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Objective: It is well known that glucose and lipid metabolism disorders and insulin resistance are common in sepsis, which affect the occurrence and prognosis of multiple organ dysfunction in septic patients. Previous study reported the predictive value of triglyceride-glucose index (TyG), a clinical indicator for insulin resistance, in postoperative delirium patients. However, it remains unclear whether the TyG index is a novel predictive biomarker for sepsis-associated delirium. The aim of this study is to explore the relationship between TyG index and the risk of delirium in patients with sepsis. Methods: Adult septic patients were identified from the MIMIC-IV database and divided into four groups based on the mean value of TyG. The primary outcome was the incidence of delirium. The association between TyG and the risk of developing delirium was evaluated by restricted cubic spline (RCS), multivariate logistic regression and subgroup analysis. Propensity Score Matching (PSM) method was used to balance the baseline data. Results: A total of 3,331 septic patients were included in the analysis, and further divided into four groups: Q1 (TyG ≤ 8.67), Q2 (8.67 < TyG ≤ 9.08), Q3 (9.08 < TyG ≤ 9.61), and Q4 (TyG > 9.61). The RCS curves demonstrated a non-linear positive relationship between TyG index and the risk of developing delirium, and an optimal cut-of value 9.09 was recommended. After balancing the baseline information by PSM, patients in the TyG > 9.09 group had a significant higher incidence of delirium compared with those in the TyG ≤ 9.09 group. In logistic regression analysis, TyG > 9.09 was significantly associated with lower risk of developing delirium in both original cohort (OR 1.54–1.78, all P < 0.001) and the PSM cohort (OR 1.41–1.48, all P < 0.001). No association was found between the TyG index and mortality (all P > 0.05). In subgroup analysis, our findings were consistent (all OR > 1 in all subgroups). Conclusion: Our study demonstrated an independent association between TyG index and increased risk of delirium in septic patients, indicating that TyG index can serve as a biomarker for delirium in sepsis. [ABSTRACT FROM AUTHOR]

Objective: The European Society of Intensive Care Medicine (ESICM) recently recommended changes to the criteria of acute respiratory distress syndrome (ARDS), patients with high-flow oxygen were included, however, the effect of these changes remains unclear. Our objectives were to evaluate the performance of these new criteria and to compare the outcomes of patients meeting the new ARDS criteria with those meeting the Berlin ARDS criteria. Methods: This was a retrospective cohort. The patients admitted to the intensive care unit (ICU) were diagnosed with ARDS. Patients were classified as meeting Berlin criteria ARDS (n = 4279), high-flow nasal oxygen (HFNO) criteria ARDS (n = 559), or new criteria ARDS (n = 4838). Results: In comparison with HFNO criteria ARDS and new criteria ARDS, patients with Berlin criteria ARDS demonstrated lower blood oxygen levels assessed by PaO2/FiO2, SpO2/FiO2, and ROX (SpO2/FiO2/respiratory rate) (p < 0.001); and higher severity of illness assessed by the Sequential Organ Failure Assessment (SOFA) score, Acute Physiology And Chronic Health Evaluations (APACHE II), Simplified Acute Physiology Score (SAPS II) (p < 0.001), (p < 0.001), and longer ICU and hospital stays (p < 0.001). In comparison with the HFNO criteria, patients meeting Berlin criteria ARDS had higher hospital mortality (10.6% vs. 16.9%; p = 0.0082), 28-day mortality (10.6% vs. 16.5%; p = 0.0079), and 90-day mortality (10.7% vs. 17.1%; p = 0.0083). ARDS patients with HFNO did not have severe ARDS; Berlin criteria ARDS patients with severe ARDS had the highest mortality rate (approximately 33%). PaO2/FiO2, SpO2/FiO2, and ROX negatively correlated with the SOFA and APACHE II scores. The SOFA and APACHE II scores had high specificity and sensitivity for prognosis in patients with new criteria ARDS. Conclusion: The new criteria of ARDS reduced the severity of illness, length of stay in the ICU, length of hospital stays, and overall mortality. SOFA and APACHE II scores remain important in assessing the prognosis of patients with new criteria ARDS. Trial registration: Registration number: ChiCTR2200067084. [ABSTRACT FROM AUTHOR]

Objectives. Nonhepatic hyperammonemia often occurs in patients with sepsis. Ammonia plays an essential role in the occurrence of hepatic encephalopathy. However, the relationship between nonhepatic serum ammonia levels and sepsis-associated encephalopathy (SAE) remains unclear. Thus, we aimed to evaluate the association between serum ammonia levels and patients with SAE. Methods. Data of critically ill adults with sepsis who were admitted to the intensive care unit were retrieved from the Medical Information Mart for Intensive Care IV (MIMIC IV) between 2008 and 2019 and retrospectively analyzed. Data of patients with sepsis patients and serum ammonia not related to acute or chronic liver disease were not included. Results. Data from 720 patients with sepsis were included. SAE was found to have a high incidence (64.6%). After adjusting for other risk factors, a serum ammonia level of ≥45 μmol/L (odds ratio (OR): 3.508, 95% confidence interval (CI): 2.336–5.269, p < 0.001) was found to be an independent risk factor for patients with SAE; moreover, as the serum ammonia level increased, the hospital mortality of SAE gradually increased in a certain range (serum ammonia <150 μmol/L). Serum ammonia levels of ≥45 μmol/L were associated with higher Simplified Acute Physiology Score II and Sequential Organ Failure Assessment (SOFA) scores in patients with SAE. Besides, our study found that patients with SAE used opioid analgesics (OR:3.433, 95% CI: 1.360–8.669, p = 0.009) and the SOFA scores of patients with SAE (OR: 1.126, 95% CI: 1.062–1.194, p < 0.001) were significantly higher than those without SAE. Conclusions. Nonhepatic serum ammonia levels of ≥45 μmol/L evidently increased the incidence of SAE. Serum ammonia levels should be closely monitored in patients with sepsis. [ABSTRACT FROM AUTHOR]

Objective. The study focused on the nursing strategies of patients with ventilator-associated pneumonia (VAP) and multicriteria decision analysis (MCDA) in nursing supervision, so as to improve the survival rate and prognosis of patients with VAP. Methods. 200 patients of the database in the ICU who required mechanical ventilation were selected as research subjects. They were divided into control group and intervention group according to different nursing measures. The incidence of VAP was compared between the two groups, and 15 experts were consulted on the prevention measures of VAP. On the basis of ARIMA-GARCH mathematical modeling, using the method of multicriteria decision analysis, the cluster nursing strategy for ventilator-associated pneumonia patients was developed and verified. Results. In the control group, of the 34 patients infected with VAP, Gram-positive bacteria were detected in 11 cases, including 6 cases of Streptococcus pneumoniae, 3 cases of Escherichia coli, and 2 cases of golden yellow Staphylococcus. Gram-negative bacteria were detected in 10 cases, including 5 (50%) cases of Acinetobacter baumannii, 2 cases of Klebsiella pneumoniae, 2 cases of Brucella Bacillus, and 1 case of Pseudomonas aeruginosa. In the intervention group, 18 cases were diagnosed with VAP, including 4 (44.4%) cases of bacterial infection, 3 (44.4%) cases of virus infection, and 2 (22.2%) cases of fungal infection. According to the opinions of the 15 experts, a total of 6 bundled measures were adopted to prevent VAP, including 0.1% chlorhexidine for oral care; strict implementation of hand hygiene; the daily wake-up for spontaneous breath training and extubation assessment; continuous subglottic suction; raising the bed head by 30°–45°; and nasal feeding through the nasal tube without special condition. Conclusion. There are many factors that affect the occurrence of VAP in mechanically ventilated patients in the ICU, and the imperfect measures of bundles of care are the main one. The implementation rates of distinct intervention strategies are different. The implementation rate of 2 measures is lower than 95%, which are the continuous subglottic suction and daily wake-up for spontaneous breath training and extubation assessment. [ABSTRACT FROM AUTHOR]