Anesthesiology

High-flow nasal oxygen in infants: similar desaturation risk, less gastric insufflation

In 125 infants undergoing elective tracheal intubation, high-flow nasal oxygenation (HFNO) was compared with standard face mask preoxygenation and ventilation using 100% oxygen. HFNO did not reduce desaturation episodes (SpO2 <95% for ≥5 s) compared with face mask ventilation, and severe desaturation (SpO2 <90%) was similar. First-attempt intubation success, lowest SpO2, post-intubation end-tidal gases, and atelectasis scores were also comparable between groups. HFNO significantly reduced gastric insufflation compared with face mask ventilation, suggesting a safety advantage without improved oxygenation outcomes. 1

Prospective EHR-embedded random forest model predicts postoperative mortality with high discrimination

A 32-feature random forest model for in-hospital postoperative mortality was prospectively validated and implemented in real time within a single-centre EHR. The implemented model achieved an AUROC of 0.874, with discrimination better than ASA physical status and lower than the original 58-feature model. Workflows enabled automated, real-time data feeds and direct transfer of risk outputs into the EHR for clinician review. Surveyed anesthesiologists reported feasibility of using the decision support tool, but the study did not assess effects on patient outcomes. 2

Acute normovolaemic haemodilution in elective cardiac surgery: limited benefit on overall transfusion

This meta-analysis pooled randomized trials of acute normovolaemic haemodilution (ANH) in adults undergoing elective cardiac surgery. ANH did not significantly reduce the proportion of patients transfused with allogeneic packed red blood cells during the postoperative hospital stay (RR 0.94; 95% CI 0.85–1.02). ANH reduced red cell transfusions within the first 48 postoperative hours, but this early effect did not translate into lower overall in-hospital exposure. There were no significant differences in surgical re-exploration, all-cause mortality, or other secondary outcomes between ANH and standard care groups. Most trials had intermediate risk of bias from incomplete reporting and lack of blinding, tempering strong practice-changing conclusions. 3

Post-intensive care syndrome affects more than half of ICU survivors in a nationwide cohort

Using South Korea’s national insurance database, investigators studied 234,069 adults who survived at least 12 months after an ICU admission. Among survivors without prior related diagnoses, 55.6% developed new post-intensive care syndrome (PICS) within 12 months, most commonly physical impairments. Risk factors included older age, female sex, lower income, pre-existing disability, cerebrovascular disease, dementia, chronic lung disease, mechanical ventilation, and continuous renal replacement therapy. These data demonstrate substantial survivorship burden after critical illness and support structured, multidisciplinary follow-up targeting high-risk ICU survivors. 4