Daily Anesthesiology Research Analysis
Analyzed 71 papers and selected 3 impactful papers.
Summary
Three impactful studies advance perioperative and critical care anesthesiology today: an ML-enabled national platform (PregMedNet) maps medication–neonatal outcome associations in pregnancy; a prospective ICU echocardiography study shows MAPSE and GLS outperform LVEF for mortality risk and are highly feasible; and a pre-registered meta-analysis finds tissue-perfusion–guided resuscitation does not reduce mortality versus standard care.
Research Themes
- AI/ML platforms for medication safety and perinatal outcomes
- ICU echocardiography metrics beyond LVEF for risk stratification
- Evidence synthesis on microcirculation-guided resuscitation targets
Selected Articles
1. PregMedNet: Multifaceted maternal medication impacts on neonatal complications.
Using nationwide claims linked to an ML pipeline, PregMedNet maps >27,000 maternal medication–neonatal outcome associations across 1,152 drugs and 24 outcomes, reporting adjusted ORs and drug–drug interactions. One association is supported by in vivo validation, and graph learning suggests plausible pathways, positioning the platform as a resource for perinatal medication safety and hypothesis generation.
Impact: Introduces a scalable, ML-enabled framework with partial experimental validation to interrogate perinatal drug safety at unprecedented breadth, informing future clinical and mechanistic studies.
Clinical Implications: Clinicians and obstetric anesthesiologists can use these signals to inform shared decision-making, prioritize monitoring for at-risk neonatal outcomes, and identify drug classes warranting prospective validation—while recognizing observational limitations.
Key Findings
- Built a nationwide ML platform (PregMedNet) covering >27,000 drug–disease pairs across 1,152 medications and 24 neonatal outcomes.
- Reported adjusted odds ratios and drug–drug interactions for maternal medication–neonatal outcome associations.
- One association received in vivo experimental support, increasing confidence in at least part of the findings.
- Graph learning suggested biological pathways underpinning selected associations.
Methodological Strengths
- Large-scale, systematic analysis of nationwide claims data with advanced ML pipeline
- Partial orthogonal validation via in vivo experiment and graph-based mechanistic inference
Limitations
- Observational claims data subject to confounding, misclassification, and indication bias; causal inference is limited
- Experimental validation covered only one association; external clinical validation is pending
Future Directions: Prospective registries and pragmatic trials for high-signal drug classes; external validation across health systems; integration with maternal–fetal pharmacokinetics and mechanistic studies to move from association to actionability.
While medication use is common among pregnant women, medication safety remains insufficiently characterized because studies in pregnant women are challenging due to safety concerns. The recent digitization of healthcare databases and advances in computational methods have created new opportunities for large-scale, retrospective drug safety evaluations. Here, we present PregMedNet, a platform that characterizes multifaceted maternal medication associations on neonatal outcomes during pregnancy, covering more than 27,000 drug-disease pairs across 1,152 medications and 24 outcomes. These results encompass known and additional odds ratios (ORs), adjusted ORs, and drug-drug interactions, systematically analyzed using nationwide claims data and an advanced machine learning pipeline. Notably, one of the associations identified in this study is supported by in vivo experiments, increasing confidence in PregMedNet's findings and highlighting the utility of claims data and machine learning for perinatal medication safety studies. Additionally, potential biological mechanisms underlying the associations are explored using a graph learning method, providing candidate pathways for future mechanistic investigations. We expect that PregMedNet will contribute to advancing maternal medication safety and improving neonatal outcomes by providing extensive, multifaceted drug safety information on this previously underrepresented population.
2. Echocardiographic assessment of left ventricular longitudinal function in critically ill patients.
In this mixed ICU cohort (n=411), MAPSE (feasibility 90%) and GLS (65%) were more prognostic for mortality than LVEF, which had limited prognostic utility. MAPSE emerged as the most feasible and informative longitudinal index, supporting its incorporation into routine ICU echocardiography for risk stratification.
Impact: Provides pragmatic, feasible echocardiographic markers (MAPSE, GLS) with superior prognostic performance over LVEF in a real-world mixed ICU population.
Clinical Implications: Incorporate MAPSE alongside GLS in ICU echocardiography protocols to detect longitudinal LV dysfunction and improve mortality risk stratification, especially when LVEF appears preserved.
Key Findings
- Feasibility: LVEF 71%, GLS 65%, MAPSE 90%, and S' 83% within 24 h of ICU admission.
- Impaired MAPSE and GLS were associated with increased mortality, whereas LVEF and S' were not.
- MAPSE was the most feasible measurement and provided prognostic information beyond LVEF.
Methodological Strengths
- Prospective cohort with standardized early TTE acquisition and predefined metrics
- Direct feasibility assessment and mortality linkage in a mixed ICU population
Limitations
- Exploratory secondary analysis; potential residual confounding inherent to observational designs
- Offline analysis may introduce measurement variability across operators
Future Directions: Multicenter validation, threshold determination for MAPSE/GLS-guided management, and integration with POCUS workflows and clinical decision support.
BACKGROUND: In the intensive care unit (ICU), conventional assessment of left ventricular systolic function relies on left ventricular ejection fraction (LVEF), but LVEF often has limited prognostic ability. Measures of longitudinal LV performance [global longitudinal strain (GLS), mitral annular plane systolic excursion (MAPSE), and tissue Doppler-derived systolic velocity (S')] are increasingly used in critical care echocardiography and may capture clinically relevant dysfunction better than LVEF. To date, the prognostic implications of GLS, MAPSE, and S' have been studied mainly in septic cohorts, while their feasibility and prognostic value in mixed ICU populations remain uncertain. We therefore aimed to evaluate the feasibility and prognostic value of these parameters in a mixed ICU cohort. METHODS: In this exploratory secondary analysis of a prospective observational ICU cohort, transthoracic echocardiography was performed within 24 hours of ICU admission. LVEF by Simpson biplane, GLS, MAPSE, and S' were analysed offline. Feasibility was quantified as the proportion of patients with analysable measurements. Associations between echocardiographic parameters were assessed using simple linear regression and are reported as coefficients of determination (R RESULTS: Of 411 enrolled patients, 377 had at least one parameter available and were included. Feasibility was 71% for LVEF, 65% for GLS, 90% for MAPSE, and 83% for S'. GLS correlated most strongly with LVEF (R CONCLUSIONS: In a mixed ICU cohort, impaired MAPSE and GLS were associated with increased mortality, in contrast to LVEF and S'. MAPSE was also the most feasible measurement. Incorporation of MAPSE into routine ICU echocardiography may improve detection and risk stratification of LV dysfunction in critical illness. TRIAL REGISTRATION: Secondary analysis of data from a single-centre prospective observational study focused on systolic dysfunction in ICU patients (Clinical Trials ID: NCT03787810).
3. The effectiveness of tissue-perfusion-guided resuscitation in shock: A systematic review and meta-analysis.
Across eight RCTs (n=2,394), tissue-perfusion–guided therapy did not reduce 30-day mortality versus standard care (RR 0.96, 95% CI 0.83–1.10). The review was PRISMA-compliant, PROSPERO-registered, used random-effects meta-analysis and RoB2, and evaluated ICU/HLOS, fluids, and organ support as secondary endpoints.
Impact: Provides high-level, negative evidence tempering enthusiasm for microcirculation-targeted resuscitation strategies in shock, guiding clinicians toward evidence-based targets.
Clinical Implications: Routine use of tissue-perfusion–guided targets to improve survival in shock is not supported; focus on established macrohemodynamic goals and judicious fluid stewardship while awaiting more definitive data.
Key Findings
- Eight RCTs with 2,394 patients were included under a PROSPERO-registered, PRISMA 2020-compliant protocol.
- Tissue-perfusion–guided therapy did not significantly reduce 30-day mortality versus standard care (RR 0.96; 95% CI 0.83–1.10).
- Secondary outcomes assessed included ICU/hospital length of stay, fluid volumes/balance, and organ support requirements under a random-effects model with RoB2 risk-of-bias assessment.
Methodological Strengths
- Pre-registered (PROSPERO) PRISMA-compliant systematic review and meta-analysis restricted to RCTs
- Use of random-effects models and RoB2 for rigorous bias assessment
Limitations
- Heterogeneity in definitions and implementation of tissue-perfusion targets across trials likely limits generalizability
- Abstracted data on secondary outcomes are not fully detailed; mortality estimates may still be underpowered for small effects
Future Directions: Standardize tissue-perfusion protocols and phenotyping; test integrated macro–microcirculatory strategies in adequately powered multicenter RCTs with patient-centered outcomes.
Resuscitation from shock generally targets macrohemodynamic parameters. However, this approach may not be followed by improved microcirculation and carries a risk of fluid overload. We aimed to evaluate the efficacy of tissue-perfusion-guided therapy (TP-GT) compared with standard care in adult patients with shock. Following the PRISMA 2020 guidelines, we searched MEDLINE, Embase, and CENTRAL on October 26, 2025, for randomized controlled trials (RCTs) comparing TP-GT to standard therapy. The protocol was prospectively registered on PROSPERO (CRD420251163043). The primary outcomes were 30-day and 90-day mortality. Secondary outcomes included intensive care unit length of stay (ICU LOS), hospital length of stay (HLOS), fluid administration volumes, fluid balances and organ support requirements. The meta-analyses were performed using the random-effect model, and the risk of bias was assessed using the RoB2 tool. Eight RCTs were analyzed, comprising 2,394 patients. TP-GT did not significantly reduce either 30-day mortality (Risk Ratio [RR] 0.96; 95% CI 0.83-1.10;