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.

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.

Castleman disease (CD) is a rare lymphoproliferative disorder, with non‐specific clinical manifestations, often delayed diagnosis and treatment, which pose a significant challenge in the present times. Patients diagnosed with this disease have poor prognosis due to the limited treatment options. Multicentric CD occurs at multiple lymph node stations and is associated with a proinflammatory response that leads to the development of the so‐called ‘B symptoms’. IL‐6 seems to be a key cytokine involved in various manifestations such as lymphadenopathies, hepatosplenomegaly, and polyclonal hypergammaglobulinemia. Its levels correlate with the activity of the disease. Other consequences of MCD include increased fibrinogen levels leading to deep vein thrombosis and thromboembolic disorders, high hepcidin levels causing anaemia, elevated VEGF levels promoting angiogenesis and vascular permeability, which, along with hypoalbuminemia, induce oedema, ascites, pleural and pericardial effusions, and in severe cases, generalized anasarca. In extreme cases multiple organ failure can occur, often resulting in death. We propose the use of continuous renal replacement therapy (CRRT) in managing severe multicentric CD. Our arguments are based on the principles that CRRT is able to remove IL‐6 from circulation thus attenuating the cytokine storm, can influence hepcidin levels, and reduction in oedema, and is often used in multiple organ failure to regain homeostasis control. Therefore, it could be used as a therapy or bridge therapy in severe cases. To sustain our hypothesis with evidence, we have gathered several studies from the literature confirming the successful removal of cytokines, especially IL‐6 from circulation, which can be used as a starting point.

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.