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Giménez-Esparza Vich C, Martínez F, Olmos Kutscherauer D, Molano D, Gallardo MDC, Olivares-Durán EM, Caballero J, Reina R, García Sánchez M, Carini FC. Analgosedation and delirium practices in critically ill patients in the Pan-American and Iberian setting, and factors associated with oversedation after the COVID-19 pandemic: Results from the PANDEMIC study. Med Intensiva 2025; 49:502123. [PMID: 39894710 DOI: 10.1016/j.medine.2025.502123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 08/28/2024] [Accepted: 09/12/2024] [Indexed: 02/04/2025]
Abstract
Oversedation has adverse effects on critically ill patients. The Analgosedation and Delirium Committee of the FEPIMCTI (Pan-American and Iberian Federation of Critical Care Medicine and Intensive Care) conducted a cross-sectional study through a survey addressed to ICU physicians: PANDEMIC (Pan-American and Iberian Study on the Management of Analgosedation and Delirium in Critical Care [fepImCti]). HYPOTHESIS: Worsening of these practices in the course of the pandemic and that continued afterwards, with further oversedation. OBJECTIVES: Perception of analgosedation and delirium practices in Pan-American and Iberian ICUs before, during and after the COVID-19 pandemic, and factors associated with persistent oversedation after the pandemic. Of the 1008 respondents, 25% perceived oversedation after the pandemic (95%CI 22.4-27.8). This perception was higher in South America (35.8%, P < .001). Main risk factor: habit acquired during the pandemic (adjusted OR [aOR] 3.16, 95%CI 2.24-4.45, P < .001). Main protective factor: delirium monitoring before the pandemic (aOR 0.70, 95%CI 0.50-0.98, P = .038). The factors identified in this study provide a basis for targeting future interventions.
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Affiliation(s)
| | - Felipe Martínez
- Facultad de Medicina, Escuela de Medicina, Universidad Andrés Bello, Viña del Mar, Chile
| | - Daniela Olmos Kutscherauer
- Terapia Intensiva, Hospital Municipal Príncipe de Asturias; Profesora Asistente por Concurso de la Cátedra de Semiología UNC, Córdoba, Argentina
| | - Daniel Molano
- Unidad de Cuidado Intensivo, Hospital de San José; Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
| | | | - Enrique Mario Olivares-Durán
- Unidad Médica de Alta Especialidad No. 1, Centro Médico Nacional del Bajío, Instituto Mexicano del Seguro Social, León, Mexico; Departamento de Enfermería y Obstetricia Sede León; División de Ciencias de la Salud, Universidad de Guanajuato, Campus León, León, Mexico
| | - Jesús Caballero
- Servei de Medicina Intensiva, Hospital Universitari Arnau de Vilanova de Lleida, IRBLleida, Lleida, Spain
| | - Rosa Reina
- Servicio de Terapia Intensiva, Hospital San Martín, La Plata; Docente Cátedra Terapia Intensiva, Facultad de Ciencias Médicas, Universidad Nacional de La Plata, Buenos Aires, Argentina
| | | | - Federico C Carini
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Ontario, Canada; Unidad de Terapia Intensiva de Adultos, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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102
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Zahra F, Tjuwatja N, Irianti S, Adriansyah PNA. Insights into Congenital Body Stalk Anomaly Coupled with Placenta Accreta Conditions: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2025; 26:e946041. [PMID: 40302190 PMCID: PMC12051406 DOI: 10.12659/ajcr.946041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2025] [Accepted: 03/12/2025] [Indexed: 05/01/2025]
Abstract
BACKGROUND Body stalk anomaly is a rare abdominal wall defect thought to be a consequence of abnormalities in the development of cephalic, caudal, and lateral embryonic folding and defect in closure of the body wall during embryogenesis. Placenta accreta spectrum (PAS) is a general term frequently used to encompass accreta, increta, and percreta conditions. This report describes a distinct pregnancy with a body stalk abnormality and PAS. CASE REPORT A 34-year-old woman, gravida 2 para 1, with no previous abortions, was referred to the Maternal-Fetal Medicine Unit for further investigation of omphalocele at 29 weeks of gestation. Although the defect was not suspected during the first trimester scan, subsequent obstetric ultrasounds revealed a severe abdominal wall defect, kyphoscoliosis, a very rudimentary umbilical cord, and limb defects. Ultrasound examination of the placenta showed increased vascularity at the placental bed and loss of the retroplacental-myometrial radiolucent interface, leading to diagnosis of suspected body stalk anomaly, with PAS. Cesarean delivery was performed at 30 weeks, with plan for conservative treatment for PAS, including uterine-sparing surgery. Baby was born weighing 800 g and measuring 25 cm in length, with an APGAR score of 1-1. Clinical examination confirmed a very short umbilical cord and severe abdominal wall and limb defects. However, due to significant hemorrhage during surgical procedure, cesarean hysterectomy was done. CONCLUSIONS The management of body stalk anomaly with PAS is challenging. Preconception counseling is important to detect abnormalities earlier, and a multidisciplinary care team is needed to create patients' treatment plans. This congenital defect is invariably fatal.
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Affiliation(s)
- Fatima Zahra
- Fetal and Maternal Medicine Division, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Padjadjaran – Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Nathania Tjuwatja
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Padjadjaran – Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Setyorini Irianti
- Fetal and Maternal Medicine Division, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Padjadjaran – Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
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103
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Busico M, Villarejo F. Is hemodynamic instability an absolute contraindication for prone position? Med Intensiva 2025:502201. [PMID: 40312184 DOI: 10.1016/j.medine.2025.502201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2025] [Revised: 02/25/2025] [Accepted: 02/28/2025] [Indexed: 05/03/2025]
Affiliation(s)
- Marina Busico
- Unidad de Cuidados Intensivos, Clínica Olivos, Swiss Medical, Buenos Aires, Argentina.
| | - Fernando Villarejo
- Unidad de Cuidados Intensivos, Clínica Olivos, Swiss Medical, Buenos Aires, Argentina
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104
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Salgado-Reguero ME, Furtado-Eraso S, Bujanda-Sainz de Murieta A, García-Vivar C, Soto-Ruiz N, Escalada-Hernández P. Humanization strategies in pediatric intensive care: A scoping review. ENFERMERIA INTENSIVA 2025; 36:500531. [PMID: 40311421 DOI: 10.1016/j.enfie.2025.500531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 07/01/2024] [Accepted: 07/29/2024] [Indexed: 05/03/2025]
Abstract
BACKGROUND The international HU-CI project advocates eight strategic strands for the humanization of intensive care units. Despite of adult ICUs have received attention to promote humanization of care, in the paediatric context, the humanization of care continues to receive limited attention, with limited data on paediatric structures and humanization patterns lacking integration into practice. OBJECTIVES Identify available evidence related to humanization concepts according to the theoretical framework of the HU-CI Project and understand the implementations in the field of paediatric intensive care units. METHOD A scoping review was conducted through a literature search in PubMed and CINAHL. Studies addressing concepts or elements related to the strategic lines of the HU-CI framework within the context of paediatric intensive care units were included. The perspective of patients, families, and frontline healthcare professionals was considered, using quantitative, qualitative, and mixed methods approaches. Data analysis followed a narrative approach, categorically synthesised according to the strategic lines of the HU-CI framework in paediatric intensive care units. RESULTS A total of 41 articles were included. Within the eight action lines of action of the HU-CI framework, end-of-life care and communication predominated over flexible schedules, family presence and participation in care, patient well-being, professional care, post-ICU syndrome and humanised infrastructure. CONCLUSIONS The analysed action lines suggest the need for development and improvement through further research to facilitate their full integration into the practice of paediatric intensive care units.
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Affiliation(s)
- María Esther Salgado-Reguero
- Servicio Navarro de Salud-Osasunbidea (SNS-O), Hospital Universitario de Navarra, Unidad de Cuidados Intensivos Pediátricos, Pamplona, Navarra, Spain; Departamento de Ciencias de la Salud, Universidad Pública de Navarra (UPNA), Pamplona, Navarra, Spain; IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Navarra, Spain
| | - Sara Furtado-Eraso
- Servicio Navarro de Salud-Osasunbidea (SNS-O), Atención Primaria, Pamplona, Navarra, Spain; Departamento de Ciencias de la Salud, Universidad Pública de Navarra (UPNA), Pamplona, Navarra, Spain; IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Navarra, Spain.
| | - Arantxa Bujanda-Sainz de Murieta
- Departamento de Ciencias de la Salud, Universidad Pública de Navarra (UPNA), Pamplona, Navarra, Spain; IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Navarra, Spain
| | - Cristina García-Vivar
- Departamento de Ciencias de la Salud, Universidad Pública de Navarra (UPNA), Pamplona, Navarra, Spain; IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Navarra, Spain
| | - Nelia Soto-Ruiz
- Departamento de Ciencias de la Salud, Universidad Pública de Navarra (UPNA), Pamplona, Navarra, Spain; IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Navarra, Spain
| | - Paula Escalada-Hernández
- Departamento de Ciencias de la Salud, Universidad Pública de Navarra (UPNA), Pamplona, Navarra, Spain; IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Navarra, Spain
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105
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Yaman Aktas Y, Özkan E. Nociceptive and non-nociceptive pain in critical care patients after cardiac surgery. J Perioper Pract 2025:17504589251329284. [PMID: 40302683 DOI: 10.1177/17504589251329284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2025]
Abstract
AIM To assess pain intensity during nociceptive (endotracheal suctioning) and non-nociceptive (body temperature measurement) procedures in critically ill patients after cardiac surgery. METHODS A descriptive and cross-sectional design was carried out. The study sample consisted of 60 critically ill patients. The study used the Critical Care Pain Observation Scale, the Behavioural Pain Scale, the Ramsey Sedation Scale and Physiological Parameter Form for data collection. Pain was assessed before, during, and 20 min after endotracheal suctioning and body temperature measurement in the study. RESULTS The pain scores were found to be statistically significant differences during endotracheal suctioning and body temperature measurement (p < 0.001). Pain scores were found to be higher during endotracheal suctioning, which is a nociceptive procedure (p < 0.05). Systolic and diastolic blood pressure, heart rate scores were also determined to be statistically higher during endotracheal suctioning (p < 0.05). CONCLUSION Pain scores and physiological parameters were found to be higher during endotracheal suctioning, a procedure known to be nociceptive. Critical care nurses are recommended to follow pain assessment protocols.
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Affiliation(s)
- Yesim Yaman Aktas
- Department of Surgical Nursing, Faculty of Health Sciences, Giresun University, Giresun, Turkey
| | - Esra Özkan
- Department of Surgical Nursing, Faculty of Health Sciences, Giresun University, Giresun, Turkey
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106
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Ekestubbe L, Forssten MP, Cao Y, Sarani B, Mohseni S. Morbidity prediction in conservatively managed rib fracture patients. Eur J Trauma Emerg Surg 2025; 51:184. [PMID: 40299043 PMCID: PMC12041140 DOI: 10.1007/s00068-025-02860-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2025] [Accepted: 04/03/2025] [Indexed: 04/30/2025]
Abstract
PURPOSE Rib fractures, common in blunt chest trauma, affect 10% of trauma patients and are linked to increased pulmonary morbidity and mortality. This study applies machine learning to identify predictors of complications in conservatively managed rib fracture patients. METHODS Data from the 2013-2021 American College of Surgeons' Trauma Quality Improvement Program included adults (≥ 18 years) with isolated thoracic injury from blunt trauma and conservatively managed rib fractures. Variables included demographics, comorbidities, injury severity, injury patterns, admission vitals, and complications. The permutation importance method identified top predictors of in-hospital complications. RESULTS Of 321,355 rib fracture patients, 183,303 (57.0%) had isolated rib fractures. The five primary predictors of complications in all rib fracture patients were age, Glasgow Coma Scale (GCS) on admission, Revised Cardiac Risk Index (RCRI), chronic obstructive pulmonary disease (COPD), and alcohol use disorder. For isolated rib fracture patients, the same predictors applied but in the order: age, RCRI, GCS, COPD, and alcohol use disorder. A logistic regression model using these predictors showed acceptable discriminative capacity for complications in the full cohort [AUC (95% CI): 0.72 (0.71-0.72)] and isolated rib fracture patients [AUC (95% CI): 0.72 (0.71-0.73)]. CONCLUSION Cardiovascular risk, age, and level of consciousness on admission are key predictors of complications in conservatively managed rib fracture patients. Though complication rates remain low overall, elderly patients with multiple cardiovascular risk factors face a heightened risk of deterioration.
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Affiliation(s)
- Lovisa Ekestubbe
- Department of Orthopedic Surgery, Orebro University Hospital, Orebro, Sweden
| | - Maximilian Peter Forssten
- Department of Orthopedic Surgery, Orebro University Hospital, Orebro, Sweden
- School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Orebro University, Orebro, Sweden
| | - Babak Sarani
- Center of Trauma and Critical Care, George Washington University, Washington, DC, USA
| | - Shahin Mohseni
- School of Medical Sciences, Orebro University, Orebro, Sweden.
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107
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Tran V, Barrington G, Page S. Emergency Department Clinical Quality Registries: A Scoping Review. Healthcare (Basel) 2025; 13:1022. [PMID: 40361801 PMCID: PMC12071968 DOI: 10.3390/healthcare13091022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2025] [Revised: 04/09/2025] [Accepted: 04/23/2025] [Indexed: 05/15/2025] Open
Abstract
BACKGROUND Emergency departments (ED) are vital within the health system, often representing the first hospital contact for patients who are undifferentiated and may be critically ill. Although advancements in digital technology and increasing use of electronic medical records in health systems have led to the dramatic growth of large data sets, the presence of ED clinical registries to measure quality of care in the literature is currently unknown. OBJECTIVES Our scoping review aims to investigate the extent of emergency department clinical registries reported in peer-reviewed literature. METHODS We conducted a scoping review of ED registries in accordance with the PRISMA-ScR checklist. Searches were undertaken in PUBMED, EMBASE, and SCOPUS. Studies were included if they described a clinical registry with a focus on the ED. RESULTS We identified 60 manuscripts with 27 identified as primary registries (6 had a general scope, 21 were condition or population specific). The remaining 33 papers were investigational reports sourced from the identified primary registries. Funding sources were identified for some registries: three by research grants, two by medical colleges, five by government organizations or initiatives, two by pharmaceutical companies, and three by research institutes. No funding information was provided in 12 studies. The reported registry periods ranged from 31 days to 4018 days (median 365 days, IQR 181-1309 days). A grey literature search revealed that six registries were ongoing. CONCLUSIONS Internationally, there appears to be a wide degree of heterogeneity with primary ED registry publications and secondary publications. Having a standardized approach to ED registries is needed. Integrating ED registries with a learning health system model will enable clinicians to serve their community proactively and with a focus on quality, rather than the current safety-focused approach.
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Affiliation(s)
- Viet Tran
- Royal Hobart Hospital, Tasmanian Health Service, Hobart 7000, Australia
- Tasmanian School of Medicine, University of Tasmania, Hobart 7000, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart 7000, Australia
- Tasmanian Emergency Medicine Research Institute, Hobart 7000, Australia
| | - Giles Barrington
- Royal Hobart Hospital, Tasmanian Health Service, Hobart 7000, Australia
- Tasmanian School of Medicine, University of Tasmania, Hobart 7000, Australia
- Tasmanian Emergency Medicine Research Institute, Hobart 7000, Australia
| | - Simone Page
- Royal Hobart Hospital, Tasmanian Health Service, Hobart 7000, Australia
- Tasmanian School of Medicine, University of Tasmania, Hobart 7000, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart 7000, Australia
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108
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Casas IM, Marzi I. Quality improvement program for the severely injured. Eur J Trauma Emerg Surg 2025; 51:186. [PMID: 40299068 PMCID: PMC12041159 DOI: 10.1007/s00068-025-02826-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2025] [Accepted: 03/06/2025] [Indexed: 04/30/2025]
Abstract
Over recent decades, advancements in trauma care have significantly reduced mortality rates among severely injured patients. These improvements are largely attributable to the establishment of trauma care systems, including prehospital management protocols and the creation of trauma centres with immediate surgical team availability. However, patient outcomes continue to vary, reflecting differences in the quality of trauma care influenced by organisational models and local practices. To address this, governments and scientific organisations have underscored the importance of evaluating care quality at local, national, and international levels. This chapter explores strategies for assessing quality of trauma care, establishing reliable quality indicators (QIs), and standardising auditing processes to guide improvements in patient outcomes and system performance.
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Affiliation(s)
- Isidro Martínez Casas
- Trauma and Emergency Surgery Unit, General Surgery Department, Virgen del Rocío University Hospital, Sevilla, Spain
| | - Ingo Marzi
- Department of Trauma Surgery and Orthopedics, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany.
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109
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Aguilar-Ancori EG, Marin-Carrasco M, Campo-Pfuyo LI, Muñiz-Duran JG, Espinoza-Culupú A. Identification of pandemic ST147, ESBL-type β-lactamases, carbapenemases, and virulence factors in Klebsiella pneumoniae isolated from southern Peru. Sci Rep 2025; 15:14870. [PMID: 40295561 PMCID: PMC12037762 DOI: 10.1038/s41598-025-97464-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2024] [Accepted: 04/04/2025] [Indexed: 04/30/2025] Open
Abstract
Multidrug-resistant Klebsiella pneumoniae (MDR K. pneumoniae) is a significant pathogen associated with nosocomial infections, often leading to high morbidity and mortality. This resistance is largely due to the efficient horizontal transfer of mobile genetic elements such as plasmids, which carry resistance genes and virulence factors. These elements contribute to the production of extended-spectrum β-lactamases (ESBL) and carbapenemases, which further complicates treatment. Despite the high prevalence of MDR K. pneumoniae in Peruvian hospitals, the genomic characterization of these strains remains limited. This study investigated the phenotypic and molecular identification of extended-spectrum β-lactamases (ESBLs), carbapenemases, and virulence factors in 91 MDR K. pneumoniae strains collected from three hospitals between 2022 and 2023. Phenotypic detection of ESBLs was performed using the Jarlier method, while carbapenemases were identified via double-disk synergy testing with boronic acid, EDTA, and Carba NP test. The positive isolates were further analyzed for resistance genes (blaCTX-M, blaTEM, blaSHV, blaKPC, blaNDM, blaIMP, and blaVIM). Four isolates were subjected to whole-genome sequencing (WGS) for further characterization. All multidrug-resistant K. pneumoniae strains (100%) were ESBL-positive, with 14.3% producing carbapenemases, primarily KPC-type and metallo-β-lactamases (MBLs). The virulence factor analyses revealed that only 7.7% exhibited hypermucoviscosity. Protease activity was detected in 19.8% of the strains, and lipase activity in 1.1%. Regarding biofilm formation, 85.7% of the strains showed moderate adherence. Molecular analysis identified ESBL (blaCTX-M, 78%; blaTEM, 71.4%; blaSHV, 82.4%) and carbapenemase genes (blaKPC 7.7%, blaNDM 4.4%). Genomic analysis revealed various antimicrobial resistance mechanisms, including porin-coding gene mutations, aminoglycoside resistance linked to fluoroquinolone resistance, and multidrug efflux pump regulators. Sequence typing has identified high-risk clones (ST147, ST629, and ST37) associated with hospital outbreaks globally. These findings underscore the considerable concern of MDR and hypervirulent K. pneumoniae in Peruvian hospitals. These findings emphasize the pressing need for sustained genomic surveillance, enhanced infection control measures, and strategies to address the expanding problem of MDR K. pneumoniae.
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Affiliation(s)
- Elsa Gladys Aguilar-Ancori
- Faculty of Biological Sciences, Universidad Nacional de San Antonio Abad del Cusco, Cusco, Peru.
- University Institute of Tropical Diseases and Biomedicine of Cusco, UNSAAC, Cusco, Peru.
| | - Marishani Marin-Carrasco
- Faculty of Biological Sciences, Universidad Nacional de San Antonio Abad del Cusco, Cusco, Peru
- University Institute of Tropical Diseases and Biomedicine of Cusco, UNSAAC, Cusco, Peru
| | | | | | - Abraham Espinoza-Culupú
- Molecular Microbiology and Biotechnology Laboratory, Faculty of Biological Sciences, Universidad Nacional Mayor de San Marcos, Lima, Peru
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Arribas-Leal JM, Rivera-Caravaca JM, Vicente-Andreu C, Verdú-Verdú A, Sornichero Á, Pérez-Martínez D, Blanco-Morillo J, Gutiérrez F, Simón-Páez M, Jara R, Canovas-Lopez SJ, Albacete-Moreno C. Experience with ECMO therapy for acute respiratory distress syndrome treatment throughout the COVID-19 pandemic. Med Intensiva 2025:502207. [PMID: 40300975 DOI: 10.1016/j.medine.2025.502207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2024] [Revised: 02/14/2025] [Accepted: 03/13/2025] [Indexed: 05/01/2025]
Abstract
OBJECTIVE To analyze our experience with extracorporeal membrane oxygenation (ECMO) therapy for acute respiratory distress syndrome (ARDS) treatment during the COVID-19 pandemic. DESIGN Retrospective, observational, single center study. SETTING Third-level hospital in Spain. PATIENTS Adult patients with COVID-19 ARDS treated with an ECMO system in our center between March 2020 and March 2023. INTERVENTIONS Retrospective collection of variables during hospital admission and follow-up. MAIN VARIABLES OF INTEREST Demographic variables, clinical history, variables related to ECMO therapy, COVID-19 wave number, in-hospital mortality, adverse events, ICU and hospital length of stay, and functional status at follow-up were collected. RESULTS Eighty-one patients were included. Of these, 61 patients (75%) died during hospitalization. Patients who died were older and had more comorbidities. During the second, third, and sixth waves, mortality was higher. In the multivariate analysis, the only independent predictor of mortality was age (OR 1.24 95% CI (1.027-1.5, P = 0.025). After discharge, 40% of patients had difficulties returning to normal life due to respiratory failure requiring oxygen and arthropathies. CONCLUSION In-hospital mortality increased during the pandemic. Older age was the only independent predictor of mortality. After discharge, no deaths were recorded during the first 18 months of follow-up, although 40% of surviving patients had respiratory and motor sequelae making it difficult for them to return to a normal life.
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Affiliation(s)
- José María Arribas-Leal
- Department of Cardiovascular Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain.
| | - José Miguel Rivera-Caravaca
- Faculty of Nursing, University of Murcia, Murcia, Spain; Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - Claudia Vicente-Andreu
- Department of Cardiovascular Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - Alicia Verdú-Verdú
- Perfusion Service and Extracorporeal Therapies, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Ángel Sornichero
- Perfusion Service and Extracorporeal Therapies, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Daniel Pérez-Martínez
- Department of Intensive Care, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Juan Blanco-Morillo
- Perfusion Service and Extracorporeal Therapies, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Francisco Gutiérrez
- Department of Cardiovascular Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - Marina Simón-Páez
- Department of Microbiology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Rubén Jara
- Department of Intensive Care, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Sergio J Canovas-Lopez
- Department of Cardiovascular Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - Carlos Albacete-Moreno
- Department of Intensive Care, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
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111
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Li T, Cui H, Ma W, Li F, Yang H, Cheng Y, Quan G. Nephrotic syndrome complicated with disseminated Nocardia sepsis: a case report and literature review. BMC Infect Dis 2025; 25:608. [PMID: 40287633 PMCID: PMC12032823 DOI: 10.1186/s12879-025-11018-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2024] [Accepted: 04/21/2025] [Indexed: 04/29/2025] Open
Abstract
We present a patient diagnosed with nephrotic syndrome and disseminated Nocardia sepsis who was successfully treated with a combination of antibiotics and supportive care, including extracorporeal membrane oxygenation (ECMO). In addition, we performed a literature review of similar cases to provide valuable guidance for future management of cases. The present case demonstrates that ECMO should be included in the comprehensive treatment strategy for disseminated Nocardia sepsis in a patient with nephrotic syndrome. In the present case, Nocardia infection occurred during prolonged steroid and immunosuppressive therapy for nephrotic syndrome, accompanied by septic shock, respiratory failure, multiple organ dysfunction, ventilator-associated pneumonia, catheter-associated bloodstream infection with multidrug-resistant bacteria potentially due to ECMO, and hemopneumothorax. The patient received invasive ventilation, ECMO, hemoperfusion for cytokine removal, and thoracoscopic drainage, which effectively eliminated symptoms to achieve complete recovery. ECMO was applied as a life-support intervention to manage severe respiratory failure and septic shock secondary to disseminated Nocardia sepsis. This approach provides adequate infection control and stabilization of organ functions. The findings suggested that a combination of 2 to 3 antibiotics, including trimethoprim-sulfamethoxazole, imipenem, and linezolid, alleviated the severe Nocardia infections. Therefore, ECMO may serve as a supportive intervention in severe infections but requires careful risk-benefit analysis. In such cases, strict monitoring is required to prevent the occurrence of bloodstream infections, particularly multidrug-resistant bacteria, during ECMO cannulas or circuits.
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Affiliation(s)
- Ting Li
- Department of Respiratory and Critical Care Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, China
| | - Haiyan Cui
- Department of Respiratory and Critical Care Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, China
| | - Weiquan Ma
- Department of Critical Care Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, China
| | - Fen Li
- Department of Critical Care Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, China
| | - Hong Yang
- Department of Critical Care Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, China.
| | - Yuanxiong Cheng
- Department of Respiratory and Critical Care Medicine, Guangdong Second Provincial General Hospital, Guangzhou, 510403, China.
| | - Guoli Quan
- Department of Respiratory and Critical Care Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, China.
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de Miguel-Balsa E, Rios-Albert E, Quevedo-Sánchez B, Jorda-Miñana A, Portillo-Requena C, Perez-Quesada S, Alfaro-Garcia E, Alcalá-López A. Comparative analysis of patient and family satisfaction in Spanish Intensive Care Units: A cross-sectional study of the impact of diagnosis. Anaesth Crit Care Pain Med 2025; 44:101515. [PMID: 40286874 DOI: 10.1016/j.accpm.2025.101515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Revised: 12/10/2024] [Accepted: 12/11/2024] [Indexed: 04/29/2025]
Abstract
BACKGROUND Analysing relatives and patients experiences and satisfaction can highlight areas for improving Intensive Care Units (ICUs) care. Patients and families may differ about satisfaction and experience, depending on the diagnosis and procedures. We aimed to compare the experience and satisfaction of patients according to diagnosis, severity, and the procedures received, and also between relatives and patients. METHODS Prospective analysis of voluntary responses to the FS (Family Satisfaction)- ICU 24 R questionnaire from surviving ICU patients and their relatives (January-April 2023) in four Spanish hospitals, according to diagnostic groups. Responses were scored on a Likert scale (0: worst score; 100: best score), and means and standard deviations were compared. RESULTS 185 responses were analysed, mostly acute cardiac pathology patients (91, 50.83%), followed by septic shock patients (22.9%). Patients rated the team performance higher than their relatives (98.79 ± 5.37 vs 89.68 ± 18.43; p < 0.0001), also symptom management such as pain (95.62 ± 9.52 vs 89.64 ± 17.24; p = 0.0001, and dyspnoea (94.23 ± 12.27 vs 88.09 ± 17.87; p = <0.001), the information process (91.50 ± 13.43 vs 83.17 ± 21.00; p < 0.001), and decision-making (80.38 ± 13.60 vs 65.84 ± 23.60; p < 0.001). Patients found visits to be scarce (43.75 ± 20.79), although their families were satisfied with their involvement in care (85.49 ± 19.64). Patients with sepsis and septic shock rated pain management the lowest compared to other diagnostic groups (sepsis/septic shock 89.58 ± 12.5 vs 98.61 ± 5.89; p < 0.001). CONCLUSIONS Open visiting policies and enhancing the protocols for conscious sedation/analgesia in invasive procedures are opportunities to improve the satisfaction and experience of ICU patients and their families.
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Affiliation(s)
- Eva de Miguel-Balsa
- Clinical Medicine Department, Medicine Faculty. Miguel Hernández University, Crta. Nacional, N-332 s/n, 03550 Sant Joan (Alicante). Spain; Intensive Care Medicine Department. Hospital General Universitario de Elche, C/Almazara, 11, 03203 Elche (Alicante). Spain.
| | - Esther Rios-Albert
- Foundation for the Promotion of Health and Biomedical Research in the Valencian Community (FISABIO), Av. de Catalunya, 21, 46020 Benimaclet, (Valencia). Spain
| | - Beatriz Quevedo-Sánchez
- Intensive Care Medicine Department, Hospital Clínico Universitario de Valencia, Av. de Blasco Ibáñez, 17. 46010, El Pla del Real (Valencia). Spain
| | - Angela Jorda-Miñana
- Intensive Care Medicine Department, Hospital Clínico Universitario de Valencia, Av. de Blasco Ibáñez, 17. 46010, El Pla del Real (Valencia). Spain
| | - Cristina Portillo-Requena
- Intensive Care Medicine Department, Hospital Vega Baja. Ctra, Orihuela - Almoradí S/N, 03314 ,San Bartolomé (Alicante). Spain
| | - Sonia Perez-Quesada
- Intensive Care Medicine Department, Hospital General Universitario de Elda, Ctra. Sax- La Torreta, S/N. 03600 Elda, (Alicante). Spain
| | - Elena Alfaro-Garcia
- Intensive Care Medicine Department. Hospital General Universitario de Elche, C/Almazara, 11, 03203 Elche (Alicante). Spain
| | - Adoración Alcalá-López
- Intensive Care Medicine Department. Hospital General Universitario de Elche, C/Almazara, 11, 03203 Elche (Alicante). Spain
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Diéguez Castillo C, Sidahi Serrano M, Martín Aguilar A, De Luis Román D. Use of Oligomeric Formulas in Malabsorption: A Delphi Study and Consensus. Nutrients 2025; 17:1426. [PMID: 40362734 PMCID: PMC12073096 DOI: 10.3390/nu17091426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2025] [Revised: 04/11/2025] [Accepted: 04/15/2025] [Indexed: 05/15/2025] Open
Abstract
Background: Malabsorption syndrome is characterized by chronic diarrhea, abdominal distension, and malnutrition, thereby complicating its diagnosis and treatment. Oligomeric enteral formulas, designed to facilitate absorption in patients with compromised bowel function, have shown clinical efficacy, though their implementation lacks standardization due to the lack of uniform protocols. Objective: To establish a multidisciplinary consensus on the use of oligomeric formulas in patients with malabsorption using a Delphi methodology. Material and Method: A Delphi study was conducted with 156 specialists in endocrinology, gastroenterology, oncology, and internal medicine. Two rounds of structured surveys assessed clinical practices, associated symptoms, and the use of oligomeric enteral formulas. Data were analyzed using descriptive statistics and non-parametric tests, defining consensus with a median of ≥7 and an interquartile range of ≤3. Likewise, a Median (MED) score of ≤3 was considered as a consensus to reject the statement, while an Interquartile range (IQR) of ≥4 or a MED of 4-6 was considered as no agreement. These statements were reviewed and included in the second round. Results: Screening for malnutrition is widely supported (79%), but only 38% of participants reported having specific management protocols. Symptoms such as abdominal distension, abdominal pain, and diarrhea were identified as key predictors of intolerance to polymeric formulas, establishing oligomeric enteral formulas as first choice in these cases. In addition, the effectiveness of an approach that progresses from oligomeric to polymeric enteral formulas once symptoms have stabilized was highlighted. The need for standardized protocols was recognized as a priority to guide nutritional assessment and treatment in patients with malabsorption. Conclusions: This consensus reinforces the importance of implementing specific clinical protocols for the nutritional management of malabsorption, including the initial use of oligomeric enteral formulas in patients with severe symptoms and their controlled transition to polymeric enteral formulas.
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Affiliation(s)
| | | | | | - Daniel De Luis Román
- Center of Investigation Endocrinology and Nutrition, Valladolid University Clinical Hospital, Medicine School University, 47002 Valladolid, Spain;
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Marioni J, Romero BC, Mugas ML, Martinez F, Gómez TI, Morales JMN, Konigheim BS, Borsarelli CD, Nuñez-Montoya SC. The Natural Anthraquinone Parietin Inactivates Candida tropicalis Biofilm by Photodynamic Mechanisms. Pharmaceutics 2025; 17:548. [PMID: 40430841 PMCID: PMC12114814 DOI: 10.3390/pharmaceutics17050548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2025] [Revised: 04/11/2025] [Accepted: 04/11/2025] [Indexed: 05/29/2025] Open
Abstract
Background/Objectives: Parietin (PTN), a blue-light absorbing pigment from Teloschistes spp. lichens, exhibit photosensitizing properties via Type I (superoxide anion, O2•-) and Type II (singlet oxygen, 1O2) mechanisms, inactivating bacteria in vitro after photoexcitation. We evaluate the in vitro antifungal activity of PTN against Candida tropicalis biofilms under actinic irradiation, its role in O2•- and 1O2 production, and the cellular stress response. Methods: Minimum inhibitory concentration (MIC) of PTN was determined in C. tropicalis NCPF 3111 under dark and actinic light conditions. Biofilm susceptibility was assessed at MIC/2, MIC, MICx2, MICx4, and MICx6 in the same conditions, and viability was measured by colony-forming units. Photodynamic mechanisms were examined using Tiron (O2•- scavenger) or sodium azide (1O2 quencher). O2•- production was measured by the nitro-blue tetrazolium (NBT) reduction and nitric oxide (NO) generation by Griess assay. Total antioxidant capacity was studied by FRAP (Ferrous Reduction Antioxidant Potency) assay and superoxide dismutase (SOD) activity by NBT assay. Results: Photoexcitation of PTN reduced C. tropicalis biofilm viability by four logs at MICx2. Sodium azide partially reversed the effect, whereas Tiron fully inhibited it, indicating the critical role of O2•-. PTN also increased O2•- and NO levels, enhancing SOD activity and FRAP. However, this antioxidant response was insufficient to prevent biofilm photoinactivation. Conclusions: Photoinactivation of C. tropicalis biofilms by PTN is primarily mediated by O2•-, with a minor contribution from 1O2 and an imbalance in NO levels. These findings suggest PTN is a promising photosensitizer for antifungal photodynamic therapy.
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Affiliation(s)
- Juliana Marioni
- Departamento de Ciencias Farmacéuticas, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Haya de la Torre y Medina Allende, Ciudad Universitaria, Córdoba X5000HUA, Argentina; (J.M.); (B.C.R.); (T.I.G.)
- Instituto de Bionanotecnología del NOA (INBIONATEC), Universidad Nacional de Santiago del Estero—CONICET, RN9, Km 1125, Santiago del Estero G4206XCP, Argentina; (J.M.N.M.); (C.D.B.)
| | - Bianca C. Romero
- Departamento de Ciencias Farmacéuticas, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Haya de la Torre y Medina Allende, Ciudad Universitaria, Córdoba X5000HUA, Argentina; (J.M.); (B.C.R.); (T.I.G.)
- CONICET, Unidad de Investigación y Desarrollo en Tecnología Farmacéutica (UNITEFA), Haya de la Torre y Medina Allende, Ciudad Universitaria, Córdoba X5000HUA, Argentina
| | - Ma. Laura Mugas
- Departamento de Ciencias Farmacéuticas, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Haya de la Torre y Medina Allende, Ciudad Universitaria, Córdoba X5000HUA, Argentina; (J.M.); (B.C.R.); (T.I.G.)
- Centro de Investigaciones sobre Porfirinas y Porfirias (CIPYP), CONICET and Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Córdoba 2351 1er subsuelo, Ciudad de Buenos Aires 1120AAF, Argentina
| | - Florencia Martinez
- Instituto de Virología “Dr. J. M. Vanella”, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba X5000HUA, Argentina; (F.M.); (B.S.K.)
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Córdoba X5000HUA, Argentina
| | - Tomas I. Gómez
- Departamento de Ciencias Farmacéuticas, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Haya de la Torre y Medina Allende, Ciudad Universitaria, Córdoba X5000HUA, Argentina; (J.M.); (B.C.R.); (T.I.G.)
- CONICET, Unidad de Investigación y Desarrollo en Tecnología Farmacéutica (UNITEFA), Haya de la Torre y Medina Allende, Ciudad Universitaria, Córdoba X5000HUA, Argentina
- Instituto de Virología “Dr. J. M. Vanella”, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba X5000HUA, Argentina; (F.M.); (B.S.K.)
| | - Jesús M. N. Morales
- Instituto de Bionanotecnología del NOA (INBIONATEC), Universidad Nacional de Santiago del Estero—CONICET, RN9, Km 1125, Santiago del Estero G4206XCP, Argentina; (J.M.N.M.); (C.D.B.)
| | - Brenda S. Konigheim
- Instituto de Virología “Dr. J. M. Vanella”, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba X5000HUA, Argentina; (F.M.); (B.S.K.)
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Córdoba X5000HUA, Argentina
| | - Claudio D. Borsarelli
- Instituto de Bionanotecnología del NOA (INBIONATEC), Universidad Nacional de Santiago del Estero—CONICET, RN9, Km 1125, Santiago del Estero G4206XCP, Argentina; (J.M.N.M.); (C.D.B.)
| | - Susana C. Nuñez-Montoya
- Departamento de Ciencias Farmacéuticas, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Haya de la Torre y Medina Allende, Ciudad Universitaria, Córdoba X5000HUA, Argentina; (J.M.); (B.C.R.); (T.I.G.)
- CONICET, Unidad de Investigación y Desarrollo en Tecnología Farmacéutica (UNITEFA), Haya de la Torre y Medina Allende, Ciudad Universitaria, Córdoba X5000HUA, Argentina
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Ikumi S, Tarasawa K, Shiga T, Imaizumi T, Kaiho Y, Iwasaki Y, Yabuki S, Wagatsuma Y, Takaya E, Fushimi K, Ito Y, Fujimori K, Yamauchi M. Outcomes and cost-effectiveness of intermediate care units for patients discharged from the intensive care unit: a nationwide retrospective observational study. Crit Care 2025; 29:157. [PMID: 40269982 PMCID: PMC12020178 DOI: 10.1186/s13054-025-05393-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2024] [Accepted: 03/28/2025] [Indexed: 04/25/2025] Open
Abstract
BACKGROUND The clinical and economic impacts of intermediate care units (IMCUs) on intensive care unit (ICU)-discharged patients remain unclear due to inconsistent outcomes in previous studies. Under Japan's National Health Insurance Scheme, ICUs are categorized by staffing intensity (high or low). Using a nationwide inpatient database in Japan, we evaluated the clinical outcomes and cost-effectiveness of IMCUs for ICU-discharged patients. METHODS This retrospective observational study used a Japanese administrative database to identify patients admitted to the high-intensity ICU in hospitals with IMCUs between April 2020 and March 2023. Patients were categorized into the IMCU (IMCU group) and general ward (non-IMCU) groups. Propensity scores were estimated using a logistic regression model incorporating 14 variables, including patient demographics, and treatments received during ICU stay. One-to-one propensity score matching balanced baseline characteristics of each group. Clinical outcomes were compared between both groups, including in-hospital mortality, ICU readmission, length of ICU stay, length of hospital stay, and total medical costs. Surgical status and surgical area (e.g., cardiovascular) were considered in subgroup analyses. Data analyses were conducted using the chi-square test for categorical variables and t-test for continuous variables. RESULTS Overall, 162,243 eligible patients were categorized into the IMCU (n = 21,548) and non-IMCU (n = 140,695) groups. Propensity score matching generated 18,220 pairs. The IMCU group had lower in-hospital mortality and ICU readmission rates than the non-IMCU group. However, total costs were higher in the IMCU group. Subgroup analyses revealed the IMCU group had significantly lower mortality and lower total costs than the non-IMCU group in the cardiovascular [open thoracotomy] surgery subgroup. CONCLUSIONS Discharge to an IMCU is associated with lower in-hospital mortality and ICU readmission rates compared to general ward discharge. High-risk subgroups, such as cardiovascular surgery patients, experienced cost-effective benefits from IMCU care. These findings highlight an association between IMCU admission and improved patient outcomes, suggesting a potential role in optimizing resource use in intensive care. Given the likelihood of selection bias in admission allocation, these findings should be interpretation with caution.
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Affiliation(s)
- Saori Ikumi
- Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- AI Lab, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Kunio Tarasawa
- Department of Health Administration and Policy, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Takuya Shiga
- Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
- Experience Design and Alliance Section, Tohoku University Hospital, Sendai, Miyagi, Japan.
| | - Takahiro Imaizumi
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Yu Kaiho
- Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yudai Iwasaki
- Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Department of Emergency Medicine and Critical Care Medicine, Tochigi Prefectural Emergency and Critical Care Centre, Imperial Foundation Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan
| | - Shizuha Yabuki
- Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yukito Wagatsuma
- Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Eichi Takaya
- AI Lab, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, Bunkyo-Ku, Tokyo, Japan
| | - Yukiko Ito
- College of Policy Studies, Tsuda University, Shibuya, Tokyo, Japan
| | - Kenji Fujimori
- Department of Health Administration and Policy, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Masanori Yamauchi
- Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Jalil Y, Damiani LF, García-Valdés P, Basoalto R, Gallastegui J, Gutierrez-Arias R. Myokine Secretion Dynamics and Their Role in Critically Ill Patients: A Scoping Review. J Clin Med 2025; 14:2892. [PMID: 40363924 PMCID: PMC12072662 DOI: 10.3390/jcm14092892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2025] [Revised: 01/28/2025] [Accepted: 02/10/2025] [Indexed: 05/10/2025] Open
Abstract
Background/Objectives: Myokines can modulate organ function and metabolism, offering a protective profile against ICU complications beyond preventing local muscle wasting. This scoping review aims to explore and summarize the evidence regarding the secretion of myokines and their potential local or systemic effects in critically ill patients. Methods: A scoping review following Joana Briggs Institute recommendations was conducted. A systematic search of MEDLINE (Ovid), Embase (Ovid), CENTRAL, CINAHL (EBSCOhost), WoS, and Scopus was conducted from inception to February 2023. We included primary studies evaluating myokine secretion/concentration in critically ill adults undergoing physical rehabilitation interventions. Two independent reviewers performed study selection and data extraction. Results: Seventeen studies published between 2012 and 2023 were included. Most were randomized clinical trials (47%). Physical rehabilitation interventions included electrical muscle stimulation, as well as passive and active mobilization, delivered alone or combined, in single or daily sessions lasting 20-60 min. Twelve studies (70%) evaluated interleukin-6, while interleukin-10, tumour necrosis factor-α, Interleukin-8, and myostatin were also commonly studied. Thirteen studies (76%) reported changes in myokine secretion or gene expression, although no clear concentration change pattern emerged. Myokines involved in muscle protein synthesis and breakdown may protect against muscle waste and weakness. Conclusions: The study of myokine dynamics in critically ill patients highlights the systemic impact of physical rehabilitation. This emerging field has grown in interest over the past decade, offering significant research potential. However, challenges such as study design, small sample sizes, and variability in physical therapy protocols hinder a comprehensive understanding of myokine responses.
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Affiliation(s)
- Yorschua Jalil
- Escuela de Ciencias de la Salud, Departamento de Kinesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 1270709, Chile; (Y.J.); (L.F.D.); (P.G.-V.); (J.G.)
- CardioREspirAtory Research Laboratory, Departamento Ciencias de la Salud, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile;
- Department of Intensive Care Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 1270709, Chile
| | - L. Felipe Damiani
- Escuela de Ciencias de la Salud, Departamento de Kinesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 1270709, Chile; (Y.J.); (L.F.D.); (P.G.-V.); (J.G.)
- CardioREspirAtory Research Laboratory, Departamento Ciencias de la Salud, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile;
- Department of Intensive Care Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 1270709, Chile
| | - Patricio García-Valdés
- Escuela de Ciencias de la Salud, Departamento de Kinesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 1270709, Chile; (Y.J.); (L.F.D.); (P.G.-V.); (J.G.)
- CardioREspirAtory Research Laboratory, Departamento Ciencias de la Salud, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile;
| | - Roque Basoalto
- CardioREspirAtory Research Laboratory, Departamento Ciencias de la Salud, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile;
- Department of Intensive Care Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 1270709, Chile
| | - Julen Gallastegui
- Escuela de Ciencias de la Salud, Departamento de Kinesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 1270709, Chile; (Y.J.); (L.F.D.); (P.G.-V.); (J.G.)
| | - Ruvistay Gutierrez-Arias
- Departamento de Apoyo en Rehabilitación Cardiopulmonar Integral, Instituto Nacional del Tórax, Santiago 8320000, Chile
- INTRehab Research Group, Instituto Nacional del Tórax, Santiago 8320000, Chile
- Faculty of Rehabilitation Sciences, Exercise and Rehabilitation Sciences Institute, Universidad Andres Bello, Santiago 7591538, Chile
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Krivonos D, Pavlenko A, Lukina-Gronskaya A, Korneenko E, Speranskaya A, Ilina E. Case Report: Fatal case of dual infection Metapneumovirus complicated by Streptococcus pyogenes. Front Med (Lausanne) 2025; 12:1576583. [PMID: 40330784 PMCID: PMC12052555 DOI: 10.3389/fmed.2025.1576583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2025] [Accepted: 03/31/2025] [Indexed: 05/08/2025] Open
Abstract
Human Metapneumovirus (hMPV) is a common cause of acute respiratory viral infection in humans, typically occurring in children and causing no serious complications. However, the severity of the disease can be exacerbated by certain bacterial pathogens that lead to severe illness and even death. This report details a fulminant case of dual infection with hMPV and group A Streptococcus (Streptococcus pyogenes) in a three-year-old child. The whole genome sequencing of isolated clinical S. pyogenes strains was conducted, followed by an analysis of the genomic characteristics of the pathogen. Also, potential viral and bacterial pathogens were identified by qPCR and 16S rRNA metagenomic sequencing in any autopsy materials obtained from the patient. Children who had contact with the patient and began to exhibit symptoms of a cold were also tested and confirmed to have uncomplicated hMPV infection. The S. pyogenes strain has been found to contain five genes for various streptococcal exotoxins (speA, speB, speJ, speG and smeZ). In addition, the speA gene is situated in close proximity to the prophage, which may suggest that it is encoded and transferred specifically by the bacteriophage. We hypothesize that it was the cumulative effects of different streptococcal exotoxins that led to the patient's death.
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Affiliation(s)
- Danil Krivonos
- Research Institute for Systems Biology and Medicine (RISBM), Moscow, Russia
- Moscow Center for Advanced Studies, Moscow, Russia
| | - Alexander Pavlenko
- Research Institute for Systems Biology and Medicine (RISBM), Moscow, Russia
| | | | - Elena Korneenko
- Research Institute for Systems Biology and Medicine (RISBM), Moscow, Russia
- Saint Petersburg Pasteur Institute, Federal Service on Consumer Rights Protection and Human Well-Being Surveillance, Saint Petersburg, Russia
| | - Anna Speranskaya
- Research Institute for Systems Biology and Medicine (RISBM), Moscow, Russia
| | - Elena Ilina
- Research Institute for Systems Biology and Medicine (RISBM), Moscow, Russia
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Tigano S, Casolaro G, Bianchini A, Bernardi E, Laici C, Ramahi L, Vitale G, Siniscalchi A. Hemodynamic Monitoring During Liver Transplantation for Patients on Perioperative Extracorporeal Membrane Oxygenation (ECMO) Support: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:768. [PMID: 40283059 PMCID: PMC12028808 DOI: 10.3390/medicina61040768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2025] [Revised: 04/04/2025] [Accepted: 04/16/2025] [Indexed: 04/29/2025]
Abstract
Background and Objectives: Indications for liver transplants are increasing worldwide due to the growing number of transplants performed on patients with significant cardiovascular and respiratory risk factors. Additional support for this trend comes from the growing use of marginal organs, which is made possible by donations made after circulatory death (DCD). Liver transplantation (LT) in such high-risk patients may be challenging and may require perioperative Extracorporeal Membrane Oxygenation (ECMO). There is a lack of evidence on the best hemodynamic monitoring techniques for patients undergoing ECMO support during the perioperative period of LT. This review aims to provide a comprehensive overview of the hemodynamic monitoring standards of patients supported by ECMO before, during, and after LT. Materials and Methods: Comprehensive research was conducted through the PubMed database, and 153 articles regarding patients who needed perioperative ECMO support were found. Among these, 18 articles were finally included in our analysis as the authors specified hemodynamic monitoring techniques and data. The articles included case reports, letters to the editor, and correspondence. Results: We identified 20 cases of patients supported by ECMO as a planned preoperative strategy (9 patients), as a rescue therapy during surgery (7 patients), and as a postoperative support (4 patients). Cardiac catheterism and echocardiography (transthoracic and transesophageal) were the authors' most cited hemodynamic monitoring techniques. Conclusions: Data on hemodynamic monitoring methods used to manage patients supported by ECMO during the whole perioperative period of LT are poor and derived from descriptive low-quality studies. However, a multimodal approach that includes continuous monitoring of pulmonary pressures and echocardiography can increase diagnostic accuracy and improve the decision-making process to manage this complex patient population.
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Affiliation(s)
- Stefano Tigano
- Postoperative and Abdominal Organ Transplant Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (S.T.); (A.B.); (E.B.); (C.L.); (L.R.); (A.S.)
| | - Giulio Casolaro
- Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Università di Bologna, 40126 Bologna, Italy;
| | - Amedeo Bianchini
- Postoperative and Abdominal Organ Transplant Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (S.T.); (A.B.); (E.B.); (C.L.); (L.R.); (A.S.)
| | - Enrico Bernardi
- Postoperative and Abdominal Organ Transplant Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (S.T.); (A.B.); (E.B.); (C.L.); (L.R.); (A.S.)
| | - Cristiana Laici
- Postoperative and Abdominal Organ Transplant Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (S.T.); (A.B.); (E.B.); (C.L.); (L.R.); (A.S.)
| | - Linda Ramahi
- Postoperative and Abdominal Organ Transplant Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (S.T.); (A.B.); (E.B.); (C.L.); (L.R.); (A.S.)
| | - Giovanni Vitale
- Internal Medicine Unit for the Treatment of Severe Organ Failure, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Antonio Siniscalchi
- Postoperative and Abdominal Organ Transplant Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (S.T.); (A.B.); (E.B.); (C.L.); (L.R.); (A.S.)
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Matache (Vasilache) ER, Gurau G, Raileanu CR, Zaharescu A, Popa GV, Maftei NM, Busila C, Matei MN, Tutunaru D. Pathogen Profile of Children Hospitalised with Viral Respiratory Infections in Galati County, Romania. Viruses 2025; 17:586. [PMID: 40285028 PMCID: PMC12031162 DOI: 10.3390/v17040586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2024] [Revised: 04/14/2025] [Accepted: 04/17/2025] [Indexed: 04/29/2025] Open
Abstract
Respiratory infections are the most common infectious diseases among children, representing a cause of death and generating a significant number of hospitalisations. The aim of the study was to analyse the epidemiological and clinical characteristics of viral pathogens causing respiratory tract infections in newborns and young children admitted to Galati pediatric hospital between October 2022 and December 2023. The diagnosis was performed using multiplex RT-PCR panels, which allowed simultaneous identification of respiratory pathogens (viruses and bacteria). From a total of 803 hospitalised patients with respiratory diseases, 607 (75.6%) children had a positive result for at least one respiratory virus and 96 patients (11.9%) were identified with bacterial infections. Mixed coinfections were found in almost half of the patients (44.5%). Most of RSV positive children had an increased length of stay, more than 7 days. It was shown a decline in severe cases of viral respiratory infections with prolonged hospitalisation as patients age up to 5 years.
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Affiliation(s)
- Elena-Roxana Matache (Vasilache)
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, 800008 Galati, Romania;
- Medical Laboratory Department, “Sf. Ioan” Emergency Clinical Hospital for Children, 800494 Galati, Romania;
| | - Gabriela Gurau
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, 800008 Galati, Romania;
- Medical Laboratory Department, “Sf. Ioan” Emergency Clinical Hospital for Children, 800494 Galati, Romania;
| | - Cosmin-Raducu Raileanu
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, 800008 Galati, Romania;
- Medical Laboratory Department, “Sf. Ioan” Emergency Clinical Hospital for Children, 800494 Galati, Romania;
| | - Anamaria Zaharescu
- Department of Dental Medicine, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, 800008 Galati, Romania; (A.Z.); (G.V.P.); (M.N.M.)
| | - Gabriel Valeriu Popa
- Department of Dental Medicine, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, 800008 Galati, Romania; (A.Z.); (G.V.P.); (M.N.M.)
| | - Nicoleta-Maricica Maftei
- Medical Laboratory Department, “Sf. Ioan” Emergency Clinical Hospital for Children, 800494 Galati, Romania;
- Department of Pharmaceutical Sciences, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, 80008 Galati, Romania;
| | - Camelia Busila
- “Sf. Ioan” Emergency Clinical Hospital for Children, 800494 Galati, Romania;
- Medical Clinical Department, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, 800008 Galati, Romania
| | - Madalina Nicoleta Matei
- Department of Dental Medicine, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, 800008 Galati, Romania; (A.Z.); (G.V.P.); (M.N.M.)
- “Sf. Ioan” Emergency Clinical Hospital for Children, 800494 Galati, Romania;
| | - Dana Tutunaru
- Department of Pharmaceutical Sciences, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, 80008 Galati, Romania;
- Medical Laboratory Department, “Sf. Apostol Andrei” Emergency Clinical Hospital, 800578 Galati, Romania
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Kalayci F, Ozkaya Parlakay A, Yigit M, Güler GN, Demircioglu Kalayci B, Cetin AN, Dervisoglu Yurteri M, Karakose E, Celebier K, Yilmaz N, Tolunay O. Increased risk during winter: common respiratory viruses and clinical outcomes in hospitalized children. BMC Infect Dis 2025; 25:563. [PMID: 40253326 PMCID: PMC12008977 DOI: 10.1186/s12879-025-10950-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2024] [Accepted: 04/09/2025] [Indexed: 04/21/2025] Open
Abstract
BACKGROUND Acute respiratory infections (ARIs) are a leading cause of hospitalisation, severe morbidity, and mortality in children, representing a significant public health concern. This study aimed to evaluate the clinical features, laboratory findings, and outcomes of pediatric patients hospitalised due to ARIs caused by common respiratory viruses, including influenza virüs (IFV), human bocavirus (hBoV), human metapneumovirus(hMPV), human rhinovirus (hRV), and human respiratory syncytial virüs (hRSV). METHODS We conducted a retrospective analysis of 1465 hospitalized pediatric patients at Ankara Bilkent City Hospital Children's Hospital between August 2019 and March 2024. Nasopharyngeal swabs were analyzed using multiplex real-time PCR to identify viral pathogens. Clinical data, including demographics, intensive care needs, respiratory support, and chronic health conditions, were reviewed. RESULTS A total of 1465 hospitalized children were included in the study, with a median age of 3 years and 61.8% being male. Of these patients, 32.9% (n = 482) had chronic health conditions. IFV was detected in 30.1% of patients, hBoV in 28.3%, hRSV in 18.4%, hRV in 14.4%, and hMPV in 8.8%. Over half of the infections occurred during the winter months, with IFV being the most commonly observed virus. Fever was most frequently observed in IFV cases, while cough and hypoxia were more prevalent in hBoV and hRSV infections. Admission to the Pediatric Intensive Care Unit was necessary in 19.5% of cases, with 33.1% of these requiring invasive mechanical ventilation. Invasive mechanical ventilation was most frequently required in hBoV cases. The mortality rate was 8.7%, predominantly observed in patients with chronic health conditions; hBoV was associated with the highest mortality. CONCLUSION This study provides a comprehensive analysis of the clinical, laboratory, and radiological characteristics of children hospitalized due to viral lower respiratory tract infections, offering valuable insights into common respiratory pathogens. The findings underscore a higher incidence of these infections during the winter months. It is recommended that hBoV and IFV infections be closely monitored in children with underlying chronic conditions. Moreover, the study highlights the importance of meticulous management of hBoV and hRSV infections, given their association with an increased need for intensive care support.
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Affiliation(s)
- Furkan Kalayci
- Department of Pediatrics, Ankara Bilkent City Hospital, Bilkent, Ankara, 06800, Turkey.
| | - Aslinur Ozkaya Parlakay
- Division of Pediatric Infectious Disease, Department of Pediatrics, Ankara Bilkent City Hospital, Yildirim Beyazit University, Bilkent, Ankara, 06800, Turkey
| | - Metin Yigit
- Department of Pediatrics, Ankara Bilkent City Hospital, Bilkent, Ankara, 06800, Turkey
| | - Gamze Nur Güler
- Department of Pediatrics, Ankara Bilkent City Hospital, Bilkent, Ankara, 06800, Turkey
| | | | - Aybuke Nur Cetin
- Department of Pediatrics, Ankara Bilkent City Hospital, Bilkent, Ankara, 06800, Turkey
| | | | - Ece Karakose
- Department of Pediatrics, Ankara Bilkent City Hospital, Bilkent, Ankara, 06800, Turkey
| | - Kaan Celebier
- Department of Pediatrics, Ankara Bilkent City Hospital, Bilkent, Ankara, 06800, Turkey
| | - Naci Yilmaz
- Department of Pediatrics, Ankara Bilkent City Hospital, Bilkent, Ankara, 06800, Turkey
| | - Orkun Tolunay
- Department of Pediatrics, Ankara Bilkent City Hospital, Bilkent, Ankara, 06800, Turkey
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Estela-Zape JL, Sanclemente-Cardoza V, Arzayus-Patiño L, Noreña-Buitrón LD, Espinosa MA. Rhabdomyosarcoma in adults with severe thrombocytopenia: Challenges in clinical management and therapeutic complications. Respir Med Case Rep 2025; 55:102211. [PMID: 40343148 PMCID: PMC12059698 DOI: 10.1016/j.rmcr.2025.102211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2025] [Revised: 03/30/2025] [Accepted: 04/11/2025] [Indexed: 05/11/2025] Open
Abstract
Alveolar rhabdomyosarcoma (ARMS) in adults is a rare condition with a poor prognosis compared to other subtypes. The management of this pathology is complex due to the lack of standardized guidelines and the limited response to multimodal treatments, including chemotherapy, radiotherapy, and surgery. We report the case of a 40-year-old male with stage IV ARMS and pulmonary metastasis, who underwent resection of right supraclavicular sarcoma and cervical lymph node dissection. He was later referred for palliative chemotherapy following an acute clinical presentation lasting two days, characterized by right facial edema, inflammation, ulceration, and severe pain. Initial treatment included ampicillin/sulbactam, trimethoprim/sulfamethoxazole, and dexamethasone. Chemotherapy with doxorubicin and ifosfamide was delayed due to thrombocytopenia, elevated D-dimer and fibrinogen levels, and an echocardiographic finding that required differentiation between thrombus and metastatic lesion. Anticoagulation with fondaparinux and transfusions were initiated, and the patient received 10 sessions of radiotherapy. During hospitalization, the patient developed orthopnea, pleural effusion, superior vena cava syndrome, and hemodynamic deterioration, necessitating vasopressor support and mechanical ventilation. Despite these interventions, the patient progressed to refractory shock, severe hypoxemia, and died from cardiac arrest. This case highlights the challenges in managing ARMS in adults with severe thrombocytopenia.
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Russo L, Kazmi A, Ahmed N. Current Management and Future Challenges in the Management of Severe Traumatic Brain Injury. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:738. [PMID: 40283029 PMCID: PMC12028990 DOI: 10.3390/medicina61040738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2025] [Revised: 04/10/2025] [Accepted: 04/14/2025] [Indexed: 04/29/2025]
Abstract
Background and Objectives: Severe Traumatic Brain Injury (TBI) is one of the devastating injuries occurring in all ages across the globe. Despite many advancements in the management of severe TBI, mortality and morbidities remain high. Evidence-based management in severe TBI has reduced mortality. The purpose of this review is to discuss the current management and present the future challenges in this patient cohort. Materials and Methods: A literature review was conducted to identify the current practice patterns and guidelines of severe TBI. We examined the literature regarding medical and surgical managements of the severe TBI. Results: Initial management of severe TBI includes stabilization of the primary injury and prevention of secondary insult to brain. Hemodynamic, intracranial pressure and cerebral perfusion pressure monitoring, antiseizure prophylaxis, hyperosmolar therapy, sedation, medical induced coma, and nutritional and ventilatory support are part of the medical management. Operative intervention includes craniotomy and decompressive craniectomy. Most of the current practices are recommended by the Brain Trauma Foundation (BTF). These guidelines are based on the existing literature, however, some of the recommendations by the BTF lack level one evidence. Conclusions: BTF guidelines provide recommendations in the management of severe TBI. High quality prospective randomized trials are needed to further explore the new modalities and interventions in the field of severe TBI.
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Affiliation(s)
- Larissa Russo
- Department of Surgery, Division of Trauma, Jersey Shore University Medical Center, Neptune, NJ 07753, USA;
| | - Aasim Kazmi
- Department of Neurosurgery, Jersey Shore University Medical Center, Neptune, NJ 07753, USA;
| | - Nasim Ahmed
- Department of Surgery, Division of Trauma, Jersey Shore University Medical Center, Neptune, NJ 07753, USA;
- Hackensack Meridian School of Medicine, Nutley, NJ 07110, USA
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Balaram DS, Gutti NB, Gutte SH. Paroxysmal Sympathetic Hyperactivity in Dengue Encephalitis: An Overlooked Entity. Neurol India 2025:02223311-990000000-00082. [PMID: 40238655 DOI: 10.4103/neurol-india.neurol-india-d-23-00448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 05/06/2024] [Indexed: 04/18/2025]
Affiliation(s)
- Deepika Shree Balaram
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Nagendra B Gutti
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Shreyas H Gutte
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
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Tack J, Bruyneel A, Maes J, Mercier G, Taccone FS, Pirson M. Association Between Nursing Workload and Intensive Care Unit Readmissions: A Prospective Cohort Study. J Adv Nurs 2025. [PMID: 40239007 DOI: 10.1111/jan.16984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2024] [Revised: 03/18/2025] [Accepted: 04/07/2025] [Indexed: 04/18/2025]
Abstract
AIM The aim of this study was to assess the relationship between nursing workload at the time of intensive care unit discharge and the likelihood of intensive care unit readmission. DESIGN This single-center prospective cohort study was conducted at a Belgian academic hospital and included all intensive care unit admissions from June 1, 2021 to May 31, 2022. METHODS The Nursing Activities Score was documented by the nurse responsible for each patient during every shift. Adult patients (≥ 18 years) with intensive care unit stay exceeding 24 h during the study period were eligible for inclusion. Those discharged to another hospital, a nursing home, or their own home were excluded due to the inability to ensure follow-up. RESULTS Among the 1293 eligible admissions recorded during the study period, 133 patients (10.3%) experienced readmission. Readmitted patients exhibited a higher prevalence of medical reasons for intensive care unit admission, significantly increased mortality rates, and longer hospital length of stay compared to non-readmitted patients. The average daily Nursing Activities Score did not differ significantly between the two groups. The Nursing Activities Score at intensive care unit discharge was notably higher in readmitted patients, and those with a score above the median at discharge demonstrated an increased risk of readmission within 30 days. In multivariable analysis, a high Nursing Activities Score at intensive care unit discharge was an independent predictor of readmission. CONCLUSIONS An elevated nursing workload, as indicated by the Nursing Activities Score recorded at intensive care unit discharge, was significantly associated with a higher risk of readmission. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE The study examines the relationship between nursing workload at the time of ICU discharge and the likelihood of unplanned readmission. The results highlight the critical role of nursing workload assessment at ICU discharge in capturing the complexity of care requirements patients face at discharge. The results emphasise the importance of revising discharge planning processes, identifying nursing workload as a critical factor in unplanned readmissions. REPORTING METHOD STROBE guidelines were used for this study. PATIENT OR PUBLIC CONTRIBUTION Not applicable.
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Affiliation(s)
- Jérôme Tack
- Research Center in Health Economics, Management of Health Care Institutions and Nursing Sciences, School of Public Health, Free University of Brussels, Brussels, Belgium
- Clinical Research and Translational Unit, Grand Hospital of Charleroi (GHdC), Charleroi, Belgium
| | - Arnaud Bruyneel
- Research Center in Health Economics, Management of Health Care Institutions and Nursing Sciences, School of Public Health, Free University of Brussels, Brussels, Belgium
| | - Julie Maes
- Nursing Department, HELORA Mons Hospital Constantinople and Warquignies Site, Mons, Belgium
| | - Gwennaëlle Mercier
- Intensive Care Unit, Hôpital Universitaire de Bruxelles (HUB)-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Fabio Silvio Taccone
- Intensive Care Unit, Hôpital Universitaire de Bruxelles (HUB)-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Magali Pirson
- Research Center in Health Economics, Management of Health Care Institutions and Nursing Sciences, School of Public Health, Free University of Brussels, Brussels, Belgium
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Sancho D, Rezusta A, Acero R. Integrating Lean Six Sigma into Microbiology Laboratories: Insights from a Literature Review. Healthcare (Basel) 2025; 13:917. [PMID: 40281866 PMCID: PMC12026800 DOI: 10.3390/healthcare13080917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2025] [Revised: 04/08/2025] [Accepted: 04/14/2025] [Indexed: 04/29/2025] Open
Abstract
BACKGROUND/OBJECTIVES Clinical laboratories are fundamental to healthcare systems, contributing to over 70% of clinical decisions while accounting for only 2-3% of hospital budgets. Among them, microbiology laboratories provide critical information that directly influences patient outcomes and satisfaction. This study presents a structured review of the current state of Lean Six Sigma (LSS) implementation in microbiology and comparable laboratory environments. The objective is to identify relevant contributions within the state of the art to highlight potential benefits applicable to microbiology laboratories and to detect persistent gaps and unresolved needs. METHODS A systematic literature review was performed across six databases (Web of Science, ScienceDirect, Scopus, ProQuest, PubMed, and Google Scholar) to identify studies published between 2012 and September 2024. After screening, 33 studies were selected for full-text analysis. RESULTS The selected literature was analyzed to assess the extent to which LSS methodologies have been applied in microbiology laboratories. Particular attention was given to the definition and use of key performance indicators (KPIs). While industry-adapted metrics such as cost reduction and turnaround time are commonly employed, clinical indicators, such as patient impact, satisfaction, and diagnostic accuracy, are underutilized. Additionally, the analysis revealed a frequent omission of the control phase in LSS projects, limiting long-term process monitoring. The review also identifies the most suitable LSS tools and evaluates how laboratories manage interruptions in routine workflows. CONCLUSIONS Future research should prioritize the integration of clinical KPIs into LSS frameworks, establish robust control phases for sustained monitoring, and systematically address the impact of process interruptions on optimization efforts.
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Affiliation(s)
- David Sancho
- Instituto de Investigación en Ingeniería de Aragón (I3A), 50018 Zaragoza, Spain;
- Design and Manufacturing Engineering Department, University of Zaragoza, 50018 Zaragoza, Spain
| | - Antonio Rezusta
- Microbiology Unit, Miguel Servet University Hospital, 50009 Zaragoza, Spain;
- Instituto de Investigación Sanitaria de Aragón (IISA), 50009 Zaragoza, Spain
| | - Raquel Acero
- Instituto de Investigación en Ingeniería de Aragón (I3A), 50018 Zaragoza, Spain;
- Design and Manufacturing Engineering Department, University of Zaragoza, 50018 Zaragoza, Spain
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Yuan J, Yang P, Yu L, Zhang W, Yu J, Chen Q. Comparison of video laryngoscopy with direct laryngoscopy in critically ill patients: a systematic review and meta-analysis of randomized controlled trials. Eur J Med Res 2025; 30:282. [PMID: 40229889 PMCID: PMC11998270 DOI: 10.1186/s40001-025-02525-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 03/27/2025] [Indexed: 04/16/2025] Open
Abstract
BACKGROUND Although Video laryngoscope (VL) can reduce the difficulty of endotracheal intubation and improve the glottic view, its use in critically ill patients is controversial. METHODS Randomized controlled trials (RCTs) of VL and direct laryngoscopy (DL) for critically ill patients were searched on electronic databases, including Web of Science, PubMed, and Embase. Additional publications were identified by screening the reference lists of the identified articles and relevant previously published reviews. RESULTS Overall, 25 RCTs involving 5836 critically ill patients were included in the analysis. There was no significant difference in the first intubation rate between the VL and DL groups (25 studies; RR, 1.03; 95% CI 0.96-1.11; n = 5836; p = 0.37; very low certainty). However, Multivariate meta-regression analysis identified two main sources of bias: whether intubation was performed in a hospital (p = 0.04) and operator proficiency with DL compared to VL (p < 0.001). Subgroup analysis showed that VL improved the first intubation rate in in-hospital intubation (19 studies; RR, 1.12; 95% CI 1.04-1.22; n = 4441; p < 0.01, very low certainty) and VL showed good potential to reduce the first-attempt intubation success rates, but not significantly (6 studies; RR, 0.75; 95% CI 0.56-1.00; n = 1395; p = 0.05, very low certainty). In subgroups with similar operator proficiency VL and DL, VL increased the success rate for first intubation (16 studies; RR, 1.14; 95% CI 1.06-1.23; n = 3,971; p < 0.01; very low certainty). However, VL decreased the first intubation rate (4 studies; RR, 0.65; 95% CI 0.49-0.88; n = 810; p < 0.01; very low certainty) in a subgroup where operator proficiency was higher for DL than for VL. CONCLUSION VL does not increase the first intubation rate. However, VL increases the first-attempt intubation success rate for in-hospital intubation and operators with similar proficiency in VL and DL.
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Affiliation(s)
- Jun Yuan
- Department of Critical Care Medicine, Jiangdu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225200, China
| | - Penglei Yang
- Department of Critical Care Medicine, Jiangdu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225200, China
| | - Lina Yu
- Department of Critical Care Medicine, Jiangdu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225200, China
| | - Wenguang Zhang
- Department of Emergency, Jingjiang People's Hospital, Jingjiang, 214599, China
| | - Jiangquan Yu
- Department of Critical Care Medicine, Northern Jiangsu People's Hospital, Yangzhou, 225001, Jiangsu, China
| | - Qihong Chen
- Department of Critical Care Medicine, Jiangdu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225200, China.
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Cuenca Fito E, Gómez-Acebo I, González Castro A. Development and validation of predictive mortality models in critically ill oncological patients in the ICU: An urgent need. Med Intensiva 2025:502163. [PMID: 40240250 DOI: 10.1016/j.medine.2025.502163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2024] [Revised: 01/13/2025] [Accepted: 01/19/2025] [Indexed: 04/18/2025]
Affiliation(s)
- Elena Cuenca Fito
- Servicio Medicina Intensiva, Hospital Universitario de Ourense, Orense, Spain.
| | - Inés Gómez-Acebo
- University of Cantabria-IDIVAL, Santander, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
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Annamalai C, Viswanathan P. Vitamin D and Acute Kidney Injury: A Reciprocal Relationship. Biomolecules 2025; 15:586. [PMID: 40305356 PMCID: PMC12025042 DOI: 10.3390/biom15040586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2025] [Revised: 04/07/2025] [Accepted: 04/07/2025] [Indexed: 05/02/2025] Open
Abstract
Vitamin D is a sterol prohormone with no intrinsic biological activity. Calcitriol, the active form of vitamin D, is synthesized in the kidneys. It has well-known pleiotropic and cytoprotective properties. In addition to regulating parathyroid hormone secretion and enhancing gut calcium absorption, it exhibits antioxidant, anti-inflammatory, antiproliferative, and antineoplastic effects. However, the role of vitamin D in AKI is unclear, unlike in CKD. Thus, this review aimed to understand how dysregulated vitamin D homeostasis occurs in AKI, as well as to explore how vitamin D deficiency and excess influence AKI. A comprehensive literature search was conducted between January 2000 and June 2024 to uncover relevant works detailing vitamin D homeostasis in health as well as investigating the impact of vitamin D deficiency and excess in humans, animals, and in vitro cell models of AKI. According to the findings of this review, vitamin D appears to have a reciprocal relationship with AKI. Acute renal injury, among other factors, can cause hypo- or hypervitaminosis D. Conversely, AKI can also be caused by vitamin D deficiency and toxicity. Even though hypovitaminosis D is associated with AKI, it is uncertain how it impacts AKI outcomes in distinct clinical scenarios. Newer therapeutic options might emerge as a result of understanding these challenges. Vitamin D supplementation may ameliorate renal injury but needs further validation. Furthermore, hypervitaminosis D has also been implicated in AKI by causing hypercalcemia and hyperphosphatemia. It is crucial to avoid prolonged, uncontrolled, and unsupervised supraphysiological vitamin D administration, especially intramuscular injection.
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Affiliation(s)
| | - Pragasam Viswanathan
- Renal Research Lab, Pearl Research Park, School of Biosciences and Technology, VIT, Vellore 632014, Tamil Nadu, India;
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López-López C, Robleda-Font G, Arranz-Esteban A, Pérez-Pérez T, Solís-Muñoz M, Sarabia-Cobo MC, Frade-Mera MJ, Temprano-Vázquez S, Paredes-Garza F, Castanera-Duro A, Bragado-León M, Romero de-San-Pío E, Gil-Saaf I, Alonso-Crespo D, Rojas-Ballines C, Latorre-Marco I. Development and psychometric validation of the Behavioral Indicators of Pain Scale-Brain Injury (ESCID-DC) for pain assessment in critically ill patients with acquired brain injury, unable to self-report and with artificial airway. ENFERMERIA INTENSIVA 2025; 36:500523. [PMID: 40239437 DOI: 10.1016/j.enfie.2025.500523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 09/10/2024] [Accepted: 10/15/2024] [Indexed: 04/18/2025]
Abstract
INTRODUCTION The aim of this study was to develop and validate the adaptation of the behavioural indicators of pain scale (ESCID) for patients with acquired brain injury (ESCID-DC), unable to self-report and with artificial airway. METHODS Multicenter study conducted in 2 phases: scale development and evaluation of psychometric properties. Two blinded observers simultaneously assessed pain behaviours with two scales: ESCID-DC and Nociception Coma Scale-Revised version-adapted for Intubated patients (NCS-R-I). Assessments were performed at 3 time points: 5 min before, during and 15 min after the application of the painfull procedures (tracheal suction and application of pressure to the right and left nail bed) and a non-painful procedure (rubbing with gauze). On the day of measurement, the Glasgow Coma Score (GCS) and the Richmond Agitation Sedation Scale (RASS) were evaluated. A descriptive and psychometric analysis was performed. RESULTS A total of 4152 pain evaluations were performed in 346 patients, 70% men with a mean age of 56 years (SD = 16.4). The most frequent etiologies of brain damage were vascular 155 (44.8%) and traumatic 144 (41.6%). The median GCS and RASS on the day of evaluation were 8.50 (IQR = 7 to 9) and -2 (RIQ = -3 to -2) respectively. In ESCID-DC the median score was 6 (IQR = 4 to 7) during suction, 3 (RIQ = 1 to 4) for right pressure and 3 (RIQ = 1 to 5) for left pressure. During the non-painful procedure it was 0. The ESCID-DC showed a high discrimination capacity between painful and non-painful procedures (AUC > 0.83) and is sensitive to change depending on the time of application of the scale. High interobserver agreement (Kappa > 0.87), good internal consistency during procedures (α-Cronbach≥0.80) and a high correlation between the ESCID-DC and the NCS-R-I (r ≥ 0.75) were obtained. CONCLUSIONS The results of this study demonstrate that the ESCID-DC is a valid and reliable tool for assessing pain in patients with acquired brain injury, unable to self-report and with artificial airway.
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Affiliation(s)
- Candelas López-López
- Unidad de Cuidados Intensivos de Trauma y Emergencias, Hospital Universitario 12 de Octubre, Madrid, Spain; Grupo de Investigación en Cuidados (InveCuid), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain.
| | - Gemma Robleda-Font
- Centro Cochrane Iberoamericano, Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Barcelona, Spain; Facultad de Medicina y Ciencias de la Salud, Universidad Internacional de Cataluña, Sant Cugat del Vallès, Barcelona, Spain
| | - Antonio Arranz-Esteban
- Unidad de Cuidados Intensivos de Trauma y Emergencias, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Teresa Pérez-Pérez
- Departamento de Estadística y Ciencia de Datos, Universidad Complutense de Madrid, Madrid, Spain
| | - Montserrat Solís-Muñoz
- Unidad de Investigación, Desarrollo e Innovación en Cuidados de Salud, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain; Grupo de Investigación en Enfermería y Cuidados de Salud, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Madrid, Spain
| | - María Carmen Sarabia-Cobo
- Departamento de Enfermería, Universidad de Cantabria, Santander, Spain; Unidad de Investigación en Enfermería, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain
| | - María Jesús Frade-Mera
- Grupo de Investigación en Cuidados (InveCuid), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain; Unidad de Cuidados Intensivos, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | - Aaron Castanera-Duro
- Área del Paciente Crítico, Reanimación y Anestesia, Hospital Universitario Dr. Josep Trueta, Girona, Spain; Departamento de Enfermería, Universidad de Girona, Girona, Spain
| | - Mónica Bragado-León
- Unidad de Cuidados Intensivos, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain
| | | | - Isabel Gil-Saaf
- Unidad de Cuidados Intensivos, Hospital Universitario de Navarra, Pamplona, Spain
| | - David Alonso-Crespo
- Unidad de Cuidados Intensivos, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain; Grupo de Investigación Traslacional en Cuidados, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | | | - Ignacio Latorre-Marco
- Grupo de Investigación en Enfermería y Cuidados de Salud, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Madrid, Spain; Unidad de Cuidados Intensivos, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain
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Coloretti I, Corcione A, De Pascale G, Donati A, Forfori F, Marietta M, Panigada M, Simioni P, Tascini C, Viale P, Girardis M. Protein C in adult patients with sepsis: from pathophysiology to monitoring and supplementation. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2025; 5:21. [PMID: 40229903 PMCID: PMC11998338 DOI: 10.1186/s44158-025-00243-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2025] [Accepted: 04/04/2025] [Indexed: 04/16/2025]
Abstract
Protein C (PC) plays a crucial role in modulating inflammation and coagulation in sepsis. Its anticoagulant and cytoprotective properties are critical in mitigating sepsis-induced coagulopathy, which is associated with high mortality rates. In sepsis, low levels of PC are associated with an elevated risk of multiple organ dysfunction and increased mortality. Routine monitoring of PC levels is not widely implemented but appears relevant in selected populations, such as patients with purpura fulminans, sepsis-induced coagulopathy (SIC), disseminated intravascular coagulopathy (DIC) or hyperinflammatory septic shock phenotypes. Treatment with PC has been limited to PC concentrate approved for paediatric use in congenital PC deficiencies and purpura fulminans, while the efficacy of PC supplementation in sepsis remains a subject of debate. Considering the physiological significance of PC and its role in sepsis pathophysiology, additional studies are necessary to fully elucidate its therapeutic efficacy in specific clinical settings.
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Affiliation(s)
- Irene Coloretti
- Anaesthesiology and Intensive Care Department, University Hospital of Modena, University of Modena, Reggio Emilia, Modena, Italy.
| | - Antonio Corcione
- Department of Critical Care, AORN Ospedali Dei Colli, Naples, Italy
| | - Gennaro De Pascale
- Dipartimento Di Scienze Biotecnologiche Di Base, Cliniche Intensivologiche E Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento Di Scienze Dell'Emergenza, Fondazione Policlinico Universitario A. Gemelli IRCCS, Anestesiologiche E Della Rianimazione, Rome, Italy
| | - Abele Donati
- Department of Biomedical Sciences and Public Health, Università Politecnica Delle Marche, Ancona, Italy
- Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Delle Marche, Ancona, Italy
| | - Francesco Forfori
- Dipartimento Di Patologia Chirurgica, Medica, Molecolare Ed Area Critica, Università Di Pisa. AOUP, Pisa, Italy
| | - Marco Marietta
- Department of Hematology-Azienda Ospedaliero, Universitaria Di Modena, Modena, Italy
| | - Mauro Panigada
- Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Simioni
- Clinica Medica 1, Azienda Ospedale Università Di Padova, Padua, Italy
| | - Carlo Tascini
- Department of Medicine (DMED), University of Udine, Udine, Italy
- Infectious Diseases Clinic, ASUFC "Santa Maria Della Misericordia" University Hospital of Udine, Udine, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
- Infectious Diseases Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Massimo Girardis
- Anaesthesiology and Intensive Care Department, University Hospital of Modena, University of Modena, Reggio Emilia, Modena, Italy
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Annetta MG, Pinelli F, Ortiz Miluy G, Scoppettuolo G, Pittiruti M. The SaRePo protocol: A seven-step strategy to minimize complications potentially related to the removal of totally implanted central venous access devices. J Vasc Access 2025:11297298251333863. [PMID: 40230069 DOI: 10.1177/11297298251333863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2025] Open
Abstract
Removal of totally implanted central venous access devices (brachial ports, chest-ports, femoral ports) is potentially associated with the risk of untoward events, some of them negligible (prolonged maneuver time due to technical difficulties), some relevant (hematoma), and some severe (embolization of catheter fragments into the circulation). The removal technique suitable for minimizing such complications has been described only in few manuals, but it has never been standardized. This paper describes a standardized protocol (SaRePo: Safe Removal of Ports) which consists of seven basic strategies to be adopted systematically during removal of totally implanted venous access devices, so to minimize the risk of adverse events. These strategies include: evaluation of the patient's history, preprocedural ultrasound scan of the veins, appropriate aseptic technique, proper local anesthesia, catheter extraction, removal of the reservoir from the pocket, closure of the surgical incision.
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Affiliation(s)
- Maria Giuseppina Annetta
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario "A. Gemelli"-IRCCS, Rome, Italy
| | - Fulvio Pinelli
- Department of Anesthesia and Critical Care, University of Florence, "Careggi" Hospital, Florence, Italy
| | | | | | - Mauro Pittiruti
- Department of Surgery, Catholic University Hospital "A. Gemelli," Rome, Italy
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Lavezzo B, Biancofiore G, Luca E, Balagna R, Bignami E, Boggi U, Cataldo R, Chiaramonte G, Cortegiani A, Fiandra U, Mariani R, Manici M, Mattei A, Sollazzi L, Tritapepe L, Tosi M, Turi S, Zago M, Aceto P. Planning intensive care unit admission after elective major abdominal surgery: good clinical practice document by SIAARTI-SIC-ANIARTI. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2025; 5:20. [PMID: 40229867 PMCID: PMC11995668 DOI: 10.1186/s44158-025-00239-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2025] [Accepted: 03/27/2025] [Indexed: 04/16/2025]
Abstract
Postoperative complications (PCs) are a major cause of mortality following elective major abdominal surgery (EMAS). The increasing complexity of abdominal procedures, particularly in oncology, may significantly affect patient outcomes. However, this has also introduced a higher variability in postoperative management, and the use of tailored approaches to address critical issues such as hemodynamic stabilization, infection management, and respiratory failure. While elective admission to intensive care units (ICU) is a standard practice to manage high-risk surgical patients, ICU resource allocation is often influenced by local practices and bed availability.This document presents a framework for preoperative ICU admission planning after EMAS. It focuses on the identification of patient and surgical risk factors-using established scoring systems-and provides statements to determine ICU admission. The aim is to optimize resource allocation, reduce PCs, and prevent unplanned ICU admissions. This good clinical practice statement was developed through a multidisciplinary panel formed by selected members coming from SIAARTI (Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care), SIC (Italian Society of Surgery) and ANIARTI (National Association of Critical Area Nurses).The designed scientific board developed, through a systematic literature review and a consensus methodology, a roadmap for defining the priorities of perioperative care based on the complexity of the patient and the surgical procedure. Eventually, the panel worked out statements about six voted queries that could have supported the preoperative indication to postoperative ICU admission.Evaluation of patients' characteristics, comorbidities, and surgical factors are all essential to plan ICU admission for immediate postoperative patient care after EMAS.The presence and severity of comorbidities, assessed through various severity scores, play a crucial role in predicting PCs and guiding ICU admission decisions. Tools such as the American Society of Anesthesiologists physical status, Charlson Comorbidity Index, and Rockwood Frailty Index, along with surgical risk scores and intraoperative events, help define the need for intensive care. Preoperative frailty assessment-achieved using the Clinical Frailty Scale-is essential to anticipate postoperative care needs. Finally, during the postoperative phase, continuous monitoring and reassessment in the post-anesthesia care unit are key to determine whether ICU admission is required. Establishing high-dependency units and tailored care pathways based on individual patient needs and available resources will enhance patient outcomes and optimize postoperative care.
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Affiliation(s)
- Bruna Lavezzo
- Anesthesia and Intensive Care Unit, SS Annunziata Hospital, Savigliano, Azienda Sanitaria Locale Cuneo1, Cuneo, Italy.
| | - Giandomenico Biancofiore
- Division of Transplant Anesthesia and Critical Care, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Ersilia Luca
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Roberto Balagna
- Emergency Department Azienda Sanitaria Locale Città di Torino, Anaesthesia and Intensive Care Unit, Martini Hospital, Turin, Italy
| | - Elena Bignami
- Anesthesiology, Intensive Care and Pain Medicine, University Hospital of Parma, Parma, Italy
| | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Rita Cataldo
- Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Giuseppe Chiaramonte
- Anesthesia and Critical Care Department IRCCS, ISMETT-Istituto Mediterraneo Per I Trapianti E Terapie Ad Alta Specializzazione, Palermo, Italy
| | - Andrea Cortegiani
- Section of Anesthesia, Analgesia, Intensive Care and Emergency, Department of Surgical Oncological and Oral Science, Paolo Giaccone Polyclinic University of Palermo, Palermo, Italy
| | - Umberto Fiandra
- Department of Quality, Risk Management and Accreditation, Azienda Ospedaliera Universitaria Città Della Salute E Della Scienza Di Torino, Turin, Italy
| | - Roberta Mariani
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L'Aquila, L'Aquila, Italy
| | - Matteo Manici
- Anesthesiology, Intensive Care and Pain Medicine, University Hospital of Parma, Parma, Italy
| | - Alessia Mattei
- Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Liliana Sollazzi
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Basic Biotechnological Science, Intensive Care and Peri-Operative Clinics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luigi Tritapepe
- Department of Anesthesia and Intensive Care, Sapienza University of Rome, Rome, Italy
- Department of Anesthesia and Intensive Care, San Camillo-Forlanini Hospital, Rome, Italy
| | - Martina Tosi
- Anaesthesia and Intensive Care Department, University Hospital of Modena, Modena, Italy
| | - Stefano Turi
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mauro Zago
- Robotic and Emergency Surgery Department, General and Emergency Surgery Division, A. Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - Paola Aceto
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
- Department of Basic Biotechnological Science, Intensive Care and Peri-Operative Clinics, Università Cattolica del Sacro Cuore, Rome, Italy.
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Procopio F, Galvanin J, Costa G, Rocchi L, Piccioni F, Cecconi M, Torzilli G. Model for estimating the risk of postoperative morbidity and optimizing patients' management after hepatectomy. HPB (Oxford) 2025:S1365-182X(25)00553-2. [PMID: 40295153 DOI: 10.1016/j.hpb.2025.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2024] [Revised: 03/19/2025] [Accepted: 04/10/2025] [Indexed: 04/30/2025]
Abstract
BACKGROUND Early detection of major complications and immediate therapeutic interventions may improve patient outcome after hepatectomy. The aim of the present study was to develop a model predicting the risk of postoperative complications after hepatectomy and help identify patients who require close-monitoring in intensive care unit (ICU). METHODS Patients underwent hepatectomy at Humanitas Research Hospital, Italy, between 2010 and 2021 were considered. We used preoperative, intraoperative and combined predictors to build three models predicting Clavien-Dindo III-V complications. Model performances was evaluated internally via bootstrapping. RESULTS Of 1497 patients, 7% had Clavien-Dindo III-V complications. Tumor pathology, tumor burden, previous chemotherapy, liver characteristics, clinical portal hypertension, cardiopathy, creatinine and total protein level were incorporated in the preoperative model. In addition to these variables, type of hepatectomy, operation time, additional surgical procedure, and transfusion were incorporated into the combined model. The bootstrap corrected C-indices for preoperative, intraoperative and combined models were 0.68, 0.70 and 0.72. The median predicted probability of major complications over-1000 bootstraps was close to observed probabilities for all models. CONCLUSION These prognostic models may help identify patients at high-risk of major complication and guide decision-making for individual patients and postoperative ICU-care assessment. Observed optimism in model performance necessitates external validation.
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Affiliation(s)
- Fabio Procopio
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072, Milan, Italy; Department of Hepatobiliary & General Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Jacopo Galvanin
- Department of Hepatobiliary & General Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Guido Costa
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072, Milan, Italy; Department of Hepatobiliary & General Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Laura Rocchi
- Anesthesia and Intensive Care Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Federico Piccioni
- Anesthesia and Intensive Care Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072, Milan, Italy; Anesthesia and Intensive Care Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Guido Torzilli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072, Milan, Italy; Department of Hepatobiliary & General Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy.
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Paredes-García S, López-Batet N, Carmona F, Sisó-Almirall A, González-de Paz L. A new community-based cardiopulmonary resuscitation training program for primary care: needs assessment, development, and pilot testing. Fam Pract 2025; 42:cmaf019. [PMID: 40285412 DOI: 10.1093/fampra/cmaf019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2025] Open
Abstract
OBJECTIVE The general population's interest in cardiopulmonary resuscitation (CPR) remains largely unknown. Fewer than one-third of individuals are familiar with CPR, and there are no comprehensive training programs available. This study aimed to examine CPR interest among patients visited in the primary care setting, design a new program, and assess the feasibility and efficacy of the training initiative. METHODS This two-phase project aimed to (i) examine patients' knowledge and interests and (ii) design and evaluate a training program within the PC setting. Knowledge and interests were assessed using a survey. The training program design adhered to European guidelines. The pilot study assessed effectiveness through self-administered tests, instructor evaluation of the chain of survival, correct use of an automated external defibrillator (AED), and a manikin capable of measuring chest compression. RESULTS A total of 243 patients participated. Among them, 26.16% had received prior CPR training, only 5% knew how to perform CPR maneuvers, and 84.8% were interested in learning. A 90-min training program was designed. After the training session (N = 50), all participants reported feeling capable of performing CPR techniques using the AED; 94% demonstrated proficiency in AED use, and 20% performed high-quality chest compressions (correct release, depth, and rate). CONCLUSION The general population had limited knowledge about CPR but was highly interested in acquiring CPR skills. The PC-based training program enabled bystanders to perform CPR and use AEDs, potentially improving survival rates in out-of-hospital cardiac arrests.
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Affiliation(s)
| | - Nuria López-Batet
- Consorci d'Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
| | | | - Antoni Sisó-Almirall
- Consorci d'Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
- Department of Medicine, University of Barcelona (UB), Barcelona, Spain
- Primary Healthcare Transversal Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Luis González-de Paz
- Consorci d'Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
- Primary Healthcare Transversal Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Public Health, Mental Health, and Mother and Child Health. University of Barcelona (UB), Barcelona, Spain
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Zhou XF, Chen H, Ke J, Lin SR, Huang TF, Chen BY, Jiang XD, Chen F. Lactate and CO 2-derived parameters are not predictive factors of major postoperative complications after cardiac surgery with cardiopulmonary bypass: a diagnostic accuracy study. Front Cardiovasc Med 2025; 12:1504431. [PMID: 40290193 PMCID: PMC12022843 DOI: 10.3389/fcvm.2025.1504431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Accepted: 03/25/2025] [Indexed: 04/30/2025] Open
Abstract
Purpose This study aimed to compare the performance of lactate and CO2-derived parameters in predicting major postoperative complications (MPC) after cardiac surgery with cardiopulmonary bypass. Methods Lactate and CO2-derived parameters, including the venous-arterial difference in CO2 partial pressure (Pv-aCO2), the venous-arterial difference in CO2 partial pressure to arterial-venous O2 content ratio (Pv-aCO2/Ca-vO2), and the venous-arterial difference in CO2 content to arterial-venous O2 content ratio (Cv-aCO2/Ca-vO2) at ICU admission, 3 h, 6 h, and 12 h later were collected. Receiver-operating characteristics (ROC) curve analysis was carried out to assess the predictive performance. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of MPC. Results MPC occurred in 77 (54.2%) of 142 patients. No significant difference was observed between the MPC and no-MPC groups regarding lactate and CO2-derived parameters. The area under the curves (AUCs) were 0.532 (0.446-0.616) for lactate, 0.559 (0.473-0.642) for Pv-aCO2, 0.617 (0.532-0.697) for Pv-aCO2/Ca-vO2, and 0.625 (0.540-0.705) for Cv-aCO2/Ca-vO2, respectively, and there was no significant difference between the parameters. In the post-hoc analysis, all parameters' AUCs were lower than 0.75 in predicting acute renal failure, and there was no significant difference between these parameters. Cv-aCO2/Ca-vO2 at 12 h yielded the highest AUC of 0.853 (0.784-0.907) in predicting mortality and the highest AUC of 0.808 (0.733-0.869) in predicting delirium. In multivariate analysis, hypertension, surgery duration, and PaO2/FiO2 were identified as independent predictors of MPC, while lactate and CO2-derived parameters lost statistical significance after adjustment for covariates. Conclusions Lactate and CO2-derived parameters cannot be used as reliable indicators to predict the occurrence of MPC after cardiopulmonary bypass. Instead, traditional clinical factors such as hypertension, extended surgical duration, and impaired oxygenation emerged as the most reliable risk indicators.
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Affiliation(s)
- Xiao-Fen Zhou
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
- The Fourth Department of Critical Care Medicine, Fuzhou University Affiliated Provincial Hospital, Fuzhou, Fujian, China
- Fujian Provincial Key Laboratory of Emergency Medicine, Fuzhou, Fujian, China
- Fujian Emergency Medical Center, Fuzhou, Fujian, China
| | - Han Chen
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
- The Fourth Department of Critical Care Medicine, Fuzhou University Affiliated Provincial Hospital, Fuzhou, Fujian, China
| | - Jun Ke
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
- Fujian Provincial Key Laboratory of Emergency Medicine, Fuzhou, Fujian, China
- Fujian Emergency Medical Center, Fuzhou, Fujian, China
- Department of Emergency, Fuzhou University Affiliated Provincial Hospital, Fuzhou, Fujian, China
| | - Shi-Rong Lin
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
- Fujian Provincial Key Laboratory of Emergency Medicine, Fuzhou, Fujian, China
- Fujian Emergency Medical Center, Fuzhou, Fujian, China
- Department of Emergency, Fuzhou University Affiliated Provincial Hospital, Fuzhou, Fujian, China
| | - Ting-Feng Huang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
- The Fourth Department of Critical Care Medicine, Fuzhou University Affiliated Provincial Hospital, Fuzhou, Fujian, China
| | - Bing-Ying Chen
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
- The Fourth Department of Critical Care Medicine, Fuzhou University Affiliated Provincial Hospital, Fuzhou, Fujian, China
| | - Xin-Da Jiang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
- The Fourth Department of Critical Care Medicine, Fuzhou University Affiliated Provincial Hospital, Fuzhou, Fujian, China
| | - Feng Chen
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
- Fujian Provincial Key Laboratory of Emergency Medicine, Fuzhou, Fujian, China
- Fujian Emergency Medical Center, Fuzhou, Fujian, China
- Department of Emergency, Fuzhou University Affiliated Provincial Hospital, Fuzhou, Fujian, China
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Genç AC, Özmen E, Çekiç D, İşsever K, Türkoğlu Genç F, Genç AB, Toçoğlu A, Durmaz Y, Özkök H, Yaylacı S. Comprehensive analyses: Using machine learning models for mortality prediction in the intensive care unit of internal medicine. J Investig Med 2025:10815589251335327. [PMID: 40205744 DOI: 10.1177/10815589251335327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2025]
Abstract
Mortality prediction in the intensive care unit (ICU) is essential in patient management. Emerging methods such as machine learning (ML) can be employed to predict ICU patients' mortality. Patients receiving treatment in the ICU of the internal medicine department were subjected to ML analysis upon admission, considering demographic, laboratory, and medical scores. Data from 787 internal medicine ICU patients were analyzed, with only a subset (220) included in the study for the 30-day mortality prediction model. The performance of boosting and Logistic Regression models in mortality prediction was compared. Categorical boosting (CatBoost) achieved the highest area under the curve (AUC) of 0.90, while extreme gradient boosting reached a maximum AUC of 0.85, and Logistic Regression attained the highest AUC of 0.83. Incorporating Acute Physiology and Chronic Health Evaluation II, Simplified Acute Physiology Score II, and Sequential Organ Failure Assessment scores with clinical and laboratory values, CatBoost demonstrated the strongest predictive performance with high sensitivity and specificity. In the ICU of the internal medicine department, it was concluded that the ML models successfully predict mortality.
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Affiliation(s)
- Ahmed Cihad Genç
- Department of Internal Medicine, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Ensar Özmen
- Department of Internal Medicine, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Deniz Çekiç
- Department of Internal Medicine, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Kubilay İşsever
- Department of Internal Medicine, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Fevziye Türkoğlu Genç
- Department of Internal Medicine, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Ahmed Bilal Genç
- Department of Internal Medicine, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Aysel Toçoğlu
- Department of Internal Medicine, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Yusuf Durmaz
- Department of Intensive Care Unit, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Hüseyin Özkök
- Department of Intensive Care Unit, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Selçuk Yaylacı
- Department of Internal Medicine, Faculty of Medicine, Sakarya University, Sakarya, Turkey
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Irigoyen-von-Sierakowski Á, Díaz-Navarro M, Visedo A, Pérez-Granda MJ, Martín-Rabadán P, Muñoz P, Guembe M. Reliability of differential time to positivity technique for diagnosing catheter-related bloodstream infections: a retrospective analysis. Microbiol Spectr 2025:e0267824. [PMID: 40197990 DOI: 10.1128/spectrum.02678-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Accepted: 03/05/2025] [Indexed: 04/10/2025] Open
Abstract
The differential time to positivity (DTTP) technique is the recommended conservative procedure to diagnose catheter-related bloodstream infection (C-RBSI). However, its reliability and accuracy remain under debate. Therefore, we aimed to compare the DTTP technique feasibility to detect C-RBSI compared to the catheter culture (CC) method. We conducted a 9-month retrospective study including bacteremic episodes in which both DTTP blood cultures (BC) and CC were obtained. We analyzed the diagnostic validity of the DTTP technique for detecting C-RBSI compared to the gold standard (C-RBSI with CC), along with patient clinical data. We included 37 episodes of C-RBSI where both DTTP BC and CC were obtained. C-RBSI was confirmed by both techniques in only 13 episodes (35.1%), whereas in 11 (29.7%) and 13 (35.1%), only DTTP BC or DTTP BC with CC (with a difference between catheter lumen and peripheral BC growth of <2 hours) was positive, respectively. Therefore, the validity values of the DTTP technique for predicting C-RBSI were as follows: sensitivity, 50.0%; specificity, 71.8%; positive predictive value, 54.2%; and negative predictive value, 68.3%. The distribution of microorganisms was similar among the three groups. All patients in whom colonization was not demonstrated by CC (n = 11) had been receiving antibiotics before catheter withdrawal. DTTP is a conservative technique that might help to diagnose C-RBSI mostly in situations where catheter removal cannot be achieved. However, it should be interpreted with caution and never be used to rule out C-RBSI. CC before starting antimicrobial therapy remains the most reliable method to diagnose and confirm an episode of C-RBSI.IMPORTANCEWe try to clarify the reliability of the differential time to positivity technique to predict C-RBSI. It may be interpreted with caution and considering clinical signs, as some C-RBSI can be misdiagnosed.
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Affiliation(s)
- Álvaro Irigoyen-von-Sierakowski
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Marta Díaz-Navarro
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Andrés Visedo
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - María Jesús Pérez-Granda
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
| | - Pablo Martín-Rabadán
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
- School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Patricia Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
- School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - María Guembe
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
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Zhou L, Zhang W, Shao M, Wang C, Wang Y. Deciphering the impact of sepsis phenotypes on improving clinical outcome predictions: a multicenter retrospective analysis based on critical care in China. Sci Rep 2025; 15:12057. [PMID: 40200027 PMCID: PMC11978960 DOI: 10.1038/s41598-025-93961-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2024] [Accepted: 03/11/2025] [Indexed: 04/10/2025] Open
Abstract
Sepsis is a clinically heterogeneous disease with high mortality. It is crucial to develop relevant therapeutic strategies for different sepsis phenotypes, but the impact of phenotypes on patients' clinical outcomes is unclear. This study aimed to identify potential sepsis phenotypes using readily available clinical parameters and assess their predictive value for 28-day clinical outcomes by logistic regression analysis. In this retrospective analysis, researchers extracted clinical data from adult patients admitted to the First Affiliated Hospital of Anhui Medical University between April and August 2022 and from the 2014-2015 eICU Collaborative Study database. K-Means clustering was utilized to identify and refine sepsis phenotypes, and their predictive performance was subsequently evaluated. Logistic regression models were trained independently for each phenotype and five-fold cross-validation was used to predict clinical outcomes. Predictive accuracy was then compared to traditional non-clustered prediction methods using model assessment scores. The study cohort consisted of 250 patients from the First Affiliated Hospital of Anhui Medical University, allocated in a 7:3 ratio for training and testing, respectively, and an external validation cohort of 3100 patients from the eICU Cooperative Research Database. The results of the phenotype-based prediction model demonstrated an improvement in F1 score from 0.74 to 0.82 and AUC from 0.74(95%CI 0.71-0.80) to 0.84(95%CI 0.82-0.87), and these results also highlight the superiority of clinical outcome prediction with the help of sepsis phenotypes over traditional prediction methods. Phenotype-based prediction of 28-day clinical outcomes in sepsis demonstrated significant advantages over traditional models, highlighting the impact of phenotype-driven modeling on clinical outcomes in sepsis.
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Affiliation(s)
- Luyao Zhou
- School of Biomedical Engineering, Anhui Medical University, Hefei, 230032, China
| | - Weimin Zhang
- School of Biomedical Engineering, Anhui Medical University, Hefei, 230032, China
| | - Min Shao
- Department of Critical Care Medicine, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Cui Wang
- Department of Critical Care Medicine, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yu Wang
- School of Biomedical Engineering, Anhui Medical University, Hefei, 230032, China.
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Halata D, Zhor D, Skulec R, Seifert B. Accuracy of point-of-care ultrasound examination of the lung in primary care performed by general practitioners: a cross-sectional study. BMC PRIMARY CARE 2025; 26:99. [PMID: 40200132 PMCID: PMC11978004 DOI: 10.1186/s12875-025-02802-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2024] [Accepted: 03/25/2025] [Indexed: 04/10/2025]
Abstract
BACKGROUND Lung ultrasonography (LUS) is a point-of-care imaging modality with growing potential in primary care. OBJECTIVES While its use is well established in hospital settings, data on its accuracy when performed by general practitioners (GPs) remain limited. This study aimed to assess the diagnostic accuracy of LUS conducted by GPs following structured training. METHODS We recruited 17 GPs from various regions of the Czech Republic. They completed a two-day educational course focused on LUS. Patients with current dyspnoea (NYHA II-IV) or a history of dyspnoea within the last four weeks were included and underwent LUS to assess the presence of pleural effusion and interstitial syndrome. An independent expert sonographer, blinded to clinical data, evaluated recorded LUS video loops as the reference standard. LUS findings were categorized into A profile (presence of A lines and intact lung sliding, indicating normal aeration), B profile (three or more B lines per intercostal space in at least two intercostal spaces per hemithorax, suggesting interstitial syndrome), pulmonary consolidation and pleural effusion. RESULTS A total of 128 patients were enrolled in the study. A total of 768 thoracic segments were examined. A profile was identified in 642 (83.6%) segments, B profile in 108 (14.1%), pulmonary consolidation in 8 (1.0%), and pleural effusion in 12 (1.6%). For the identification of A profile, the sensitivity was 97.51% (95% CI 95.98-98.57), and the specificity was 88.10% (95% CI 81,13-93,18); for B profile, the sensitivity was 87.04% (95% CI 79,21-92,73), and the specificity was 97.73% (95% CI96,28-98,72); for pulmonary consolidation, the sensitivity was 100.0% (95% CI 63,06-100,00), and the specificity was 100.0% (95% CI 99,52-100,0); for pleural effusion, the sensitivity was 83.33% (95% CI 51,59-97,91), and the specificity was 99.87% (95% CI 99,27-100,00). CONCLUSION Our findings provide important preliminary data, demonstrating that GPs can perform LUS accurately after a structured training program. THE TRIAL REGISTRATION IDENTIFIER: is NCT04905719.
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Affiliation(s)
- David Halata
- Department of Preventive Medicine, Faculty of Medicine in Hradec Kralove, Charles University, Simkova 870, Hradec Kralove, 500 03, Czech Republic.
- Working group on ultrasound in primary care, Czech Society of General Practice, Czech Medical Association of Jan Evangelista Purkyne, Sokolska 490/31, 120 00, Prague, Czech Republic.
- European Rural and Isolated Practitioners Association (EURIPA), WONCA Europe, Ljubljana, Slovenia.
| | - Dusan Zhor
- Working group on ultrasound in primary care, Czech Society of General Practice, Czech Medical Association of Jan Evangelista Purkyne, Sokolska 490/31, 120 00, Prague, Czech Republic
| | - Roman Skulec
- Department of Emergency Medicine, Bory Hospital, a.s, Bratislava, Slovak Republic
- Department of Clinical Disciplines and Emergency Medicine, Faculty of Social Sciences and Health Care, Constantine the Philosopher University, Nitra, Slovak Republic
- Department of Anaesthesiology, Perioperative and Intensive Medicine, J. E. Purkyne University in Usti nad Labem, Masaryk Hospital, Usti nad Labem, Czech Republic
- Faculty of Medicine in Hradec Kralove, Charles University, Prague, Czech Republic
- Training facility for Point-of-Care Ultrasound, Institute for Postgradual Medical Education , Prague, Czech Republic
| | - Bohumil Seifert
- Institute of General Practice, First Faculty of Medicine, Charles University, Prague, Czech Republic
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Pérez-Galicia A, Lugo-Caballero C, Martínez-Calvillo S, Ortiz-Navarrete V, Manning-Cela RG. Major Histocompatibility Complex Class I and II Allele Frequencies and Disease Associations in Mexicans: A Systematic Review and Meta-Analysis. Arch Med Res 2025; 56:103201. [PMID: 40199052 DOI: 10.1016/j.arcmed.2025.103201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 12/26/2024] [Accepted: 02/26/2025] [Indexed: 04/10/2025]
Abstract
BACKGROUND The major histocompatibility complex (MHC) plays a crucial role in immune responses and is associated with disease susceptibility. This study systematically reviews MHC class I and class II allele frequencies and their associations with diseases in the Mexican population from 1979 to 2023. METHODS A systematic review following PRISMA guidelines was conducted. Reports were obtained from the Allele Frequency Net Database and PubMed using keywords related to HLA and Mexican populations. A total of 776 reports were screened, and 214 were retained for final analysis. Seventy-six studies comprising allele frequency data from over 20,000 individuals across Mexican states and indigenous communities were analyzed. In addition, over 138 articles were examined to identify alleles associated with various diseases. RESULTS The analysis identified 117 alleles whose frequencies varied regionally within Mexico. While DPA1*01, DPB1*04:01, and DQA1*03 were predominant, DRB1*04, DQB1*03, and DQA1*05 were also prominent but variable. Certain alleles, such as A*02, B*35, C*04, and C*07, were relatively common in the population. Numerous disease correlations were uncovered, such as B*27's strong association with spondyloarthropathies. DRB1*15:01 and DRB1*04 conferred an increase in multiple sclerosis, while DRB1*04 may protect against some skin diseases. CONCLUSION This review improves the understanding of MHC allele frequencies and disease associations in Mexicans, highlighting genetic diversity. The findings lay the groundwork for future research on genetic predispositions and health outcomes, aiding healthcare strategies in this diverse population. Further studies are needed to address data gaps and refine genetic profiles for targeted medical applications.
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Affiliation(s)
- Anahi Pérez-Galicia
- Departamento de Biomedicina Molecular, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, CDMX, Mexico
| | - Cesar Lugo-Caballero
- Centro Regional de Investigación Dr. Hideyo Noguchi, Universidad Autónoma de Yucatán, Mérida, Yucatán, Mexico
| | - Santiago Martínez-Calvillo
- Unidad de Investigación en Biomedicina, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Edo, de México, Mexico
| | - Vianey Ortiz-Navarrete
- Departamento de Biomedicina Molecular, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, CDMX, Mexico
| | - Rebeca G Manning-Cela
- Departamento de Biomedicina Molecular, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, CDMX, Mexico.
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141
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Pensato U, Tanaka K, Kaveeta C, Ospel J, Horn M, Rodriguez-Luna D, Singh N, Banerjee A, Wasyliw S, Horn K, Bobyn A, Neweduk A, Qiu W, Goyal M, Menon B, Demchuk A. Stepwise improvement in intracerebral haematoma expansion prediction with advanced imaging: a comprehensive comparison of existing scores. Stroke Vasc Neurol 2025:svn-2024-003988. [PMID: 40194847 DOI: 10.1136/svn-2024-003988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2024] [Accepted: 03/05/2025] [Indexed: 04/09/2025] Open
Abstract
BACKGROUND We aim to comprehensively assess and compare the predictive performance of haematoma expansion (HE) scores in a homogeneous cohort of acute intracerebral haemorrhage (ICH) patients. METHODS Existing scores for predicting HE in acute ICH patients were included and categorised by imaging modality: non-contrast CT (NCCT), single-phase CT angiography (sCTA) and multiphase CTA (mCTA). The predictive performance of the scores was evaluated with the c-statistic in a population of consecutive adult patients with acute ICH admitted to a tertiary care centre in Southern Alberta, Canada, between February 2012 and May 2020, investigated with a multimodal imaging protocol (NCCT, sCTA and mCTA). The primary outcome was HE (ICH volume growth ≥6 mL or ≥33%), and the secondary outcome was severe HE (ICH volume growth ≥12.5 mL or ≥66%). The DeLong test compared the best-performing scores from each imaging category. RESULTS 16 HE scores were assessed (NCCT=8, sCTA=6 and mCTA=2) in 217 patients with a median age of 70 years (IQR=60-80), and 86 (39.6%) were females. 51 (23.5%) patients experienced HE and 35 (16.1%) had severe HE. The c-statistic for predicting HE ranged from 0.516 to 0.674 for NCCT-based scores, 0.627 to 0.725 for sCTA-based scores and 0.800 to 0.814 for mCTA-based score. The c-statistic for predicting severe HE ranged from 0.505 to 0.666 for NCCT scores, 0.651 to 0.740 for sCTA scores and 0.813 to 0.828 for mCTA scores. A statistically significant difference favouring mCTA over other imaging modalities in predicting both HE and severe HE was observed. CONCLUSIONS Advanced imaging demonstrated a stepwise improvement in the predictive performance of HE scores. However, no existing score achieved excellent predictive performance (c-statistics ≥0.90) in our cohort, highlighting the need for further refinement.
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Affiliation(s)
- Umberto Pensato
- Department of Neurology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Milan, Italy
| | - Koji Tanaka
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Chitapa Kaveeta
- Department of Medicine, Mahidol University, Salaya, Thailand
| | - Johanna Ospel
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - MacKenzie Horn
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Nishita Singh
- Department of Neurology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ankur Banerjee
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sanchea Wasyliw
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kennedy Horn
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Amy Bobyn
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Anneliese Neweduk
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Wu Qiu
- Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Mayank Goyal
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Bijoy Menon
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Andrew Demchuk
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
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Bay P, Martin-Loeches I, Haudebourg AF, Lê MP, Peytavin G, Rameix-Welti MA, Fourati S, de Prost N. How to manage antivirals in critically ill patients with influenza? Clin Microbiol Infect 2025:S1198-743X(25)00162-4. [PMID: 40204233 DOI: 10.1016/j.cmi.2025.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2025] [Revised: 03/19/2025] [Accepted: 04/01/2025] [Indexed: 04/11/2025]
Abstract
BACKGROUND Influenza is a significant cause of morbidity and mortality, particularly in critically ill patients. The availability of effective antiviral therapies is pivotal in mitigating the severity and complications associated with influenza. OBJECTIVES This review evaluates the antivirals available for the treatment of severe influenza in critically ill patients, focusing on the strength of recommendations and levels of evidence derived from clinical trials, observational studies, and guidelines. The aim is to provide clinicians with evidence-based insights to optimize antiviral strategies in the intensive care unit setting. SOURCES A comprehensive literature search was conducted using PubMed, Embase, and Cochrane Library databases for studies published up to January 2025. Keywords included "antiviral therapy," "influenza," "critically ill patients," "oseltamivir," "peramivir," "zanamivir," "lanimavir," "baloxavir," and "favipiravir." Additional references were identified from the bibliographies of relevant articles. CONTENT The following topics are covered: antivirals available for treating influenza and evidence supporting their use in critically ill patients, pharmacokinetic issues of enteral oseltamivir administration in critically ill patients, and neuraminidase inhibitors resistance. IMPLICATIONS Neuraminidase inhibitors constitute the vast majority of antivirals currently prescribed for influenza. The most commonly prescribed neuraminidase inhibitor to date is oseltamivir. Although its efficacy in nonsevere cases of influenza is well established, the evidence for its efficacy in critically ill patients is based on less robust studies, as no randomized controlled trials have been conducted in this population. Limited data on oseltamivir pharmacokinetics is available in critically ill patients. The selection of A(H1N1)pdm09 resistant variants to oseltamivir is particularly problematic in critically ill patients hospitalized in intensive care units. Data on other antivirals, such as neuraminidase inhibitors (i.e. zanamivir, peramivir and laninamivir) or baloxavir marboxil in critically ill patients are scarce. Further research is needed to develop new drugs and assess their efficacy in critically ill patients and to better assess the effect of oseltamivir in this population.
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Affiliation(s)
- Pierre Bay
- Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor-Albert Chenevier, Service de Médecine Intensive Réanimation, Créteil Cedex, France; Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, Créteil, France; INSERM U955, Institut Mondor de Recherche Biomédicale, Créteil, France; INSERM U955, Team Viruses, Hepatology, Cancer, Créteil, France
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization, (MICRO), St James' Hospital, Dublin, Ireland
| | - Anne-Fleur Haudebourg
- Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor-Albert Chenevier, Service de Médecine Intensive Réanimation, Créteil Cedex, France; Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, Créteil, France; INSERM U955, Institut Mondor de Recherche Biomédicale, Créteil, France
| | - Minh P Lê
- Service de Pharmacologie, DMU Biologie et Génomique Médicale (BioGeM), Hôpital Bichat-Claude Bernard, Paris, France; INSERM UMR 1137, IAME, Paris, France
| | - Gilles Peytavin
- Service de Pharmacologie, DMU Biologie et Génomique Médicale (BioGeM), Hôpital Bichat-Claude Bernard, Paris, France; INSERM UMR 1137, IAME, Paris, France
| | - Marie-Anne Rameix-Welti
- Centre National de Référence Virus des Infections Respiratoires, Institut Pasteur, Université Paris Cité, Paris, France; M3P, Institut Pasteur, Université Paris-Saclay, Université de Versailles St. Quentin, Université Paris Cité, UMR 1173 (2I), INSERM, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Slim Fourati
- Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, Créteil, France; INSERM U955, Institut Mondor de Recherche Biomédicale, Créteil, France; INSERM U955, Team Viruses, Hepatology, Cancer, Créteil, France; Department of Virology, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - Nicolas de Prost
- Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor-Albert Chenevier, Service de Médecine Intensive Réanimation, Créteil Cedex, France; Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, Créteil, France; INSERM U955, Institut Mondor de Recherche Biomédicale, Créteil, France; INSERM U955, Team Viruses, Hepatology, Cancer, Créteil, France.
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Gao F, Zheng Z, Liu X, Li J. CMPK2 promotes microglial activation through the cGAS-STING pathway in the neuroinflammatory mechanism. Sci Rep 2025; 15:11807. [PMID: 40189684 PMCID: PMC11973145 DOI: 10.1038/s41598-025-97232-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Accepted: 04/03/2025] [Indexed: 04/09/2025] Open
Abstract
The activation of microglia and the resulting neuroinflammation play crucial regulatory roles in the pathogenesis and progression of neurological diseases, although the specific mechanisms remain incompletely understood. Cytidine monophosphate kinase 2 (CMPK2) is a key mitochondrial nucleotide kinase involved in cellular energy metabolism and nucleotide synthesis. Recent studies suggest that CMPK2 plays a role in microglial-mediated neuroinflammation; however, its specific impact on microglial activation remains unclear. In this study, we hypothesize that CMPK2 promotes microglial-mediated neuroinflammation by activating the cGAS-STING signaling pathway. To investigate this mechanism, we employed lipopolysaccharide (LPS)-treated microglial cells to investigate the detailed mechanisms by which CMPK2 regulates neuroinflammation. Our experimental results indicate that in the BV2 and mouse primary microglial neuroinflammation model, both CMPK2 protein and transcript levels were significantly elevated, accompanied by microglial activation phenotypes such as increased cell size, shortened processes, transformation to round or rod-like shapes, and elevated CD40 expression. Concurrently, there was an increase in pro-inflammatory cytokine levels and a decrease in anti-inflammatory cytokine levels. Further investigation revealed that in the microglial, the expression of cGAS and STING was elevated, along with an increase in oxidative products and inflammatory responses. CMA stimulation further intensified these changes, while cGAS knockdown mitigated them. Finally, we demonstrated that cGAS knockdown inhibited the oxidative stress, cell activation-related changes, and neuroinflammatory responses induced by CMPK2 overexpression in the BV2 neuroinflammation model. Molecular docking experiments showed that CMPK2 stably binds to cGAS at the protein level. These findings suggest that the cGAS-STING pathway mediates CMPK2-induced microglial activation. In summary, our study demonstrates that LPS-induced CMPK2 overactivity promotes microglial activation and neuroinflammatory through the cGAS-STING pathway.
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Affiliation(s)
- Feng Gao
- Department of Neurosurgery, Xingtai People's Hospital, Xingtai, Hebei, China.
| | - Zijian Zheng
- Department of Neurosurgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China.
| | - Xinjie Liu
- Department of Neurosurgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Jianwei Li
- Department of Neurosurgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
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Azeli Y, Solà-Muñoz S, Trenado J, Jacob J, Cubedo M, Delgado R, Mugica EM, Fontan I, Bracero A, López-López C, Carricondo-Avivar MDM, Luque-Hernández MJ, Villalba E, Simón S, Castejón ME, Goñi C, Cardenete C, Quintela Z, Abejón R, Bermejo Á, Martín M, Soto-García MÁ, Morales-Alvarez J, Cuartas-Alvarez T, Castro-Delgado R, Jiménez-Fàbrega X. A transfer triage tool for COVID-19 mass critical care surges. Sci Rep 2025; 15:11726. [PMID: 40188194 PMCID: PMC11972393 DOI: 10.1038/s41598-025-95337-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 03/20/2025] [Indexed: 04/07/2025] Open
Abstract
The objective of this study is to develop and validate a predictive model for mortality among severe COVID-19 patients who are candidates for inter-hospital transfer. A multicenter prospective observational study was conducted between 1 January 2021 and 30 April 2021 (third and fourth pandemic waves) in regional coordination centers of the Emergency Medical Services of eight Spanish autonomous communities. Hospitalized patients with severe COVID-19 transferred to other hospitals were included. Clinical variables from the initial evaluation, the triage score, and in-hospital mortality rates were collected. A Lasso-type regression analysis was performed to fit the mortality predictive model and its performance was evaluated by a leave-one-out cross-validation. Subsequently, the regional mass triage (MATER) score was created. 1,018 transferred patients were included, with a mean age of 62.3 years (SD 12), of whom 65.1% were male and 89.6% were admitted to an Intensive Care Unit. In-hospital mortality was 23.0%. The MATER score included six variables and presented good discrimination ability with an area under the curve of 0.79 (95% CI 0.77-0.81) and a good calibration with a Brier score of 0.135. The MATER score successfully predicted the mortality rate of severe COVID-19 patients and can be helpful in decision-making for triage and transfer prioritization in mass critical care surges.
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Affiliation(s)
- Youcef Azeli
- Sistema d'Emergències Mèdiques de Catalunya, Carrer de Pablo Iglesias 101-115, L'Hospitalet de Llobregat, Barcelona, Spain.
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), SEMES, Madrid, Spain.
- Hospital Universitari Sant Joan de Reus, Reus, Spain.
- Institut d'Investigació Sanitària Pere i Virgili (IISPV), Tarragona, Spain.
| | - Silvia Solà-Muñoz
- Sistema d'Emergències Mèdiques de Catalunya, Carrer de Pablo Iglesias 101-115, L'Hospitalet de Llobregat, Barcelona, Spain
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), SEMES, Madrid, Spain
| | - José Trenado
- Sistema d'Emergències Mèdiques de Catalunya, Carrer de Pablo Iglesias 101-115, L'Hospitalet de Llobregat, Barcelona, Spain
- Facultad de Medicina de la Universidad de Barcelona, Barcelona, Spain
- Hospital Mutua de Terrassa, Barcelona, Spain
| | - Javier Jacob
- Facultad de Medicina de la Universidad de Barcelona, Barcelona, Spain
- Hospital Universitario de Bellvitge, Barcelona, Spain
| | | | - Ricardo Delgado
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), SEMES, Madrid, Spain
- Gerencia de Urgencias, Emergencias y Transporte Sanitario, GUETS, SESCAM, Castilla-La Mancha, Spain
| | - Edurne Miren Mugica
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), SEMES, Madrid, Spain
- Emergencias Osakidetza, The Basque Country, Spain
| | - Iraitz Fontan
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), SEMES, Madrid, Spain
- Emergencias Osakidetza, The Basque Country, Spain
| | - Antonio Bracero
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), SEMES, Madrid, Spain
- Hospital Reina Sofía, Córdoba, Córdoba, Spain
| | - Cristina López-López
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), SEMES, Madrid, Spain
- Centro de Emergencias Sanitarias 061, Andalucía, Spain
| | - Maria Del Mar Carricondo-Avivar
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), SEMES, Madrid, Spain
- Centro de Emergencias Sanitarias 061, Andalucía, Spain
| | - María José Luque-Hernández
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), SEMES, Madrid, Spain
- Centro de Emergencias Sanitarias 061, Andalucía, Spain
| | - Eloy Villalba
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), SEMES, Madrid, Spain
- SAMU061 Islas Baleares, Islas Baleares, Spain
| | - Silvia Simón
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), SEMES, Madrid, Spain
- Servicio de Urgencias y Emergencias 061 de La Rioja, La Rioja, Spain
| | - María Elena Castejón
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), SEMES, Madrid, Spain
- SAMU, Servicio de Emergencias Sanitarias, Alicante, Spain
| | - Cristina Goñi
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), SEMES, Madrid, Spain
- Servicio de Urgencias Extrahospitalarias y Osasunbidea, Navarra, Spain
| | - César Cardenete
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), SEMES, Madrid, Spain
- Servicio de Urgencias Médicas de Madrid-SUMMA 112, Madrid, Spain
| | - Zita Quintela
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), SEMES, Madrid, Spain
- Servicio de Urgencias Médicas de Madrid-SUMMA 112, Madrid, Spain
| | - Raquel Abejón
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), SEMES, Madrid, Spain
- Servicio de Urgencias Médicas de Madrid-SUMMA 112, Madrid, Spain
| | - Ángel Bermejo
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), SEMES, Madrid, Spain
- Servicio de Urgencias Médicas de Madrid-SUMMA 112, Madrid, Spain
| | - Mario Martín
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), SEMES, Madrid, Spain
- Servicio de Urgencias Médicas de Madrid-SUMMA 112, Madrid, Spain
| | - Maria Ángeles Soto-García
- Sistema d'Emergències Mèdiques de Catalunya, Carrer de Pablo Iglesias 101-115, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jorge Morales-Alvarez
- Sistema d'Emergències Mèdiques de Catalunya, Carrer de Pablo Iglesias 101-115, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Tatiana Cuartas-Alvarez
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), SEMES, Madrid, Spain
- Health Service of the Principality of Asturias (SAMU-Asturias), Health Research Institute of the Principality of Asturias (Research Group on Prehospital Care and Disasters), Asturias, Spain
| | - Rafael Castro-Delgado
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), SEMES, Madrid, Spain
- Health Service of the Principality of Asturias (SAMU-Asturias), Health Research Institute of the Principality of Asturias (Research Group on Prehospital Care and Disasters), Asturias, Spain
- Departamento de Medicina, Universidad de Oviedo, Oviedo, Spain
| | - Xavier Jiménez-Fàbrega
- Sistema d'Emergències Mèdiques de Catalunya, Carrer de Pablo Iglesias 101-115, L'Hospitalet de Llobregat, Barcelona, Spain
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), SEMES, Madrid, Spain
- Facultad de Medicina de la Universidad de Barcelona, Barcelona, Spain
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Wang Y, Zhang Z, Qu X, Zhou G. Role of the endothelial cell glycocalyx in sepsis-induced acute kidney injury. Front Med (Lausanne) 2025; 12:1535673. [PMID: 40255592 PMCID: PMC12006053 DOI: 10.3389/fmed.2025.1535673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2024] [Accepted: 03/25/2025] [Indexed: 04/22/2025] Open
Abstract
Sepsis-induced acute kidney injury (S-AKI) is a common complication of sepsis. It occurs at high incidence and is associated with a high level of mortality in the intensive care unit (ICU). The pathophysiologic mechanisms underlying S-AKI are complex, and include renal vascular endothelial cell dysfunction. The endothelial glycocalyx (EG) is a polysaccharide/protein complex located on the cell membrane at the luminal surface of vascular endothelial cells that has anti-inflammatory, anti-thrombotic, and endothelial protective effects. Recent studies have shown that glycocalyx damage plays a causal role in S-AKI progression. In this review, we first describe the structure, location, and basic function of the EG. Second, we analyze the underlying mechanisms of EG degradation in sepsis and S-AKI. Finally, we provide a summary of the potential therapeutic strategies that target the EG.
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Affiliation(s)
- Yixun Wang
- The First College of Clinical Medical Science, China Three Gorges University, Yichang, China
- Department of Critical Care Medicine, Yichang Central People's Hospital, Yichang, China
- Yichang Sepsis Clinical Research Center, Yichang, Hubei, China
| | - Zhaohui Zhang
- The First College of Clinical Medical Science, China Three Gorges University, Yichang, China
- Department of Critical Care Medicine, Yichang Central People's Hospital, Yichang, China
- Yichang Sepsis Clinical Research Center, Yichang, Hubei, China
| | - Xingguang Qu
- The First College of Clinical Medical Science, China Three Gorges University, Yichang, China
- Department of Critical Care Medicine, Yichang Central People's Hospital, Yichang, China
- Yichang Sepsis Clinical Research Center, Yichang, Hubei, China
| | - Gaosheng Zhou
- The First College of Clinical Medical Science, China Three Gorges University, Yichang, China
- Department of Critical Care Medicine, Yichang Central People's Hospital, Yichang, China
- Yichang Sepsis Clinical Research Center, Yichang, Hubei, China
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146
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Canetta C, Accordino S, Sozzi FB. Intermediate Care Units in Internal Medicine. Eur J Intern Med 2025:S0953-6205(25)00127-X. [PMID: 40187912 DOI: 10.1016/j.ejim.2025.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2024] [Revised: 03/25/2025] [Accepted: 03/26/2025] [Indexed: 04/07/2025]
Abstract
BACKGROUND Intermediate Care Units (ImCU) have been historically described as an intermediate level of care between standard wards and intensive care units (ICU), and general medical ImCUs have evolved as specifically addressed to high care medical patients. The objective of this study is to explore designs, appropriateness criteria, and quality of care of general medical ImCUs. METHODS a comprehensive literature search was performed in electronic database (PubMed/Medline, Embase, Cochrane and Web of Science) up to July 30th 2024 and data about general medical ImCU denominations, settings, processes and outcomes were extracted. RESULTS 34 studies were included in systematic analyses, the more used nomenclature was ImCU (70.6 %), followed by High Dependency Unit (20.6 %). The median number of beds was 8 [4-11], the nurse-to-patients ratio 1:3.1, and internists involved in comanagement in 40.0 %. Either a step-up from standard wards or a step-down from ICUs role were reported, with a median of 50.8 % [26.2-71.0] of patients directly admitted from Emergency Departments. The main distinctive activities were continuous monitoring and non-invasive ventilation. The median ICU transfer rate was 8.0 % [5.6-12.3], while in-ImCU and in-hospital mortality were 6.2 % [3.6-8.3] and 14.0 % [8.7-19.1], respectively. CONCLUSIONS general medical ImCUs are being increasingly recognized as the appropriate setting for high care medical patients but present to date a wide variability of formats. Activity-based admission criteria tailored on each hospital reality could be a process model for adequate patient flow, and quality of care key indicators should consider the functional general medical ImCU role in hospital macro-systems.
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Affiliation(s)
- Ciro Canetta
- High Care Internal Medicine Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico of Milan, Italy
| | - Silvia Accordino
- High Care Internal Medicine Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico of Milan, Italy.
| | - Fabiola B Sozzi
- Cardiology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico of Milan, Italy
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147
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Repetto P, Ruiz C, Rojas V, Olivares P, Bakker J, Alegria L. Spiritual care for prevention of psychological disorders in critically ill patients: study protocol of a feasibility randomised controlled pilot trial. BMJ Open 2025; 15:e084914. [PMID: 40180407 PMCID: PMC11969617 DOI: 10.1136/bmjopen-2024-084914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/07/2025] [Indexed: 04/05/2025] Open
Abstract
INTRODUCTION A significant number of critically ill patients who survive their illness will experience new sequelae or a worsening of their baseline health status following their discharge from the hospital. These consequences may be physical, cognitive and/or psychological and have been labelled postintensive care syndrome (PICS). Prior research has demonstrated that spiritual care aligned with a specific creed during hospitalisation in the intensive care unit (ICU), as part of a comprehensive care plan, may be an effective strategy for preventing psychological sequelae in surviving critically ill patients. However, there is a gap in clinical literature regarding the effectiveness of generalist spiritual care in preventing psychological sequelae associated with PICS. This pilot study aims to explore the feasibility of implementing a generalist spiritual care strategy in the ICU and to evaluate its preliminary effectiveness in preventing anxiety and depression symptoms and post-traumatic stress disorder in critically ill patients. METHODS AND ANALYSIS This is a single-site, feasibility randomised controlled pilot trial of a generalist spiritual care intervention compared with the current standard of care. A total of 30 adults who are critically ill and have undergone invasive mechanical ventilation for a minimum of 72 hours without alterations in consciousness will be randomly assigned to either the spiritual care group or the usual care group at a ratio of 1:1. The primary outcome will be the feasibility and acceptability of the spiritual care strategy in critically ill patients. Secondary aims include evaluating the differences in anxiety and depression symptoms and post-traumatic stress disorder between the spiritual care group and the usual care control group at 3 months after ICU discharge. Subjects will be followed up until 3 months post-ICU discharge. ETHICS AND DISSEMINATION The Ethics Committee for Medical Sciences of Pontificia Universidad Católica de Chile (#220111005) and the Ethics Committee of Servicio de Salud Metropolitano Sur Oriente approved the study. Pontificia Universidad Católica de Chile funded the study (project number 105699/DPCC2021). The findings will be widely disseminated through peer-reviewed publications, academic conferences, local community-based presentations, partner organisations and the Chilean Intensive Care Society. TRIAL REGISTRATION NUMBER NCT06048783.
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Affiliation(s)
- Paula Repetto
- Escuela de Psicología, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Centro para la Prevención y Control del Cáncer (CECAN), Santiago, Chile
| | - Carolina Ruiz
- Departamento de Medicina Intensiva, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Unidad de Paciente Critico, Complejo Asistencial Dr Sotero del Río, Santiago, Chile
| | - Verónica Rojas
- Unidad de Paciente Critico, Departamento de Medicina, Facultad de Medicina, Universidad de Chile, Santiago de Chile, Chile
| | - Patricia Olivares
- Departamento de Medicina Interna, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Servicio de Medicina Interna, Complejo Asistencial Dr Sotero del Río, Santiago, Chile
| | - Jan Bakker
- Department of Intensive Care Adults, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Leyla Alegria
- Departamento de Medicina Intensiva, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Departamento del Adulto y Senescente, Escuela de Enfermería, Pontificia Universidad Católica de Chile, Santiago, Chile
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Lobo-Valbuena B, Sánchez-Roca MD, Regalón-Martín MP, Torres-Morales J, Enciso-Calderón V. Interprofessional intervention in the prevention of PICS and PICS-F. ENFERMERIA INTENSIVA 2025; 36:500528. [PMID: 40184765 DOI: 10.1016/j.enfie.2025.500528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 07/12/2024] [Accepted: 07/16/2024] [Indexed: 04/07/2025]
Abstract
The follow-up of the critically ill patient at discharge is an essential process to ensure continuity of care and prevent complications after the stay in an intensive care unit (ICU). The nurse's role as coordinator of this follow-up is crucial because of her experience in managing complex care and her ability to act as a liaison between the patient, her family and the interprofessional health care team. The article highlights that the transition of the critically ill patient from the ICU to other inpatient units or home represents a vulnerable period, where the risk of readmission and complications is high. The nurse plays a central role in planning and executing a comprehensive discharge plan, which includes educating the patient and family about continuing care, communicating with other healthcare professionals, and recognising warning signs that require immediate medical attention. In addition, she addresses the emotional and psychological needs of the patient and family, providing support and resources to adjust to life post-ICU. The nurse acts as an advocate for the patient, ensuring that person-centred care is maintained, respecting the patient's preferences and values.
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Affiliation(s)
- Beatriz Lobo-Valbuena
- Unidad de Cuidados Intensivos, Hospital Universitario del Henares, Coslada, Madrid, Spain; Grupo de Investigación en Patología Crítica, Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain.
| | | | | | - Julia Torres-Morales
- Unidad de Continuidad Asistencial, Hospital Universitario del Henares, Coslada, Madrid, Spain
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Jiang W, Qin Y, Chen L. Bibliometric analysis of multimodal analgesia research in the perioperative period: trends, contributions, and emerging areas (2013-2023). Front Med (Lausanne) 2025; 12:1573112. [PMID: 40248084 PMCID: PMC12004494 DOI: 10.3389/fmed.2025.1573112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2025] [Accepted: 03/17/2025] [Indexed: 04/19/2025] Open
Abstract
Objectives Multimodal analgesia (MA) is a cornerstone in perioperative pain management, enhancing pain relief and minimizing opioid consumption by targeting various pain pathways. This study conducts a bibliometric analysis of MA research from 2013 to 2023 to understand its development and impact on perioperative care. Methods A comprehensive literature search of the Web of Science Core Collection (WOSCC) was conducted, covering publications from January 2013 to December 2023. Data were analyzed using VOSviewer and other bibliometric tools to identify publication trends, key contributors, and emerging research themes. Results The analysis identified 1,939 studies on MA, with a notable increase in annual publications since 2020. The USA, China, and Canada were the leading contributors. Key terms like Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), Enhanced Recovery After Surgery (ERAS), and Patient-Controlled Analgesia (PCA) were frequently associated with MA. Significant journals included the Cureus Journal of Medical Science and Anesthesia and Analgesia. Influential authors such as Richard D. Urman and Henrik Kehlet were highlighted for their contributions. The research showed significant advancements and growing global interest in MA. Conclusion The study underscores the growing importance of MA in perioperative pain management, with significant contributions from leading countries and researchers. Future research should focus on optimizing pain management protocols, enhancing patient recovery, and reducing opioid dependency through MA.
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Affiliation(s)
- Wenchen Jiang
- Department of Anesthesiology, Hunan Provincial Maternal and Child Health Care Hospital (Hunan Institute of Reproductive Medicine), Changsha, Hunan, China
| | - Yi Qin
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Liang Chen
- Department of Anesthesiology, Hunan Provincial Maternal and Child Health Care Hospital (Hunan Institute of Reproductive Medicine), Changsha, Hunan, China
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150
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Bastos Mendes LF, Dal-Pizzol HR, Prestes G, Saibro Girardi C, Santos L, Gelain DP, Westphal GA, Walz R, Ritter C, Dal-Pizzol F, Fonseca Moreira JC. Prediction of COVID-19 mortality using machine learning strategies and a large-scale panel of plasma inflammatory proteins: A cohort study. Med Intensiva 2025:502200. [PMID: 40185655 DOI: 10.1016/j.medine.2025.502200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2024] [Accepted: 03/01/2025] [Indexed: 04/07/2025]
Abstract
OBJECTIVE To apply machine learning algorithms to generate models capable of predicting mortality in COVID-19 patients, using a large platform of plasma inflammatory mediators. DESING Prospective, descriptive, cohort study. SETTING 6 intensive care units in 2 hospitals in Southern Brazil. PATIENTS Patients aged > 18 years who were diagnosed with COVID-19 through reverse transcriptase reaction or rapid antigen test. INTERVENTIONS None. MAIN VARIABLES OF INTEREST Demographic and clinical variables, 65 inflammatory biomarkers, mortality. RESULTS Combinations of two or three proteins yield higher predictive value when compared to individual proteins or the full set of the 65 proteins. A proliferation-inducing ligand (APRIL) and cluster of differentiation 40 ligand (CD40L) consistently emerge among the highest-ranking combinations, suggesting a potential synergistic effect in predicting clinical outcomes. The network structure suggested a dysregulated immune response in non-survivors characterized by the failure of regulatory cytokines to temper an overwhelming inflammatory reaction. CONCLUSION Our results highlight the value of feature selection and careful consideration of biomarker combinations to improve prediction accuracy in COVID-19 patients.
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Affiliation(s)
- Luiz Filipe Bastos Mendes
- Departamento de Bioquímica, Centro de Estudos em Estresse Oxidativo, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Henrique Ritter Dal-Pizzol
- Departamento de Bioquímica, Centro de Estudos em Estresse Oxidativo, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Gabriele Prestes
- Laboratory of Experimental Pathophysiology, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina (UNESC), Criciúma, Santa Catarina, Brazil
| | - Carolina Saibro Girardi
- Departamento de Bioquímica, Centro de Estudos em Estresse Oxidativo, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Lucas Santos
- Departamento de Bioquímica, Centro de Estudos em Estresse Oxidativo, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Daniel Pens Gelain
- Departamento de Bioquímica, Centro de Estudos em Estresse Oxidativo, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Roger Walz
- Center for Applied Neuroscience, University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Cristiane Ritter
- Laboratory of Experimental Pathophysiology, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina (UNESC), Criciúma, Santa Catarina, Brazil; Intensive Care Unit, Hospital São José, Criciúma, SC, Brazil
| | - Felipe Dal-Pizzol
- Laboratory of Experimental Pathophysiology, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina (UNESC), Criciúma, Santa Catarina, Brazil; Intensive Care Unit, Hospital São José, Criciúma, SC, Brazil.
| | - Jose Claudio Fonseca Moreira
- Departamento de Bioquímica, Centro de Estudos em Estresse Oxidativo, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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