Both the role and the importance of magnesium in clinical practice have grown considerably in recent years. Emerging evidence suggests an association between loss of magnesium homeostasis and increased mortality in the critical care setting. The underlying mechanism is still unclear, but an increasing number of in vivo and in vitro studies on magnesium’s immunomodulating capabilities may shed some light on the matter. This review aims to discuss the evidence behind magnesium homeostasis in critically ill patients, and its link with intensive care unit mortality via a likely magnesium-induced dysregulation of the immune response. The underlying pathogenetic mechanisms, and their implications for clinical outcomes, are discussed. The available evidence strongly supports the crucial role of magnesium in immune system regulation and inflammatory response. The loss of magnesium homeostasis has been associated with an elevated risk of bacterial infections, exacerbated sepsis progression, and detrimental effects on the cardiac, respiratory, neurological, and renal systems, ultimately leading to increased mortality. However, magnesium supplementation has been shown to be beneficial in these conditions, highlighting the importance of maintaining adequate magnesium levels in the intensive care setting.

Background: Optimal pain control with limited muscle weakness is paramount for a swift initiation of physical therapy and early discharge. Fascia iliaca compartment block (FICB) has been recommended since it offers good pain control with a low risk of motor block. Pericapsular nerve group (PENG) block with lateral femoral cutaneous block (LFCN) has been proposed as an effective alternative to FICB that offers better pain control with a considerably lower risk of motor block. We aimed to compare the aforementioned blocks and determine which one yielded the lowest numeric rating scale (NRS) score. Methods: We designed a retrospective analysis of patients undergoing elective total hip arthroplasty. The primary outcome was the NRS score at 6, 12, and 24 hours. The secondary outcomes were total opioid consumption, time to first PRN opioid, and time to first postoperative ambulation. Results: 52 patients were recruited, (13 PENG plus LFCN, 39 FICB). PENG plus LCFN resulted in a lower NRS at all three-time points (mean difference and 95%CI at 6 h 0.378 [-0.483; 1.240], at 12 h 0.336 [-0.378; 1.050], and at 24 h 0.464 [0.013; 0.914] P = 0.02). Moreover, less PRN opioids were requested in the PENG plus LCFN vs. FICB group (0 [0;7.5] vs 60 [15;80] milligrams of morphine equivalents, P = 0.001). No delay in the first ambulation or initiation of physical rehabilitation was reported in either group. Conclusions: PENG plus LCFN seems to offer better pain control and lead to less PRN opioids. Neither block hindered physical therapy nor ambulation. These results need to be confirmed with a larger prospective and randomized study.

Background: Total hip arthroplasty (THA) improves the quality of life by alleviating pain and restoring function. The optimal pain control with minimal muscle weakness is paramount for early rehabilitation and for reducing complications. Although PROSPECT and ICAROS guidelines recommend the Fascia Iliaca Compartment Block (FICB), it is associated with insufficient pain relief and a prolonged quadriceps motor block. The association of the PENG (Pericapsular Nerve Group) with LFCN (lateral femoral cutaneous nerve) blocks may address these limitations, provide improved motor-sparing pain control, and offer a more tailored approach that enhances both an early postoperative recovery and patient satisfaction. Methods: A randomized controlled trial (November 2023–July 2024) compared the PENG + LFCN to the FICB in patients undergoing elective THAs under spinal anesthesia. The primary outcome was quadriceps weakness at 6 h post-block. Secondary outcomes included the degree of hip flexion and pain scores at 6, 24, and 48 h post-block, opioid consumption, and time to ambulation. Results: Fifty-eight patients were randomized (twenty-nine per group). The PENG + LFCN group achieved a significantly greater muscle strength (MRC: 4 [4; 4] vs. 3 [3; 4], p < 0.0001) and better hip flexion at all measured moments (6 h: 45° [37; 60] vs. 30° [25; 43], 24h: 59° [49; 66] vs. 47° [36; 50], 48 h: 62° [55; 70] vs. 50° [40; 55], all p < 0.0001). Resting pain was lower in the PENG + LFCN group (0 [0; 1], 0 [0; 2], and 0 [0; 1] vs. 2 [0; 3], 1 [0; 3], 1 [0; 3]), as was the dynamic pain during movement (1 [0; 2], 2 [2; 4], and 2 [1; 2] vs. 3 [2; 5], 3 [2; 4], and 3 [1; 3]; all p < 0.001), along with a lower total opioid consumption (0 [0; 0] vs. 7.5 [7.5; 22.5] MME, p < 0.001). Conclusions: The PENG + LFCN block outperformed the FICB in muscle strength, hip flexion, pain control, and opioid use, suggesting it may be a more effective option for THAs.

Critically ill patients receiving continuous renal replacement therapy (CRRT) face distinct nutritional challenges requiring specialized parenteral nutrition (PN) strategies. This review synthesizes current evidence with clinical expertise to provide a comprehensive nutritional framework for this population. Key findings reveal that CRRT significantly impacts nutrient homeostasis through daily losses of amino acids (14–22 g), water-soluble vitamins, and trace elements via the extracorporeal circuit. Results from observational studies demonstrate that higher protein targets (1.8–2.5 g/kg/day) are necessary to achieve positive nitrogen balance, while energy prescriptions must subtract “hidden” calories from citrate anticoagulation (3–4 kcal/mmol) and propofol (1.1 kcal/mL). Clinical outcome data, though primarily observational, indicate that achieving nutritional adequacy correlates with reduced ICU stays (average reduction 2.1–3.4 days), shorter mechanical ventilation duration, and improved functional recovery. Evidence supports that early PN prescription when indicated, coupled with systematic consideration of therapy modality, extracorporeal losses, oral intake capacity, and mobilization status, optimizes nutritional support. We conclude that successful implementation requires: (1) dynamic adjustment based on CRRT parameters, (2) integration with enteral nutrition when feasible, (3) regular metabolic monitoring, (4) multidisciplinary collaboration, and (5) structured protocols. Future research using point-of-care analysis and AI-driven support systems is needed to establish evidence-based guidelines in this specialized population.

Background: Emergency Front Of Neck Access techniques are an essential skill for anesthesiologists, enabling them to effectively manage the critical “can’t intubate, can’t oxygenate” scenarios. Current literature suggests minimal improvement in mortality associated with these scenarios due to their rarity and difficulty in providing adequate training. This study aims to evaluate whether high-fidelity training can outperform low-fidelity training in teaching Emergency Front Of Neck Access. Methods: We designed a prospective, single-blinded observational trial to assess the presumed superiority of high-fidelity training compared to low-fidelity training in teaching Emergency Front Of Neck Access to our anesthesiology department. The Performance Rating Scale (PRS) was the tool we employed to assess the participants’ performance during both scenarios. The primary outcome was the difference in PRS between the high- and low-fidelity training groups. The secondary outcomes were the correlation between PRS scores and the participants’ past clinical experience with Emergency Front Of Neck Access, the number of tracheostomies performed, and years of clinical service. Results: A total of 30 participants from our anesthesia department were enrolled. There was a statistically significant difference in Performance Rating Scale scores between high-fidelity and low-fidelity training. The low-fidelity group had a median score of 7 (range -7 to 9), while the high-fidelity group had a median score of -3 (range -11 to 11). None of the secondary outcomes reached statistical significance. Conclusions: Our findings suggest that the benefits of high-fidelity training may justify the additional costs associated with incorporating it into conventional airway management training.