Graphene-based nanomaterials (GBNs) have emerged as promising candidates for diverse biomedical applications, but their clinical translation has been hindered by inherent cytotoxicity. We synthesized three distinct cerium-containing graphene nanocomposites using a single-step, in situ electrochemical exfoliation process and investigated their structure-activity relationships in normal dermal fibroblasts (BJ) and hepatocarcinoma cells (HepG2). The properties of the resulting nanocomposites, including their morphology, cerium loading, and the surface redox state (Ce3+/Ce4+ ratio) were directly dictated by the employed synthesis parameters, such as the cerium salt precursor and its concentration. These distinct materials induced differential cellular responses that ranged from preferential cytotoxicity in HepG2 cells to a significant cytostimulatory effect and increased ATP levels in BJ fibroblasts, particularly in EXF3-treated cells. Our findings indicate that by employing the in situ electrochemical exfoliation method, the hybrid graphene compounds might be further tailored for specific purposes, moving the narrative beyond the mere functionalization of the graphene in order to achieve biocompatibility.

Background and Objectives: Many burn patients are initially admitted to non-burn center intensive care units (ICUs) due to resource constraints, geographic barriers, or delayed transfer. Their management requires multidisciplinary, phase-specific clinical and assistive practices, yet outcomes from non-specialized centers remain scarce. This study aimed to (1) determine six-month survival among all adult burn patients initially admitted to a non-burn center ICU, (2) identify clinical predictors of mortality, and (3) explore reasons for transfer to burn centers within a resource-limited healthcare setting. Materials and Methods: We conducted a retrospective observational cohort study including 42 adult burn patients initially admitted to the ICU of a regional non-burn hospital in Romania (2019-2024). Of these, 24 were treated entirely in the non-burn center (initially treated in the ICU and then further managed on the same hospital's wards), and 18 were, after initial ICU stabilization, subsequently transferred to burn centers. Six-month survival was assessed using Kaplan-Meier analysis. Logistic regression and Cox proportional hazards models were used to assess associations with mortality. Clinical trajectories and transfer decisions were also analyzed. Results: Six-month survival was 61.9% (95% CI 48.8-78.5), with most deaths occurring within 60 days. Total body surface area (TBSA) (HR 1.05, 95% CI 1.02-1.08, p < 0.001) and acute kidney injury (AKI) (HR 3.48, 95% CI 1.18-10.29, p = 0.024) were independently associated with mortality. Patients transferred to burn centers had greater TBSA (median 35% vs. 15%, p = 0.003), consistent with severity-driven referral decisions. Conclusions: Among all burn patients initially admitted to a non-burn center ICU, six-month survival was 62%, with TBSA and AKI independently associated with mortality in adjusted analyses. These findings underscore the importance of phase-specific, multidisciplinary care pathways, including early resuscitation, renal and hemodynamic monitoring, coordinated nursing care, rehabilitation planning, and transfer protocols to improve outcomes.

The increasing use of Technology-Critical Elements (TCEs) in modern technology has led to widespread environmental release, raising questions about their biological effects, as emerging evidence suggests significant toxicity. We investigated the effects of three technology-critical elements, Indium oxide (In2O3), Lanthanum nitrate hexahydrate (La(NO3)3·6H2O) and Cerium(III) nitrate hexahydrate (Ce(NO3)3·6H2O), on human dermal fibroblasts (BJ) and hepatocarcinoma cells (HepG2), assessing their uptake, impact on viability, and induced cellular stress responses, quantified by markers of inflammation, oxidative stress, and membrane damage. Our results show a strong differential susceptibility: normal BJ fibroblasts proved vulnerable, whereas HepG2 cells were highly resistant. This divergence occurred despite substantial and comparable accumulation of all three TCEs in both cell lines, indicating that toxicity is uncoupled from the magnitude of the uptake. Mechanistically, the differential toxicity correlated strongly with opposing antioxidant responses. Additionally, low concentrations of cerium (III) nitrate (12.5–50 µg/mL) uniquely stimulated the proliferation of HepG2 cells (up to 129% of control). While these findings identify multiple mechanistic hazards regarding the potential of low-level technology-critical element exposure, they must be interpreted cautiously and warrant further investigation in more complex biological models.

Background/Objectives: The COVID-19 pandemic complicated the diagnosis of Ventilator-Associated Pneumonia (VAP), leading to empiric antibiotic overuse due to the difficulty in distinguishing viral progression from bacterial superinfection. However, it remains unclear whether COVID-19-associated VAP displays a distinct antimicrobial resistance profile compared to classical VAP. Methods: This monocentric, retrospective cohort study primarily investigated differences in clinical phenotypes and antibiotic resistance profiles between patients with VAP-COVID (n = 26) and non-COVID-VAP (n = 26). Logistic regression was used to identify factors associated with the COVID-19 phenotype and predictors of antimicrobial resistance. As a secondary objective, we evaluated the diagnostic efficacy of a multiplex Point-of-Care PCR (POC-PCR) system (n = 22) compared to standard culture (n = 26) regarding turnaround time and resistance detection. Results: Patients with VAP-COVID exhibited significantly higher resistance rates to carbapenems (76.9% vs. 50%, p = 0.04) and fluoroquinolones (88.5% vs. 61.5%, p = 0.02) despite fewer traditional risk factors at admission. The clinical profile of the VAP-COVID group was distinguished by a significantly lower incidence of parapneumonic pleural effusion (19.2% vs. 84.6%, p < 0.001) and a higher median Neutrophil-to-Lymphocyte Ratio (41.36 vs. 9.63, p < 0.001). Regarding diagnostic speed, POC-PCR significantly reduced the time to result validation compared to standard culture (~1 h vs. ~62.5 h, p < 0.001). Conclusions: VAP in COVID-19 patients presents a distinct microbiological profile characterized by higher antimicrobial resistance. In this context, the integration of rapid molecular diagnostics may support earlier microbiological guidance compared to standard methods.

ABSTRACT Colonization by multidrug‐resistant organisms (MDROs) is a risk factor for infection and mortality in critically ill patients, yet current strategies to prevent or control dissemination show variable effectiveness. Whether alterations in microbiota structure and composition (dysbiosis) are associated with MDRO colonization in critically ill patients is an open question this study aims to address. We conducted the first systematic review and meta‐analysis comparing intestinal microbiota structure (diversity) and composition (relative abundance of bacteria) between colonized critically ill patients and noncolonized/control patients. PubMed, Web of Science, and Scopus were systematically searched from inception to September 2025. The study protocol was preregistered on Open Science Framework, under embargo. Of 3003 records identified, 11 studies (n = 2823 patients) published between 2019 and 2025 met the inclusion criteria. The most frequently reported colonizing strains in MDROs‐colonized patients were vancomycin‐resistant Enterococci (58.2%), carbapenem‐resistant Enterobacterales (21.6%), extended‐spectrum β‐lactamase–producing Enterobacterales (13.4%). All studies employed 16S ribosomal RNA sequencing to assess intestinal microbiota. Colonized critically ill patients had lower values of dominance/evenness and richness, reaching significantly lower values of information when compared with controls (mean difference in Shannon index = –1.18; 95% CI, –1.84 to –0.52; p < 0.001). Composition investigation revealed a significant increase in the Pseudomonadota phylum and the Enterobacteriaceae family in MDROs‐colonized patients. Current evidence is limited and largely associational. Nevertheless, altered intestinal microbiota consistently characterize colonized critically ill patients. Further studies are warranted to determine whether early detection of dysbiosis can enhance early prediction/diagnosis of MDROs‐colonization and guide the targeted microbiota‐based strategies to prevent infections.

Background/Objectives: Percutaneous dilatational tracheostomy (PDT) is a commonly performed procedure in critically ill patients. Various guidance techniques, including anatomical landmark-guided (ALG), ultrasound-guided (USG) and bronchoscopy-guided (BG), aim to enhance procedural safety and efficacy. This systematic review and meta-analysis aimed to compare the safety and efficacy across ALG, USG, and BG techniques in PDT, focusing on complications and procedure times. Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted. Studies identified through PubMed, CENTRAL, Scopus, and Web of Science databases up to July 2025 comparing ALG, USG, and BG PDT were included. Primary outcomes were minor and major bleeding, with transient hypoxia, transient hypotension, endotracheal tube cuff puncture, pneumothorax, and procedure time as secondary outcomes. Data were pooled using random-effects models, with risk ratios (RR) and 95% confidence intervals (CI) for complications and mean differences for procedure times. Heterogeneity was assessed using I2 statistics, with Bonferroni correction for multiple comparisons. Results: This meta-analysis included five RCTs (568 patients) comparing USG vs. ALG, six RCTs (404 patients) comparing USG vs. BG, and five RCTs (448 patients) comparing ALG vs. BG. USG significantly reduced minor bleeding compared to ALG (RR 2.30, 95% CI 1.38-3.84, p = 0.001) and BG (RR 0.42, 95% CI 0.20-0.91, p = 0.02), and major bleeding compared to ALG (RR 2.62, 95% CI 1.00-6.86, p = 0.04). ALG was associated with higher minor bleeding risk than BG (RR 1.81, 95% CI 1.05-3.12, p = 0.03). No significant differences were found for transient hypoxia, hypotension, endotracheal tube cuff puncture, or pneumothorax across comparisons, though trends suggested lower hypoxia risk with USG and higher pneumothorax risk with ALG. Procedure times were similar (ALG: 10.4 min, USG: 11.7 min, BG: 12.7 min; p = 0.493). Some rare complications, like paratracheal placement and mediastinitis, were too infrequent for analysis. Conclusions: USG PDT significantly reduces the risk of minor and major bleeding relative to ALG and minor bleeding compared to BG, without prolonging procedure time. USG and BG show comparable safety for most non-bleeding outcomes. No significant differences in procedure times. Future research should focus on larger RCTs to assess rare complications and explore hybrid USG-BG approaches to optimize PDT safety and efficacy.

Vancomycin is an antibiotic active against methicillin-resistant Staphylococcus aureus infection. It has a narrow therapeutic index, and the bacterial resistance is increasing which brings efficacy and safety concerns. To overcome these, it is recommended that therapeutic drug monitoring (TDM) to be performed, but it is still not implemented in Romania. This is a pilot study initiated by the clinical pharmacist in an intensive care unit to highlight the TDM benefits. The objective of the retrospective, open-label, single-centre study conducted in a Romanian hospital was to analyse the pharmacokinetics and pharmacodynamics of vancomycin using TDM, to compare the frequency of renal function impartment in patients with TDM versus patients without TDM and to evaluate the clinical pharmacist's role in managing ICU patients receiving vancomycin. In 62% of cases, the prescribed dose did not produce adequate serum concentrations, and TDM played a crucial role in managing these patients. A 34% reduction in the incidence of renal impairment was achieved through clinical pharmacist-led TDM for vancomycin. It is essential for Romanian hospitals to involve clinical pharmacists in the care of ICU patients and to implement TDM as a standard practice to improve care quality.

Background:Simulation based education and training (SBET) is an important part of formal medical education and training, with anesthesia and intensive care domains being among the first to use this teaching method. Implementation of SBET into anesthesia and intensive care training is included in the recommendations lists of the European Society of Anesthesia and Intensive Care, with Point of Care Ultrasound (POCUS) being on the list of procedures that residents should be trained in using SBET. Objectives:In this study the objective is to assess the clinical use of POCUS by trainees in Anesthesia and Intensive Care that finished a simulation program on a high-fidelity simulator. Methods:We developed a questionnaire comprised of seven sections that evaluates the use of POCUS in clinical practice related to airway, lung, cardiac ultrasound, the availability of POCUS, possible barriers that create limitations, as well as scoring and feedback regarding the simulation sessions and distributed it to trainees that finished the simulation sessions. Results:Over 90% of respondents declare using POCUS in their daily clinical practice, with more use of pulmonary evaluations than cardiac evaluations. Most of the responders declared good or very good knowledge and ability to diagnose most of the critical conditions described in the curriculum for lung and cardiac POCUS. Conclusions:Self-assessment methods may be used alongside traditional methods to offer a wider view on POCUS competency and maintenance of skills of trainees in anesthesia and intensive care.

Objective: The role of calcium in coagulation homeostasis is well established, although the relationship between calcium levels and postoperative bleeding in major cardiac surgery remains largely unexplored. Methods: This retrospective, single-center study investigated the correlations between ionized calcium levels measured at several timepoints: preoperatively (after induction of anesthesia), immediately after cardiopulmonary bypass (CPB) weaning, on the first postoperative day measured three times at 8 h intervals, preoperative vitamin D values, and several significant bleeding outcomes. These outcomes included the volume of blood in the drainage bag (measured in milliliters on days 1 and 2), the need for surgical or medical hemostasis, the requirement for blood transfusion (red blood cells, fresh frozen plasma, or platelets), and the occurrence of extracardiac hemorrhagic complications. A multivariable logistic regression analysis was performed, with a two-sided p-value of <0.00625 considered significant after applying Bonferroni correction. Results: The study included 83 patients with a mean age of 64.9 ± 8.5 years, with 49 (59%) being male. The most common procedures were aortic valve replacement (26 patients, 31%) and coronary artery bypass grafting (26 patients, 31%). The multivariable regression analysis demonstrated a trend toward an association between low levels of preoperative calcium and increased bleeding volume immediately after CBP and on the first day after the intervention (r = 0.30; p = 0.08 for day 1 and r = 0.24; p = 0.03 for day 2). Similar trends were observed for the association between low levels of preoperative calcium, use of medical hemostasis (r = 0.30; p = 0.009), and red blood cell transfusion (r = 0.24; p = 0.03). Additionally, we observed a trend towards a positive correlation between lower serum vitamin D levels and increased postoperative blood loss on both day 1 (r = 0.32; p = 0.07) and day 2 (r = 0.29; p = 0.04). The subgroup analysis of valve procedures vs. coronary procedures showed no statistically difference between preoperative ionized calcium levels, postoperative bleeding (289 27 vs. 283 mL, p = 0.87), the need for surgical hemostasis (p = 0.5), or blood transfusion requirement (p = 0.57). Conclusions: In our study, preoperative calcium levels were consistently associated with increased bleeding after major cardiac surgery. Post-CPB ionized calcium levels did not influence bleeding outcomes. The role of calcium in coagulation homeostasis during major cardiac surgery warrants further research, ideally with more robust data, as our study’s small sample limits robust evidence. Further larger studies will conclude on the importance of calcium levels in cardiac surgery related to hemostasis and bleeding outcomes. Lower preoperative ionized calcium and vitamin D levels showed exploratory associations with increased bleeding-related outcomes following major cardiac surgery. These findings are hypothesis-generating, and larger prospective studies are needed to confirm these potential relationships and clarify their clinical implications.

Background/Objectives: The aging population poses a significant challenge to global public health, impacting the physical, mental, and social health of older adults. Social activity has been widely acknowledged as a protective factor for both mental and physical well-being. Research indicates that consistent engagement in social activities can mitigate the risk of depression, prevent cognitive decline, and support physical functionality. This study aims to explore the correlations and associations between two variables related to social activity (self-reported activity level and time spent with friends) and various other variables among geriatric patients in Northern Romania. Methods: This cross-sectional, single-center observational study utilized data from 588 geriatric patients (402 females and 186 males) admitted to the Geriatrics ward of the Municipal Clinical Hospital. The dataset included variables such as sociodemographic information, Geriatric Depression Scale (GDS), Montreal Cognitive Assessment (MoCA), and SARC-F questionnaire scores, time spent with friends, and activity levels. Descriptive statistics were computed alongside statistical tests to examine group differences, associations, and predictive relationships. Results: The sample was characterized by variability in age, educational attainment, and pension levels. The statistical analyses revealed significant differences based on education, pension, and civil status. Patients with higher GDS and SARC-F scores had lower odds of spending time with friends or belonging to the active or extremely active groups. Notably, women reported higher GDS scores and lower activity levels compared to men. Conclusions: Understanding the factors that influence social activity among older adults is essential for designing targeted interventions aimed at preventing social isolation and fostering healthy aging across diverse demographic and environmental contexts.

Background/Objectives: Colorectal cancer (CRC) represents one of the most prevalent forms of cancer, with high mortality rates. The aim of this study was to observe and understand the metabolic changes in CRC through targeted metabolomics. Methods: Samples collected from 58 CRC patients and 35 healthy individuals have been analyzed by liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS), targeting two classes of metabolites: amino acids and acylcarnitines. Results: Statistical analysis revealed 26 significantly modified (p-value < 0.01; |FC| > 1.2) metabolites in CRC patients compared to the control group and 22 between colon cancer and control, whereas 8 metabolites differed only significantly between rectal cancer and healthy patients. Some of these significantly modified metabolites characterize cancer-specific adaptations, such as increased energy demand, increased tumor invasiveness, capabilities to promote amino acid synthesis, and tumor resistance against acute immune response. Moreover, receiver operator characteristic (ROC) analysis revealed that a set of two acylcarnitines (C6DC and C4-OH) can differentiate between CRC patients and healthy individuals with a high degree of confidence (AUC 0.837). Conclusions: By implementing a metabolomics approach targeting amino acids and acylcarnitines, several metabolic alterations induced by CRC have been highlighted. Even though these modifications are not specific enough to act as disease markers, they might prove useful for evaluating patient status.

Introduction: Linezolid is a reserve antibiotic used to treat infections caused by Gram-positive bacteria with resistance genes. In critically ill patients, high intra- and interindividual variability has been observed, prompting the search for alternative methods to reduce this variability and achieve the pharmacokinetic/pharmacodynamic indices necessary for a favorable efficacy–safety balance. Aim of the study: We wished to compare the safety and effectiveness of a continuous infusion (CI) versus an intermittent infusion (II) of linezolid in patients requiring intensive care. Materials and Methods: This study, registered under the number NCT05801484), was a prospective, open-label, single-center, two-arm study. Data on hematologic safety and effectiveness were collected and compared between patients receiving CI and II, respectively, at the same daily dose of linezolid (1200 mg). Results: Twenty-nine patients from the intensive care unit were included, divided into two groups. No statistically significant difference was found in 30-day mortality between the groups, nor in the likelihood of post-treatment culture negativity. However, a significantly greater reduction in C-reactive protein levels was observed in the CI group compared to the II group. Regarding safety, at CrCl < 60 mL/min, the decrease in platelets was statistically significant in group II but not in group CI. Additionally, at the 30-day follow-up, recovery from thrombocytopenia was better in the CI group. Conclusions: Continuous infusion of linezolid proved to be non-inferior to intermittent infusion at the same daily dose in terms of effectiveness. Furthermore, a lower risk of adverse reactions was identified with continuous infusion.

Background/objectives: Point-of-care ultrasound (POCUS) in the intensive care unit (ICU) has gained much attention in the last few years as an alternative to the classic ways of assessing and diagnosing life-threatening conditions in critical patients. During the COVID-19 pandemic, we proposed a POCUS protocol based on the airway, breathing, and circulation (ABC) approach to quickly evaluate and diagnose life-threatening diseases in critical patients with acute respiratory failure and shock, and later, we used it as a curriculum to teach POCUS to anesthesia and intensive care trainees. Methods: We developed an evaluation protocol where evaluators with experience in POCUS in critically ill patients had to assess the trainee’s ultrasound scan; this was based on the ABC protocol taught in the simulation laboratory and applied in a clinical setting at the bedside. Results: Statistically significant differences were observed in some categories evaluated regarding independence and diagnosis. Conclusion: Initial POCUS simulation-based training using an ABC POCUS protocol (that demonstrated good results in the simulation laboratory) is useful when transferring US skills to the bedside and is applicable in daily clinical practice with good results in terms of operator independence.

This study investigates the association between the Functional Health Pattern Assessment Screening Tool (FHPAST) and frailty in hospitalized geriatric patients. One hundred and forty patients (mean age 78.2 years, age range 65–90) were screened for frailty using the Frail Scale during hospitalization in the geriatric unit. Among them, 57 patients were identified as prefrail (40.7%), and 83 were identified as frail (59.3%). A comparative analysis between groups in terms of the FHPAST components covering health risk, general well-being, and health promotion was performed. Correlations between FHAPST components, socio-demographic data, frailty criteria, as well as logistic regression to identify variables that better predict frailty were also sought. Frailty was mainly associated with difficulty urinating, limitations in performing activities of daily living and walking, physical discomfort, less positive feelings in controlling one’s own life, lower compliance with recommendations from the healthcare provider, and engagement in seeking healthcare services. Patients with difficulty urinating and walking had a probability of 4.38 times (OR = 4.38, CI 95% [1.20–15.94]), p = 0.025) and 65.7 times (OR = 65.7, CI 95% [19.37–223.17], p < 0.001) higher of being frail rather than prefrail. The relationship between frailty and prefrailty in hospitalized geriatric patients and components of nursing Functional Health Patterns (FHP) has yet to be explored. This study provides evidence of the most prevalent needs of frail geriatric patients in hospital settings.

Outcome and predictors of early- and late-onset septic shock are still controversial. The aim of the study was to compare the relevant predictors of 28-day mortality in early- and late-onset septic shock and other non-septic critical illnesses.

Background: The perioperative impact of calcium and vitamin D on left ventricular (LV) performance during major cardiac surgery remains unexplored. We aimed to assess the relation of calcium and vitamin D measured at different time points with the LV ejection fraction (EF), and to investigate whether changes in EF correlate with postoperative outcomes. Methods: We enrolled 83 patients, in whom ionized calcium was measured before, during, and after surgery (until discharge), vitamin D preoperatively, and EF pre- and postoperatively at 24 h. The postoperative outcomes were cardiopulmonary bypass (CPB) time, aortic cross-clamp time, mechanical ventilation time, vasoactive inotropic score (VIS) (intraoperative, day 0, day 1), and ICU stay time. Results: The mean age was 64.9 ± 8.5 years, with 21 of the patients (25%) having an EF < 50%. The median change from preoperative to postoperative EF was −2.0 (−10.0–0.0) % (p < 0.001). At the baseline, the EF < 50% group had significantly lower preoperative vitamin D levels than the EF ≥ 50% group (p = 0.048). The calcium trend did not differ across the groups. Preoperative EF was significantly associated with CPB time (r = 0.22, p = 0.044) and aortic cross-clamp time (r = 0.24, p = 0.031). Postoperative EF was significantly and inversely associated with intraoperative VIS (r = −0.28, p = 0.009), VIS day 0 (r = −0.25, p = 0.020), VIS day 1 (r = −0.23, p = 0.036), and ICU length of stay (r = −0.22, p = 0.047). Finally, the change in ejection fraction was significantly and inversely associated with CPB time (r = −0.23, p = 0.037), aortic cross-clamp time (r = −0.22, p = 0.044), intraoperative VIS (r = −0.42, p < 0.001), VIS day 0 (r = −0.25, p = 0.024), mechanical ventilation time (r = −0.22, p = 0.047), and ICU length of stay (r = −0.23, p = 0.039). Conclusions: The fluctuations in perioperative ionized calcium levels were not associated with the evolution of LVEF, although preoperative vitamin D levels may affect those with low EF. Correspondingly, a reduced EF significantly impacted all the studied postoperative outcomes. Further investigation into biomarkers affecting cardiac inotropic function is warranted to better understand their significance.

Background: Linezolid has been found to have considerable interindividual variability, especially in critically ill patients, which can lead to suboptimal plasma concentration. To overcome this shortcoming, several solutions have been proposed. These include using loading dose, higher maintenance doses, and dose stratification according to the patient’s particularities, therapeutic drug monitoring, and drug administration via continuous infusion (CI) instead of intermittent infusion (II). In the present study, we aim to compare the pharmacokinetic (PK) parameters of linezolid after administration as II versus CI to critically ill patients. Methods: In a prospective study conducted in an intensive care unit, we compared the same two daily doses of linezolid administered via II versus CI. The serum concentration was measured, and pharmacokinetic parameters were calculated. The pharmacokinetic/pharmacodynamic (PK/PD) indices for efficacy chosen were area under the concentration–time curve at steady state divided by the minimum inhibitory concentration over 80 (AUC24–48/MIC > 80). Results: Greater serum concentration variability was observed in the II group than in the CI group. The %T > MIC > 80% was achieved for MICs of 1 and 2 µg/mL 100% of the time, whereas for the II group, this was 93% and 73%, respectively. AUC24–48/MIC > 80 was reached in 100% of cases in the CI group compared with 87% in the II group for a MIC of 1 µg/mL. Conclusions: The two infusion methods may be used comparably, but utilizing CI as an alternative to II may have potential benefits, including avoiding periods of suboptimal concentrations, which may enhance safety profiles and clinical outcomes. Considering the relatively few studies performed on linezolid to date, which are increasing in number, the results of the present study may be of interest.

The use of biomarkers in cardiovascular surgery is an evolving field with promising potential; however, current research remains largely limited, requiring further validation for routine clinical application. This review explores the application of biomarkers in cardiovascular surgery, focusing on heart failure, cardiac ischemia, and organ dysfunction, including renal, cerebral, pulmonary, and splanchnic impairments. Additionally, it examines the significance of biomarkers in assessing the inflammatory state and oxidative stress during the perioperative period, particularly in the context of major surgical trauma and cardiopulmonary bypass (CPB). From January 2018 to June 2024, we reviewed 133 studies and four systematic reviews and meta-analyses using the Medline, Embase, and Central databases, screening for pre- or postoperative biomarker levels in patients undergoing cardiac surgery. Outcomes of interest were postoperative mortality, nonfatal myocardial infarction, stroke, congestive heart failure, and major adverse cardiovascular events (MACEs). Studies reporting multivariable-adjusted risk estimates were included. The findings revealed that cardiac troponins (cTns) and creatine kinase isoenzyme MB (CK-MB) remain the most widely utilized biomarkers for assessing myocardial injury post-surgery. These elevated biomarker levels were consistently associated with an increased risk of postoperative complications, including low cardiac output syndrome, prolonged ventilation, and mortality. Emerging biomarkers, such as heart-type fatty acid-binding protein (h-FABP) and high-sensitivity C-reactive protein (hs-CRP), demonstrated promising early detection and risk stratification results. In particular, h-FABP increased rapidly within one hour of myocardial injury, peaking at 4–6 hours and returning to baseline within 24 hours. This rapid clearance makes h-FABP a valuable tool for early myocardial injury detection, potentially allowing for timely interventions. Inflammatory biomarkers, including hs-CRP and pentraxin 3 (PTX3), were found to be associated with poor outcomes, such as increased morbidity and mortality. Elevated preoperative levels of these markers were indicative of a heightened inflammatory response, correlating with worse postoperative recovery and higher rates of complications. Furthermore, the neutrophil-to-lymphocyte ratio (NLR) emerged as a cost-effective and easily accessible predictor of postoperative outcomes. Elevated NLR values were linked to an increased risk of adverse events, including prolonged ventilation, low cardiac output syndrome, and overall mortality. Further, the practicality of measuring NLR through routine blood tests makes it viable for widespread clinical use. In conclusion, integrating biomarkers in cardiovascular surgery significantly advances predicting postoperative outcomes for cardiac surgery patients. Therefore, it is essential to categorize these biomarkers into two distinct groups in the future, inflammatory and non-inflammatory (related to organ damage), to improve understanding and enhance their clinical applicability. Future research should focus on standardizing the use of these biomarkers and exploring their combined predictive power to enhance risk stratification and improve patient prognosis.

Background: Due to a lack of randomised controlled trials and guidelines, and only case reports being available in the literature, there is no consensus on how to approach anaesthetic management in patients with giant intraabdominal tumours. Methods: This study aimed to evaluate the literature and explore the current status of evidence, by undertaking an observational research design with a descriptive account of characteristics observed in a case series referring to patients with giant intraabdominal tumours who underwent anaesthesia. Results: Twenty patients diagnosed with giant intraabdominal tumours were included in the study, most of them women, with the overall pathology being ovarian-related and sarcomas. Most of the patients were unable to lie supine and assumed a lateral decubitus position. Pulmonary function tests, chest X-rays, and thoracoabdominal CT were the most often performed preoperative evaluation methods, with the overall findings that there was no atelectasis or pleural effusion present, but there was bilateral diaphragm elevation. The removal of the intraabdominal tumour was performed under general anaesthesia in all cases. Awake fiberoptic intubation or awake videolaryngoscopy was performed in five cases, while the rest were performed with general anaesthesia with rapid sequence induction. Only one patient was ventilated with pressure support ventilation while maintaining spontaneous ventilation, while the rest were ventilated with controlled ventilation. Hypoxemia was the most reported respiratory complication during surgery. In more than 50% of cases, there was hypotension present during surgery, especially after the induction of anaesthesia and after tumour removal, which required vasopressor support. Most cases involved blood loss with subsequent transfusion requirements. The removal of the tumor requires prolonged surgical and anaesthesia times. Fluid drainage from cystic tumour ranged from 15.7 L to 107 L, with a fluid extraction rate of 0.5–2.5 L/min, and there was no re-expansion pulmonary oedema reported. Following surgery, all the patients required intensive care unit admission. One patient died during hospitalization. Conclusions: This study contributes to the creation of a certain standard of care when dealing with patients presenting with giant intraabdominal tumour. More research is needed to define the proper way to administer anaesthesia and create practice guidelines.