Editorial: Insights in Intensive Care Medicine and Anesthesiology: 2022 Provisionally Accepted

Ata M. Kaynar^{1, 2*}

• ¹School of Medicine, University of Pittsburgh, United States
• ²University of Pittsburgh, United States

In a clinical trial, Part et al (Pressure Changes in the Endotracheal Tube Cuff in Otorhinolaryngologic Surgery: A Prospective Observational Study) studied the endotracheal cuff inflation pressures as the pressure is critical for effective mechanical ventilation, while higher pressures could lead to mucosal ischemia. In a single-center observational study, alterations in cuff pressure outside the appropriate range occurred in 96.0% of patients and 34.2% demonstrated inadequate endotracheal tube cuff pressure for more than 20% of the total anesthesia time. The highest rate for inappropriate cuff pressures were observed in patients undergoing head and neck surgery with possible causative factors including positional changes, surgical procedure, anatomical manipulation, and anesthetic procedure.In a review, Carsetti et al (Anesthetic management of patients with sepsis/septic shock) studied the management of sepsis during the anesthetic phase. While the intra-operative period is much shorter as compared to the length of the hospital stay for a septic patient, the intra-operative period is one of the hemodynamically most tumultuous periods increasing the risk for inappropriate end-organ perfusion and subsequent injury. Their review is a succinct guide for practicing anesthesiologists.In a review, Litvinova et al (Patent landscape review of non-invasive medical sensors for continuous monitoring of blood pressure and their validation in critical care practice) explored the increasing number of technologies on continuous non-invasive monitoring of blood pressure. Such novel technologies will change the practice of hemodynamic monitoring leading to less common use of invasive arterial catheterization akin to the decreased utilization of pulmonary artery catheters.In a clinical trial, Gao et al (Effects of opioid-free propofol or remimazolam balanced anesthesia on hypoxemia incidence in patients with obesity during gastrointestinal endoscopy: a prospective, randomized clinical trial) compared propofol plus esketamine vs. remimazolam plus esketamine opioid-free balanced anesthesia on the incidence and severity of hypoxemia among obese patients undergoing gastrointestinal endoscopy. This particular group has a higher risk of intra-operative hypoxemia with associated morbidity and mortality. Among 264 patients in this trial, the incidence of severe hypoxemia in the remimazolam group was significantly lower than the propofol group. The time to recovery from anesthesia was also faster in the remimazolam group suggesting a new option for a safer anesthetic plan.In a systematic review, Molla et al (Magnitude of pediatric mortality and determinant factors in intensive care units of a low-resource country, Ethiopia: A systematic review and metaanalysis) studied pediatric ICU mortality in Ethiopia as compared to higher income countries. Multiple reports suggest an approximately 50% decrease in in-hospital mortality among critically ill children in the US and Europe in the past 20 years to around 2-4% mainly due to centralization and a dedicated transport system, changes in admission criteria to allow less severe cases in ICUs and changes in end-of-life care to support dying at home rather than in hospitals (doi.org/10.1097/01.ccm.0000528115.33510.1b) and (doi.org/10.1371/journal.pone.0265792). Similarly, in Korea, the mortality rates are also around 4.4% (doi.org/10.3346/jkms.2023.38.e178) However, the mortality rates in Ethiopia were around 28.5% with risk predictors including the use of mechanical ventilator, Glasgow coma scale <8, presence of comorbidities, and use of inotropes. This work was highlighting the gap in health care in different parts of the world giving researchers and clinicians an opportunity to act upon. Similar to the work by Molla et al, Endeshaw et al (Survival status and predictors of mortality among patients admitted to surgical intensive care units of Addis Ababa governmental hospitals, Ethiopia: A multicenter retrospective cohort study.) studied in a retrospective trial the ICU mortality in Ethiopia. The overall ICU mortality among 378 patients over a 5 day course was staggering 44.97% with an incidence rate of 5.9 cases per 100 person-day observation. Trauma, Glasgow coma score <9, readmission to the SICU, mechanical ventilation, and creatinine level were found to be significantly associated with mortality in the SICU. Both above studies underline the great disparities in between low and income countries as compared to others in terms of ICU outcomes stressing the importance of defining the epidemiology so that the scientific community can act upon towards improved outcomes.In a clinical trial, Rahimi-Bashar et al (Comparison the effects of spinal anesthesia, paracervical block and general anesthesia on pain, nausea, vomiting and analgesic requirements in diagnostic hysteroscopy: a non-randomized clinical trial study) compared the effects of spinal anesthesia to paracervical block and to general anesthesia, on pain, the frequency of nausea and vomiting and analgesic requirements in diagnostic hysteroscopy. The mean pain score during recovery and the need for analgesic injections was significantly higher in the general anesthesia group, however, no statistically significant difference was observed between the paracervical and spinal anesthetic groups. Despite reduced pain during recovery in patients receiving spinal anesthesia, duration of anesthesia, recovery period, and return of motor function were significantly prolonged compared to those receiving paracervical block or general anesthesia. BT≥37.5•C) as a continuous variable was associated with a 19% decrease in 28-day ICU mortality and with a 20% decrease in in-hospital mortality for each 1•C increase in body temperature. When temperature was used as a categorical variable, hypothermia was significantly associated with 28-day ICU mortality. Hypothermia had significantly increased mortality while hyperthermia had not.As you, the reader, can see, the 2022 collection is a sampling of work of our colleagues from all corners of the world and I would like to stress the importance of this platform to share knowledge among all to further science and health.