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Background: Cancer patients who are exposed to sepsis and had previous chemotherapy may have increased severity. Among chemotherapeutic agents, anthracyclines have been associated with cardiac toxicity. Like other chemotherapeutic agents, they may cause endothelial toxicity. The aim of this study was to evaluate the effect of anthracycline treatment on the outcome of cancer patients with sepsis. Methods: Data from cancer patients admitted to intensive care units (ICUs) for sepsis or septic shock were extracted from the Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique database (1994–2015). Comparison between patients who received anthracycline and those who did not was performed using a propensity score, including confounding variables (age and underlying diseases). A competing risk adjusted for severity of illness (Sequential Organ Failure Assessment [SOFA] score) was used to analyze the duration of vasopressor requirement. Results: Among 2046 patients, 1070 (52.3%) patients who received anthracycline were compared with 976 (47.7%) who did not. The underlying disease was mostly acute hematological malignancy (49.2%). Sepsis, mostly pneumonia (47.7%), had developed 2 days (interquartile range [IQR]:1–4 days) prior to ICU admission. Most patients (n=1156/1980,58.4%) required vasopressors for 3 days (IQR: 2–6 days). Factors associated with the need for vasopressors were aplasia (hazard ratio [HR]=1.72, 95% confidence interval [CI]: 1.21 to 2.47, P=0.002) and day 1 respiratory SOFA score (HR=7.07, 95% CI: 2.75 to 22.1, P

Abstract Background Risk factors for bloodstream infection in patients with COVID-19 in the intensive care unit (ICU) remain unclear. The purpose of this systematic review was to study the risk factors for BSI in patients admitted to ICUs for COVID-19. Methods A systematic search was performed on PubMed, EMBASE, Cochrane Library, and Web of Science up to July 2024. Data were reported as combined odds ratio (OR) for categorical variables and weighted mean difference (WMD) for continuous variables. Results 6914 studies were retrieved, of which 55 were included in the meta-analysis. Men (OR = 1.28, 95% CI: 1.10–1.50, P = 0.006), high SAPS II score (WMD = 6.43, 95% CI: 0.23–12.63, P = 0.042), diabetes (OR = 1.34, 95% CI: 1.04–1.73, P = 0.022), tracheal intubation (OR = 8.68, 95% CI: 4.68–16.08, P

Abstract This study explores the association between serum chloride concentrations and all-cause mortality among patients in the Surgical Intensive Care Unit (SICU). Employing a retrospective cohort design, the study utilized data extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, specifically focusing on individuals admitted to the surgical/trauma ICUs. This dataset encompassed demographic profiles, laboratory findings, historical medical data, vital statistics, and variables pertinent to prognosis. Participants were divided into four groups based on their serum chloride concentrations. The primary outcomes assessed were mortality rates at 30, 90, and 180 days post-admission to the ICU. Analytical methods included Kaplan–Meier survival curves, Cox proportional hazards regression models, and Restricted Cubic Spline (RCS) analyses to delineate the relationship between serum chloride concentrations and patient outcomes. The study cohort comprised 10,996 patients, with observed mortality rates of 12.78% at 30 days, 17.14% at 90 days, and 20.32% at 180 days. Kaplan–Meier analyses revealed significant disparities in survival rates across the quartiles of serum chloride during the follow-up intervals (p

Abstract Background Frailty and sarcopenia are important conditions that grow more common as people age. Frailty, a multi-system illness linked to heightened vulnerability to stresses, and sarcopenia, a loss of muscle mass and function, both raise the likelihood of unfavorable health outcomes including disability or death. This work’s objective was to study the clinical utility of sarcopenia and frailty in critically ill elderly patients with multiple comorbidities. Patients and methods Clinical frailty scale and SARC-F scale questionnaire were done in 70 critically ill patients admitted to geriatric ICU in geriatric hospital. Results There was a highly significant effect of frailty on primary outcomes whether sarcopenia was present or not (which means that effect of frailty on primary outcomes is more prominent than sarcopenia). The associated factors of frailty including primary admission cause, type of associated comorbidities, and primary outcome (mortality, prolonged hospital stay, long-term ICU care) were found to be important. There was a highly significant effect on the presence of sarcopenia regarding mean age, associated comorbidities, and degree of frailty, with a higher percentage for the need of noradrenaline treatment in ICU patients, highly significant relation to patient mortality. Conclusions The risk of death in critical illness is increased by sarcopenia and frailty. Clinical examinations should routinely identify the risk factors for frailty and sarcopenia. By providing appropriate therapies, medical professionals in intensive care units may be able to improve patient outcomes. Clinicians may be able to get prognostic information on the survival and recovery of their frail intensive care unit patients by routinely assessing frailty at the time of admission. Crucially, this might assist patients and their families in making well-informed choices on the course of treatment while they are in critical condition. Crucially, more investigation is needed to ascertain whether there are modifiable elements that might enhance the prognosis of critically sick fragile people.

Background: Acute respiratory failure is a dreaded complication of interstitial lung disease (ILD) and is the most significant reason for mortality in most forms of ILDs. Knowledge of outcome predictors that can be assessed early after intensive care unit (ICU) admission would help guide the use of specific treatments. The present study attempts to identify the baseline characteristics of ILD patients admitted due to acute respiratory failure to ICU and to evaluate the cause of acute respiratory failure in these patients, management, and the outcomes. Materials and Methods: An observational cohort study was carried out in a tertiary care center in North India on 50 previously diagnosed patients of ILD hospitalized due to acute respiratory failure between January and December 2022. All relevant clinical, investigational, and treatment data were collected from the hospital information system. Results: The baseline mean FVC and 6-min walk distance were lower for non-survivors. The baseline mean DLCO was significantly lower among non-survivors. Comparatively, the radiology pattern of both groups showed that the usual interstitial pneumonia (UIP) pattern was associated with highest mortality. However, this difference was not statistically significant. Mortality was higher in those with lower PaO2/FiO2 ratio than among the survivors. Sputum culture positivity had a statistically significant impact on mortality. The mean hospital stay time was considerably higher in patients with idiopathic pulmonary fibrosis (IPF) and in patients with Type 2 respiratory failure. Conclusion: Baseline lung function tests, comorbidities, and exacerbating factors are invaluable in predicting the clinical outcomes. It is essential to perform all the diagnostic examinations at the earliest to ensure prompt initiation of the most appropriate therapy and lower hospital mortality. Distinguishing those patients who have a known cause for their ILD from those who do not was found to be crucial for deciding the most appropriate management.

Abstract Background and aim Critically ill cirrhotic patients exhibit high in-hospital mortality and require substantial healthcare resources, including multiorgan support. Egypt has the highest age-standardized death rate from cirrhosis worldwide. This study aimed to compare the performance and accuracy of different prognostic scores for mortality prediction, including Child-Turcotte-Pugh (CTP), Model for End-Stage Liver Disease (MELD), MELD with serum sodium incorporation (MELD-Na), Royal Free Hospital (RFH), as well as general intensive care unit (ICU) prognostic models, Acute Physiology and Chronic Health Evaluation II (APACHE II), and Chronic liver failure -sequential organ failure assessment (CLIF-SOFA), in cirrhotic patients admitted to an ICU in an Egyptian tertiary facility. Patients and methods This prospective observational study included ninety patients admitted to the ICU between July 2021 and June 2022. All patients underwent clinical assessment with the estimation of all included scores within the first 24 h of admission, alongside basic laboratory and radiological investigations. Results Mortality occurred in 56.7% (n = 51) of the patients. Non-survivors exhibited statistically significantly higher APACHE II, CLIF-SOFA, RFH, and CTP scores but lower Glasgow Coma Scale (GCS) than survivors. However, no statistically significant difference was found regarding the performance of the scoring systems. At cut-off levels > 20 for APACHE II and > 46 for CLIF-SOFA, these scores were the most independent predictors of in-hospital mortality. Conclusions While CTP, MELD, and MELD-Na scores demonstrated satisfactory performance in critically ill cirrhotic patients, APACHE II and CLIF-SOFA scores were superior in predicting short-term mortality in this patient population.

Abstract Background The effect of ramelteon, a melatonin receptor agonist, on survival in septic patients remains unknown. The purpose of this retrospective cohort study was to explore the relationship between ramelteon exposure and survival outcomes in septic patients. Methods Data from septic patients admitted to the intensive care unit (ICU) were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, with patients categorized into ramelteon exposure and non-exposure groups based on the use of ramelteon. The primary outcome was 30-day mortality, and secondary outcomes included 90-day mortality, in-hospital mortality, length of ICU stay, and hospital stay. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were employed to address confounding variables. Kaplan–Meier (K-M) analysis and Cox proportional hazards regression models for stepwise regression were utilized to assess the impact of ramelteon exposure on survival. Results This study included 22,152 unexposed patients and 2,708 exposed patients, resulting in 2,607 matched pairs after PSM. Following PSM, ramelteon exposure was associated with significantly lower in-hospital mortality (11.6% vs.19.7%, p

Abstract Obesity is a significant public health challenge, yet the link between BMI and mortality in critical illness remains unclear. This study analyzed 19,311 patients from the MIMIC-III database, categorized into underweight, normal weight, overweight, and obese groups. Using Cox models and restricted cubic splines, we explored the complex association between BMI and mortality. Finally, multiple sensitivity analyses were performed to test the robustness of the results. The proportion of underweight patients (2.3%) was the lowest, while overweight (34.8%) and obese (34.5%) patients constituted a large proportion. Being underweight portended a greater risk, while being overweight or obese was associated with a lower risk of mortality, which is consistent with the sensitivity analysis. Moreover, we observed a typical L-shaped association between BMI and the risk of mortality with and without adjustment, with the lowest mortality occurring at approximately 32 kg/m2. The overall pattern of the nonlinear association between BMI and mortality was similar for most subgroup analyses. Underweight was associated with a greater risk of mortality, while obesity and overweight were both associated with a lower risk of mortality in critically ill patients. BMI had a typical L-shaped association with the risk of mortality.

Objective: This study aims to evaluate the correlation between peripheral oxygen saturation/fraction of inspired oxygen (SpO2/FiO2) and arterial partial pressure of oxygen (PaO2)/FiO2 ratio in the diagnosis and assessment of severity in acute respiratory distress syndrome (ARDS) patients admitted to intensive care unit (ICU) during the SARS-CoV-2 outbreak. Methods: A retrospective observational study was conducted in patients admitted to COVID-ICU during a 1-year period. Time coinciding values of SpO2 and PaO2 were noted from patients’ medical records. An evaluation was made to judge the efficacy of the SpO2/FiO2 ratio (S/F ratio) for the prediction of 100, 200, 300, and >300 mmHg cutoff values of PaO2/FiO2 ratio (P/F ratio) using receiver operating characteristic (ROC) curves. Results: The medical records of 196 patients were evaluated. A strong positive correlation was identified between P/F and S/F ratios in the sample population (correlation coefficient r = 0.716, p < 0.002). The area under the ROC curve of the S/F ratio was 0.720 (95% confidence interval [CI] 0.637–0.804) for mild ARDS. The optimal S/F threshold was found to be ≤411% (sensitivity and specificity 65% and 80%, respectively). Similarly, the S/F threshold was ≤405% (area under the curve [AUC] 0.781, 95% CI 0.713–0.848, p < 0.000) for moderate ARDS (sensitivity 71.8% and specificity 70.8%), and ≤ 395% (AUC 0.762, 95% CI 0.689–0.835, p < 0.000) for severe ARDS (specificity 73.5% and sensitivity 66.7%). Conclusions: The S/F ratio can be used as a reliable, noninvasive alternative tool for the diagnosis of ARDS and assessment of severity. This can be used as an early warning score in patients admitted in low-resource settings with respiratory illness, and an escalation of care can be decided.

Abstract Aims This study aimed to assess the use of high‐sensitivity troponin T (hsTNT) and N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) in screening for cardiac dysfunction [left ventricular (LV) systolic or diastolic dysfunction or right ventricular (RV) dysfunction] in mixed intensive care unit (ICU) patients and establish whether these biomarkers are independently associated with an increased risk of death. Methods We performed a secondary analysis of a single‐centre prospective observational study in which consecutive ICU patients were examined with transthoracic echocardiography (TTE) and cardiac biomarkers. Patients with systolic or diastolic LV dysfunction, RV dysfunction or a combination of these were compared with patients with normal cardiac function. Sensitivity and specificity for different cut‐off levels were calculated using receiver operating characteristic curves. Regression models were used to evaluate the associations between cardiac biomarkers, sepsis, renal failure and mortality. Results A total of 276 patients were included. Most of the patients had cardiac dysfunction on TTE (64%). Combined cardiac dysfunction was most prevalent (71 patients, 26%), followed by isolated diastolic LV dysfunction (40 patients, 15%). Levels of hsTNT and NT‐proBNP were higher in all types of cardiac dysfunction versus patients with normal cardiac function. The area under the curve (AUC) for hsTNT to detect any cardiac dysfunction was 0.75. An optimal cut‐off at 30.5 ng/L rendered a positive predictive value (PPV) of 80% and a negative predictive value (NPV) of 58%. The AUC for NT‐proBNP to detect any cardiac dysfunction was 0.788. Using an optimal cut‐off at 1145 ng/L rendered a PPV of 86% and an NPV of 58%. Using a clinically relevant 90% sensitivity for detecting cardiac dysfunction put the cut‐offs at 14.1 ng/L for hsTNT and 247 ng/L for NT‐proBNP, resulting in a specificity of 48% and 46%, respectively. Levels of NT‐proBNP were associated with sepsis and renal failure (P

Background: Enteral nutrition is recommended within 24 to 48 hours after intensive care unit (ICU) admission when resuscitation and hemodynamic stability have been achieved. This study aims to determine the tolerability of enteral nutrition in septic shock patients in the ICU. Objective: To determine the tolerability of enteral nutrition in septic shock patients in the ICU of RSUP H. Adam Malik Medan. Methods: This study is a retrospective observational study, which was conducted in the ICU of the RSUP H. Adam Malik Medan by taking patient data from January to December 2022. The samples were septic shock patients who were admitted to the ICU using mechanical ventilation and vasopressors with a length of treatment of more than 48 hours. Data was collected on the time required for enteral nutrition administration, as well as assessing patient tolerability (presence of vomiting, residuals, and incidence of ileus). Other assessments included length of stay and mortality rate. Result: This study consisted of 47 samples, with 23 male (48.9%) and 24 female (51.1%) samples. Based on the underlying disease, 40.4% of the samples were diagnosed with pneumonia. In the tolerability of enteral nutrition, 83% of the samples were tolerant of early enteral nutrition, but with a high mortality rate of 89.4%. The initiation time of enteral nutrition in patients was 4.94 ± 1.79 hours (p=0.001). The average hospital stay for sepsis patients was 7.30 ± 6.55 days (p=0.001). Conclusion: Most sepsis and septic shock patients in the ICU are tolerant of early enteral nutrition

Abstract Background Muscle wasting constitutes a frequent complication in critical illness and may be most prevalent in chronic critical illness as inpatients with prolonged ICU length of stay. Objective To evaluate the incidence and percentage of muscle wasting estimated by ultrasonography during ICU stay in patients with sepsis and receiving medications as corticosteroids, muscle relaxant, and certain antibiotics during ICU stay and hospital stay. Patients and methods We enrolled 90 patients diagnosed with sepsis who were admitted to ICU at Kasr Alainy Hospital were subdivided in to 3 groups: Group 1 consists of 30 patients receiving steroids. Group 2 consists of 30 patients receiving antibiotic causing muscle wasting in the form of aminoglycosides. Group 3 consists of 30 patients receiving neuromuscular blocking agents (muscle relaxants) for any indication in ICU. Results Our study included 90 patients, with mean age 50.44 ± 6.79 years, with male % 60%, APACHE II score 7.16 ± 3.59, SOFA score 7.16 ± 3.59, results showed there was a significant decline in QMT on both right and left sides as well as RFCSA on both right and left sides when compared with baseline starting from the 3rd day of ICU admission till the end of the study period (15th day of ICU admission) (P

Abstract Introduction Sinks have been introduced near patients to improve hand hygiene as part of infection prevention and control measures. However, sinks are a known reservoir for gram-negative bacterial pathogens in particular and their removal to prevent bacterial infections in intensive care patients is currently recommended by several international guidelines. Methods Healthcare workers (HCWs) in 15 intensive care units (ICUs) in Germany were given the opportunity to complete an anonymous survey on the use of sinks between August 2022 and January 2023. Observations were then made in three participating ICUs to determine the frequency and reason for contact with the sink. Results 258 questionnaires were returned (nurses 87%). 90% found it useful to very useful to have a sink in the patient room, and 56% reported using it daily for hand hygiene. We observed 33 contacts between nurses and sinks over 17 h. In 20/33 (60%) cases, the sink was used for waste disposal. In 3/33 (10%) it was used for hand washing. Discussion Sinks are still used for daily care in intensive care units. Educational Interventions in existing buildings to minimise risk through “sink hygiene” (i.e. separation of sinks for water disposal and uptake) can make an important contribution to infection prevention.

Abstract Objective The aim of this study was to describe the characteristics of patients admitted to the intensive care unit with severe pneumonia due to SARS-CoV-2, comparing them according to successive waves, and to identify prognostic factors for morbidity and mortality. Materials and methods This single-center retrospective observational descriptive study was conducted from March 10, 2020, to October 17, 2021. All adult patients admitted with SARS-CoV-2 pneumonia presenting acute respiratory failure were included. COVID 19 diagnosis was confirmed by RT-PCR testing of respiratory specimens. The primary endpoint was ICU mortality. Secondary endpoints were the occurrence of ventilator-associated pneumonia (VAP) or bronchopulmonary aspergillosis. Results Over the study period, 437 patients were included of whom 282 (65%) patients were ventilated for 9 [5;20] days. Among the studied population, 38% were treated for one or more episodes of VAP, and 22 (5%) for bronchopulmonary aspergillosis. ICU mortality was 26% in the first wave, then fell and stabilized at around 10% in subsequent waves (p = 0.02). Increased age, Charlson index, SOFA score and lactatemia on admission were predictive of mortality. Survival at 90 days was 85% (95% CI 82–88) and was unaffected by the presence of VAP. However, the occurrence of bronchopulmonary aspergillosis increased mortality to 36%. Conclusion In this study, we observed mortality in the lower range of those previously reported. Risk factors for mortality mainly included age and previous comorbidities. The prognosis of these critically ill Covid 19 patients improved over the four waves, underlining the likely beneficial effect of vaccination and dexamethasone.

A leak valve is intended to provide leak ventilation during positive pressure ventilation. This is an important way for patients to experience difficult or prolonged weaning. It is designed with an anti-asphyxia valve to allow for spontaneous breathing and prevent CO2 rebreathing figure 1. It also allows continuous airflow through the vent holes. We report a case of a 22-year-old female patient diagnosed with post-tubercular obstructive airway disease with hypercapnic respiratory failure discharged with tracheostomy with home oxygen and noninvasive ventilation support with leak valve after prolonged weaning in the intensive care unit.

Background: Delirium or an acute confusional state (ACS) is characterised as being a frequent and complex hospital complication in older adult patients, which can affect their level of independence and increase patient morbidity and mortality. Critically ill patients in the intensive care unit (ICU) frequently develop ICU delirium, leading to longer hospital and ICU stays, increased mortality and long-term impairment. Objectives: This review aims to assess existing evidence of interventions that can be considered effective for the management and prevention of delirium in ICUs, reducing short-term morbidity and mortality, ICU and hospital admission times and the occurrence of other long-term complications. Methodology: For this systematic review, we searched Medline, PubMed, Cochrane Library, CINHAL, LILACS, SciELO and Dialnet from January 2018 to August 2024, in English, Spanish and French. MeSH descriptors were adjusted to search the different databases. We also checked Prospero for ongoing systematic reviews. Main results: The electronic search yielded a total of 2656 studies, of which 14 trials met the eligibility criteria, with a total of 14,711 participants. We included eight randomised clinical trial (RCTs), four cohort analyses, one systematic review and one observational trial, including participants over 65 years admitted to the ICU. Ten of these studies were based on pharmacological interventions, three of them examined non-pharmacological interventions and the remaining study examined mixed (pharmacological and non-pharmacological) interventions. Six placebo RCTs were included, plus four reported comparisons between different drugs. Regarding non-pharmacological interventions, nursing programmes focused on optimising modifiable risk factors or the use of therapies such as bright light are emerging. Regarding mixed interventions, we found the combination of invasive techniques and with sedoanalgesia. Conclusions: Due to its satisfactory level of sedation, dexmedetomidine is presented as a viable option because, although olanzapine offers safer results, postoperative administration angiotensin inhibitor systems significantly reduced the incidence of delirium. As for propofol, no significant differences were found. Among the non-pharmacological and mixed therapies, bright light therapy was able to reduce the incidence of delirium, and the combination of epidural/general anaesthesia was effective in all subtypes of delirium. Concerning the remaining interventions, the scientific evidence is still insufficient to provide a definitive recommendation.

Summary: Background & Aims: Sarcopenia and myosteatosis are proving to be major factors to predict mortality in intensive care patients. Few studies are currently focusing on evaluating the functional impact after intensive care discharge and none has considered sarcopenia and myosteatosis as prognostic factors.The aim of our study was to determine whether sarcopenia and myosteatosis are reliable prognostic factors for mid-term functional impact in critical patients a few months after intensive care discharge. Methods: We carried out a retrospective monocentric study using computed-tomography scanner performed on intensive care admission and/or three months after discharge to assess sarcopenia and myosteatosis in 43 patients with critical illnesses who underwent a multidisciplinary evaluation on a multidisciplinary consultation's day hospital.We used L3 and/or T4 computed-tomography-scan levels to assess sarcopenia with the skeletal muscle index and myosteatosis with skeletal muscle density. These data were compared with main patient characteristics on intensive care admission and during intensive care stay and with functional assessments at the post intensive care multidisciplinary consultations, based on hand grip strength test, 6-minute walking test, and peak inspiratory pressure. Results: We found a good correlation of both skeletal muscle index and skeletal muscle density for T4 and L3 levels. Skeletal muscle index was correlated with hand grip strength test, and skeletal muscle density with 6-minute walking test, which are both functional tests recommended in the algorithm of the European Working Group on Sarcopenia in Older People to diagnose sarcopenia. Peak inspiratory pressure was correlated with both skeletal muscle index and skeletal muscle density and also with other functional tests. Conclusions: We confirmed the reliability of thoracic computed-tomography-scan to assess sarcopenia and myosteatosis. We found that skeletal muscle index and skeletal muscle density are independent but complementary predictive factors for functional impact at mid-term in intensive care patients. Peak inspiratory pressure could be a useful tool for the assessment and management of sarcopenia.

Abstract Background Lung phenotypes have been extensively utilized to assess lung injury and guide precise treatment. However, current phenotypic evaluation methods rely on CT scans and other techniques. Although lung ultrasound (LUS) is widely employed in critically ill patients, there is a lack of comprehensive and systematic identification of LUS phenotypes based on clinical data and assessment of their clinical value. Methods Our study was based on a retrospective database. A total of 821 patients were included from September 2019 to October 2020. 1902 LUS examinations were performed in this period. Using a dataset of 55 LUS examinations focused on lung injuries, a group of experts developed an algorithm for classifying LUS phenotypes based on clinical practice, expert experience, and lecture review. This algorithm underwent validation and refinement with an additional 140 LUS images, leading to five iterative revisions and the generation of 1902 distinct LUS phenotypes. Subsequently, a validated machine learning algorithm was applied to these phenotypes. To assess the algorithm’s effectiveness, experts manually verified 30% of the phenotypes, confirming its efficacy. Using K-means cluster analysis and expert image selection from the 1902 LUS examinations, we established seven distinct LUS phenotypes. To further explore the diagnostic value of these phenotypes for clinical diagnosis, we investigated their auxiliary diagnostic capabilities. Results A total of 1902 LUS phenotypes were tested by randomly selecting 30% to verify the phenotypic accuracy. With the 1902 LUS phenotypes, seven lung ultrasound phenotypes were established through statistical K-means cluster analysis and expert screening. The acute respiratory distress syndrome (ARDS) exhibited gravity-dependent phenotypes, while the cardiogenic pulmonary edema exhibited nongravity phenotypes. The baseline characteristics of the 821 patients included age (66.14 ± 11.76), sex (560/321), heart rate (96.99 ± 23.75), mean arterial pressure (86.5 ± 13.57), Acute Physiology and Chronic Health Evaluation II (APACHE II)score (20.49 ± 8.60), and duration of ICU stay (24.50 ± 26.22); among the 821 patients, 78.8% were cured. In severe pneumonia patients, the gravity-dependent phenotype accounted for 42% of the cases, whereas the nongravity-dependent phenotype constituted 58%. These findings highlight the value of applying different LUS phenotypes in various diagnoses. Conclusions Seven sets of LUS phenotypes were established through machine learning analysis of retrospective data; these phenotypes could represent the typical characteristics of patients with different types of critical illness.

Abstract Background As a supportive treatment, the effectiveness of oxygen therapy in ischemic stroke (IS) patients remains unclear. This study aimed to evaluate the relationships between arterial partial pressure of oxygen (PaO2) and both consciousness at discharge and all-cause mortality risk in ICU IS patients. Methods Blood gas measurements for all patients diagnosed with IS were extracted from the MIMIC-IV database. Patients were classified into four groups based on their average PaO2 during the first ICU day: hypoxemia (PaO2

Abstract Objectives To investigate the implications of frailty as a predictive factor for outcomes among patients with oral and maxillofacial space infection. Methods A retrospective cohort study was conducted to analyze 348 medical records, gathering data on several key aspects. These included the etiology of infection, the location of inflamed areas, the treatment administered, and the ultimate treatment outcomes. Additionally, the study collected information on the Symptom Severity (SS) score, frailty score, age, gender, the presence of systemic diseases, alcohol consumption, and smoking history. Results A total of 155 patients were classified as frailty, while 193 patients were classified as non-frailty. We found a significantly different in age, BMI, hospitalization expenses, length of hospital stay, SS, fibrinogen and admission to ICU between the frail group and the non- frail group. Conclusions Frailty serves as a valuable predictor of outcomes among patients with oral and maxillofacial space infections. By identifying high-risk patients, frailty can be employed as a clinical tool to guide perioperative care, ultimately optimizing patient outcomes. Notably, frail patients often require more ICU treatment.

Abstract Data on cholestasis and biliary injury in patients with COVID-19 are scarce. The primary aim of this study was to evaluate the prevalence of cholestasis and factors associated with its development and outcome in critically ill patients with COVID-19 associated acute respiratory distress syndrome (ARDS). In this retrospective exploratory study, COVID-19 patients with ARDS admitted to an intensive care unit (ICU) at the Medical University of Vienna were evaluated for the development of cholestasis defined as an alkaline phosphatase level of 1.67x upper limit of normal for at least three consecutive days. Simple and multiple logistic regression analysis was used to evaluate parameters associated with development of cholestasis and survival. Of 225 included patients 119 (53%) developed cholestasis during ICU stay. Patients with cholestasis had higher peak levels of alkaline phosphatase, gamma-glutamyl transferase, bilirubin and inflammation parameters. Factors independently associated with cholestasis were extracorporeal membrane oxygenation support, ketamine use, high levels of inflammation parameters and disease severity. Presence of cholestasis and peak ALP levels were independently associated with worse ICU and 6-month survival. Development of cholestasis is a common complication in critically ill COVID-19 patients and represents a negative prognostic marker for survival. It is associated with disease severity and specific treatment modalities of intensive care.

Abstract Planning and budgeting for healthcare facilities necessitate precise estimation and a thoughtful analysis of the required area for each department, as well as extensive knowledge of the most important elements that can influence the design and provide an appropriate environment for staff and patients. A gross conversion factor is influential in calculating the entire area of a department. However, there is no precise standard indicating how this factor should be calculated. To address this problem, quality function deployment (QFD) has been implemented. The intensive care unit (ICU) is one of the highly equipped departments that should be properly planned; therefore, it was selected for application. The five steps of the QFD are used to identify and rank the most important and efficient design features. Only the top factors are considered in calculating the required area for the ICU department. This approach presents a unique method for estimating the gross square area based on calculating the gross conversion factor. To demonstrate the proposed approach’s efficacy, it was applied to two Egyptian public hospitals. The results reveal that 15–16% of the total space of both hospitals can be reduced from the total department space. Moreover, an outstanding reduction in ICU design and preparation expenses has been achieved. The design reduces the required budget for a project while maintaining the same construction material quality and accommodating extra beds. Additionally, the QFD proves its ability to redesign the ICU department while reducing costs.

Abstract Background Inflammatory markers were found to be elevated in patients with coronavirus disease (COVID-19). C-reactive protein (CRP), serum ferritin, and D-dimer levels may predict morbidity and mortality in (COVID-19) patients. Radiology plays a key role in the diagnosis, management, and follow-up of this disease. This study aimed to describe the radiological features of (COVID-19) infection, measure C-reactive protein (CRP), D-dimer, and ferritin levels and to correlate them with patient’s outcome and to consider them as predictors of morbidity and mortality in (COVID-19) patients. Methods This prospective cross-sectional analytic study had been done on 159 patients aged ≥ 18 years old, admitted at Assiut University Hospital RICU from November 2021 to November 2022, diagnosed as COVID-19 by positive RT-PCR. All patients were categorized on bases of HRCT chest disease reporting and data system (CO-RADS) scoring system into non-severe (CO-RADS 1,2,3) and severe (CO-RADS 4,5) groups. Inflammatory markers such as CRP, ferritin, and D-dimer were measured. Age, sex, comorbidities, need to mechanical ventilation MV, and mortality rate were reported. Correlation between HRCT(CO-RADS) score, inflammatory markers, and patient’s outcome was assessed. Results Higher CRP and serum ferritin levels, lower lymphocytic count, and higher frequency of need for mechanical ventilation were significantly greater in the severe group (P

Abstract Identifying COVID-19 patients’ clinical phenotypes based on characteristics and comorbidities, as well as their differences, helps in terms of clinical care and potential crises. Our goal is to use Latent Class Analysis (LCA) to identify COVID-19 patient profiles based on demographics, symptoms, and comorbidities, and evaluate their correlation with ICU admission, hospitalization duration, and mortality in a cross-sectional study. We included hospitalized patients with positive SARS-CoV-2 tests in two referral hospitals in the south of Iran between January 2020 and July 2021. Data from 7,968 patients were evaluated in two time-specific intervals, known as “stratum,” based on the point at which the COVID-19 fourth peak and vaccinations were nearly initiated. After applying LCA, three classes identified the most at-risk individuals, including elderly women with hypertension, diabetes, and heart disease, and elderly men with heart and lung conditions, compared to two classes of healthier, younger individuals. Hospital stays were longer in the first stratum compared with the second (P-value = 0.043). ICU admission during the first stratum was significantly higher than in the second stratum (P

Abstract Whereas urinary creatinine excretion (UCE) is an established marker of muscle mass, both in critically ill and non-critically ill patients, analysis of urinary urea excretion (UUE) may allow estimation of proteolysis that is associated with critical illness. We evaluated the time courses of plasma urea and creatinine as well UUE and UCE in critically ill patients with a prolonged ICU stay. Our goal was to evaluate changes in plasma urea and creatinine in conjunction with their urinary excretion, to get a better understanding of urea handling in ICU patients. From 2002 to 2021, plasma urea and creatinine, UUE and UCE were determined in routinely obtained 24 h urine samples between ICU admission and day 30, in adult patients with an ICU-stay ≥ 28d. Urea-to-creatinine ratios in plasma and urine were calculated. Patients with stage 3 acute kidney injury (AKI) were excluded. Analyses were performed separately for females and males and for patients with and without acute renal failure to account for respectively differences in muscle mass and impaired renal function. Of 47,120 patients, who were admitted to the ICU between 2002 and 2021, 638 patients met the inclusion criteria. During the first 10 days mean ± SD plasma urea increased from 9.7 ± 6.0 mmol/L at ICU admission to 12.4 ± 7.9 mmol/L (P

Abstract Introduction Critically ill patients often endure pain, a distressing experience that can trigger diverse pathophysiological consequences. While remifentanil, with its rapid kinetics, is commonly used for analgesia in intensive care units (ICU), it frequently leads to opioid-related adverse effects. A promising alternative has emerged in oliceridine, a novel G protein-biased μ-opioid receptor agonist. This new drug offers the potential for effective pain relief with fewer side effects. However, its efficacy and safety profile in mechanically ventilated ICU patients remain to be fully elucidated. Methods This is a multicenter, prospective, randomized, single-blind, active-controlled trial conducted across 24 ICUs in China. A total of 292 mechanically ventilated patients requiring analgesia and sedation will be randomly assigned in a 1:1 ratio to either the oliceridine or remifentanil group. The oliceridine group will receive oliceridine (2–20 μg/kg/h), while the remifentanil group will receive remifentanil (1.5–12 μg/kg/h). Both groups will receive propofol for sedation if necessary. The target for analgesia is Critical-Care Pain Observation Tool (CPOT)

Abstract Background Patient safety is a global health issue that affects patients worldwide. Providing safe care in the intensive care units (ICUs) is one of the most crucial tasks for nurses. Numerous factors can impact the capacity of nurses to deliver safe care within ICUs. Consequently, this study was undertaken with the aim of identifying the components of safe nursing care in ICUs. Methods The current research constitutes a qualitative conventional content analysis study conducted from January 2022 to June 2022. The study participants comprised nurses, intensivists, nurse responsible for patient safety, paramedic, patients, and patients’ family member, totaling 21 individuals selected through purposive sampling. Data collection involved individual, in-depth, and semi-structured interviews. Subsequently, data analysis was performed utilizing the approach outlined by Graneheim and Lundman (Nurse Educ Today 24(2):105–12, 2004), leading to the identification of participants’ perspectives. Results Three themes were identified as components of safe nursing care in ICUs. These themes include professional behavior (with categories: Implementation of policies, organizing communication, professional ethics), holistic care (with categories: systematic care, comprehensive care of all systems), and safety-oriented organization (with categories: human resource management and safe environment). Conclusions The findings of this study underscore the significance of advocating for safe nursing practices in ICUs by emphasizing professional conduct, holistic care, and safety-focused organizational structures. These results align with existing research, suggesting that by introducing tailored interventions and tactics informed by these elements, a safer environment for nursing care can be established for ICUs patients.

Abstract Background The role of the geriatric nutritional risk index (GNRI) as a prognostic factor in intensive care unit (ICU) patients with acute kidney injury (AKI) remains uncertain. Objectives The aim of this study was to investigate the impact of the GNRI on mortality outcomes in critically ill patients with AKI. Methods For this retrospective study, we included 12,058 patients who were diagnosed with AKI based on ICD-9 codes from the eICU Collaborative Research Database. Based on the values of GNRI, nutrition-related risks were categorized into four groups: major risk (GNRI

Deying Xiao,1,2,&ast; Long Xie,1,&ast; Wenhong Lin,1 Jinhua Fu,1 Lin Deng,1 Qian Zhuang,2,3 Maobai Liu2,3 1Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, People’s Republic of China; 2The School of Pharmacy, Fujian Medical University, Fuzhou, 350004, People’s Republic of China; 3Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, 350001, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Maobai Liu; Qian Zhuang, Department of Pharmacy, Fujian Medical University Union Hospital, No. 29, Xinquan Road, Antai Street, Gulou District, Fuzhou, 350001, People’s Republic of China, Tel +86-591-83357896, Email liumaobai10@163.com; ZhuangQ0591@163.comBackground: This evaluation aims to provide a reference for clinical decision-making regarding the use of SPN in intensive care unit (ICU) patients. The objective of this study is to evaluate the quality of clinical practice guidelines for the use of supplementary parenteral nutrition (SPN) in ICU patients, both domestically and internationally.Patients and Methods: The quality of clinical practice recommendations for SPN use in ICU patients was assessed using a systematic approach.Results: Five nutrition recommendations in total were included for analysis. The average standardized scores for the recommendations across the six domains of the Appraisal of Guidelines for Research and Evaluation II (AGREE II) are as follows: Scope and purpose scored 87.96%, stakeholder Involvement scored 68.52%, rigour of development scored 73.40%, clarity of presentation scored 84.80%, applicability scored 64.72%, and editorial independence scored 91.10%. In the comprehensive evaluation, two guidelines were rated as grade A recommendations, and three were rated as grade B recommendations. Most guidelines recommended against early use of SPN when energy and protein requirements could not be met solely through enteral nutrition (EN) in ICU patients. The guidelines emphasized achieving target energy levels and discontinuing parenteral nutrition (PN) as soon as the energy requirements were met to prevent overfeeding.Conclusion: This study utilized the AGREE II scale to assess the quality of five nutrition guidelines. All 5 guidelines were deemed acceptable Recommendations include focusing on participants, rigour, and applicability to enhance guideline quality. Clinicians should exercise professional judgment when applying guidelines as they complement training and judgment, rather than replacing them.Keywords: ICU, patients, supplementary parenteral nutrition, clinical practice guidelines, guideline evaluation

This article provides a general overview of the pathway to become an intensivist in the United States of America (USA). It begins with a detailed description of the current structure of critical care training in the USA and the application process to fellowship training programs. There is then a presentation of the general structure of critical care units within the USA and how intensive care unit physicians fit into it. The article concludes with a discussion of how American critical care fits globally within international critical care societies.

Objective: The purposes of our study were to determine the relationship between coronavirus disease (COVID) pneumonia and mortality and immunization status of patients and to present our first extracorporeal membrane oxygenation (ECMO) experiences by retrospectively evaluating pregnant women. Materials and Methods: The research was conducted by screening the files of 37 pregnant/postpartum COVID-2019 cases monitored and treated in the intensive care unit between March 1, 2020 and December 1, 2021. The patients’ ages, systemic comorbidities, vaccination details, and clinical and laboratory features were recorded and analyzed. The patients were divided into two groups as survivors (group 1; n=17) and exitus ones (group 2; n=20); and the results were compared statistically. Results: Of 37 patients, 17 (45.9%) survived (group 1) and 20 (54.1%) died (group 2) with a median of 31 gestational weeks and 9 days length of stay in the ICU. ICU admission time [which day of polymerase chain reaction (PCR)+] and cesarean time (which day of PCR+) were 8 days. Nine (24%) patients received ECMO and mechanical ventilation, with 6 (66.6%) exitus and 3 (33.3%) survivors who were discharged from the hospital without sequelae. Of 37 pregnant/postpartum patients, 36 were unvaccinated. Conclusion: Vaccination should be given priority in pregnant women, and ECMO may be effective in the recovery of oxygenation in pregnant COVID-19 patients.

Abstract Background Pneumonia, a leading cause of morbidity and mortality worldwide, often necessitates Intensive Care Unit (ICU) admission. Accurate prediction of pneumonia mortality is crucial for tailored prevention and treatment plans. However, existing mortality prediction models face limited adoption in clinical practice due to their lack of interpretability. Objective This study aimed to develop an interpretable model for predicting pneumonia mortality in ICUs. Leveraging the Shapley Additive Explanation (SHAP) method, we sought to elucidate the Extreme Gradient Boosting (XGBoost) model and identify prognostic factors for pneumonia. Methods Conducted as a retrospective cohort study, we utilized electronic health records from the eICU-CRD (2014–2015) for all adult pneumonia patients. The first 24 h of each ICU admission records were considered, with 70% of the dataset allocated for model training and 30% for validation. The XGBoost model was employed, and performance was assessed using the area under the receiver operating characteristic curve (AUC). The SHAP method provided insights into the XGBoost model. Results Among 10,962 pneumonia patients, in-hospital mortality was 16.33%. The XGBoost model demonstrated superior predictive performance (AUC: 0.778 ± 0.016)) compared to traditional scoring systems and other machine learning method, which achieved an improvement of 10% points. SHAP analysis identified Aspartate Aminotransferase (AST) as the most crucial predictor. Conclusions Interpretable predictive models enhance mortality risk assessment for pneumonia patients in the ICU, fostering transparency. AST emerged as the foremost predictor, followed by patient age, albumin, BMI et al. These insights, rooted in strong correlations with mortality, facilitate improved clinical decision-making and resource allocation.

Abstract Background Maintaining the dose-intensity of cancer treatment is an important prognostic factor of aggressive hematological malignancies. The objective of this study was to assess the long-term outcomes of intensive care unit (ICU) survivors with acute myeloid leukemia (AML) or aggressive B-cell non-Hodgkin lymphoma (B-NHL) with emphasis on the resumption of the intended optimal regimen of cancer treatment. Patients and methods We conducted a retrospective (2013–2021) single-center observational study where we included patients with AML and B-NHL discharged alive from the ICU after an unplanned admission. The primary endpoint was the change in the intended optimal cancer treatment following ICU discharge. Secondary endpoints were 1-year progression-free survival and overall survival rates. Determinants associated with modifications in cancer treatment were assessed through multivariate logistic regression. Results Over the study period, 366 patients with AML or B-NHL were admitted to the ICU, of whom 170 survivors with AML (n = 92) and B-NHL (n = 78) formed the cohort of interest. The hematological malignancy was recently diagnosed in 68% of patients. The admission Sequential Organ Failure Assessment (SOFA) score was 5 (interquartile range 4–8). During the ICU stay, 30 patients (17.6%) required invasive mechanical ventilation, 29 (17.0%) vasopressor support, and 16 (9.4%) renal replacement therapy. The one-year survival rate following ICU discharge was 59.5%. Further modifications in hematologic treatment regimens were required in 72 patients (42%). In multivariate analysis, age > 65 years (odds ratio (OR) 3.54 [95%-confidence interval 1.67–7.50], p 20 µmol/L (OR 3.01 [1.10–8.15], p = 0.031), and therapeutic limitations (OR 16.5 [1.83–149.7], p = 0.012) were independently associated with modifications in cancer treatment. Post-ICU modifications of cancer treatment had significant impact on in-hospital, 1-year overall survival and progression-free survival. Conclusion The intended cancer treatment could be resumed in 58% of ICU survivors with aggressive hematological malignancies. At the time of ICU discharge, advanced age, persistent liver dysfunction and decisions to limit further life-support therapies were independent determinants of cancer treatment modifications. These modifications were associated with worsened one-year outcomes.

The World Health Organization (WHO) considers carbapenem-resistant organisms (CROs) to be critical-level pathogens. Regular screening for high-risk CRO colonization is essential, especially in the ICU. Direct detection of carbapenem-resistant genes is possible using the FDA-approved Xpert Carba-R assay. This study evaluated its reliability compared with the culture technique at a tertiary hospital in Indonesia. A high number of CRO colonization was found using the culture technique and the Xpert Carba-R assay with about 31 and 26 positive results out of 100 total samples, respectively. Both methods detected blaNDM in 11 samples, and the Xpert Carba-R assay detected one sample co-presenting with blaVIM that was not detected by PCR. The Xpert Carba-R assay did not detect the gene in 73 samples following negative results with the culture technique. Fifteen samples were detected gene by the Xpert Carba-R assay though there was no gene by the culture method, showing that the Xpert Carba-R assay demonstrated a high degree of sensitivity in identifying carbapenem-resistance genes. Carbapenem-resistance genes common in Indonesia other than those examined by Xpert Carba-R assay in this study (i.e., blaOXA-23 and blaOXA-24) or non-enzymatic mechanisms may also produce resistance in many colonies without the examined genes. Finally, the Xpert Carba-R assay produced faster findings than the culture technique.

Abstract Background Multiple trauma has serious complications, which increases the risk of morbidity and mortality in the patients. This study aimed to evaluate the impact of supplementation with phytosomal curcumin on clinical and laboratory factors in critically ill patients with multiple trauma. Methods In this double-blind trial, 53 patients with multiple trauma, who were admitted to the intensive care unit (ICU) were randomized to receive either 2 capsules, each capsule containing 250 mg phytosomal (a total of 500 mg daily) as an intervention group or 2 identical capsules (placebo capsules), each containing 250 mg maltodextrin for 7 days. Clinical and laboratory were parameters assessed before and after the intervention. Results After seven days of intervention, the mean increase from baseline in the Glasgow coma scale (GCS) score was significantly higher in the curcumin compared with the placebo group (P-value: 0.028), while the reduction in the APACHE-II score in the curcumin group was greater than that the placebo group in a marginally non-significant fashion (P-value: 0.055). Serum total bilirubin (P-value: 0.036) and quantitative C-reactive protein (CRP) (P-value: 0.044) levels significantly decreased while potassium (P-value: 0.01) significantly increased in the curcumin compared with the placebo group. Moreover, supplementation with phytosomal curcumin significantly increased platelet count (P-value: 0.024) as compared with placebo. The 28-day mortality rate was 7.7% (n: 2 patients) and 3.7% (n: 1 patients) in the placebo and curcumin groups, respectively (P-value > 0.05). Conclusion Phytosomal curcumin had beneficial effects on several clinical and laboratory factors including GCS, APACHEII, serum total bilirubin, CRP, and platelet count in ICU-admitted patients with multiple trauma. Trial registration IRCT20090306001747N1, Available on: https://www.irct.ir/trial/52692 . The first registration date was 12/01/2021.

Objectives: Monitoring muscle mass (cross-sectional area [CSA]) and quality (echogenicity) using ultrasound may help optimise nutrition support in the critically ill. However, to date, ultrasound imaging has not been included in the undergraduate training of dietitians, who are mostly responsible for the nutrition care of critically ill patients. This study assessed the accuracy and reliability of bedside imaging performed by a dietitian trained according to standardised methodology, followed by blinded analyses.Methods: Two operators (a trainer and dietitian trainee) performed B-mode ultrasonography of the rectus femoris quadriceps muscle. For inter-rater accuracy, imaging was performed independently on 32 subjects by both operators, and for intra-rater reliability both obtained a second image on 15 subjects. A blinded assessor performed analyses (CSA and echogenicity) on all images. In a subset of 11 subjects, a musculoskeletal sonographer repeated all measurements. Inter- and intra-rater reliability were determined by calculating intraclass correlation coefficients (ICC), based on an absolute-agreement, 2-way mixed-effects model. An ICC > 0.75 was classified as good and > 0.90 as excellent.Results: Intra- (ICC = 0.9–0.94) and inter-rater (ICC = 0.85–0.95) reliability of the imaging performed was good to excellent. No statistically significant differences were found between the two operators (mean difference for CSA = 0.18 cm2, 95% CI = −0.38–0.03, p = 0.08; mean difference for echogenicity = 6.88, CI = −0.71–14.78, p = 0.07). Inter-rater reliability for image analyses was excellent (ICC = 0.97–1.0).Conclusion: Bedside ultrasound performed by a dietitian trained according to standardised methodology shows good to excellent reliability and reproducibility. Training dietitians to perform bedside ultrasound may help to monitor muscle mass and quality in the critically ill.

Aim. To analyze dynamic of incidence and mortality of COVID-19 and clinical and epidemiological characteristics of adult patients with a new coronavirus infection during the early period of the Omicron SARS-COV-2 distribution in Russia. Materials and Methods. We conducted a retrospective analysis of the dynamics of COVID-19 incidence and mortality in Russia until 2023. Study included patients aged ≥18 years with a laboratory-confirmed diagnosis of COVID-19, detected in the period from 01/02/2022 to 14/03/2022 (n = 3 582 688) in 85 regions of Russia. Participants were included regardless their COVID-19 vaccination history. Results. We identified 6 periods of rise and decline in the COVID-19 incidence until 2023 in Russia. The 5th (January–July 2022) and the 6th (August-November 2022) periods were associated with the spread of the Omicron SARS-CoV-2. The median age of patients in the early period of Omicron spreading was 49 (36–62) years, 62.7% were women. The largest proportion of patients were represented by the age groups 30–39 and 40–49 years (19.2% each), the lowest – 18–29 years (12.3%). Proportion of patients with mild disease was 90.0%, moderate – 8.5%, severe – 0.9%, extremely severe – 0.6%. Hospitalization rate, proportion of patients treated in the intensive care unit and rate of invasive mechanical ventilation were 7.6%, 9.5% and 6.7% respectively. The median period from the onset of symptoms to the diagnosis was 2 (1–3) days, median of duration of the disease was 8 (6-10) days and median duration of hospitalization was 10 (7–14) days. The median age of the deceased patients was 77 (69–84) years, of which 50.8% were women, 72.6% were persons ≥70 years old. One or more concomitant diseases were detected among 8.7% of patients who became ill and 75.8% of those who died. The probability of hospitalization, admission to the ICU, IMV and death in patients with one or more concomitant diseases were 24.5, 3.2, 3.5 and 35.8 times higher, respectively, compared with patients without concomitant diseases. Conclusion. In the early period of the spread of the Omicron variant in Russia, among adult patients with COVID-19, excluding their vaccine history, the frequency of severe and extremely severe forms of infection was 1.5%. The elderly age and the presence of concomitant diseases remained key risk factors for the development of adverse outcomes of the COVID-19

Background: Invasive candidiasis (IC) is widely recognized as a major cause of morbidity and mortality especially among patients hospitalized in intensive care units (ICU). Hence, we conducted a prospective matched case-control study in three ICUs of the university hospital Sahloul in Sousse region (Tunisia), with the aim of describing the epidemiology, microbiology and risk factors of IC, in order to provide a risk predictive model for early diagnosis of these infections in ICU. Methods: A prospective matched case-control study was conducted jointly between the microbiology laboratory and three ICUs for a period of seven months (February-August 2020). A case report form was used to collect data prospectively for each included patient. Patient’s characteristics and risk factors were analyzed using univariate and multivariate conditional logistic regression models. Results: Out of 112 included patients, 30 patients had IC. The incidence rate of IC in ICU was 11.7 episodes per 1000 patient-days (86.4 per 1000 ICU admissions). Prolonged ICU stay (≥14 days) had a 3-fold increase in the risk of IC (p=0.003). Multivariate analysis showed that diabetes (p=0.035), cardiovascular disease (p=0.028) and recent surgery (p=0.004) were independent risk factors for IC. Non-albicans Candida species were responsible for 60% of IC cases and 70% of candidemia cases. Resistance to fluconazole was mainly seen among C. glabrata and uncommon Candida species. Conclusion: This study provides a risk predictive model for early diagnosis of IC in ICU, which can improve the diagnosis of these infections and contribute to guide targeted preventive and therapeutic antifungal strategies.

Abstract Background Heart failure is a disease that threatens global public safety. In recent years, the obesity paradox has been studied in cardiovascular disease and other fields. With the progress of aging, metabolic changes and regulation of fat function, it also provides many bridges for the dialogue between disease and molecular metabolism. The purpose of this study is to investigate the effect of obesity on the outcome of adult intensive care patients with heart failure combined with age factors. Method Data were derived from the fourth-generation Medical Information Marketplace for Intensive Care (MIMIC-IV version2.1) using structured query language on the Navicat (12.0.11) platform. People were divided into two groups based on the body mass index (BMI), one group with BMI ≥ 30 kg/m² and another group with BMI

Abstract Background During the first wave of the COVID‐19 pandemic, the availability of mechanical ventilators was very limited and ad hoc recommendations establishing age to be used for patient triage for having access to intensive care beds (ICBs) were proposed. No reports have evaluated how this policy impacted ICB admission in Western countries. Aims We analyzed the age‐related probability of ICB admission during first COVID‐19 pandemic wave. Materials and Methods We included all patients ≥65 years attended in 42 Spanish emergency departments (EDs) covering around 22% of the Spanish population during 1‐week of the first wave of the COVID‐19 pandemic (9128 ED visits) and compared the probability of ICB admission respect to patients coming to these EDs 1‐week of 1‐year earlier (24,128 ED visits). Results We found that compared with patients aged 65, the probability of ICB admission was significantly reduced from 79 years and up during the pandemic period (odds ratio [OR] = 0.60 for patients aged 79, 95% confidence interval [CI] = 0.39–0.94), while a significant reduction of ICB admission probabilities was found from 88 years and up during the pre‐COVID‐19 period (OR = 0.66 for patients aged 88, 95% CI = 0.45–0.95) (p

Background and purpose: In late December 2019, pneumonia originating from nCOV-2019 spread rapidly around the world, and in March 2020, the World Health Organization officially declared it a pandemic and chose the name "COVID-19" for the resulting disease. A significant proportion of COVID-19 patients experience severe pulmonary complications and life-threatening conditions that necessitate respiratory support and admission to the intensive care unit (ICU). Since the detection of the first case of COVID-19 in Iran, the country has experienced several waves, with different strains of the coronavirus prevailing in each wave. According to the studies conducted in this field, in the first wave, the alpha strain (B.1.1) 7), the second wave of the beta strain (B.1.351), the third wave of the gamma strain (P.1), the fourth wave of the delta strain (B.1.617.2) and in the fifth wave the Amicron strain (B.1.1.529) of the strain were dominant in patients. This study aims to evaluate the clinical and paraclinical findings, as well as the outcomes, of COVID-19 patients admitted to the intensive care units at a referral teaching hospital in northern Iran during the first through fifth waves of the pandemic. Materials and methods: This research is a descriptive-analytical retrospective study that was conducted on all patients with COVID-19 who were hospitalized in the ICU of Razi Qaemshahr Hospital (Infectious Diseases Referral Center of Mazandaran Province) in first to fifth waves. Personal information, underlying diseases, time from the onset of symptoms to a hospital visit, laboratory tests, and length of stay of the patient in the intensive care unit was collected through dossier reading and spss25 software was used for statistical analysis. Results: Out of the 304 patients admitted to the ICU during the first through fifth waves of the COVID-19 outbreak, 50.3% were male. The age range of the patients was from 22 years to 98 years with an average of 65.14±15.08. 244 patients had at least one underlying disease. So 41% of the patients had diabetes and 50% had blood HTN. Among 244 patients with underlying disease, only 28 patients recovered and 216 patients died, which difference was significant (P=0.01). The second wave had the highest number of patients (25.7%), while the third wave had the lowest (16.4%). The average hemoglobin level differed significantly between the second and fourth waves, being 1.37 units lower in the fourth wave. The mortality rates varied significantly across the different waves (P

Continuous venovenous hemofiltation (CVVH) with citrate anticoagulation has been shown to be associated with substantial losses of calcium and negative calcium balance in ICU patients, which may lead to excessive bone loss and osteoporosis. The aim of this study is to investigate whether plasma parathormone monitoring can identify patients with negative calcium balance during CVVH. This is a retrospective single-center study of all adult ICU patients treated with citrate CVVH from 2021 to 2023. PTH was measured routinely once per week. Calcium excretion in ultrafiltrate fluid and CVVH calcium balance were measured daily. In total, 274 PTH measurements were performed in 111 patients. In 61 measurements (22%), PTH was higher than the upper limit of normal (>8 pmol/L). If PTH was higher than normal, plasma ionized calcium was less than 1.16 mmol/L in 77% of cases and hypercalcemia was never present. In a subgroup of patients treated with CVVH for at least 36 h in the preceding 72 h, PTH values were similar for quartiles by cumulative calcium balance. Increased plasma concentrations of PTH are frequently found in ICU patients treated with citrate CVVH, but no association was found between PTH and the CVVH calcium balance over the last 72 h.

PurposeWe aim to ascertain the extent to which the blood urea nitrogen (BUN) to serum albumin (ALB) ratio (BAR) could be implemented to anticipate the short- and long-term prognosis of acute ischemic stroke (AIS) patients in intensive care units (ICUs).MethodsThe data was derived from the Marketplace for Intensive Care Medical Information-IV (MIMIC-IV v3.0) database, primarily pertaining to AIS patients as categorized by the International Classification of Diseases (ICD)-9 and ICD-10. The outcomes encompassed short-term ACM incorporating ICM admissions and 30-day, as well as longer-term ACM involving 90-day and 365-day. Any confounding effects were mitigated with a 1:1 propensity score matching (PSM) approach. We determined the critical BAR level affecting patient survival with the use of maximum chosen rank statistics. The connection between BAR and ACM at various time intervals was ascertained with the multivariate Cox regression (MCR) models after the adjustment for covariates. Kaplan–Meier (KM) survival curves were generated to illustrate variations in BAR and death over various time intervals. Additionally, the linear or non-linear connection between BAR and ACM was ascertained with restricted cubic spline (RCS) approaches, supplemented by interaction and subgroup analyses.ResultsPrior to PSM, we incorporated 1,764 suitable subjects with a median BAR of 5.52 mg/g. This cohort was composed of 1,395 and 369 patients in the BAR

ObjectivesThis study aimed to investigate the association of baseline coagulation proteins with hospitalization variables in COVID-19 patients admitted to ICU, as well as coagulation system changes after one-year post-discharge, taking into account gender-specific bias in the coagulation profile.MethodsWe conducted a prospective longitudinal study on 49 ICU-admitted COVID-19 patients. Proteins were measured using a Luminex 200™. The association between coagulation protein levels and hospitalization variables was carried out by generalized linear models adjusted by the most relevant covariates.ResultsAt ICU admission, lower factor XII, antithrombin, and protein C levels were linked to the need for invasive mechanical ventilation (IMV) or its duration (p=0.028; p=0.047 and p=0.015, respectively). Likewise, lower factor XII, antithrombin, and prothrombin levels were associated with longer ICU length of stay (ICU LOS) (p=0.045; p=0.022; p=0.036, respectively). From baseline to the end of the follow-up, factor XII, antithrombin, prothrombin, and protein C levels notably increased in patients with longer ICU LOS. One-year post-discharge, differences were found for factor IX, aPTT, and INR. Gender-stratified analysis showed sustained alterations in males.ConclusionsDepleted specific coagulation factors on ICU admission are associated with increased severity in critically ill COVID-19 patients. Most coagulation alterations recover one-year post-discharge, except for factor IX, aPTT and INR, which remain reduced.

BackgroundLeptospirosis is an acute infectious disease that occurs by infection, progresses rapidly, and has a high mortality rate, with an estimated 1.2 million new cases and nearly 59,000 deaths each year. Due to its diverse clinical manifestations, diagnosis is often delayed. Therefore, it is necessary to pay attention to its clinical manifestations, diagnostic techniques, and treatment methods.Case reportA 51-year-old male patient from the Han ethnic group experienced fever, chills, headache, and overall fatigue after being exposed to rain, followed by yellowing of the skin and worsening of breathing difficulties. Metagenomic next-generation sequencing (mNGS) indicates infection with leptospirosis and influenza A. After 5 days of treatment with venovenous extracorporeal membrane oxygenation (VV-ECMO), Penicillium, and Oseltamivir, the condition improved.ConclusionLeptospirosis improves with VV-ECMO support and anti-infective treatment with penicillin and oseltamivir. VV-ECMO provides a therapeutic time window for rescue, and mNGS lays a foundation for early detection of etiology of leptospirosis.

Summary: Background: Patients with obesity are at high-risk of extubation failure. Discrepancies were found in the results of recent randomized controlled trials (RCTs) regarding the roles of noninvasive ventilation (NIV), high flow nasal cannula (HFNC) and conventional oxygen therapy (COT) to prevent extubation failure in critically ill patients with obesity. Methods: In this systematic review and network meta-analysis, we searched MEDLINE, Cochrane Center Register of Controlled Trials and Web of Science from 1 January 1998 to 1 July 2024 for RCTs evaluating noninvasive respiratory support therapies (NIV, HFNC, COT, NIV + HFNC) after extubation in critically ill adults with obesity. Primary outcome was reintubation at day 7. Secondary outcome was 28-day mortality. We generated pooled risk ratios (RR) and numbers needed to treat (NNT). We rated risk of bias using the Cochrane risk-of-bias 2.0 tool. The study was registered with PROSPERO (CRD 42022308995). Findings: In seven RCTs including 1933 patients, NIV + HFNC (RR 0.36 [95% confidence interval (CI) 0.16–0.82], NNT = 10 [95% CI 7–33]) and NIV (RR 0.45 [95% CI 0.23–0.88], NNT = 11 [95% CI 8–50]) but not HFNC (RR 0.79 [95% CI 0.40–1.59]) reduced reintubation at day 7, compared to COT. Compared to HFNC, NIV + HFNC (RR 0.46 [95% CI 0.23–0.90], NNT = 14 [95% CI 10–77]) but not NIV (RR 0.57 [95% CI 0.32–1.02]) reduced reintubation at day 7. Compared to HFNC, both NIV (RR 0.31 [95% CI 0.13–0.74], NNT = 15 [95% CI 12–40]) and NIV + HFNC (RR 0.30 [95% CI 0.10–0.89], NNT = 15 [95% CI 11–90]) reduced 28-day mortality. Interpretation: The results suggest that compared to COT and HFNC, NIV alone or with HFNC reduces reintubation in critically ill patients with obesity after extubation. Compared to HFNC, NIV alone or with HFNC reduces mortality. The number needed to treat with NIV or NIV + HFNC to avoid one death was 15. These findings support the application of NIV to mitigate extubation failure in critically ill adults with obesity. Funding: None.

AimThis study aimed to evaluate the association between serum calcium level and the risk of acute kidney injury (AKI) in patients with subarachnoid hemorrhage (SAH).MethodsIn this retrospective cohort study, data on adults from the Medical Information Mart for Intensive Care (MIMIC-III and MIMIC-IV) databases, spanning from 2008 to 2019, were extracted. In the logistic regression models, confounding variables, including age, white blood cell (WBC), systolic blood pressure (SBP), heart rate, blood urea nitrogen (BUN), glucose, international normalized ratio (INR), and the Charlson Comorbidity Index (CCI), were finally adjusted by stepwise regression. The outcome event was the occurrence of AKI after intensive care unit (ICU) admission. The univariate and multivariate logistic regression models were utilized to assess the association between serum calcium level and the risk of AKI in SAH patients, with odds ratios (ORs) and 95% confidence intervals (CIs). To further explore the association, subgroup analyses were performed, stratified by age, Glasgow Coma Scale (GCS) scores, drugs, and surgical methods.ResultsA total of 1,128 patients with SAH were included in the study, of which 457 patients developed AKI. Low levels of serum calcium were significantly associated with a high risk of AKI in patients with SAH, with an OR (95%CI) of 1.38 (1.01–1.89). Further subgroup analyses showed that low levels of calcium were significantly associated with a high risk of AKI in SAH patients aged ≥60 years (OR = 0.27, 95%CI: 0.09–0.83), who had GCS score ≥13 (OR = 1.57, 95%CI: 1.08–2.30), who did not use calcium channel blockers (CCB) (OR = 2.22, 95%CI: 1.16–4.25) and angiotensin-converting enzyme (ACE) inhibitors (OR = 1.51, 95%CI: 1.06–2.14), and who did not undergo aneurysm embolization (OR = 1.48, 95%CI: 1.01–2.17) and aneurysm clipping (OR = 1.45, 95%CI: 1.04–2.01).ConclusionThe results of our study indicated that low levels of serum calcium were significantly associated with the risk of AKI in patients with SAH.

IntroductionNorthern Iran is one of the regions of the country most affected by COVID-19. The aim of the current study was to examine the demographics, clinical characteristics, and outcomes of suspected and laboratory-confirmed patients

Among hospitalized patients worldwide, infections caused by multidrug-resistant (MDR) bacteria are a major cause of morbidity and mortality. This study aimed to isolate MDR bacteria from five intensive care units (ICUs) at Tripoli University Hospital (TUH). A prospective cross-sectional study was conducted over a seven-month period (September 2022 to March 2023) across five ICUs at TUH. A total of 197 swabs were collected from Patients’, healthcare workers’ and ICUs equipment. Samples collected from patients were nasal swabs, oral cavity swabs, hand swabs, sputum specimens, skin swabs, umbilical venous catheter swabs, and around cannula. Swabs collected from health care workers were nasal swabs, whereas ICUs equipment’s samples were from endotracheal tubes, oxygen masks, and neonatal incubators. Identification and antimicrobial susceptibility test was confirmed by using MicroScan auto SCAN 4 (Beckman Coulter). The most frequent strains were Gram negative bacilli 113 (57.4%) with the predominance of Acinetobacter baumannii 50/113 (44%) followed by Klebsiella pneumoniae 44/113 (40%) and Pseudomonas aeruginosa 6/113 (5.3%). The total Gram positive bacterial strains isolated were 84 (42.6%), coagulase negative Staphylococci 55 (66%) with MDRs (89%) were the most common isolates followed by Staphylococcus aureus 15 (17.8%). Different antibiotics were used against these isolates; Gram- negative isolates showed high resistance rates to ceftazidime, gentamicin, amikacin and ertapenem. A. baumannii were the most frequent MDROs (94%), and the highest resistance rates in Gram-positive strains were observed toward ampicillin, oxacillin, ampicillin/sulbactam and Cefoxitin, representing 90% of total MDR Gram-positive isolates. ESBL and MRS were identified in most of strains. The prevalence of antibiotic resistance was high for both Gram negative and Gram positive isolates. This prevalence requires strict infection prevention and control intervention, continuous monitoring, implementation of effective antibiotic stewardship, immediate, concerted and collaborative action to monitor its prevalence and spread in the hospital.

Background Sepsis-associated acute kidney injury (S-AKI) is a critical illness and is often associated with high morbidity and mortality rates. The soluble urokinase-type plasminogen activator receptor (suPAR) is an important immune mediator and is involved in kidney injury. However, its diagnostic value in S-AKI patients remains unclear. Therefore, we assessed the early predictive value of suPAR for S-AKI patients.Methods We prospectively enrolled adult patients, immediately after fulfilling the sepsis-3 criteria. Plasma suPAR levels at 0-, 12-, 24-, and 48-h post-sepsis diagnosis were measured. S-AKI development was the primary outcome. S-AKI risk factors were analyzed using logistic regression, and the value of plasma suPAR for early S-AKI diagnosis was assessed using receiver operating characteristic (ROC) curves.Results Of 179 sepsis patients, 63 (35.2%) developed AKI during hospitalization. At 12-, 24-, and 48-h post-sepsis diagnosis, plasma suPAR levels were significantly higher in patients with S-AKI than in patients without S-AKI (p