Anesthesiology

SCCM issues conditional recommendation for neuromuscular blockade in moderate–severe ARDS

These SCCM guidelines conditionally recommend neuromuscular blocking agents for adult ARDS patients with PaO2/FiO2 <150. Recommendations derive from GRADE-based systematic reviews of five PICO questions on NMBA use in ARDS. The panel found equipoise for titratable versus fixed-dose regimens and for monitoring-based sedation and analgesia strategies around paralysis. They also judged evidence insufficient to recommend for or against NMBA use specifically during prone positioning. 1

Narrative review refines intraoperative fluid choices and targets in non-cardiac surgery

This review underscores that both uncorrected fluid loss and fluid overload during non-cardiac surgery increase complications. Balanced crystalloids are conceptually preferable, but moderate intraoperative 0.9% saline volumes did not clearly increase complications. Moderate doses of hydroxyethyl starch appeared safe intraoperatively despite intensive care concerns, while albumin lacks outcome data to justify higher cost. For elective major non-cardiac surgery, a mildly positive intraoperative fluid balance of 1–2 liters is generally recommended. 2

TCI for propofol–remifentanil improves stability and ICU stay after elderly cardiac surgery

This international retrospective study compared target-controlled versus manually controlled propofol–remifentanil infusions in cardiac surgery patients aged 65 years or older. After propensity matching, target-controlled infusion was associated with shorter ICU length of stay in both the Union and INSPIRE cohorts. In the primary cohort, target-controlled infusion also showed lower odds of reintubation, acute kidney injury, and in-hospital mortality versus manual control. The validation cohort confirmed shorter ICU stays and fewer reintubations with target-controlled infusion. 3

High-dose intermittent meropenem linked to lower 90-day mortality in critically ill patients

This observational ICU cohort compared high-dose meropenem 6 g/day with standard-dose 3 g/day intermittent infusions, using 2:1 propensity score matching. Among 1,716 matched patients, high-dose therapy was associated with significantly lower 90-day mortality than standard dosing, with an adjusted risk difference of 9.4%. Thirty-day mortality, resistance emergence, extracorporeal membrane oxygenation initiation, new ARDS, and ICU or hospital stay were similar between groups. High-dose meropenem was associated with a lower adjusted risk of acute kidney injury than standard dosing. 4