Casualty Rates Research Articles

Research Progress in the Construction of Delirium Risk Warning Model for ICU Patients Based on Decision Tree: A Review of the Literature

Intensive Care Unit (ICU) delirium is a cerebral syndrome characterized by acute disturbance of consciousness, with an incidence of 38%-87%. The occurrence of delirium can lead to prolonged hospital stay, accidental extubation rate, mortality and other adverse consequences. Therefore, early identification of delirium and active correction of reversible causes appear to be particularly important. At present, the risk prediction models for delirium in ICU constructed at home and abroad mainly use logistic regression to build delirium risk prediction models for patients admitted to ICU≥24h. However, studies have found that as many as 25% of critically ill patients will develop delirium within 24h of admission to ICU. Therefore, it is particularly important to construct a delirium early warning model for patients entering ICU24h. Logistic regression model has low processing efficiency for non-linear and interactive data, and can not intuitively show the importance of each variable in the predicted result. As a non-parametric statistical method, decision tree can overcome the disadvantages of Logistic regression model and build a better prediction model. Therefore, this study used 24h after admission to ICU as the segmentation point to build a decision tree model for predicting early and late delirium in ICU patients, forming a corresponding risk level system, and compared it with similar delirium models to verify the predictive value of the decision tree model for early and late delirium in ICU patients, providing a basis for the formulation of further intervention and nursing plans. Thereby reducing the incidence of ICU delirium.

Market-Consistent Valuation and Capital Assessment for Demographic Risk in Life Insurance: A Cohort Approach

We explore the quantification of demographic risk in accordance with the market-consistent actuarial valuation principles. Our contribution includes closed formulas for assessing the inflows and outflows of an insurance policy portfolio using a cohort approach. To maintain versatility, we address both traditional and equity-linked policies, providing a market-consistent valuation of liabilities. Subsequently, we compute the capital requirement for idiosyncratic risk (linked to accidental mortality) and systematic risk (trend risk), presenting an approach that allows consideration of the risks at cohort level. Specifically, we evaluate the minimum capital using an annual time horizon, a 99.5 % confidence level, and the Value at Risk as the risk measure, developing a framework aligned with the European Solvency II regulation for insurance and reinsurance companies. Moreover, the model can be easily adapted to accommodate other regulatory frameworks, incorporating specific rules and accounting principles relevant to diverse jurisdictions worldwide. The numerical analysis and the sensitivities reveal that the accidental volatility of policyholders’ deaths is influenced by the inherent characteristics of the cohort’s policies, the age of policyholders, and the variability of sums insured. Furthermore, trend risk is contingent on both accidental volatility and the longevity forecasting model employed.

Optimization model for mass casualty management system using qos-aware routing protocol and casualty triage prediction

Abstract Purpose Unexpected events, whether man-made or natural, cause significant distress and disorder. The number and magnitude of disasters and catastrophes have been rising globally in recent decades, according to historical data. Continued real-time monitoring of mass casualty along with the arrangement of needed medical resources to handle the mass casualty is required to reduce the mortality and morbidity rates. Methods Electronic tag-based casualty monitoring and machine learning-based Decision Support Systems are emerging as a more effective and proactive solution that provides continuous remote monitoring of patients. A novel framework based on Body-to-Body Network, Prediction model, and Genetic Algorithm-based medical resource optimization is proposed for the continuous monitoring of the mass casualty and medical resource allocation at the incident. The aim of this work is to give priority to the handling of critical casualties. Firstly, a Quality of Service and load-sensitive routing protocol for transmitting mass casualties' physiological parameters across a wireless network is proposed, with the critical casualty being emphasized. Secondly, the clinical seriousness degree of the mass casualty is predicted using Backpropagation Artificial Neural Network. Finally, an optimization model using a Genetic algorithm and queuing theory is proposed to find the required optimal number of medical resources to handle critical and non-critical casualties separately. Also, the proposed optimization model considers the predicted clinical level transition rates of the mass casualty. Results The performance and accuracy of the proposed framework are evaluated using the MIMIC-II dataset. The outcome demonstrates that the framework emphasizes critical casualty management. Furthermore, the framework allocates an adequate number of servers by incorporating the proposed routing protocol in comparison to the AODV protocol. Conclusion The inclusion of a prediction model in the framework aids in allocating an adequate number of servers by considering the predicted clinical deteriorating transition rates of casualties at a mass casualty incident. In terms of the estimated length of the casualty at the incident, the results suggest that incorporating a medical resource optimization model outperforms the non-optimal option.

Examining Geographic Disparities in Fatal Automobile Accidents Across Kuwait Using GIS

Traffic accidents are considered a major public health issue worldwide, causing more than a million deaths annually and roughly five times that many injuries. Studying such accidents from a geographic perspective may help policy makers form better mitigation strategies for reducing accident rates. A Geographic Information System (GIS) is a powerful tool for performing this task due to its ability to visualize the spatial distribution of traffic accident data. Our research focused upon analyzing the geographic disparities in fatal car accidents. We chose to examine data between October 1, 2022 and March 31, 2023 for the state of Kuwait, which has a relatively high fatal accident rate per capita. We used various GIS-based tools in this research, such as average nearest neighborhood, point density, and optimized hot spot analysis. The results showed a significant disparity in accidents between urban and rural areas. Furthermore, an accident rate comparison between winter and summer seasons also revealed seasonal geographic disparities.

Road casualties analysis

This article examines the circumstances of road casualties over the period 2012–2021 in Greater Manchester in North West England. In particular, the demographics of road casualties, the nature of the road activity involved, and the nature of the roads where the casualties occurred are examined. Over the period studied there was an overall decrease in road casualties, similar to that of Great Britain overall, and there were 1.55 times as many male as female road casualties. The largest decrease in road casualties by age group was amongst those aged less than 18. The majority of road casualties occurred on urban roads with a speed limit of 21–30 mph. There was a strong relationship between age group and the rate of road casualties for pedestrians, driver/riders, and passengers.

Probabilistic assessment of earthquake casualties in residential areas

Accurately and reasonably assessing earthquake casualties is crucial for seismic disaster planning and governmental decision-making. However, current research on earthquake casualty assessments often lacks sufficient consideration of the uncertainties related to seismic scenarios and influencing factors. To enhance the authenticity and reliability of casualty assessments, this study proposes a seismic casualty assessment model capable of simultaneously considering multiple influencing factors. It quantitatively evaluates each influencing factor and comprehensively integrates the uncertainty characteristics associated with seismic occurrence time, building damage states, and the number of occupants. Using a residential area as an example, the research compares casualty assessment results with and without considering apartment layouts and the age structure of residents. It also explains the probabilistic method for quantifying casualties and constructing vulnerability models for seismic events in the residential area. Additionally, a simplified analytical method applicable to probabilistic assessment of earthquake casualties in masonry residential areas in Beijing is proposed. The research findings indicate that the apartment layouts within buildings have a relatively minor impact on the assessment results of casualties in the residential area, while the age structure of residents significantly affects earthquake casualty estimates. Casualty rates in the residential area, considering uncertainties in the three factors, approximately follow a log-normal distribution. For seismic intensities ranging from VI(0.05g) to IX(0.40g), the standard deviation of casualty rates across different seismic intensities exceeds 0.4. The probabilistic analysis method proposed in this study enhances existing models for earthquake casualty assessments and addresses the shortcomings in probabilistic evaluation research.

Mortality among Swedish seafarers 1985-2013.

The aim was to investigate mortality among Swedish seafarers compared to the general population, and differences in mortality between occupational categories and differences over time. Longitudinal register-based cohort study of 85,169 Swedish seafarers registered in the Swedish Transport Agency's Seafarers' Registry (SR) 1985-2013. The cohort was matched with the Swedish Cause of Death Register. Standardized mortality ratios (SMRs) and 95% confidence intervals (CIs) were calculated stratified by gender, job category, start of sea service, and time registered in the SR. Seafarers were followed until 66 years of age. Mortality by diseases was analyzed for seafarers with at least 5 years of sea service and mortality due to external causes was analyzed for all seafarers. Total mortality was increased among men who started to work before 1985 (SMR: 1.27, 95% CI: 1.21-1.32) and borderline significantly increased among women (SMR: 1.14, 95% CI: 0.99-1.32). Mortality ratios due to lung cancer, accidents, suicides, and mental disorders including substance abuse, were increased among seafarers who started to work before 1985. Mortality risks were particularly increased among the crew. SMRs tended to decrease over time, but mortality due to accidents was still increased among the crew who started to work 1985 or later (SMR: 1.64, 95% CI: 1.02-2.63). Swedish seafarers had an increased mortality compared to the general population in 1985-2013, particularly the crew. There is still an increased mortality in accidents among crew who started to work 1985 or later.

Exploring variations in flood events and casualties over Yamuna River basin, India

ABSTRACT The current study seeks to investigate the temporal and spatial distribution of flood events and casualties in the Yamuna River basin from 1978 to 2014. The data were compiled from the published reports on disastrous weather events and analyzed with simple quantitative methods (sums, averages, and percentages). The analysis revealed the occurrence of a total of 1886 flood events, which resulted in 5481 casualties (148 per year). The years 1995, 2003, 1993, and 1996 were observed as the most devastating years, contributing about 30 percent of the total flood events, while 1978, 1980, 1981, 1995, 2006, and 2013 were the deadliest years in terms of casualties (47 percent). The largest number of flood events and casualties were recorded during June–September months. Considering the event/casualty density and rates, the states of Himachal Pradesh and Uttarakhand experienced the highest event density (0.036 and 0.091) and casualty rates (2.1 and 1.9 persons). These findings will help in identifying and demarcating the worst flood-affected areas over the Yamuna River basin, which can subsequently help in reducing the flood risk and human casualties in these regions after initiating suitable flood mitigation measures.

The changing politics of road death in Britain: from policy action to kicking the can down the road

Britain has one of the lowest road casualty rates globally, yet tens of thousands of people are killed or seriously injured annually, and numbers have plateaued since 2012. Despite the consequential impact of road trauma, there has been limited evaluation of Britain's policy response. This paper uses Kingdon's Multiple Streams Model to understand agenda setting and analyses how road safety policies were made or not made over time. Critical discourse analysis evaluates patterns and themes in new data acquired via thirty-five interviews with politicians and policy participants, and data from Parliamentary debates and policy documents, spanning the period between 1987 and 2021. The data suggests two distinct time periods: 1987 to 2002, the policy problem was accepted, policy solutions advanced, when policy windows opened as political discourse was constructive, the multiple streams coupled, and policy change resulted. Policy development in road safety is therefore possible when it is viewed as an important policy agenda in need of attention. After 2003, there was a perception the problem had been resolved. Road safety lost out to a dominant mobility framing, road deaths were reframed as accidental and so unavoidable, solutions were contested, the politics stream flowed slowly, and from 2011, with the tight fiscal environment, discarded targets, and significant competition for attention from alternative policy areas, policy stasis resulted. The prevailing politics meant that the policy problem remained sidelined and policy solutions continued to be kicked down the road. The paper explores how this shift occurred and the consequences on the politics of road death.

Seismic loss assessment of direct-DBD platform-type cross-laminated timber shear wall systems using FEMA P-58 methodology

An efficient design method should provide practitioners with a means for sizing timber buildings to meet specific performance levels against estimated earthquake intensities. Displacement and energy design considerations in force-based design (FBD) procedures are not as precise as intended in complex systems, such as mid- to high-rise timber buildings. The main aim of this study is to tailor the direct displacement-based design (D-DBD) classical framework to platform-type cross-laminated timber (CLT) shear wall structural systems and validate their performance for low-rise to high-rise timber mixed-use buildings. A comparison with results obtained via the FBD analyses is also provided. To this end, timber buildings with heights of 4, 8 and 12 stories are designed via the D-DBD and FBD methods. The seismic performance of platform-type CLT wall buildings is assessed in terms of the repair cost, repair time and casualty rate using FEMA P-58 methodology. The seismic response of CLT shear walls shows that the FBD method may lead to an expensive overdesign, especially in high-rise platform-type CLT walls. Conversely, the D-DBD method develops structural systems which can sustain a comparable level of damage from low- to high-rise platform-type CLT walls. Although the seismic loss assessment of buildings shows slightly better performance for the FBD method than the D-DBD method, it is worth noting that the D-DBD method does not lead to an unsafe building. Consequently, the D-DBD method sounds like a proper alternative approach for designing the CLT shear walls to achieve target performance levels without requiring a premium upfront cost.

Is Declined Cognitive Function Predictive for Fatal Accidents Involving Aging Pilots?

Background. Civil aviation comprises airlines/charters and general aviation (GA). Currently, airlines are experiencing a pilot shortage, partly reflecting scheduled retirements mandatory for airline (but not GA) pilots aged 65 years, fueling a debate as to whether the retirement age should be increased. Herein, using 16–40 years-of-age aviators as a reference, we determined whether GA pilots aged 60+ years (i) incurred an elevated accident rate, employing, for the first time, age-tiered flight time as a measure of risk exposure and (ii) carried an excess risk for cognitive deficiency-related fatal accidents. Methods. Airplane accidents (2002–2016) involving Class 3 medical certificated pilots were per the National Transportation Safety Board (NTSB) databases. Age-tiered pilot risk exposure represented a summation of flight hours per Class 3 medical applications. Cognitive decline measures were per NTSB field codes. Statistical analyses employed Chi-Square, Mann–Whitney, logistic regression, and binomial tests. Results. Using flight hours as the denominator, the fatal accident rate for older pilots (41–80 years) was unchanged compared with aviators aged 16–40 years. In the logistic regression, no cognitive deficiency measure was predictive (p = 0.11, p = 0.15) for pilots aged 61+ years who were involved in fatal accidents. Conclusion. These findings question the necessity of an automatic disqualification of air transport pilots at 65 years of age.

Socially responsible behaviour of a pedestrian − Obligation or necessity?

As vulnerable road users, pedestrians are the object of research in various areas of road safety. One of the ways to reduce the level of risky behaviour of pedestrians is to increase their social responsibility by applying the “traditional” 3 E: engineering, education, and enforcement. Social responsibility involves a focus on responsibility for both actions related to personal safety and actions that benefit society. This paper deals with the results of a survey of pedestrians regarding their risky behaviour while walking, namely, violation of crossing rules and distraction by using a smartphone or listening to music through headphones. It was found that risky behaviour depends on the age of pedestrians, and listening to music through headphones also depends on the person’s gender. It was established that respondents’ assessment of the safety of transport modes does not correlate with data on mortality in road traffic accidents using different types of transport. It is proposed that social responsibility of pedestrians can be increased by analyzing the causes and events that lead to traffic accidents during the study of safety disciplines in higher education institutions.

Comparison of GAP, R-GAP, and new trauma score (NTS) systems in predicting mortality of traffic accidents that injure hospitals at Mashhad University of medical sciences

BackgroundThere are several trauma scoring systems with varying levels of accuracy and reliability that have been developed to predict and classify mortality in trauma patients in the hospital admission. Considering the importance of the country's emergency organization and the World Health Organization in the category of traffic accidents, we used this information in the study. The objective of this study is to evaluate and compare the predictive power of three scoring systems (R-GAP, GAP, and NTS) on traffic accident injuries. MethodsIn an analytical cross-sectional study, all the data related to the mission of traffic accidents at the pre-hospital emergency management of Mashhad University of Medical Sciences in 2022 were extracted from the automation system, and the outcome of the patients in the hospital was recorded from the integrated hospital system. Then, GAP, R-GAP, and New Trauma Scores (NTS) were calculated, and their results were compared using ROC curve and logistic regression. ResultsIn this study, 47,971 injuries from traffic accidents were evaluated. Their average age was 30.16 ± 10.93 years. R-GAP showed negligible difference than GAP and NTS scores (the area under the curve equals 0.904, 0.935, and 0.884, respectively), and the average scores of R-GAP, GAP, and NTS are equal to 22.45/45 ± 1/9, 22.25 ± 1.5, and 22.49 ± 1.3, respectively. Injury severity based on R-GAP, GAP, and NTS scores was mild in most patients. The effect of these models on the patient outcome based on OR values, R-GAP, GAP, and NTS models showed high values. All analysis was performed in SPSS 26. ConclusionAccording to the study results, it seems that R-GAP, GAP, and NTS, have the highest power to predict death in traffic accident injuries. It is recommended to include these points in the electronic file of the pre-hospital emergency for the injured. Also, the severity and outcome of the patient can be predicted by these scores, which play an important role in the triage of the injured and determining the appropriate treatment center.

Temporal change and spatial heterogeneity of the association between ambient temperature and transport accident mortality in Japan from 1972 to 2019: a nationwide time-stratified case-crossover study

Abstract Studies have demonstrated that ambient temperature was associated with transport accidents; however, little is known about the temporal change and spatial heterogeneity of this association. This study investigated the temporal change and spatial variation in the association between temperature and transport accident mortality in Japan using daily time-series data from 1972 to 2019. First, we used time-stratified case-crossover analyses with a distributed lag nonlinear model to estimate the risks of transport accident mortality with temperature in 47 prefectures in Japan. We then pooled the estimates to obtain the risk at the country level through multivariate meta-analysis. In addition, we divided the whole time period into five sub-periods to explore temporal changes in the association and fitted the mixed-effects meta-regression to identify climatic, demographic, and socioeconomic factors that may explain the spatial heterogeneity. We found that temperature was positively associated with transport accident mortality, with a percent change (PC) of 1.47% (95% confidence interval [CI]: 1.10%, 1.85%) increase in transport accident mortality per 1 °C increase in daily mean temperature. The risk of transport accident mortality associated with temperature has decreased from 1972 [PC = 2.14% (95% CI: 1.51%, 2.77%)] to 2000 [PC = 0.89% (95% CI: 0.21%, 1.57%)] but increased slightly from 2001 [PC = 1.13% (95% CI: 0.47%, 1.48%)] to 2019 [PC = 1.60% (95% CI: 0.73%, 2.48%)]. The association between temperature and transport accident mortality was larger in relatively less developed prefectures, as explained by demographic and socioeconomic factors (e.g., total population, proportion of older people and females, and number of general hospitals). Our findings may help to better understand the association between high temperature and transport accident mortality and underlying potential mechanisms, which can provide implications for public health policies to reduce the mortality burden from transport accidents in the future.

Corrupting the Battlefield: How Corruption Influences Belligerents’ Battlefield Performance

In some modern conflicts, stronger militaries have displayed poor performance in conflicts, as evidenced by slow military offensives, high battlefield casualty rates, failure to secure planned objectives and defeat in the war. Poor conflict performance, in these cases, is attributed to material and certain non-material state characteristics such as regime type, economic development, and ideology. Current explanations of conflict performance, however, have yet to integrate empirical evidence identifying another state characteristic as a negative influence on state capacity: corruption. To address this gap, we identify direct and indirect theoretical channels by which state-level corruption impacts conflict performance. Corruption decreases the war material available to troops on the ground and negatively impacts strategic decision-making by commanders. An analysis of states in interstate conflicts from 1816 to 1990 confirms the relationship between corruption and several measures of conflict performance. Case evidence from the First Russian-Chechen War is used to illustrate the mechanisms of our argument.

Trends in traffic accident mortality and social inequalities in Ecuador from 2011 to 2022

BackgroundTraffic accidents (TA) remain a significant global public health concern, impacting low—and middle-income countries. This study aimed to describe the trend in TA mortality and inequalities in Ecuador for 2011–2022, distributed by year, gender, age group, geographical location, type of accident, and social inequalities.MethodsAn ecological study was conducted using INEC national-level data on TA fatalities in Ecuador. Mortality rates were calculated per 100,000 population and analyzed by year, gender, age group, geographic region, and accident type. Annual percentage variation (APV) was determined using linear regression models. Inequality analyses examined associations between TA mortality and socioeconomic factors like per capita income and literacy rates. Complex measures such as the Slope Inequality Index (SII) were calculated to assess the magnitude of inequalities.ResultsThere were 38,355 TA fatalities in Ecuador from 2011 to 2022, with an overall mortality rate of 19.4 per 100,000 inhabitants. The rate showed a non-significant decreasing trend (APV − 0.4%, p = 0.280). Males had significantly higher mortality rates than females (31.99 vs. 7.19 per 100,000), with the gender gap widening over time (APV 0.85%, p = 0.003). The Amazon region had the highest rate (24.4 per 100,000), followed by the Coast (20.4 per 100,000). Adults aged ≥ 60 years had the highest mortality (31.0 per 100,000), followed by those aged 25–40 years (28.6 per 100,000). The ≥ 60 age group showed the most significant rate decrease over time (APV − 2.25%, p < 0.001). Pedestrians were the most affected group after excluding unspecified accidents, with a notable decreasing trend (APV − 5.68%, p < 0.001). Motorcyclist fatalities showed an increasing trend, ranking third in TA-related deaths. Lower literacy rates and per capita income were associated with higher TA mortality risks. Inequality in TA mortality between provinces with the highest and lowest per capita income increased by 247.7% from 2011 to 2019, as measured by the SII.ConclusionWhile overall TA mortality slightly decreased in Ecuador, significant disparities persist across demographic groups and geographic regions. Older adults, males, pedestrians, and economically disadvantaged populations face disproportionately higher risks. The increasing trend in motorcycle-related fatalities and widening socioeconomic inequalities are particularly concerning.

Optimal distribution of emergency resources to accidents for pre-rescue in chemical industrial parks

Medical and fire resources are scheduled to chemical industrial parks which have caused mass casualties due to accidents. However, most of models of emergency logistics do not account for pre-rescue before large-scale rescue which may increase the casualty rate because of the long emergency response time and distance. This paper presents a mathematical model proposed for optimal distribution of emergency resources for rescuing the trapped victims who are highly likely to be seriously injured or even killed before the arrival of ambulances and fire engines. Due to the different types and risks of accidents at various locations have different impacts on people, we consider the detailed characteristics of accident scenarios and maximum tolerance time for the trapped victims to determine the priority of rescue sites. In addition, this paper proposes two indices of pavement resistance coefficient and obstacle to reflect the environment after accidents, which are not involved in other models of emergency resources distribution. Based on these, a penalty cost objective function is established to maximize the rescue rate. The optimal delivery route which reflects the distribution process is planned for the robot that will save more casualties. Two simulations and a real accident case study were conducted by minimizing the objective function, and the numerical results showed the reliability and effectiveness of the presented model for making optimal decisions for emergency distribution to accidents in chemical industrial parks.

Multi-Criteria Model for Identifying and Ranking Risky Types of Maritime Accidents Using Integrated Ordinal Priority Approach and Grey Relational Analysis Approach

Accidents in marine operations are occurring consistently despite government safety initiatives and efforts to lower the number of accidents and the ensuing human casualties. Since each accident type has a different frequency and casualty rate, identifying risky accident types is important to determine the priority for taking necessary risk reduction actions. Usually, a risk is calculated using two criteria, i.e., the frequency and fatality of an accident. However, the accident statistics show that for the last 5 years from 2018 to 2022, the injury rate is more than three times the death rate in maritime accidents in Korean waters. Considering the importance of injury, unlike other previous studies, we perform a risk analysis with three criteria, i.e., frequency, death, and injury to complement the conventional risk calculation methods, which can help decision-makers allocate the limited resources to the riskiest types of accidents in order of priority. In doing so, we employed an integrated ordinal priority approach (OPA) and grey relational analysis (GRA) method to assign proper weight to each criterion and rank eight accident types. We categorized the accidents types into three different groups where safety accidents and collisions were ranked as the most dangerous types. The combined OPA and GRA technique has been effectively applied to other risky industries, as well as the maritime industry. Additionally, the proposed method is suitable for multi-criteria models when each criterion has a different importance. Finally, the method can be integrated into the framework of the risk ranking process to enhance the analysis results.

Pedestrian safety on the road to net zero: cross-sectional study of collisions with electric and hybrid-electric cars in Great Britain

BackgroundPlans to phase out fossil fuel-powered internal combustion engine (ICE) vehicles and to replace these with electric and hybrid-electric (E-HE) vehicles represent a historic step to reduce air pollution and...

Effect of esketamine combined with dexmedetomidine on delirium in sedation for mechanically ventilated ICU patients: protocol for a nested substudy within a randomized controlled trial

BackgroundUse of sedatives and analgesics is associated with the occurrence of delirium in critically ill patients receiving mechanical ventilation. Dexmedetomidine reduces the occurrence of delirium but may cause hypotension, bradycardia, and insufficient sedation. This substudy aims to determine whether the combination of esketamine with dexmedetomidine can reduce the side effects and risk of delirium than dexmedetomidine alone in mechanically ventilated patients.MethodsThis single-center, randomized, active-controlled, superiority trial will be conducted at The First Affiliated Hospital of Nanjing Medical University. A total of 134 mechanically ventilated patients will be recruited and randomized to receive either dexmedetomidine alone or esketamine combined with dexmedetomidine, until extubation or for a maximum of 14 days. The primary outcome is the occurrence of delirium, while the second outcomes include the number of delirium-free days; subtype, severity, and duration of delirium; time to first onset of delirium; total dose of vasopressors and antipsychotics; duration of mechanical ventilation; ICU and hospital length of stay (LOS); accidental extubation, re-intubation, re-admission; and mortality in the ICU at 14 and 28 days.DiscussionThere is an urgent need for a new combination regimen of dexmedetomidine due to its evident side effects. The combination of esketamine and dexmedetomidine has been applied throughout the perioperative period. However, there is still a lack of evidence on the effects of this regimen on delirium in mechanically ventilated ICU patients. This substudy will evaluate the effects of the combination of esketamine and dexmedetomidine in reducing the risk of delirium for mechanically ventilated patients in ICU, thus providing evidence of this combination to improve the short-term prognosis. The study protocol has obtained approval from the Medical Ethics Committee (ID: 2022-SR-450).Trial registrationClinicalTrials.gov: NCT05466708, registered on 20 July 2022.