Background: Post-hemorrhagic hydrocephalus (PHH) is a frequent complication of aneurysmal subarachnoid hemorrhage (aSAH), yet the relationship between serum magnesium (Mg) level and PHH remains unclear. To our knowledge, this is the first prospective study to specifically examine the association between admission serum Mg level and PHH in aSAH patients.Methods: In this prospective, multicenter study (October 2019–October 2024), 131 patients with confirmed aSAH were enrolled from four neuro-intensive care units. Patients were stratified by admission serum Mg level as <2.2 mg/dL or ≥2.2 mg/dL. The primary outcome was PHH incidence; secondary outcomes were cerebral vasospasm (CV), delayed cerebral ischemia (DCI), and 30-day modified Rankin Scale (mRS) score.Results: Baseline characteristics were similar between groups. Serum Mg ≥2.2 mg/dL was not significantly associated with reduced vasospasm, DCI, or poor functional outcome. However, serum Mg >2.5 mg/dL correlated with lower PHH incidence in univariate analysis (odds ratio, 0.36; P=0.027) but not in multivariate analysis (P=0.136). Independent predictors of PHH were posterior circulation aneurysm, high Fisher grade, and high Hunt and Hess grade. Poor 30-day mRS was independently associated with high Fisher and Hunt and Hess grades.Conclusions: Admission serum Mg level was not independently associated with PHH, although a potential protective trend was noted at higher levels (>2.5 mg/dL). These findings suggest a possible role of Mg in PHH prevention. Further prospective trials are warranted to clarify the therapeutic potential of Mg and to establish optimal monitoring and correction strategies in aSAH management.

Background: Body weight can fluctuate during critical illness due to factors such as fluid shifts, nutritional status, the type of acute illness, and underlying comorbidities. We investigated the association between acute body weight variability (WV) and clinical outcomes in critically ill pediatric patients.Methods: We retrospectively analyzed data from patients aged 1 month to 18 years who were admitted to the pediatric intensive care unit (PICU) of a university-affiliated tertiary hospital between August 2017 and July 2021. WV was defined as the percentage difference between the measured body weight at PICU admission and the usual body weight, obtained either from recent hospital records or caregiver reports. Associations between WV and clinical outcomes, including PICU mortality and ventilator-free days (VFDs), were assessed.Results: Of the 926 patients, 74 (8.0%) died. Median WV was significantly higher in non-survivors than in survivors (8.7% vs. 0.0%; P<0.001). Increased WV was independently associated with higher mortality (hazard ratio [HR], 1.102; 95% CI, 1.073–1.131) and fewer VFDs (odds ratio [OR], 0.599; 95% CI, 0.524–0.684). Combining WV with Pediatric Index of Mortality 3 score significantly improved mortality prediction over either parameter alone (area under the curve, 0.888; P=0.047).Conclusions: Higher WV at PICU admission is independently associated with adverse clinical outcomes, including increased mortality and fewer VFDs. WV could complement existing mortality prediction models in pediatric critical care.

Background: Early mobilization after cardiac surgery is crucial for enhancing recovery, minimizing complications, and promoting timely discharge. The 6-minute walk test (6MWT) is a validated measure of functional capacity; however, its use during the early postoperative period—particularly in Intensive care Unit (ICU) settings in India—remains underexplored. This study assesses the safety, feasibility, and functional performance outcomes of the 6MWT administered on postoperative days (PODs) 2 to 4 and identifies factors associated with test completion.Methods: A cohort-based observational study was conducted in a tertiary care ICU between June and September 2021. In total, 150 cardiac surgery patients aged 30–70 years were enrolled. Inclusion required hemodynamic stability, no vasopressor/inotropic support, and ambulation from POD 2. The 6MWT was administered per the American Thoracic Society guidelines. Clinical, demographic, and physiological parameters were recorded and analyzed using descriptive statistics, paired t-tests, and regression analyses.Results: Of the 150 patients, 140 completed the test. The mean age was 52±14 years, and 75% of participants were male. Mean walking distances improved from 78.14 m (21.7% of predicted) on POD 2 to 193.51 m (53.75%) on POD 4. Completion rates increased from 40.0% to 99.2%. Physiological responses remained within safe limits, and no serious adverse events occurred. The regression analyses identified education, diet, and oxygen saturation as positive predictors and comorbidities, being female, oxygen use, and physical occupation as negative predictors.Conclusions: The 6MWT is a safe, feasible, and informative tool for assessing early functional recovery in stable post-cardiac surgery ICU patients to aid individualized rehabilitation and discharge planning.

Background: Predicting the weaning outcomes is critical, since premature or delayed extubation is associated with an increased risk of mortality. This study aimed to compare two physiological indices, thoracic fluid content (TFC) and diaphragmatic excursion (DE), for predicting weaning success in mechanically ventilated patients. Methods: This observational cohort study involved 100 mechanically ventilated patients with congested lungs who were eligible for weaning. Patients’ TFC and DE were measured using electrical cardiometry and ultrasonography, respectively, before starting the spontaneous breathing trial. Following extubation, patients were grouped into successful and failed-weaning groups, with failure defined as reintubation or a need for non-invasive ventilation within 48 hours. Respiratory and cardiovascular variables were compared. The receiver operating characteristic (ROC) curve was used to assess the ability of TFC and DE to predict weaning success.Results: Successful weaning occurred in 73 patients (73%) and failed weaning occurred in 27 patients (27%). The two groups’ baseline characteristics were comparable; however, TFC and DE were significantly different between the failed- and successful-weaning groups (P<0.001). The area under the ROC curve (AUC) exhibited moderate predictive abilities of both the TFC and DE in predicting weaning success (AUC, 0.805, cutoff <40 kΩ−1 and AUC, 0.774, cutoff >1.45 cm). In the cardiac patient subgroup, TFC exhibited high predictive ability (AUC, 0.861), but DE did not achieve comparable results (AUC, 0.750).Conclusions: Both TFC and DE are significant predictors for successful weaning from mechanical ventilators. In particular, a TFC of <40 kΩ−1 demonstrated an excellent ability to predict weaning success in patients with low ejection fraction.

Background: Multi-organ distress syndrome (MODS) causes morbidity in patients with trauma. This study evaluates the effectiveness of interleukin-33 (IL-33), which reflects tissue damage and the inflammatory response, as a MODS indicator in patients with trauma.Methods: Patients with trauma admitted to our trauma center between July 2022 and July 2023 were included. IL-33 levels were measured in blood samples for 4 days. Correlations with clinical and laboratory indicators, including initial IL-33 levels, were analyzed to identify independent predictors of MODS.Results: Among the 87 patients enrolled, 20 developed MODS. Initial IL-33 levels were elevated in the MODS group, compared with the non-MODS group. In the non-MODS group, IL-33 levels increased on day 1 and then declined, whereas in the MODS group, IL-33 levels were highest at admission (day 0) and decreased continuously through day 3. In patients with detectable initial IL-33 levels, the measured levels correlated with higher Abbreviated Injury Scale 5 scores and the Injury Severity Score (ISS). A logistic regression analysis revealed the ISS and delta neutrophil index as factors contributing to MODS progression.Conclusions: The findings suggest that initial IL-33 levels are elevated in the MODS group, compared with non-MODS group, and exhibit a rapidly declining trend, showing an initial association with MODS that was not maintained in a multivariate analysis. These findings suggest that IL-33 might have relevance in assessing trauma severity; however, further validation is required before it can be considered a biomarker for MODS.

Background: Systemic inflammation following cardiopulmonary bypass (CPB) can interfere with analysis of routine clinical and biochemical parameters. Procalcitonin (PCT) is a potential biomarker for diagnosing early postoperative sepsis in pediatric patients following cardiac surgery utilizing CPB. This study aimed to evaluate the diagnostic accuracy of PCT compared to other biomarkers, especially C-reactive protein (CRP), in this clinical setting. Methods: A prospective single-center study was conducted over a 10-month period during the coronavirus disease 2019 (COVID-19) pandemic (2021–2022), enrolling 89 pediatric patients postcardiac surgery. PCT, CRP, and complete blood count were analyzed, and area under the curve (AUC) was employed for statistical analysis. Results: PCT and CRP demonstrated moderate discriminatory ability with AUCs of 0.678 and 0.635, respectively. White cell count exhibited fair discriminatory power, and platelet count performed poorly in distinguishing septic from nonseptic cases (AUC: white cell count, 0.545; platelet, 0.486). Conclusions: PCT and CRP hold promise as diagnostic markers for early postoperative sepsis in pediatric cardiac surgery patients. However, these biomarkers are not adequate standalone indicators, emphasizing the continued need for clinical judgment supported by multiple diagnostic parameters.

The admission of a child to an intensive care unit, such as pediatric or neonatal intensive care units, serves as a significant stressor for parents. This condition is exacerbated when the child undergoes treatment in isolation from their parents. One strategy to address this challenge involves positioning parents at the bedside during the child’s care. This study aimed to identify and synthesize qualitative and quantitative research evidence on partnerships involving parents in the care of critically ill children. This research employed an integrative review method, and it was registered with the International Prospective Register of Systematic Reviews as a research-implementation protocol (ID no. CRD42023414924t). Six databases were searched for relevant literature, including ScienceDirect, Scopus, ProQuest, Sage Journals, PubMed, and Google Scholar. The evaluation of article quality used the 2018 version of the Mixed Methods Appraisal Tool, while content analysis was employed for data analysis. The results indicated that 18 articles fulfilled the inclusion requirements, out of the 5,435 articles found during the search phase. The analysis resulted in the discovery of three primary themes: partnership components, partnership outcomes and factors influencing partnerships. These three themes collectively constitute the conceptual model of partnerships in treating children with critical illness. It can be concluded that the active participation of parents in a child's critical care will yield positive outcomes for both the child and the parents. Existing empirical data underscore the significance of comprehending the factors influencing this specific situation.

Background: Real-time ultrasound-guided catheterization of the internal jugular vein (IJV) is widely used for its safety and high success rate. However, it becomes difficult when the IJV’s cross-sectional area (CSA) is reduced. A reported technique applies manual pressure (with fingers) to the supraclavicular IJV to impede venous return and enlarge the distal CSA. While effective in previous studies, its clinical utility remains unclear, as those studies involved only healthy volunteers and used blind technique. Therefore, this study aimed to evaluate the efficacy of our novel ultrasound-guided compression of the proximal IJV.Methods: In this prospective observational study, 25 hospitalized patients were included. Two ultrasound machines were used: one to visualize the CSA of the distal IJV, and the other to apply and guide compression of the supraclavicular IJV, ensuring real-time confirmation of venous occlusion. Patients were asked about pain during the compression procedure. The primary outcome was the degree of dilation at the puncture site of the IJV. Results: All 25 patients (mean Sequential Organ Failure Assessment score: 5.2±3.6) completed the study. Supraclavicular IJV compression resulted in a significant increase in the CSA of the distal IJV by approximately 150%, from 0.4±0.3 cm² to 1.0±0.3 cm² (P<0.001). No patient reported any pain during the procedure.Conclusions: Ultrasound-guided supraclavicular IJV compression significantly increased the CSA of the distal IJV in hospitalized patients. This method enhances vein visibility by increasing IJV volume, potentially improving the success and safety of central venous catheterization.