Daily Anesthesiology Research Analysis

BACKGROUND: The potential to mitigate pain by targeting a single receptor while simultaneously modulating peripheral and spinal circuits, offers an exciting nonopioid therapeutic strategy. Neurotensin receptor type 2 (NTSR2) is a promising yet underexplored pathway for nonopioid analgesia. The authors investigated the antinociceptive effects of NTSR2 activation and its mechanisms in rodent models of perioperative and chronic pain. METHODS: Using NT79, a selective NTSR2 agonist, the authors assessed pain behaviors in male and female rats and mice. Animals were randomly assigned to receive saline (control) or NT79 at multiple doses. Clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated protein 9 (Cas9)-mediated NTSR2 knockdown and pharmacologic inhibition of γ-aminobutyric acid (GABA) receptors were used to dissect NTSR2-d

OBJECTIVES: To perform an updated systematic review and meta-analysis of the efficacy and safety of intensive (INT) vs. conventional (CONV) blood glucose (BG) targets for critically ill adults on insulin infusions. DATA SOURCES: We conducted a comprehensive search of Embase and OVID Medline databases from inception to October 16, 2023. We manually excluded studies published before 2000 due to potential lack of relevance as glycemic control in the ICU was not routinely practiced before 2000. STUDY SELECTION: We included randomized controlled trials (RCTs) evaluating adult, critically ill patients on insulin infusions comparing INT vs. CONV targets for efficacy and safety outcomes. DATA EXTRACTION: Data were screened and extracted with accuracy confirmed by a second reviewer. Study methodological characteristics, patient population, interventions, and outcome data were recorded. Studies without numerical outcomes were summarized as text statements. DATA SYNTHESIS: Forty-five RCTs were included involving 32,215 patients. No differences were seen between INT and CONV targets for hospital mortality or ICU mortality. INT targets were associated with lower ICU length of stay (LOS), infections, and critical illness polyneuropathy (CIP); however, INT targets demonstrated a 3.6-fold higher risk of severe hypoglycemia. Most of the studies with significant differences contained serious inconsistencies or risk of bias. In the subgroup analyses, INT targets demonstrated favorable neurologic outcomes in neurologic ICU patients, lower ICU LOS in mixed ICU patients, and lower ICU mortality in the cardiac surgery subgroup. CONCLUSIONS: INT BG targets demonstrated mild to moderate improvements in several important morbidity secondary outcomes, including LOS, infections, and CIP, but were associated with a 3.6-fold higher risk of severe hypoglycemia. No differences were seen in ICU or hospital mortality. INT targets should not be routinely used over CONV targets when trying to minimize hypoglycemia as a marker of patient safety. However, as stated in the Society of Critical Care Medicine guidelines, a lower target within the INT range (110-140 mg/dL; 6.1-7.8 mmol/L) may be considered acceptable in select centers where the risk of hypoglycemia is documented to be negligible based on routine assessment and with the use of optimized glycemic management protocols.

OBJECTIVES: The venous excess ultrasound (VExUS) grading system has gained recognition in acute and critical care medicine as a promising approach to evaluate venous congestion and optimize fluid management. However, the diagnostic accuracy and prognostic value of VExUS remain unclear. DATA SOURCES: PubMed, Embase.com, Web of Science (Core Collection), and Wiley/Cochrane Library from inception to May 19, 2025, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and in collaboration with a medical information specialist. STUDY SELECTION: Study selection was systematically performed by a panel of authors. A total of 32 studies were included, consisting of 3142 patients, with six diagnostic, 22 prognostic studies, and four studies that reported on both diagnostic and prognostic outcomes. DATA EXTRACTION: Relevant data were extracted by two authors, and the corresponding authors were contacted when necessary. DATA SYNTHESIS: For diagnostic studies, no meta-analysis could be performed. Studies suggest moderate to good diagnostic accuracy for detecting increased central venous and right atrial pressures (sensitivity 78-95%, specificity 80-90%). Prognostic studies in cardiac patients found an association between VExUS greater than or equal to 2 and acute kidney injury (AKI; odds ratio [OR], 4.44; 95% CI, 2.34-8.43; moderate certainty) and mortality (OR, 3.17; 95% CI, 1.30-7.75, low certainty). For critically ill patients, no associations between VExUS greater than or equal to 2 and AKI (OR, 1.45; 95% CI, 0.70-2.99; very low certainty) and mortality (OR, 1.25; 95% CI, 0.77-2.03; low certainty) were found. Per-patient analysis showed an association between VExUS 3 and mortality for all patients and an association with AKI for cardiac patients. CONCLUSIONS: Results from this systematic review and meta-analysis suggest that VExUS has moderate to good accuracy to diagnose increased central venous pressure and right atrial pressure. In cardiac patients, higher VExUS grades are associated with AKI and mortality, but in critically ill patients, the association between VExUS grades and outcomes is less clear.