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Background: The association between the stress hyperglycemia ratio (SHR), which represents the degree of acute stress hyperglycemic status, and the risk of mortality in cerebrovascular disease patients in the intensive care unit (ICU) remains unclear. This study aims to investigate the predictive ability of SHR for in-hospital mortality in critically ill cerebrovascular disease patients and to assess its potential to enhance existing predictive models. Methods: We extracted data from the Medical Information Mart for Intensive Care (MIMIC-IV) database for patients diagnosed with cerebrovascular disease and used Cox regression to assess the association between SHR and mortality. To investigate the nature of this association, we applied restricted cubic spline analysis to determine if it is linear. The predictive ability of SHR for mortality risk was evaluated using receiver operating characteristic (ROC) curves and the C-index. Results: We included a total of 2,461 patients, with a mean age of 70.55 ± 14.59 years, and 1,221 (49.61%) being female. Cox regression analysis revealed that SHR was independently associated with both in-hospital mortality (per standard deviation (SD) increase: hazard ratio (HR) 1.35, 95% confidence interval (CI) 1.23–1.48) and ICU mortality (per SD increase: HR 1.37, 95% CI 1.21–1.54). The risk of death increased in an approximately linear fashion when SHR exceeded 0.77–0.79. Subgroup analysis indicated the association was more pronounced in non-diabetic individuals. Additionally, incorporating SHR into existing models improved both discrimination and reclassification performance. Conclusion: SHR serves as an independent risk factor for in-hospital mortality in cerebrovascular disease patients in the ICU. Adding SHR to existing models enhances their predictive performance, offering clinical value in the identification of high-risk patients. [ABSTRACT FROM AUTHOR]

Background: Work-related musculoskeletal disorders (WRMSDs) are significant concern in intensive care units (ICUs) due to distinct work environment. This study aims to comprehensively investigate determinants of WRMSDs and ergonomic challenges, specific to ICU nurses, providing valuable insights for targeted interventions. Methods: In this six-month convergent mixed methods study, 200 consenting nurses with over one year of experience from seven ICUs across three public tertiary hospitals of Ahmedabad participated. Structured questionnaires were used to collect data on socio-demographics, occupation, physical and workplace factors, risk perception, and musculoskeletal pain (through modified Nordic Musculoskeletal Questionnaire) and ergonomic issues using REBA (Rapid Entire Body Assessment) scale. Qualitative insights were obtained through in-depth interviews until saturation of responses. Statistical analysis involved chi-square, t-test and logistic regression, with a significance level set at p < 0.05. Thematic analysis was used to interpret the findings of qualitative study. Results: The study included predominantly female ICU nurses (78%) with a mean age of 34 years. A high prevalence of WRMSDs (84%) was observed, with the lower back and neck being the most affected regions. Nurses with WRMSDs reported significantly higher mean scores for physical factors (15.1 vs. 11.1, p = 0.00), physical workload (12.8 vs. 10.7, p = 0.001), work environment (13.1 vs. 10.1, p = 0.00), and risk perception (11.8 vs. 8.9, p = 0.00) compared to those without WRMSDs. Logistic regression identified key risk factors for WRMSDs, including longer ICU tenure [OR = 1.4 (1.13–1.66)], high shift frequency [OR = 2.7 (1.27–5.95)], higher physical factor score [OR = 1.2 (1.05–1.42)], higher physical workload score [OR = 1.2 (1.09–1.49)], higher risk perception [OR = 1.3 (1.10–1.78)], and lack of exercise [OR = 0.5 (0.27–0.93)]. The qualitative findings highlighted key ergonomic challenges, including inadequate equipment, heavy patient loads, poor posture during tasks, and insufficient breaks, contributing to WRMSDs among ICU nurses. Conclusion: The findings underscore urgent need for targeted interventions to address risk factors associated with WRMSDs, including ergonomic training, workplace modifications, and education programs to enhance risk awareness and preventive behaviours. Future research should focus on developing and evaluating comprehensive interventions that integrate both physical and work environment factors to effectively mitigate WRMSDs among ICU nurses. [ABSTRACT FROM AUTHOR]

Background: Clinical reasoning is a critical skill for healthcare professionals, vital for making accurate diagnoses and effective treatment decisions. This study focuses on enhancing collaborative clinical reasoning (CCR) among multidisciplinary healthcare teams in a neurosurgery intensive care unit (NICU) in Taiwan. The study utilizes video-reflexive ethnography (VRE) to examine the factors influencing CCR, the cognitive processes involved, and the efficacy of VRE in promoting CCR. Methods: The study employed a qualitative research design, utilizing VRE. Participants included 17 healthcare professionals from a NICU, comprising attending physicians, residents, nurses, and respiratory therapists. Data collection involved video recordings of daily ward rounds, field observations, and reflexive interviews where participants reviewed video clips of their interactions. Thematic analysis was conducted on the transcripts of video recordings and interview. Results: Thematic analysis revealed seven key themes in CCR: information sharing, active verbal and behavioral information gathering, information processing and recall, modification and discussion, short-term indications, and management plans and goals. Information sharing was fundamental, with team members frequently exchanging patient data to ensure a common understanding. Active information gathering, both verbal and behavioral, was crucial for obtaining real-time patient insights. Cognitive processing involved synthesizing data to form initial hypotheses, while modification and discussion highlighted the iterative nature of CCR. Conclusions: This study underscores the importance of effective communication, active information gathering, and iterative discussions in enhancing CCR. VRE proved to be a valuable tool for promoting self-awareness and continuous improvement among healthcare teams. The findings suggest that education programs should focus on developing teamwork and communication skills, and interventions should aim to optimize information flow and foster a culture of open communication. By enhancing CCR, healthcare teams can improve patient outcomes and ensure safer healthcare delivery. Clinical trial number: Not required, as this is not a clinical trial and does not involve any healthcare interventions with human participants. [ABSTRACT FROM AUTHOR]

Background: Rapid progression of symptoms and development of Acute Respiratory Distress Syndrome (ARDS) frequently occurred during COVID-19 pandemic, while CT-Scan was useful to assess severity of lung damage, with classic patterns like early Ground Glass Opacity and/or late consolidation. Likewise, lung injury has been related to activation of the coagulation-fibrinolysis systems and pro-inflammatory mediators; where D-Dimer acquires prognostic relevance. The present study aimed to evaluate whether the extent of lung involvement and pattern of lung injury, as determined by chest CT-scan, are related with D-Dimer; and further impact clinical prognosis in patients with ARDS due to COVID-19. Methods: Longitudinal, prospective, observational, multi-center study. Patients diagnosed with ARDS due to COVID-19, without previous lung damage, clotting disorder and/or anticoagulants use, who were attended at the Intensive Care Unit and Internal Medicine Department from March to June 2020. Tomographic extent of lung involvement was analyzed by image software, as well as damage patterns, assessed by experienced radiologists. Endpoints included relation of lung injury with coagulopathy markers like D-Dimer, and prognostic outcome including mortality, mechanical ventilation and hospitalization time. Results: One-hundred and four patients mean aged 55 years old, 66% males, main comorbidities obesity, hypertension and diabetes mellitus. Larger lung damage was associated with older age, male gender and higher pro-inflammatory mediators like leukocytes and ferritin; whilst consolidation pattern was related to higher Body Mass Index. Higher values of D-Dimer were related either to a larger extent of lung involvement or late consolidation pattern. In addition, the extent of lung involvement was related with longer hospital stay, higher requirement of mechanical ventilation (HR 0.12, p < 0.01) and mortality rate (HR 0.13, p < 0.01); whereas late consolidation was mainly associated with requirement of mechanical ventilation (HR 0.23, p < 0.01). Conclusion: Tomographic extent of lung involvement and the pattern of lung injury are related with coagulopathy severity markers like D-Dimer, and own prognostic clinical ability in ARDS. [ABSTRACT FROM AUTHOR]

Background: Increasing life expectancy has led to a rise in hip fractures and an associated increase in hemiarthroplasty procedures aimed at restoring mobility and preventing muscle loss. Despite the extensive literature on failed hemiarthroplasty, limited data address the influence of pre-operative fracture types—intracapsular versus extracapsular—on outcomes, including inpatient mortality. This study investigates the revisions of uncemented bipolar hemiarthroplasties concerning fracture type and identifies risk factors for inpatient mortality. Methods: This retrospective cohort study included 68 patients (16 males and 52 females) who underwent revision of uncemented bipolar hemiarthroplasties at a single institution between 2017 and 2024. Data on demographics, comorbidities, fracture type, surgical details and outcomes were analysed. Statistical analyses included t tests, chi-square tests and logistic regression, with significance set at p < 0.05. Results: Of 1,690 hemiarthroplasties performed, 68 required revision (revision rate: 4%). Revisions for extracapsular fractures were associated with a higher prevalence of diabetes mellitus (p = 0.01) and elevated Almelo Hip Fracture Score (AHFS; p = 0.01). The overall inpatient mortality rate was 19%, significantly higher in males (43.75%) than females (11.54%; p = 0.00). Deceased patients demonstrated higher AHFS and American Society of Anaesthesiologists scores but lower Parker Mobility Scores (p = 0.01). Prolonged intensive care unit (ICU) stays were also linked to increased mortality (p = 0.02). Logistic regression identified male sex as an independent predictor of mortality (odds ratio: 9.37; p < 0.05). Conclusions: Pre-operative fracture type significantly influences revision outcomes in failed hemiarthroplasties. Moreover, extracapsular fractures are linked to diabetes mellitus and higher AHFS, whereas male sex, ICU stay duration and comorbidity scores predict inpatient mortality. These findings highlight the need for tailored perioperative care to mitigate risks. Trial registration: Not applicable. [ABSTRACT FROM AUTHOR]

Background: Streptococcus pneumoniae infections continue to pose significant health risks, particularly in adults with underlying conditions. This study assesses both demographic and clinical profiles of adult patients with invasive and non-invasive pneumococcal diseases, focusing on their vaccination status and outcomes. Methods: We retrospectively analyzed clinical data from 217 adults diagnosed with pneumococcal infections at Eskişehir Osmangazi University Faculty of Medicine, a tertiary-care university hospital in Eskişehir, Türkiye, from January 2016 to November 2023. Cases meeting specific clinical and microbiological criteria were included. Logistic regression was utilized to identify key predictors of mortality. Results: Of the 217 patients initially screened, 155 were included in the final analysis, comprising 75 cases of invasive and 80 cases of non-invasive disease. Notably, among those recommended for pneumococcal vaccination, only 20.6% were vaccinated, and strikingly, only 9% were vaccinated before infection. Significant correlations were observed between mortality and various factors, including age, comorbidities, bacteremia, invasive disease, and intensive care unit admissions. Mortality occurred in 39 (25.2%) of the patients, with notably higher risks among those with comorbidities and requiring intensive care. Conclusion: Pneumococcal infections continue to impose a significant health burden, particularly among older adults and those with pre-existing conditions. Our findings highlight the critical role of comorbidities and intensive care unit admissions in affecting patient outcomes, stressing the importance of timely interventions and enhanced health strategies to improve vaccination rates and overall outcomes in high-risk populations. [ABSTRACT FROM AUTHOR]

Introduction: Cunninghamella elegans infections cause rare and severe mucormycosis. Bordetella bronchiseptica and Pneumocystis jirovecii relate to pneumonia. They are all clinically uncommon pathogens and no reports of co-infections have been reported. Case presentation: Here we present a case of a 67-year-old male patient who initially presented with fever, chills, and mild cough. B. bronchiseptica, P. jirovecii, Aspergillus fumigatus, and human alphaherpesvirus 1 (HSV1) were detected by clinical metagenomic next-generation sequencing (mNGS) of his bronchoalveolar lavage fluid (BLAF). Despite receiving anti-infective treatment, the patient rapidly developed respiratory failure and was transferred to the intensive care unit. Subsequent mNGS testing further revealed the presence of C. elegans, indicating that different pathogens played dominant roles at various stages of the disease progression. The routine culture also identified several of the above pathogens, but the results were reported much later than those of mNGS. Eventually, imaging findings and symptoms of the patient improved with comprehensive antibiotic coverage, and he was transferred to a lower-level hospital for rehabilitation treatment. Conclusions: This is the first detailed report of the combined infection of B. bronchiseptica, P. jirovecii, and C. elegans. During the treatment process, we also observed rare and unusual neurological side effects: visual and auditory hallucinations, restlessness, and aphasia. Also, the case indicates that traditional methods are insufficient for the etiological diagnosis needs of critical and severe patient populations, and timely use of mNGS should be recommended. [ABSTRACT FROM AUTHOR]

Background: Recent advancements in the management of pediatric liver trauma have highlighted the effectiveness of non-operative management as the preferred therapeutic approach. This report presents the case of an 8-year-old patient who sustained significant liver trauma from a substantial fall, successfully managed through non-operative management. Case presentation: An 8-year-old Iranian child presented with a Grade IV liver laceration and contusion, pneumothorax, and rib fractures after a 1.5 m fall. Initial stable vitals were confirmed. Diagnostic evaluations included serial focused assessment with sonography for trauma scans and computed tomography imaging of the thorax, abdomen, and pelvis. Treatment involved intensive care unit monitoring, intravenous fluid therapy, and a chest tube insertion. The patient's condition improved significantly after 6 days in the intensive care unit, demonstrating the efficacy of non-operative management. The patient was successfully discharged following conservative management. Written informed consent was obtained from the patient's legal guardian for publication of this case report and any accompanying images. Conclusions: This case highlights the effectiveness of non-operative management in managing high-grade liver injuries. Over the past 2 decades, non-operative management has become increasingly prevalent, particularly in urban healthcare settings, due to its ability to manage hepatic trauma without surgical risks. Advanced imaging and multidisciplinary approaches are critical to its success. [ABSTRACT FROM AUTHOR]

Background: There is little research on long-term, patient-centered outcomes in critically ill patients undergoing tracheostomy for secretion management or prolonged ventilation. The goal of this study was to determine and compare hospital and long-term mortality, and incidence of new institutionalization amongst patients who underwent an ICU tracheostomy for these two aforementioned indications. Methods: This was a single center historic cohort study of all ICU patients who received a tracheostomy for secretion management or prolonged ventilation from 2011 to 2022. We compared hospital and long-term mortality and incidence of new institutionalization between these two groups. Results: A cohort of 247 patients (133 secretion management, 114 prolonged ventilation) was established. Overall hospital mortality was 86/247 (35%), mortality at 1 year was 106/207 (51%), and at 3 years was 117/167 (70%), with no significant difference between the two indications. Patients with prolonged ventilation indication had a significantly higher ICU mortality [34/114 (30%) vs. 13/133 (10%), P < 0.001]. Amongst hospital survivors, 49/137 (36%) were unable to return home, with significantly more patients tracheostomized for secretion management requiring new institutionalization [37/78 (47%) vs. 12/59 (20%), P = 0.002]. Conclusions: Tracheostomy indication may be an important determinant of short- and long-term patient-centered outcomes. Patients receiving a tracheostomy for secretion management were twice as likely to be discharged to a new institution compared to prolonged ventilation patients. Patient-centered outcomes should be included in future studies and if confirmed, these outcomes should be incorporated into discussions about tracheostomy decision making. [ABSTRACT FROM AUTHOR]

Background: Making appropriate end-of-life decisions in the intensive care unit (ICU) requires shared interprofessional decision-making. Thus, a decision-making climate that values the contributions of all team members, addresses diverse opinions and seeks consensus among team members is necessary. Little is known about religion's influence on ethical decision-making climates. Therefore, this study aimed to examine the association between religious belief and ethical decision-making climates. Methods: The study was a cross-sectional analytical observation study as a part of the prospective observational DISPROPRICUS study. A total of 2,275 nurses and 717 physicians from 68 ICUs representing 12 countries in Europe and the US participated. All participants were asked which religion (if any) they belonged to and how important their religion (if any) was for their professional attitude towards end-of-life care. Perceptions of ethical decision-making climates were evaluated using a validated, 35-item self-assessment questionnaire that evaluates seven factors. Using cluster analysis, ICUs were categorised into four ethical decision-making climates: good, average (with nurses' involvement at the end of life), average (without nurses' involvement at the end of life) and poor. Results: Of the 2,992 participants, 453 (15%) were religious (had religious convictions and found them important or very important for their attitude towards end-of-life care). The remaining 2,539 were non-religious (i.e. had religious convictions but assessed that they were not important for their attitude towards end-of-life care). When adjusting for country and ICU, the overall perception of the four ethical climates was associated with religious beliefs, with non-religious healthcare providers having more positive perceptions of the ethical climates compared to religious healthcare providers (p < 0.01). Within good climates, non-religious healthcare providers rated leadership by physicians (p < 0.01), interdisciplinary reflection (p = 0.049) and active decision-making by physicians (p = 0.02) as more positive compared to religious participants. In poor climates, religious healthcare providers had a more positive perception of the active involvement of nurses (p = 0.01). Within the other climates, no differences were found. Conclusions: Overall perceptions of ethical decision-making climates were associated with religious beliefs, with non-religious healthcare providers generally having a more positive perception of the ethical climates than religious healthcare providers. [ABSTRACT FROM AUTHOR]

Background: Patient-ventilator asynchrony (PVA) can result in ventilator-induced lung injury (VILI), prolong mechanical ventilation, and ventilator withdrawal failure. The ability of healthcare providers in China to recognize patient-ventilator asynchrony is unknown. The aim of our study was to evaluate the ability and potential influencing factors to correctly identify patient-ventilator triggering asynchrony in tertiary hospitals in China. Methods: This was an observational study carried out in 53 tertiary hospitals in China. A total of 191 healthcare providers were asked to finish entry test and evaluation test sequentially. Entry test identified qualified professionals by matching concepts with its corresponding interpretations. Evaluation test assessed the ability in recognizing patient-ventilator asynchrony waveforms by matching asynchrony waveforms with corresponding concepts. A total of 109 qualified professionals were identified. Further analysis based on professional title, role in critical care team, years of experience in managing invasive mechanical ventilation, number of published articles in the field of clinical critical respiratory medicine and training in respiratory waveform/respiratory mechanics was carried out among qualified professionals. A self-innovate Remote-VentlateView platform was used to discriminate the patient-ventilator triggering asynchrony. Results: Among 109 qualified professionals, the average recognition accuracy was 3.45 out of 8 sets. Inconsistency of concept cognition and waveform recognition of patient-ventilator asynchrony was found among all types of asynchronies. The accuracy of the trained professionals was greater than that of the nontrained professionals for ineffective trigger [76.7% vs. 59.2% (p = 0.009)], auto-trigger [26.7% vs. 12.2% (p = 0.014)] and reverse triggers [30.8% vs. 12.2% (p = 0.002)]. Professionals who published more than 2 articles in the field of critical respiratory performed better on auto-triggers [41.7% vs. 15.9% (p = 0.001)] and reverse triggers [38.9% vs. 19.2% (p = 0.018)]. Neither experience in managing invasive mechanical ventilation nor professional title was associated with the ability of healthcare providers to identify asynchrony. Conclusions: Receiving training in mechanical ventilation and conducting critical respiratory clinical research may increase healthcare providers' ability to identify patient-ventilator asynchrony by using waveform analysis. The Remote-VentlateView platform may assist in identifying patient-ventilator asynchronies. [ABSTRACT FROM AUTHOR]

Background: Acute kidney injury (AKI) is defined by a sharp decrease in the estimated glomerular filtration rate (eGFR). However, the impact of medication history on the survival of AKI patients has received little attention. Hence, it is necessary to investigate the potential of medication history as a predictor of survival outcomes among AKI patients in the intensive care unit (ICU). Methods: Critically ill AKI patients were sourced from the MIMIC-IV database. To ascertain significant, drug-related, independent predictors of survival, univariate Cox analysis and stepwise Cox regression were performed. Based on the identified predictor, a nomogram was developed to estimate the individualized survival probability for AKI patients. Additionally, to address potential confounders among patients with medications referenced in the nomogram, a propensity score matching procedure was applied. Ultimately, a comparative analysis was performed to elucidate the prognostic disparities among these patient subgroups. Results: This study enrolled 1,208 patients and developed a nomogram incorporating oxygen flow rate, respiratory frequency, continuous venovenous hemodiafiltration status, age, and medication use (including ibuprofen, epinephrine, cefazolin, warfarin, and vasopressin). The predictive model demonstrated diagnostic accuracy, with AUC values for 1-year, 3-year, and 5-year survival among AKI patients of 0.827, 0.799, and 0.777 in the training dataset, and 0.760, 0.743, and 0.740 in the internal validation dataset, respectively. Kaplan–Meier survival analyses revealed significant differences in survival outcomes among AKI patients based on their exposure to different medications. Conclusions: In summary, the developed prediction model demonstrated accuracy for AKI patients in the ICU and helped clinical decision-making. However, future studies will require external validation to confirm these findings. [ABSTRACT FROM AUTHOR]

Background: Hemorrhagic stroke is a potentially fatal condition with high mortality and morbidity. However, there is a lack of evidence for this relationship in critically ill patients with hemorrhagic stroke. This study aims to explore the relationship between hypomagnesemia and ICU mortality in severe hemorrhagic stroke patients. Methods: The study included 2,026 severe hemorrhagic stroke patients from the Electronic Intensive Care Unit Collaborative Study database, categorized into hypomagnesemia and non-hypomagnesemia groups based on serum magnesium levels. Primary outcome was ICU mortality. Secondary outcome was mechanical ventilation use. Multivariate Cox proportional hazards regression analyses were used to study the relationship between hypomagnesemia and the outcomes. We also performed a cumulative survival rate analysis by Kaplan–Meier curves. Results: A total of 2,026 severe hemorrhagic stroke patients, aged over 16 and hospitalized in the ICU for more than 24 h, were enrolled. Among them, 277 (13.7%) died in the ICU, and hypomagnesemia was observed in 489 patients. Multivariable Cox regression analyses demonstrated that hypomagnesemia was related to a 28% increased risk of ICU mortality (HR 1.28, 95% CI [1.02–1.68], p = 0.035) and a 15% increased risk of mechanical ventilation use (HR 1.15, 95% CI [1.04—1.33], p = 0.010) in severe hemorrhagic stroke patients. Conclusions: Our findings suggested that hypomagnesemia is associated with increased risks of ICU mortality and mechanical ventilation use in severe hemorrhagic stroke patients. Future randomized, prospective studies are needed to elucidate the role of hypomagnesemia and explore potential interventions. [ABSTRACT FROM AUTHOR]

Objectives: To determine whether perioperative administration of dexmedetomidine reduces the incidence of postoperative delirium in adult patients undergoing cardiac surgery. Methods: We searched the PubMed, Embase and Cochrane Library databases for randomized controlled trials from the last 10 years up to March 10, 2024. We then conducted a meta-analysis to evaluate the effectiveness and safety of dexmedetomidine in preventing delirium after cardiac surgery in adults. This meta-analysis followed the steps in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA2020) guidelines. This study is registered with INPLASY under number INPLASY202430132. Results: A total of 2689 patients were included in our analyses. All included studies were randomized controlled trials. Dexmedetomidine can reduce the occurrence of delirium in patients after cardiac surgery(OR 0.75, 95%CI 0.57–0.98, I2 = 12%, P = 0.04). In terms of other end events, length of intensive care unit(ICU) stay(MD -0.16, 95%CI -1.85-1.53, I2 = 0%, P = 0.85) and mortality(OR 1.59, 95%CI 0.74–3.42, I2 = 0%, P = 0.23) were not statistically different with dexmedetomidine compared with placebo. Bradycardia (OR 0.85, 95%CI 0.54 ~ 1.34, I2 = 72%, P = 0.49) and hypotension (OR 1.97, 95%CI 0.96 ~ 4.03, I2 = 84%, P = 0.06) were not significantly different between the two groups. Conclusions: Dexmedetomidine is safe for cardiac surgery patients and to some extent reduces the incidence of delirium in cardiac surgery patients, which is more important in preoperative use. [ABSTRACT FROM AUTHOR]

Background: In the intensive care unit (ICU), invasive aspergillosis (IA) has a poor prognosis. Some studies report a positive association between diabetes mellitus (DM) and IA in critically ill patients, but the relationship between DM and IA in the ICU remains controversial. We aimed to clarify the relationship between DM and IA among patients in the ICU in a systematic review and meta-analysis. Methods: We retrieved all reports published in PubMed, EMBASE, and the Cochrane Library databases before July 12, 2023. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) to evaluate the relationship between DM and IA. Subgroup analyses were conducted to further analyze sources of heterogeneity. Heterogeneity was evaluated using the Cochran's Q test and I2 statistic. Additionally, we evaluated publication bias using funnel plots, Egger's test, and Begg's test. Finally, sensitivity analysis was conducted to evaluate the robustness of the results. Results: Twenty studies with 6155 participants were included in this meta-analysis. We found a positive association between DM and IA among patients in the ICU (OR = 1.18, 95% CI:1.01 to 1.39; p = 0.04). The heterogeneity was not significant (I² = 5%; p = 0.39) and publication bias was not significant (Egger's test: p = 0.654; Begg's test: p = 0.417). The results of sensitivity analysis supported a stable association between DM and IA. Subgroup analysis indicated that patients' comorbidities might be a potential source of heterogeneity. Additionally, patients with DM had a significantly higher risk of COVID-19-associated pulmonary aspergillosis (CAPA) than those without DM (OR = 1.40, 95% CI: 1.15 to 1.70; p < 0.001). The heterogeneity was not significant (I² = 0%; p = 0.91). In the subgroup with influenza, the OR of the relationship between DM and IA was 0.81 (95% CI: 0.54, 1.23; p = 0.32; heterogeneity: p = 0.36; I² = 8%). Conclusions: Patients with DM in the ICU showed a higher risk of developing IA than patients in the ICU without DM. DM was a significant risk factor for IA, with the highest risk observed in critically ill patients diagnosed with CAPA. [ABSTRACT FROM AUTHOR]

Background: Families of critically ill patients in the intensive care unit (ICU) need a variety of information about the patient. Meeting these information needs improves the quality of communication between the family and ICU staff, as well as reduces the risk of post-intensive care syndrome-family (PICS-F). However, information needs continue to be unmet, and information regarding which specific information needs are met or unmet is insufficient. Additionally, the unmet needs that affect PICS-F are unknown. Therefore, this study aims to identify the unmet information needs of families of patients admitted to the ICU in terms of communication with ICU staff and determine their association with PICS-F. Methods: This study will be a single-center cross-sectional study using a questionnaire survey. The participants will include family members of patients admitted to the emergency ICU of the Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital in Japan. Eligibility for participation will be assessed from medical records, and family members of patients who meet the eligibility criteria will be identified and sent a questionnaire. PICS-F and unmet information needs will be assessed 1 to 12 months after patients leave the ICU. PICS-F assessment will include the evaluation of anxiety, depression, post-traumatic stress disorder, and prolonged grief disorder. Univariate and multiple logistic regression analyses will be used to examine the association between PICS-F and unmet information needs. Discussion: This study will fill a research gap in communication between ICU staff and families of ICU patients by examining the information that tends not to be provided or understood by families, thereby providing an understanding of the information that is likely to be an unmet information need. Additionally, this study can contribute to the development of future communication strategies by investigating which unmet information needs are associated with PICS-F risk, thus emphasizing the information needs that should be given priority when developing effective communication strategies. Trial registration: University Hospital Medical Information Network Center Clinical Trials Registry UMIN 000053813. [ABSTRACT FROM AUTHOR]

Background: Patients at need for ventilation often are at risk of acute respiratory distress syndrome (ARDS). Although lung-protective ventilation strategies, including low driving pressure settings, are well known to improve outcomes, clinical practice often diverges from these strategies. A clinical decision support (CDS) system can improve adherence to current guidelines; moreover, the potential of a CDS to enhance adherence can possibly be further increased by combination with a nudge type intervention. Methods: A prospective cohort trial was conducted in patients at risk of ARDS admitted to an intensive care unit (ICU). Patients were assigned to control or intervention by their date of admission: First, the control group was included without changing anything in clinical practice. Next, the CDS was activated showing an alert in the patient data management system if driving pressure exceeded recommended values; additionally, data on the performance of the wards were sent to the healthcare professionals as the nudge intervention. The main hypothesis was that this combined intervention would lead to a significant decrease in excess driving pressure. Results: The 472 included patients (230 in the control group and 242 in the intervention group) consisted of 33% females. The median age was 64 years; median Sequential Organ Failure Assessment score was 8. There was a significant reduction in excess driving pressure in the augmented ventilation modes (0.28 ± 0.67 mbar vs. 0.14 ± 0.45 mbar, p = 0.012) but not the controlled mode (0.37 ± 0.83 mbar vs. 0.32 ± 0.8 mbar, p = 0.53). However, there was no significant difference between groups in mechanical power, the number of ventilator-free days, or the percentage of patients showing progression to ARDS. Although there was no difference in progression to ARDS, 28-day mortality was higher in the intervention group. Notably, the mean overall driving pressure across both groups was low (12.02 mbar ± 2.77). Conclusions: In a population at risk of ARDS, a combined intervention of a clinical decision support system and a nudge intervention was shown to reduce the excessive driving pressure above 15 mbar in augmented but not in controlled modes of ventilation. [ABSTRACT FROM AUTHOR]

Background: Teamwork is a core competence for all health care professionals and quality of care is a vital outcome. The pandemic backdrop of 2020–2022 led to initial chaos and adaptation of the nurses’ roles and responsibilities in the intensive care unit. Therefore, the purpose was to describe the intensive care nurses’ experiences of working in teams during the Covid-19 pandemic and discussing the results through the lens of transitiontheory. Methods: Individual and semi-structured interviews were conducted with 16 intensive care nurses. The interview transcripts were analysed using Braun & Clarke’s six-step inductive thematic analysis. Results: The intensive and critical care nurses’ experiences during the first 18 months of the Covid-19 pandemic captured chronological and conceptual commonalities, which were represented in three themes, “Losing the security of the ICU team”, “Having time to adapt and finding structure for collaborative work”, and “Gaining professional growth through adapting collaborative work to contextual challenges”. Conclusion: Losing the security of the intensive care unit team, having to adapt to constant changes, and the need to provide care to an increased number of critically ill patients led to a sense of being left to manage on their own. The intensive care unit nurses missed the interprofessional collaboration that had previously been a core part of their professional role. The adaptability and willingness to find solutions helped nurses regain control, manage the challenges they faced and find new ways to collaborate. Clinical trial number: Not applicable. [ABSTRACT FROM AUTHOR]

Objective: Early diagnosis of intensive care unit-acquired weakness (ICUAW) is crucial for improving the outcomes of critically ill patients. Hence, this study was designed to identify predisposing factors for ICUAW and establish a predictive model for the early diagnosis of ICUAW. Methods: This prospective observational multicenter study included septic patients from the comprehensive ICUs of West China Hospital of Sichuan University and 10 other hospitals between September and November 2023. Inclusion criteria were as follows: age over 18 years; expected ICU stay longer than 3 days; and voluntary informed consent. Patients were classified into ICUAW (MRC score < 48) and non-ICUAW (MRC score ≥ 48) groups based on muscle strength assessments. The analyzed key predictive factors encompassed demographic data, SOFA and APACHE II scores, inflammatory markers (PCT, IL-6, and CRP), and ultrasound measurements of muscle thickness and cross-sectional area. Logistic regression analysis was conducted for variable selection and nomogram model construction. Results: A total of 116 septic patients were included, comprising 77 males and 39 females (mean age: 56.94 ± 19.90 years). A nomogram model predicting ICUAW probability was developed, which involved vastus intermedius diameter, rectus femoris cross-sectional area, IL-6, and CRP. The AUC of the composite diagnostic ROC curve was 0.966 (95%CI: 0.936 − 0.996), with a sensitivity of 88% and a specificity of 95.8%. Conclusions: Conclusively, a nomogram model is constructed for diagnosing ICUAW in septic patients, which is simple and rapid and allows for visual representation, with excellent diagnostic capability. [ABSTRACT FROM AUTHOR]

Introduction: : Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is commonly used for diagnosing mediastinal lymphadenopathy. Despite a low complication rate, severe hemorrhage can occur which is reported in this literature, particularly in hypervascular conditions like Castleman disease. Methods: A 54-year-old male with idiopathic multicentric Castleman disease underwent EBUS-TBNA for mediastinal lymph node sampling. During the procedure, vascular invasion led to significant bleeding, requiring immediate interventions including suctioning and therapeutic bronchoscopy. Results: The patient experienced massive hemorrhage, resulting in airway obstruction, oxygen desaturation, and cardiac arrest. Aggressive resuscitation successfully restored cardiac rhythm after 15 min. The patient was then stabilized and transferred to the intensive care unit for monitoring. Conclusions: This case underscores the risk of severe hemorrhage in hypervascular conditions during EBUS-TBNA. Pre-procedural imaging, careful planning, and immediate availability of hemostatic measures are crucial to reducing complications and improving outcomes in high-risk patients. [ABSTRACT FROM AUTHOR]

Background: Incentive spirometer is used in lung expansion therapy to maintain alveolar patency and improve pulmonary volumes in postoperative cardiac surgical patients. Deep breathing exercises with an incentive spirometer significantly reduce the development of postoperative pulmonary complications after open-heart cardiac surgery. Aim: To determine the effect of deep breathing exercises with an incentive spirometer initiated in the preoperative period on respiratory parameters and complications in patients who underwent open-heart surgery. Methods: This randomized controlled study was conducted with a total of 66 participants. The participants were randomized into a deep breathing group (n = 32) and a control group (n = 34). The control group received hospital routine physiotherapy, and the deep breathing group started to perform deep breathing exercises with an incentive spirometer in the preoperative period. Data were collected with the Sociodemographic and Medical Data Form and Patient Follow-up Form (respiratory rate, oxygen saturation (SpO2) level, arterial blood gas parameters and posteroanterior chest X-ray were monitored with this form prepared by the investigators). The Medical Research Council Scale was used to determine the severity of dyspnea in the patients included in the study. Primary outcomes included respiratory rate, oxygen saturation, arterial blood gas parameters, posteroanterior chest X-ray, and evaluation of postoperative pulmonary complications development. Secondary outcomes included the mechanical ventilation time, length of intensive care unit stay, and length of hospital stay. Results: The incidence of postoperative pulmonary complications was 3.1% and 23.5% (p < 0.05) in the deep breathing and control groups, respectively. The mechanical ventilation time, length of hospital stay, and length of stay in the intensive care unit were significantly shorter in the deep breathing group (p < 0.05). In the deep breathing group, the mean SpO2 values evaluated before surgery, on the first day in the Cardiovascular Surgery Unit, and on the day of discharge were significantly higher than the control group (p < 0.05). Conclusion: Deep breathing exercises with an incentive spirometer initiated in the preoperative period contribute to a reduction in postoperative pulmonary complication rates, shortening of mechanical ventilation time, length of stay in the intensive care unit, length of hospital stay, and improvement of pre- and postoperative oxygenation. Trial registration: The trial was registered on June 17, 2022, at https://www.clinicaltrials.gov/, registration number NCT05428722. [ABSTRACT FROM AUTHOR]

Background: In recent months, Bordetella pertussis has reappeared after maintaining a low rate for many years. Although pertussis is usually characterized by a favorable course, several factors can contribute to the severity of the disease, such as mixed respiratory infections. In this study, we evaluate B.pertussis cases observed in the pediatric population followed at the Bambino Gesù Children's Hospital and analyzed the potential impact of co-infections in relation to disease severity. Methods: From January to May 2024, a total of 1,151 children and adolescents (both inpatients and outpatients) were screened for the presence of respiratory pathogens, including B.pertussis, with clinically relevant respiratory symptoms. Results: Among the 1,151 patients screened, 66 tested positive for B.pertussis. Fourteen patients had respiratory failure, and six of them required intensive care unit (ICU) admission, while 52 had mild infection. 23.3% of patients had B.pertussis alone, while 76.7% had co-infections (including 5 patients admitted to the ICU). A higher co-infection rate was observed in patients with respiratory failure than in those without failure (92.9% vs. 69.0%, p-value:0.041). Rhinovirus, Metapneumovirus and Parainfluenza-virus were the most prevalent in our pediatric population. Co-infections of human bocavirus with B.pertussis were observed exclusively in patients with respiratory failure. Conclusions: Our results highlighted an increase in B.pertussis cases from January to May 2024, reaching a peak of cases in the month of May. This study shows a high rate of B.pertussis co-infection, and a trend toward association between B.pertussis and specific viruses, that might play a role in increasing disease severity. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to identify the risk factors of severe orofacial and neck infections and the factors that could prevent them and reduce their severity. Methods: A three-year prospective observational study was conducted from 8.15.2016 to 8.31.2019 at a tertiary care hospital. 94 patients participated the study. The criteria for inclusion in the study were that the patients were adults with neck and severe orofacial infections that required treatment in hospital. Patients under the age of 18 and patients who did not consent to participate in the study were excluded. The responses to the questionnaire designed for this study were collected, as was supplemental data from medical records. The patient data were analyzed. Length of stay (LOS), intensive care unit (ICU) stay, complications and mortality were used as the main outcome variables, and various pre-admission factors and clinical and laboratory parameters were used as the predictor variables. The method used was univariate analysis. Results: In 79 (84.0%) cases, surgery confirmed an abscess and pus. Age (p = 0.001) and underlying diseases (p = 0.024) contributed to complications. Bulging of the lateral pharyngeal wall or laryngeal swelling on admission was significantly related to the need for intensive care treatment (p < 0.001). The spaces most often involved were the submandibular (n = 15; 16.0%), sublingual (n = 15; 16.0%) and parapharyngeal (n = 14; 14.9%) spaces. Sixty-three cases (67.0%) were of odontogenic origin, and 58.5% of the patients reported having attended previous health care appointments due to an acute dental problem. The patients with odontogenic infections had poor oral hygiene and most likely did not brush their teeth daily (p = 0.029). "Dishwater" pus was associated with longer hospitalization (p < 0.001), intensive care treatment (p < 0.001), and surgical revisions (p < 0.001). One lethal outcome (1.1%) was reported. Conclusion: Age and underlying illnesses should be considered complicating factors, and lateral pharyngeal or laryngeal edema should be considered risk factors for ICU treatment. This study also emphasized the preventive role of good dental hygiene and the importance of patients' follow-up treatment after acute dental interventions. [ABSTRACT FROM AUTHOR]

Background: This study aimed to explore the association between the stress hyperglycemia ratio (SHR) and short- and long-term outcomes in critically ill patients with sepsis. Methods: This retrospective observational cohort study was conducted using the Medical Information Mart for Intensive Care-IV (MIMIC-IV v2.2) database. Patients were categorized into 4 SHR quartiles. The main focus was on in-hospital mortality and 1-year all-cause mortality as primary endpoints, while intensive care unit and hospital stays were considered as secondary outcomes. Regression and subgroup analyses were used to assess the correlation between SHR and the primary and secondary outcomes. Restricted cubic spline analysis was utilized to explore the nonlinear relationships between SHR and in-hospital and 1-year all-cause mortality. Results: This study included two groups of patients, comprising 7456 and 6564 individuals. The in-hospital and 1-year mortality was 11.96% and 17.96% in Cohort 1 and 2, respectively. SHR was associated with an elevated risk of in-hospital mortality (OR: 2.08, 95%CI 1.66–2.61) and 1-year mortality (HR: 1.70, 95% CI 1.42–2.04). Patients in SHR quartile 4 had a higher risk of in-hospital (OR: 1.86, 95% CI 1.51–2.30) and 1-year (HR: 1.44, 95% CI 1.23–1.69) mortality than those in quartile 2. Restricted cubic spline analysis showed a "J-shaped" relationship between SHR and all-cause mortality in both cohorts. The relationship between high SHR and mortality remained consistent across almost all predefined subgroups. Conclusions: Our study suggests that high SHR is associated with increased in-hospital and 1-year mortality in critically ill sepsis patients. Further investigations are needed to validate these results. [ABSTRACT FROM AUTHOR]

Background: The use of antibiotic therapy in acute pancreatitis remains controversial and is currently recommended only for confirmed infections of peripancreatic necrosis. However, reliable early predictors of septic complications and unfavorable outcomes are substantially lacking. Methods: Patients with acute pancreatitis were retrospectively reviewed and divided into two groups: one with a septic course defined by pathogen detection [GERM(+)] and one without [GERM(-)]. After propensity score matching, both groups were compared regarding clinical outcomes. Early predictors of pathogen detection were evaluated by multivariate analysis. Results: 424 patients with acute pancreatitis were included. After propensity score matching 123 GERM(-) patients were compared to 74 GERM(+) patients. GERM(+) patients demonstrated significantly worse clinical outcomes with higher rate of intensive care treatment (59.5% vs. 35.0%; p = 0.0011) and consecutive longer stay in intensive care unit (11.5 ± 25.2d vs. 3.0 ± 7.9d; p = 0.0007), longer in-hospital stay (26.8 ± 22.0d vs. 14.7 ± 15.0d; p = 0.0003) as well as worse results in the composite outcome length of in-hospital stay > 15d or death (67.6% vs. 31.7%; p < 0.0001). Prescence of ascites and elevated white blood cell count at the onset of acute pancreatitis were identified as significant predictive factors in the early disease associated with invasive infection and pathogen detection. The most frequently detected pathogens were commensals of the gastrointestinal tract, observed in 70.7% of the examined body fluids and 50.7% of the examined blood cultures. Conclusions: Detection of pathogens is associated with unfavorable clinical outcomes in acute pancreatitis. The presence of ascites and elevated white blood cell count at onset of acute pancreatitis are significant predictive factors indicating the risk of invasive infection with relevant bacterial load. Thus, an aggressive, early anti-infective strategy against pathogens of intestinal origin should be considered in these cases and may improve patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Carbapenem-Resistant Gram-Negative Bacteria, including Carbapenem-Resistant Enterobacterales (CRE) and Carbapenem-Resistant Pseudomonas aeruginosa (CRPA), are common causes of infections in intensive care units (ICUs) in Italy. Objective: This prospective observational study evaluated the epidemiology, management, microbiological characterization, and outcomes of hospital-acquired CRE or CRPA infections treated in selected ICUs in Italy. Methods: The study included patients with hospital-acquired infections due to CRE and CRPA treated in 20 ICUs from June 2021 to February 2023. The primary endpoint was the 1-year incidence of CRE/CRPA infections. Secondary endpoints included the rate of CRE/CRPA infections, mortality in ICU, infection outcome, and microbiological characterization. Results: Among 13,088 patients admitted over the 12-month study period across each of the 20 ICUs, 283 had CRE infections, and 138 had CRPA infections. The incidence of CRE and CRPA infections was 3.57 per 1000 patient days and 1.74 per 1000 patient days, respectively. The proportion of CRE and CRPA infections over the total number of infections due to Enterobacterales and Pseudomonas aeruginosa was 19.2% and 26.8%, respectively. Among 158 patients included in the full analysis, 98 (62%) had CRE infections and 60 (38%) had CRPA infections. Ventilator-associated pneumonia and bloodstream infections were the most common infections, occurring in 53.8 and 34.2% of cases. Empirical therapy targeting gram-negative pathogens resulted inappropriate in 59.2% of analysed patients (77/130). The overall crude mortality in ICU rate was 30.4%, with a higher rate in CRE patients (36.7%) than in CRPA patients (20.0%). Clinical success, including microbiological eradication, was achieved in 50.6% of cases. Klebsiella pneumoniae was observed as the predominant CRE species, and all CRE isolates, including metallo-β-lactamases-producing CRE (MBL-CRE), were susceptible to Aztreonam-Avibactam. Conclusions: These results highlight the high prevalence of CRE/CRPA infections in Italian ICUs and emphasize the need for enhanced prevention and surveillance strategies. [ABSTRACT FROM AUTHOR]

Background: Approximately 20–25% of patients who survive medical treatment at an intensive care unit (ICU) develop post-traumatic stress symptoms. There is currently a gap in follow-up care for them. As part of the PICTURE study, general practitioners (GPs) carried out a brief interview-based intervention. The aim of this sub-study is to record the most distressing memories of ICU treatment from the patient's perspective and their evaluation of a GP-based brief psychological intervention. Methods: Participants were recruited from the intervention group of the main PICTURE study using selective sampling. All of them had experienced an ICU stay with mechanical ventilation and severe organ failure in the previous two years. They were interviewed about their experience of psychological stress during their ICU stay and their retrospective evaluation of the intervention. Semi-structured, guideline-based telephone interviews were conducted for this purpose, processed, and analyzed using the structuring qualitative content analysis based on Mayring. Findings: When asked N = 8 patients about the most stressful memory of their stay at ICU, the main themes were helplessness, pain, fixation, inability to communicate and sleep disturbances. The question of amnesia regarding the stay in the ICU was answered affirmatively by half of the interviewees but was not experienced as stressful. The brief trauma-focused intervention carried out by their GPs was well received by all respondents. Conclusions: The interviewees confirm that aversive traumatizing experiences are often associated with intensive care treatment and reinforce each other. These are due to the treatment setting but should be reduced wherever possible. In view of chronification and the lack of specific follow-up treatment options for these patients and the long waiting times for psychotherapy, the implementation of low-threshold treatment options by GPs appears to be ideally suited to closing this gap in care, particularly for patients with mild to moderate symptoms of a post-traumatic stress disorder. Trial registration: The main trial was registered at ClinTrials gov (NCT03315390) and at the German Register of Clinical Trials (DRKS, DRKS00012589) on 17/10/2017. [ABSTRACT FROM AUTHOR]

Background: Delirium is a common complication in patients at the intensive care unit (ICU) and is associated with prolonged ICU-stay and hospitalization and with increased morbidity. The impact of ICU-delirium on long-term survival is not clearly understood. Methods: This retrospective single center observational study was conducted at the Institute of Intensive Care Medicine at the University Hospital Zurich, Switzerland. All adult ICU-survivors over a four-year period were screened for eligibility. ICU-delirium was defined based on the Intensive Care Delirium Screening Checklist (ICDSC), together with the coded diagnosis F05 in the International Classification of Diseases (ICD-2019). ICU-survivors who developed delirium during their ICU stay (group D) were compared with ICU-survivors who did not (group ND). Survival was evaluated according to data from hospital electronic health records up to four years from ICU-discharge. The survival analysis was reported using Kaplan-Meier curves and absolute risk differences (ARD). A multivariable logistic regression model was fitted with long-term survival at four years after ICU-discharge as outcome of interest, including several clinical conditions and interventions associated with long-term survival for ICU patients. For subgroup analysis, ICU-survivors were grouped based on age at the time of admission (45–54, 55–64, ≥ 65 years), and on relevant clinical conditions. Results: A total of 9'604 patients fulfilled the inclusion criteria, of them 22.6% (n = 2'171) developed ICU-delirium. Overall, patients in the group D had a significantly lower probability of survival than patients in the group ND (p < 0.0001, ARD = 11.8%). In the multivariable analysis, ICU-delirium was confirmed as independently associated with long-term survival. After grouping for age categories, patients between 55 and 64 years of age in the group D were less likely to survive than patients in the group ND at every time point analyzed, up to four years after ICU discharge (p < 0.001, ARD = 7.3%). This difference was even more significant in the comparison between patients over 65 years (p < 0.0001, ARD 11.1%). No significant difference was observed in the other age groups. Conclusions: In the study population, ICU-delirium was independently associated with a reduced long-term survival. Patients who developed ICU-delirium had a reduced survival up to four years after ICU discharge and this association was particularly evident in patients above 55 years of age. [ABSTRACT FROM AUTHOR]

Background: Collaborative multidisciplinary approaches in obstetrics, particularly in conjunction with Intensive Care Units (ICUs), offer innovative treatment strategies for critically ill pregnant women. This study aimed to assess pregnancy outcomes and mortality in critically ill pregnant women in the Intensive Care Unit (ICU) and to provide valuable clinical insights for improving the management of obstetric emergency care, reducing maternal and neonatal adverse outcomes, and improving the level of obstetric care. Methods: This study retrospectively included 152 critically ill pregnant women admitted to the ICU. They were grouped according to the main reason for ICU admission as well as the variety of diseases present at the time of admission. Then their clinical data were evaluated. Results: The results showed that the main obstetric factors leading to ICU admission were pregnancy-related hypertensive disease, postpartum hemorrhage, and acute fatty liver of pregnancy; the non-obstetric factors included either pregnancy complicated by heart disease, sepsis, or malignant tumors. The maternal mortality rate was higher in the non-obstetric direct factor group than in the obstetric direct factor group (22.12% vs. 6.25%, p = 0.016). As for the pregnancy outcome, the cesarean section rate in the group affected by obstetric factors was significantly higher than that in the group affected by non-obstetric factors (p = 0.008). Furthermore, the incidence of pregnancy termination and induced abortion before 28 weeks in the group affected by non-obstetric factors was significantly higher than that in the group affected by obstetric factors (all p < 0.05). There was a statistically significant difference in mortality among the three groups of patients with different SOFA scores (p = 0.000), suggesting that the mortality of critically ill pregnant women with higher SOFA scores increased, making it a valuable tool for evaluating prognosis. Conclusion: Non-obstetric factors were the primary contributors for ICU admission of expecting mothers. Therefore, utilizing modalities that successfully analyze these factors can aid in understanding the characteristics of critically ill pregnant women, and advancing perinatal healthcare technologies to reduce maternal mortality rates. [ABSTRACT FROM AUTHOR]

Background: Acute respiratory distress syndrome (ARDS) is a prevalent complication among critically ill patients, constituting around 10% of intensive care unit (ICU) admissions and mortality rates ranging from 35 to 46%. Hence, early recognition and prediction of ARDS are crucial for the timely administration of targeted treatment. However, ARDS is frequently underdiagnosed or delayed, and its heterogeneity diminishes the clinical utility of ARDS biomarkers. This study aimed to observe the incidence of ARDS among high-risk patients and develop and validate an ARDS prediction model using machine learning (ML) techniques based on clinical parameters. Methods: This prospective cohort study in China was conducted on critically ill patients to derivate and validate the prediction model. The derivation cohort, consisting of 400 patients admitted to the ICU of the Peking University Third Hospital(PUTH) between December 2020 and August 2023, was separated for training and internal validation, and an external data set of 160 patients at the FU YANG People's Hospital from August 2022 to August 2023 was employed for external validation. Least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression were used to screen predictor variables. Multiple ML classification models were integrated to analyze and identify the best models. Several evaluation indexes were used to compare the model performance, including the area under the receiver-operating-characteristic curve (AUC) and decision curve analysis (DCA). SHapley Additive ex Planations (SHAP) is used to interpret ML models. Results: 400 critically ill patients were included in the analysis, with 117 developing ARDS during follow-up. The final model included gender, Lung Injury Prediction Score (LIPS), Hepatic Disease, Shock, and combined Lung Contusion. Based on the AUC and DCA in the validation group, the logistic model demonstrated excellent performance, achieving an AUC of 0.836 (95% CI: 0.762–0.910). For external validation, comprising 160 patients, 44 of whom developed ARDS, the AUC was 0.799 (95% CI: 0.723–0.875), significantly outperforming the LIPS score alone. Conclusion: Combining the LIPS score with other clinical parameters in a logistic regression model provides a more accurate, clinically applicable, and user-friendly ARDS prediction tool than the LIPS score alone. [ABSTRACT FROM AUTHOR]

Background: Interleukin-6 (IL-6) is a cytokine that predicts clinical outcomes in critically ill patients, including those with sepsis. Elderly patients have blunted and easily dysregulated host responses to infection, which may influence IL-6 kinetics and alter the association between IL-6 levels and clinical outcomes. Methods: This retrospective observational study included patients aged ≥ 16 years who were admitted to the intensive care unit at Chiba University Hospital. The patients were categorized into two groups: non-elderly (< 70 years) and elderly (≥ 70 years). Associations between log-transformed blood IL-6 levels and 28-day in-hospital mortality (primary outcome) and multiple organ dysfunction (MOD) on days 3 and 7 (secondary outcomes) were examined. Results: The non-elderly and elderly groups included 272 and 247 patients, respectively. There were no significant differences in the Sequential Organ Failure Assessment score, components of the APACHE II score (Acute physiology score and Chronic health points), MOD at baseline, or any of the outcome measures between the groups. In the non-elderly group, univariate Cox regression analysis showed a significant association between IL-6 levels and mortality (hazard ratio [HR] 1.71, 95% confidence interval [CI] 1.25–2.37, P < 0.001). This association remained significant after adjusting for sex, body mass index, steroid use prior to sepsis onset, and number of chronic organ dysfunctions (HR 1.66, 95% CI 1.20–2.32, P = 0.002). However, no significant association was observed in the elderly group in either the univariate (P = 0.69) or multivariable analyses (P = 0.77). Multivariable logistic regression analysis of MOD on days 3 and 7 revealed significant associations between MOD and IL-6 levels in both groups. Conclusions: Blood IL-6 levels were significantly associated with mortality in non-elderly patients with sepsis, but not in elderly patients. IL-6 levels were associated with MOD in both groups. Therefore, IL-6 levels should be interpreted with caution when predicting mortality in elderly patients with sepsis. Trial registration: Not applicable. [ABSTRACT FROM AUTHOR]

Background: Patients hospitalized outside of monitored environments may experience sudden clinical worsening requiring transfer to the Intensive Care Unit. Early detection based on the clinical nurse's identification of the risk of clinical deterioration represents an opportunity to prevent serious adverse events. Nurse worry is defined as the use of clinical reasoning combined with intuition that precedes the patient's clinical deterioration. Objective: The objective of this study was to evaluate nurse worry as a trigger for rapid response team activation in patients hospitalized in non-critical units and its association with the need in ICU admission. Methods: This retrospective cohort study utilized data retrieved from an anonymized institutional database used to monitor the actions of the rapid response team. Data collected from January 2021 to December 2022 were analyzed, encompassing patients over 18 years old admitted to non-critical units and evaluated by the rapid response team. Analyzed variables included demographic characteristics, MEWS score, and causes for activating the rapid response team, such as changes in vital signs and nurse worry. Main outcomes assessed were transfer to the ICU, medical procedures, and drug administration. Patients were divided into three groups for analysis: those triggered for RRT assessment exclusively by changes in vital signs, those triggered exclusively by nurse worry and those triggered by the nurse worry combined with changes in vital signs. Results: A total of 4634 rapid response team consultations were included, with 1574 triggered by changes in vital signs, 1263 triggered by nurse worry and 1797 triggered by the nurse worry associated with changes in vital signs. The group with nurse concern showed a lower need for transfers to the ICU (40%) compared to the group with changes in vital signs (50%) p < 0.001 although there was no difference in relation to the need for medical procedures,17% in both groups. Conclusion: The NW emerges as a relevant factor in triggering RRT and may be associated with improved outcomes, such as reduced need for ICU transfers. However, the observational design of the study does not allow for establishing causal relationships. [ABSTRACT FROM AUTHOR]

Background: Complete Cytoreduction (CC) in ovarian cancer (OC) has been associated with better outcomes. Outcomes after CC have a multifactorial and interrelated cause that may not be predictable by conventional statistical methods. Artificial intelligence (AI) may be more accurate in predicting outcomes. This systematic review aimed to determine the accuracy of AI compared to traditional statistics in predicting outcomes after CC in OC. Methods: PubMed, Scopus, Google Scholar, Embase, and Web of Science databases were searched with Mesh terms to find studies that investigated the role of AI in predicting outcomes after CC in EOC from the beginning of 2015 to February 2024. The outcomes included overall survival (OS), removal of all macroscopic disease (R0), length of hospital stay (LOS), and intensive care unit (ICU) admission. This systematic review was conducted based on the PRISMA guidelines. Heterogeneity between studies was evaluated using the I2 test. Egger's test was used to check publication bias. Results: Ten studies (3460 participants) were included. The pooled estimate of 3 studies showed that the accuracy of AI for predicting OS was (Mean: 69.64%, CI 95%:66.50, 72.78%, I2:0%). The pooled estimate of 4 studies showed that the accuracy of AI for predicting R0 was (Mean: 80.5%, CI 95%:71.46, 89.6%, I2:47.9%). The use of AI in predicting outcomes, including ICU admission, urinary tract infection (UTI), and LOS was investigated in one study, and the AUC of AI for predicting all three outcomes was approximately 90%. Conclusion: AI may accurately predict the outcomes after CC in OC patients. Most studies agree that Artificial Neural Networks (ANN) and Machine Learning (ML) models outperform conventional statistics in predicting postoperative outcomes. [ABSTRACT FROM AUTHOR]

Objective: This study aims to investigate the predictive effectiveness of bedside lung ultrasound score (LUS) in conjunction with rapid shallow breathing index (RSBI) and oxygenation index (P/F ratio) for weaning pediatric patients from mechanical ventilation. Methods: This was a retrospective study. Eighty-two critically ill pediatric patients, who were admitted to the Pediatric Intensive Care Unit (PICU) and underwent mechanical ventilation from January 2023 to April 2024, were enrolled in this study. Prior to weaning, all patients underwent bedside LUS, with concurrent measurements of their RSBI and P/F ratio. Patients were followed up for weaning outcomes and categorized into successful and failed weaning groups based on these outcomes. Differences in clinical baseline data, LUS scores, RSBI and P/F ratios between the two groups were compared. The predictive value of LUS scores, RSBI and P/F ratios for weaning outcomes was assessed using receiver operating characteristic (ROC) curves and the area under the curve (AUC). Results: Out of the 82 subjects, 73 (89.02%) successfully weaned, while 9 (10.98%) failed. No statistically significant differences were observed in age, gender, BMI, and respiratory failure-related comorbidities between the successful and failed weaning groups (P > 0.05). Compared to the successful weaning group, the failed weaning group exhibited longer hospital and intubation durations, higher LUS and RSBI, and lower P/F ratios, with statistically significant differences (P < 0.05). An LUS score ≥ 15.5 was identified as the optimal cutoff for predicting weaning failure, with superior predictive power compared to RSBI and P/F ratios. The combined use of LUS, RSBI and P/F ratios for predicting weaning outcomes yielded a larger area under the curve, indicating higher predictive efficacy. Conclusion: The LUS demonstrates a high predictive value for the weaning outcomes of pediatric patients on mechanical ventilation. [ABSTRACT FROM AUTHOR]

Background and objectives: Antibody-negative autoimmune encephalitis (AE) is a form of encephalitis characterized by the absence of detectable autoimmune antibodies, despite immunological evidence. However, data on management of patients with antibody-negative AE in the intensive care unit (ICU) are limited. This study aimed to explore the characteristics and subtypes of antibody-negative AE, assess the effects of immunotherapy, and identify factors independently associated with poor functional outcomes in patients requiring intensive care. Methods: This retrospective, single-center study analyzed consecutive adult patients diagnosed with antibody-negative AE and admitted to the ICU of a large tertiary hospital between 2019 and 2023. Multivariate regression analysis was used to identify factors linked to poor functional outcomes six months after ICU admission, as defined by a modified Rankin Scale score of 3–6. Generalized linear mixed models were applied to evaluate the effect of immunotherapy on longitudinal changes in the Clinical Assessment Scale in Autoimmune Encephalitis and modified Rankin Scale scores. Results: Of the 1220 patients with severe encephalitis admitted to the ICU, 107 were diagnosed with antibody-negative AE and included in the analysis. Six months after ICU admission, 67 patients (62.6%) had poor functional outcomes, including 28 deaths (26.2%). Factors independently associated with poor outcomes were high-dose corticosteroid therapy (odds ratio [OR] 8.734, 95% confidence interval [CI] 2.483–30.717), older age at onset (OR 1.063, 95% CI 1.028–1.099), acute respiratory failure at ICU admission (OR 10.931, 95% CI 2.062–57.751), and dyskinesia/dystonia (OR 14.109, 95% CI 1.336–148.957). The generalized linear mixed model also indicated that high-dose corticosteroid therapy was associated with poorer longitudinal outcomes. Conclusions: While high-dose corticosteroids are frequently used to treat AE, their risks may outweigh their benefits in severe antibody-negative AE cases. Older patients and those with dyskinesia/dystonia or respiratory failure, may require more careful monitoring and timely intervention for improved outcomes. However, prospective validation of these findings is necessary to confirm their applicability and guide future treatment strategies. [ABSTRACT FROM AUTHOR]

Background: Intensive care unit (ICU) nurses work under heavy workloads, which can lead to serious consequences for nurses' outcomes and patient safety. This study aimed to examine the relationship between professional quality of life (Pro QOL), and sleep quality among ICU nurses during the COVID-19 outbreak. Methods: A cross-sectional and multicentre study was conducted on 253 nurses in 20 COVID-19 ICUs in four major teaching hospitals from July 2021 to June 2022. Data were collected via a demographic information form, the Professional Quality of Life Scale, and the Pittsburgh Sleep Quality Index (PSQI). Results: Nurses in COVID-19 ICUs experienced moderate levels of compassion satisfaction, compassion fatigue, and poor sleep quality. The mean scores of the Pro QOL dimensions were 33.49 ± 6.77, 32.28 ± 8.83, and 29.58 ± 11.67 for compassion satisfaction, burnout, and secondary traumatic stress, respectively. The results revealed that 220 (87%) of the nurses experienced poor sleep quality. A significant relationship was shown between the Pro QOL dimensions and the mean total score of sleep quality, which can predict 0.45% of the variance (F = 7.11, p < 0.001, adjusted R2 = 0.45). Conclusion: Our results confirmed the link between the Pro QOL and sleep quality among ICU nurses. It is suggested that nurse managers implement practical interventions to improve the QWL of nurses in the ICUS. This will subsequently lead to improved outcomes for nurses and ensure patient safety. [ABSTRACT FROM AUTHOR]

Background: Patients with sepsis in the intensive care unit (ICU) often experience rapid muscle loss. The urea-to-creatinine ratio (UCR) is thought to reflect muscle breakdown (creatinine) and catabolism (urea) and is commonly used to assess nutritional and metabolic status. This study aimed to investigate whether changes in UCR (ΔUCR) can predict the development of rapid muscle loss in patients with sepsis. Methods: This retrospective observational study was conducted in a university ICU between 2014 and 2021, involving adult patients (≥ 18 years) diagnosed with sepsis. The primary outcome was the incidence of rapid muscle loss during ICU hospitalization. Changes in the cross-sectional muscle area at the third lumbar vertebra (L3SMA) were measured using CT images to evaluate muscle loss. Rapid muscle loss was defined as a change in ΔL3SMA greater than 2% per day. Multivariable logistic regression was used to examine the association between UCR or ΔUCR and rapid muscle loss. The area under the receiver operating characteristic curve (AUC) was calculated to assess the predictive performance of UCR or ΔUCR for rapid muscle loss. Results: Of the 482 patients, 141 (29.2%) experienced rapid muscle loss during their ICU stay. Multivariable logistic regression analysis revealed that ΔUCR was significantly associated with an increased risk of rapid muscle loss, with an odds ratio (OR) of 1.02 [95% CI: 1.01, 1.02]. The AUC for ΔUCR in predicting rapid muscle loss was 0.76 [95% CI: 0.68–0.83], with a threshold value of 19.4 µmol urea/µmol creatinine for ΔUCR. Conclusion: The results demonstrate that ΔUCR is independently associated with rapid muscle loss in patients with sepsis and the AUC of the ROC curve for the ability of ΔUCR to predict rapid muscle loss was 0.76. Though additional prospective data are needed, our results suggest that ΔUCR may be useful in the early identification of critically ill patients with sepsis at risk of rapid muscle loss. [ABSTRACT FROM AUTHOR]

Background and aim: Removing the chest tube in cardiac patients after surgery is one of the worst experiences of hospitalization in the intensive care units. Various pharmacological and non-pharmacological methods are available to control pain in these patients. This study aimed to investigate the combined effect of reflexology massage and respiratory relaxation on pain following chest tube removal in cardiac surgery patients of Shahid Beheshti Hospital in Shiraz, Iran, in 2023. Methods: This was a double-blind randomized clinical trial performed on 140 patients who underwent heart surgery and had a chest tube in Shiraz, Iran. The samples were randomly divided into four groups: 1- control group, 2- respiratory relaxation group, 3- foot reflex massage group, and 4- a combination of respiratory relaxation and reflexology massage. To collect data, two demographic questionnaires, and a visual analog scale were used. Results: The participants of the four groups were not meaningfully different in terms of age, BMI, duration of surgical operation, gender, job, education, place of residency, number of chest tubes, history of operation (P = 0.99, 0.31, 0.06, 0.81, 0.97, 0.96, 0.17, 0.10, 0.89 respectively). The mean scores of pain intensity during chest tube removal, and 15 min after chest tube removal were not statistically different among the four groups of study (P = 0.15, 0.54 respectively); However, just after chest tube removal, the mean scores of pain intensity differed meaningfully among four groups (P = 0.008). Conclusion: The results showed that reflexology massage and respiratory relaxation both reduce pain immediately after chest tube removal in heart surgery patients. Also, the combination of these two techniques was more effective in reducing patients' average pain. [ABSTRACT FROM AUTHOR]

Objective: In this study, we aimed to screen the risk factors for delayed extubation after surgery for Ebstein's anomaly (EA), determine the diagnostic cut-off values, and develop a prediction equation to accurately encourage rapid recovery after surgery. Methods: The perioperative data of 76 pediatric patients undergoing EA surgery in the Surgical Department of the Pediatric Heart Center of Anzhen Hospital from September 2013 to September 2021 were retrospectively analyzed. Results: Among these cases, 37 (48.6%) were male, with an average age of 4.67 (2, 11.19) years and an average weight of 18 (12.4, 37) kg. The median postoperative duration of mechanical ventilation was 18 (10, 24) h, and the duration of mechanical ventilation ≥ 24 h (75th percentile) was defined as delayed extubation. Body weight (11.25 kg) and preoperative oxygen saturation (SpO2) (95.5%) were protective factors, while the simplified Great Ormond Street Echocardiogram (GOSE) value (0.995) and the intraoperative cardiopulmonary bypass (CPB) time (135 min) were the risk factors. The prediction model was developed based on these indexes: logit (P) = 8.9 + (0.02 × CPB time) + (2.2 × simplified GOSE) – (0.14 × preoperative SpO2) − (0.06 × body weight), and the area under the receiver operator characteristic (ROC) curve was 83.4% (P < 0.01). Patients with delayed extubation had a longer intensive care unit stay and a higher incidence of adverse events (P < 0.01). Conclusion: Low body weight, low preoperative SpO2, high GOSE value, and long intraoperative CPB time for pediatric patients with EA are likely to lead to prolonged postoperative duration of mechanical ventilation. For low-risk children, early extubation after surgery can be more actively encouraged; however, more care should be taken to avoid the risk of re-intubation. [ABSTRACT FROM AUTHOR]

Background: Cardiac surgery is a major contributor to acute kidney injury (AKI); approximately 22% of patients who undergo cardiac surgery develop AKI, and among them, 2% will require renal replacement therapy (RRT). AKI is also associated with heightened risks of mortality and morbidity, longer intensive care stays, and increased treatment costs. Due to the challenges of treating AKI, prevention through the use of care bundles is suggested as an effective approach. This review aimed to assess the impact of care bundles on kidney outcomes, mortality, and hospital stay for cardiac patients in critical care. Methods: PubMed, Scopus, Web of Science, and EMBASE were searched up to November 2024. Inclusion criteria were studies on individuals with cardiac diseases receiving critical care, that used AKI care bundle as the intervention, and reported outcomes related to AKI, mortality, and other kidney-related events. We used the Cochrane Collaboration's risk of bias tool 2 and the Newcastle-Ottawa scale for quality assessment. Pooled odds ratios (ORs) or risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. Results: Seven studies on total 5045 subjects, including five observational and two randomized controlled trials (RCTs) were included. The implementation of care bundles significantly reduced the incidence of all-stage AKI (OR: 0.78; 95%CI: 0.61–0.99) and moderate-severe AKI (OR: 0.56; 95%CI: 0.43–0.72). Also, the implementation of care bundle increased the incidence of persistent renal dysfunction after 30 days by 2.39 times. However, there were no significant changes in RRT, major adverse kidney events, or mortality between the groups. The mean quality assessment score for observational studies was 7.2 out of ten, while there were noted concerns in the risk of bias assessment of the RCTs. Conclusions: The application of care bundles in patients, including those undergoing cardiac surgeries as well as non-cardiac critical illness, appears to be effective in reducing AKI, particularly in moderate and severe stages. However, given the inclusion of non-cardiac patients in some studies, the observed effect may not be solely attributable to cardiac surgery cases. Future large-scale RCTs focusing specifically on cardiac surgery patients are recommended to clarify the impact of care bundles within this subgroup. Registration ID in PROSPERO: CRD42024498972. [ABSTRACT FROM AUTHOR]

Background: During COVID-19 pandemic, a rapid readjustment to continued delivery of healthcare was required. Redeployment is an intentional process to mobilise human resources by reassigning a healthcare worker to a new role or new work location, to achieve sustainable delivery of patient care. We report redeployment experiences of staff from a specialist children's hospital during first and second waves of the United Kingdom COVID-19 pandemic. Methods: This study focuses on a specialist children's hospital where redeployment occurred externally to adult intensive care units and other COVID-19 specific initiatives, and internally as some service activity reduced and others expanded. This was a study of staff experiences using a qualitative rapid appraisal design. Hospital staff participated in an in-depth one-to-one telephone interview. We used a semi-structured interview guide, and recorded and transcribed all interviews. Rapid Research Evaluation and Appraisal Lab sheets were used to share data; team-based analysis was facilitated using a framework approach. Results: Recruitment and interviews took place from March-November 2021. Twenty-four staff participated: 17 nurses, five doctors and two other healthcare professionals. Interviewees articulated their experiences of redeployment both within the specialist children's hospital and externally to other health settings (predominantly adult intensive care). Redeployment impacted staff in multiple ways professionally and personally and was reported to be both challenging and rewarding. The reality of working in different settings was felt by everyone, with unfamiliar environments, patient safety, and delivery of a more task-based model of care creating some negative experiences. We identified five main themes: (i) Drivers and Agency; (ii) Journey to Redeployment; (iii) Working Reality; (iv) Personal Impact and Support; (v) Professional Disruption. Conclusions: Although experience of those redeployed varied, prior background of working in intensive care settings and with adult patients, with opportunities to share practice with colleagues, mitigated challanges for our participants. Positive experiences were associated with perceptions of support received, being welcomed in the new setting, and feeling valued. This study also highlights the act of 'volunteering', the nature of 'voluntariness' and the difference that may exert on the overall redeployment experience. Future guidance would be encouraged to consider the voluntary nature of redployment. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to translate the Burnout Syndrome Assessment Scale (BOSAS) for Nurses Working in Intensive Care Units into Turkish validity and reliability. Methods: The questionnaire was planned to be of a methodological type and translation-back translation methods were used to translate it into Turkish. The content validity was established by submitting it to a panel of 12 faculty members with expertise in nursing. The Burnout Syndrome Assessment Scale (BOSAS) for Nurses Working in Intensive Care Units, the Maslach Burnout Inventory (MBI), and the Nurse Information Form were applied to 200 nurses. Internal consistency analyses were conducted using Cronbach's alpha coefficients and item analysis. Confirmatory factor analysis was employed to evaluate the construct validity. To ascertain the scale's stability over time, a test-retest method was implemented, involving the administration of a questionnaire to 150 intensive care nurses at two-week intervals. The MBI facilitated the assessment of the level of agreement between parallel forms, and intraclass correlations were computed. Results: Following confirming language equivalence for the scale, the content validity index was subsequently computed. The items' content validity indices (CVIs) ranged between 0.833 and 1.000 and were higher than the generally accepted standard level. Nevertheless, since most of the items related to the scale were explained over a single dimension, the factor analysis application was carried out over a single dimension. The MBI was used to assess the interreliability of the Burnout Syndrome Assessment (BOSAS) Scale for Nurses Working in Intensive Care Units in parallel forms. The scale's internal consistency coefficient demonstrated a high-reliability level, achieving a value of 0.95. The intraclass correlation coefficients (ICCs) obtained for each subdimension and overall questionnaire were high. Conclusion: The Turkish adaptation of this scale is a valid and reliable tool for evaluating and identifying burnout among nurses in intensive care settings. [ABSTRACT FROM AUTHOR]

Background: Although surviving sepsis campaign (SSC) guidelines are the standard for sepsis and septic shock management, outcomes are still unfavourable. Given that perfusion pressure in sepsis is heterogeneous among patients and within the same patient; we evaluated the impact of individualized hemodynamic management via the transcranial Doppler (TCD) pulsatility index (PI) on mortality and outcomes among sepsis-induced encephalopathy (SIE) patients. Methods: In this prospective, single-center randomized controlled study, 112 patients with SIE were randomly assigned. Mean arterial pressure (MAP) and norepinephrine (NE) titration were guided via the TCD pulsatility index to achieve a pulsatility index < 1.3 in Group I, whereas the SSC guidelines were used in Group II to achieve a MAP ≥ 65 mmHg. The primary outcome was intensive care unit (ICU) mortality and the secondary outcomes were; MAP that was measured invasively and values were recorded; daily in the morning, at the end of NE infusion and the end of ICU stay, duration of ICU stay, cerebral perfusion pressure (CPP), sequential organ failure assessment (SOFA) score, norepinephrine titration and Glasgow coma scale (GCS) score at discharge. Results: ICU mortality percentage wasn't significantly different between the two groups (p value 0.174). There was a significant increase in the MAP at the end of norepinephrine infusion (mean value of 69.54 ± 10.42 and p value 0.002) and in the GCS score at ICU discharge (Median value of 15 and p value 0.014) in the TCD group, and episodes of cerebral hypoperfusion with CPP < 60 mmHg, were significantly lower in the TCD group (median value of 2 and p value 0.018). Heart rate values, number of episodes of tachycardia or bradycardia, Total norepinephrine dosing, duration of norepinephrine infusion, SOFA score, serum lactate levels, and ICU stay duration weren't significantly different between the two groups. Conclusions: Individualizing hemodynamic management via the TCD pulsatility index in SIE patients was not associated with significant mortality reduction. However, it reduces episodes of cerebral hypoperfusion and improves GCS outcome but doesn't significantly affect heart rate values, SOFA score, serum lactate level, length of ICU stay, total NE dosing, and duration of NE infusion. Trial registration: The clinical trial was registered on clinucaltrials.gov under the identifier NCT05842616 https://clinicaltrials.gov/study/NCT05842616?cond=NCT05842616&rank=1 on 6-May-2023 before the enrolment of the first patient. [ABSTRACT FROM AUTHOR]

Background: In the intensive care unit (ICU), the incidence of iron-deficiency anemia (IDA) is relatively high and is associated with various adverse clinical outcomes. Therefore, it is crucial to identify simple and practical indicators to assess the mortality risk in ICU patients with IDA. This study aims to investigate the relationship between the Neutrophil Percentage-to-Albumin Ratio (NPAR) levels in patients with IDA in the ICU and their all-cause mortality at 30 and 365 days. Materials and methods: We analyzed data from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) 3.0 database spanning the years 2008–2022 and identified a cohort of 817 patients with IDA who met our inclusion criteria. Through multivariate Cox regression analysis, the relationship between NPAR levels and 30-day and 365-day mortality risks was assessed, and restricted cubic splines (RCS) models were used to explore potential nonlinear relationships. Additionally, an inflection point analysis was conducted to evaluate the potential of NPAR levels in predicting short- and long-term mortality risks. Results: The study found that high NPAR levels were significantly associated with an increased risk of 30-day and 365-day mortality in patients with IDA (hazard ratio [HR] range 1.49–2.23, p < 0.001 for all). The relationship between natural logarithmic transformation (ln) NPAR levels and 30-day and 365-day mortality risks exhibited an inverse "L" shaped pattern. Patient mortality risk increased significantly when ln-transformed NPAR levels exceeded 1.2 (HR range 3.366–4.304, p < 0.001 for all). Additionally, subgroup analyses did not reveal any significant interactions, indicating that the predictive effect of NPAR on mortality risk is relatively consistent across different subgroups. Conclusion: We found an inverse "L" shaped relationship between ln-transformed NPAR levels and 30-day and 365-day mortality risks, particularly when ln-transformed NPAR values exceed 1.2, which is significantly associated with an increased risk of death within 30 and 365 days for patients. [ABSTRACT FROM AUTHOR]

Background: The noise levels in intensive care units usually exceed the recommended limits in (inter)national recommendations. Such noise levels can affect both the recovery of intensive care patients and the performance of staff. The aim of this study was to reduce ward-based noise levels in three intensive care units (anesthesiological, neurological, and neonatological). Methods: The implementation of a setting-specific intervention bundle consisting of (a) ward-specific guide to noise management, (b) further noise reduction and prevention measures and (c) the use of "noise traffic lights" was evaluated in an implementation study with a pre-post design. Our primary endpoint was changes in sound level (equivalent continuous sound pressure (LAeq)) 12 weeks after the intervention, and the secondary endpoint was sound level (LAeq), peak sound pressure and maximum sound level at different time points, including changes at 24-week follow-up. Results: After the intervention phase, we observed a significant overall reduction in the sound level of 0.77 decibels (A-weighted) (dB (A)), 95%-CI [0.06, 1.49], p = 0.034 with post-intervention measurements of LAeq1h 56.43 dB (A) compared to pre-intervention measurements of 57.21 dB (A). The difference was particularly large (2.21 dB (A) [p < 0.0001] in one of the three intensive care units. After adjusting our analysis for the intensity of nursing workload, the sound level reduction was smaller. Comparisons of LAeq1h between measurement times during the daytime periods showed a post-interventional difference of 58.28 dB(A) to 58.84 dB(A) baseline during the day of 0.57 dB(A), 95%-CI [-0.07, 1.21], p = 0.08 and at night of 53.36 dB(A) post-interventionally to 54.48 dB(A) baseline a difference of 1.11 dB(A) 95%-CI [0.19, 2.04], p = 0.02. In follow-up, baseline sound levels became realigned and we noted a rise in sound level of 0.81 dB (A) [p = 0.01]. Conclusions: Our implementation study indicates that a bundle of interventions can reduce noise levels in intensive care units, although the clinical relevance of the measured effect must be questioned. Sufficient resources and a participatory approach using an implementation framework should therefore be employed to manage sustainable noise abatement. Trial registration: German Clinical Trials Register (DRKS): trial registration number: DRKS00025835; Date of registration: 12.08.2021. [ABSTRACT FROM AUTHOR]

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 < 0.001). The results from the multivariable Cox regression suggested a substantial inverse association between high serum chloride levels and decreased mortality at 30 days (hazard ratio [HR]: 0.96; 95%confidence interval [CI]: 0.95–0.97; P < 0.001), 90 days (HR: 0.97; 95% CI: 0.96–0.98; P < 0.001), and 180 days (HR: 0.97; 95% CI: 0.96–0.98; P < 0.001). Particularly, patients in the highest quartile of serum chloride faced significantly lower mortality risks compared to those in the lowest quartile (30 days HR = 0.65, 90 days HR = 0.71, 180 days HR = 0.69, P < 0.001). RCS analysis depicted an L-shaped curve demonstrating the dynamics between serum chloride concentrations and the risk of all-cause mortality across the 30-day, 90-day, and 180-day periods.Starting at a concentration of 104 mmol/L, a decrease in serum chloride levels was associated with an increased risk of mortality.These findings elucidate a marked nonlinear association between serum chloride levels and all-cause mortality in SICU patients, enhancing our comprehension of serum chloride's impact on clinical outcomes in this setting. [ABSTRACT FROM AUTHOR]

Background: Aluminum phosphide is an excellent insecticide available as a chalky white or brown tablet. Aluminum phosphide is traded in the Egyptian market as tablets under the brand name celphos. To date, no specific antidotes for aluminum phosphide poisoning have been identified. Management is primarily supportive, to control toxic symptoms and prevent the anticipated consequences. Therefore, educating parents about first aid management is of utmost importance. This study aimed to evaluate the knowledge, behavior, and practices of parents concerning aluminum phosphide poisoning and its first-aid measures. Methods: This study used a quasi-experimental research design and was conducted in the inpatient clinical toxicology department ward of Menoufia University Hospital between June 2022 and May 2023. Children (n = 98) who met the inclusion criteria (aged between 0 and 18 years and who experienced accidental or suicidal aluminum phosphide poisoning) were recruited from the inpatient clinical toxicology department ward, intensive care unit in the emergency department, and critical care unit of Menoufia University Hospital. Four questionnaires were used to collect data for this study: (1) sociodemographics, poisoning data, physical examination, and laboratory investigations; (2) knowledge of parents; (3) practice of parents; and (4) behavior response scales. Results: This study analyzed 98 cases of acute ALP poisoning, predominantly affecting females (67.3%) aged 16–18 years, with most incidents occurring in summer (51.1%) and rural areas (80.6%). Suicidal ingestion accounted for 86.7% of cases, and delays in hospital arrival were noted in 65.3%. Clinical findings included vomiting (76.6%), dyspnea (77.5%), and cardiogenic shock (84.8%). ECG abnormalities were found in 82.7% of patients, and metabolic acidosis was present in 82.3% of patients. An educational program significantly improved the knowledge and first-aid practices of the participants regarding ALP poisoning, highlighting the need for enhanced awareness and intervention strategies. Conclusions: Community awareness programs, such as first-aid education initiatives, can positively influence the knowledge, practices, and behaviors of mothers in terms of providing first aid for aluminum phosphide toxicity. [ABSTRACT FROM AUTHOR]

Background: Ureaplasma urealyticum, Ureaplasma parvum, and Mycoplasma hominis were widely known as ammonia-producing microorganisms and can cause hyperammonemia, leading to cerebral edema and altered consciousness, which represent serious complications in lung transplant recipients. However, there is limited knowledge on the epidemiology and outcomes of infections caused by U. urealyticum, U. parvum, and M. hominis in non-transplant patients with severe pneumonia in the ICU. Methods: Patients with severe pneumonia who underwent clinical metagenomics of bronchoalveolar lavage fluid (BALF) at the intensive care units (ICUs) of 17 medical centers from January 2019 to March 2023 were enrolled. All cases were divided into the positive group and the negative group based on whether U. urealyticum, U. parvum, or M. hominis was detected in lower respiratory tract. The clinical characteristics and outcomes were compared among the groups. The survival analysis after propensity score matching (PSM) was used to evaluate whether the mortality rate of U. urealyticum, U. parvum, and M. hominis positive patients were increased. Multivariate logistic regression was used to evaluate whether these microbials positivity were a risk factor for central nervous system dysfunction. Results: In a total number of 1737 patients, 55 patients (3.17%) in the positive group and 1682 patients (96.83%) in the negative group. Patients in the positive group were younger, had a greater proportion of male patients, and had a longer time from ICU admission to clinical metagenomics testing. In contrast, the negative group had a higher proportion of patients with cerebrovascular disease. After PSM, there was no statistically significant difference in 28-day mortality following ICU admission between the two groups (hazard ratio [HR], 0.842; 95% confidence interval [CI], 0.489–1.451; p = 0.536). Multivariate logistic regression analysis showed an association between the detection of U. urealyticum, U. parvum, or M. hominis and neurological dysfunction (odds ratio [OR], 1.84; 95% CI 1.04–3.24; p = 0.035). Conclusion: The detection of U. urealyticum, U. parvum, or M. hominis in the lungs of patients is associated with neurological dysfunction. [ABSTRACT FROM AUTHOR]

Klebsiella pneumoniae, a pathogen of concern worldwide can be classified as classical K. pneumoniae (cKp) and Hypervirulent K. pneumoniae (HvKp). In health care settings, genotyping and identification of hypervirulent strains enables better clinical management. The present study was conducted in a north Indian tertiary care hospital which receives both Indian and foreign patients. During the study period (September –December 2022), 29 isolates of K. pneumoniae were collected from Out Patients department (OPD), Intensive Care Unit (ICU) and wards. Genotypic profiling was based on Multi Locus Sequence Typing (MLST) and wzi type. Virulence was determined by PCR based screening of genes (RmpA, iucB, ybts, iroN) as well as phenotypic tests: string test, biofilm formation and serum neutralization assay. We identified 17 Sequence Type and 14 wzi strain. The most common Sequence Type was ST231 (6/29) followed by ST 6260 (3/29)0.15 (51.7%) isolates were carbapenem resistant (CR). Eleven isolates carried the aerobactin gene iucB and/or rmpA genes. The results of the study show the presence of diverse genotypes and virulence genes of K. pneumoniae, stressing the need for stricter surveillance. We also observed a significantly higher average length of stay in patients carrying hypervirulent or carbapenem resistant strains (p < 0.05). [ABSTRACT FROM AUTHOR]

Background: Increasing the level of resilience and happiness of intensive care nurses can lead to an improvement in their psychological health. This study aimed to extract the possible effectiveness of mHealth application utilizing the micro-learning method on a mobile phone platform on the intensive care nurses' resilience and happiness. Materials and methods: This single-blind randomized controlled trial was conducted in 2022-24. Sixty nurses working in intensive care units at two hospitals in Tehran, Iran were recruited using purposive sampling and randomly assigned to either the intervention or control group. Techniques of resilience and increasing happiness were taught to the intervention group using the mHealth application based on the micro-learning method. No training was provided to the control group. For data collection, questionnaires of individual characteristics, Connor-Davidson Resilience, and Oxford Happiness were used. Results: Before the intervention, there was no significant difference between the mean of the subscales and the total score of resilience and happiness of the intervention and control groups (P < 0.05). However, after the intervention, there was a significant difference (P < 0.05). After using the mHealth application, the total resilience score of the intervention group increased from 67.30 ± 10.12 to 79.27 ± 5.87 (P < 0.0001), while the resilience of the control group changed from 68.80 ± 9.09 to 65.93 ± 8.44 (P = 0.548). Similarly, using the mHealth educational application based on micro-learning led to an increase in the happiness score of the intervention group from 38.50 ± 11.10 to 67.83 ± 8.84 (P < 0.0001), whereas the happiness score of the control group nurses after the intervention (38.93 ± 14.33) compared to the baseline (41.40 ± 14.51) did not change significantly (P = 0.388). Conclusions: The use of the mHealth application based on the micro-learning method played an effective role in training resilience and happiness skills in nurses. It is recommended to conduct more studies using this new educational approach. Trial registration: The study has been registered in the Iranian Registry of Clinical Trials (No. IRCT20221225056916N1, Date: 04/29/2023). [ABSTRACT FROM AUTHOR]