High BMI at Liver Transplantation: A Retrospective Single-Center Analysis of Blood Product Utilization and Postoperative Outcomes.

Obesity, generally defined as High BMI is increasingly prevalent in liver transplant recipients, but its impact on perioperative management is still not understood. This study examined intraoperative transfusion as a marker of surgical complexity, alongside blood loss, ventilation duration, and Intensive Care Unit length of stay. We conducted a retrospective single-center analysis of adult liver transplant recipients between June 1, 2012, and March 31, 2024.

Intraosseous versus intravenous vascular access in adults with out-of-hospital cardiac arrest: a meta-analysis with trial sequential analysis and meta-regression analysis.

Establishing vascular access during cardiopulmonary resuscitation is essential for delivering guideline-recommended medications. This meta-analysis aims to compare the clinical effectiveness of initial vascular access attempts through the intraosseous route to the intravenous route in patients with out-of-hospital cardiac arrest (OHCA). A comprehensive literature search was conducted across PubMed, Cochrane, Scopus, and Web of Science, up to March 2025, for randomized controlled trials (RCTs) and propensity score-matched (PSM) observational studies comparing initial attempt intraosseous access with initial intravenous access in patients with OHCA.

State of the art: Renal recovery after AKI - from basic science to clinical practice.

Purpose: Acute kidney injury (AKI) is common in critically ill patients and associated with a high risk of mortality, chronic kidney disease (CKD) and cardiovascular morbidity. The risks are higher in patients with incomplete or no renal recovery. The purpose of this review is to summarize the current understanding of the mechanisms of renal recovery, list some key risk factors for nonrecovery and highlight knowledge gaps.

Research without prior consent procedure and intervention effect on mortality in critical care: a meta-epidemiological study of randomized controlled trials.

Background: In critical care randomized controlled trials (RCTs), obtaining informed consent from patients or proxies can be challenging and may delay randomization, potentially affecting intervention efficacy. Research without prior consent (RWPC) procedures are increasingly used to facilitate timely inclusion but their impact on trial outcomes remains uncertain. We aimed to assess whether RWPC procedures are associated with differences in intervention effects on mortality in critical care RCTs.

Preoperative Cardiovascular Risk and Postoperative Outcomes by Renin-Angiotensin System Inhibitor Use: A Secondary Analysis of a Randomized Clinical Trial.

Importance: The STOP-or-NOT randomized clinical trial compared the outcomes of continuing vs discontinuing renin-angiotensin system inhibitors (RASi) prior to major noncardiac surgery and found no difference in the postoperative risk of death or major complications, but it remains unclear whether preoperative cardiovascular risk stratification influences the response to this intervention. This post hoc analysis explores whether preoperative cardiovascular risk stratification affects the outcomes in patients who continue vs discontinue RASi use before major surgery.

Objective: To evaluate whether preoperative cardiovascular risk stratification affects the strategy of RASi management before major noncardiac surgery.

Evaluating the risks and benefits of continuing withholding renin-angiotensin system inhibitors: a systematic review and meta-analysis with trial sequential analysis.

Background: The best perioperative management of renin-angiotensin system inhibitors (RASi) in patients undergoing noncardiac surgery has been an ongoing debate as a result of inconclusive previous studies and insufficient data for robust guidelines. Although continuation of RASi may lead to intraoperative hypotension, withholding might also cause postoperative complications. Our meta-analysis aims to explore the postoperative outcomes of strategies of RASi management before surgery by evaluating randomised clinical trials, to provide more definitive conclusions for clinical practice.

Vasopressin Is Not Associated With Severe Kidney Injury in Liver Transplantation: A Propensity Score-adjusted Analysis.

Background: Hypotension during liver transplantation often requires vasopressor therapy. Acute kidney injury is a common complication after liver transplantation. Vasopressin acts as a portal flow modulator, may increase the glomerular filtration rate, and reduce the dose of catecholamines required.

Iloprost for the Treatment of Severe Septic Shock with Persistent Hypoperfusion: A Double-Blind, Randomized Controlled Trial.

Preclinical and preliminary clinical data suggest that iloprost may improve tissue perfusion in septic shock. However, its effect on organ failure remains unclear. To investigate whether iloprost provides organ protection in septic shock with hypoperfusion.

Postoperative Outcomes Among Sodium-Glucose Cotransporter 2 Inhibitor Users.

Importance: Case reports and small retrospective studies have suggested that there is an increased risk of postoperative euglycemic ketoacidosis (eKA) and acute kidney injury (AKI) among patients using sodium-glucose cotransporter 2 inhibitors (SGLT2i) preoperatively. However, there has not been a representative assessment of the risks of these agents among patients undergoing surgery.

Objective: To evaluate the risk of postoperative eKA, AKI, and mortality within 30 days after surgery among preoperative long-term SGLT2i users compared with nonusers.

Therapeutic Potential of Centhaquine Citrate, a Selective Alpha-2B Adrenoceptor Agonist, in the Management of Circulatory Shock.

Shock is a life-threatening condition marked by inadequate tissue perfusion and organ dysfunction with high morbidity and mortality. Activation of the sympatho-adrenergic system is pivotal in response to all four major categories (i.e.

Alterations in the renin-angiotensin system during septic shock.

Background: Alterations in the classical Renin-Angiotensin Aldosterone System (RAAS) have been described during septic shock and are associated with patient outcomes. Since the alternative RAAS has also been reported to be altered in critically ill patients, and given that the RAAS can be modulated by specific therapeutics, such as angiotensin II, understanding its pathophysiology is of primary interest.

Objective: To describe the alterations in the classical and alternative RAAS during septic shock in comparison with healthy controls.

Advancing surgical outcomes through cardiovascular biomarker sub-phenotyping.

Recent findings from Gutierrez del Arroyo and colleagues identified distinct sub-phenotypes in patients undergoing major noncardiac surgery based on biomarkers such as N terminal pro-brain natriuretic peptide, renin, aldosterone, and angiotensin-converting enzyme 2, which were associated with varying risks of postoperative myocardial injury. Although their findings highlight the potential of sub-phenotyping for advancing perioperative precision medicine, further research is needed to validate these sub-phenotypes and explore their role in tailoring perioperative management strategies.

Safety and Feasibility of Early Extubation in Liver Transplantation: Experience in 1555 Patients.

Background: Early extubation after liver transplantation can decrease cost and intensive care unit lengths of stay, but its adoption remains limited because of safety concerns. We assessed the feasibility and safety of early extubation at a liver transplant center with a high early extubation rate. We analyzed subgroups of high-risk patients, including high model for end-stage liver disease-sodium (MELD-Na) score, high intraoperative blood loss, and patients undergoing simultaneous liver-kidney transplantation.

Management of renin-angiotensin system inhibitors prior to major surgery: insights from the STOP-or-NOT trial.

Strong recommendations on how to manage renin-angiotensin system inhibitors, including angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, before surgery are lacking because of a lack of evidence, which is mostly limited to data from observational studies. The STOP-or-NOT trial was a large multicentre randomised trial designed to determine whether chronic renin-angiotensin system inhibitors should be continued or discontinued before major noncardiac surgery. As principal investigators of the STOP-or-NOT trial, we discuss the trial's results and how they contribute to the existing literature on management of renin-angiotensin system inhibitors before surgery.

Previous treatment with anthracycline does not affect the course of sepsis in cancer patients: Retrospective cohort study.

Background: Cancer patients who are exposed to sepsis and had previous chemotherapy may have increased severity. Among chemotherapeutic agents, anthracyclines have been associated with cardiac toxicity. Like other chemotherapeutic agents, they may cause endothelial toxicity.

New drugs for acute kidney injury.

Acute kidney injury (AKI) presents a significant challenge in the management of critically ill patients, as it is associated with increased mortality, prolonged hospital stays, and increased healthcare costs. In certain conditions, such as during sepsis or after cardiac surgery, AKI is one of the most frequent complications, affecting 30%-50% of patients. Over time, even after the resolution of AKI, it can evolve into chronic kidney disease, a leading global cause of mortality, and cardiovascular complications.