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This article contributes to the sociology of diagnosis by exploring how an acute medical condition, sepsis, was categorised over a 25-year period. We focus on publications reporting the outcomes of three consensus conferences that were convened to stabilise definitions of sepsis and on the failure of a controversial drug. We also focus on the category of severe sepsis by exploring why it was considered useful when introduced in 1991 but redundant by 2016. Drawing on insights from the sociology of valuation, our analysis of pivotal events within this period involving actors from clinical practice, biomedical science, regulation and industry identifies numerous and often contesting evaluative frameworks that came to bear on the categorisation of sepsis. Our analysis further reveals that the evaluative framework of clinical practice, mobilised by the professional specialty of intensive and critical care, became dominant in this categorisation, and that this did not reflect a dominance of biomedicine despite concerning an acute medical condition. Our contributions are to posit the ontological purpose of diagnostic categories and the role of valuation practices and strategic agency in diagnosis-as-category., (© 2023 The Authors. Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for the Sociology of Health & Illness.)

Purpose: Intensive care medicine (ICM) has the particularity of being a multidisciplinary specialty and its literature reflects this multidisciplinarity. However, the proportion of each field in this literature and its trend dynamics are not known. The objective of this study was to analyze the ICM literature, extract latent topics and search for the presence of research trends., Material and Methods: Abstracts of original articles from the top ICM journals, from their inception until December 31st, 2019, were included. This corpus was fed into a structural topic modeling algorithm to extract latent semantic topics. The temporal distribution was then analyzed and the presence of trends was searched by Mann-Kendall trends tests., Results: Finally, 49,276 articles from 10 journals were included. After topic modeling analysis and experts' feedback, 124 research topics were selected and labeled. Topics were categorized into 19 categories, the most represented being respiratory, fundamental and neurological research. Increasing trends were observed for research on mechanical ventilation and decreasing trends for cardiopulmonary resuscitation., Conclusions: This study reviewed all articles from major ICM journals in a comprehensive way. It provides a better understanding of ICM research landscape by analyzing the temporal evolution of latent research topics in the ICM literature., Competing Interests: Declaration of Competing Interest None., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Adequate pharmacotherapy in critically ill patients is challenging for many clinicians. Disease-related pathophysiological changes often lead to complex therapy strategies including many intensive care treatments (e.g. invasive ventilation, renal replacement therapy). These measures often influence drug prescribing and dosing. Therefore, in organ dysfunction such as renal and liver impairment reduced drug elimination has to be considered by adapting drug dosing towards elimination rates. Moreover, as intensive care medicine often includes the use of multiple drugs the risk for drug-drug interactions increases. The current article gives an overview about the complexity of individual pharmacotherapy in intensive care units whilst providing information for its clinical implementation.

The infectious pandemics and epidemics of the past 200 years have caused millions of deaths. However, these devastating events have also led to creative thinking, imaginative experimentation and the evolution of medical care. As a result, the history of critical care medicine is entwined with the story of these global disasters. This article will take case studies from recent pandemics and epidemics and examine their impact on the development of anaesthesia and intensive care medicine.

Abstract To determine the prevalence of functional, respiratory and renal impairments and of post-intensive-care-syndrome (PICS) among patients who had attended a post-ICU multidisciplinary consultation (post-ICU-MC) around 3 months after ICU discharge, we performed a retrospective, monocentric observational study, at Clermont Ferrand University hospital, France. We included patients who had attended a post-ICU-MC. Their characteristics during ICU stay and at the post-ICU-MC were collected. Functional status was assessed by the 6-min-walking test, handgrip test and peak inspiratory pressure, respiratory function by exploratory functional outcomes, mental status by SF-36 score, and quality of life by SF-36 score and European Quality of Life 5 Dimensions questionnaire. Overall, we enrolled 67 patients, of whom 70%, 74%, and 68% had functional, respiratory, and renal impairments, respectively, at the post-ICU-MC. Additionally, 40%, 28%, 19%, and 2.5% had three, two, one, and none of these impairments, respectively. All patients experienced mental disorders and a decline in quality of life. Functional impairment correlated with frailty score and sex, and respiratory function with age. To conclude, the prevalence of PICS in our cohort was high, as was that of functional, respiratory and renal failure.

Background: Shock index is the ratio of heart rate to the systolic blood pressure. The use of shock index for risk stratification or as an indicator of clinical improvement is helpful in early recognition of shock and optimizing treatment in sepsis and septic shock. Aims and Objectives: The objective of the study was to assess the shock index and associated outcome in children with sepsis/septic shock at the tertiary care hospital. Materials and Methods: A cross-sectional study was conducted among 95 patients admitted with sepsis or septic shock to the pediatric intensive care unit and pediatric wards of a tertiary center in Surat. The study was done over a period of 2 years from January 2020 to December 2021. The study was carried out after obtaining ethical approval from the Human Research Ethics Committee, GMC Surat. Through-out the study privacy and confidentiality was maintained at all cost for each participant by coding of patients data. Results: The mean age of the study population was 3.12±2.40 years, with age range from 1 month to 12 years. The gender distribution of the study population had 51.6% male and 48.4% female. On analysis of the shock index to the mortality of the patients at 0, 1, 2, 4, and 6 h after admission, the cutoff value of shock index at 1.6, 1.7, 1.7, 1.4, and 1.3 had a sensitivity of 89.4%, 84.8%, 78.8%, 82.3%, and 86.4%, with a specificity of 62.4%, 69%, 75.9%, 72.4%, and 75.9%, respectively. The cutoff values of the various age groups decrease as the ages of the patients increase. The overall survival rate in the study was 30.5% and mortality rate at 69.5%. Conclusion: The study concluded that shock index can be used in emergency for triage of critically ill patients. Shock index and mortality were higher compared to other studies as majority of the study participants were referred cases and were in critical stages of shock on admission to the tertiary care center.

Abstract Shock is a life-threatening condition. This study evaluated if sublingual microcirculatory perfusion on admission is associated with 30-day mortality in older intensive care unit (ICU) shock patients. This trial prospectively recruited ICU patients (≥ 80 years old) with arterial lactate above 2 mmol/L, requiring vasopressors despite adequate fluid resuscitation, regardless of shock cause. All patients received sequential sublingual measurements on ICU admission (± 4 h) and 24 (± 4) hours later. The primary endpoint was 30-day mortality. From September 4th, 2022, to May 30th, 2023, 271 patients were screened, and 44 included. Patients were categorized based on the median percentage of perfused small vessels (sPPV) into those with impaired and sustained microcirculation. 71% of videos were of good or acceptable quality without safety issues. Patients with impaired microcirculation had significantly shorter ICU and hospital stays (p = 0.015 and p = 0.019) and higher 30-day mortality (90.0% vs. 62.5%, p = 0.036). Cox regression confirmed the independent association of impaired microcirculation with 30-day mortality (adjusted hazard ratio 3.245 (95% CI 1.178 to 8.943, p = 0.023). Measuring sublingual microcirculation in critically ill older patients with shock on ICU admission is safe, feasible, and provides independent prognostic information about outcomes. Trial registration NCT04169204.

Abstract Pediatric trauma plays a crucial role in pediatric mortality, with traffic injuries and falls frequently cited as leading causes of significant injuries among children. A comprehensive investigation, including geographical factors, is essential for developing effective strategies to prevent injuries and alleviate the burden of pediatric trauma. This study involved a retrospective analysis of clinical data from pediatric patients admitted to our hospital’s intensive care unit (ICU) due to trauma over a 10-year period. Comprehensive analyses were conducted to elucidate trends, demographics, injury patterns, and risk factors associated with these admissions. This retrospective study included 951 pediatric patients (mean age: 4.79 ± 3.24 years; mean weight: 18.45 ± 9.02 kg; median time to ICU admission post-injury: 10.86 ± 14.95 h). Among these patients, 422 (44.4%) underwent emergency surgery, and 466 (49%) required mechanical ventilation support, with a mean duration of 70.19 ± 146.62 h. The mean duration of ICU stay was 6.24 ± 8.01 days, and the overall mean hospitalization duration was 16.08 ± 15.56 days. The predominant cause of unintentional injury was traffic accidents (47.9%), followed by falls (42.5%) and burns/scalds (5.3%). Most incidents involved children aged 0–6 years (70.7%), with males comprising 60.0% of patients. Injury incidents predominantly occurred between 12 and 6 PM (44.5%) and on non-workdays (37.6%). The most common locations where injuries occurred were roadsides (49%) and rural areas (64.35%). Single-site injuries (58.78%) were more prevalent than multiple-site injuries (41.22%), and head injuries were the most common among single-site injuries (81.57%). At ICU admission, the mean injury severity score was 18.49 ± 8.86. Following active intervention, 871 patients (91.59%) showed improvement, while 80 (8.41%) succumbed to their injuries. Traffic injuries remain the primary cause of pediatric trauma leading to ICU admission, underscoring the importance of using appropriate child restraint systems and protective gear as fundamental preventive measures. The increased incidence of injuries among children aged

Abstract Remdesivir therapy has been declared as efficient in the early stages of Covid-19. Of the 339 patients (males 55.8%, age 71(59;77) years) with a detectable viral load, 140 were treated with remdesivir (of those 103 in the ICU and 57 immunosuppressed) and retrospectively compared with 199 patients (of those 82 in the ICU and 28 immunosuppressed) who were denied therapy due to advanced Covid-19. The viral load was estimated by detecting nucleocapsid antigen in serum (n = 155, median 217(28;1524)pg/ml), antigen in sputum (n = 18, COI 18(4.6;32)), nasopharyngeal antigen (n = 44, COI 17(8;35)) and the real-time PCR (n = 122, Ct 21(18;27)). After adjustment for confounders, patients on remdesivir had better 12-month survival (HR 0.66 (0.44;0.98), p = 0.039), particularly when admitted to the ICU (HR 0.49 (0.29;0.81), p = 0.006). For the immunocompromised patients, the difference did not reach statistical significance (HR 0.55 (0.18;1.69), p = 0.3). The other most significant confounders were age, ICU admission, mechanical ventilation, leukocyte/lymphocyte ratio, admission creatinine and immunosuppression. The impact of monoclonal antibodies or previous vaccinations was not significant. Despite frequent immune suppression including haemato-oncology diseases, lymphopenia, and higher inflammatory markers in the remdesivir group, the results support remdesivir administration with respect to widely available estimates of viral load in patients with high illness severity.

Abstract The primary aim of this study was to evaluate computed tomography (CT)-based bone density analysis at the level of thoracic vertebra 12 (Th12) as a screening method for decreased bone density in patients admitted to the intensive care unit (ICU). Interobserver variability was analyzed. Secondary aims were to assess the prevalence of CT-based low bone density upon ICU admission in a cohort of COVID-19 patients and to assess the potential effect of long-term ICU stay on bone density in these patients. Retrospective single-center cohort study. ICU of the Leiden University Medical Center (LUMC), the Netherlands. Patients admitted to the ICU of the LUMC between March 1st, 2020 and February 1st, 2022 with a diagnosis of COVID-19, and a length of ICU stay of ≥ 21 days. In the included patients both baseline chest CT scans (obtained upon ICU admission) and follow-up chest CT scans (obtained ≥ 21 days after ICU admission) were available for analysis. A total of 118 CT scans in 38 patients were analyzed. There was a good interobserver variability, with an overall mean absolute difference (between measurements of three observers) of 9.7 Hounsfield Units (HU) and an intraclass correlation coefficient (ICC) of 0.93 (95% CI 0.88–0.96). The effect of intravenous contrast administration on bone density measurements was small (+ 7.5 HU (95% CI 3.4–11.5 HU)) higher in contrast enhanced CT images compared to non contrast enhanced CT images). Thirty-seven percent of patients had a bone density

Introduction: This study was performed to determine the difficulties experienced by parents with children in home care who were discharged from intensive care. Methods: A phenomenological qualitative method was used to determine the difficulties experienced by the parents. The sample of the study consisted of parents (n=22) whose children met the inclusion criteria and needed home care. The data were analyzed in the MAXQDA qualitative data analysis program in accordance with Colaizzi’s seven-stage method. Results: The average age of the children in the study group was 85.63±58.40 months. 56.7% of them were male. 40% of the children were followed up with a diagnosis of neurological disease. All children discharged from the intensive care unit had tracheostomy. 95.4% of them used home-type mechanical ventilators, and 95.3% were fed enterally. In line with the data obtained from the interviews of the parents, it was determined that there were difficulties in terms of feelings about discharge, physical conditions for home care, family relationship, social relationship, difficulty in physical care, inadequacy in support systems and financial status. Conclusion: The home care of children, who are dependent on medical technology and discharged from intensive care, is mostly performed by their families. Children dependent on medical technology should be supported by home care personnel to avoid potential risks.

Introduction: To evaluate the duration of pediatric intensive care stay, hospitalization and the factors affecting mortality in patients who were operated by pediatric surgery and followed up in pediatric intensive care unit (PICU) in the postoperative period. Methods: One hundred forty-three patients who were operated between September 2018 and January 2020 and hospitalized in the PICU for post-operative follow-up were included in the study. Results: The median age of the 143 patients included in the study was 31.00 (1-205) months, and 76 (53.1%) were male. Ninety-six patients had no comorbidity, 47 patients had at least one comorbidity. The most frequent developed post-operative complications were sepsis (n=7) and intra-abdominal hypertension (n=7). The presence of sepsis extended the intensive care unit stay by 4.46 days, the need for inotropes by 3.61 days, the development of intra-abdominal hypertension by 3.33 days, and the presence of comorbidity by 0.86 days. The presence of sepsis extended the hospitalization period 28.04 days, the need for respiratory support 21.78 days, and the presence of malnutrition 14.42 days. Conclusion: It would be more appropriate to follow-up patients, who are operated by pediatric surgery, especially those with comorbidity and malnutrition, who need intraoperative blood products or who have the risk of developing complications in the postoperative period in PICUs.

Traumatic brain injury (TBI) remains one of the leading causes of long-term disability, especially among young and middle-aged people. One of the main directions of treatment for patients with TBI is to prevent the development of secondary brain damage due to systemic dysfunction. Anemia occupies an important place among them. Anemia is considered a marker of illness severity in critically ill patients and is included in the list of parameters for risk prediction in intensive care units. However, the relationship between anemia and adverse outcomes in patients with TBI is controversial. Aim. The purpose of the work is to analyze the effect of anemia on the course of severe TBI, to determine the position of anemia in the pathophysiological mechanisms of brain damage, the development of blood transfusion-associated complications, to evaluate different blood transfusion strategies (liberal and restrictive) and their impact on treatment results, taking into account individual tolerance to anemia. Studies suggest that the restrictive transfusion strategy could be useful in reducing complications and length of hospital stay. However, the lack of clear evidence for optimal hemoglobin levels as a trigger to initiate blood transfusions reinforces the need for further clinical studies. The use of multimodal neuromonitoring allows to evaluate the latest approaches to assessing individual hemoglobin thresholds. These methods could help in identifying patients at increased risk of complications and determining optimal strategies to manage anemia. Conclusions. The problem of tolerance to anemia in patients with severe TBI remains a controversial topic, and determining hemoglobin thresholds for blood transfusion in this group of patients requires further studies, special attention should therefore be paid to an individual approach to resolving the issue of red blood cell transfusion, in particular, integrating clinical status of a patient and concomitant pathology. The risk of possible brain damage worsening associated with anemia due to deterioration of cerebral oxygenation should always be weighed against the risk of developing transfusion-associated complications.

Abstract Mortality of patients hospitalized with COVID-19 has remained high during the consecutive SARS-CoV-2 pandemic waves. Early discrimination of patients at high mortality risk is crucial for optimal patient care. Symmetric (SDMA) and asymmetric dimethylarginine (ADMA) have been proposed as possible biomarkers to improve risk prediction of COVID-19 patients. We measured SDMA, ADMA, and other L-arginine-related metabolites in 180 patients admitted with COVID-19 in four German university hospitals as compared to 127 healthy controls. Patients were treated according to accepted clinical guidelines and followed-up until death or hospital discharge. Classical inflammatory markers (leukocytes, CRP, PCT), renal function (eGFR), and clinical scores (SOFA) were taken from hospital records. In a small subgroup of 23 COVID-19 patients, sequential blood samples were available and analyzed for biomarker trends over time until 14 days after admission. Patients had significantly elevated SDMA, ADMA, and L-ornithine and lower L-citrulline concentrations than controls. Within COVID-19 patients, SDMA and ADMA were significantly higher in non-survivors (n = 41, 22.8%) than in survivors. In ROC analysis, the optimal cut-off to discriminate non-survivors from survivors was 0.579 µmol/L for SDMA and 0.599 µmol/L for ADMA (both p

Background Major trauma places substantial demand on critical care services, is a leading cause of death in under 40-year-olds and causes significant morbidity and mortality across all age groups. Various factors influence patient outcome and predefining these could allow prognostication. The aim of this study was to identify predictors of mortality from major trauma in intensive care. Methods This was a retrospective study of adult trauma patients admitted to general intensive care between January 2018 and December 2019. We assessed the impact on mortality of patient demographics, patterns of injury, injury scores (Glasgow Coma Score (GCS), Charlson’s comorbidity index (CCI), Acute Physiology and Health Evaluation II (APACHE II), Injury Severity Score (ISS) and Probability of Survival Score (Ps19)), number of surgeries and mechanism of injury using logistic regression. Results A total of 414 patients were included with a median age of 54 years (IQR 34–72). Overall mortality was 18.6%. The most common mechanism of injury was traffic collision (46%). Non-survivors were older, had higher ISS scores with lower GCS on admission and lower probability of survival scores. Factors independently predictive of mortality were age 70-80 (OR 3.267, p = 0.029), age >80 (OR 27.043, p < 0.001) and GCS < 15 (OR 8.728, p < 0.001). Ps19 was the best predictor of mortality (p

Background At the beginning of December 2022, the Chinese government made major adjustments to the epidemic prevention and control measures. The epidemic infection data and laboratory makers for infected patients based on this period may help with the management and prognostication of COVID-19 patients.Methods The COVID-19 patients hospitalized during December 2022 were enrolled. Logistic regression analysis was used to screen significant factors associated with mortality in patients with COVID-19. Candidate variables were screened by LASSO and stepwise logistic regression methods and were used to construct logistic regression as the prognostic model. The performance of the models was evaluated by discrimination, calibration, and net benefit.Results 888 patients were eligible, consisting of 715 survivors and 173 all-cause deaths. Factors significantly associated with mortality in COVID-19 patients were: lactate dehydrogenase (LDH), albumin (ALB), procalcitonin (PCT), age, smoking history, malignancy history, high density lipoprotein cholesterol (HDL-C), lactate, vaccine status and urea. 335 of the 888 eligible patients were defined as ICU cases. Seven predictors, including neutrophil to lymphocyte ratio, D-dimer, PCT, C-reactive protein, ALB, bicarbonate, and LDH, were finally selected to establish the prognostic model and generate a nomogram. The area under the curve of the receiver operating curve in the training and validation cohorts were respectively 0.842 and 0.853. In terms of calibration, predicted probabilities and observed proportions displayed high agreements. Decision curve analysis showed high clinical net benefit in the risk threshold of 0.10-0.85. A cutoff value of 81.220 was determined to predict the outcome of COVID-19 patients via this nomogram.Conclusions The laboratory model established in this study showed high discrimination, calibration, and net benefit. It may be used for early identification of severe patients with COVID-19.

Aim: Diabetic ketoacidosis (DKA) is a critical, potentially life-threatening complication of diabetes mellitus (DM) in children, characterized by hyperglycemia, acidosis, and ketonemia/ketonuria. Despite its known risk factors and mortality rates, few studies have focused on the pediatric population, especially in specific regions under standard treatment protocols. This study investigated the demographic, clinical, and laboratory characteristics of children with DKA, identified its triggering factors, the factors affecting DKA severity and its complications, as well as evaluating the outcomes of a standardized treatment protocol in a Turkish pediatric intensive care unit (PICU). Materials and Methods: In this single-center retrospective study at Göztepe Prof. Dr. Süleyman Yalçın City Hospital’s PICU, we included 115 children diagnosed with DKA between 2015 and 2022, following the DKA Treatment Protocol of the Turkish Society of Pediatric Emergency and Intensive Care Medicine and the International Society for Pediatric and Adolescent Diabetes guidelines. We analyzed the patients’ demographic, clinical, and laboratory characteristics, treatment outcomes, and their complications using SPSS 25.0. Results: The sample primarily consisted of female patients and those newly diagnosed with DM, with a median age of 110 months. The mortality rate was low at 0.87%, with one death due to sepsis-induced multiple organ failure. DKA severity (lower GCS, younger age, electrolyte imbalance, acidosis, complications) correlated with longer PICU stays and recoveries in the children. The findings also highlighted the standardized treatment protocol's effectiveness in managing DKA and reducing complications. Conclusion: This study underscores the importance of early diagnosis, standardized treatment protocols, and comprehensive care in pediatric DKA management. It emphasizes the need for ongoing education and awareness among healthcare providers and caregivers in order to prevent DKA and its severe outcomes. Further multicenter studies are necessary to extend these findings to the broader pediatric population and refine DKA management strategies.

Abstract Renal recovery following dialysis-requiring acute kidney injury (AKI-D) is a vital clinical outcome in critical care, yet it remains an understudied area. This retrospective cohort study, conducted in a medical center in Taiwan from 2015 to 2020, enrolled patients with AKI-D during intensive care unit stays. We aimed to develop and temporally test models for predicting dialysis liberation before hospital discharge using machine learning algorithms and explore early predictors. The dataset comprised 90 routinely collected variables within the first three days of dialysis initiation. Out of 1,381 patients who received acute dialysis, 27.3% experienced renal recovery. The cohort was divided into the training group (N = 1135) and temporal testing group (N = 251). The models demonstrated good performance, with an area under the receiver operating characteristic curve of 0.85 (95% CI, 0.81–0.88) and an area under the precision-recall curve of 0.69 (95% CI, 0.62–0.76) for the XGBoost model. Key predictors included urine volume, Charlson comorbidity index, vital sign derivatives (trend of respiratory rate and SpO2), and lactate levels. We successfully developed early prediction models for renal recovery by integrating early changes in vital signs and inputs/outputs, which have the potential to aid clinical decision-making in the ICU.

Abstract Background High stakes examinations used to credential trainees for independent specialist practice should be evaluated periodically to ensure defensible decisions are made. This study aims to quantify the College of Intensive Care Medicine of Australia and New Zealand (CICM) Hot Case reliability coefficient and evaluate contributions to variance from candidates, cases and examiners. Methods This retrospective, de-identified analysis of CICM examination data used descriptive statistics and generalisability theory to evaluate the reliability of the Hot Case examination component. Decision studies were used to project generalisability coefficients for alternate examination designs. Results Examination results from 2019 to 2022 included 592 Hot Cases, totalling 1184 individual examiner scores. The mean examiner Hot Case score was 5.17 (standard deviation 1.65). The correlation between candidates’ two Hot Case scores was low (0.30). The overall reliability coefficient for the Hot Case component consisting of two cases observed by two separate pairs of examiners was 0.42. Sources of variance included candidate proficiency (25%), case difficulty and case specificity (63.4%), examiner stringency (3.5%) and other error (8.2%). To achieve a reliability coefficient of > 0.8 a candidate would need to perform 11 Hot Cases observed by two examiners. Conclusion The reliability coefficient for the Hot Case component of the CICM second part examination is below the generally accepted value for a high stakes examination. Modifications to case selection and introduction of a clear scoring rubric to mitigate the effects of variation in case difficulty may be helpful. Increasing the number of cases and overall assessment time appears to be the best way to increase the overall reliability. Further research is required to assess the combined reliability of the Hot Case and viva components.

Abstract This study aimed to explore the changes of pharmacokinetic parameters after meropenem in patients with abdominal septic shock after gastrointestinal perforation, and to simulate the probability of different dosing regimens achieving different pharmacodynamic goals. The study included 12 patients, and utilized high performance liquid chromatography-tandem mass spectrometry to monitor the plasma concentration of meropenem. The probability of target attainment (PTA) for different minimum inhibitory concentration (MIC) values and %fT > 4MIC was compared among simulated dosing regimens. The results showed that in 96 blood samples from 12 patients, the clearance (CL) of meropenem in the normal and abnormal creatinine clearance subgroups were 7.7 ± 1.8 and 4.4 ± 1.1 L/h, respectively, and the apparent volume of distribution (Vd) was 22.6 ± 5.1 and 17.2 ± 5.8 L, respectively. 2. Regardless of the subgroup, 0.5 g/q6h infusion over 6 h regimen achieved a PTA > 90% when MIC ≤ 0.5 mg/L. 1.0 g/q6h infusion regimen compared with other regimen, in most cases, the probability of making PTA > 90% is higher. For patients at low MIC, 0.5 g/q6h infusion over 6 h may be preferable. For patients at high MIC, a dose regimen of 1.0 g/q6 h infusion over 6 h may be preferable. Further research is needed to confirm this exploratory result.

Background: Dexmedetomidine is a selective alpha-2-adrenoceptor agonist. It exerts both sedative and analgesic effects through mechanisms different from those of other sedatives. The safety and efficacy of dexmedetomidine are altered by various factors. Aims and Objectives: This study aims at identifying the various factors that will affect the sedative and hemodynamic responses of dexmedetomidine in seriously ill patients. Materials and Methods: A continuous infusion of dexmedetomidine (0.2–0.7 μg/kg/h) was administered to intensive care unit patients who needed sedation. We investigated the safety and effectiveness of administering dexmedetomidine between responders and non-responders over a short (≤24 h) and lengthy (>24 h) period. Results: A total of 84 patients were analyzed who received dexmedetomidine. The longest possible duration of dexmedetomidine administration was 24.7 days and 7.8 days, respectively. Compared to the first 24 h, the number of patients who needed more sedatives or analgesics was not increasing beyond that time. In the first 24 h and after the first 24 h, 35 out of 84 patients (41.2%) and 22 out of 84 patients (26.3%), respectively, needed more sedatives; in the first 24 h and after the first 24 h, 22 out of 84 patients (26.0%) and 18 out of 84 patients (21.4%) needed more analgesics. Conclusion: The safety and effectiveness of dexmedetomidine were similar across the demographic factors in this study. The interindividual variability due to pharmacokinetic parameters can be further studied along with pharmacogenomic factors that may cause the difference in the responses to dexmedetomidine use.

Abstract Introduction Nurses in intensive care units (ICUs) face high stress and anxiety, impacting their well-being and productivity. Addressing this, this study evaluated the impact of resilience training via a mHealth application based on micro-learning on ICU nurses’ stress and anxiety levels. Materials and methods This study, a single-blind randomized controlled trial conducted in 2022-23, involved sixty ICU nurses from two Tehran hospitals. Nurses were chosen through purposive sampling and divided into intervention and control groups by simple randomization. The intervention group was taught resilience via an educational mHealth application based on micro-learning, with data collected using the anxiety and stress subscales of DASS-21. Results Before the intervention, there were no significant differences in stress and anxiety scores between the intervention and control groups (P > 0.05). Upon utilizing the mHealth application, the intervention group exhibited significant reductions in stress, from 10.77 ± 3.33 to 9.00 ± 1.66 (P = 0.001), and in anxiety, from 9.43 ± 3.35 to 7.93 ± 0.98 (P

Objective: In this study, it was aimed to evaluate the practices of physicians working in intensive care units about post-resuscitation care in patients whose spontaneous circulation returned with cardiopulmonary resuscitation. Materials and Methods: In this cross-sectional study, a web-based questionnaire containing 28 questions was applied to physicians working in an intensive care units. Results: A total of 118 specialist physicians participated in the study. The mean arterial pressure target after resuscitation was mostly (91.5%) 65-75 mmHg, and the most preferred inotropic agent was noradrenaline (81.2%). It was determined that 52.1% of the participants applied targeted temperature management and continued for 24 h. Neuroprognostic evaluation was performed after 24 h, and most commonly Glasgow coma scale (96.6%), pupillary and corneal reflexes (92.2%), and computerized brain tomography (60.3%) were used. However, it was observed that biomarkers and neurophysiological methods were used less frequently. Conclusion: In this study, it was observed that there were differences in practices according to hospital conditions in post-resuscitation care, but physicians generally followed international guidelines. Simultaneously, it is considered that in addition to the international guidelines, national guidelines are necessary in accordance with the conditions of our country, and training was needed for standard applications.

Abstract Background The objective of this study was to evaluate the impact of nursing interventions on sleep quality in hospitalized patients. Methods A comprehensive literature search was conducted, encompassing databases such as PubMed/MEDLINE, Scopus, Web of Science, EMBASE, ProQuest, Science Direct, and Cochrane Library, with publications up until September 2022 being considered. A random-effects model was utilized to calculate standardized mean differences (SMD) and 95% confidence intervals (CIs) for continuous outcomes. Results A total of 77 studies involving 7771 participants were included in the systematic review. Among these, 18 studies met the inclusion criteria for the meta-analysis, involving a total of 1153 participants. The meta-analysis results indicated a positive effect of nursing interventions on sleep quality, as measured by the Pittsburgh Sleep Quality Index (PSQI) score (SMD = −4.21, 95% CI = −5.75 to −2.67, P

Introduction: Estimating intensive care admission of orthopedic patients is challenging because of patient variance and multiple comorbidities, primarily in geriatrics, and not yet standardized for the planned and qualified utility of hospital services. This study aimed to reveal the perioperative risk scores of orthopedic patients followed postoperatively in intensive care to investigate the efficacy of these scores in predicting intensive care admission and mortality. Methods: Patients transferred from the orthopedic ward to the intensive care unit (ICU) at any time during their postoperative follow-up from 2022 to 2023 were investigated. Primarily searched scores were the Surgical Apgar, Wells for pulmonary embolism, Charlson Comorbidity Index, ARISCAT for Postoperative Pulmonary Complications preoperatively, and Simplified Acute Physiology III, Sequential Organ Failure Assessment (SOFA), quick-SOFA, and Acute Physiology and Chronic Health Evaluation postoperatively. These scores were evaluated in relation to total intensive care and hospital stay with mortality. Results: The majority of the study population was found to be ASA-2 (45%). Ninety-eight percent of the patients were admitted to the ICU within three postoperative days, with the indication of planned postoperative follow-up mainly after proximal femoral nailing (24%). Among preoperative scores, wells had a significant positive correlation with ICU readmission and length of ICU stay (r=0.32, p=0.001). 62.7% of the patients had severe Charlson Comorbidity Risk Index. Up to postoperative scores, SAPS3 had a significant positive correlation with total ICU and hospital stay, with a significant difference in mortality (p=

We studied 50 patients with invasive nocardiosis treated during 2004–2023 in intensive care centers in France and Belgium. Most (65%) died in the intensive care unit or in the year after admission. Nocardia infections should be included in the differential diagnoses for patients in the intensive care setting.

Healthcare-associated infections pose a significant risk for patients and a tremendous burden on hospitals and healthcare systems. Because they can significantly affect treatment outcomes, rigorous surveillance and prevention strategies are key interventions against their occurrence. With the growing problem of antimicrobial resistance, further aggravated throughout the COVID-19 pandemic, it has become challenging to find viable therapeutic options. This is particularly the case in intensive care units, where pathogens exhibit the highest resistance rates. Surveillance of healthcare-associated infections comprises continuous monitoring of causative agents, infection types, and the degree of antimicrobial resistance. Such data can inform intervention choices aimed at prevention, but they are critical in selecting the right empirical and targeted treatment. Alongside clinical, epidemiological, and microbiological data, economic analyses are an equally important aspect of healthcare-associated infection surveillance. They provide key insights into the financial burden on hospitals that are responsible for effective preventative measures. Serbia is, according to national data, a country with one of the lowest rates of healthcare-associated infections in Europe, but has one of the highest antimicrobial resistance rates in Europe. These findings point to a need for systemic changes, including more rational antibiotic use and education of the general public, but also of healthcare professionals, with the idea of preventing further progression and impact on treatment outcomes.

Summary: Background: The circadian timing system coordinates daily cycles in physiological functions, including glucose metabolism and insulin sensitivity. Here, the aim was to characterise the 24-h variation in glucose levels in critically ill patients during continuous enteral nutrition after controlling for potential sources of bias. Methods: Time-stamped clinical data from adult patients who stayed in the Intensive Care Unit (ICU) for at least 4 days and received enteral nutrition were extracted from the Medical Information Mart for Intensive Care (MIMIC)-IV database. Linear mixed-effects and XGBoost modelling were used to determine the effect of time of day on blood glucose values. Findings: In total, 207,647 glucose measurements collected during enteral nutrition were available from 6,929 ICU patients (3,948 males and 2,981 females). Using linear mixed-effects modelling, time of day had a significant effect on blood glucose levels (p

Objective: This study was conducted to investigate the relationships between workload perception and the work-life balance of intensive care nurses working during the pandemic. Materials and Methods: Descriptive and cross-sectional research was conducted with 325 intensive care nurses who were members of the Turkish Intensive Care Nurses Association. Data were collected via WhatsApp using Google Surveys for a Nurse Information form, the Individual Workload Perception scale, and the Work-Life Balance scale. Pearson’s correlation and regression analyses were used for the data analysis in addition to descriptive statistics. Results: The total average score of the Personal Workload Scale of the intensive care nurses was 3.26±0.60 [minimum (min): 1.71; maximum (max): 4.87] and the total average score of the Work-life Balance scale was 2.79±0.710 (min: 1.3; max: 4.9). The Workload scale total average score significantly increased the Work-life Balance total average score (β=0.658). Daily work time in the intensive care unit significantly decreased the work-life balance total average score (β=-0.160). Conclusion: Intensive care nurses’ workload perception and work-life balance were at a moderate level. Workload and long working hours deteriorate the work-life balance of intensive care nurses. Administrative and organizational regulations to enhance the work-life balance of the intensive care nurses by decreasing the workload can be effective in reaching the desired patient care results.

Objective: Intensive care subspecialty programs have been opened in many medical faculties and training-research hospitals in our country, and intensivists who have graduated are working in the field. The aim of this study aimed to collect information about the status of intensive care subspecialty education and the working conditions of intensive care specialists working in the field. Materials and Methods: After obtaining the ethics committee approval, three questionnaires for intensive care subspecialty educational staff (ES), research assistants (RA), and graduated specialists (PG) were prepared through the Google Survey and published on social media. In the questionnaires, the status of education and working conditions in the field after graduation were questioned. The descriptive statistics method was used for analysis. Results: The questionnaires were answered by 38 ES, 99 RA, and 46 PG. Fifty-four percent of the ES were between the ages of 51 and 60 and 65.8% were women. Fifty-one percent of ES were working in a university hospital. Forty-seven percent of full-time ES were working in the department of anesthesiology and reanimation subdepartment of intensive care, and the rate of participation of all partner clinics in the program was 86.5%. Twenty-seven (71.1%) of the ES thought that the TUKMOS core training program should be changed. The main specialty of 54.5% of RAs were anesthesiology and reanimation, and 52% of them were studying at a state university. The rate of those who were on duty at the hospital was 87.8%, and the rate of those who described the rotation training as “medium” was 36.5%. Sixty-five percent of the PGs were anesthesiology and reanimation specialists, and 64.4% said that they would like to primarily work in training and research hospitals in terms of efficiency and qualit; 87% of them stated that intensive care specialists should be able to work in any kind of intensive care unit, 69.6% thinks that the education they receive is sufficient. Conclusion: We believe that evaluating and sharing the data of this study may cause positive changes in intensive care subspecialty education and post-graduate working conditions.

Accurate measurement of body temperature is crucial post-cardiovascular surgery, given the intricate and high-risk nature of cardiovascular procedures. In this prospective observational study, the safety and efficacy of infrared tympanic thermometers (ITT) and non-contact infrared temporal artery thermometers (NCTAT) were assessed in intensive care patients recovering from cardiovascular surgery. Conducted at a state hospital in Istanbul from April to July 2016, the study included 60 eligible patients meeting the specified criteria. Results indicated a slightly higher body temperature measurement with ITT (36.42±0.72) compared to NCTAT (36.02±0.79). NCTAT and ITT values were found (right ear: bias =0.39°C, limits of agreement: -1.99°C to 1.21°C; left ear: bias =0.29°C, limits of agreement: -1.59°C to 1.01°C) in the statistical evaluation by Bland and Altman analysis method. Repeatability, intragroup correlation and scatter plots of both measuring devices did not show a significant difference. In conclusion, within the cardiovascular surgical intensive care unit, both types of thermometers prove suitable for body temperature measurement. Healthcare professionals can make informed choices between the two based on the distinct advantages and disadvantages associated with each device. [Med-Science 2023; 12(4.000): 1244-9]

Abstract Background Prone position is used in acute respiratory distress syndrome and in coronavirus disease 2019 (Covid-19) acute respiratory distress syndrome (ARDS). However, physiological mechanisms remain unclear. The aim of this study was to determine whether improved oxygenation was related to pulmonary shunt fraction (Q’s/Q’t), alveolar dead space (Vd/Vtalv) and ventilation/perfusion mismatch (V’A/Q’). Methods This was an international, prospective, observational, multicenter, cohort study, including six intensive care units in Sweden and Poland and 71 mechanically ventilated adult patients. Results Prone position increased PaO2:FiO2 after 30 min, by 78% (83–148 mm Hg). The effect persisted 120 min after return to supine (p

Background and purpose: Nurses working in the intensive care unit (ICU) face more ethical conflicts in caring for COVID-19 patients. The present study aimed to assess the relationship between moral disengagement and the quality of nursing care in nurses caring for Covid-19 patients hospitalized in the special ICU department of medical-educational centers affiliated with Mazandaran University of Medical Sciences. Materials and methods: This descriptive cross-sectional study was conducted on 150 nurses caring for COVID-19 patients hospitalized in the ICU of Mazandaran University of Medical Sciences from 2021 to 2022. Date collection tools included demographic information questionnaires, Fida et al.'s moral disengagement, and nursing care quality. Data analysis was performed using descriptive (frequency, percentage, mean, standard deviation) and inferential (Pearson correlation coefficient and linear regression) statistics. Results: The moral disengagement score of nurses was 40.58±8.64. The mean scores of quality of nursing care in total, psychosocial dimension, communication dimension, and physical dimension were 177.3±13.25, 74.92±6.50, 36.80± 2.82, and 66.73±5.45, respectively. No significant relationship was observed between the quality of nursing care and moral disengagement (P>0.05). Conclusion: The lack of a significant relationship between the quality of nursing care and moral disengagement in the present study was in the condition of the COVID-19 pandemic when people were under high organizational and psychological pressures. Therefore, for a better conclusion, it is suggested that this research be carried out in non-emergency conditions and after the pandemic again in the inpatient wards of infected patients.

Introduction: Post-intensive care syndrome (PICS) is defined as “new or deteriorating physical, cognitive, or mental health state after intensive care”. This study compared patients with and without a diagnosis of coronavirus disease-2019 (COVID-19) who received noninvasive mechanical ventilation support in the intensive care unit and were monitored for the onset of PICS. Methods: Retrospective imaging was performed on 50 COVID-positive and 50 non-COVID patients who were over 18 years of age and receiving non-invasive mechanical ventilation. The Mini Mental State test, Beck Depression test, Beck Anxiety test, and Post-Traumatic Stress Disorder test were administered to the patients to evaluate cognitive and psychiatric functioning after contacting them via the hospital system and obtaining the required consents. Results: Patients with COVID had longer stays in the ICU (p

Abstract Introduction Bacteremia caused by Serratia rubidaea is seldom mentioned in comparison with other Enterobacteriaceae species. It primarily affects immunocompromised patients undergoing invasive procedures. Furthermore, the incidence, clinical features, and microbiological profile of this pathogen in the intensive care unit are rarely described. Case presentation We present four North African case studies of bacteremia in four young female patients admitted to the intensive care unit for ketoacidosis with a history of diabetes mellitus. All four patients developed catheter-related infections complicated by deep vein thrombosis. The catheter site was femoral in all cases, and the main clinical manifestation was poorly tolerated fever. The pathogen was isolated in multiple peripheral blood cultures (> 4) for each patient, showing a similar profile in all cases: resistance to third-generation cephalosporins and sensitivity to aminoglycosides, piperacillin, fluoroquinolones, and folate-pathway inhibitors. Targeted treatment consisted of a combination of ciprofloxacin 400 mg twice per day and trimethoprim/sulfamethoxazole 400/80 mg thrice per day for all four cases. However, in one case, this regimen was switched to amikacin due to adverse effects. The outcomes were favorable in the majority of cases. The patients described in this study were 21, 66, 22, and 27-year-old North African women. Conclusion Most of the reported cases shared common risk factors and clinical aspects. Notably, a case of thrombosis complicating a catheter infection caused by Serratia rubidaea has not been previously reported in the literature. Furthermore, this bloodstream infection typically affects deeply immunocompromised patients. However, our four cases, admitted to the intensive care unit for ketoacidosis, only had a history of diabetes mellitus.

Introduction: The infant mortality rate is one of the most important parameters for evaluating the health index in societies. The present study aimed to investigate the mortality rate of infants hospitalized in the neonatal intensive care unit (NICU) (Ayatollah Taleghani Hospital, Ilam) from 2018-2019. Material & Methods: This cross-sectional descriptive study was conducted on infants hospitalized in the NICU department of Ayatollah Taleghani Hospital in Ilam, from April 2018 to March 2019. The sampling was performed using the census method. The data collection tools included a demographic questionnaire and a researcher-made checklist. The collected data were analyzed in SPSS software (version 26) using chi-square and independent t-tests at a significance level (P0.05). Discussion & Conclusion: Due to the high mortality rate in premature neonates with less than 32 weeks of gestation, effective measures should be put on the agenda to prevent premature birth and respiratory distress syndrome.

Abstract Background Currently, evidence about the long-term consequences of COVID-19 on return to work and health-related quality of life (HRQoL) is limited. We evaluated return to work and its associations with baseline characteristics and physical and mental recovery over time in patients up to 1 year after hospitalization for COVID-19. Secondly, we aimed to evaluate the association between return to work and health-related quality of life (HRQoL). Methods CO-FLOW, a multicenter prospective cohort study, enrolled adult participants hospitalized for COVID-19, aged ≥ 18 years within 6 months after hospital discharge. Return to work and HRQoL were collected at 3, 6, and 12 months after hospital discharge using the iMTA Productivity Cost Questionnaire and the 36-Item Short Form Health Survey, respectively. Data were collected between July 1, 2020, and September 1, 2022. Generalized estimating equations with repeated measurements were used to assess outcomes over time. Results In the CO-FLOW study, 371 participants were employed pre-hospitalization. At 3, 6, and 12 months post-discharge, 50% (170/342), 29% (92/317), and 15% (44/295) of participants had not returned to work, and 21% (71/342), 21% (65/317), and 16% (48/295) only partially, respectively. ICU admission (adjusted odds ratio (95% confidence interval): 0.17 (0.10 to 0.30), p

Severe viral infections often result in abnormal platelet function, affecting various stages of hemostasis. Activated platelets are often considered prothrombotic and more susceptible to further stimulation. However, emerging evidence suggests that initial hyperactivation is followed by platelet exhaustion and hypo-responsiveness, affecting platelet degranulation, activation, and aggregation. We examined early alterations in platelet aggregation among patients (N = 28) with acute respiratory distress syndrome and SARS-CoV-2 infection who were receiving mechanical ventilation and venovenous extracorporeal membrane oxygenation support. Blood samples were stimulated with four different activators: arachidonic acid, adenosine diphosphate, thrombin receptor-activating protein 6, and ristocetin. Our observations revealed that platelet aggregation was reduced in most patients upon admission (ranging from 61 to 89%, depending on the agonist used), and this trend intensified during the 5-day observation period. Concurrently, other coagulation parameters remained within normal ranges, except for elevated d-dimer and fibrinogen levels. Importantly, we found a significant association between platelet aggregation and patient mortality. Impaired platelet aggregation was more severe in patients who ultimately died, and reduced aggregation was associated with a significantly lower probability of survival, as confirmed by Kaplan–Meier analysis (p = 0.028). These findings underscore the potential of aggregometry as an early detection tool for identifying patients at higher risk of mortality within this specific cohort.

Alcohol withdrawal syndrome (AWS) is defined as the cessation or reduction in heavy and prolonged alcohol use within several hours to a few days of cessation. The recommended first-line therapy for AWS ranging from mild to severe or complicated remains benzodiazepines; in cases where benzodiazepines are not adequate in controlling persistent autonomic hyperactivity or anxiety, dexmedetomidine could be utilized. The possible advantage of dexmedetomidine compared to benzodiazepines is that it does not cause respiratory depression, thus reducing the risk of intubation and hospitalization in the ICUs, with the potential reduction in healthcare costs. The purpose of this systematic review and meta-analysis (PROSPERO CRD42018084370) is to evaluate the effectiveness and safety of dexmedetomidine as adjunctive therapy to the standard of care for the treatment of AWS. We retrieved literature from PubMed, EMBASE, and CENTRAL until 10 January 2024. Eligible studies were both randomized trials and nonrandomised studies with a control group, published in the English language and peer-reviewed journals. The primary outcome was tracheal intubation; secondary outcomes were (i) bradycardia and (ii) hypotension. A total of 3585 papers were retrieved: 2635 from EMBASE, 930 from Medline, and 20 from CENTRAL. After eliminating duplicates, 2960 papers were screened by title and abstract; 75 out of the 2960 papers were read in full text. The qualitative synthesis included nine of all manuscripts read in full text. The quantitative synthesis included eight studies for the primary outcome (tracheal intubation), seven for the secondary outcome bradycardia, and six for the secondary outcome hypotension. The meta-analysis showed that Dexmedetomidine, as adjunctive therapy, is not more effective than standard therapy in reducing the risk of tracheal intubation in AWS [RR: 0.57, 95% CI: 0.25–1.3, p = 0.15]. It also appears to be less safe than sedative therapy as it significantly increases the risk of bradycardia [RR: 2.68, 95% CI: 1.79–4.16, p = 0.0016]. Hypotension was not significantly different in patients who received dexmedetomidine [RR: 1.5, 95% CI: 0.69–3.49, p = 0.21].

Coronavirus 2 or SARS-CoV-2 is predominantly manifests as a respiratory infection; however, it has been linked to a spectrum of neurological disorders such as vertigo, cephalalgia, cognitive impairment, myalgia, and anosmia. Emerging reports indicate several neurological illnesses that coincide with COVID-19, such as encephalitis and, notably, stroke. In this report, We present an instance of a patient infected with COVID-19 with Guillain-Barré Syndrome in this case report. Guillain-Barre Syndrome (GBS) is an inflammatory polyradiculoneuropathy linked to various viral infections. We present the case of a 76-year-old female patient hospitalized with acute progressive symmetric ascending quadriparesis. Seven days before hospitalization, the patient experienced fever and cough with RT-PCR testing confirmed a positive COVID-19 infection. Cerebrospinal fluid analysis revealed dissociation of cytoalbumin. Coronavirus stimulates inflammatory cells and produces various cytokines, leading to immune-mediated processes. GBS represents an immune-mediated disorder, with its pathogenesis intricately influenced by the pivotal role of molecular mimicry in its onset. Plasmapheresis was performed, resulting in an improved clinical outcome for the patient.

Introduction: PICU admission of a child may cause anxiety and stress among the caregivers. The criteria for admission to a PICU are terrifying and may legitimately cause parents to fear that their child may pass away or suffer a serious disability. They may be overburdened with stress and anxiety of illness and compliment medical information while trying to maintain a balance with other family demands. They must learn coping mechanisms and use resources to stay stable when they face challenges. Evidence on the coping mechanisms used by primary caregivers to control their stress and anxiety is scarce so this study assessed the anxiety and coping mechanism among the primary caregivers of children admitted in PICU. Materials and Methods: A cross-sectional study was conducted among 143 primary caregivers by using convenience sampling technique at PICU, AIIMS, Jodhpur, from April 31, 2021, to January 20, 2022. The participants were enrolled after obtaining informed consent and were interviewed by the researcher. Results: Study findings revealed that primary caregivers had 38% severe anxiety, 54% moderate anxiety, and 8% mild anxiety. They used emotion-focused coping (43.5%) followed by problem focused coping (37.2%) and avoidant coping (19.3%). Also, there was a significant association found between anxiety of primary caregivers and gender of the child (P = 0.012). Conclusion: Anxiety and stress are one of the expected psychological problems faced by caregivers of children admitted in PICU. Healthcare workers must make concerted attempts to support caregivers adaptive coping mechanisms, so they can retain a sense of balance.

Objective:Left ventricular assist device surgery (LVAD) associated acute kidney injury (AKI) is a severe complication of cardiac surgery with 15-45% incidence. The study evaluated AKI in the early postoperative period after LVAD surgery using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria and compare patients with and without AKI to determine the incidence, risk factors, and clinical outcomes.Materials and Methods:In this retrospective cohort study, the medical records of all patients aged between 18 and 75 years who underwent LVAD implantation from January 2011 to December 2016 were reviewed. Patients were divided into two groups based on the development of AKI to analyze demographic features and perioperative variables. AKI was defined according to the KDIGO criteria.Results:Out of 57 patients, 10 (18%) were female, and the cohort’s mean age was 44.6±16.1 years. Thirty-six patients (63%) developed AKI following LVAD implantation. Logistic regression analysis revealed the duration of cardiopulmonary bypass (CPB), mean arterial pressure, and cumulative fluid balance on the first postoperative day as independent risk factors for AKI [odds ratio (OR): 1.013, confidence interval (CI) 95% 1.000-1.025, p=0.05; OR: 0.929, CI 95% 0.873-0.989, p=0.02; OR: 1.001, CI 95% 1.000-1.001, p=0.04 respectively]. Hospital mortality (58% vs. 24%, p=0.01) and 30-day mortality (39% vs. 5%, p=0.01) were significantly higher in patients who had AKI.Conclusion:Risk factors for the occurrence of AKI include a longer duration of CPB, lower mean arterial pressures, and higher cumulative fluid balance on the first postoperative day. Therefore, AKI is one of the most important causes of morbidity and mortality after LVAD.

Introduction:Critically ill children often require transport during diagnosis and treatment procedures during intensive care hospitalization. With this study, it was aimed to evaluate the practice of transport and the problems encountered during transport in pediatric intensive care units in Turkey.Methods:A questionnaire consisting of 18 questions was filled in with internet access by the head nurses of the pediatric intensive care unit, who agreed to participate in the study. Responses to questions about the characteristics of the participating centers, transport practices, problems encountered during transport, interventions and the registration system were evaluated.Results:A total of 29 tertiary pediatric intensive care units from 8 provinces in Turkey were included in the study. The mean number of beds was 14. In most pediatric intensive care units, 5 to 10 patients (51.7%) were transferred within 1 week. It was observed that the most patients were transported to the inpatient service (89.7%), followed by the operating room (69%). There was a protocol for patient transport in 69% of the units. The transport decision was made by the responsible specialist physician at a rate of 96.6%. 65% of the participants stated that the transport was recorded on a form. Transports were accompanied by 93% nurses, 86% allied health personnel, and 79% doctors. In 20 centers (69%), transport was possible with an invasive mechanical ventilator and 11 (37.9%) with a non-invasive mechanical ventilator. The most common problem encountered during transportation was the inadequacy of the physical conditions of the hospital (48.3%). There were 4 (13.8%) participants who encountered problems during patient transport in the last week. It was stated that the oxygen tube was depleted in one of them, and respiratory arrest developed in another patient.Conclusion:In this study, it was shown that; In our country, there are significant differences in intrahospital transport conditions, transport teams, equipment used during transport between centers. Transport standards should be established and these should take into account the conditions of our country. For these, compliance and monitoring mechanisms should be established.

Background and purpose: As direct and continuous care providers to patients, nurses face various types of psychological stress in the work environment more than other groups. Meanwhile, moral distress in special care units is much more impressive. This study aimed to explain the moral distress experienced by nurses that provided care to patients with COVID-19 patients in special care units. Materials and methods: We performed a conventional qualitative content analysis in 2020-2021. The study population included nurses caring for COVID-19 patients in special care units selected by purposive sampling in educational hospitals affiliated with Mazandaran University of Medical Sciences. In-depth, semi-structured interviews were carried out for data collection. Graneheim and Lundman qualitative approach was used to analyze the data. The trustworthiness of the study was assessed by Guba and Lincoln's stringent criteria. Results: In this study, 14 nurses (25-48 yeas of age) were interviewed. We found three main layers and eight sub-layers, including multiple annoyances (mental and physical stress, negative effects on family and friends relationships, negative effects on professional work), work pressure (hard conditions of the patient and companion, difficulty and work stress, weak management), and persistence and adaptation (self-protection, coping with difficult conditions). Conclusion: Based on this study, nurses should be encouraged to express their feelings so that they can establish a balance between the difficulty of ethical decisions and meeting the patient's needs and managing their emotions.

Abstract Background and Aims Critically ill patients with liver failure have high mortality. Besides the management of organ‐specific complications, liver transplantation constitutes a definitive treatment. However, clinicians may hesitate to introduce mechanical ventilation for patients on liver transplantation waitlists because of poor prognosis. This study investigated the outcomes of intensive care and ventilation support therapy effects in patients with liver failure. Methods This single‐center study retrospectively enrolled 32 consecutive patients with liver failure who were admitted to the intensive care unit from January 2014 to December 2020. The medical records were reviewed and analyzed retrospectively for Acute Physiologic and Chronic Health Evaluation (APACHE)‐II. The model for end‐stage liver disease scores, 90‐day mortality, and survival was assessed using the Kaplan–Meier method. Results The average patient age was 45.5 ± 20.1 years, and 53% of patients were women. On intensive care unit admission, APACHE‐II and model for end‐stage liver disease scores were 20 and 28, respectively. Among 13 patients considered for liver transplantation, 4 received transplants. Thirteen patients (40.6%) were intubated and mechanically ventilated in the intensive care unit. The 90‐day mortality rate of patients with and without mechanical ventilation in the intensive care unit (13, 61.5% vs. 19, 47.4%, p = 0.4905) was similar. APACHE‐II score >21 was an independent predictor of mechanical ventilation requirement in patients with liver failure during intensive care unit stay. Conclusion Although critically ill patients with liver failure are at risk of multiorgan failure with poor outcomes, mechanical ventilation did not negatively affect the 90‐day mortality or performance rates of liver transplantation. Clinicians should consider mechanical ventilation‐based life support in critically ill patients with liver failure who are awaiting liver transplantation.

Background. Pathophysiological processes in lungs in COVID-19 have some similarities with macrophage activation syndrome, disseminated intravascular coagulation, which occur in other diseases and correspond to modern paradigm of “thrombosis”. Antiaggregants can influence the COVID-19 as contributing factors in reducing the level of “thrombosis” and preventing platelet aggregation. It is possible to assess the role of platelet aggregation in COVID-19 using aggregograms. The purpose of the study is to compare the aggregograms of patients without antiaggregant and those receiving standard-dose antiaggregant at COVID-19. Materials and methods. The study included 55 patients aged 41 to 75 years (mean age 63.9±1.3 years). There were 32 men and 23 women. The patients were divided into 2 groups according to the pattern of anti-aggregates use in the intensive care protocol: Group 1 (26 patients) - patients who did not take antiplatelet agents before COVID-19, but started for thromboprophylaxis as prescribed by a doctor in the intensive care unit. Group 2 (29 patients) - patients who had not taken antiplatelet agents before COVID-19 and did not take them during COVID-19 treatment in the ICU. Results. Analyzing the platelet aggregation indices of patients in groups 1 and 2, both groups of patients have a tendency to an increased rate of platelet aggregation by the inducer ADP at 0,5; 1.0;2.0 mmol/l compared with normal reference values. Conclusions. The above indicates the development of platelet hyperaggregation with vasculitis in both groups, which is characteristic of the systemic inflammatory response syndrome in COVID-19 and supports the “thrombosis” theory. The average increase in aggregation was no more than 20% of the reference values. In the treatment of group 1 patients on the 5th day, positive dynamics in the reduction of platelet aggregation capacity was observed when platelets were incubated with ADP at dilutions of 0.5; 1.0 and 2.0 mmol/l, respectively. This indicated a decrease in platelet aggregation capacity, which is undoubtedly an additional factor in reducing the risk of thrombosis.

Genetic counselors (GCs) face unique challenges in the acute care setting. Acute care environments—such as neonatal and pediatric intensive care units—are characterized by urgency, complexity, and rapid decision making. These settings require GCs to navigate a delicate balance between addressing the immediate clinical needs of patients and providing comprehensive genetic information to families, while demanding adaptation of existing skills for practice.Rapid genomic testing (rGT) is increasingly becoming standard of care in acute care. GCs are well placed to support families through the rGT process. Despite this, there is a lack of consistency in the provision of comprehensive acute care genetic counseling globally and a subsequent need for professional guidance in this area.The Acute Care Genomics study piloted a national approach to delivering rGT for infants and children admitted to intensive care units in Australia with suspected genetic conditions between 2018 and 2022. GCs from across Australia were involved in both pre- and post-test counseling for the families of these critically unwell children. Based on our collective experience of delivering this national rGT program, this article provides a discussion of common challenges for health professionals new to delivering rGT in intensive care. We share some practical solutions and make recommendations for supporting families in this area of practice.

Uterine fibroids are a common gynaecological condition that can sometimes be large and multiple, significantly impacting the affected woman's quality of life. Managing multiple fibroids in women who want to preserve their fertility can be complex, as myomectomy is more challenging compared to hysterectomy. A 30-year-old woman was admitted with complaints of heavy menstrual bleeding, severe anaemia, and an abdominal mass equivalent to a 36-week gravid uterus. Ultrasound followed by Magnetic Resonance Imaging (MRI) revealed multiple fibroids. Since she strongly desired to preserve her fertility, an abdominal myomectomy was planned. The present case highlights the removal of 147 fibroids from the patient, along with a discussion on the challenges faced during surgery and the postoperative period. The authors emphasises that such cases require a highly multidisciplinary approach and should be performed in institutions with adequate blood banks and intensive care support.