anterior plane catheters with 989 propensity-matched historical patients, pneumothorax occurred in 12% vs 3% (OR 5.3; 95% CI 2.1-13.6). ICU readmission, ventilation time and length of stay did not differ.

Why it matters. A safety signal for teams adding continuous chest-wall catheters to enhanced recovery pathways after cardiac surgery.

Limitation. Historical comparison; the authors note causality is unclear and closer trial monitoring may have detected more pneumothoraces.

Cardiac arrest followed 1.2% of PICU intubations, and each extra attempt raised the odds

Among 27,773 intubations in international PICUs and pediatric cardiac ICUs (2015-2023), intubation-associated cardiac arrest occurred in 1.2%. Each additional attempt raised the odds (aOR 1.70), shock (aOR 4.67) and oxygenation failure (aOR 2.29) were strong risk factors, and video laryngoscopy was associated with lower odds (aOR 0.76).

Why it matters. Adds registry evidence for prioritizing first-attempt success, including video laryngoscopy, in critically ill children.

Limitation. Retrospective registry analysis; associations may reflect confounding.

Blunted frontal alpha shift at induction tracked with postoperative delirium in older adults

In an exploratory study of 83 older patients with usable EEG under sevoflurane, those who developed delirium (19 of 100 enrolled) lacked the alpha power increase seen before loss of responsiveness (frontal 4.24 vs -0.88 dB) and had less efficient functional brain networks during maintenance.

Why it matters. Raises the possibility of an intraoperative EEG marker of delirium susceptibility.

Limitation. Small single-center exploratory study; 17 patients were excluded for EEG artifacts.

CT angiography for brain death was far less sensitive within 12 hours of brainstem areflexia

In 118 ICU patients undergoing death determination by neurological criteria, cerebral CTA sensitivity was 87.3% overall: 67.4% when performed within 12 h of the first signs of brainstem areflexia vs 98.7% after 12 h. The authors recommend waiting at least 12 h and repeating inconclusive scans.

Why it matters. Offers a practical timing rule that could reduce false-negative ancillary testing.

Limitation. Retrospective cohort; the authors call for confirmation of the 12-hour threshold.

C-MAC videolaryngoscope eased arm muscle strain and workload vs Macintosh in simulated difficult airways

In a randomized crossover manikin study of 35 experienced anesthesiologists, direct laryngoscopy produced more brachioradialis activity than C-MAC videolaryngoscopy in normal, locked-jaw (18 vs 12 µV) and rigid-neck scenarios. Direct laryngoscopy was fastest but applied the most incisor force; King Vision carried the highest perceived workload.

Why it matters. Suggests device choice affects operator ergonomics in difficult airways, an under-studied side of airway management.

Limitation. Manikin simulation; results may not translate to patients.

Emergency surgery, intraoperative complications and ASA >2 predicted unplanned ICU admission across 75 ICUs

In this prospective study of 55,963 surgical patients across 75 ICUs, 2764 (4.9%) were planned for ICU admission, but 804 could not be admitted because of bed limits. Emergency surgery (OR 12.4), intraoperative complications (OR 3.1) and ASA >2 (OR 2.7) independently raised the risk of unplanned admission; 90-day mortality was 7.5% overall and 18.9% after emergent admission.

Why it matters. Raises the question of whether combining risk scores with intraoperative events could better target scarce postoperative ICU beds.

Limitation. Observational design in one national network; the benefit of ICU care was judged by modified Wang criteria, not tested directly.

Nearly 1 in 5 ICU patients on vasoactive drugs had a significant brachial-to-radial pressure gradient

In a prospective study of 303 patients across 13 Polish ICUs, 56 (18.4%) had a gradient between noninvasive brachial and invasive radial MAP above 11 mm Hg. Only vasoactive dose was independently associated with it (OR 1.68; 95% CI 1.12-2.52), and ICU mortality was higher in these patients (48.0% vs 30.1%).

Why it matters. Raises the question of how far radial arterial readings can be relied on in patients on high vasoactive doses.

Limitation. Observational study; a noninvasive brachial cuff was the comparator, not a central arterial line.

Deep-learning chest X-ray ARDS score predicted ventilated patients’ mortality beyond the P/F ratio

In 6591 mechanically ventilated patients at one center, a deep-learning ARDS-CXR score predicted 28-day mortality with AUROC 0.68 vs 0.64 for Pao2/Fio2. Mortality was 35.1% with a positive score vs 13.5% with a negative score, and the association held after adjusting for Pao2/Fio2 or APACHE-IV.

Why it matters. Raises the question of using imaging-derived lung injury scores for risk stratification or trial enrichment.

Limitation. Single-center retrospective cohort; discrimination was modest.

Cluster trials reported smaller effects than individually randomized trials on length-of-stay outcomes

A meta-epidemiological study of 65 meta-analyses (212 trials, 315,276 patients) in prehospital, emergency and critical care found no difference in mortality effect sizes between cluster and individually randomized trials, but smaller effects in cluster trials for length-of-stay or days-alive outcomes.

Why it matters. A methods caution for readers pooling ICU trials of different designs.

Limitation. Under half of the eligible meta-analyses reported randomization type.

UK enhanced care units with ring-fenced elective beds had fewer surgical cancelations

Across 28 UK hospitals with both enhanced and critical care facilities (4112 referred patients), cancelation rates were usually lower in enhanced care than in critical care. Beds reserved for elective cases (OR 0.54) and multispecialty care (OR 0.48) were linked to fewer cancelations; admitting emergency cases was linked to more (OR 1.61).

Why it matters. Points to structural choices, such as protecting elective beds, that may keep high-risk surgery on schedule.

Limitation. Retrospective data from a 3-month window; associations, not causal effects.

Preoperative cognitive training linked to about half the risk of postoperative delirium in a meta-analysis

Pooling 13 RCTs (1446 patients), preoperative cognitive training was associated with lower postoperative delirium (RR 0.53; 95% CI 0.36-0.77; low certainty) and delayed neurocognitive recovery (RR 0.66; very low certainty). Trial sequential analysis boundaries were not crossed, so false-positive findings remain possible.

Why it matters. Suggests a cheap, nonpharmacologic delirium-prevention strategy that now needs large trials.

Limitation. Several included trials had high risk of bias, and required information sizes were not reached.

Remimazolam vs Propofol for Motor and Somatosensory Evoked Potentials in Spinal Tumor Surgery

Phase 4 trial planning 190 participants, sponsored by Beijing Tsinghua Chang Gung Hospital. Status: not yet recruiting. Conditions: Spinal Cord Neoplasms, Spinal Neoplasms.

Equivalence of Oral Melatonin and Oral Midazolam in Preoperative Anxiolysis for Pediatric Fast-Track Cardiac Surgery

Phase 2/3 trial planning 100 participants, sponsored by Ain Shams University. Status: active not recruiting. Conditions: Comparative Effectiveness.

Role of Perineural Catheter in Pain Control and Opioid Consumption After Major Amputation of Lower Limb

Phase 4 trial planning 96 participants, sponsored by Aga Khan University. Status: not yet recruiting. Conditions: Phantom Limb Pain After Amputation, Stump Pain.

Effects of Ciprofol on Perioperative Neurocognitive Function in Elderly Patients Undergoing Daytime Surgery

Phase 4 trial planning 148 participants, sponsored by Second Affiliated Hospital of Wenzhou Medical University. Status: enrolling by invitation. Conditions: PND, POCD - Postoperative Cognitive Dysfunction.

Effect of Neuromuscular Blocking Agent Use on Video Laryngeal Mask Airway Insertion

Phase 4 trial planning 128 participants, sponsored by Hacettepe University. Status: not yet recruiting. Conditions: Airway Management, Laryngeal Mask Airways, Neuromuscular Blockade.

Superficial Parasternal Block Combined With Rectus Sheath Block for Open Cardiac Surgery

Phase 4 trial planning 100 participants, sponsored by Hôpital du Valais. Status: not yet recruiting. Conditions: Cardiac Valve Disease, Coronary Heart Disease.