Radosław Owczuk

Objectives: To determine the incidence of a significant noninvasive brachial-to-radial arterial pressure gradient (NIBR-APG) and its clinical associations in critically ill patients receiving vasoactive agents. Design: Prospective, multicenter, observational study. Setting: Thirteen ICUs in Poland. Patients: Adult ICU patients with radial arterial catheters receiving vasoactive agents hospitalized between April 2025 and July 2025. Interventions: None. Measurements and Main Results: Invasive radial mean arterial pressure (MAP) and noninvasive brachial MAP were measured twice and averaged. A NIBR-APG greater than 11 mm Hg was predefined as clinically significant. Baseline characteristics, hemodynamic variables, and outcomes were recorded. Among 303 patients, 49.5% were surgical admissions and 33.3% had septic shock. The median NIBR-APG was 4.5 mm Hg (interquartile range, 0.0–10.0 mm Hg). Fifty-six patients (18.4%) exhibited a NIBR-APG greater than 11 mm Hg. Compared with patients without a significant gradient, these patients received higher norepinephrine-equivalent doses (0.23 vs. 0.10 µg/kg/min), had higher Sequential Organ Failure Assessment scores (11 vs. 10), prolonged capillary refill time (3.0 vs. 2.5 s), and higher lactate concentrations (2.7 vs. 1.3 mmol/L). In multivariable analysis, only vasoactive drug dose was independently associated with NIBR-APG greater than 11 mm Hg (odds ratio, 1.68; 95% CI, 1.12–2.52). ICU mortality was higher in patients with significant gradients (48.0% vs. 30.1%). Conclusions: Nearly one in five critically ill patients receiving vasoactive agents demonstrated a clinically significant NIBR-APG. The presence of this gradient was independently associated with higher vasoactive drug requirements and was accompanied by greater illness severity and higher ICU mortality.

The autonomic regulation of cardiac function influences cardiac repolarization, the prolongation of which is associated with life-threatening arrhythmias. This effect can be modified by the pharmacological disruption of conduction in autonomic peripheral nerves. The aim of this study was to determine the influence of thoracic paravertebral blockade (PVB) on the QT interval and transmural dispersion of repolarization (TDR) depending on the side of the block. Sixty females scheduled for unilateral breast surgery were allocated to the study groups according to the site of the operation and underwent PVB at the T3 level with 0.5% ropivacaine. A 12-lead ECG was recorded before the blockade and after confirmation of the block area covering the T1-T4 dermatomes (6–11 min). QT, the corrected QT (QTc), Tp-e (as TDR marker) and Tp-e/QT ratio were analyzed. In the right group significant prolongation of the QT and QTc according to the Fridericia and Framingham formulas was observed, along with significant decreases in heart rate and blood pressure. In the left group no significant repolarization or hemodynamic changes occurred. No significant changes in Tp-e or Tp-e/QT ratio were observed in either group. Due to the short observation period, further studies are needed to fully describe the PVB effect.

These guidelines provide evidence-based recommendations for central venous cannulation in critically ill patients in the intensive care unit. The document was developed by the Working Group of the Polish Society of Anaesthesiology and Intensive Therapy (Polskie Towarzystwo Anestezjologii i Intensywnej Terapii – PTAiIT) based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology, which encompasses systematic reviews of the literature, meta-analyses, and – in the absence of sufficient data – expert consensus. These guidelines aim to standardise the approach to central venous cannulation, increase the effectiveness of procedures, and minimise the risk of complications. The guidelines address pre-procedural ultrasound assessment, selection of the optimal vascular access site, comparison of ultrasound-guided versus landmark cannulation at different access sites, confirmation of catheter position after cannulation, and the role of positional manoeuvres.

Background: The Endothelial Activation and Stress Index (EASIX) is a biomarker initially developed to predict survival in patients with acute graft-versus-host disease after allogeneic haemato-poietic stem cell transplantation and is regarded as a surrogate of endothelial dysfunction. This study aimed to evaluate whether EASIX reflects early hemodynamic instability and vasopressor requirement in critically ill patients. Methods: We retrospectively analysed 447 patients admitted to the intensive care unit (ICU) at the University Clinical Centre in Gdańsk. Illness severity scores—including the Simplified Acute Physiology Score II (SAPS II), Acute Physiology and Chronic Health Evaluation II (APACHE II), and Sequential Organ Failure Assessment (SOFA)—and laboratory parameters, were collected at admission. EASIX, simplified EASIX (sEASIX), and modified EASIX (mEASIX) were calculated using established formulas. Vasopressor requirements, ex-pressed as norepinephrine equivalents (NEE), were recorded during the first 72 h. Statistical analyses included Spearman’s correlation, logistic regression, and receiver operating characteristic curve analysis. Results: In univariate analysis, EASIX was associated with ICU mortality (OR 1.333; 95% CI 1.135–1.576), but this association was not significant after adjustment. EASIX positively correlated with vasopressor requirements, severity scores (SOFA, SAPS II, APACHE II), and inflammatory and metabolic markers (PCT, CRP, lactate). It correlated with norepinephrine-equivalent doses within the first 48 h and moderately discriminated high-dose vaso-pressor use (>0.1 µg/kg/min). A weak negative correlation with ICU length of stay was observed. No association with age was found. Conclusions: EASIX is an age-independent marker associated with disease severity and early vaso-pressor burden in ICU patients. Rather than providing a direct measurement of endothelial function, it reflects a global signal of systemic stress and microvascular derangement and should be interpreted accordingly.

Critically ill patients often need continuous renal replacement therapy (CRRT). This process can remove particles as large as 10 kDa, including medications such as fondaparinux. In this study, we investigated whether patients who received prophylactic doses of fondaparinux and are treated with continuous veno-venous hemodiafiltration (CVVHDF) would achieve prophylactic levels of anti-Xa factor activity. In this observational study, we compared two groups of patients: 20 individuals who underwent CVVHDF and 20 individuals who did not undergo CVVHDF. Each patient received a prophylactic subcutaneous dose of 2.5 mg daily of fondaparinux. Anti-Xa factor activity was measured on the third day of treatment with fondaparinux. Blood samples were collected at four time points: immediately before the administration of fondaparinux and then 3, 6, and 9 h later. Anti-Xa factor activity levels were below the recommended range in the control group and in most CVVHDF patients but significantly increased after fondaparinux administration. Interestingly, individuals who underwent CVVHDF had greater anti-Xa factor activity than control patients did at several time points. In critically ill patients treated with prophylactic fondaparinux, CVVHDF appears to have a statistically significant but small effect on Xa factor activity. However, the clinical significance of this finding is unknown. Clinical Trial Registration: The study was prospectively registered at ClinialTrials.gov (NCT04671160).

Background: While sentinel lymph node (SLN) biopsy has been integrated into international guidelines for endometrial cancer, a standardized technique is still lacking. This study addresses whether the concurrent use of two tracers, technetium-99 (Tc) and indocyanine green (ICG), administered intracervically through distinct techniques, enhances the performance of SLN biopsies. As the blue dye is used routinely by some centers, it can be used alone; however, our analysis focused on only Tc and ICG (as is used in the majority of centers). Methods: A prospective multicentric observational study was designed to evaluate the unilateral detection rate, bilateral detection rates, sensitivity, and consistency of SLNs when using both tracers simultaneously in patients with early-stage endometrial cancer. Results: Our findings demonstrated that the simultaneous use of ICG and Tc significantly outperformed the use of either tracer alone. Unilateral detection rates were 69.2% for Tc, 84.9% for ICG, and 88.4% for both. Bilateral detection rates were 57.0% for Tc, 77.9% for ICG, and 83.6% for both. Additionally, the incidence of “empty pockets” was low with both tracers, at 2.7%. Notably, the concurrent application of both tracers identified instances where the Tc-labeled sentinel node differed from the ICG-labeled sentinel node. Conclusions: The combined use of Tc and ICG in SLN biopsy for early-stage endometrial cancer significantly enhances detection rates and reduces the occurrence of “empty pockets”, potentially decreasing the need for site-specific lymphadenectomy.

Background: This study evaluates the impact of pre-existing comorbidities and in-hospital complications on COVID-19 mortality rates. Methods: A retrospective single-center study was conducted using electronic health records from 640 COVID-19 patients hospitalized at the University Clinical Centre in Gdansk, Poland, between November 2020 and May 2021. Patients were categorized based on disease severity into stable or ICU wards based on the disease severity. Data on demographics, comorbidities, complications, and treatments were collected and verified. Statistical analyses, including odds ratios (ORs) and confidence intervals (CIs), assessed mortality risk factors supported by python-based processing. Results: The mean patient age was 67 years (SD ± 15.89), comprising 39% females (n = 250) and 60.94% males (n = 390). Mortality risk was highest in patients aged 65 years and older (OR 3.00; 95% CI, 1.97–4.60). Among the pre-existing comorbidities, chronic kidney disease (OR 3.28; 95% CI, 2.12–5.09), atrial fibrillation (OR 2.43; CI 95%, 1.63–3.61), and heart failure (OR 2.89; 95% CI, 1.91–4.37) were significant predictors of mortality. In hospital complications, such as severe respiratory failure requiring ICU ventilation (OR 23.59; 95% CI, 2.81–197.87), myocardial infarction (OR 25.43; 95% CI, 3.16–204.97), acute kidney injury requiring renal replacement therapy (OR 19.15; 95% CI, 6.49–56.51), sepsis (OR 7.22, 95% CI, 3.77–13.84), stroke, further increased mortality risk. Conclusions: COVID-19 patients with pre-existing renal and cardiovascular conditions face a higher risk of fatal outcomes. Early diagnosis and intervention targeting these complications are vital to in reducing mortality. Further research is needed to reconcile disparities with existing literature. Keywords: COVID-19 complications SARS-CoV-2 comorbidity in-hospital mortality risk factors

Background: Critically ill patients frequently require continuous renal replacement therapy (CRRT). During CRRT, particles up to 10 kDa in size, such as enoxaparin, may be removed. The aim of this study was to determine if patients receiving prophylactic doses of enoxaparin and treated with continuous veno-venous hemodiafiltration (CVVHDF) reach prophylactic values of anti-Xa factor activity. Methods: In this observational trial, we compared two groups: 20 patients treated with CVVHDF and 20 patients not treated with CVVHDF. All of them received prophylactic doses of 40 mg of enoxaparin subcutaneously. Anti-Xa factor activity was determined on the third day of receiving a prophylactic dose of enoxaparin. The first blood sample was taken just before the administration of enoxaparin, and other samples were taken 3 h, 6 h, and 9 h after the administration of a prophylactic dose of enoxaparin. Results: At 3 and 6 h after administration of enoxaparin in both groups, we observed a significant increase in anti-Xa factor activity from baseline, with the peak after 3 h of administration. There were no significant differences in the numbers of patients who had anti-Xa factor activity within the prophylactic range between CVVHDF and control groups. Conclusion: CVVHDF has only a mild effect on the enoxaparin prophylactic effect measured by anti-Xa factor activity. Thus, it seems there is no need to increase the dose of enoxaparin for patients requiring CVVHDF.

Dexmedetomidine, a central α-2 agonist, is used for procedural sedation and for conscious sedation influences on heart rate and blood pressure. Authors verified whether it is possible to predict bradycardia and hypotension with the use of heart rate variability (HRV) analysis for an autonomic nervous system (ANS) activity assessment. The study included adult patients of both sexes with an ASA score of I or II scheduled for ophthalmic surgery to be performed under sedation. The loading dose of dexmedetomidine was followed by a 15 min infusion of the maintenance dose. The frequency domain heart rate variability parameters from the 5-min Holter electrocardiogram recordings before dexmedetomidine administration were used for the analysis. The statistical analysis also included pre-drug heart rate and blood pressure as well as patient age and sex. The data from 62 patients were analysed. There was no relationship between the decrease in heart rate (42% of cases) and initial HRV parameters, haemodynamic parameters or sex and age of patients. In multivariate analysis, the only risk factor for a decrease in mean arterial pressure (MAP) > 15% from the pre-drug value (39% of cases) was the systolic blood pressure before dexmedetomidine administration as well as for a >15% decrease in MAP sustained at more than one consecutive time point (27% of cases). The initial condition of the ANS did not correlate with the incidence of bradycardia or hypotension; HRV analysis was not helpful in predicting the abovementioned side effects of dexmedetomidine.