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Purpose Although the definition of septic shock has been standardized, some variation in mortality rates among clinical trials is expected. Insights into the sources of heterogeneity may influence the design and interpretation of septic shock studies. We set out to identify inclusion criteria and baseline characteristics associated with between-trial differences in control group mortality rates. Methods We conducted a systematic review of RCTs published between 2006 and 2018 that included patients with septic shock. The percentage of variance in control-group mortality attributable to study heterogeneity rather than chance was measured by I.sup.2. The association between control-group mortality and population characteristics was estimated using linear mixed models and a recursive partitioning algorithm. Results Sixty-five septic shock RCTs were included. Overall control-group mortality was 38.6%, with significant heterogeneity (I.sup.2 = 93%, P < 0.0001) and a 95% prediction interval of 13.5-71.7%. The mean mortality rate did not differ between trials with different definitions of hypotension, infection or vasopressor or mechanical ventilation inclusion criteria. Population characteristics univariately associated with mortality rates were mean Sequential Organ Failure Assessment score (standardized regression coefficient ([beta]) = 0.57, P = 0.007), mean serum creatinine ([beta] = 0.48, P = 0.007), the proportion of patients on mechanical ventilation ([beta] = 0.61, P < 0.001), and the proportion with vasopressors ([beta] = 0.57, P = 0.002). Combinations of population characteristics selected with a linear model and recursive partitioning explained 41 and 42%, respectively, of the heterogeneity in mortality rates. Conclusions Among 65 septic shock trials, there was a clinically relevant amount of heterogeneity in control group mortality rates which was explained only partly by differences in inclusion criteria and reported baseline characteristics., Author(s): Harm-Jan de Grooth [sup.1] [sup.2], Jonne Postema [sup.2], Stephan A. Loer [sup.2], Jean-Jacques Parienti [sup.3] [sup.4], Heleen M. Oudemans-van Straaten [sup.1], Armand R. Girbes [sup.1] Author Affiliations: (1) 0000 [...]

Background and Objectives: The evolving surgical techniques in thoracoscopic surgery necessitate the exploration of anesthesiological techniques. This study aimed to investigate whether incorporating a continuous erector spinae plane (ESP) block into a multimodal analgesia regimen is non-inferior to continuous thoracic epidural analgesia (TEA) in terms of quality of postoperative recovery for patients undergoing elective unilateral video-assisted thoracoscopic surgery., Methods: We conducted a multicenter, prospective, randomized, open-label non-inferiority trial between July 2020 and December 2022. Ninety patients were randomly assigned to receive either continuous ESP block or TEA. The primary outcome parameter was the Quality of Recovery-15 (QoR-15) score, measured before surgery as a baseline and on postoperative days 0, 1, and 2. Secondary outcome parameters included pain scores, length of hospital stay, morphine consumption, nausea and vomiting, itching, speed of mobilization, and urinary catheterization., Results: Analysis of the primary outcome showed a mean QoR-15 difference between the groups ESP block versus TEA of 1 (95% CI -9 to -12, p=0.79) on day 0, -1 (95% CI -11 to -8, p=0.81) on day 1 and -2 (95% CI -14 to -11, p=0.79) on day 2., Conclusions: The continuous ESP block is non-inferior to TEA in video-assisted thoracoscopic surgery., Trial Registration Number: Dutch Trial Register (NL6433)., Competing Interests: Competing interests: AB is a clinical consultant for Philips Research (Eindhoven, the Netherlands) since January 2016. JSHAK received a grant from Werfen BV for unrelated research. The other authors declare no potential conflict of interest., (© American Society of Regional Anesthesia & Pain Medicine 2024. No commercial re-use. See rights and permissions. Published by BMJ.)