Dtsch Arztebl Int. 2026.

Epidural Analgesia in Labor: A Nationwide Evaluation of Utilization in Germany.

Lumbar epidural anesthesia (LEA) is considered the gold standard for the treatment of pain during vaginal delivery. Despite procedural advances and high maternal satisfaction in surveys, the extent of LEA utilization in Germany and its trend over time remain unclear.

Intensive Care Med. 2026.

Patient blood management in general intensive care patients.

Critically ill and high-risk perioperative patients requiring intensive care are often multimorbid and depend on rapid, highly specialized management. While most comorbidities are difficult to modify in the acute setting, anemia, particularly iron-defi ciency anemia, represents a potentially modifiable risk factor. Clinicians are also often confronted with complex alterations in hemostasis that require rapid assessment and targeted therapeutic interventions, including the optimal use of blood products. This narrative review summarizes the current evidence on Patient Blood Management strategies, including anemia management, the use of small-volume tubes, and the appropriate use of blood products in intensive care unit patients.

Curr Opin Anaesthesiol. 2026.

Advances in the understanding and management of hospital-acquired anemia.

Hospital-acquired anemia (HAA) is a common complication associated with adverse outcomes, including increased transfusion requirements and prolonged hospital length of stay. The precise etiology of HAA remains elusive, and preventive or therapeutic strategies are inconsistently applied or lacking altogether. This review summarizes current evidence on the incidence, underlying mechanism, clinical consequences, and available interventions for HAA.

BMC Med Inform Decis Mak. 2026.

Anaesthesia professionals' perspectives on ECG interpretation and arrhythmia situation awareness with Visual Patient Heart: a qualitative multicentre study.

The Visual Patient Avatar concept transforms conventional patient monitoring data into a dynamic, animated representation of the patient, enhancing situation awareness of vital signs and measurement status. Rapid recognition and response to cardiac pathologies are critical in anaesthesia and critical care. Visual Patient Heart (VPH) integrates cardiac data from the Philips "ST/AR algorithm", a feature in Philips patient monitors, into visual design elements inside the heart element of the Visual Patient Avatar, specifically aiming to improve situation awareness of arrhythmias and ST-segment deviations.

Front Med (Lausanne). 2026.

Monitoring unfractionated heparin in ECMO and cardiac surgery: the search for a valid reference standard.

Unfractionated heparin remains the standard anticoagulant during cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO). Despite decades of clinical use, however, no universally validated reference method exists for measuring biologically active unfractionated heparin in these settings. Conventional assays such as the activated clotting time and the activated partial thromboplastin time lack specificity and standardisation. Consequently, anti-factor Xa (anti-Xa) assays are increasingly recommended as alternative methods (or even reference methods). Nevertheless, their validity as a true reference standard in CPB and ECMO has never been formally established. This situation creates a methodological paradox: an assay with context-dependent limitations is used to calibrate and validate other imperfect tests. Anti-Xa assays differ substantially in design, particularly regarding the inclusion of dextran sulphate. Dextran sulphate was introduced to prevent neutralisation of heparin by platelet factor 4. However, platelet factor 4 release also occurs during extracorporeal circulation. Depending on assay configuration and clinical context, anti-Xa measurements may therefore overestimate or underestimate biologically active heparin-especially at low concentrations or following protamine reversal. As a result, anti-Xa assays cannot be assumed to be interchangeable in CPB and ECMO. We argue that heparin monitoring in extracorporeal circulation requires conceptual re-evaluation. Distinct clinical scenarios must be differentiated, and rigorous validation studies are essential before any assay can be regarded as a true reference standard.

Br J Anaesth. 2026.

Responsible use of large language models in manuscript authorship, peer review, and editorial processes: a Delphi consensus among editors-in-chief of anaesthesia and pain medicine journals (RULE-AP).

This article presents a Delphi consensus developed by a panel of editors-in-chief of anaesthesiology and pain medicine journals to guide the responsible use of large language models (LLMs) in academic publishing. LLMs offer potential benefits for scientific writing, including language editing, summarisation, translation, information organisation, and support for non-native English speakers, but their misuse raises concerns about accuracy, transparency, confidentiality, and research integrity. Through a three-round modified Delphi process involving 53 editors-in-chief or their delegates, 59 statements were generated and categorised into guidance for authors, editors, reviewers, and publishers with a particular attention to LLM disclosure practices and perceived risks. The consensus recognises that LLMs are useful tools in academic publishing for authors, reviewers, and editors. However, their use must be guided by ethics, legality, and principles of transparency and accountability. LLMs may assist with limited editorial and authorial tasks provided that their use is fully disclosed and all outputs are verified by humans. The consensus also emphasises the inappropriateness of using LLMs to generate original or ideative content, which should remain a strictly human responsibility. Moreover, LLMs must not generate data, references, conclusions, or entire manuscripts, nor be used for editorial decisions or peer-review reports. Editors expressed concerns about 'hallucinations', erosion of critical skills, confidentiality breaches, and the proliferation of low-quality LLM-generated manuscripts. The resulting guidance highlights transparency, human accountability, and careful verification as essential principles for integrating LLMs into scholarly workflows while preserving the integrity of scientific publishing.

Mil Med. 2026.

Military Patient Blood Management as a Critical Factor in Combat-Related Septic Reconstructive Surgery: A Case Report.

Patient Blood Management (PBM) is an evidence-based, multidisciplinary strategy that aims to optimize hemoglobin levels, to minimize perioperative blood loss, and to reduce avoidable transfusions. In military medicine, combat-related traumatic injuries (CRTI) pose specific challenges, as wounded soldiers frequently develop multifactorial anemia because of acute and chronic blood loss, inflammation, malnutrition, and delayed access to care. Although blood transfusions are a common treatment, they carry medical risks and represent a scarce, logistically demanding resource, especially in deployed or resource-limited settings. This case report illustrates the importance of early anemia screening, differentiation, and targeted treatment with a PBM framework in septic reconstructive surgery. A 32-year-old Ukrainian soldier was admitted to the Emergency Department of the Military Hospital Berlin, Germany. Eight months ago, the soldier sustained a blast injury with a femoral fracture and stabilization by external fixation in his home country. Diagnostic work-up detected chronic osteomyelitis and previously untreated iron deficiency. During ongoing surgical and antimicrobial treatment, the anemia progressed postoperatively but was successfully managed with intravenous and oral iron supplementation, without the need for blood transfusion. This case highlights the importance of structured anemia management in military surgery, even in young and otherwise healthy patients, to improve clinical outcomes while preserving limited resources. This aspect is of relevance during large-scale combat operations with high numbers of casualties. In this context, anemia management relies on the simple identification of underlying causes and correction of deficiencies in iron, vitamin B12, or folate when present, offering an effective and easily applicable strategy before resorting to blood transfusion.

Int J Emerg Med. 2026.

Time to intubate with an innovative intubation device: a dual-center randomized crossover non-inferiority simulation study.

BACKGROUND: Endotracheal intubation is a high-stakes intervention in emergency airway management, with patient safety closely linked to first-pass success and avoidance of repeated attempts. The Frankfurt Intubation Device (FID) is a bougie-inspired intubation device intended to provide fast protection against aspiration once positioned in the trachea. METHODS: This dual-center randomized crossover simulation study used an easy-to-intubate airway manikin. Ninety participants were divided into three groups of different experience (anesthesiologists, non-physician critical care staff, and medical students) to perform intubation with the Frankfurt Intubation Device (FID) and a standard endotracheal tube with stylet in randomized order. The primary outcome was non-inferiority of time to airway protection, measured from laryngoscope insertion to inflation of a cuffed device positioned in the trachea (T2; Δ = 5 s). Secondary outcomes included first-pass success, tooth damage, and exploratory assessment of training effects, with additional time-based outcomes assessed descriptively. RESULTS: Across all participants, the FID was non-inferior to the endotracheal tube with stylet for T2 (mean paired difference − 0.77 s, 95% CI − 2.50 to 0.97; non-inferiority margin 5 s). Exploratory analyses demonstrated consistent non-inferiority for T2 across experience groups (G1–G3) and randomization sequences. First-pass success was high in both arms (FID 96.7% vs. ET+stylet 94.4%), while tooth damage occurred less frequently with the FID (7.8% vs. 14.4%). Training effects were observed in the simulator. CONCLUSION: In this standardized simulation study using an easy-to-intubate airway manikin, the Frankfurt Intubation Device demonstrated non-inferiority to conventional endotracheal intubation with stylet for time to airway protection. Secondary findings support continued staged evaluation of the FID, particularly in more challenging airway scenarios and among users with limited airway experience, where differences in procedural performance may become more apparent. TRIAL REGISTRATION: Not applicable (simulation study).

Anaesthesiologie. 2026.

[Not Available].

Transfus Med Hemother. 2026.

Beyond Iron Deficiency: Unveiling the Prevalence of Folate and Vitamin B12 Deficiencies in Major Surgical Patients.

Preoperative anaemia is associated with increased morbidity and mortality in surgical patients. While iron deficiency is a well-recognized cause, the contribution of other nutritional deficiencies, such as folate and vitamin B12, remains underexplored. Therefore, this study aimed to assess the prevalence and role of folate and vitamin B12 deficiencies in preoperative anaemia among patients undergoing major surgery.

Arch Gynecol Obstet. 2026.

Short-term maternal outcomes after intraoperative administration of prophylactic oxytocin during cesarean sections: a retrospective cohort study with a comparison of different administration protocols.

The objective of this study was to evaluate the impact of different intraoperative prophylactic oxytocin regimens on maternal blood loss during cesarean section, and to compare effects in procedures performed before versus after onset of labor.

JMIR Form Res. 2026.

Using a Wearable-Based Animated Patient Avatar to Improve Patients' Perception of Vital Signs: Multicenter Computer-Based Study.

Visual patient avatars are an innovative patient monitoring technology that can be used to translate numerical and waveform data into intuitive, avatar-based representations of patient conditions. Previous research indicates that this technology improves health care providers' situational awareness compared to conventional monitoring methods. As patient-worn continuous vital sign monitoring continues to evolve, we introduce the Visual Patient Wearable device to provide avatar-based visualization tailored to this application.

J Cardiovasc Dev Dis. 2026.

Clinical Characteristics and Outcomes of 1894 Women with Peripartum Cardiomyopathy Treated with and Without Levosimendan in Germany.

Peripartum cardiomyopathy (PPCM) is a rare form of heart failure occurring during the last month of pregnancy or within five months postpartum. While levosimendan is considered beneficial in heart failure and cardiogenic shock, evidence supporting its use in PPCM is limited. This study investigated the prevalence of PPCM in Germany and evaluated outcomes associated with levosimendan use.

BJA Open. 2026.

Interventions for iron deficiency with or without anaemia in visceral surgery: recommendations for future research.

J Clin Med. 2026.

Who Needs Most? Multicenter Subanalysis of Blood Transfusion Profiles in the German Patient Blood Management Network Registry.

: Blood transfusion practices have evolved significantly in order to enhance patient care. The optimal strategies for administering red blood cell (RBC) transfusions is becoming rather clear; however, a comprehensive understanding of patients requiring transfusions of other blood components remains inadequate, leading to variability in clinical practice and outcomes. Here we examine surgical patients that could benefit from perioperative risk stratification. : We analyzed subgroups of a prospective, multicenter follow-up study and identified three distinct transfusion profiles across surgical disciplines: low (n = 1,035,588, 92.0%), moderate (n = 81,243, 7.2%), and high (n = 8413, 0.7%). These profiles are characterized by varying requirements for RBC, plasma, and platelet units. : While most patients were clustered in the low transfusion profile, blood component use only increased significantly in the high transfusion profile. Notably, patients in the high transfusion profile benefited from Patient Blood Management (PBM) interventions with a reduction of the predefined composite endpoint of in-hospital mortality and postoperative complications (ischemic stroke, myocardial infarction, pneumonia, sepsis and acute renal failure with renal replacement therapy) from 28.2% to 26.0% and an OR of 0.90 (95% CI 0.80-1.00, = 0.048) compared to the moderate transfusion profile. Conversely, the low transfusion profile encompassed patients with minimal transfusion needs, presenting opportunities to refine resource allocation and risk stratification. : These findings underscore the potential for improving patient outcomes and indicate that implementing targeted PBM interventions can reduce the risk of adverse events and mortality. This study advances the field by identifying specific transfusion profiles that can guide future research and clinical practices towards more personalized and efficient blood management in perioperative care.