Spiritual care for prevention of psychological disorders in critically ill patients: study protocol of a feasibility randomised controlled pilot trial

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.

Interprofessional intervention in the prevention of PICS and PICS-F

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.

Bibliometric analysis of multimodal analgesia research in the perioperative period: trends, contributions, and emerging areas (2013-2023)

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.

Prediction of COVID-19 mortality using machine learning strategies and a large-scale panel of plasma inflammatory proteins: A cohort study

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.

Association Between Energy Delivery and Outcomes in Adult Critically Ill Patients Diagnosed With or At Risk of Malnutrition: A Systematic Review and Meta-analysis With Trial Sequential Analysis

CONTEXT

There is a common belief that adult critically ill patients diagnosed with or at risk of malnutrition would benefit from higher energy delivery.

OBJECTIVE

This systematic review and meta-analysis aimed to evaluate the association between energy delivery and mortality in adult critically ill patients diagnosed with or at risk of malnutrition.

DATA SOURCES

Databases including Medline, Embase, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central, and Google Scholar were searched from inception to November 20, 2023.

DATA EXTRACTION

Randomized controlled trials (RCTs) and observational studies that (1) included critically ill patients (aged ≥18 years) diagnosed with or at risk of malnutrition using validated tools following intensive care unit (ICU) admission, (2) had at least 20% energy difference between intervention and comparison groups, and (3) reported mortality outcomes were included. The random-effects model was used to pool the data.

DATA ANALYSIS

Two RCTs (4681 at-risk patients) and 5 observational studies (1587 at-risk patients [including 389 high-risk patients]) were included. The pooled mean energy delivered during the first 7-14 days of ICU admission in higher vs lower energy groups was 25.6 ± 5.9 vs 9.7 ± 5.6 kcal/kg per day (P = .004) in RCTs and 21.0 ± 5.2 vs 13.3 ± 5.3 kcal/kg per day (P < .001) in observational studies. No mortality difference was found between higher vs lower energy groups in at-risk patients (risk ratio: 0.99; 95% CI: 0.85, 1.17; P = .94) in RCTs and high-risk patients (adjusted odds ratio: 1.37; 95% CI: 0.43, 4.32; P = .59) in observational studies. Trial sequential analysis was performed and 31 232 patients were required to show a potential treatment effect.

CONCLUSION

These data do not support the prevailing belief that higher energy delivery improves survival in adult critically ill patients diagnosed with or at risk of malnutrition.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42021274378.

Epidemiological changes and outcomes of people living with HIV admitted to the intensive care unit: a 14-year retrospective study

PURPOSES

Since 2016, the World Health Organization has recommended universal antiretroviral therapy (ART) for all people living with Human Immunodeficiency Virus (PLHIV). This recommendation may have influenced the characteristics and outcomes of PLHIV admitted to the Intensive Care Unit (ICU). This study aims to identify changes in the epidemiological and clinical characteristics of PLHIV admitted to the ICU, and their short- and medium-term outcomes before and after the implementation of universal ART (periods 2006-2015 and 2016-2019).

METHODS

This retrospective, observational, single-center study included all adult PLHIV admitted to the ICU of a University Hospital in Barcelona from 2006 to 2019.

RESULTS

The study included 502 admissions involving 428 patients, predominantly men (75%) with a median (P25-P75) age of 47.5 years (39.7-53.9). Ninety-one percent were diagnosed with HIV before admission, with 82% under ART and 60% admitted from the emergency department. In 2016-2019, there were more patients on ART pre-admission, reduced needs for invasive mechanical ventilation (IMV) and fewer in-ICU complications. ICU mortality was also lower (14% vs 7%). Predictors of in-ICU mortality included acquired immunodeficiency syndrome defining event (ADE)-related admissions, ICU complications, higher SOFA scores, IMV and renal replacement therapy (RRT) requirement. ART use during ICU admission was protective. Higher SOFA scores, admission from hospital wards, and more comorbidities predicted one-year mortality.

CONCLUSIONS

The in-ICU mortality of critically ill PLHIV has decreased in recent years, likely due to changes in patient characteristics. Pre- and ICU admission features remain the primary predictors of short- and medium-term outcomes.

Risk factors and outcomes of pediatric non-invasive respiratory support failure in Latin America

Background

Noninvasive respiratory support (NRS) is standard in pediatric intensive care units (PICUs) for respiratory diseases, but its failure can lead to complications requiring invasive mechanical ventilation (IMV). This study aimed to identify risk factors for NRS failure in children with acute respiratory failure (ARF) in PICUs, and compare complications and outcomes between IMV-only and NRS failure patients.

Methods

We conducted a cohort study using data from the LARed Network prospective registry (April 2017-November 2022), in children under 18 years admitted to PICUs for ARF. Cases were divided into subgroups: those managed with IMV only, those who experienced NRS failure requiring IMV, those who received NRS successfully, and those who did not require NRS or IMV. Exclusions included patients with home respiratory support prior to admission, patients without PICU discharge at the cutoff date of the analysis and those with incomplete data. Multivariate mixed models analyzed NRS failure risk factors, and complications between the IMV-only and NRS failure groups, using centers as a random effect.

Results

A total of 7374 children met the inclusion criteria, with 6208 in the NRS group and 1166 in the IMV-only group. The NRS success rate was 85.3 %. Risk factors for NRS failure included age (median of 4.6 months, interquartile range of 2.1-14.2 months), history of prematurity (adjusted odds ratio [aOR]=1.53, 95 % confidence interval [CI]: 1.20 to 1.95) or malnutrition (aOR=1.85, 95 % CI: 1.18 to 2.91), suspected bacterial infection (aOR=5.12, 95 % CI: 4.05to 6.49), FiO2 >30 % (aOR=1.52, 95 % CI: 1.18 to 1.97), severe hypoxemia with SpO2/FiO2 ≤150 (aOR=1.85, 95 % CI: 1.48 to 2.30), tachypnea (aOR=1.42, 95 % CI: 1.18 to 1.72), tachycardia (aOR=1.77, 95 % CI: 1.47 to 2.12), and lung consolidations (aOR=1.45, 95 % CI: 1.14 to 1.85) or interstitial infiltrates (aOR=1.29, 95 % CI: 1.05 to 1.58) on chest X-ray. There were no significant differences in morbidity, mortality, duration of IMV, or PICU length of stay between patients who received IMV only and those who experienced NRS failure. However, patients who experienced NRS failure were more likely to develop withdrawal symptoms related to sedative or opioid discontinuation and/or delirium (aOR=2.57, 95 % CI: 1.85 to 2.57).

Conclusion

This study identified key risk factors for predicting NRS failure in children with acute ARF in PICUs, including younger age, prematurity, malnutrition, suspected bacterial infection, FiO2 >30 %, severe hypoxemia (SpO2/FiO2 ≤150), tachypnea, tachycardia, and radiological findings such as lung consolidation and interstitial infiltrates. Compared to patients managed with IMV from the start, those who experienced NRS failure were more likely to develop withdrawal symptoms and/or delirium, although clinical outcomes such as mortality, IMV duration, and PICU length of stay were similar in both groups.

Awake Venovenous Extracorporeal Membrane Oxygenation in the Intensive Care Unit: Challenges and Emerging Concepts

Extracorporeal membrane oxygenation (ECMO) is an advanced treatment for severe respiratory failure. Implantation of ECMO before invasive ventilation or extubation during ECMO has been reported and is becoming increasingly popular. Avoidance of sedation and invasive ventilation during ECMO (commonly referred to as "awake ECMO") may have potential advantages, including a lower rate of delirium, shorter mechanical ventilation time, and the possibility of undergoing early rehabilitation and/or physiotherapy. However, awake ECMO is also associated with several risks, such as self-inflicted lung injury and cannula displacement or self-removal. Accordingly, invasive ventilation before ECMO, as well as weaning from ECMO before weaning from mechanical ventilation, remain the most common approaches. In this review, the authors describe indications, contraindications, advantages, disadvantages, and current evidence on the use of ECMO without invasive ventilation in patients with respiratory failure.

Impact of pre-existing cancer diagnoses on burn injury survival and morbidity

OBJECTIVES

Severe burns place patients in a compromised state, especially those with pre-existing chronic diseases such as malignancy. Due to improvements in detection and treatment, cancer mortality has declined significantly, leaving a growing population of cancer survivors. Therefore, we wondered whether pre-existing cancer diagnoses influence patient outcomes following burn injury.

METHODS

46,275 patients with a neoplasm diagnosis prior to experiencing a burn injury were identified using the TriNetX research network. Two control groups were organized: 1) cancer patients without burns and 2) burn patients with no history of cancer. The test group included patients with a pre-existing cancer diagnosis who received a subsequent burn injury. Outcomes included death, sepsis, nutritional deficiency, eating disorder, immunodeficiency, and depression. Odds ratios were calculated with 95 % confidence intervals.

RESULTS

Of the nearly 10 million cancer patients, 0.45 % experienced a burn injury after diagnosis. Compared to propensity-matched burned patients without cancer, burned patients with a previous cancer diagnosis had increased odds of developing sepsis (2.013, 1.895-2.138), nutritional deficiency (1.874, 1.58-2.221), immunodeficiency (5.584, 4.85-7.06), eating disorder (2.384, 1.947-2.918), and depression (1.772, 1.695-1.853). The odds ratios of sepsis (1.718, 1.612-1.83), nutritional deficiency (1.963, 1.593-2.418), immunodeficiency (1.265, 1.098-1.459), eating disorder (2.569, 2.077-3.177), and depression (1.538, 1.468-1.611) were increased when compared to cancer patients without burn injury. Burned patients with a previous neoplasm of hematologic origin fared worse in the odds of developing the mentioned outcomes compared to those with solid neoplasms. Lastly, burned patients with any previous neoplasm who later received chemotherapy and/or radiation suffered worse outcomes than those who never received such treatment.

CONCLUSION

Patients who developed neoplasms before receiving a burn injury demonstrated considerable increases in odds of poor outcomes. Increased odds of developing poor outcomes were greater in those with hematologic neoplasms and those who received chemotherapy or radiation treatment.

Out-of-Hospital Cardiac Arrest 30-Day-Outcomes: The Importance of the First Electrocardiogram After Successful Resuscitation

BACKGROUND

While there is substantial evidence on the impact of prehospital resuscitation efforts on survival after out-of-hospital cardiac arrest (OHCA), the importance of the first electrocardiogram after return of spontaneous circulation has been much less studied.

OBJECTIVES

The aim of this study was to identify prognostically relevant electrocardiographic findings in patients after OHCA due to myocardial infarction (MI).

METHODS

A total of 119 patients admitted to hospital after suffering an OHCA due to MI were retrospectively analyzed. Patient characteristics and the first 12-lead electrocardiogram after return of spontaneous circulation were collected. The primary outcome was 30-day mortality.

RESULTS

A number of electrocardiographic findings were significantly associated with 30-day mortality: atrial fibrillation/flutter (HR 2.29 [95% CI 1.17-4.49, p = 0.015]), right bundle branch block (HR 2.23 [95% CI 1.14-4.56, p = 0.020]), bifascicular block (HR 2.51 [95% CI 1.04-6.059, p = 0.040]), T inversion (HR 2.01 [95% CI 1.02-3.99, p = 0.043]), QTc duration ≥500 ms (HR 2.21 [95% CI 1.10-4.42, p = 0.025]) and QT dispersion ≥ 100 ms (HR 2.11 [95% CI 1.02-4.37, p = 0.045]).

CONCLUSION

Several different electrocardiographic findings are associated with increased mortality in patients with OHCA due to MI.

Factors associated with early readmission to Intensive Care Units. A systematic review

INTRODUCTION

Readmission to the Intensive Care Unit (ICU) determines worse outcomes such as higher mortality, increased hospital and ICU stay, as well as higher economic costs. When deciding which patient is suitable for transfer from the ICU, factors associated with readmission must be considered to avoid it. Knowledge of these factors helps professionals identify those patients with a higher probability of readmission, prioritizing their care, establishing and preparing interventions that seek to reduce the risk of readmission.

OBJECTIVE

Determine factors associated with early readmission in patients transferred from the ICU to general hospitalization wards of the same hospital.

METHOD

Studies were retrieved from databases: CINAHL, EMBASE, BVS, PubMed, SCOPUS and WOS identifying original studies on adult patients readmitted early to the ICU during the same hospitalization, in any language and without time limit. Studies of patient readmission after seven days, review articles, editorials, protocols, clinical guidelines, qualitative studies and opinion surveys were excluded.

RESULTS

Of 755 files found, 28 articles made up the review. The most analyzed factors were age, sex, severity of the disease, comorbidity, length of stay in the ICU, mechanical ventilation and nocturnal discharge. Those most frequently associated with readmission were age, severity of illness, comorbidity, and length of ICU stay. NEWS, MEWS, and SWIFT scores were also factors associated with readmission.

CONCLUSION

More research is needed to identify those modifiable factors that can decrease readmission rates. Using readmission prediction instruments at the time of discharge could support the decision of which patient is most prepared for it.

Evaluation of a low-cost portable NIRS device for monitoring muscle ischemia

The main objective of this study is to evaluate the low-cost, open-source HEGduino device as a tissue oximetry monitor to advance the research of somatic NIRS monitoring. Specifically, this study analyzes the use of this portable functional NIRS system for detecting the cessation of blood flow due to vascular occlusion in an upper limb. 19 healthy patients aged between 25 and 50 were recruited and monitored using HEGduino device. Participants underwent a vascular occlusion test on one forearm. Raw values collected by HEGduino as well as the processed variables derived from the measurements were registered. Additional variables to characterize the signal noise during the tests were also recorded. The results of the data distribution curves for all the subjects in the study accurately detected the physiological events associated with transient tissue ischemia. The statistical analysis of the recorded data showed that the difference between the baseline values recorded by the red led (RED) and its normalized minimum variable was always different from zero (p < 0.014). Furthermore, the difference between the normalized baseline values recorded by the infrared led (IR) and the corresponding normalized minimum value was also different from zero (p < 0.001). The R-squared coefficient of determination for the noise variables considered in this study on the normalized RED and IR values was 0.08 and 0.105, respectively. The study confirms the potential of HEGduino system to detect an interruption of the blood flow by means of variations in regional tissue oxygen saturation. This study demonstrates the potential of the HEGduino device as a monitoring alternative to advance the study of the applicability of NIRS in muscle tissue oximetry.

Impact of patient safety on outcomes. From prevention to the treatment of post-intensive care syndrome

Survivors of critical illness may present physical, psychological, or cognitive symptoms after hospital discharge, encompassed within what is known as post-intensive care syndrome. These alterations result from both the critical illness itself and the medical interventions surrounding it. For its prevention, the implementation of the ABCDEF bundle (Assess/treat pain, Breathing/awakening trials, Choice of sedatives, Delirium reduction, Early mobility and exercise, Family) has been proposed, along with additional strategies grouped under the acronym GHIRN (Good communication, Handout materials, Redefined ICU architectural design, Respirator, Nutrition). In addition to these preventive measures during the ICU stay, high-risk patients should be identified for subsequent follow-up through multidisciplinary teams coordinated by Intensive Care Medicine Departments.

Accuracy of colour Doppler ultrasound for nasogastric tube placement in emergency department: A prospective observational study

OBJECTIVE

Nasogastric tube (NGT) placement is a common procedure in EDs. Successful NGT placement reduces complications such as aspiration pneumonia, pneumothorax and mortality. While chest radiography is the gold standard for confirmation, colour Doppler ultrasonography (CDU) has demonstrated high accuracy. As its applicability in the ED remains underexplored, the present study evaluates the accuracy of CDU in confirming NGT placement in the ED.

METHODS

A prospective observational study was conducted in a tertiary hospital ED from October 2022 to October 2023. Adult patients requiring NGT insertion were eligible. NGT placement was performed using a standardised protocol and confirmed with CDU and chest radiography. Accuracy of CDU was assessed against chest radiography, and procedural times for confirmation were compared using the Kruskal-Wallis H test.

RESULTS

Of 157 patients screened, 144 were included. CDU demonstrated 92.45% (95% confidence interval 85.67-96.69) sensitivity, 80.56% (63.98-91.81) specificity, positive predictive value 0.93 (0.88-0.96), negative predictive value 0.78 (0.64-0.88), positive likelihood ratio 4.75 (2.44-9.27) and negative likelihood ratio 0.09 (0.05-0.19). The median (interquartile range) confirmation times were 3.0 min (2.0-3.0) for CDU and 42.0 min (30.0-55.0) for radiography (P < 0.001).

CONCLUSION

CDU should not currently be used as a standalone method for confirming NGT placement due to its limitations and risk of false-positive results. Further research is required to address these challenges before considering its clinical implementation.

FATP1-mediated fatty acid uptake in renal tubular cells as a countermeasure for hypothermia

Hypothermia is a condition in which body temperature falls below 35 °C, resulting from exposure to low environmental temperatures or underlying medical conditions. Postmortem examinations have revealed increased levels of fatty acids in blood and lipid droplet formation in renal tubules during hypothermia. However, the causes and implications of these findings are unclear. This study aimed to analyze the biological significance of these phenomena through lipidomics and transcriptomics analyses of specimens from emergency hypothermia patients and mouse hypothermia models. Both human hypothermia patients and murine models exhibited elevated plasma concentrations of fatty acids and their derivatives compared with controls. Hypothermic mouse kidneys displayed lipid droplet formation, with gene expression analysis revealing enhanced fatty acid uptake and β-oxidation in renal tubular cells. In primary cultured mouse renal proximal tubular cells, low temperatures increased the expression levels of Fatty acid transport protein 1 (FATP1), a fatty acid transporter, and boosted oxygen consumption via β-oxidation. Mice treated with FATP1 inhibitors showed a more rapid decrease in body temperature upon exposure to low temperatures compared with untreated mice. In conclusion, increased fatty acid uptake mediated by FATP1 in renal tubular cells plays a protective role during hypothermia. KEY MESSAGES: Low temperatures increase FATP1 expression and fatty acid uptake in renal proximal tubular cells, resulting in enhanced β-oxidation. Renal proximal tubular cells play an important role in the resistance to hypothermia via lipid uptake. Maintaining renal lipid metabolism is essential for cold stress adaptation.

Use of a drug-related problem oriented medical record in the medication review of critically ill patients - Randomized clinical trial

BACKGROUND

The identification and reduction of drug-related problems (DRPs) through DRP-oriented medical records during the hospitalization of critically impatients can optimize health indicators, such as length of hospital stay.

OBJECTIVE

To determine the effect of medical records focused on drug-related problems on the duration of stay for patients in intensive care units.

METHOD

A randomized controlled clinical trial was conducted with patients assigned to intervention or the usual care groups involving clinical pharmacists. This trial occurred between March 2018 and March 2019 and was completed in two intensive care units within two hospitals in Brazil. Exploratory secondary outcomes included the mortality rate and reductions in Sequential Organ Failure Assessment (SOFA) and Δ SOFA scores.

RESULTS

A total of 150 patients participated-54.6 % were women, most being white (77.3 %). Further, the main diagnosis was Acute Coronary Syndrome (22.6 %), followed by Congestive Heart Failure (12.6 %) and Heart Failure (10 %). A significant difference was observed in the length of stay between the intervention group and the control group, respectively 7.08 days (±4.38) and 10.7 days (±6.32). Among the secondary outcomes, a significant difference was observed in the mortality rates between the two groups: (6.58 %) in the intervention group and 25.68 % in the control group. Regarding Δ SOFA, the intervention group exhibited a reduction of 4.63 in the SOFA score during hospitalization. The control group showed an increase of 1.88 in the score during the same period.

CONCLUSION

This study demonstrated that the use of Diagnoses - Adverse Clinical Findings - Medications (DAM), a medical record model aimed at resolving drug-related problems, reduced the length of hospital stay and mortality rates among patients. Furthermore, this model proved to be more effective than the usual care provided by clinical pharmacists.

Transbronchial Lung Cryobiopsy (TBLC) in an Acute Respiratory Distress Syndrome (ARDS) Patient Under Extracorporeal Membrane Oxygenation (ECMO)

We report one of the first known cases of transbronchial lung cryobiopsy (TBLC) performed in a patient with severe acute respiratory distress syndrome (ARDS) receiving extracorporeal membrane oxygenation (ECMO). After transient stopping of anticoagulation, TBLCs were performed in a controlled environment at the bedside in the intensive care unit (ICU). The ECMO avoided severe oxygenation deterioration, and bleeding was controlled by Fogarty balloon inflation. No major complications occurred, and the pulmonary biopsies helped obtain prognostic information and decide the most appropriate management. Nevertheless, the safety of this technique in such high-risk patients should be further investigated in larger case series, as it can be harmful if not performed in an appropriate environment.

Effect of Home Care on Physical Function in Post-Intensive Care Unit Patients: A Meta-Analysis

BACKGROUND

A decline in physical function is commonly observed after patients transition to their homes following hospital admission; this is especially true for patients requiring mechanical ventilation in an intensive care unit (ICU).

OBJECTIVE

This meta-analysis examines characteristics and effects of home-based or outpatient+home-based interventions used to improve physical function post-discharge in patients who received mechanical ventilation in an ICU.

METHODS

PRISMA guidelines were utilized. The literature search was conducted with the assistance of a medical librarian. Study inclusion criteria were post-ICU adult patients receiving mechanical ventilation who then had home-based or outpatient+home-based care to improve physical function after discharge. Effect size (Hedges' g) was calculated with random effects models.

RESULTS

Our search yielded 11 studies that met the inclusion criteria. The majority were randomized controlled trials, with 1 quasi-experimental study. All studies included physical therapists, and 2 included nurses. The 11 studies reported results for 39 physical function measurements. The overall pooled intervention effect across the 4 studies that utilized the 6-minute walk test was 0.32 (95% confidence intervals [CI]: 0.05 to 0.58), for the 3 studies that utilized the Timed Up and Go test it was 1.38 (95% CI: -0.09 to 2.84), and for the 8 studies that used the SF-36 Physical Function subscale, it was 0.31 (95% CI: 0.09 to 0.52).

CONCLUSIONS

This review's findings show that patients may improve their physical function after participating in specific intervention programs that are home-based alone or outpatient+home-based care. However, the effect sizes are small, so it may be useful to explore how to maximize the gains in physical function.

A modified Delphi consensus on the use of intramuscular midazolam for early status epilepticus treatment (ESET) in Malaysia

OBJECTIVES

Despite intramuscular (IM) midazolam being recommended as a primary treatment for status epilepticus (SE), its usage in Malaysian prehospital settings remains suboptimal. This study aimed to explore the awareness, practice, and barriers among healthcare professionals regarding the use of IM midazolam as a rescue medication for prehospital SE in Malaysia and provide a consensus for its implementation.

METHODS

An online cross-sectional survey and modified Delphi study was conducted among healthcare professionals across Malaysia from 22 March to 31 August 2024. A modified Delphi process was used to develop a consensus from existing literature, with two Delphi rounds assessing the relevance, clarity, and importance of each question. Consensus was achieved if 90 % or more participants agreed.

RESULTS

Among 137 responses, 89.1 % of healthcare professionals were aware of rescue medications. However, only 62.0 % recognized the superior absorption and bioavailability of IM midazolam over rectal diazepam, and 78.1 % were aware of its efficacy in terminating seizures. Of those (69.3 %) involved in SE management, 29.5 % (n = 28) were engaged in prehospital management of SE. Only 35.7 % (n = 10) reported that prehospital personnel were permitted to use IM midazolam for SE management and all required physician endorsement. Notably, 78.9 % of participants reported that 25 % or fewer patients with SE were treated with IM midazolam. The main barriers include unfamiliarity (64.2 %) and lack of protocols (62.1 %). A strong consensus was reached on the recommendation of IM midazolam as a first-line treatment for SE management.

CONCLUSION

While Malaysian healthcare professionals are aware of rescue medications for prehospital seizure emergencies, they lack an understanding of IM midazolam's benefits. Key barriers include unfamiliarity and lack of protocols despite strong consensus on its first-line use.

Isolated adrenocorticotropic hormone deficiency manifested after COVID-19

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 and long COVID can present with nonspecific symptoms resembling adrenal insufficiency. This similarity of symptoms means that adrenal insufficiency hidden among nonspecific manifestations of COVID-19 may pass underrecognized. We present the case of a 53-year-old Japanese man who developed isolated adrenocorticotrophic hormone (ACTH) deficiency (IAD) and acute adrenal insufficiency after COVID-19, thus mimicking prolonged symptoms of COVID-19. The patient developed fever, cough, and sore throat and was diagnosed with COVID-19. After anti-viral treatment, fever, loss of appetite, and general fatigue persisted, and hyponatremia was observed. Endocrinological testing on admission showed baseline concentrations of 3.5 μg/dL for cortisol and <1.5 pg/mL for ACTH. No abnormalities of other pituitary hormones were evident. Standard ACTH stimulation tests showed a decreased peak serum cortisol concentration and corticotropin-releasing hormone stimulation tests revealed no ACTH secretory response. Magnetic resonance imaging of the pituitary revealed no abnormalities. Adrenal insufficiency due to IAD was diagnosed based on the results of endocrinological testing. Intravenous and oral hydrocortisone improved symptoms and hyponatremia. The patient has experienced no recurrence of adrenal insufficiency under hydrocortisone treatment. COVID-19 can mimic adrenal insufficiency. IAD should be considered when nonspecific symptoms persist after treatment for COVID-19.

A Micro-costing Analysis of Single-use and Reusable Flexible Bronchoscope Usage in the Bronchoscopy Service at A Tertiary Care University Hospital

BACKGROUND

Single-use flexible bronchoscopes (SFBs) are increasingly used to minimize cross-infection risk, particularly in immunocompromised and intensive care unit patients. However, broader adoption requires cost analysis. We conducted a 1-year cost-minimization analysis comparing SFBs and reusable flexible bronchoscopes (RFBs) at a tertiary care university hospital.

METHODS

We evaluated the costs per procedure, considering capital equipment, maintenance, repair, reprocessing, and overhead costs. We also analyzed the impact of annual procedure volume on costs and performed a sensitivity analysis to assess the effect of uncertainty on costs.

RESULTS

A total of 1394 bronchoscopies were performed. RFBs were less expensive for an annual volume of >50 bronchoscopies/year, with a 22% lower cost per procedure than that for SFBs (€203 vs. €259). This cost advantage became increasingly favorable with an increasing number of procedures, reaching a plateau after exceeding 250 bronchoscopies/year. The capital equipment, the annual number of bronchoscopies, and reprocessing were the major cost drivers for RFBs. During nonworking hours, the cost per procedure of RFBs ranged from €349.45 to €392.29. Using RFBs during interventions involving a high risk of bronchoscope damage (frequency of damage >10%) would increase the cost per bronchoscopy to >€263 (exceeding the cost of SFBs).

CONCLUSION

RFBs were 22% less expensive than SFBs for services with a moderate to high volume of bronchoscopies. However, this difference could not justify using RFBs in patients with a high cross-infection risk. SFBs might be less costly for procedures outside working hours and interventions involving a high risk of bronchoscope damage.

Mortality predictors and definition proposal for complicated coagulase-negative Staphylococcus bacteraemia: a multicentre prospective cohort study

OBJECTIVES

The study aimed to explore a definition for complicated coagulase-negative staphylococci bloodstream infections (CoNS BSIs) and to identify predictors for mortality.

METHODS

A prospective cohort study was conducted from October 2016 to March 2017 in 26 Spanish hospitals. Complicated CoNS BSI criteria included lack of early catheter removal in catheter-related cases, foreign indwelling implant, persistent bacteraemia, fever ≥72 hours on active therapy, metastatic infection or deep-seated focus, and infective endocarditis. Independent predictors for 30-day mortality were evaluated by Cox regression, and the impact of the definition of complicated bacteraemia was assessed.

RESULTS

Overall, 445 CoNS BSI cases were included; catheter-related infections were predominant (336/445, 75.5%). Complicated bacteraemia was identified in 240 of 445 patients (53.9%); 30-day mortality in complicated and uncomplicated cases was 53 of 240 (22.1%) and 24/205 (11.7%), respectively (p 0.004). Predictors of 30-day mortality identified in the multivariate analysis included age (hazard ratio [HR]: 1.03, 95% CI: 1.01-1.05), cerebrovascular disease (HR: 2.58, 95% CI: 1.45-4.58), immunosuppressive therapy (HR: 2.16, 95% CI: 1.22-3.84), SOFA score (HR: 1.09, 95% CI: 1.03-1.16), and complicated bacteraemia (HR: 2.14, 95% CI: 1.29-3.53). A catheter-related source of bacteraemia was found to be protective (HR: 0.49, 95% CI: 0.30-0.80). When specific criteria to define complicated bacteraemia were included, fever ≥72 hours was associated with an increased risk of death (HR: 2.52, 95% CI: 1.52-4.17) and early catheter removal was protective (HR: 0.47, 95% CI: 0.26-0.83).

DISCUSSION

A high proportion of patients presented complicated bacteraemia according to the proposed criteria; these patients had higher hazards for mortality. Other mortality predictors were identified. Further studies would be needed to validate the proposed criteria.

Caring to care: Nurturing ICU healthcare professionals' wellbeing for enhanced patient safety

Healthcare professionals working in the Intensive Care Unit (ICU) care for patients suffering from a critical illness and their relatives. Working within a team of people with different personalities, competencies, and specialties, with constraints and demands might contribute to a working environment that is prone to conflicts and disagreements. This highlights that the ICU is a stressful place that can threaten healthcare professionals' wellbeing. This article aims to address the concept of wellbeing by describing how the stressful ICU work-environment threatens the wellbeing of health professionals and discussing how this situation jeopardizes patient safety. To promote wellbeing, it is imperative to explore actionable interventions such as improve communication skills, educational sessions on stress management, or mindfulness. Promoting ICU healthcare professionals' wellbeing through evidence-based strategies will not only increase their personal resilience but might contribute to a safer and more efficient patient care.

How to involve the patient and family in improving safety in intensive medicine services (SMI)?

Patient safety is a priority for health systems and is especially relevant for critically ill patients. Despite its relevance in recent years, many patients suffer adverse events with harm and negative repercussions for professionals and institutions. Numerous safe practices have been promoted and strategies have been developed that have been incorporated into institutional policies and thereby improving the safety culture. But there are still underdeveloped strategies, such as incorporating the participation of patients and family members in their safety. Until recently, the patient and family have been considered as a passive part in the reception of health services, not as an active part, much less as a possible opportunity to improve safety against errors that occur during care. The critically ill patient and/or family members must be informed and, ideally, trained to facilitate active participation in their safety. It is not about transferring responsibility, but about facilitating and promoting their participation by reinforcing their safety. And professionals must be committed to their safety and facilitate the conditions to encourage their participation. We provide tools and reflections to help professionals implement the participation of patients and family members in safety as they pass through intensive medicine services.

POCUS in the PICU: A Narrative Review of Evidence-Based Bedside Ultrasound Techniques Ready for Prime-Time in Pediatric Critical Care

Point-of-care ultrasound (POCUS) is an accessible technology that can identify and treat life-threatening pathology in real time without exposing children to ionizing radiation. We aim to review current evidence supporting the use of POCUS by pediatric intensivists with novice-level experience with bedside ultrasound. Current evidence supports the universal adoption of POCUS-guided internal jugular venous catheter placement and arterial line placement by pediatric critical care physicians. Focused cardiac ultrasound performed by PICU physicians who have completed appropriate training with quality assurance measures in place can identify life-threatening cardiac pathology in most children and important physiological changes in children with septic shock. POCUS of the lungs, pleural space, and diaphragm have great potential to provide valuable information at the bedside after validation of these techniques for use in the PICU with additional research. Based on currently available evidence, a generalizable and attainable POCUS educational platform for pediatric intensivists should include training in vascular access techniques and focused cardiac examination. A POCUS educational program should strive to establish credentialing and quality assurance programs that can be expanded when additional research validates the adoption of additional POCUS techniques by pediatric intensive care physicians.

Nimodipine in Aneurysmal Subarachnoid Hemorrhage: Are Old Data Enough to Justify Its Current Treatment Regimen?

Nimodipine, a dihydropyridine L-type calcium channel antagonist, constitutes one of the mainstays of care to prevent delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage (aSAH) because it has been associated with a reduction in infarction rates and improvement in functional outcomes despite not significantly preventing angiographic vasospasm. Although it is a widely accepted treatment, controversies surrounding the current regimen of nimodipine in patients with aSAH exist. Still, there is a wide space open for randomized controlled trials or alternative study designs comparing different routes of administration, dosing, and timing of nimodipine treatment regimen in patients with aSAH.

Impact of differential glycemic management goals in pre-anhepatic and anhepatic phase on early grafted liver function after liver transplantation: An open-label, randomized, controlled study

BACKGROUND

Liver graft function is related to the quality of liver transplantation (LT). High-quality perioperative glycemic management is considered hepatoprotective. However, no studies have explored the effects of specialized and staged blood glucose management target ranges on reducing glycemic variability (GV) and early allograft dysfunction (EAD) after LT.

METHODS

In this prospective randomized controlled trial, a total of 188 LT recipients were randomly assigned 1:1 to the less intensive glucose management (LIGM) group and the more intensive glucose management (MIGM) group. They followed goals of 7.8-10.0 mmol/L and 4.5-6.7 mmol/L in the pre-anhepatic and anhepatic phases, respectively, and the goals of 4.1-10.0 mmol/L in the neohepatic phase and postoperatively. The primary outcome was EAD, and the secondary outcomes were GV, incidence of hyperglycemia/hypoglycemia, postoperative liver enzyme levels, 30-day postoperative infection rate, one-year survival rate, and TNF-α, IL-6 and C-reactive protein levels.

RESULTS

A total of 182 adult patients (89 in the LIGM group and 93 in the MIGM group) completed the study. The mean age of the recipients was 51.46 ± 10.79 years, and the median MELD score before surgery was 16. The incidence of EAD was significantly lower in the LIGM group than in the MIGM group (10.11 % vs 31.18 %, P < 0.001), with a relative risk (RR) of 0.32 (2-sided 95 % CI 0.110-0.562). There was no statistical difference in the 30-day postoperative infection rate between the two groups (P > 0.05). The one-year survival rate of the LIGM group was higher than that of the MIGM group (92.13 % vs 82.02 %, P = 0.044).

CONCLUSIONS

Adopting LIGM (7.8-10.0 mmol/L) during the pre-anhepatic and anhepatic phases helps to reduce the incidence of EAD after LT and promotes the recovery of liver function, but does not increase the incidence of postoperative infections.

The Comparative Epidemiology, Pathophysiology and Management of Cardiogenic Shock Associated With Acute Myocardial Infarction and Advanced Heart Failure

Cardiogenic shock (CS) results from low cardiac output caused by myocardial dysfunction, coupled with systemic end-organ tissue hypoperfusion and elevated ventricular filling pressures, along a spectrum of shock severity. This narrative review aims to compare the epidemiology, pathophysiology, and contemporary management of 2 common etiologies of CS caused by acute myocardial infarction (AMI-CS) and advanced heart failure (HF-CS). CS complicates up to 14% of AMI and 5% of HF admissions. Rapid therapeutic intervention after prompt recognition of CS etiology is the mainstay toward improving clinical outcomes and mitigating end-organ sequelae and death. In AMI-CS, persistent hypotension often leads to subsequent hypoperfusion and congestion, and early culprit coronary artery lesion revascularization is critical. In HF-CS, congestion often precedes hypoperfusion and hypotension, and targeting the underlying nonischemic cause of myocardial dysfunction is key. Tailoring of hemodynamic strategies with vasoactive agents and temporary mechanical circulatory and end-organ support to manage the predominant ventricular failure, hemometabolic phenotypes, and shock severity associated with each etiology is discussed. Given the limited evidence-base in CS care, we also highlight potential knowledge gaps ripe for future exploration.

Ivabradine exposures reported to United States poison centers 2015-2023

INTRODUCTION

Ivabradine was approved for use in the United States in 2015 for the management of heart failure. It acts through inhibition of sodium channels found in cardiac myocytes (the "funny" pacemaker current, If), which reduces heart rate without significantly affecting inotropy.

METHODS

We queried the National Poison Data System® for reported ivabradine exposures from April 15, 2015-December 31, 2023. Age was stratified into child (0-5 years), adolescent (6-17 years), adult (18-64 years) and geriatric (65+ years). Other descriptive statistics gathered included patient sex, management site, and medical outcome as coded by America's Poison Centers®.

RESULTS

There were 240 ivabradine exposures, with 55.0% managed on-site and not transferred to a healthcare facility. The most common reported symptom was bradycardia, reported in 36 patients (15.1%). There were 139 cases that were followed to a known outcome. Within this cohort, 60%, 14%, and 27% of patients suffered no effect, minor effect, or moderate effect, respectively. Exposures in children comprised 18.8% of cases; none required intervention. Intentional self-harm exposures comprised 17.1% of all cases and were more likely to have worse outcomes. Five adult patients received intensive therapy (endotracheal intubation, vasopressors, cardiac pacing, hemodialysis). There were no reported deaths from ivabradine exposure.

DISCUSSION

This study has limitations. First, our data source was limited by being retrospective and incomplete; we could only study the information that was reported to poison centers, and exposures were not confirmed by laboratory testing. It is possible that cases without further follow-up had other treatments and clinical effects not reported here. Finally, reports to poison centers likely underestimate the true number of ivabradine exposures.

CONCLUSION

Adults with unintentional, asymptomatic exposures to ivabradine may be candidates for home monitoring. In ivabradine exposures refractory to medical management, clinicians should consider cardiac pacing or other supportive measures as a temporizing measure.

Efficacy of Ceftazidime-avibactam in treating Gram-negative infections: a systematic review and meta-analysis

INTRODUCTION

Ceftazidime-avibactam (CAZ-AVI) has emerged as a promising treatment option for Gram-negative infections, particularly those caused by CAZ-Non-Susceptible (NS) pathogens. This systematic review and meta-analysis aim to assess the efficacy and safety of CAZ-AVI in these challenging infections.

METHODS

We systematically queried EMBASE, Cochrane CENTRAL, and PubMed/Medline for studies published until September 15, 2024. Randomized Controlled Trials (RCTs) evaluating CAZ-AVI against Gram-negative infections were included. A meta-analysis was performed to calculate pooled odds ratios (OR) for both clinical and microbiological success.

RESULTS

A total of 146 studies were identified through database searches, leading to the inclusion of 17 studies. Among the efficacy studies for Gram-negative pathogens, there was no significant difference in clinical success rates for CAZ-AVI compared to comparators (pooled OR: 0.90, p = 0.22), and a non-significant increase in microbiological success was observed (pooled OR: 1.20, p = 0.41). In contrast, for CAZ-NS pathogens, six studies reported no significant difference in clinical cure rates (pooled OR: 0.77, p = 0.24), while four studies indicated a non-significant increase in microbiological cure rates (pooled OR: 1.83, p < 0.02).

CONCLUSIONS

This study suggests that CAZ-AVI is a viable option for treating Gram-negative infections, including CAZ-NS pathogens. While it has shown promising activity against these resistant pathogens, its clinical and microbiological success rates are comparable to other antibiotics in the overall analysis. However, CAZ-AVI may offer an advantage in managing resistant infections. These findings underscore the need to consider CAZ-AVI in treatment guidelines and emphasize the importance of antibiotic stewardship programs to optimize its use and prevent resistance. Ongoing monitoring of resistance patterns and patient outcomes is essential to ensure its long-term efficacy.

Experience of multidisciplinary cooperation in treating 15 extensively burned casualties：The Zhejiang LNG tanker explosion on 13 June 2020

BACKGROUND

On June 13, 2020, an explosion involving a liquefied natural gas (LNG) tanker truck occurred in eastern China. Fifteen patients with extremely severe burns (referred to as "June 13" patients) were treated in the burn-intensive care unit (ICU) joint ward within the general ICU.

METHODS

A multidisciplinary treatment team comprising 129 doctors, 126 nurses, and 165 auxiliary staff members was assembled. Additionally, 15 burn and ICU experts from various regions of China joined us. After concluding the treatment, patient data were collected and analyzed. The differences in clinical data between the deceased and surviving patients were retrospectively compared. Subsequently, the clinical data of 177 non-"June 13" patients with total burned body surface area (TBSA) > 50 % treated in the burn department from 2016 to 2023 were collected to compare the efficacy of our multidisciplinary collaborative treatment model.

RESULTS

The average TBSA of 15 "June 13" patients was 85.07 ± 15.85 % (range 50-98 %). Among them, 11 patients had a TBSA greater than 90 %, with 6 exceeding 95 %. Seven patients succumbed to their injuries, while 8 patients survived. The incidence of severe complications, such as multiple organ failure (MOF) and fungal infections, was higher in the deceased group than in the survival group. The surviving patients exhibited larger burn wound areas repaired by skin grafting on the 30th and 60th days, with significantly less residual wound area than the deceased group. In comparison with the non-"June 13" patients, the "June 13" patients were notably older and had larger TBSA, as well as larger areas of third-degree TBSA and higher mean revised Baux scores. After 1:2 matching for revised Baux score, the "June 13" group underwent a significantly higher number of operations (p-value =0.007). The "June 13" group showed a lower mortality rate, although not statistically significant (20 % vs 55 %, p = 0.119; log-rank p = 0.059 for Kaplan-Meier curves).

CONCLUSION

Multidisciplinary collaboration, guided by a comprehensive treatment plan, may improve the management of patients with extensive burns. Timely and effective surgical management is crucial for reducing mortality and improving patient prognosis.

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

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.

Nutritional Status and Somatotype of School-Aged Youth (5-17 Years) Residing at Moderate Altitude in the Ambato Department of Catamarca Province, Argentina

OBJECTIVES

To analyze the somatotype and its relationship with nutritional status, determined by Body Mass Index (BMI), in populations from moderate altitude in the province of Catamarca, Argentina.

METHODS

A cross-sectional descriptive study was conducted on 139 schoolchildren aged 5-17 years (51.79% girls) from the rural localities of Las Juntas and Las Piedras Blancas (1609 m above sea level), Ambato Department, Catamarca province. Anthropometric measurements were taken to calculate BMI and the three somatotype components: endomorphy, mesomorphy, and ectomorphy, according to Heath and Carter. Participants were classified based on WHO categories: underweight, normal weight, overweight, and obesity.

RESULTS

Overweight was observed in 16.5% of the participants. Obesity (7.5%) was present only in boys. The average somatotype profile was 3.9-2.5-2.2, indicating moderate adiposity, low musculoskeletal development, and relative linearity. Regression analysis showed that BMI increased with the first two components and decreased with the third. Differences in somatotype distribution by sex and age were observed, along with low concordance between obesity categories (BMI) and high endomorphy. Boys tended to exhibit more mesomorphic somatotypes, while girls showed predominantly endomorphic somatotypes as BMI increased.

CONCLUSIONS

The analyzed population of children and adolescents showed a predominantly endomorphic somatotype with a low prevalence of obesity. The low concordance between nutritional status (BMI) and somatotype highlights the need for complementary criteria to evaluate body composition.

Relationship between perceived stress and health literacy on family satisfaction among family members of critically ill patients: A multicenter exploratory study

BACKGROUND

Intensive care unit (ICU) admission is often a stressful experience that can negatively influence family satisfaction (FS) with patient care, communication, and decision-making. Health literacy (HL) is associated with the patient's ability to obtain, process, and understand health-related information. Few studies have explored the influence of perceived stress and HL on FS simultaneously.

OBJECTIVE

To examine the association of perceived stress and HL with FS among family members of ICU patients.

DESIGN

A multicenter exploratory cross-sectional study.

METHODS

An exploratory, cross-sectional, multicenter study was conducted in three ICUs from different hospitals in Chile. Family members of ICU patients with ≥48 h of stay and respiratory support were eligible. The Family Satisfaction in the Intensive Care Unit-24 questionnaire and the Perceived Stress Scale were used. HL was evaluated using three screening questions. Multiple beta regressions were fit to explore the association between perceived stress, HL, and FS.

RESULTS

A total of 101 family members with 63.4% identified as at risk of low HL were included. Multiple beta regression revealed that low HL was not associated with FS. Conversely, FS was negatively associated with perceived stress, being admitted to the ICU of the central or southern region, and having a close personal relationship with a healthcare provider but positively associated with the number of communications with ICU staff.

CONCLUSIONS

While perceived stress can be detrimental to FS, HL seems not to impact FS levels among family members of ICU patients. Further studies are required to explore the influence of HL on FS.

IMPLICATIONS OF THE CLINICAL PRACTICE

This study advances the knowledge regarding variables affecting FS in the ICU. Evaluating the family members' emotional status may help ICU healthcare providers in the allocation of resources to support family members and to properly assess their satisfaction.

PATIENT OR PUBLIC CONTRIBUTION

Family members of ICU patients participated in this study.

Feasibility within-subject RCT of neuromuscular electrical stimulation; an Intervention to Maintain and improve neuroMuscular function during period of Immobility (IMMI)

INTRODUCTION

Neuromuscular electrical stimulation (NMES) is a potentially effective intervention to improve outcomes after a fragility fracture, but its feasibility in this group has not been established.

METHODS

A feasibility study was conducted in two phases: 1) in the hospital only, and 2) hospital, rehabilitation centres, and participants' homes. Patients with fragility fracture were randomised to receive NMES for 6 weeks/discharge either to the right or left leg, with the other leg serving as control. Patients who had no mobility issues had contraindications to NMES and were unable to give consent were excluded. NMES was applied to quadriceps and tibialis anterior muscles for 30 min, 3 days/week. Sessions were progressed to achieve 60 min, 5-7 days/week. Feasibility outcomes included participant characteristics, recruitment rate, tolerability, and number of NMES sessions. Clinical outcomes included muscle strength, and ADL at six months.

RESULTS

Overall, 1052 patients were identified, of whom 113 (11%) were eligible, and 29 (3%) were recruited (median Clinical Frailty Score 3, median Barthel ADL score 93/100). The recruitment rate was 0.45/week in phase 1 and 0.9/week in phase 2. Fifty-three percent achieved the target of 24 NMES sessions. However, 5/29 withdrew due to intolerance of NMES. Leg muscle strength improved in both treated and untreated legs, with marginally greater improvement observed in the tibialis anterior of treated legs.

CONCLUSION

Although it would be feasible to evaluate the specific effect of NMES in fragility fracture patients in a multi-centre trial using home-based NMES, this would be possible only in a minority of mildly frail fragility fracture patients with little premorbid disability.

Predictive models assessing the impact of intensive care unit admission on the outcomes of acutely poisoned patients

Although intensive care unit (ICU) admission is the cornerstone in management of critically acute poisoned patients, the decision of ICU admission is often challenging, especially with limited resources. Hence, our study aimed to assess predictive models of the impact of ICU admission on outcomes of patients with acute poisoning. This retrospective cohort study recruited records of acutely poisoned patients admitted to Tanta University Poison Control Center between 2021 and 2023. Patient demographic and toxicological data, as well as initial clinical and laboratory profiles, were retrieved. Afterward, patients were categorized according to mortality and complicated outcomes. Out of 221 acutely poisoned patients admitted to the ICU, the incidences of mortality and complications in survivors were 54.3% and 57.4%, respectively. Aluminum phosphide (ALP) was the most common cause of poisoning (59%), with a significant association with mortality and predominance in cardiac complications. However, respiratory and neurological complications were evident among illicit substances, cholinesterase inhibitors, and neuropsychiatric drugs. The model anticipating morality included time from presentation to ICU admission, mean arterial pressure (MAP), oxygen saturation, pH, and ALP poisoning. Furthermore, the complication predictive model comprised time from exposure to poison center presentation, time from presentation to ICU admission, and MAP. Both models exhibited good to excellent discrimination performance and consistent calibration. Accordingly, prompt admission of all ALP-poisoned patients to ICU with a highly standardized level of care may alleviate their deleterious outcomes. However, drug categories with reversible courses should be adequately treated with frequent respiratory and hemodynamic monitoring in less-equipped ICUs.

Agreement between manual and automatic ultrasound measurement of the velocity-time integral in the left ventricular outflow tract in intensive care patients: evaluation of the AUTO-VTI® tool

Transthoracic echocardiography is widely used in intensive care unit (ICU) to manage patients with acute circulatory failure. Recently, automated ultrasound (US) measurement applications have been developed but their clinical performance has not been evaluated yet. The aim of this study was to assess the agreement between automated and manual measurements of the velocity-time integral in the left ventricular outflow tract (VTI-LVOT) using the auto-VTI® tool. This prospective, single-center, interventional study included ICU patients with acute circulatory failure. The examination involved two successive manual measurements of VTI-LVOT (mean of 3 consecutive heartbeats in regular sinus rhythm, and 5 heartbeats in irregular rhythm), followed by a measurement using auto-VTI® software. In patients receiving a fluid challenge, trending ability in detecting fluid responsiveness was also evaluated. Seventy patients were included between January 19, 2020, and September 24, 2020, at the Nîmes University Hospital. The feasibility of the auto-VTI® was 94%. The mean difference between the two methods was 11% with limits of agreement from - 19% to 42%. The proportion of agreement at the 15% difference threshold was 68% [58%; 80%]. The precision and least significant change measured for the manual measurement of VTI were 7.4 and 10.5%, respectively, and by inference for the automated method 28% and 40%. The new auto-VTI® tool, despite interesting feasibility, demonstrated an insufficient agreement with a systematic bias and an insufficient precision limiting its implementation in critically ill patients.Clinical trial registration: ClinicalTrials.gov identifier: NCT04360304.

Thoracoabdominal normothermic regional perfusion in donors with neurological determination of death extends organ donors pool

BackgroundHeart transplantation team of the Heart Institute of the Ministry of Health of Ukraine performs thoracoabdominal normothermic regional perfusion (TA-NRP) procedure for organ preconditioning in marginal donors. Martial law in Ukraine worsens preexisting shortage of donor organs since February 2022. The use of TA-NRP has been shown to be effective in rescucitating organs in donors with circulatory determination of death (CDD), and we hypothesize that TA-NRP can be used to perform in situ organ perfusion in donors with neurological determination of death (NDD) as well, thereby improve organ quality.MethodsA single centre, retrospective analysis of outcomes after heart transplantation using organs from donors with NDD who underwent TA-NRP for preconditioning from 2022 to 2024 year at the Heart Institute Ministry of Health of Ukraine. The indications for TA-NRP were hemodynamic instability of donors with NDD, characterized by the need for norepinephrine >1.0 μg/kg/h to maintain mean blood pressure >50 mm Hg.ResultsTA-NRP for donor preconditioning was performed in 12 cases (11.3%) of 106 heart transplantations between 2019 and 2023. The average duration of TA-NRP was 124.5 ± 10.1 minutes. Prior to TA-NRP initiation, all donors exhibited metabolic acidosis, hyperkalemia, and hyperlactatemia. The implementation of TA-NRP normalized the acid-base balance, demonstrated by a significant increase in pH (p < .001), correction of base excess (BE) (p < .001), and an increase in bicarbonate levels (HCO3-) (p < .001). TA-NRP also significantly reduced baseline lactate levels from 10.4 ± 2.91 mmol/L to 1.57 ± 0.33 mmol/L (p < .001) and decreased potassium levels (p = .003). Additionally, it led to a significant reduction in donor heart rate (p = .001) and an increase in mean arterial pressure (p = .012), accompanied by a 6.6-fold reduction in donor norepinephrine requirements (p = .003).ConclusionThe use of TA-NRP in donors with NDD improved organ quality which resulted in 30 days survival rate of 83% and 1-year survival rate of 75% in organ recipients.

Comparative Efficacy of Continuous Positive Airway Pressure Versus High-Flow Nasal Cannula Therapy in Children With Acute Bronchiolitis: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis compared the efficacy of continuous positive airway pressure (CPAP) and high-flow nasal cannula (HFNC) therapy in children with acute bronchiolitis. A comprehensive literature search across multiple electronic databases identified six randomized controlled trials for inclusion. The primary outcomes assessed were treatment failure, the need for invasive mechanical ventilation, and length of hospital stay. Pooled analysis revealed no significant difference between CPAP and HFNC in the risk of requiring invasive mechanical ventilation (RR 0.94, 95% CI: 0.60-1.46) with minimal heterogeneity across studies. Treatment failure was higher in the HFNC group than in CPAP, but this difference was not statistically significant (RR 1.20, 95% CI: 0.63-2.27), though heterogeneity was substantial (I²=70%). Sensitivity analysis after removing one study showed a significantly higher risk of treatment failure with HFNC (RR 1.67, 95% CI: 1.07-2.61) with reduced heterogeneity. Length of hospital stay was comparable between both interventions (MD 0.57, 95% CI: -0.16-1.31). Both respiratory support strategies effectively reduce respiratory effort in moderate to severe bronchiolitis through different mechanisms, such as CPAP, which provides consistent positive end-expiratory pressure, and HFNC through enhanced minute ventilation and nasopharyngeal dead space reduction. Despite some limitations, including small sample sizes and inability to conduct subgroup analyses due to lack of individual patient data, this meta-analysis suggests HFNC may serve as a viable alternative to CPAP, particularly in resource-limited settings, showing comparable outcomes for critical endpoints while potentially offering practical advantages in administration and patient comfort.

A Systematic Review of the Costs of Drug-Associated Acute Kidney Injury and Potential Cost Savings With Nephrotoxin Stewardship Prevention Strategies

There is a scarcity of information related to the financial impact of acute kidney injury (AKI), and even more so the economics of drug-associated AKI (D-AKI). Our goal was to provide a comprehensive summary of the economic burden of D-AKI by evaluating the costs of D-AKI compared to not developing AKI and cost savings associated with nephrotoxin stewardship approaches. Following the PRISMA guidelines, a literature search was conducted using PubMed to identify articles from database inception through November 2023. The main outcomes included AKI incidence, resource use, and cost of nephrotoxin stewardship programs/D-AKI event or no event. Key findings were summarized based on whether the study compared the cost of D-AKI vs. no AKI or identified potential cost savings associated with a nephrotoxin stewardship method to prevent D-AKI or worsening D-AKI. All costs were adjusted to USD2023. Twenty-five studies met the inclusion criteria. Eight studies compared the cost of D-AKI to no AKI. Total admission costs of patients who developed D-AKI ranged from $47,696 to $173,569. Nineteen studies implemented nephrotoxin stewardship with 12 substituting a less nephrotoxic drug; five using therapeutic drug monitoring and two altering drug dosing to limit exposure. Overall, these prevention strategies ranged from $5,171 to $364,973 in total medical cost savings and $17 to $942 in total cost savings per patient-day. The in-hospital economic impact of D-AKI is substantial. Implementing nephrotoxin stewardship strategies to reduce D-AKI is associated with cost savings. Institutions should adopt strategic and efficient nephrotoxin stewardship programs to optimize patient care and reduce costs.

Ability to identify patient-ventilator asynchronies in intensive care unit professionals: A multicenter cross-sectional analytical study

INTRODUCTION

Patient-ventilator asynchrony (PVA) is frequent in intensive care. Its presence is associated with prolonged days of mechanical ventilation and may lead to increased mortality in the intensive care unit (ICU) and hospital. Little is known about the ability of Colombian intensive care professionals to identify asynchronies, and the factors associated with their correct identification are not apparent.

AIM OF THE STUDY

To describe the ability of Colombian intensive care professionals to identify patient-ventilator asynchronies (PVA) using waveform analysis. In addition, to define the characteristics associated with correctly detecting PVA.

MATERIAL AND METHODS

We conducted a multicenter, cross-sectional, national survey-based study between January and August 2024. Colombian physiotherapists, respiratory therapists, nurses and intensive care physicians from 24 departments participated in the study. An online survey was used. They were asked to identify six different PVAs presented as videos. The videos were displayed using pressure/time and flow/time waveform of a Puritan Bennett 840 ventilator.

RESULTS

We recruited 900 participants, 60% female, most of whom were physiotherapists (53%). Most professionals had specialty training in critical care (42%), and 32% reported having specific PVA training. Double triggering was the most frequently identified PVA (75%). However, only 3.67% of participants recognized all six PVAs. According to multiple logistic regression analysis, working in a mixed unit (OR 2.59; 95% CI 1.19 - 5.54), caring for neonates (OR 5.19; 95% CI 1.77 - 15.20), and having specific training (OR 2.38; 95% CI 1.16 - 4.76) increases the chance of correctly recognizing all PVAs.

CONCLUSION

In Colombia, a low percentage of professionals recognize all PVAs. Having specific training in this topic, working in mixed ICUs and neonatal intensive care was significantly associated with identifying all PVAs.

Value of blood perfusion index in guiding fluid resuscitation against septic shock

ObjectiveSeptic shock is a serious medical condition characterized by extreme inflammation and blood vessel permeability. Fluid resuscitation is a crucial treatment for septic shock, but the optimal approach for fluid management remains controversial. In this study, we explored how blood perfusion index (PI) monitoring can help direct fluid resuscitation therapy for septic shock.MethodsBetween January 2019 and December 2021, 50 patients with septic shock were admitted to The Affiliated Hospital of Hangzhou Normal University and randomly assigned to either a control or study group (25 cases each). All patients were given the sepsis treatment bundle recommended by the 2018 guidelines and were subjected to Pulse Indicator Continuous Cardiac Output (PiCCO) -based hemodynamic monitoring. Fluid resuscitation was administered based on specific indicators in the control group. We used PI to direct fluid resuscitation in the research group. Several parameters were assessed, including blood lactate (BLAC), hemoglobin (Hb), stroke volume index (SVI), norepinephrine dosage, extravascular lung water (EVLW), volume of resuscitation fluid and the ICU mortality.ResultsThere were statistically significant reductions in BLAC in the study group compared to the control group 6 h, 24 h, and 48 h after treatment (P < 0.05). In the study group, the SVI was higher 24 and 48 h post-treatment compared to the control group (P < 0.05). Norepinephrine doses were similarly lowered in the study group. In the comparison of extravascular lung water between the two groups, the extravascular lung water in the study group was less than that in the control group 24 h after fluid resuscitation, and the difference was statistically significant. the ICU mortality [44%vs. 56% (X2 = 0.720, P = 0.572)] in the study group were lower than those in the control group, but the difference had no statistical significance.ConclusionsIn patients with septic shock, fluid resuscitation guided by PI monitoring improves BLAC and SVI while decreasing norepinephrine dosage, and avoid the risk of fluid overload due to increased EVLW fluid overload, demonstrating clinical significance and application value.

Organ perfusion pressure predicts outcomes in cardiogenic shock patients

AIMS

The diagnosis of cardiogenic shock (CS) relies upon signs and/or symptoms of end-organ hypoperfusion. The combination of hypoperfusion and systemic congestion identifies patients at particularly high risk. This study evaluated organ perfusion pressure (OPP), calculated as mean arterial pressure minus invasive central venous pressure, as a predictor of outcomes in CS.

METHODS AND RESULTS

All consecutive patients with acute myocardial infarction-related CS (AMI-CS) or acutely decompensated heart failure-related CS (ADHF-CS) enrolled in the multicentre Altshock-2 registry between January 2020 and November 2023 were included. The primary outcome was in-hospital all-cause mortality. Overall, 316 patients were included (mean age: 64 ± 13 years, 62 [20%] female, median left ventricular ejection fraction: 22% [interquartile range, IQR 15-30%], 261 [85.9%] SCAI stage C or worse, median OPP at presentation: 57.0 mmHg [IQR 47.0-69.8 mmHg]). A total of 117 (37%) patients died during the hospitalization. Low OPP (i.e. <57.0 mmHg) was associated with significantly higher in-hospital all-cause mortality (hazard ratio [HR] 1.757, 95% confidence interval [CI] 1.208-2.556, p = 0.003), whereas low mean arterial pressure alone was not (HR 1.323, 95% CI 0.901-1.941, p = 0.153). After multivariable adjustment for significant clinical data available at first bedside assessment (age and Sequential Organ Failure Assessment score), low OPP still predicted significantly higher in-hospital all-cause mortality (HR per mmHg decrease: 1.016, 95% CI 1.004-1.029, p = 0.010). Low OPP appeared particularly powerful in predicting higher in-hospital all-cause mortality among ADHF-CS patients (HR 3.172, p = 0.002).

CONCLUSION

In this multicentre, observational, prospective study on patients hospitalized for CS, lower OPP on admission was associated with significantly higher in-hospital all-cause mortality.

Epidemiology of Traumatic Injuries at a Single Regional Trauma Center in South Korea: Age-Specific and Temporal Trends (2014-2023)

Background/Objectives: Trauma remains a leading cause of morbidity and mortality worldwide, significantly affecting younger and aging populations. The regional trauma center establishment in South Korea in 2014 marked a pivotal advancement in the national trauma care system. This study reviews data from the Incheon Regional Trauma Center, analyzing patient demographics, injury mechanisms, and outcome trends. Methods: This retrospective analysis included 32,025 patients with trauma treated at the Incheon Regional Trauma Center from 2014 to 2023. Data from the Korean Trauma Database included demographics, injury mechanisms, Injury Severity Scores (ISSs), and outcomes. We considered the initial treatment setting in our analysis to evaluate its potential impact on patient outcomes. Patients were stratified into four ISS categories and five age groups (0-12, 13-19, 20-64, 65-79, and ≥80 years). Statistical comparisons used chi-square tests and analysis of variance. Results: The proportion of older patients (≥65 years) increased significantly from 23.3% in 2014 to 45.2% in 2023, with patients aged ≥ 80 years showing the highest rise and mortality (6.7%). Traffic accidents decreased from 30.7% to 28.2%, while slip injuries increased from 26.9% to 34.0%. Patients with ISSs > 15 increased, peaking in 2022 (mortality, 15.6%). Despite improved trauma care infrastructure, the overall mortality rate reached 5.9% in 2022, possibly due to more complex cases and an aging population. Conclusions: This study highlights evolving challenges in trauma care due to demographic shifts and rising injury severity. These findings underscore the need for tailored geriatric trauma care, improved infrastructure, and targeted interventions for high-risk groups. Further research is needed to optimize trauma systems and address the growing burden of geriatric trauma.

[Incidence of acquired morbidity and its impact on patients in a pediatric intensive care unit based on the functional status scale]

Introduction

a significant number of children suffer cognitive, physical, mental and social limitations as a result of critical illnesses and their subsequent treatment. Pollack et al. developed the functional status scale with the purpose of measuring the change in functional status during hospitalization.

Objectives

evaluate the acquired morbidity upon discharge from the Pediatric Intensive Care Unit (PICU). Specific objectives: compare mortality and acquired morbidity rates, analyze changes in functional status categories, identify the most affected domains, describe relationships between domain affection and admission diagnosis, between domain affection and age group, between morbidity and days in invasive mechanical ventilation (IMV), non-invasive ventilation and high-flow oxygen therapy.

Methodology

observational, descriptive, prospective and longitudinal study. Patients between 1 and 180 months of age requiring ventilatory support for at least 48 hours, between February 2021 and February 2024, were included.

Results

90.9% survived, and of these, 26.9% developed acquired morbidity. The 42% of patients changed their functional status at least one point. The most affected domains were motor and feeding. Those who died had fewer days of IMV and hospitalization.

Conclusion

The incidence of acquired morbidity was higher than mortality in the analyzed period. Children who developed morbidity remained hospitalized for a longer period of time and had greater requirements and days of IMV. Increased survival makes mortality an insufficient outcome metric. More studies with longer follow-up are needed.

[Role of ultrasound in critically ill patients with heart failure]

Heart failure (HF) is a clinical syndrome with symptoms and/or signs caused by structural and/or functional cardiac abnormalities. After discharge, patients with acute heart failure (AHF) face a significant risk of rehospitalization and mortality. Detection of residual congestion is crucial to reduce readmissions, improve prognosis, and decrease mortality. Echocardiography provides critical information about the severity of left ventricular dysfunction, elevated filling pressures, valvular dysfunction, and estimation of pulmonary artery systolic pressure. The VExUS approach integrates ultrasound evaluation of the inferior vena cava, hepatic veins, portal vein, and renal veins, providing valuable information about systemic congestion. Lung ultrasound detects pulmonary congestion, facilitating early intervention to prevent progression and hospitalizations. Ultrasound evaluation of the internal jugular vein and femoral vein complements the evaluation of venous congestion. Distension of the internal jugular vein during the Valsalva maneuver or the relationship between the diameter of the internal jugular vein and the femoral vein can predict adverse outcomes in patients with HF. In conclusion, a comprehensive ultrasound approach is crucial in the management of patients with critically ill heart failure. Multiparameter ultrasound evaluation provides vital information, guiding appropriate therapeutic interventions and avoiding potentially harmful measures.

Nosocomial Bloodstream Infection in Critically Ill Patients: Is Extracorporeal Membrane Oxygenation a Relevant Factor?

BACKGROUND

Nosocomial bloodstream infections (BSIs) in critically ill patients can cause clinical deterioration, extend intensive care unit (ICU) stays, and increase mortality risk. Extracorporeal membrane oxygenation support (ECMO) is a known risk factor for BSI, and infections in these patients are assumed to have a worse prognosis. However, no comparative studies exist between ECMO and non-ECMO patients.

METHODS

A three-year prospective observational study was conducted in a 24-bed medical ICU. Consecutive nosocomial BSIs episodes were recorded, and BSIs in mechanically ventilated patients were analyzed based on ECMO treatment status.

FINDINGS

A total of 98 BSI episodes were included: 30 (30.6%) in ECMO and 68 (69.3%) in non-ECMO patients. The total number of ECMO patients during the study period was 110, with a bacteraemia rate of 27.7% (20.26 episodes per 1000 treatment-days). In non-ECMO patients, the BSI rate was 7.9% (p<0.001). ECMO patients were younger and had fewer co-morbidities. BSI type and aetiology were similar between groups, but severity was higher in ECMO patients. Although multidrug-resistant microorganisms were more frequent in ECMO patients, the appropriate treatment rate was similar. ICU-mortality was 66.6% in ECMO patients and 30.8% in non-ECMO patients (p <0.001). However, CRRT (OR 3.67), SOFA score (OR 1.54) and COVID-19 diagnosis (OR 1.54) were the only independent risk factors associated with mortality in BSI patients.

CONCLUSION

Although BSI was more frequent and severe in ECMO patients, ECMO support was not independently related to mortality in patients with healthcare-associated BSI.

Volume OXygenation index in predicting the efficacy of early non-invasive ventilation in patients with acute hypoxic respiratory failure: A multicenter study

BACKGROUND

The Volume OXygenation (VOX) index was initially designed to predict treatment failure of high-flow nasal cannula therapy. However, its predictive power for non-invasive ventilation (NIV) remains uncertain.

OBJECTIVES

To evaluate the predictive capability of the VOX index regarding treatment failure in patients undergoing NIV.

METHODS

This retrospective study was conducted in three hospitals from September 2017 to September 2021. Patients with acute hypoxic respiratory failure (AHRF) who underwent early NIV treatment were categorized into high-risk and low-risk groups based on the 2-hour NIV VOX Youden index.

RESULTS

At 2 h of NIV, the area under the receiver operating characteristic curve for predicting NIV failure using the VOX index was 0.843 (95 % CI 0.805-0.882). Using a VOX value threshold of 20.45 to predict NIV failure, the sensitivity was 69.1 %, and the specificity was 94.4 %. Following NIV treatment, the low-risk group had a lower intubation rate (7.98 % vs. 77 %, P < 0.05) and mortality rate (4.79 % vs. 17.5 %, P < 0.05).

CONCLUSION

In early NIV treatment for AHRF, the VOX index obtained after 2 h of NIV demonstrates a strong predictive power for NIV failure. Patients with a VOX value > 20.45 have a low probability of NIV failure, suggesting that it can be used as an evaluation index to assess the efficacy of NIV.

Chlorhexidine solutions are more effective than povidone-iodine solutions as skin disinfectants for the prevention of intravascular catheter-related infections: A meta-analysis

Catheter-related infections pose a significant risk to critically ill patients, making it crucial to select an appropriate sterilization solution. However, there is currently no consensus on the use of chlorhexidine-containing solutions or povidone-iodine (PVI) and the auxiliary ingredients in solutions. Meta-analysis. PubMed, EMBASE, OVID, Web of Science, and Cochrane Library databases. Two reviewers independently performed study screening and data extraction and used the Cochrane risk-of-bias tool 2.0 (RoB 2.0) for quality assessment. We included 10 fully published RCTs with 12 pairs of comparisons, which included a total of 9,689 catheters. The analysis revealed that chlorhexidine gluconate (CHG)-containing solutions were significantly more effective than PVI in preventing CRBSI (RR = 0.460, 95% CI 0.323-0.654, P < 0.001), catheter-related sepsis (RR = 0.419, 95% CI 0.206-0.853, P = 0.016), and catheter colonization (RR = 0.409, 95% CI 0.266-0.630, P < 0.001). Further subgroup analysis demonstrated that, regardless of the concentration of CHG (≤ 1% or > 1%), it was superior to PVI in preventing CRBSI and catheter colonization (RR = 0.271 ~ 0.585, 95% CI 0.110 ~ 0.400‒0.590‒0.926). CHG-alcohol is most effective at preventing catheter-related infections, especially those caused by 70% alcohol. Compared to PVI, CHG-70% alcohol is the most effective disinfectant for preventing catheter-related infections, as it combines the rapid disinfection and evaporation properties of alcohol with the prolonged antimicrobial effects of chlorhexidine.PROSPERO registration number: CRD42024507163.