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Background Methods Results Conclusions Oesophagectomy for surgical management of oesophageal carcinoma has previously been performed via an open approach (OE), with a change in recent years to a minimally invasive technique (MIO). We performed a retrospective study to compare the rates of post‐operative complications between OE and MIO patients at our institution. Secondary outcomes included nodal yield and ICU LOS.This is a retrospective, observational, case‐matched single centre study of 2‐stage oesophagectomies for carcinoma from January 2011 to December 2021. Fourty‐four MIO patients were matched by age to 44 OE patients. Post‐operative pulmonary, cardiac and surgical complications were defined using the Esophagectomy Complications Consensus Group (ECCG) guidelines.Baseline characteristics were similar for the two groups, with a higher ASA grade for patients undergoing MIO. There was no significant difference in post‐operative pulmonary complication rates between the OE versus MIO groups (41% versus 55%, P = 0.29). There were more cardiac arrhythmias in the MIO group however this was not statistically significant (9.1% versus 22.7%, P = 0.08). Rate of re‐operation was equal between the groups with no difference between rates of other surgical complications, ICU LOS or hospital LOS. Significantly higher nodal yield was achieved in the MIO group. Overall rate of Clavien‐Dindo graded complications were similar (55% versus 66%, P = 0.28).MIO was associated with higher lymph node yield, and comparable complication rates when compared to OE and does not significantly alter time spent in hospital. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Background: Patients with lymphoma may require intensive care (ICU) because of disease- or treatment-related complications. The lymphoma–HIV interaction complicates management, but whether outcomes are worse in these patients, when critically ill, is unclear. A retrospective observational cohort study reviewed outcomes of patients admitted to ICU, subsequent 5-year survival, and prognostic factors. Setting: Academic ICU at the UK National Centre for HIV Malignancy. Methods: Records between 2007 and 2020 identified the following cohorts: HIV lymphoma, lymphoma alone, HIV alone, and patients without HIV/lymphoma. Patient demographics, lymphoma characteristics, ICU admission data, and survival outcomes were collected. Five-year survival outcomes were analyzed for the lymphoma cohorts. ICU outcomes were analyzed for all cohorts. Descriptive statistics summarized baseline characteristics and outcomes. Multivariate regression identified factors associated with ICU mortality. Results: Of 5929 patients admitted to the ICU, 63 had HIV lymphoma and 43 had lymphoma alone. Survival to ICU discharge was 71% and 72%, respectively. Adjusted log-odds ratio for ICU survival was significantly better in the comparator cohort. ICU survival between the HIV lymphoma and lymphoma-alone cohorts was not significantly different. Adjusted 5-year survival was not significantly different between lymphoma cohorts. Factors independently associated with a worse ICU survival prognosis were emergency admissions, Acute Physiology and Chronic Health Evaluation II score, initial lactate, and day requiring level 3 support. Mechanical ventilation and higher Acute Physiology and Chronic Health Evaluation II scores were independent risk factors for worse 5-year survival in the lymphoma cohorts. Conclusions: ICU outcomes and 5-year survival rates of patients with lymphoma were unaffected by HIV status, revealing favorable outcomes in patients with HIV-related lymphoma admitted to the ICU. [ABSTRACT FROM AUTHOR]

Summary Introduction Methods Results Discussion Cognitive impairment is a significant healthcare problem globally and its prevalence is projected to affect over 150 million people worldwide. Survivors of critical illness are impacted frequently by long‐term neurocognitive dysfunction regardless of presenting illness, but the mechanisms are poorly understood. The goal of this review was to synthesise the existing evidence regarding potential mechanisms underlying neurocognitive dysfunction following critical illness in order to guide potential avenues for future research.We performed a systematic search of the literature for studies published between 1 January 1974 and 15 July 2023. We included publications involving adult patients with critical illness due to any aetiology that assessed for cognitive impairment following recovery from illness, and explored or investigated potential underlying causative mechanisms. The quality and risk of bias of the individual studies was assessed using the Newcastle‐Ottawa scale.Of the 7658 reviewed references, 37 studies comprising 4344 patients were selected for inclusion. Most studies were single centre with sample sizes of < 100 patients. The proportion of patients with long‐term cognitive impairment ranged from 13% to 100%. A wide variety of theoretical mechanisms were explored, with biomarkers and neuroimaging utilised most frequently. Many studies reported associations between investigated mechanisms and reduced cognition; several of these mechanisms have been implicated in other forms of long‐term neurodegenerative conditions. Increased levels of inflammatory cytokines during acute illness and white matter hyperintensities on neuroimaging following recovery were the associations reported most commonly.The underlying pathophysiology of neurocognitive decline after critical illness is not yet understood fully. The mechanisms implicated in other neurodegenerative conditions suggest that this may represent an accelerated version of the same processes. Large scale studies are required to further elucidate the cause of this significant problem for survivors of critical illness. [ABSTRACT FROM AUTHOR]

Background Aims Materials and methods Results Conclusions Pregnant and post‐partum (collectively peri‐partum) women may be at increased risk of severe COVID‐19 disease.To describe the characteristics, interventions, and outcomes of peri‐partum patients admitted to intensive care units (ICUs) in Australia with COVID‐19.We conducted a prospective, multicentre observational study using the SPRINT‐SARI Australia database across 63 ICUs in Australia. All women <45 years of age, admitted to a participating Australian ICU, with laboratory‐confirmed COVID‐19 between 1 March 2020 and 1 June 2023 were included. Participants were categorised as either peri‐partum, defined as pregnant or up to six weeks post‐partum, or non‐pregnant. The primary outcome was in‐hospital mortality.A total of 737 eligible female patients were admitted to ICUs over the study period: 168/737 (23%) were peri‐partum, while 569/737 (77%) were non‐pregnant. The median age of peri‐partum women was 31 (interquartile range (IQR) 27–36) years old, and median gestation was 28.0 (IQR 4–40) weeks. When compared to non‐pregnant women, peri‐partum women had lower rates of comorbidities (1.8% vs 14.4% P < 0.001), lower vaccination rates (27.4% vs 45.2%, P < 0.001), similar rates of mechanical ventilation, and greater use of tocilizumab (29.2% vs 4.0%, P < 0.001). Complications were low in both groups. In‐hospital mortality was lower in peri‐partum patients: 1/168 (0.6%) vs 24/569 (4.2%); P = 0.04.Peri‐partum patients made up ~25% of all women aged <45 years old admitted to Australian ICUs with COVID‐19, and nearly 30% required mechanical ventilation. Despite lower vaccination rates in peri‐partum patients, in‐hospital mortality was lower than in non‐pregnant patients. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Design Methods Results Conclusion Implications for the Profession Impact Reporting Method Patient or Public Contribution To explore the perspectives of nurse educators, clinical nurse educators and nurse specialists with regard to supporting the deployed registered nurses in Australian intensive care units during the COVID‐19 pandemic surge.A qualitative‐descriptive study design was used.Intensive care nurse educators, clinical nurse educators and nurse specialists who had been involved with the preparation and support of nurses for deployment to intensive care units for COVID‐19 surge were purposively recruited from around Australia. Data were collected through 18 semi‐structured interviews and examined using thematic framework analysis of NVivo software.Participants described a number of challenges related to surge deployment including the varied skill sets and inadequate preparation for deployed staff, lack of a clear scope of practice and their general reluctance to deploy to intensive care units. Mixed communication from hospital managers about the mandatory or voluntary nature of deployments and the plans for return of nurses to their usual place of work were also considered problematic. Conversely, factors that supported effective deployment included consistently deploying the same staff, scope of practice guides, task cards and colour coding to identify the experience of nurses. The burden of the pandemic, including variable waves of surge, infection control complexities and fear of caring for patients with COVID‐19, influenced the participants' experiences and perspectives. Additionally, there was a significant personal toll for participants because of the increased load of supervising deployed staff and concerns related to accountability for nursing care, and personal and patient safety.The deployment of nursing staff to intensive care units to support increased patient numbers is necessary during surge events. Having clarity about what role those nurses perform within intensive care units is essential in order to design training and support strategies that prepare them adequately so as not to place undue burden on an already strained intensive care nursing workforce.The toll of the COVID pandemic on ICU nurses was immense. This was further compounded by inadequate preparation and the strain of supporting deployed nurses in surged intensive care units.This research outlines the lessons learned from deploying nurses into surged intensive care units in the Australian setting. Supporting deployed nurses places a significant burden on the intensive care team; this is heavier when there is uncertainty about the scope of deployed staff and accountability for patient safety. These findings contribute to the body of evidence that will assist in for planning more effective deployment strategies for future intensive care surge events.Reporting complied with the COREQ criteria for qualitative research.There was no patient or public contribution. [ABSTRACT FROM AUTHOR]

Acute respiratory distress syndrome (ARDS) is a complex disease pattern in which pathogenesis polymorphonuclear neutrophil granulocytes (PMN) play a key role. In previous experiments, we could show that interaction with collagen III (an important component of pulmonary tissue) is a possible trigger of neutrophil reactive oxygen species (ROS) production. To investigate possible correlations, further elucidate ARDS pathophysiology, and maybe find pharmacological targets, we evaluated PMNs from blood (circulating PMNs: cPMNs) and tracheal secretion (tPMNs) from patients with and without ARDS with regard to function and phenotype. Blood samples and tracheal secretions were obtained from intensive care patients with and without ARDS. Isolation of cPMN was performed by density-gradient gravity sedimentation without centrifugation. For tPMN isolation, endotracheal aspirate was filtered, and tPMNs were separated from the remaining aspirate using a particle filter. Specific surface epitopes (CD66b, CD62L, fMLP-receptor, LOX-1, CD49d, CD29, CD11b) of the isolated PMN cells were labeled with antibody-coupled dyes and analyzed by flow cytometry. Neutrophil ROS production before and after activation with N-formyl-methyl-leucyl-phenylalanine (fMLP) and tumor necrosis factor α (TNFα) was quantified using rhodamine-123. In addition, a qualitative cytological hematoxylin-eosin (HE) staining was performed with a portion of the secretion. tPMNs were observed in both bloody and mucosal tracheal secretions from ARDS patients. The epitope distribution on cPMNs and tPMNs differed significantly in patients with and without ARDS: tPMNs generally showed increased expression of CD66b, LOX-1 and fMLP-receptor compared to cPMNs, and decreased expression of CD62L. The CD49d levels of all cPMNs were at the same level as tPMNs in ARDS, whereas CD49d expression was increased on tPMNs without ARDS. ROS production was significantly stimulated by fMLP/TNFα in cPMNs regardless of the patient group, while it was similarly increased in tPMNs with and without stimulation. Increased expression of CD66b, LOX-1 and fMLP-receptor on tPMNs indicated a higher activity status compared to cPMNs. Increased CD49d expression on tPMNs without ARDS marks different PMN surface changes in lung disease. PMNs appear to be in a more activated state in lung secretions than in blood, as indicated by higher CD66b and lower CD62L expression, higher constitutive ROS production and lower excitability with fMLP and TNFα. In the context of possible CD49d-triggered ROS production, it is noteworthy that CD49d is downregulated in secretion from patients with ARDS compared to patients without. This phenotypic and functional PMN characterization can provide valuable diagnostic and therapeutic information for the intensive care treatment of ARDS patients. [ABSTRACT FROM AUTHOR]

Background: The long-term risk of cardiovascular and thrombotic events following severe COVID-19 remains largely unknown. This study aimed to assess the risk of atherosclerotic cardiovascular disease (ASCVD) within one year after hospital discharge in patients who received intensive care for severe COVID-19. Methods: A register-based nationwide case-control study on a cohort of patients with severe COVID-19 (cases) requiring mechanical ventilation and discharged alive without experiencing cardiovascular or thrombotic events during their hospital stay. Each case was matched (age, sex, district of residence) with up to 10 population-based controls. The primary outcome was ASCVD occurring after hospital discharge, defined as a composite endpoint, including myocardial infarction (MI), unstable angina pectoris and ischemic stroke. Secondary endpoints were MI, stroke, all-cause mortality, and venous thromboembolic events. Hazard ratio (HR) (95% CI) was used with adjustments for age, sex, socioeconomic factors, and co-morbidities. Results: In total, 31,375 individuals (70% men, median age 62 years) were included, of which 2854 had severe COVID-19 and 26,885 matched control subjects. The adjusted HR for ASCVD during the first year compared to control subjects was 3.1 (95% CI 1.7–5.4). Adjusted HRs for secondary outcomes for myocardial infarction were 2.0 (95% CI 0.8–5.3), for stroke 1.9 (95% CI 0.7–5.3), for pulmonary embolism 49.4 (95% CI 28.0–87.1), and deep venous thrombosis (DVT) 16.0 (95% CI 7.8–32.6). Conclusions: Severe COVID-19 requiring intensive care was associated with a substantial increase in 1-year risk for ASCVD and venous thromboembolic events. [ABSTRACT FROM AUTHOR]

Phosphate is a predominately intracellular anion that has several key roles in normal cellular functions. Derangements in serum phosphate concentration occur frequently during critical illness, particularly hypophosphataemia, which has been reported in up to 75% of Intensive Care Unit (ICU) patients. The association between hypophosphataemia and ICU outcomes reported in the literature are conflicting and and subject to substantial confounding. Exogenous phosphate can be administered in the ICU using the enteral and intravenous route safely. However, whether administering phosphate and correcting hypophosphataemia results in any patient-centred benefits, or harms, remains uncertain, particularly for patients with mild hypophosphataemia or low-normal phosphate levels. This review will highlight key aspects of hypophosphataemia management in the critically ill, summarise current best practice, and outline major research priorities. [ABSTRACT FROM AUTHOR]

Background: Tracheostomy is an essential procedure in cases of respiratory failure in patients requiring long-term ventilation or showing airway obstruction. Tracheostomy has both immediate and long-term complications. Among these, tracheo-innominate fistula is an emergency that is a rare long-term complication. When it occurs, this event is catastrophic for the patient's life, as it causes death in a very short time due to hemorrhagic shock. Therefore, it is essential to identify risk factors to prevent these cases. Methods: We describe the autopsy findings in a case of death from tracheo-innominate fistula of a patient admitted to the Intensive Care Unit. Results: The autopsy demonstrated, in addition to the large fistula, the coexistence of a malformation of the cervical spine with a significant increase in the diameter of the neck. Therefore, we emphasize in this case the importance of evaluating risk factors in subjects with tracheostomy by highlighting the role of anatomy and the size of the neck as potential predictable risks. Conclusions: The work retraces through a review the pathogenesis of this rare complication and emphasizes the need for early diagnosis and prevention of the risk of death with specific risk scales. [ABSTRACT FROM AUTHOR]

Early postoperative left ventricular dysfunction due to myocardial stunning can negatively affect outcomes in patients with mitral regurgitation undergoing mitral valve surgery. The aim of this study was to evaluate the impact of the ultra-short acting ß-blocking agent esmolol, administered after the anesthesia induction and before aortic cross-clamping, on myocardial protection and on postoperative clinical course in patients undergoing mitral valve surgery for mitral regurgitation. Patients undergoing mitral valve surgery for primary mitral regurgitation were analyzed according to the use or not of esmolol. Clinical, procedural and laboratory data were collected. A 1:2 propensity score matching analysis (esmolol vs. control) was performed to adjust for baseline differences. The primary endpoint was the occurrence of postoperative low cardiac output syndrome. Out of 322 patients (age: 66 ± 11 years; 140 women) with mitral regurgitation undergoing mitral valve surgery, 99 received esmolol while 223 patients did not. Low cardiac output syndrome occurred significantly less frequently in patients treated with esmolol as compared to patients not receiving it (12.1% vs. 33.2%, p < 0.001 before matching and 13.0% vs. 30.4%, p = 0.006 after matching). Peak postprocedural creatin kinase MB release was lower in patients treated with esmolol as compared to those not treated with esmolol (57 ± 30 µg/mL vs. 82 ± 70 µg/mL, p < 0.001 before matching and 57 ± 31 µg/mL vs. 83 ± 79 µg/mL, p = 0.008 after matching). Acute kidney injury and length of intensive care unit stay were reduced in the esmolol group both before and after matching. In conclusion esmolol administered after anesthesia induction and before aortic cross-clamping could improve myocardial protection in patients with mitral regurgitation undergoing mitral valve surgery. [ABSTRACT FROM AUTHOR]

Racial and ethnic disparities in malnutrition are well-known, but it is unknown if there are disparities in early nutrition delivery for intensive care unit (ICU) patients, which is associated with better outcomes. We investigated the timing of enteral nutrition (EN) and parenteral nutrition (PN) initiation in the ICU, examining for racial differences. Using the eICU-Collaborative Research Database (eICU-CRD) from 2014 to 2015, we analyzed patients eligible for EN and PN from 208 hospitals. EN and PN delivery was captured through intake/output entries. Exclusions included pre-existing EN/PN and short (<4 d) mechanical ventilation. Severity-of-illness was assessed using the sequential organ failure assessment (SOFA) score. Self-identified race was defined as the primary exposure, and Cox proportional hazards models were used to examine the association between race and time to EN and PN initiation, adjusting for patient, ICU, and hospital characteristics. Of 1914 patients from 14 hospitals with EN data (5.3% Black, 42.4% female, median age 65 y), 888 received EN. Among Black and White patients, the median [Q1, Q3] time from mechanical ventilation to EN was 1.5 [1.0, 2.8] d. Race was not associated with time until EN initiation (hazard ratio = 0.961, 95% confidence interval 0.693, 1.333). Rather, other variables including sex, SOFA score, hospital characteristics and ICU unit type appeared to account for variation in EN initiation. Among 31,551 patients from 59 hospitals with PN data (11.3% Black, 45.1% female, median age 67 y), 1140 received PN, with a median [Q1, Q3] time to PN initiation of 7.4 [4.2, 12.4] d amongst Black and White patients. Race was not associated with time until PN initiation (hazard ratio = 1.095, 95% confidence interval = 0.901, 1.331). Instead, sex, body mass index, SOFA score, hospital characteristics and ICU unit type appeared to account for variation in PN initiation. Disparities in EN and PN delivery in the eICU-CRD dataset from 2014 to 2015 were not associated with race, but rather with sex, body mass index, SOFA, hospital characteristics and ICU unit type. Further investigations using more current data are needed. [ABSTRACT FROM AUTHOR]

Aim: Medical institutions restricted visitation to neonatal intensive care units (NICUs) during the coronavirus disease (COVID‐19) pandemic. Therefore, this study aimed to investigate the impact of COVID‐19 NICU visitor restrictions on parents. Methods: We conducted a questionnaire of 378 parents of infants who were hospitalised for more than 1 week at two NICUs in our area and discharged between 1 April 2020 and 31 March 2022. While the visiting rules for NICUs during this period varied depending on the phase of the COVID‐19 epidemic, generally, only parents were allowed to visit the NICUs for a few hours daily. Results: A total of 157 parents (A University Hospital (AMUH), n = 79; AK General Hospital (AKGH), n = 78) responded to the survey (41.3% response rate), with 40% stating that their emotions towards their infants were affected by restrictions due to the COVID‐19 pandemic. Parents' feelings towards their infants were influenced by mode of delivery, parity, duration of hospitalisation and opportunities to visit the NICU. More than 70% of respondents felt stressed due to COVID‐19 restrictions, and anxiety and emotional stress related to visitor restrictions were significantly affected by the number and duration of visits and allowability of family member visits. Parents felt that the restrictions had a negative impact on breastfeeding, overall infant care and infant–family bonding. Conclusion: As parents felt an impact on the bond with their infant during visitation restrictions, it is essential for facilities to implement measures to protect infant–family bonding during potential future pandemics. [ABSTRACT FROM AUTHOR]

Background: Elderly patients under invasive mechanical ventilation (IMV) are more susceptible to muscle weakness. In the out-of-hospital environment, there are benefits to transcutaneous electrical diaphragmatic stimulation (TEDS), which is an easy-to-apply and low-cost technique. Objective: To evaluate the effect of TEDS on respiratory muscle strength, diaphragm thickness (DT), and IMV time in critically ill elderly patients. Methods: This was a randomized controlled trial in which patients were divided into an experimental group (EG) and a control group (CG). TEDS started 24 h after orotracheal intubation and lasted until the end of weaning. Both groups underwent the following assessments during the spontaneous breathing test after weaning from mechanical ventilation (MV): measurement of respiratory muscle strength by pressure gauge, analysis of DT by lung ultrasound, and extubation failure prevention checklist. Results: There were 23 participants in the EG and 21 in the CG. The median age was 66 (60–79) years. The mean values of the diaphragmatic thickening index in the EG and CG participants were 99.13 ± 26.75 and 66.88 ± 31.77, respectively (p =.001, Cohen's d = 1.094). The mean values of maximum inspiratory pressure in the EG and CG were 22.04 ± 3.41 and 19.34 ± 4.23 cmH2O, respectively (p =.005, Cohen's d = 0.698). The Tobin index and the integrative weaning index were similar between groups (p =.584 and p =.102, respectively). The duration of MV in the EG and CG was 6.28 ± 2.68 and 9.21 ± 2.76 days, respectively (p =.001, Cohen's d = -1.075). Conclusion: Critically ill elderly patients receiving TEDS had shorter MV time, greater inspiratory muscle strength, and greater diaphragmatic contraction capacity according to their thickness fraction. [ABSTRACT FROM AUTHOR]

Background: Acute muscle wasting is common in critically ill patients, and this can lead to unfavorable clinical outcomes. The aim of this study was to identify factors associated with muscle wasting and to investigate the association between skeletal muscle wasting and prolonged hospital stay in critically ill patients with acute brain injury. Methods: This single-center prospective observational study was conducted in critically ill patients with acute brain injury who stayed in the intensive care unit for at least 1 week. The rectus femoris cross-sectional area was measured via ultrasound at baseline and a week after the first assessment. Univariate and multivariate logistic regression analyses were performed to identify factors that predicted prolonged hospital stay. Results: A total of 86 patients were included in the study. Their mean age was 49.4 ± 16.9 years, 57% were male, and 46.5% had an admission diagnosis of subarachnoid hemorrhage. The percentage change in the rectus femoris cross-sectional area was 15.8% (95% confidence interval [CI] − 19.8% to − 12.0%; p < 0.001), and 57% of all patients had acute muscle wasting. According to the univariate analysis, there was a significant association between prolonged hospital stay and acute muscle wasting (odds ratio [OR] 3.677; 95% CI 1.487–9.043; p = 0.005), mechanical ventilation status (OR 3.600; 95% CI 1.455–8.904; p = 0.006), and Glasgow Coma Scale score (OR 0.888; 95% CI 0.808–0.976; p = 0.014) at intensive care unit admission. The multivariate analysis demonstrated that acute muscle wasting (OR 3.449; 95% CI 1.344–8.853; p = 0.010) was an independent risk factor for prolonged hospital stay. Conclusions: There was considerable muscle wasting in critically ill patients with brain injuries over a 1-week period. Acute muscle wasting was associated with prolonged hospital stay in critically ill patients with acute brain injury. [ABSTRACT FROM AUTHOR]

Background: Social determinants of health (SDOH) have been linked to neurocritical care outcomes. We sought to examine the extent to which SDOH explain differences in decisions regarding life-sustaining therapy, a key outcome determinant. We specifically investigated the association of a patient's home geography, individual-level SDOH, and neighborhood-level SDOH with subsequent early limitation of life-sustaining therapy (eLLST) and early withdrawal of life-sustaining therapy (eWLST), adjusting for admission severity. Methods: We developed unique methods within the Bridge to Artificial Intelligence for Clinical Care (Bridge2AI for Clinical Care) Collaborative Hospital Repository Uniting Standards for Equitable Artificial Intelligence (CHoRUS) program to extract individual-level SDOH from electronic health records and neighborhood-level SDOH from privacy-preserving geomapping. We piloted these methods to a 7 years retrospective cohort of consecutive neuroscience intensive care unit admissions (2016–2022) at two large academic medical centers within an eastern Massachusetts health care system, examining associations between home census tract and subsequent occurrence of eLLST and eWLST. We matched contextual neighborhood-level SDOH information to each census tract using public data sets, quantifying Social Vulnerability Index overall scores and subscores. We examined the association of individual-level SDOH and neighborhood-level SDOH with subsequent eLLST and eWLST through geographic, logistic, and machine learning models, adjusting for admission severity using admission Glasgow Coma Scale scores and disorders of consciousness grades. Results: Among 20,660 neuroscience intensive care unit admissions (18,780 unique patients), eLLST and eWLST varied geographically and were independently associated with individual-level SDOH and neighborhood-level SDOH across diagnoses. Individual-level SDOH factors (age, marital status, and race) were strongly associated with eLLST, predicting eLLST more strongly than admission severity. Individual-level SDOH were more strongly predictive of eLLST than neighborhood-level SDOH. Conclusions: Across diagnoses, eLLST varied by home geography and was predicted by individual-level SDOH and neighborhood-level SDOH more so than by admission severity. Structured shared decision-making tools may therefore represent tools for health equity. Additionally, these findings provide a major warning: prognostic and artificial intelligence models seeking to predict outcomes such as mortality or emergence from disorders of consciousness may be encoded with self-fulfilling biases of geography and demographics. [ABSTRACT FROM AUTHOR]

Purpose: Low-value care is common in intensive care units (ICUs), unnecessarily exposing patients to risks and harms, incuring costs to the patient and healthcare system, and contributing to healthcare's carbon footprint. We aimed to identify, collate, and summarise published evidence on the impact of interventions to reduce low-value care in ICUs. Methods: We searched MEDLINE, Embase, and Cochrane CENTRAL from inception to 22 September 2023 for evaluations of interventions aiming to reduce low-value care, supplemented by reference lists and recently published articles. We recorded impacts on the low-value target, health outcomes, resource use, cost, and the environment. Results: From 1155 studies screened, 32 eligible studies were identified evaluating interventions to reduce: routine blood testing (n = 13), routine chest X-rays (n = 10), and other types (or multiple types) of low-value care (n = 9). All but 3 of the interventions found reductions in the immediate low-value care target (usually the primary outcome). Although the small sample size of most included studies, limited their ability to detect impacts on other outcomes, many interventions were also associated with improved health outcomes and financial savings. The only study that reported environmental impacts found the intervention was associated with reduced carbon dioxide equivalent (CO2-e) emissions. Conclusions: Interventions to reduce low-value care in ICUs may have important health, financial, and environmental co-benefits. Further research may inform wider scale-up and sustainability of successful strategies to decrease low-value healthcare. More empirical evidence on potential environmental benefits may inform policies to lower healthcare's carbon footprint. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to explore the experiences of care, psychosocial support, and psychosocial wellbeing among patients treated for COVID-19 in intensive care 12 to 18 months after discharge. Methods: This study used a qualitative approach with a descriptive design. Semi-structured interviews were performed with 20 adult patients treated for COVID-19 12 to 18 months after being discharged from a university hospital in Sweden. Data were analysed using qualitative content analysis. Findings: The participants were severely affected by COVID-19 both during the hospital stay and afterwards. They experienced overwhelming fears and uncertainties related to their wellbeing and possibility to recover. The care was described chaotic with staff that were stressed; however, the efforts of the staff during this strenuous circumstance were still positively acknowledged. Difficulties to stay in touch with family and friends due to visiting restrictions affected the patient's psychosocial wellbeing. Conclusion: Contracting COVID-19 in the beginning of the pandemic was a stressful event. Being seen and heard is of importance as it has the possibility to create a feeling of security and being cared for despite unclarities about treatment and illness trajectory. Accordingly, healthcare staff play an important role for the psychosocial wellbeing of patients treated for COVID-19. [ABSTRACT FROM AUTHOR]

Purpose: To examine patients' experiences of receiving care on an ICU for COVID-19 and the subsequent rehabilitation process. Methods: An explorative and inductive design was used. Participants were recruited from two university hospitals in Sweden. Patients admitted to the ICU due to COVID-19 from March 2020 to April 2021, who enrolled in the ICU follow-up, and understood and spoke Swedish were invited to participate. In total, 20 participants completed a semi-structured interview, of whom 18 were included in the thematic analysis. Results: The analysis resulted in two themes: "An isolated world with silver linings" and "Recovery in the wake of the pandemic". Findings show that patients cared for on an ICU for COVID-19 during the pandemic felt safe but experienced a sense of vulnerability. After discharge, physical rehabilitation was a slow process with frustrating day-to-day fluctuations. Mentally, participants felt isolated, fatigued, and emotionally sensitive. Patients reported that love and support from family and friends were crucial for the recovery process. Conclusions: This study highlights the challenges of recovering from COVID-19, emphasizing the importance of continued support from health care, public services, family and friends. It provides important insights into patients' experiences and can inform future healthcare strategies and policies. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to investigate the development of fatigue and mental illness between 3 and 12 months after critical COVID-19 and explore risk factors for long-lasting symptoms. Study Design and Methods: A prospective, multicenter COVID-19 study in southern Sweden, including adult patients (≥18 years) with rtPCR-confirmed COVID-19 requiring intensive care. Survivors were invited to a follow-up at 3 and 12 months, where patient-reported symptoms were assessed using the Modified Fatigue Impact Scale (MFIS), the Hospital Anxiety and Depression Scale (HADS) and the Posttraumatic Stress Disorder Checklist version 5 (PCL-5). The development between 3 and 12 months was described by changes in relation to statistical significance and suggested values for a minimally important difference (MID). Potential risk factors for long-lasting symptoms were analyzed by multivariable logistic regression. Results: At the 3-month follow-up, 262 survivors (87%) participated, 215 (72%) returned at 12 months. Fatigue was reported by 50% versus 40%, with a significant improvement at 12 months (MFIS; median 38 vs. 33, P <.001, MID ≥4). There were no significant differences in symptoms of mental illness between 3 and 12 months, with anxiety present in 33% versus 28%, depression in 30% versus 22%, and posttraumatic stress disorder in 17% versus 13%. A worse functional outcome and less sleep compared to before COVID-19 were risk factors for fatigue and mental illness at 12 months. Conclusions: Fatigue improved between 3 and 12 months but was still common. Symptoms of mental illness remained unchanged with anxiety being the most reported. A worse functional outcome and less sleep compared to before COVID-19 were identified as risk factors for reporting long-lasting symptoms. [ABSTRACT FROM AUTHOR]

The EFFORT Protein trial assessed the effect of high vs usual dosing of protein in adult ICU patients with organ failure. This study provides a probabilistic interpretation and evaluates heterogeneity in treatment effects (HTE). We analysed 60-day all-cause mortality and time to discharge alive from hospital using Bayesian models with weakly informative priors. HTE on mortality was assessed according to disease severity (Sequential Organ Failure Assessment [SOFA] score), acute kidney injury, and serum creatinine values at baseline. The absolute difference in mortality was 2.5% points (95% credible interval –6.9 to 12.4), with a 72% posterior probability of harm associated with high protein treatment. For time to discharge alive from hospital, the hazard ratio was 0.91 (95% credible interval 0.80 to 1.04) with a 92% probability of harm for the high-dose protein group compared with the usual-dose protein group. There were 97% and 95% probabilities of positive interactions between the high protein intervention and serum creatinine and SOFA score at randomisation, respectively. Specifically, there was a potentially relatively higher mortality of high protein doses with higher baseline serum creatinine or SOFA scores. We found moderate to high probabilities of harm with high protein doses compared with usual protein in ICU patients for the primary and secondary outcomes. We found suggestions of heterogeneity in treatment effects with worse outcomes in participants randomised to high protein doses with renal dysfunction or acute kidney injury and greater illness severity at baseline. [ABSTRACT FROM AUTHOR]

Background and purpose: Exacerbation of myasthenia gravis (MG) with respiratory failure requires intensive care. We aimed to study the risk factors for intensive care unit admission for MG exacerbation and myasthenic crisis (MC) and the prognosis of people with MG (pwMG) thereafter. Methods: This retrospective study investigated patients in the Helsinki and Uusimaa hospital district during the years 2008–2021. PwMG (International Classification of Diseases, 10th revision code G70.0) were identified through a data repository search, followed by a chart review of patient records. Risk factors for intensive care due to MG exacerbation were evaluated as compared with the patients only treated in the outpatient clinic and those treated in the neurological ward for MG exacerbation. The outcomes of patients in intensive care for any reason were also compared with those of patients in intensive care for exacerbation of bronchial asthma. Results: Of 577 pwMG, 35 (6.1%) needed intensive care for MG within a median of 5.3 months from diagnosis. The mean (±SD) age at MG diagnosis was higher in the intensive care group (60.5 [±16.1] years) compared to the outpatient (48.3 [±20.9] years; p < 0.001) and neurological ward groups (53.4 [±20.8] years; p = 0.044). Thymoma (odds ratio [OR] 4.8, 95% confidence interval [CI] 1.19–19.43; p = 0.028) and female sex (OR 2.1, 95% CI 1.02–4.48; p = 0.045) were independent risk factors for intensive care. In‐hospital mortality was 4% for MC patients. Six‐month mortality after intensive care for MG exacerbation (14.3%) was twice that for asthma exacerbation (7.7%). Conclusion: Our study shows an increased risk of intensive care treatment for patients with late‐onset MG, female sex or thymoma, occurring usually within 6 months from diagnosis, which emphasises the importance of early treatment choices. [ABSTRACT FROM AUTHOR]

Despite the use of multidomain prevention strategies, delirium still frequently occurs in hospitalized adults. With delirium often associated with undesirable symptoms and deleterious outcomes, including cognitive decline, treatment is important. Risk-factor reduction and the protocolized use of multidomain, nonpharmacologic bundles remain the mainstay of delirium treatment. There is a current lack of strong evidence to suggest any pharmacologic intervention to treat delirium will help resolve it faster, reduce its symptoms (other than agitation), facilitate hospital throughput, or improve post-hospital outcomes including long-term cognitive function. With the exception of dexmedetomidine as a treatment of severe delirium-associated agitation in the ICU, current practice guidelines do not recommend the routine use of any pharmacologic intervention to treat delirium in any hospital population. Future research should focus on identifying and evaluating new pharmacologic delirium treatment interventions and addressing key challenges and gaps surrounding delirium treatment research. [ABSTRACT FROM AUTHOR]

Aims: To describe intensive care unit nurses' experiences of moral distress during the COVID‐19 pandemic, and their recommendations for mitigative interventions. Design: Interpretive description. Methods: Data were collected with a purposeful sample of 40 Canadian intensive care unit nurses between May and September 2021. Nurses completed a demographic questionnaire, the Measure of Moral Distress—Healthcare Professionals survey and in‐depth interviews. Quantitative data were analysed using descriptive statistics. Qualitative data were categorized and synthesized using reflexive thematic analysis and rapid qualitative analysis. Results: Half of the nurses in this sample reported moderate levels of moral distress. In response to moral distress, nurses experienced immediate and long‐term effects across multiple health domains. To cope, nurses discussed varied reactions, including action, avoidance and acquiescence. Nurses provided recommendations for interventions across multiple organizations to mitigate moral distress and negative health outcomes. Conclusion: Nurses reported that moral distress drove negative health outcomes and attrition in response to moral events in practice. To change these conditions of moral distress, nurses require organizational investments in interventions and cultures that prioritize the inclusion of nursing perspectives and voices. Implications for the Profession: Nurses engage in a variety of responses to cope with moral distress. They possess valuable insights into the practice issues central to moral distress that have significant implications for all members of the healthcare teams, patients and systems. It is essential that nurses' voices be included in the development of future interventions central to the responses to moral distress. Reporting Method: This study adheres to COREQ guidelines. Impact: What Problem did the Study Address?: Given the known structural, systemic and environmental factors that contribute to intensive care unit nurses' experiences of moral distress, and ultimately burnout and attrition, it was important to learn about their experiences of moral distress and their recommendations for organizational mitigative interventions. Documentation of these experiences and recommendations took on a greater urgency during the context of a global health emergency, the COVID‐19 pandemic, where such contextual influences on moral distress were less understood. What Were the Main Findings?: Over half of the nurses reported a moderate level of moral distress. Nurses who were considering leaving nursing practice reported higher moral distress scores than those who were not considering leaving. In response to moral distress, nurses experienced a variety of outcomes across several health domains. To cope with moral distress, nurses engaged in patterns of action, avoidance and acquiescence. To change the conditions of moral distress, nurses desire organizational interventions, practices and culture changes situated in the amplification of their voices. Where and on Whom Will the Research Have an Impact on?: These findings will be of interest to: (1) researchers developing and evaluating interventions that address the complex phenomenon of moral distress, (2) leaders and administrators in hospitals, and relevant healthcare and nursing organizations, and (3) nurses interested in leveraging evidence‐informed recommendations to advocate for interventions to address moral distress. What Does this Paper Contribute to the Wider Global Community?: This paper advances the body of scientific work on nurses' experiences of moral distress, capturing this phenomenon within the unique context of a global health emergency.Nurses' levels of moral distress using Measure of Moral Distress—Healthcare Professional survey were reported, serving as a comparator for future studies seeking to measure and evaluate intensive care unit nurses' levels of moral distress.Nurses' recommendations for mitigative interventions for moral distress have been reported, which can help inform future interventional studies. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance and healthcare-associated infections (HAIs) are major health concerns in the pediatric intensive care unit (PICU). Device-associated HAIs (DA-HAIs) produced by multidrug-resistant (MDR) bacteria are especially worrying, as they can lead to an inappropriate empirical antibiotic therapy, worsened outcomes and increased mortality. The MDR score was designed to enable the prompt identification of patients at high risk of developing an MDR infection. This was a single-center, prospective, observational study, conducted between January 2015 and December 2022, including PICU patients with a microbiologically confirmed DA-HAI. Demographic, clinical characteristics and outcomes were compared between patients with a DA-HAI caused by MDR and non-MDR-associated DA-HAI, and a risk score for multi-resistance was designed. In total, 257 DA-HAI cases were included, 86 (33.46%) caused by an MDR microbe. In the univariate analysis, comorbidity (p = 0.002), previous MDR colonization (p < 0.001), previous surgery (p = 0.018), and previous antibiotic therapy (p = 0.009) were more frequent among MDR-associated DA-HAI (MDR DA-HAI). In addition, days from device insertion to infection and from PICU admission (p < 0.005) to infection were longer in patients with MDR. In the multivariate analysis, previous comorbidity (OR 2.201), previous MDR colonization (OR 5.149), and PICU length of stay longer than 9 days (OR 1.782) were independently associated with MDR-DA-HAI. Using these three independent risk factors for MDR, a risk score was created: the MDR score. Three risk groups were obtained: low risk (0–2 points), intermediate risk (3–7 points), and high risk (8–12 points). Seventy-one patients with MDR-DA-HAI (82.6%) were classified in the intermediate or high-risk group, with a global sensitivity of 82.6%. The specificity in the high-risk group was 91.8%, and 81.0% of patients who were stratified into the low-risk group had non-MDR-associated infections, so they were correctly classified. Conclusions: The MDR score can be a useful tool to stratify patients in risk groups for MDR-DA-HAI. It may help to guide the choice of empirical therapy, leading to early optimization and avoiding delays in establishing appropriate treatment. This study reinforces the importance of stratifying patients based on their individual risk profile for MDR infection. What is Known: • Healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) are worrisome healthcare problems worldwide. Among HAIs, those associated with invasive devices are especially concerning. • The involvement of multidrug-resistant (MDR) bacteria in HAI implies poorer outcomes, particularly for critical pediatric patients, due to their fragility. What is new: • The newly designed MDR score may help to stratify pediatric patients into risk groups for MDR HAI (low, intermediate, and high risk) • The MDR score can help to select the correct initial antibiotic and consequently save broad-spectrum antibiotics for when they are actually needed. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to examine the relationship between compassion fatigue and moral sensitivity of intensive care nurses. Method: Permission was obtained from the ethics committee, institution, and nurses prior to the study. The population of the study consisted of all nurses working in a university hospital, and the sample consisted of 144 intensive care nurses who agreed to participate in the study. The data were collected through the Questionnaire, the Compassion Fatigue Scale, and the Moral Sensitivity Scale. The total score of the compassion fatigue scale ranges between 24 and 120, and a high score indicates a "high level of compassion". The total score of the moral sensitivity scale, on the other hand, varies between 30-210, and as the score increases, moral sensitivity decreases. The obtained data were evaluated with Student t, One-Way Anova, Kruskal Wallis, Mann Whitney U, and correlation analysis. Results: It was found that 55.6% of the nurses had a bachelor's degree, 44.4% had been working in the intensive care unit for 4-6 years, 39.6% had professional ethical dilemmas, and 44.6% of those who had ethical dilemmas could not solve this problem. Compassion fatigue and moral sensitivity scale mean scores were found to be 83.3 ± 6.7 and 125.4 ± 7.2, respectively, and there was a positive correlation between compassion fatigue and moral sensitivity mean scores (p < 0.05). Conclusion: The mean score of the compassion fatigue and moral sensitivity scale of intensive care nurses was at a "moderate" level, and there was a positive correlation between the nurses' moral sensitivity scale and compassion fatigue scale scores. In line with these results, it can be suggested that the compassion fatigue and moral sensitivities of nurses especially those working in intensive care be evaluated in terms of resolving the ethical dilemmas they may experience in patient care, and these nurses be supported on these matters. [ABSTRACT FROM AUTHOR]

Background: Neonatal seizures are diagnostically challenging and predominantly electrographic-only. Multichannel video continuous electroencephalography (cEEG) is the gold standard investigation, however, out-of-hours access to neurophysiology support can be limited. Automated seizure detection algorithms (SDAs) are designed to detect changes in EEG data, translated into user-friendly seizure probability trends. The aim of this study was to evaluate the diagnostic accuracy of the Persyst neonatal SDA in an intensive care setting. Methods: Single-centre retrospective service evaluation study in neonates undergoing cEEG during intensive care admission to Great Ormond Street Hospital (GOSH) between May 2019 and December 2022. Neonates with <44 weeks corrected gestational age, who had a cEEG recording duration >60 minutes, whilst inpatient in intensive care, were included in the study. One-hour cEEG clips were created for all cases (seizures detected) and controls (seizure-free) and analysed by the Persyst neonatal SDA. Expert neurophysiology reports of the cEEG recordings were used as the gold standard for diagnostic comparison. A receiver operating characteristic (ROC) curve was created using the highest seizure probability in each recording. Optimal seizure probability thresholds for sensitivity and specificity were identified. Results: Eligibility screening produced 49 cases, and 49 seizure-free controls. Seizure prevalence within those patients eligible for the study, was approximately 19% with 35% mortality. The most common case seizure aetiology was hypoxic ischaemic injury (35%) followed by inborn errors of metabolism (18%). The ROC area under the curve was 0.94 with optimal probability thresholds 0.4 and 0.6. Applying a threshold of 0.6, produced 80% sensitivity and 98% specificity. Conclusions: The Persyst neonatal SDA demonstrates high diagnostic accuracy in identifying neonatal seizures; comparable to the accuracy of the standard Persyst SDA in adult populations, other neonatal SDAs, and amplitude integrated EEG (aEEG). Overdiagnosis of seizures is a risk, particularly from cEEG recording artefact. To fully examine its clinical utility, further investigation of the Persyst neonatal SDA's accuracy is required, as well as confirming the optimal seizure probability thresholds in a larger patient cohort. [ABSTRACT FROM AUTHOR]

Background & Purpose: In response to the multitude of ethical issues that arise in the delivery of care provided in intensive care units (ICUs), nurses working in this setting frequently experience moral distress. The properties of moral distress have been well defined. However, within the context of the coronavirus-disease 2019 (COVID-19) pandemic, less is known about the properties of moral distress experienced by ICU nurses. This subsequently affects the advancement of our knowledge, specifically of effective mitigative interventions for moral distress. The purpose of this analysis is to describe the key properties of moral distress experienced by ICU nurses during the COVID-19 pandemic. Methods & Procedures: Guided by interpretive descriptive design, a purposeful sample of 40 Canadian ICU nurses described their experiences of moral distress within the context of their practice during the COVID-19 pandemic. Data generated included the administration of a demographic questionnaire and the Measure of Moral Distress - Healthcare Providers survey, and 1:1 semi-structured virtual (telephone or videoconference) interviews (May–September 2021). Analysis was informed by the tenents of reflexive thematic analysis and rapid qualitative analysis. Results: Nurses experienced moral distress under the complex interplay of two overarching, broad conditions: (1) when nurses’ voices, driven by efforts to optimize patient care at an exceptionally high standard, were not heard; and (2) when patients received substandard levels of care, that was not patient-centered, pain free, or that did not align with organizational, professional, or personal standards. These two broad conditions were influenced by three sub-conditions: (1) lack of respect for nurses’ expert knowledge; (2) cultures and systems of communication and (3) responses to safety and staffing. Discussion: Moral distress experienced by Canadian ICU nurses is a complex phenomenon. These findings advance and refine our knowledge of key components of moral distress. We identified the conditions that generate moral distress for nurses, and the properties of the antecedent moral events. Future approaches to mitigate moral distress need to address the broad conditions under which moral distress occurs. [ABSTRACT FROM AUTHOR]

Background: The term post–intensive care syndrome refers to a group of symptoms that commonly occur after intensive care unit discharge, leading to worsening physical or mental health. The incidence of this syndrome is increasing. Critical care clinicians can play a pivotal role in improving patient outcomes through knowledge of post–intensive care syndrome risk factors and symptoms. Objective: To explore critical care clinicians' current knowledge of post–intensive care syndrome as a basis for developing critical care educational interventions. Methods: This quantitative, cross-sectional, observational pilot study was conducted to survey critical care physicians, nurses, nurse practitioners, and physician assistants at a university hospital on their knowledge of post–intensive care syndrome symptoms and risk factors and their confidence in their ability to recognize the condition. Results: A total of 51 clinicians completed the survey. The overall levels of knowledge and confidence regarding post–intensive care syndrome risk factors and symptoms were low, with no significant differences found by clinician role. Conclusions: These findings support the need for interprofessional education on post–intensive care syndrome risk factors and early identification of symptoms in the critical care setting. [ABSTRACT FROM AUTHOR]

BACKGROUND: COVID-19 is associated with prolonged disability, particularly after critical illness. This study aimed to assess and compare disability post--hospital discharge of subjects who were invasively ventilated versus those who were not, following ICU admission due to COVID-19. This study also explored variables associated with long-term disability. METHODS: In this prospective cohort study, subjects with COVID-19 who received invasive ventilation, noninvasive ventilation, or high-flow nasal cannula during ICU stay were assessed with the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 at 3 and 6 months post--hospital discharge. Data were analyzed collectively and stratified as subjects with and without invasive mechanical ventilation. Analysis of variance and multiple regression analyses were applied. RESULTS: The subjects (N = 43) were mainly male, middle age, and overweight. Subjects who were invasively ventilated (n = 21) had decreased physical function compared to those who were not during hospital assessments. From 3-6 months after discharge, all WHODAS domains and the overall score decreased in both groups (P < .001), indicating disability recovery. The participation domain, which assesses joining in society, was the only domain that remained worse in the ventilation group compared to the no ventilation group (P = .01). No interaction was found between time and the study groups, suggesting that the recovery trajectory was similar. At 6 months, considering the entire cohort, 70% and 56% had no disability in self-care and getting along domains, respectively, while 42% exhibited moderate to severe disability in the participation domain. According to the overall WHODAS score, 86% of subjects still had some level of disability at 6 months. In multivariate analyses, the overall WHODAS score along with the household and participation domains showed significant positive correlations, indicating higher disability, with corticosteroid use. CONCLUSIONS: Disability persisted at 6 month post--hospital discharge for ICU survivors of COVID-19, regardless of the need for invasive mechanical ventilation. Participation was the only domain that showed higher disability among those who received invasive ventilation. [ABSTRACT FROM AUTHOR]

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Aim: Advances in intensive care have reduced mortality rates but increased the number of survivors who face medium to long-term physical, cognitive, and psychological deficits. Nurses play a crucial role in aiding these individuals during their health transition process. The aim of this study was to examine the health consequences and nursing care needs of patients post-ICU. Design: Retrospective observational study. Methods: Data were collected between December 2017 and October 2020 through a retrospective analysis of 215 clinical processes. Descriptive and inferential statistical analyses were performed using SPSS, version 24. Results: While physical sequelae, such as respiratory and digestive issues, decrease over time, mental health issues persist. Quality of life, especially regarding mobility and daily activities, remains affected. Survivors face various self-care needs, including compromised ventilation, impaired swallowing, hallucinations, depressive mood, and anxiety, but also have potential for improving self-efficacy and daily task performance. Nursing interventions should focus on neuromuscular, gastrointestinal, psychological, and cardiorespiratory health. Conclusion: Survivors of critical illness experience significant changes that impact on their quality of life. Identifying their needs allows for more personalized nursing care and the development of a follow-up model that effectively addresses these challenges and highlights the benefits of nursing interventions on health outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Head and neck cancer surgery often requires postoperative monitoring in an intensive care unit (ICU) or intermediate care unit (IMC). With a variety of different risk scores, it is incumbent upon the investigator to plan a risk-adapted allocation of resources. Tumor surgery in the head and neck region itself offers a wide range of procedures in terms of resection extent and reconstruction methods, which can be stratified only vaguely by a cross-disciplinary score. Facing a variety of different risk scores we aimed to develop a new Tumor Risk Score (TRS) enabling anterograde preoperative risk evaluation, resource allocation and optimization of cost and outcome measurements in tumor surgery of the head and neck. Methods: A collective of 547 patients (2010–2021) with intraoral tumors was studied to develop the TRS by grading the preoperative tumor size and location as well as the invasiveness of the planned surgery by means of statistical modeling. Two postoperative complications were defined: (1) prolonged postoperative stay in IMC/ICU and (2) prolonged total length of stay (LOS). Each parameter was analyzed using TRS and all preoperative patient parameters (age, sex, preoperative hemoglobin, body-mass-index, preexisting medical conditions) using predictive modeling design. Established risk scores (Charlson Comorbidity Index (CCI), American Society of Anesthesiologists risk classification (ASA), Functional Comorbidity Index (FCI)) and Patient Clinical Complexity Level (PCCL) were used as benchmarks for model performance of the TRS. Results: The TRS is significantly correlated with surgery duration (p < 0.001) and LOS (p = 0.001). With every increase in TRS, LOS rises by 9.3% (95%CI 4.7–13.9; p < 0.001) or 1.9 days (95%CI 1.0-2.8; p < 0.001), respectively. For each increase in TRS, the LOS in IMC/ICU wards increases by 0.33 days (95%CI 0.12–0.54; p = 0.002), and the probability of an overall prolonged IMC/ICU stay increased by 32.3% per TRS class (p < 0.001). Exceeding the planned IMC/ICU LOS, overall LOS increased by 7.7 days (95%CI 5.35–10.08; p < 0.001) and increases the likelihood of also exceeding the upper limit LOS by 70.1% (95%CI 1.02–2.85; p = 0.041). In terms of predictive power of a prolonged IMC/ICU stay, the TRS performs better than previously established risk scores such as ASA or CCI (p = 0.031). Conclusion: The lack of a standardized needs assessment can lead to both under- and overutilization of the IMC/ICU and therefore increased costs and losses in total revenue. Our index helps to stratify the risk of a prolonged IMC/ICU stay preoperatively and to adjust resource allocation in major head and neck tumor surgery. [ABSTRACT FROM AUTHOR]

A 25‐week‐old Oriental shorthair cat was anaesthetised to perform computed tomography and bronchoscopy. During endotracheal intubation, a deciduous premolar was contacted with the laryngoscope blade, dislodged, and subsequently aspirated into the trachea. The tooth was removed via bronchoscopy, and the cat was recovered in the intensive care unit due to the development of laryngeal oedema. The risk factors for tooth dislodgement in the cat and proposed improvements in the immediate period after dislodgement are discussed in this report. [ABSTRACT FROM AUTHOR]

Introduction: This is a phenomenologically designed qualitative study conducted to explore and conceptualize the problems experienced by intensive care nurses caring for patients undergoing continuous renal replacement therapy. Methods: Face‐to‐face, semi‐structured interviews were conducted with the participants. The interviews were transcribed verbatim, then thematic analysis was conducted. Results: The study was conducted 12 intensive care nurses. As a result, 3 main and 6 sub‐themes were identified. The themes identified were changing routines, uncertainty in terms of patient benefit, and need for adaptation. Conclusion: It was found that nurses experienced challenges in providing care to patients undergoing continuous renal replacement therapy, spent more effort to prevent complications, and lacked information on the subject. It is recommended to consider institutional and individual actions to meet the educational needs of nurses for implementing continuous renal replacement therapy. [ABSTRACT FROM AUTHOR]

Background: Acute pancreatitis following cardiac surgery is a rare complication. Early recognition of risk factors and vigilance toward initial symptoms can prevent significant morbidity and mortality. Bowel ischemia and the release of inflammatory mediators during cardiopulmonary bypass play key roles in the development of acute postoperative pancreatitis. Management is generally conservative, following the modified Atlanta 2012 criteria. This paper reviews the literature and emphasizes the importance of early investigation of abdominal pain after cardiac surgery. Case presentation: We report a case of severe acute pancreatitis that developed after double valvular replacement, performed during a 3-h cardiopulmonary bypass in a patient who initially had endocarditis and underwent dialysis 3 times. Considering the risk factors, the patient was diagnosed early and managed conservatively, leading to a positive outcome. Conclusions: Anesthesiologists must not disregard abdominal pain after cardiac surgery in the context of risk factors, as it may indicate gastrointestinal complications, including pancreatitis, which can be among the most dangerous complications if not treated promptly. [ABSTRACT FROM AUTHOR]

Background: Effective antimicrobial therapy is an essential part of intensive care medicine and renal replacement therapy is an important and common intervention which significantly affects the pharmacokinetics of many antimicrobials. This is especially critical for substances with a narrow therapeutic range, creating a dilemma of weighing the risk of toxicity from increased drug exposure against risk of ineffective treatment and promotion of antimicrobial resistance. To address this problem, we investigate a target-controlled dialysis by in vitro experiments — a novel technique in which drug is spiked into the dialysis solution to make use of the physicochemical properties of renal replacement therapy for solute transport, with the goal to reduce the risk of inadequate drug exposure. Methods: Five antibiotics (ceftazidime, meropenem, piperacillin/tazobactam, vancomycin, flucloxacillin) were dialyzed in an in vitro model of continuous veno-venous hemodialysis using 1 L of bovine serum albumin solution as simulated patient plasma compartment. This was done with and without antibiotics in target concentrations added to the dialysis solution, mimicking three clinically relevant scenarios: (i) target-controlled dialysis in a subject with sub-therapeutic drug levels, (ii) target-controlled dialysis in a subject with supra-therapeutic drug levels, and (iii) traditional dialysis of drugs starting at the target concentration. Drug levels were quantified by high-performance liquid chromatography. Additionally, the stability over 24 h of all antibiotics in two typical dialysis solutions was assessed. Results: Our data shows that with target-controlled dialysis, antibiotic concentrations will change in the desired direction towards the target concentration, depending on the patients' unbound drug levels in relation to the concentration in the dialysis solution. The desired target concentrations can be induced and maintained, regardless of the initial concentration. Furthermore, the stability tests revealed only a minor and clinically irrelevant loss in drug concentration (all < 10.2%) after 12 h. Conclusions: We outlined the mechanistic plausibility and provided experimental evidence of the feasibility of the target-controlled dialysis concept, which could help to maintain therapeutic concentrations of many time-dependent antibiotics in critically ill patients under renal replacement therapy. The required stability in dialysis solutions was shown for a set of important antibiotics. The next step will be the prudent application of this concept to patients in clinical trials. [ABSTRACT FROM AUTHOR]

Background: ICU patients are particularly susceptible to vitamin D3 deficiencies. This can be due to the severity of their underlying disease, the type of treatment they are on, and malnutrition before and inadequate nutrition during the hospitalization preceding ICU admission as well as advanced age. Literature provides no guidance on how to supplement vitamin D3 in severely deficient patients who are undergoing continuous renal replacement therapy (CRRT). Most serum 25(OH)D3 is bound with vitamin D binding protein in a complex whose molecular weight is 10 kDa. This means it can be removed during CRRT via convection mechanism. Critically ill patients undergoing CRRT can therefore be particularly prone to develop severe vitamin D3 deficiency. Methods: As the trial design, a randomized controlled, single blinded, multicenter, parallel group approach was chosen to compare a single administration of 750,000 IU of vitamin D3 via the enteral or oral route in ICU patients with severe vitamin D3 deficiency (measured serum 25(OH)D3 levels ≤ 12.5 ng/ml) undergoing CRRT with a single administration of 500,000 IU of vitamin D3. The trial will be performed in up to five university hospitals in Poland. The primary outcome is the percentage of patients that achieved serum 25(OH)D3 levels ≥ 30 ng/ml on days 3 and 7 following vitamin D3 administration. Assuming a drop-out rate of approximately 10%, the number of recruited patients should be 138. Discussion: Considering the potential pathophysiological mechanisms underlying hypovitaminosis D in critically ill patients under CRRT, it seems conceivable that these patients will require greater supplementation doses to correct severe deficiency. The study is meant to help answer the question whether increasing the supplementation dose by 50% will ensure a more effective replenishment of vitamin D3 in critically ill patients undergoing CRRT. Trial registration: ClinicalTrials.gov Identifier: NCT05657678, registered: December 12 2022, https://clinicaltrials.gov/study/NCT05657678?cond=NCT05657678&rank=1. [ABSTRACT FROM AUTHOR]

Objectives Methods Results Conclusions The survival rate of people with HIV admitted to intensive care units (ICUs) is approaching that of people without HIV. We conducted a matched‐cohort study of people with and without HIV admitted to ICU at a large hospital to compare short‐term mortality, during 2000–2019.People with HIV were matched to people without HIV (1:2) on age, sex, admission year and Acute Physiology and Chronic Health Evaluation (APACHE)‐II score. Applying logistic regression models fitted using independence estimating equations, we describe population‐averaged associations of HIV with short‐term (in‐ICU, in‐hospital) mortality during a patient's first admission to ICU, and explore whether these varied by year.A total of 177 people with HIV were matched to 354 people without HIV (71.2% vs. 71.2% male; median age: 47 vs. 48 years, median APACHE‐II: 18 vs. 17, median admission year: 2013 vs. 2013). Among people with HIV, 73.4% were on antiretroviral therapy, 51.2% had HIV‐RNA ≤50 copies/mL and median CD4 T‐cell count was 132 cells/μ$$ \upmu $$L. People with HIV had higher in‐ICU (24.3% vs. 15.3%) and in‐hospital (31.6% vs. 20.1%) mortality. People with HIV had 1.69‐fold higher odds (95% confidence interval: 1.03–2.76) of in‐ICU mortality and 1.86 (1.19–2.91) higher odds of in‐hospital mortality than people without HIV, adjusted for age, sex, year and APACHE‐II. There was no evidence that these associations varied by year (p‐interaction‐in‐ICU = 0.90; p‐interaction‐in‐hospital = 0.46).Our findings suggest that although outcomes have improved over time, people with HIV continue to have higher short‐term in‐ICU and in‐hospital mortality following ICU admission compared with people without HIV with similar characteristics. [ABSTRACT FROM AUTHOR]

Objectives: To compare indirect calorimetry (IC) readings with the Harris–Benedict equation (HBE) predictions of resting energy expenditure (REE) in intubated acute brain-injured patients in a tertiary hospital’s Neuroscience Intensive Care Unit (ICU).Design: A single-centre, retrospective study.Setting: Neuroscience Intensive Care Unit at a tertiary hospital.Subjects: All adult patients admitted to the Neuroscience Intensive Care Unit between June 1, 2020, and June 30, 2021, who had an IC reading.Outcome measures: Comparison of the measured REE using IC and the predicted REE using the HBE modified for critically ill adults. Subgroup analysis based on body mass index (BMI) was also performed.Results: A total of 108 patients had IC readings taken during the study period. There was a significant difference between the REE predicted by the HBE and the measured IC readings, with a mean difference of 465.3 kcal (95% CI 408.1–522.5, p = 0.001). A moderate positive correlation was observed (coefficient r = 0.565, p < 0.001). In patients with BMI ≥ 30 kg/m², the HBE significantly overestimated REE compared with IC readings (p = 0.005).Conclusions: The Harris–Benedict equation tends to overestimate resting energy expenditure, especially in acute brain-injured patients with a BMI ≥ 30 kg/m². Utilising IC-directed nutrition therapy in intensive care units could help in delivering personalised caloric intake, reducing the risks of underfeeding or overfeeding. [ABSTRACT FROM AUTHOR]

According to the Society of Critical Care Medicine, critical illness-related corticosteroid insufficiency (CIRCI) characterizes hypothalamic-adrenal axis insufficiency following acute medical conditions of various causes, i.e., sepsis, septic shock, acute respiratory distress syndrome, community-acquired pneumonia, and status after major surgical procedures. Due to highly variable etiology, understanding the pathomechanism and management of CIRCI assumes relevance for all centers providing intensive care. During CIRCI, multiple peripheral adaptations develop, and cortisol distribution volume increases due to hypothalamic-adrenal axis dysregulation, alterations in cortisol metabolism, and tissue resistance to corticosteroids. The proper diagnosis and treatment of CIRCI may be challenging in many cases. Although we have been acquainted with CIRCI since 2008, it remains a difficult condition with widely variable approaches among clinicians due to inconsistent high-quality study results determining the effect of corticosteroids on mortality. Corticosteroids are widely used in acutely ill patients, highlighting the necessity for reliable knowledge to support crucial clinicians' decisions in daily medical practice. In this review, we provide an overview of the clinical management of patients with CIRCI based on current recommendations and selected studies. [ABSTRACT FROM AUTHOR]

Background: The mortality rate of patients with cardiogenic shock (CS) requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO) combined with Impella (ECPELLA) support remains high. Inhaled nitric oxide (iNO) improves right ventricular (RV) function, resulting in increased Impella flow, which may facilitate early withdrawal of VA-ECMO and improve survival. This study investigated the prognostic impact of iNO therapy in ECPELLA patients. Methods: We retrospectively analyzed the data of consecutive patients with CS supported by ECPELLA from September 2019 to March 2024 at our hospital. Changes in pulmonary artery pulsatility index (PAPi) and Impella flow over time were evaluated, and VA-ECMO withdrawal rate, time to withdrawal, and 30-day survival were compared between ECPELLA patients with and without iNO therapy. Results: Of the 48 ECPELLA patients, 25 were treated with iNO. There were no significant differences between the groups in baseline characteristics or lactate levels at mechanical circulatory support induction. Patients with iNO therapy demonstrated significant improvements in the PAPi over time and a trend toward increased Impella flow, as well as a significantly higher VA-ECMO withdrawal rate (88% vs. 48%, P = 0.002) and a shorter time to VA-ECMO withdrawal (5 [3–6] days vs. 7 [6–13] days, P = 0.0008) than those without iNO therapy. Kaplan–Meier analysis demonstrated that the 30-day survival rate was significantly higher in patients with iNO than in those without (76% vs. 26%, P = 0.0002). Conclusions: iNO therapy in patients with CS requiring ECPELLA was associated with short-term prognosis by improving RV function and facilitating weaning from VA-ECMO. Trial registration Retrospectively registered in UMIN-CTR (Reference No. R00006352). [ABSTRACT FROM AUTHOR]

Background: Glycemic variability (GV) is a prevalent and significant condition observed in critically ill patients. This study aimed to investigate the relationship between early glycemic variability parameters and 28-day mortality in critically ill patients. Methods: A multicenter, prospective, and observational study was performed at five tertiary intensive care units (ICUs) in Turkey. All patients who had more than six blood glucose level (BGL) measures per 24 h were included. The parameters of GV including the SD, MGL, MGD (the difference between the maximal and minimal glucose level), and the CV (the percentage of SD to the MGL) in the first 24 h were recorded. Results: A total of 578 eligible patients were enrolled in the study, of whom 43.6% were women. The mean age of the patients was 68.09 ± 16.62 years. Overall mortality was 31.5% (n = 182). The glycemic parameters of the CV, SD, and MGD were significantly higher in the non-survivor group than in the survivor group (p = 0.040, 0.006, and 0.002, respectively). The multivariate logistic regression analysis revealed that the CV (OR 1.023; 95% CI 1.004–1.042; p = 0.017) was an independent factor that increased mortality. Spearman's rho correlation analysis revealed a strong (r:0.871) and statistically significant correlation (p < 0.001) between the CV and MGD. Conclusions: The CV calculated within the first 24 h of ICU admission is independently associated with 28-day mortality. The MGD is correlated with the CV and is maybe a practical tool to predict increased risk of mortality at the bedside. However, further studies are needed to establish the independent association of the MGD with mortality. [ABSTRACT FROM AUTHOR]

Fetal growth restriction, or intrauterine growth restriction, is a common gestational condition characterized by reduced intrauterine growth. However, severe periviable fetal growth restriction is still associated with elevated perinatal mortality and morbidity. The current literature advises delivery once it is deemed that fetal compromise is evident. As uteroplacental insufficiency is the most common etiology of this condition, we hypothesize that the use of artificial ex utero systems to provide adequate nutrition and recreate the uterine environment may be a viable treatment option in this situation, even with the possibility of treating severe fetal growth restriction and prevent sequelae. There are promising experimental studies in sheep models investigating the artificial ex utero system for potential prenatal conditions, but future additional investigation is needed before translating to clinical trials in humans. [ABSTRACT FROM AUTHOR]

With the large volume of data coming from implemented technologies and monitoring systems, intensive care units (ICUs) represent a key area for artificial intelligence (AI) application. Despite the last decade has been marked by studies focused on the use of AI in medicine, its application in mechanical ventilation management is still limited. Optimizing mechanical ventilation is a complex and high-stake intervention, which requires a deep understanding of respiratory pathophysiology. Therefore, this complex task might be supported by AI and machine learning. Most of the studies already published involve the use of AI to predict outcomes for mechanically ventilated patients, including the need for intubation, the respiratory complications, and the weaning readiness and success. In conclusion, the application of AI for the management of mechanical ventilation is still at an early stage and requires a cautious and much less enthusiastic approach. Future research should be focused on AI progressive introduction in the everyday management of mechanically ventilated patients, with the aim to explore the great potentiality of this tool. Plain Language Summary: The use of artificial intelligence for mechanical ventilation Artificial Intelligence (AI) could help the management of patients treated with mechanical ventilation in critical care practice. Current guidelines are based on data coming from the general population, without considering the individual patients' characteristics. With the use of AI for mechanical ventilation, critical care practice could be improved by offering personalized treatments, reducing complications, and assisting clinicians in decision-making to improve patient outcomes and reduce mortality rates. Despite AI in medicine has progressed in the last decade, little is known about its use in critical care and in ventilation management. In order to improve its everyday use, future research should be performed in intensive care settings. [ABSTRACT FROM AUTHOR]

Background: Understanding how preexisting comorbidities may interact with a critical illness is important for the assessment of long-term survival probability of older patients admitted to the ICU. Material and methods: The mortality after a first ICU admission in patients ≥ 55 years old registered in the Swedish Intensive Care Registry was compared to age- and sex-matched individuals from the general population with a landmark after 1 year. The comparison was adjusted for age, sex, and baseline comorbidity using Cox regression. Results: The 7-year study period included 140 008 patients, of whom 23% were 80 years or older. Patients surviving the first year remained at an increased risk compared to the general population, but much of this difference was attenuated after adjustment for baseline comorbidity (HR, 1.03; 95% CI 1.02–1.04). Excluding cardio-thoracic ICU admissions, the increased risk remained slightly elevated (adjusted HR, 1.15; 95% CI 1.13–1.16). Also, the subgroup ≥ 75 years old surviving the first year returned to a mortality rate comparable to the general population (HR, 0.98; 95% CI 0.96–0.99). Stratified by admission diagnosis an increased mortality rate remained beyond the first year for acute-on-chronic respiratory failure (adjusted HR, 1.47; 95% CI 1.36–1.58) but not for other respiratory causes (adjusted HR, 1.03; 95% CI 0.99–1.07) or admission for septic shock (adjusted HR, 1.04; 95% CI 0.95–1.13). No substantial increased mortality rate was notable beyond the first year for other admission diagnoses. Conclusion: Older ICU patients that survive the first year after an ICU admission return to a mortality rate close to that of the general population having similar baseline comorbidity, but variability is seen depending on the ICU admission diagnosis. Trial registration ClinicalTrials.gov ID: NCT06234709, date 02/01/2024. [ABSTRACT FROM AUTHOR]

Background: Many patients hospitalized for COVID-19 experience long-term health problems, but comprehensive longitudinal data up to 2 years remain limited. We aimed to (1) assess 2-year trajectories of health outcomes, including comparison between intensive care unit (ICU) treated and non-ICU-treated patients, and (2) identify risk factors for prominent health problems post-hospitalization for COVID-19. Methods: The CO-FLOW multicenter prospective cohort study followed adults hospitalized for COVID-19 at 3, 6, 12, and 24 months post-discharge. Measurements included patient-reported outcomes (a.o., recovery, symptoms, fatigue, mental health, sleep quality, return to work, health-related quality of life [HRQoL]), and objective cognitive and physical tests. Additionally, routine follow-up data were collected. Results: 650 patients (median age 60.0 [IQR 53.0–67.0] years; 449/650 [69%] male) surviving hospitalization for COVID-19 were included, of whom 273/650 (42%) received ICU treatment. Overall, outcomes improved over time. Nonetheless, 73% (322/443) of patients had not completely recovered from COVID-19, with memory problems (274/443; 55%), concentration problems (259/443; 52%), and dyspnea (251/493; 51%) among most frequently reported symptoms at 2 years. Moreover, 61% (259/427) had poor sleep quality, 51% (222/433) fatigue, 23% (102/438) cognitive failures, and 30% (65/216) did not fully return to work. Objective outcome measures showed generally good physical recovery. Most outcomes were comparable between ICU- and non-ICU-treated patients at 2 years. However, ICU-treated patients tended to show slower recovery in neurocognitive symptoms, mental health outcomes, and resuming work than non-ICU-treated patients, while showing more improvements in physical outcomes. Particularly, female sex and/or pre-existing pulmonary disease were major risk factors for poorer outcomes. Conclusions: 73% (322/443) of patients had not completely recovered from COVID-19 by 2 years. Despite good physical recovery, long-term neurocognitive complaints, dyspnea, fatigue, and impaired sleep quality persisted. ICU-treated patients showed slower recovery in neurocognitive and mental health outcomes and resumption of work. Tailoring long-term COVID-19 aftercare to individual residual needs is essential. Follow-up is required to monitor further recovery. Trial registration: NL8710, registration date 12-06-2020. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Introduction: Early detection of individuals at risk for onset of severe illness is crucial for prevention and early intervention, aiming to mitigate the long-term impact on both the individual and the community. While well-established models exist for predicting the onset and prolonged severity of illness, there is a gap in understanding illness-onset severity. This pilot study aimed to investigate premorbid objective and subjective dimensions of participation in daily life occupations, as well as sensory and cognitive functions as potential markers of the recent-onset mental illness severity. Methods: A total of 50 participants (men: N=26, 52%; women: N=24, 48%), aged 18–40 (M=26.2, SD=5.8) with recent-onset mental illness completed standard, well-established assessments of illness severity, cognitive biases and failures, neurocognitive status, participation in daily life, and sensory responsiveness thorough cross-sectional design. The differences between the groups of the illness severity were explored with descriptive statistics, followed by a Kruskal–Wallis test. Discriminant analysis was used suggesting a multi-varied model for the separation between the groups of illness severity. Results: Three groups of illness severity exhibited differences in premorbid cognitive functions (F(2)=5.8, p<.01) and participation diversity (F(2)=3.8, p<.05). Combining these two indices explained 92% of the variance between the groups (Wilks' Λ =.68, χ2(4) = 17.7, p=.001), accurately classifying mild to marked illness severity (62.5–88.5%). Conclusions: The study contributes to revealing factors involved in the formation of more severe mental illness and suggesting possible avenues for early intervention and prevention. Cognitive biases and sensory modulation dysfunction may contribute to the illness formation. Still, the most effective markers of more severe mental illness onset are functional cognition and limited participation diversity. Since addressing these markers is a unique specialization within occupational therapy, the findings highlight the potential contribution the profession can make to the early identification of the most vulnerable populations. [ABSTRACT FROM AUTHOR]

Background and purpose Methods Results Conclusions Few data are available on the course of myasthenia gravis (MG) regarding disease severity and stability over time in real‐world settings. This study used the French National Health Insurance Database (SNDS) to assess markers of disease severity in patients with MG longitudinally.All patients with MG‐related claims in the SNDS between 2013 and 2020 were identified. Patients were followed for up to 8 years after the first claim. Intensive care unit (ICU) stays, treatment with intravenous immunoglobulin (IVIg) or plasma exchange (PE), and death were documented throughout the follow‐up period. Standardized mortality rates were estimated, and mortality‐related variables were identified using a Cox model.In all, 14,459 individuals constituted the full study population, including 6354 incident patients. In the incident population, 2199 (34.6%) were admitted to ICUs at least once, principally during the first year after the index date (N = 1477; 23.3%). This proportion decreased progressively to reach 3.0% in the seventh year. A total of 2817 patients received IVIg and 432 PE, again principally in the first year. In the full study population, the standardized mortality rate was 1.08 (95% confidence interval [CI] 1.03–1.13), being lower in men (0.95, 95% CI 0.89–1.02) than in women (1.15, 95% CI 1.07–1.23) and in patients aged >65 years (1.06, 95% CI 1.01–1.11) than in younger patients (1.50, 95% CI 1.24–1.76). Male gender, older age and higher comorbidity were independently associated with mortality.A subgroup of patients with MG require ICU admission and rescue therapy with IVIg or PE, indicative of poor disease control. New therapies are needed to improve disease control and reduce disease burden. [ABSTRACT FROM AUTHOR]

Little is known about the incidence of subcutaneous emphysema (SE) after robotic cardiac surgery. The aim of this study was to describe the incidence, identify risk factors, and assess its influence on postoperative outcomes. Patients undergoing robotic mitral valve repair (n = 63, 54.3%), robotic minimally invasive direct coronary artery bypass grafting (n = 23, 19.8%), and robotic totally endoscopic coronary artery bypass grafting (n = 30,25.9%) were included in the analysis (total n = 116). Subcutaneous emphysema occurred in 53/116 patients (45.7%). It was mild in 30/53 patients (56.6%), moderate in one patient (1.9%), and severe in 22/53 patients (41.5%). Low body weight (p = 0.009), low BMI (p = 0.006), small body surface area (p = 0.01), and older age (p = 0.041) significantly correlated with SE. Patients undergoing robotic mitral valve repair were affected more often than patients undergoing robotic coronary artery bypass grafting (p = 0.04). Severe subcutaneous emphysema resulted in an increased need for CT-chest imaging (p = 0.026), and additional chest tubes (p = 0.029). Severe emphysema was highly associated with pneumothorax (p < 0.001) and increased duration of chest tube drainage (p = 0.003). Subcutaneous emphysema after robotic heart surgery occurs preferentially in patients with low body weight, low BMI, a small body surface area, and older age and is more common in robotic MVR than in robotic coronary artery bypass surgery. It leads to an increased need for thoracic imaging and additional chest tube insertion. Clinical outcomes are not affected. [ABSTRACT FROM AUTHOR]