Epidemiologic characteristics of 22,086 patients discharged from the Department of Orthopaedic Trauma at a military hospital between 2013 and 2022: a retrospective real-world study

BACKGROUND

To analyse the epidemiological characteristics of orthopaedic trauma patients and thereby optimize healthcare resource allocation and improve treatment efficiency.

MATERIALS AND METHODS

Relying on the hospital information system (HIS) database, we retrospectively analysed the epidemiological characteristics of orthopaedic trauma inpatients in our hospital between 2013 and 2022, including patient demographic information, causes of injury, location of injury and hospitalization costs.

RESULTS

The median age of the patients was 36 (26-47) years old; the age stratification of the patients was highest in the proportion of patients aged 40-50 years old (29.23%); hypertension was the most common among the patients' comorbidities (1.29%); patients' occupation was highest in heavy labourers such as farmers and workers, about 63.04% (n = 13923); patients' admissions were mainly in the form of emergencies (n = 16875, 76.41%); and patients' median hospitalization time was 7 (5, 12) days. The highest percentage of the cause of injury was due to exposure to inanimate mechanical forces (75.4%), followed by falls (16.14%) and traffic accidents (6.49%). The highest percentage of cause of injury in all age groups was due to inanimate mechanical force, and the percentage of patients with falls increased with age, and there was a positive correlation between age groups and the percentage of patients with falls (r = 0.964, p < 0.01). The highest percentage of patients with injuries to the upper extremities was about 74%. The distribution of injury sites in all age groups was highest in the upper extremities. Age was positively correlated with trunk injuries (r = 0.469, p = 0.203). The median hospitalization cost for patients over a 10-year period was approximately $1,100.

CONCLUSIONS

By analysing the epidemiological characteristics of patients, a general profile of local orthopaedic trauma patients was established, which can help in the development of disease prevention and interventions.

Prevalence of acute kidney injury in Mexico; a systematic review and meta-analysis of pre-pandemic reports

BACKGROUND

Acute Kidney Injury (AKI) is a health problem worldwide, accounting for high hospital morbidity and mortality. There is little available information regarding the characteristics and incidence of AKI in Latin America (LA), especially in Mexico.

OBJECTIVES

Systematically search the literature and perform a meta-analysis of the epidemiology of AKI in Mexico, to provide data on AKI and kidney replacement therapy (KRT) that would contribute to general knowledge in this matter.

METHODS

We performed a systematic search for articles in pediatric and adult patients admitted to the general ward, Emergency Room or Intensive Care Unit published between January 1, 2000, and September 30, 2024. MEDLINE LILIACS, EMBASE and SciELO were searched, as additional reports from supplements, abstracts, and conference sessions. We performed a random-effects meta-analysis for clinically and methodologically comparable studies to estimate the frequency of AKI and KRT. We calculated pooled estimates stratified by age group, year of publication, and setting.

RESULTS

83 full-text articles were included. The percentage of AKI was calculated at 35% (95% CI, 28-42). Mortality for AKI adult patients was 36% (95% CI, 28-45). An overall KRT rate was 7% (95% CI, 6-9), all-cause mortality for AKI requiring KRT was 49% (95% CI, 42-56), with a global Ι2 estimated in 99.87% (p < 0.01).

CONCLUSION

AKI is common in Mexico and remains a main public health problem that needs to be addressed at every level of care. Efforts should be made to reinitiate AKI research and control in Mexico and LA.

The efficacy of lung ultrasound scores-directed pulmonary surfactant treatment in preterm infants with respiratory distress syndrome: a randomized controlled pilot study

BACKGROUND

Pulmonary surfactant therapy is critical for preterm infants with respiratory distress syndrome (RDS). Lung ultrasound (LUS) offers a noninvasive, radiation-free alternative for assessing RDS severity and guiding surfactant therapy.

METHODS

Eighty-two preterm infants with RDS were randomized to receive surfactant based on either LUS scores or a conventional clinical-radiological assessment, comparing the duration of mechanical ventilation, supplemental oxygen need, NICU stay, incidence of bronchopulmonary dysplasia (BPD), and mortality.

RESULTS

No significant differences were found between the groups in terms of mechanical ventilation duration (average 4.1 vs. 4.3 days), supplemental oxygen need (average 5.7 vs. 6.1 days), or NICU stay (average 15.4 vs. 15.9 days). The incidence of BPD was 4.9% in both groups, and there were no deaths reported.

CONCLUSIONS

LUS-directed surfactant treatment did not show significant difference compared to the traditional methods, suggesting its potential as a noninvasive alternative for RDS management in preterm infants.

Oxygen therapy in the intensive care unit

Oxygen therapy is a crucial treatment method for maintaining vital signs in patients in the intensive care unit. However, several controversial issues have emerged regarding its clinical application. This article analyzes current research trends in oxygen therapy in the intensive care unit and provides guidance and recommendations. Relevant literature was retrieved from the Web of Science Core Collection, and keyword co-occurrence and highly cited literature hotspot analyses were conducted using VOSviewer 1.6.19 software. The key topics related to oxygen therapy in the intensive care unit primarily focus on four areas: oxygen therapy and mechanical ventilation in the intensive care unit, extracorporeal membrane oxygenation therapy for coronavirus disease 2019 and its role in reducing mortality, research on hypoxia and oxygen saturation monitoring, and oxygen inhalation therapy in the intensive care unit. The analysis of highly cited literature indicates that the main research hotspots regarding oxygen therapy used in the intensive care unit focus primarily on conservative oxygen therapy, high-flow nasal oxygen therapy, comparisons of high- and low-oxygenation strategies, and research on hyperbaric oxygen therapy. First, the potential of conservative oxygen therapy to reduce mortality rates in the intensive care unit has attracted considerable attention; however, further clinical studies are needed to validate its optimal parameters and suitable patient populations. Second, high-flow nasal oxygen therapy has been shown to be effective in alleviating respiratory distress and reducing the need for intubation. This therapy can deliver oxygen flows of up to 60 L/min, effectively improving respiratory distress and decreasing intubation demands. In patients subjected to high-risk extubation, the combination of high-flow nasal oxygen therapy and noninvasive ventilation significantly lowers the rate of reintubation, making the combined approach one of the best strategies to prevent respiratory failure after extubation in the intensive care unit. Third, there are differences between lower and higher oxygenation strategies regarding their effects on patient mortality, long-term outcomes, and clinician preferences; however, there is currently no clear evidence indicating which strategy is superior. Clinicians' preferences regarding various oxygenation targets may impact the design of future studies. Finally, hyperbaric oxygen therapy is recognized as an effective supportive treatment for various critical conditions and has significant application value in acute severe traumatic brain injury, cerebral resuscitation, and cardiopulmonary resuscitation. Currently, researchers are continually exploring the latest oxygen therapies in the intensive care unit. Several randomized controlled clinical trials investigating automated oxygen control, novel high-flow nasal oxygen therapy, and combined oxygen therapy are underway. The results of these trials should be closely observed. Overall, this article provides a systematic review and valuable reference for the scientific and rational application of oxygen therapy in the intensive care unit. Future research should focus on verifying the optimal parameters of conservative oxygen therapy, assessing oxygen needs in different patient populations, evaluating the long-term effects of oxygen treatment, and developing novel oxygen therapy technologies and devices.

Healing with hierarchy: Hierarchical attention empowered graph neural networks for predictive analysis in medical data

In healthcare, predictive analysis using unstructured medical data is crucial for gaining insights into patient conditions and outcomes. However, unstructured data, which contains valuable patient information such as symptoms and medical histories, often presents challenges, including lengthy text sequences and incomplete data. To address these issues, we introduce a new framework named Hierarchical Attention-based Integrated Learning (HAIL), designed to predict in-hospital mortality and the duration of stay in the intensive care unit. HAIL combines hierarchical attention mechanisms with graph neural networks to effectively manage missing data and enhance outcome predictions. Our model iteratively refines embeddings, resulting in a more thorough analysis of electronic health record data. Experimental findings demonstrate a notable performance improvement of 2%-3% across various metrics when compared to existing benchmarks on standard datasets, highlighting HAIL's effectiveness in time-sensitive clinical decision-making. Additionally, our analysis underscores the significance of patient networks in maintaining the robustness and consistent performance of the HAIL framework.

Advancing spinal care excellence: A specialized training series for trauma nurse practitioners

BACKGROUND

Trauma nurse practitioners (TNPs) play an essential role in trauma and orthopaedic care domains. Their contributions extend beyond the mere provision of patient care; they also serve to mitigate physician shortages. TNPs deliver comprehensive post- and pre-operative care and assist patients in their healing process, from the initial stages following fractures through to the various stages of treatment. This study focuses on developing a teaching series to improve their knowledge and skills in managing spine trauma. Materials and methods: We developed a structured educational program integrating theoretical instruction, interactive workshops, and practical sessions. The curriculum encompasses spinal anatomy, injury assessment, radiological imaging, and management strategies. Following these sessions, we gathered feedback through surveys to evaluate participants' confidence, knowledge enhancement, and overall satisfaction.

RESULTS

A thorough statistical analysis of the collected surveys revealed a significant enhancement in TNP confidence, as indicated by a P value of 7.45 × 10-9, thus confirming the effectiveness of the training program. Approximately 82 % of respondents reported a considerable increase in their knowledge, while 85 % indicated that the outcomes of these sessions met their expectations. Furthermore, a substantial majority of participants, 96 %, expressed a desire for additional education and training.

CONCLUSION

The educational series has enhanced the confidence and expertise of Trauma Nurse Practitioners (TNPs) in managing spinal trauma. Our findings underscore the importance of implementing structured training programs to maximise TNPs' contributions, improve patient care, and reduce the burden on orthopaedic surgeons. Future research may investigate the long-term impacts, broaden training, and incorporate additional topics. Ultimately, this underscores the significance of continuous education for orthopaedic nursing.

Application of enhanced recovery after surgery in perioperative care of infants and children with Hirschsprung disease

BACKGROUND

Enhanced recovery after surgery (ERAS) represents an innovative, protocol-driven perioperative care program designed to optimize patient outcomes. However, its application and efficacy in infants and children with Hirschsprung disease (HD) remain underexplored.

AIM

To delve into the impact of ERAS on perioperative recovery and the overall medical experience in HD infants and children.

METHODS

Thirty-eight infants and children with HD who received the Soave surgical procedure were enrolled in this case-control study. According to age- and sex-stratified single-blind randomized tables, 20 cases received ERAS treatment (ERAS group) and 18 cases received conventional treatment (control group). The two treatments were then compared in terms of perioperative recovery and medical experience.

RESULTS

Significant differences were observed in pain scores at awakening (4.2 ± 1.3 vs5.2 ± 1.2, t = 2.516, P = 0.017) and pain duration (85.69 ± 7.46 hours vs 67.00 ± 8.56 hours, t = 7.139, P < 0.001) between the ERAS and control group. The recovery of bowel movement was earlier in the ERAS group than in the control group (borborygmus time: 33.63 ± 9.83 hours vs 44.69 ± 16.85 hours, t = 2.501, P = 0.017; feeding time: 36.63 ± 9.55 hours vs 49.36 ± 16.99 hours, t = 2.884, P = 0.007; anal catheter indwelling time: 75.83 ± 13.80 hours vs 93.36 ± 20.65 hours, t = 3.104, P = 0.004), and fever duration (40.73 ± 14.42 hours vs 52.63 ± 18.69 hours, t = 2.211, P = 0.034). In the ERAS group, hospital stay was shorter (7.5 ± 0.9 days vs 8.3 ± 1.2 days) and the cost was lower (14203 ± 2381 yuan vs 16847 ± 3558 yuan). During the 1-month follow-up period, of the multiple postoperative complications observed, the occurrence of perianal dermatitis (P_Fisher = 0.016) and defecation dysfunction (P_Fisher = 0.027) were lower in the ERAS group than in the control group.

CONCLUSION

The ERAS protocol has the potential to profoundly enhance postoperative recovery and significantly elevate the overall comfort and quality of the medical experience, making it an indispensable approach that warrants widespread adoption. Continuous refinement through evidence-based practices is anticipated to further optimize its efficacy.

Sodium bicarbonate administration for metabolic acidosis in the intensive care unit: a target trial emulation

PURPOSE

Sodium bicarbonate is commonly administered to treat metabolic acidosis in intensive care units (ICUs). There is limited evidence from randomized trials to support this practice, and observational studies show conflicting results. Our aim was to perform a target trial emulation evaluating the effect of bicarbonate therapy on mortality.

METHODS

Retrospective cohort study using data from 12 Australian ICUs. Inclusion criteria were adults with pH < 7.3 and PCO2 ≤ 45 mmHg within the first three days. We excluded repeat admissions, toxicology, diabetic ketoacidosis, and pre-existing end-stage renal failure. The treatment intervention was sodium-bicarbonate administration, and the primary outcome was 30-day ICU mortality with ICU discharge as a competing event. We evaluated multiple subgroups, including patients with acute kidney injury, requirement for vasoactive therapy, and pH < 7.2. The primary model utilized a parametric g-computation and rolling entry matching was performed as a sensitivity analysis.

RESULTS

We identified 6157 eligible admissions, of which 1764 (29%) received sodium bicarbonate. Bicarbonate therapy was associated with a 1.9% absolute mortality reduction for the primary analysis [risk ratio 0.86, 95% confidence interval (CI) 0.80 to 0.91], and significant benefits were seen across all subgroups evaluated. A similar point estimate of 2.1% was observed in the sensitivity analysis, with a sustained mortality reduction seen at 30 days.

CONCLUSION

In this target trial emulation, bicarbonate administration was associated with a small but statistically significant reduction in mortality for patients with metabolic acidosis. Large sample sizes would be required to demonstrate this effect in a randomized trial.

Effectiveness of extended reality technologies in cardiopulmonary resuscitation training: a bayesian network meta-analysis

BACKGROUND

High-quality cardiopulmonary resuscitation (CPR) is critical to cardiac arrest patients. Extended Reality (XR) technologies, including Augmented Reality (AR), Virtual Reality (VR), and Mixed Reality (MR), provide immersive and interactive training, potentially enhancing CPR outcomes. This network meta-analysis compared the effectiveness of XR-based CPR training to traditional face-to-face methods.

METHODS

A Bayesian network meta-analysis was conducted following PRISMA guidelines. We systematically searched PubMed, Cochrane Library, Web of Science, EMBASE, and CNKI for randomized controlled trials (RCTs) comparing XR-based and traditional CPR training. Primary outcomes included chest compression depth and rate; secondary outcomes assessed full chest wall recoil. The CINeMA tool (GRADE framework) was used to assess evidence quality. Statistical analyses were performed using Stata 15 SE and ADDIS software with random-effects models.

RESULTS

11 RCTs (1,190 participants) were included. MR showed the improvement in chest compression depth (SMD = 10.96; 95% CI, 0.95 to 20.82) compared to VR and traditional methods. For full chest wall recoil, AR outperformed VR (SMD = 48.57; 95% CI, 19.56 to 79.75) and traditional methods (SMD = 52.95; 95% CI, 25.94 to 80.48). However, no significant differences were observed for chest compression rate. SUCRA rankings placed MR as most effective for compression depth (87.4%) and AR for full chest wall recoil (99.1%). Evidence quality was moderate to high, with minor downgrades for imprecision. No publication bias was detected.

CONCLUSIONS

XR technologies, particularly MR and AR, significantly improve chest compression depth and full chest wall recoil in comparing with face to face CRP training, offering a flexible and engaging approach to CPR training. Further studies are needed to evaluate long-term skill retention and real-world impact.

CLINICAL TRIAL NUMBER

Not applicable.

Outcomes of early high-flow nasal cannula (HFNC) use in pediatric respiratory distress in acute settings: a meta-analysis

With the increasing incidence of pneumonia and acute respiratory distress in pediatric populations, effective oxygen delivery techniques are crucial for improving clinical outcomes. However, a debate exists across current studies on the use of high-flow nasal cannula (HFNC), and whether its benefits outweight the overutilization in a hospital setting. This systematic review and meta-analysis evaluates HFNC therapy in comparison to conventional oxygen therapy and noninvasive ventilation (NIV). A literature search was conducted to identify studies comparing HFNC to other oxygen delivery modalities in pediatric populations with acute respiratory distress were included. Outcomes include intubation rates, hospital and ICU stays, adverse events, and mortality. Statistical analysis was performed using RevMan software. A total of 10 studies comprising 7,762 patients were identified for quantitative analysis. HFNC significantly reduced intubation rates compared to conventional oxygen therapy (OR = 0.55, 95% CI: 0.34-0.89, p = 0.01). It also reduced ICU length of stay compared to NIV (MD = -2.76, 95% CI: -4.98 to -0.53, p = 0.02) and was associated with a lower mortality risk compared to NIV (OR = 0.62, 95% CI: 0.44-0.86, p = 0.005). However, HFNC did not show significant differences in success rates or adverse events when compared to either oxygen therapy or NIV. Conclusion: HFNC demonstrates substantial benefits in reducing intubation rates and ICU stays compared to conventional oxygen therapy and NIV. While HFNC appears promising for pediatric respiratory distress management, increased ICU admissions and longer hospital stays remain areas for further research. What is Known: • Acute respiratory distress syndrome (ARDS) is a leading cause of morbidity and mortality in pediatric populations globally. High-flow nasal cannula (HFNC) therapy is a non-invasive oxygen delivery method that reduces inspiratory resistance and provides higher oxygen flow. • HFNC has been associated with reduced intubation rates compared to conventional oxygen therapy in past studies. • Non-invasive ventilation (NIV) and conventional oxygen therapy are established methods for respiratory support but present with limitations such as higher intubation rates and risks of complications. What is New: • HFNC significantly reduces intubation rates compared to conventional oxygen therapy (OR = 0.55, p = 0.01) and is associated with shorter ICU stays compared to NIV (MD = -2.76 days, p = 0.02). • However, HFNC does not show significant advantages in success rates or adverse events compared to other oxygen delivery methods. HFNC also resulted in longer hospital stays compared to conventional oxygen therapy (MD = 0.38 days, p = 0.01). The study highlights the need for judicious use of HFNC and the establishment of standardized clinical guidelines to optimize its use.

Penetrating trauma in Spain: analysis of the Spanish trauma registry (RETRAUCI)

OBJECTIVE

To describe the epidemiology of penetrating trauma, mortality associated factors and its management in Spanish intensive care units.

DESIGN

Multicenter, prospective registry. A comparison is established between two cohorts defined by the type of trauma (blunt and penetrating).

PATIENTS

Patients with traumatic injury admitted to the participating ICUs from June 2015 to June 2022.

INTERVENTIONS

None.

MAIN VARIABLE OF INTEREST

Epidemiology, injury pattern, prehospital and hospital care, resource utilization, and clinical outcomes.

RESULTS

12,806 patients were eligible, of whom 821 (6.4%) suffered penetrating trauma; 418 patients (50.9%) from stab wounds, 93 (11.3%) from gunshot wounds, and 310 (37.8%) from other objects. The most common intent was assault (47.7%). The mean ISS was 15.2 ± 10.6 in penetrating trauma and 19.8 ± 11.9 in blunt trauma (p < 0.001). ICU mortality was 7.8% compared to 11.7% in blunt trauma, with deaths more frequently occurring within the first 24 hours (64% vs. 39%). Factors associated with mortality included female sex, prior use of antithrombotic agents, older age, higher NISS score, and the presence of cranial trauma or shock.

CONCLUSIONS

Penetrating trauma is an emergent pathology in our context with high complexity, highlighting the need for focused study and documentation, protocol development, and resource optimization to provide quality care.

The comparison of pupillometry to standard clinical practice for pain and preemptive analgesia before endotracheal suctioning: A randomized controlled trial

BACKGROUND

Pain during endotracheal aspiration (ETA) is frequent in critically ill patients. Managing pre-emptive analgesia before procedures remains a crucial aspect of care. We compared pupillometry to standard clinical practice for assessing preemptive-analgesia administration and pain before ETA according to Behavioural Pain Scale (BPS), the Behavioural Pain Indicator Scale (ESCID), and the Pupillary Dilation Reflex (PDR).

TRIAL DESIGN

A multicentre parallel-group, controlled trial with balanced (1:1) randomization.

METHODS

Sedated, mechanically ventilated patients aged ≥ 18 with baseline BPS = 3, ESCID = 1, and RASS scores between -1 and -4 were included.

CONTROL GROUP

preemptive-analgesia was administered according to nurse criteria. In the experimental group, preemptive analgesia was administered in patients with PDR ≥ 11.5 % after a 20 mA stimulus measured using AlgiScan®. The preemptive analgesia was fentanyl one µg/kg iv bolus. We used the Chi-square statistic to compare post-intervention pain according to BPS, ESCID, and PDR pain values. A multivariate logistic regression study adjusting for sex, BIS, RASS, APACHE II, remifentanil, and preemptive analgesia was conducted.

RESULTS

Ninety-two patients were studied, 51 in control groups and 41 in intervention groups. Pain incidence was lower in the experimental group. Significantly, 43.9 % of patients in the experimental group were prescribed preemptive analgesia before ETA compared to 19.6 % in the control group (p = 0.03). Multivariate analysis showed significant reductions in pain in the group that received preemptive-analgesia before ETA guided by pupillometry across BPS [OR = 0.34 (95 % CI: 0.12-0.99), p = 0.048], ESCID [OR = 0.29 (95 % CI: 0.09-0.88), p = 0.030] and PDR [OR = 0.27 (95 % IC: 0.08-0.86), p = 0.027] compared to standard clinical practice.

CONCLUSIONS

Preemptive analgesia monitored with pupillometry group had a lower percentage of patients with pain than those who received analgesia based on standard clinical practice. This effect was independent of the sex, patient severity, BIS score, remifentanil use, or preemptive- analgesia.

IMPLICATIONS FOR CLINICAL PRACTICE

The requirement for preemptive analgesia before aspiration, evaluated through routine clinical practice, was lower than detected by pupillometric monitoring of patients. The use of pupillometry to monitor preemptive analgesia reduced pain after secretion aspiration. Pupillometry would be an effective tool to individualize the need for preemptive analgesia before potentially painful interventions, applicable to all patients regardless of sex, severity, or sedation level.

Association between lactate determined at emergency department arrival and the probability of inhospital mortality and intensive care admission in elderly patients

BACKGROUND AND IMPORTANCE

Elderly patients often have atypical clinical presentations. Lactate measurement on arrival at the Emergency Department (ED) could be useful to identify elderly patients with a bad prognosis.

OBJECTIVE

The study aimed to investigate the relationship between serum lactate determined at ED arrival and the probability of inhospital mortality and intensive care (ICU) admission in elderly patients.

DESIGN

Retrospective multipurpose registry. Secondary analysis of the EDEN cohort (Elderly Department and Elder Needs).

SETTINGS AND PARTICIPANTS

All patients ≥65 years attending 52 Spanish EDs during 2 week and in whom serum lactate was determined at ED arrival.

OUTCOME MEASURES AND ANALYSIS

The relationship between serum lactate values and the risk of inhospital all-cause death and transfer from the ED to the ICU was assessed by unadjusted and adjusted logistic regression assuming linearity and restricted cubic spline models assuming nonlinearity.

RESULTS

The cohort included 25 557 patients. The 3024 patients in whom lactate was measured were analyzed. The median age was 81 years (74-87), 1506 (27.2%) were women, 591 (19.5%) had serious comorbidities, 475 (15.7%) severe dependency, and 648 (21.4%) dementia. Death occurred during hospitalization in 217 patients (7.2%) and 53 patients (1.75%) were admitted to the ICU. Serum lactate values were nonlinear related to inhospital mortality and ICU admission. Serum lactate >3.1 mmol/L [odds ratio (OR): 1.60, 95% confidence interval (CI): 1.02-2.50] for inhospital mortality and 3.2 mmol/L (OR: 2.83, 95% CI: 1.03-6.79) for ICU admission were associated with significantly increased ORs in the adjusted models.

CONCLUSION

Serum lactate measured at ED arrival has a significant and exponential relationship with inhospital mortality and ICU admission in elderly patients.

Effect of a competence based medical education program on training quality in Intensive Care Medicine. COBALIDATION TRIAL

OBJECTIVES

The main objective of this study was to evaluate whether the implementation of CoBaTrICE (Competency-Based Training in Intensive Care Medicine in Europe) provides higher levels of competency in comparison with the current official time-based program in Intensive Care Medicine in Spain. Secondary objectives were: 1) To determine the percentage of critical essential performance elements (CEPE) accomplished, 2) To determine compliance with workplace-based assessments (wba).

DESIGN

Multicenter cluster randomized trial.

SETTING

Thirteen Spanish ICU Departments.

PARTICIPANTS

Thirty-six residents INTERVENTION: The implementation of CoBaTrICE included: (1) Training the trainers; (2) Wba; (3) The use of an electronic portfolio. The level of competency achieved by each participant was determined by a simulation-based Objective Structured Clinical Exam (OSCE) performed at the end of the 5th year of training period.

MAIN VARIABLES OF INTEREST

Total scoring in the five scenarios, CEPE completed, level of competency (1-5) achieved.

RESULTS

A total of 119 performances from 26 residents (17 from CoBaTrICE group and 9 from control group) were analyzed in the OSCE. CoBaTrICE residents´ achieved higher levels of competency [2 (1-5) vs. 2 (1-3), p = 0.07) and higher percentages of CEPE´s accomplishment than the control group (78% vs. 71%, p = 0.09).

CONCLUSIONS

The CoBaTrICE group showed a better performance trend in comparison to the control group, but the differences were not statistically significant. Since the number of Wba performed was low, additional research is needed to determine the potential superiority of CoBaTrICE.

A Combined Model of Vital Signs and Serum Biomarkers Outperforms Shock Index in the Prediction of Hemorrhage Control Interventions in Surgical Intensive Care Unit Patients

BackgroundDistinguishing surgical intensive care unit (ICU) patients with ongoing bleeding who require hemorrhage control interventions (HCI) can be challenging. Guidelines recommend risk-stratification with clinical variables and prediction tools, however supporting evidence remains mixed.MethodsThis retrospective study evaluated adult patients admitted to the surgical ICU with concern for ongoing hemorrhage under our institution's "Hemorrhage Watch" (HW) protocol and aimed to derive a clinical prediction model identifying those needing HCI with serial vital signs (VS) and serum biomarkers. The HW protocol included ICU admission followed by a 3-h observation period with VS monitoring every 15 min and hourly biomarkers. The primary outcome was the need for HCI (operative and endovascular interventions) within nine hours of ICU arrival. Secondary outcomes included in-hospital mortality, blood transfusions, and ICU and hospital length-of-stay. A clinical prediction model was developed by utilizing the variables most associated with HCI in a best subsets regression, which was subsequently internally validated using a Bootstrap algorithm.Results305 patients were identified for inclusion and 18 (5.9%) required HCI (3 operative, 15 endovascular). The median age was 70 years (IQR 54, 83), 60% had traumatic injuries, and 73% were enrolled from the emergency department. Blood product transfusion and mortality were similar between the HCI and no-HCI groups. Our analysis demonstrated that a model based on the minimum hemoglobin (9.9 vs 8.1 g/dL), minimum diastolic (57 vs 53 mm Hg) and systolic blood pressures (105 vs 90 mm Hg), and minimum respiratory rate (15 vs 18) could predict HCI with an area under the Receiver Operating Characteristics curve (AUROC) of 0.87, outperforming the Shock Index (SI) (AUROC = 0.64).ConclusionsIn this study of surgical ICU patients with concern for ongoing bleeding, a prediction model using serial VS and biomarkers outperformed the SI and may help identify those requiring HCI.

HLA-A*03 may confer protection against long COVID through an enhanced immune response

BACKGROUND

The COVID-19 pandemic has led to widespread infection, with a significant subset of patients developing persistent symptoms known as Long COVID. Understanding the genetic factors influencing Long COVID susceptibility and severity is crucial for development of targeted interventions.

OBJECTIVE

This study aimed to evaluate the impact of HLA alleles, KIR receptors, and their interactions on the development of Long COVID in patients from southeastern Spain having contracted COVID-19 during the early 2020 pandemic wave.

METHODS

A cross-sectional prospective study enrolled 153 COVID-19 patients. Three months post-infection, HLA-A, -B, -C, KIR genotyping and immunological variables were analyzed using serum and blood samples. Long COVID was diagnosed three years post- infection based on persistent symptoms.

RESULTS

Among the participants, 71 developed Long COVID. HLA-A*03 was less frequent in Long COVID compared to non-Long COVID patients (10.7 % vs. 30.5 %, p = 0.001). Patients with HLA-A*03 had a higher percentage of CD8+ T cells than patients with other allotypes (33.6 ± 13.4 % vs 28.7 ± 10.8 %, p = 0.033) and showed lower expression of KIR2DL1(1265 ± 547 vs 1465 ± 414 MFI, p = 0.031) and KIR3DL1 (300.6 ± 125.0 vs 398.9 ± 131.0 MFI, p = 0.047). Moreover, NK cells in HLA-A*03 patients showed lower expression of the TIGIT inhibitory receptor (73.7 ± 12.2 % vs 78.2 ± 10.8 %, p = 0.046).

CONCLUSION

HLA-A*03 may play a protective role against Long COVID, potentially through enhanced immune responses involving CD8+ T cells and NK cells. Further research in larger, diverse cohorts is needed to validate these findings and to refine personalized medicine strategies for managing COVID-19 sequelae.

[Connaissances, attitudes et pratiques des medecins camerounais sur la réanimation cardio-pulmonaire]

BACKGROUND

Identification of cardiopulmonary arrest and its immediate and effective management are decisive factors in survival.

OBJECTIVE

To evaluate the knowledge, attitudes, and practices of Cameroonian physicians concerning cardiopulmonary resuscitation METHODS: We conducted a cross-sectional study among doctors in Douala, Bafoussam, Garoua, and Yaoundé in Cameroon over three months from March 2024 to May 2024. We included specialists, residents/interns, and general practitioners practising in these cities who agreed to participate in the study. Were not included physicians who had been in practice for less than six months in Cameroon. Answers were validated by referring to the European Resuscitation Council 2015 recommendations and the American Heart Association 2020. Means were compared using the ANOVA and Kruskal-Wallis test. The association between different variables was assessed using a χ2 test or an exact Fisher test. A p-value < 0.05 was considered significant.

RESULTS

Of the 95 participants recruited, the median age was 31 (IQR 28- 33), with extremes between 25 and 56. Residents/interns represented the largest group in our population, with 66 (69.5%) participants. We had 56 (58.9%) participants who had already attended a cardiopulmonary resuscitation training course. Participants who had never attended a previous cardiopulmonary resuscitation training course had a significantly lower mean than those who had (9.90 ± 1.93 vs. 11.61 ± 2.80, P = 0.002). Participants whose last training was more than a year ago had a significantly lower mean score than participants whose previous training was less than a year ago (11.05 ± 2.97 vs. 12.78 ± 2.02, P = 0.016). There was a significant difference between participants' means according to the city of exercise (P=0.037). The doctors practising in Yaoundé had more inadequate practices than those practising outside of Yaoundé (OR: 7.607; 95% CI 1.897-30.509; p = 0.005).

CONCLUSION

Most of our participants' knowledge and practices regarding cardiopulmonary resuscitation were incomplete and inadequate. However, our study noted a positive attitude toward physicians. Therefore, it is essential to emphasise the training of health care providers on cardiopulmonary resuscitation.

Exploring the use of mindfulness for prevention of burnout in allied health professionals in Singapore

BackgroundBurnout is becoming increasingly prevalent among healthcare professionals where it impacts quality of care and staff turnover, especially in the wake of the COVID-19 pandemic. One promising strategy to reduce burnout is the use of mindfulness-based programs, which may aid allied health professionals (AHPs).ObjectiveTo explore the usefulness of a 10-week mindfulness program on reducing burnout symptoms in AHPs in Singapore, as well as to identify AHPs' attitudes and perceptions towards adopting mindfulness in practice.MethodsIn this mixed methods study, a purposive sample (n = 8) of physiotherapists, occupational therapists, and therapy assistants were recruited. Participants underwent a mindfulness program, comprising 5 face-to-face sessions every other week for 10 weeks. Quantitative data were collected at pre- and post-intervention stages using a survey on participant characteristics and the Maslach Burnout Inventory - Human Services Survey for Medical Personnel to assess burnout symptoms. Qualitative data were collected through semi-structured interviews.ResultsThere was a decrease in emotional exhaustion scores (34.50 to 25.50, p = 0.012) while depersonalization (p = 0.107) and personal accomplishment (p = 0.062) scores showed no significant changes. Qualitative benefits reported include increased introspection, improved emotional regulation and communication, and fostering of supportive workplace culture. Advocacy from superiors and the perceived effectiveness of mindfulness techniques can facilitate the adoption of the mindfulness program.ConclusionA 10-week mindfulness program reduced burnout symptoms, specifically emotional exhaustion, among AHPs. Future studies should explore the application of the program within a larger participant sample to develop an optimal model for feasible and pragmatic adoption within the clinical setting.

Longitudinal outcomes of thoracic endovascular aortic repair for ruptured thoracic aortic aneurysms

BACKGROUND

Limited data exist on long-term mortality and reintervention rates after emergent thoracic endovascular aortic repair (TEVAR) for ruptured thoracic aortic aneurysm (rTAA). This study aimed to characterize the long-term outcomes of emergent TEVAR for rTAA.

METHODS

All TEVARs for rTAA and elective intact thoracic aortic aneurysms (iTAAs) were reviewed at a large academic medical center from 2005 to 2022. Long-term clinical outcomes were considered over eight years.

RESULTS

Of 321 patients undergoing TEVAR for TAA, 20% (65/321) presented with rTAA. Median clinical follow-up was 5.1 years. rTAA patients had much lower 30-day survival (69.2% vs 96.9%; P < .001) and higher rates of stroke, pneumonia, and prolonged ventilation (all P ≤ .01). Long-term survival was worse for all rTAA patients compared to all iTAA patients at 1 year (46% vs 86%), 5 years (27% vs 48%), and 8 years (20% vs 32%; all P < .001), driven largely by frequent early mortality. However, for patients surviving at least 90 days, the long-term survival difference over 8 years was minimal (34% vs 33%, log-rank P = .43) among patients presenting with ruptured vs intact TAA. Ruptured aneurysms required more reinterventions within 30 days, but had comparable late reintervention rates, with type I endoleak as the leading cause.

CONCLUSIONS

The present study is the largest to focus on long-term outcomes following TEVAR for rupture TAA. Unsuprisingly, short-term outcomes are worse in patients presenting with ruptured vs intact aneurysms. However, importantly, long-term survival in rTAA patients who do survive 90 days is comparable to that of iTAA patients.

Astrocytes of the hippocampus and responses to periprandial neuroendocrine hormones

Astrocytes have risen as stars in the field of energy homeostasis and neurocognitive function, acting as a bridge of communication between the periphery and the brain, providing metabolic support, signaling via gliotransmitters, and altering synaptic communication. Dietary factors and energy state have a profound influence on hippocampal function, and the hippocampus is critical for appropriate behavioral responses associated with feeding and internal hunger cues (being in the fasted or full state), but how the hippocampus senses periprandial status and is impacted by diet is largely unknown. Periprandial hormones act within the hippocampus to modulate processes involved in hippocampal-dependent learning and memory function and astrocytes likely play an important role in modulating this signaling. In addition to periprandial hormones, astrocytes are positioned to respond to changes in circulating nutrients like glucose. Here, we review literature investigating how astrocytes mediate changes in hippocampal function, highlighting astrocyte location, morphology, and function in the context of integrating glucose metabolism, neuroendocrine hormone action, and/or cognitive function in the hippocampus. Specifically, we discuss research findings on the effects of insulin, ghrelin, leptin, and GLP-1 on glucose homeostasis, neural activity, astrocyte function, and behavior in the hippocampus. Because obesogenic diets impact neuroendocrine hormones, astrocytes, and cognitive function, we also discuss the effects of diet and diet-induced obesity on these parameters.

The Impacts of Nirmatrelvir-Ritonavir on Myocardial Injury and Long-Term Cardiovascular Outcomes in Hospitalized Patients with COVID-19 amid the Omicron Wave of the Pandemic

PURPOSE

Even though nirmatrelvir-ritonavir can improve the short-term morbidity and mortality in COVID-19 patients, the effects of this treatment on long-term major adverse cardiovascular events (MACEs), especially myocardial injury, remains undetermined.

METHODS

This prospective cohort study identified hospitalized adult patients with COVID-19 between April 19, 2022, and June 9, 2022, amid the omicron wave of the pandemic. Matched nirmatrelvir-ritonavir-treated and non-treated cohorts were formed using the propensity score matching method. The primary outcome of this study was the incidence of MACEs (cardiovascular death, myocardial infarction, stroke, new-onset heart failure or heart failure hospitalization or ventricular arrhythmia) from 30 days to 16 months after the diagnosis of COVID-19.

RESULTS

Two 949-patient cohorts with balanced baseline characteristics were formed by propensity score matching. Patients with nirmatrelvir-ritonavir, compared to those untreated, had a lower level of troponin I peak as well as the incidence of troponin I elevation. During the follow-up period, 59 patients in the nirmatrelvir-ritonavir group and 86 patients in the control group developed MACEs (P = 0.020). Regarding specific constituents of MACEs, the differences are mainly reflected in new-onset heart failure or heart failure hospitalization. COVID-19 clinical severity and troponin I peak were the independent predictors, while nirmatrelvir-ritonavir was the independent protective factor for the occurrence of MACEs in this population.

CONCLUSION

Nirmatrelvir-ritonavir was effective in reducing myocardial injury as well as long-term adverse cardiovascular outcomes among hospitalized patients with COVID-19 amid the omicron wave of the pandemic.

Atmospheric pressure plasma treatment increases the antioxidant capacity of the serum in vitro

The interaction of atmospheric pressure plasma (APP) with the liquids has been fully studied, and multiple biomedical applications of APP-activated liquids have also been verified. However, there is still no direct evidence regarding the interaction between APP treatment and serum. In the present study, the rat serum was treated with the helium APP device. Compared with APP-treated saline, the elevation of reactive oxygen species (ROS) levels in serum was significantly smaller, implying that an antioxidant system existed in serum. The proteomics suggested that differently expressed proteins were predominantly enriched in the glutathione metabolism pathway. Our results showed that APP treatment significantly increased the serum GSH level and GSH/GSSG ratio, suggesting the enhanced antioxidant capacity of the APP-treated serum. Furthermore, the antioxidant enzymes in APP-treated serum were examined. As a result, both the glutathione peroxidase (GPX) protein level and enzyme activity were up-regulated according to the parallel reaction monitoring (PRM) analysis and GPX enzyme activity analysis. Meanwhile, the activities of glutathione reductase (GR) and superoxide dismutase (SOD) enzymes were also enhanced after APP treatment, while the catalase (CAT) activity decreased. Meanwhile, the total antioxidant capacity (T-AOC) also increased, as confirmed by the evidence of the superior ROS scavenging by APP-treated serum. Our data highlight that APP treatment can enhance the antioxidant capacity of the serum, which is closely related to the up-regulated GSH level, GSH/GSSG ratio and antioxidant enzymes within serum after APP treatment.

Awake prone positioning in a patient with respiratory impairment due to subarachnoid hemorrhage: a case report

BACKGROUND

Prone positioning has been shown to be an effective rescue strategy in severe acute respiratory distress syndrome and was widely used during the coronavirus disease 2019 pandemic, both in mechanically ventilated and in awake patients. Subarachnoid hemorrhage is often associated with respiratory failure. Prone positioning has been used in brain-injured patients, but concerns relating to neurological complications from intracranial hypertension still remain.

CASE PRESENTATION

We report the case of a 59-year-old Italian patient with subarachnoid hemorrhage who safely underwent awake prone positioning after deterioration of respiratory function.

CONCLUSIONS

In this report, we show that awake pronation is possible in patients with subarachnoid hemorrhage. However, careful monitoring of Intracranial pressure and clinical examination may be the keys to successful application of this procedure.

Rare complication of extracorporeal membrane oxygenation cannula misplacement into the hepatic vein: A case report

BACKGROUND

Veno-venous extracorporeal membrane oxygenation (V-V ECMO) is a lifesaving intervention for severe respiratory failure; however, its effectiveness depends on accurate cannulation-patients with anatomical variations present with significant challenges during the procedure.

CASE SUMMARY

We describe the case of a 56-year-old woman with severe pulmonary infection and acute respiratory failure managed with V-V ECMO. During the initial cannulation, a 23Fr venous drainage cannula was inadvertently inserted into the middle hepatic vein (HV) instead of the inferior vena cava (IVC) owing to the enlargement of the HV (1.02 cm diameter) and its acute angle (77.78°) relative to the IVC. This misplacement led to extracorporeal membrane oxygenation (ECMO) flow issues which were resolved after repositioning the cannula under real-time ultrasonographic and fluoroscopic guidance. This correction stabilized the patient’s condition and restored effective ECMO function, preventing severe complications such as liver injury and liver failure.

CONCLUSION

In clinical practice, real-time ultrasonography and fluoroscopy are critical in preventing cannulation errors in patients with anatomical variations. Vigilant imaging and precise techniques are essential for optimizing ECMO management and effectively addressing complications.

Pharmacogenetic association of CYP enzymes with therapeutic propofol doses during mechanical ventilation

Propofol is commonly used to sedate patients, but variations in how individuals metabolize the drug may affect dosing requirements. The objective of this study was to explore how genetic variations in CYP450 enzymes, particularly CYP2B6, influence propofol metabolism in ICU patients receiving mechanical ventilation. Genetic variants of CYP2B6, CYP2C9, CYP2C19, and CYP3A5 were collected from an institutional genetic data repository. Patients were dichotomized into low and high metabolic activity for each enzyme, and the mean weight- and time-normalized propofol dose administered was compared between groups via t test. There was no significant difference in average daily propofol dose between patients with low and high CYP2B6 activity (11 vs. 11 mg/kg/h, P = 0.78), or any of the other CYP enzymes analyzed (all P > 0.05). This study could not replicate previous studies indicating that patients carrying genetic variants with diminished CYP2B6 activity required lower propofol doses. Future studies with prospectively collected dosing and outcomes data, and measurement of plasma drug concentrations, may provide insights into personalized propofol dosing strategies.

Microbiological safety of nutrition formulas with different feeding systems

INTRODUCTION

Enteral nutrition (EN) is a form of nutrition therapy indicated for patients who cannot eat or do not tolerate oral nutrition. However, because of their nutrient-rich composition, EN formulas provide a favorable environment for microbial growth and present a risk for contamination by pathogens, potentially leading to gastrointestinal disorders and delaying patient recovery. This study analyzed the microbiological safety of two EN feeding systems (the open-system [OS] and the ready-to-hang [RTH] system) using liquid and powdered formulas over different infusion periods.

METHOD

In the laboratory, RTH formulas were administered via infusion pumps without manual handling, whereas OS formulas were prepared manually and administered by gravity. Samples were collected and analyzed for mesophilic aerobic count, an indicator of microbiological quality, at different infusion intervals.

RESULTS

RTH formulas maintained microbial counts below safety limits after 24 and 48 h of infusion. Both liquid and powdered OS formulas remained microbiologically safe for up to 8 h of administration.

CONCLUSION

This study demonstrated that both the RTH and OS can maintain microbiological safety within the recommended infusion times of 24 and 4 h, respectively, without significant bacterial growth. The safety of these systems is contingent on the implementation of good handling practices, underscoring the need for continuous training of handlers.

Frailty at ICU admission: a potential alternative to scoring systems based on clinical observation

Frailty is a common clinical syndrome associated with increased risks of morbidity, mortality and other adverse outcomes. It is often used by healthcare providers as a tool for estimating patients` condition and triaging for Intensive Care Unit (ICU) admission, as recommended by several national guidelines. This study aimed to evaluate the utility of observed frailty, a subjective clinical assessment by physicians, as an alternative to the validated Clinical Frailty Score (CFS) and Modified Frailty Index (MFI). Additionally, the study explored the association of these frailty scoring systems with 30 day mortality, mechanical ventilation duration, and ICU length of stay. This retrospective study analyzed 100 patients admitted to an ICU at a tertiary center between March 12 and April 30, 2019. Observed frailty was assessed on a 4-point scale by physicians at ICU admission. CFS (7-point scale) and MFI (11-point scale) were retrospectively calculated. Correlations between these frailty assessments and their relationships with clinical outcomes were examined. Observed frailty correlated moderately with the CFS (Spearman coefficient = 0.4, p < 0.001) but showed a weaker, non-significant correlation with the MFI (Spearman coefficient = 0.18, p = 0.07). Significant differences in 30 day survival were observed based on the 4-point observed frailty scale (p < 0.001). Subjective assessment of frailty using a 4-point scale by physicians at ICU admission correlates with the CFS and is significantly associated with 30 day mortality. This suggests that observed frailty may be a practical tool for clinical decision-making. Further prospective studies are required to validate its utility and prognostic implications.

Evaluating the Effectiveness of Nurse-Led Early Comfort Using Analgesia, Minimal Sedatives, and Maximal Humane Care Sedation in Mechanically Ventilated Patients

Aims/Background Early Comfort using Analgesia, minimal Sedatives, and maximal Human care (eCASH) is a patient-centered sedation strategy aimed at reducing the use of sedative drugs and improving patient comfort. Therefore, this study evaluated the effectiveness of a nurse-led eCASH sedation strategy in mechanically ventilated patients. Methods This retrospective cohort study included 149 patients who received mechanical ventilation in the intensive care unit (ICU) of the Second Affiliated Hospital of Harbin Medical University between May 2020 and May 2024. Patients were divided into two groups: the observation group (eCASH sedation group, n = 70), which received nurse-led eCASH sedation, and the control group (traditional sedation group, n = 79), which underwent physician-led traditional sedation strategies. Baseline characteristics, analgesic and sedative use, analgesia and sedation outcomes, duration of mechanical ventilation, ICU stay, length of hospital stay, and incidence of delirium were compared between the two groups. Results The observation group received a significantly higher dose of fentanyl within the first 24 hours of mechanical ventilation compared to the control group (p = 0.001). However, there was no significant difference in fentanyl use at 48 and 72 hours between the two groups (p > 0.05). Dexmedetomidine use in the observation group was significantly lower than in the control group at 24, 48, and 72 hours (p < 0.05). Moreover, no significant difference was observed in the use of propofol between the two groups (p > 0.05). The observation group had a significantly higher analgesia success rate within 72 hours (p = 0.027), although the sedation success rate was not significantly different (p > 0.05). Both groups showed significant improvement over time in Richmond Agitation-Sedation Scale (RASS) and Critical-Care Pain Observation Tool (CPOT) scores (p < 0.001), with the observation group demonstrating a significantly faster improvement in analgesia effectiveness compared to the control group (p = 0.015). The duration of mechanical ventilation was significantly shorter in the observation group (p = 0.011), while the incidence of delirium was lower but not statistically significant (p = 0.519). Additionally, there were no statistically significant differences in ICU stay duration and length of hospital stay between the two groups (p > 0.05). Conclusion The nurse-led eCASH sedation strategy significantly reduces analgesic use, shortens mechanical ventilation duration, and improves analgesia outcomes in mechanically ventilated patients. The effectiveness of sedation and incidence of delirium within the eCASH were comparable to those of traditional sedation.

Serum procalcitonin and procalcitonin clearance as a prognostic biomarker of sepsis in a pediatric critical care setting: A tertiary care experience 2016-2021

BACKGROUND

Sepsis remains one of the leading causes of morbidity and mortality in critically ill children worldwide. Identifying reliable prognostic markers is essential for improving risk stratification and guiding targeted therapies. While some studies in adults suggest that procalcitonin (PCT) clearance may better predict sepsis outcomes, there is limited information regarding pediatric sepsis. This study aimed to evaluate whether PCT clearance is associated with mortality among children with severe sepsis and septic shock.

METHODS

We retrospectively reviewed medical records of children aged 1 month to 18 years admitted to the PICU who were diagnosed with severe sepsis and septic shock at Srinagarind Hospital, Thailand, between January 2016 and October 2021. Serum PCT was measured at 0, 24, and 48 hours after the initial diagnosis. PCT clearance was calculated using the relative change from baseline. The primary outcome was in-hospital mortality.

RESULTS

A total of 242 children were included, with a median age of 8 years (interquartile range [IQR]: 3-14). Most participants (62.8%) had no underlying conditions. The overall mortality rate was 26.5%. An initial PCT level > 2 ng/mL was not significantly associated with mortality (adjusted odds ratio [aOR] = 1.17; 95% confidence interval [CI]: 0.44-3.16, p = 0.8). However, decreased PCT clearance at 24 hours was strongly associated with mortality (aOR = 2.79; 95% CI: 1.11-7.01, p = 0.029). The area under the receiver operating characteristic curve for 24-hour PCT clearance to predict mortality was 0.71 (95% CI: 0.63-0.80).

CONCLUSIONS

Lower PCT clearance in the first 24 hours was significantly associated with higher mortality in pediatric patients with sepsis. Serial PCT measurements and PCT clearance monitoring may offer valuable prognostic information and could be considered as part of routine clinical evaluations in pediatric sepsis management.

Bio inspired feature selection and graph learning for sepsis risk stratification

Sepsis remains a leading cause of mortality in critical care settings, necessitating timely and accurate risk stratification. However, existing machine learning models for sepsis prediction often suffer from poor interpretability, limited generalizability across diverse patient populations, and challenges in handling class imbalance and high-dimensional clinical data. To address these gaps, this study proposes a novel framework that integrates bio-inspired feature selection and graph-based deep learning for enhanced sepsis risk prediction. Using the MIMIC-IV dataset, we employ the Wolverine Optimization Algorithm (WoOA) to select clinically relevant features, followed by a Generative Pre-Training Graph Neural Network (GPT-GNN) that models complex patient relationships through self-supervised learning. To further improve predictive accuracy, the TOTO metaheuristic algorithm is applied for model fine-tuning. SMOTE is used to balance the dataset and mitigate bias toward the majority class. Experimental results show that our model outperforms traditional classifiers such as SVM, XGBoost, and LightGBM in terms of accuracy, AUC, and F1-score, while also providing interpretable mortality indicators. This research contributes a scalable and high-performing decision support tool for sepsis risk stratification in real-world clinical environments.

Comparison of antimicrobial consumption indicators in the emergency department

BACKGROUND

Monitoring antimicrobial use in the emergency department is complex due to the wide variety of existing indicators. We evaluated the differences between various indicators used to evaluate antimicrobial use in these units.

METHODS

Retrospective analysis of administrative data from all adult patients admitted to an emergency unit (2019-2024). Aggregated quarterly data included the percentage of patients treated, DDDs/100 admissions, DDD/100 patients-day and DOT/100 admissions. An autoregressive integrated moving average (ARIMA) model was used to investigate the association between DDD/100 admissions and the other antimicrobial use indicators.

FINDINGS

Annual median antimicrobial drug use measured by DDDs/100 admissions was 11.7 (IQR 10.8-12.4). Significant differences in antimicrobial consumption correlation were noted when comparing DDD/100 admissions and DDD/100 patient-days for cephalosporins, lincosamides, and carbapenems. Significant differences in the comparison between DDD and DOT were found for imipenem, clindamycin, piperacillin-tazobactam, gentamicin, and vancomycin.

CONCLUSIONS

Aggregate antimicrobial use measured by DDDs or DOTs is consistent, though discrepancies in correlation may occur for antibiotics with multiple daily doses. DDD/100 admissions is a suitable indicator, but complementing it with DDD/100 patient-days, DOT, and percentage of patients receiving antibiotics provides valuable information for monitoring antimicrobial use.

Contemporary Rationale for Delivering Enteral Nutrition in Critically Ill Adults

OBJECTIVES

To review the rationale for and timing, dose, and monitoring of enteral nutrition and protein delivery in critically ill adults.

DATA SOURCES

Medline searches to identify relevant studies, systematic reviews and meta-analyses, and guidelines informing the phases of critical illness, enteral nutrition and protein doses, and monitoring enteral nutrition.

STUDY SELECTION

Preclinical and contemporary clinical literature informing the rationale for and timing, dose, and monitoring of enteral nutrition and protein dose in critically ill adults.

DATA EXTRACTION

The evidence describing the rationale for and timing, dose, and monitoring of enteral nutrition and protein dose in critically ill adults is summarized.

DATA SYNTHESIS

The early delivery of enteral nutrition remains a cornerstone of therapy for critically ill adults. Historically, critical care nutrition guidelines have recommended achieving full-dose enteral nutrition within the first 72 hours of ICU admission. The rationale for delivering early enteral nutrition depends on the phase of critical illness, and providing a restrictive dose during the acute phase preserves gut integrity, supports the microbiome, and modulates immune dysregulation. Contemporary randomized controlled trials comparing enteral nutrition doses during the acute phase of critical illness have found full-dose enteral nutrition, compared with restrictive dose, and may offset the benefit from enteral feeding, causing iatrogenic stresses to the system leading to worse outcomes. Even though critically ill adults have anabolic resistance and undergo skeletal muscle proteolysis, recent trials have found that high-dose protein, compared with standard, does not improve clinical outcomes and may be harmful in certain subsets of critically ill adults.

CONCLUSIONS

Contemporary data support the use of restrictive dose enteral nutrition during the acute phase of critical illness. High-dose protein is not superior to lower and is associated with worse outcomes in critically ill adults with acute kidney injury and those with greater severity of illness.

[Recommendation for medical onboarding and training on internal medicine intensive care units]

The medical onboarding process for physicians in internal medicine intensive care units in Germany reveals significant deficiencies, as highlighted by a 2023 survey from YDGIIN. Many physicians report feeling insecure and inadequately prepared after their onboarding phase. The study identifies core issues such as heterogeneous levels of training, unstructured onboarding processes, and a lack of support and competency checks in daily clinical practice. To address these challenges, the study proposes solutions including individualized onboarding, mentoring and feedback systems, and a structured onboarding and training plan. The goal is to make the onboarding process more effective, thereby improving the quality of patient care and increasing physician satisfaction.

Inhibiting cathepsin B alleviates acute lung injury caused by sepsis through suppression of pyroptosis in lung epithelial cells

Sepsis-induced lung injury is a serious complication that contributes to the high morbidity and mortality rates in septic patients. This study aims to identify genes associated with sepsis-induced lung injury and evaluate the role of cathepsin B (CTSB) in this process. Here, by analyzing three data sets of sepsis-induced lung injury in mouse models, we identified 23 common differentially expressed genes and performed enrichment analyses. Further experiments demonstrated that CTSB expression was significantly upregulated in the sepsis mouse model, and pre-treatment with the CTSB inhibitor CA-074 markedly improved the survival rate of the mice from 21.05 to 78.95%. In addition, the CTSB inhibitor reduced the systemic inflammatory response in septic mice by decreasing plasma levels of nitric oxide (NO) and the inflammatory cytokines TNF-α and IL-1β.Histological analysis showed that the CTSB inhibitor effectively suppressed CLP-induced lung tissue alterations and neutrophil infiltration, and significantly reduced the expression of inducible nitric oxide synthase (iNOS). Analysis of cell death indicated that the CTSB inhibitor decreased cell death in the lung tissue of CLP mice, particularly by inhibiting the upregulation of gasdermin D-N (GSDMD-N), which is associated with pyroptosis. Furthermore, in vitro experiments revealed that overexpression of CTSB enhanced cell death and promoted pyroptosis in lung epithelial cells. These results indicate that CTSB plays a crucial role in sepsis-induced lung injury, potentially exacerbating the inflammatory response by promoting pyroptosis. Therefore, CTSB may be a potential therapeutic target for sepsis-induced lung injury.

Rapid response system and continuity of nursing care programme for the prevention of post-ICU syndrome

The clinical deterioration of patients admitted to hospital wards, characterised by physiological abnormalities, can be predicted 6-24 h in advance and often depends on the nurse's ability to detect it early. In addition, advances in the treatment and care of the critically ill patient have increased survival after discharge from the intensive care unit (ICU). This, together with increased severity, frailty, prolonged stays and special treatment needs, means that ICU survivors may have physical weakness and mental and/or cognitive impairment that persists over time. In this context, it is necessary to provide personalised care that guarantees the continuity of nursing care in the different care settings through which patients and their families pass. For all these reasons, a continuity of care nursing consultation was designed and implemented in conjunction with a surveillance system on all hospital wards and nurse monitoring for the prevention of post-acute syndrome after discharge from a critical care unit. More than 665 adult inpatient beds are currently under surveillance. In the study period from February 2023 to January 2024, of the 2126 patients discharged from the critical care unit, 87 were in post-ICU follow-up, 55 in full follow-up and 32 in partial follow-up. The implementation of a surveillance system, monitoring in the continuity of nursing care throughout the disease and during the recovery phases, at the different levels of care (critical care, hospitalisation, primary care), can prevent and/or minimise the physical, psychological and cognitive alterations of the post-ICU syndrome and can contribute to the recovery of the quality of life of patients and their families.

Characterization of the Compounds Present in Bougainvillea x buttiana (var. Rose) with Healing Activity in a Murine Model

Background/Objective:Bougainvillea x buttiana of the Nyctagenaceae family is widely used in traditional Mexican medicine for treating different diseases. This study was planned to estimate the healing effect of the acetonic extract obtained from Bougainvillea x buttiana (var. Rose). Methods: The bracts with flowers were subjected to extraction using maceration and concentrated in vacuo. Fractionation with a similar profile resulted in 11 fractions, which were determined using TLC. A mouse wound excision model was tested to evaluate the wound healing effect of the topical treatment pre-formulated with fractions of acetonic extract, which were determined using image analysis techniques. Cytokine levels present in the sera of mice treated or not treated with the acetonic extract were determined using the ELISA method. Results: The results obtained showed that the crude acetonic extract of B. x buttiana and/or its fractions in a pre-formulated hydrogel had wound healing capacity. The wound contraction rate and the healing speed in groups of animals treated with the pre-formulated crude extract and/or its fractions were significantly higher compared with the negative control (p < 0.001). Fraction 2 demonstrated more significant healing, reduced the production of cytokines such as IL-6 and TNF-α, and enhanced the levels of IL-10. Conclusion: The present study showed that the fractions obtained from the acetonic extract of B. x buttiana bracts were able to accelerate the wound healing process through anti-inflammatory mechanisms by regulating inflammatory cytokines. The results presented demonstrate that the extracts from B. x buttiana contain compounds that may be responsible for their healing properties.

Decoding mechanisms and protein markers in lung-brain axis

BACKGROUND

The lung-brain axis represents a complex bidirectional communication network that is pivotal in the crosstalk between respiratory and neurological functions. This review summarizes the current understanding of the mechanisms and protein markers that mediate the effects of lung diseases on brain health.

MAIN FINDINGS

In this review, we explore the mechanisms linking lung injury to neurocognitive impairments, focusing on neural pathways, immune regulation and inflammatory responses, microorganism pathways, and hypoxemia. Specifically, we highlight the role of the vagus nerve in modulating the central nervous system response to pulmonary stimuli; Additionally, the regulatory function of the immune system is underscored, with evidence suggesting that lung-derived immune mediators can traverse the blood-brain barrier, induce neuroinflammation and cognitive decline; Furthermore, we discuss the potential of lung microbiota to influence brain diseases through microbial translocation and immune activation; Finally, the impact of hypoxemia is examined, with findings indicating that it can exacerbate cerebral injury via oxidative stress and impaired perfusion. Moreover, we analyze how pulmonary conditions, such as pneumonia, ALI/ARDS, and asthma, contribute to neurological dysfunction. Prolonged mechanical ventilation can also contribute to cognitive impairment. Conversely, brain diseases (e.g., stroke, traumatic brain injury) can lead to acute respiratory complications. In addition, protein markers such as TLR4, ACE2, A-SAA, HMGB1, and TREM2 are crucial to the lung-brain axis and correlate with disease severity. We also discuss emerging therapeutic strategies targeting this axis, including immunomodulation and microbiome engineering. Overall, understanding the lung-brain interplay is crucial for developing integrated treatment strategies and improving patient outcomes. Further research is needed to elucidate the molecular mechanisms and foster interdisciplinary collaboration.

Contribution of weekly ward rounds led by pediatric infectious diseases specialists in a pediatric intensive care unit

Community or healthcare-associated infectious diseases are common in Pediatric Intensive Care Units (PICUs). The main objectives of this study were 1/to describe the clinical recommendations given during weekly round of infectious disease team into a PICU and 2/to assess its compliance.An observational prospective single-center study conducted over a one-year period in a PICU of a tertiary university hospital. All clinical recommendations provided by an infectious disease team during a weekly round were collected. We reported a total of 234 clinical recommendations on 148 patients (median age 34 months [IQR 2,5 months -126 months], 52% males). Infections occurred in patients with comorbidity in 73 (49%) of them. Ninety-three patients (40%) had pulmonary infections and patients presented with septic shock in 27 cases (12%). Clinical recommendations were categorized as diagnosis, therapeutic, preventive and monitoring in 98 (42%), 205 (88%), 41 (18%), 34 (15%) respectively. There were many therapeutic modifications after round, including treatment discontinuation (n = 82, 35%), spectrum modification (n = 54, 23%) and dosage adjustment (n = 15, 7%). The duration of treatment was also optimized in 144 situations (62%). Overall, we found a complete compliance with recommendations in most cases (n = 212, 90%).

CONCLUSION

We found a very good compliance of clinical recommendations provided on a weekly basis by an infectious disease team in a PICU. Larger pediatric studies are warranted to assess a potential benefit on patients' outcome.

WHAT IS KNOWN

• Antibiotic stewardship programs have been developed to optimize antimicrobial prescribing practices.

WHAT IS NEW

• A prospective audit and feedback from a pediatric infectious disease team during once weekly rounds in PICU is associated with good adherence. • Recommendations did not focus only on therapeutic management but also on diagnosis, prevention and follow-up.

Long non-coding RNA GAS5 promotes neuronal apoptosis in spinal cord injury via the miR-21/PTEN axis

BACKGROUND

Spinal cord injury (SCI) is a severe and permanent trauma that often leads to significant motor, sensory, and autonomic dysfunction. Neuronal apoptosis is a major pathomechanism underlying secondary injury in SCI. Long non-coding RNAs (lncRNAs) have emerged as key regulators of gene expression and cellular processes, including apoptosis. However, the role of lncRNA growth arrest-specific transcript 5 (GAS5) in SCI-induced neuronal apoptosis remains unclear.

AIM

To investigate the role of lncRNA GAS5 in SCI-induced neuronal apoptosis via its interaction with microRNA (miR)-21 and the phosphatase and tensin homolog (PTEN)/AKT pathway.

METHODS

SCI rat models and hypoxic neuronal cell models were established. Motor function was assessed using the Basso-Beattie-Bresnahan score. Expression levels of GAS5, miR-21, PTEN, caspase 3, B-cell lymphoma 2 (Bcl-2), Bcl-2-associated X protein (Bax), and AKT were measured using quantitative PCR or Western blot analysis. Neuronal apoptosis was determined by TUNEL staining. Dual-luciferase reporter assays validated GAS5-miR-21 binding. Knockdown and overexpression experiments explored the functional effects of the GAS5/miR-21 axis.

RESULTS

GAS5 was significantly upregulated in the spinal cord following SCI, coinciding with increased neuronal apoptosis and decreased AKT activation. In vitro experiments demonstrated that GAS5 acted as a molecular sponge for miR-21, leading to increased PTEN expression and inhibition of the AKT signaling pathway, thereby promoting apoptosis. In vivo, GAS5 knockdown attenuated neuronal apoptosis, enhanced AKT activation, and improved motor function recovery in SCI rats.

CONCLUSION

GAS5 promotes neuronal apoptosis in SCI by binding to miR-21 and upregulating PTEN expression, inhibiting the AKT pathway. Targeting GAS5 may represent a novel therapeutic strategy for SCI.

Incidence and factors associated with post-intensive care syndrome among caregivers of intensive care unit survivors: Protocol for a cohort study

BACKGROUND

During the last decades, intensive care unit (ICU) mortality rates have significantly decreased but this progress has come with unintended consequences for patients and their caregivers. The adverse health-related effects observed in caregivers during the post-ICU period are referred to as Post-Intensive Care Syndrome-Family (PICS-F). Despite growing awareness of PICS-F, the long-term challenges faced by caregivers of ICU patients are not well characterized with several gaps in knowledge remaining unaddressed. The proposed study aims to determine the incidence of PICS-F impairments and identify associated factors among caregivers of ICU survivors.

METHODS

We plan to conduct a longitudinal prospective cohort study involving 175 caregivers of ICU patients admitted to a public hospital in Chile. Data will be collected during ICU admission, after ICU discharge, 3 months and 6 months after hospital discharge. Questionnaires will evaluate caregivers' psychological, physical and cognitive outcomes and perceived social support, resilience, family satisfaction and caregiver burden. Factors associated with PICS-F impairments will be explored using generalised linear mixed models.

DISCUSSION

The current understanding of PICS-F is limited, particularly regarding the risk and protective factors associated with the syndrome among caregivers of ICU survivors. This study will contribute to addressing this gap by providing novel data about PICS-F and exploring previously unexamined factors linked to PICS-F such as family satisfaction, psychological buffers and caregiver burden.

TRIAL REGISTRATION

Clinicaltrials.gov: NCT05827354. Registered on 25 April 2023.

Impact of ejection fraction changes on long-term outcomes in VA-ECMO patients

There is limited evidence regarding the association between myocardial function requiring extracorporeal membrane oxygenation (ECMO) and long-term survival rate in patients who reach hospital discharge. This study investigates the association between myocardial function parameters collected at different times from weaning from ECMO to long-term follow-up and the long-term mortality rate. This retrospective study investigates the effect of EF timing in the long-term. A cohort of 403 patients successfully weaned from veno-arterial ECMO (VA-ECMO) was identified from 1300 patients who underwent VA-ECMO between 2003 and 2018 after applying exclusion criteria for age and indications not of interest in the Chang Gung Memorial Hospital Research Database (CGRD). The study revealed that a notable improvement in ejection fraction (EF) percentile between ECMO placement and successful weaning was significantly linked to reduced cumulative mortality as were higher EF values before discharge. However, no significant association was found between lower long-term mortality and EF change from discharge to mid-term follow-up, or the maximum EF at mid-term follow-up. Improvements in cardiac function following the use of VA-ECMO and better baseline cardiac function are associated with lower long-term mortality. The study showed that EF monitoring at ECMO insertion and before discharge can inform physicians regarding patients' long-term outcomes. EF percentile improvement from insertion to weaning could be a positive indicator of successful weaning.

Can Acute Neurological Disease Cause Cardiomyopathy in Horses?

In human medicine, neurological diseases have been associated with transient cardiac abnormalities. In horses, myocardial disease is rarely diagnosed and has been associated with a wide variety of causes. The aim of this article is to describe three horses with no previous cardiac disease, which all developed severe cardiomyopathy following neurological disease. A 5-year-old Shetland pony stallion was diagnosed with cardiomyopathy with arrhythmias following an episode of seizures caused by an accidental intra-arterial xylazine injection. A 20-year-old crossbred mare was hospitalised for an open fracture of the left maxillary bone with copious epistaxis from both nostrils and developed acute cardiomyopathy with arrhythmias following a venous air embolism. Both had elevated troponin concentrations. Multifocal areas of haemorrhages and coagulative necrosis within the myocardium were found at the post-mortem examination of a 4-year-old thoroughbred gelding who died shortly after suffering acute brain injury following a backward fall. Based on this report, we suggest that myocardial injury can also occur in horses following neurological disease. Equine patients with acute neurological disease may benefit from cardiac monitoring; otherwise, patients with unspecific or mild symptoms of cardiomyopathy are likely to remain unidentified. The prognosis associated with this type of cardiac disease remains to be defined.

Turnover intention among intensive care nurses and the influence of the COVID-19 pandemic: a scoping review

BACKGROUND

The shortage of nurses has been an ongoing issue for many decades. An important contributing factor is voluntary turnover. Especially in intensive care (ICU) and critical care units (CCU) with high workloads, high mortality rates and stressful working conditions, the phenomenon has serious consequences. In addition, the COVID-19 pandemic has exacerbated the problem. This review examines the factors influencing the intention to leave (ITL) and intention to stay (ITS) among intensive care and critical care nurses and the influence of the COVID-19 pandemic.

METHODS

A scoping review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The databases PubMed, Wiley, Scopus, APA PsycNet and Web of Science were searched. In addition, a forward search using Google Scholar was carried out. Empirical studies reporting on factors influencing the intention to stay or leave among ICU nurses published from 2000 to 2022 were included. The factors were qualitatively coded in MAXQDA, resulting in an inductive coding frame.

RESULTS

Fifty-four studies, including 51 quantitative, one qualitative, and two mixed methods studies, were included in the review. The analysis of factors influencing the intention to either leave or stay in intensive care can be systematically classified into two categories: organisational factors and individual factors. The category of organisational factors encompasses factors, such as commitment and integration, leadership, professional collaboration and communication. Conversely, the category of individual factors comprises factors, such as professionalism, job satisfaction, mental health and social reasons. The pandemic has exacerbated certain aspects within individual and organisational factors, influencing the intention to leave intensive care. Notably, despite the significant impact of COVID-19, no "new" themes are directly attributable to it.

CONCLUSIONS

The results can help practitioners meet future challenges (maintaining adequate staffing levels in view of the existing shortage of nurses). It is the responsibility of nursing and hospital management to capitalise on the insights of this review. Future research should focus on longitudinal, interventional and qualitative study designs to understand voluntary turnover among ICU nurses.

Prognosis of Patients with Lung Cancer Admitted to the Intensive Care Unit: A Systematic Review and Meta-Analysis

IntroductionDespite recent advances in the care of critically ill patients with cancer, studies show that lung cancer is associated with higher Intensive Care Unit (ICU) mortality than other types of cancer. This systematic review and meta-analysis aim to investigate the ICU outcomes and predictors of mortality in critically ill patients with lung cancer.MethodsPubMed, OVID MEDLINE, Cochrane and Embase were searched to identify relevant studies. The primary outcome was ICU mortality. The secondary outcomes were hospital mortality and predictors of mortality. Abstracts, case reports and case series were excluded.ResultsThirty-three studies met inclusion criteria, including 28 cohort studies (n = 4123) and five population-based studies (n = 82,475). The pooled ICU mortality was 46.4% (95% CI 41.0-51.8; n = 16,772). The pooled hospital mortality was 51.9% (95% CI 46.9-56.9; n = 72,215). The pooled long-term mortality (6-12 months) was 73.5%, (95% CI 68.2- 78.2; n = 84,008). Predictors of mortality included the presence of metastatic disease (RR 1.30, 95% CI 1.06-1.59), poor performance status (RR 1.33, 95% CI 1.12-1.57), requirement for mechanical ventilation (RR 2.25, 95% CI 1.58-3.21), requirement for vasopressors (RR 1.95, 95% CI 1.54-2.46), higher APACHE or SAPS score (standardized mean difference 0.63, 95% CI 0.45-0.80), and higher SOFA score (mean difference 1.95, 95% CI 1.21-2.70).ConclusionCritically ill patients with lung cancer have reasonable short term but poor long-term outcome. Focused and early goals of care discussions are crucial part of ICU care in this patient population.

Pecto-Intercostal Fascial Plane Block for Pain Management after Cardiothoracic Surgery

PURPOSE OF REVIEW

Cardiac surgery is associated with significant postoperative pain. Compared to traditional analgesics, regional nerve blocks target specific anatomical areas to improve analgesia and to reduce postoperative opioid consumption.

RECENT FINDINGS

Pecto-intercostal fascial plane block (PIFB) is a novel analgesic technique that involves ultrasound-guided injection of anesthetic between pectoralis major and external intercostal muscles. Since PIFB is a relatively underexplored method of analgesia, to date, few manuscripts have reviewed and synthesized current literature related to PIFB.

CONCLUSION

The present investigation focuses on relevant anatomy and physiology behind the PIFB, compares this novel technique with other traditional and novel methods of analgesia, and describes indications and contraindications for PIFB in cardiac surgery and other surgeries.

Development of the mobile application Guide to medication reconciliation in the critically ill patient

OBJECTIVE

Medication reconciliation is an essential process in the care of critically ill patients, ensuring that patients' chronic medication is adapted to the patient's clinical situation and administered safely during hospitalisation. Given the profile of the patient admitted to a critical care unit (ICU), this becomes even more relevant. Reconciliation minimises possible medication errors and adverse effects, improving safety in the critically ill patient.

METHODS

The project, carried out between 2021 and 2024, was led by the FarMIC (Pharmacists in Intensive Care Medicine and Critical Care) and RedFaster (Pharmaceutical Care in Emergencies) groups of the Spanish Society of Hospital Pharmacy (SEFH), and included: selection of the drugs, review of the available literature and previous conciliation guidelines in similar areas of application, preparation of the drug information with the recommendations issued by the working group, the review of the same and the development of the mobile application.

RESULTS

In October 2024, the app 'Conciliation Guide for Critically Ill Patients®' was published, available free of charge for iOS and Android. It provides a drug index with detailed information on medication reintroduction schedules, routes of administration, monitoring, and drug-specific considerations. In addition, the tool includes information on withdrawal syndromes, drug-drug interactions with the usual ICU drugs and hazardous drugs information according to the NIOSH list.

CONCLUSIONS

This app facilitates pharmacotherapeutic reconciliation process in the ICU, supporting healthcare professionals in making personalised decisions. Its use can optimise patient safety, reduce adverse events and improve critical patient care. Finally, this tool reinforces the role of the clinical pharmacist in the ICU, who must lead this process in all care transitions and adapt it to the clinical situation of the patient.

Effects of Mobilization Within 24 Hours Based on the ICU Mobility Scale in Cancer Patients: A Randomized Controlled Clinical Trial "Mobilization Based on the ICU Mobility Scale"

BACKGROUND AND OBJECTIVE

Abdominal cancer surgery leads to loss of functional capacity. The objective was to evaluate the effects of mobilization within 24 h applied to patients with abdominal neoplasms undergoing major surgery.

METHODS

A randomized controlled clinical trial was carried out in the Intensive Care Unit. The intervention group performed mobility activities guided by the ICU mobility scale (IMS) in the first 24 h after surgery and the control group performed conventional physiotherapy. Dynamometry was evaluated in the preoperative, 1st POD and postoperative period, as well as the Timed up and go test (TUG).

RESULTS

Patients in the intervention group had greater initial mobility (IMS Scale intervention group: 6.67 ± 0.69; IMS Scale control group: 2.23 ± 0.52; p = 0.001). There was greater level of mobility until discharge from the ICU in patients in the intervention group compared to the control group (IMS at discharge from the ICU in the intervention group: 8.53 ± 0.33; IMS at discharge from the ICU in the control group: 3 ± 0.64). Both groups showed worsening in the TUG test, but it was significant only in the control group.

CONCLUSION

Early mobilization in patients with abdominal neoplasms undergoing major surgery proved to be effective in maintaining mobility and functional markers.

Lessons Learned From Awake ECMO Approach in Covid-19-Related Acute Respiratory Distress Syndrome - a Scoping Review

During the COVID-19 pandemic, specific COVID-19-related conditions renewed interest in the full-awake venovenous extracorporeal membrane oxygenation ( fa V-V ECMO) approach, in which ECMO is applied to awake, cooperative, and non-intubated patients. This scoping review aims to provide a descriptive overview of fa V-V ECMO in patients with COVID-19-related acute respiratory distress syndrome (CARDS). We searched the PubMed, Web of Science, and Scopus databases using the keywords "awake ECMO" or "spontaneous breathing AND ECMO", combined with "COVID-19", "SARS-CoV-2" or "coronavirus", utilizing the Boolean operator "AND". The search included papers published from November 1, 2019, to December 31, 2024. Sixty-four papers were assessed for eligibility at the abstract level, and fourteen articles (seven small-sample cohort studies and seven case reports) comprising 95 patients were included in the final analysis. The most frequent reasons for preferring fa V-V ECMO over mechanical ventilation were barotrauma and patient refusal of intubation and mechanical ventilation. The fa V-V ECMO strategy was successful (ie, patients not intubated, disconnected from ECMO, and discharged from the hospital) in 36.4% of cases (cohort studies only). The incidence of defined severe adverse events (bleeding, thrombosis, cannula malposition, delirium, and progression of barotrauma) was considered low. The mortality rate for CARDS patients treated with fa V-V ECMO (including only patients from cohort studies) reached 33.0%, notably lower than the 48% reported for CARDS patients treated with V-V ECMO in the ELSO registry. Patients who were intubated due to worsening respiratory failure during fa V-V ECMO had significantly higher mortality. Infectious complications, sepsis, and multiorgan failure were the most frequent causes of death. However, significant heterogeneity in the definitions and reporting of management, ECMO-related complications, and outcomes was observed across the papers. Despite the heterogeneity of the data, fa V-V ECMO in CARDS patients can be considered a safe approach associated with a lower mortality rate than that reported in the overall V-V ECMO CARDS population.