ICU Care Research Articles

Clinical outcomes of a joint ICU and palliative care multidisciplinary rounding model: A retrospective cohort study.

This retrospective cohort study assessed whether implementation of a joint inpatient palliative care (IPC) and ICU multidisciplinary rounding model affected clinical outcomes including ICU length of stay (LOS). Beginning in October of 2018, an IPC physician joined the pre-existing ICU multidisciplinary rounds. Data were collected for ICU patients admitted during a 6-month period before this intervention and a 6-month period after the intervention. Data were extracted from an integrated electronic medical records (EMR) data system and compared by Wilcoxon and chi-square test for continuous and categorical variables respectively. Negative binomial regression was used to analyze the primary outcome measure, ICU LOS. Patients in the intervention group spent fewer days in the ICU (3.7 vs. 3.9 days, p = 0.05; RR 0.82, 95% CI 0.70-0.97, p = 0.02) and in the hospital (7.5 vs. 7.8 days, p<0.01) compared to the pre-intervention group. The rate of CPR was lower in the intervention group, but the difference was not statistically significant [13(3.1%) vs. 23(5.3%), p = 0.10]. The groups did not differ significantly in rate of hospital mortality, number of days connected to mechanical ventilation via endotracheal tube, or bounceback to the ED or hospital. Multivariable analysis of the primary outcome demonstrated that patients with prior palliative care involvement had longer ICU LOS (RR 1.46, 95% CI 1.04-2.06, p = 0.03) when controlling for other variables. The presented joint IPC-ICU multidisciplinary rounding model was associated with a statistically significant reduction in ICU and hospital LOS, but the clinical significance of this reduction is unclear.

Trans-lateral ventricular approach for surgical treatment of high-located P2–P3 junction posterior cerebral artery aneurysms: from anatomical research to clinical application

BackgroundPosterior cerebral artery (PCA) aneurysms, though rare, pose treatment challenges. Endovascular therapy is the preferred option, but microsurgery becomes necessary in certain cases. Various microsurgical approaches have been suggested for PCA aneurysms, particularly those at the P2–P3 junction. This study highlights the trans-lateral ventricular approach (TVA) for addressing these complex aneurysms. This study aims to assess the feasibility and safety of the trans-lateral ventricular approach (TVA) for treating high-located complex PCA aneurysms at the P2–P3 junction. The study evaluates both clinical outcomes and anatomical considerations.MethodsTwo cases of PCA aneurysms at the P2–P3 junction were treated using TVA in 2019. Navigation-guided entry via the interparietal sulcus was planned. Ventriculostomy was performed from the cortex to the lateral ventricle’s atrium. Medial atrial floor dissection exposed PCA’s P2–P3 segments. Neuronavigation and ultrasound-aided guidance was used. Anatomical studies on fixed and contrast-perfused specimens refined the approach.ResultsBoth cases saw successful aneurysm clipping. The unruptured aneurysm patient was discharged in 6 days. The poor-grade SAH patient required extended ICU care, moving to rehabilitation with mRS = 4. The unruptured complex aneurysm case exhibited no deficits, returning to work in 3 months. Anatomical dissections validated TVA for high-located P2–P3 junction PCA aneurysms.ConclusionWhile endovascular therapy remains primary, this study demonstrates the viability of navigation-guided TVA for select high-located P2–P3 junction PCA aneurysms. Successes and challenges underscore the importance of patient selection and anatomical awareness.

Prevalence of Obesity and its Effects in Patients With COVID-19: A Systematic Review and Meta-analysis.

Background: Coronavirus disease 2019 (COVID-19) is an emerging infectious disease worldwide. Obesity has been proven to increase the susceptibility of an individual to infections, but the relationship between obesity and COVID-19 is still unclear. This study aimed to conduct a systematic review and meta-analysis of the prevalence of obesity and its effects in patients with COVID-19. Methods: Web of Science, PubMed and Embase were searched for English language studies up to May 22, 2020. We used a random or fixed-effects model to calculate pooled prevalence rates and odds ratio (OR) with 95% confidence intervals (CI). Results: Twelve studies with a total of 14 364 patients met the inclusion criteria. The pooled prevalence of obesity in patients with COVID-19 was 32.0% (95% CI, 26%-38%, P < .001). The prevalence of obesity in ICU COVID-19 patients were 37.0% (95% CI, 29%-46%, P < .001). Comparing between obese and non-obese patients, the meta-analysis showed that obesity was an important risk factor associated with COVID-19 patients needed for ICU care (OR: 1.36, 95% CI 1.22-1.52, P < .001). Conclusion: Obesity was highly prevalent (32.0%) in patients with COVID-19, especially in ICU patients (37.0%), and was an important risk factor for COVID-19 patients needed for ICU care.

Effect of neuromuscular electrical stimulation in critically ill adults with mechanical ventilation: a systematic review and network meta-analysis

BackgroundNeuromuscular electrical stimulation (NMES) is widely used as a rehabilitation methods to restore muscle mass and function in prolonged immobilization individuals. However, its effect in mechanically ventilated patients to improve clinical outcomes remains unclear.MethodsA comprehensive search was conducted using PubMed, Embase, Web of Science, PEDro, and the Cochrane Library from their inception until December 24th, 2023. The search targeted randomized controlled trials (RCTs) comparing NMES with physical therapy (PT) or usual ICU care (CG), for improving clinical outcomes in mechanically ventilated patients. We performed a network meta-analysis utilizing Stata version 14.0 and R 4.3.1.ResultsWe included 23 RCTs comprising 1312 mechanically ventilated adults. The treatments analyzed were NMES, PT, NMES combined with PT (NMES+PT), and CG. Network meta-analyses revealed that NMES or NMES+PT significantly improved extubation success rate compared to CG, with ORs of 1.85 (95% CI: 1.11, 3.08) and 5.89 (95% CI: 1.77, 19.65), respectively. Additionally, NMES exhibited a slight decrease in extubation success rate compared with NMES+PT, with OR of 0.31 (95% CI: 0.11, 0.93). Nevertheless, neither NMES nor NMES+PT showed any significant improvement in ICU length of stay (LOS), ventilation duration, or mortality when compared with PT or CG. NMES+PT emerged as the most effective strategy for all considered clinical outcomes according to the ranking probabilities. The evidence quality ranged from “low” to “very low” in this network meta-analysis.ConclusionsNMES appears to be a straightforward and safe modality for critically ill, mechanically ventilated patients. When combined with PT, it significantly improved the extubation success rate against standard ICU care and NMES alone, and showed a better ranking over PT or NMES alone for clinical outcomes. Therefore, NMES combined with PT may be a superior rehabilitation strategy for this patient group.

PATIENTS WITH ULCERATIVE COLITIS AFFECTED BY NON-ALCOHOLIC FATTY LIVER DISEASE HAVE A GREATER RISK OF MORTALITY AND WORSE CLINICAL OUTCOMES

Abstract Ulcerative colitis (UC) affects millions of patients worldwide and keeps trending upward. Non-Alcoholic Fatty Liver Disease (NAFLD) is an emerging disease predisposing to adverse outcomes. There is limited evidence of clinical outcomes of NAFLD in patients with UC. We sought to investigate this population. METHODS: We queried NIS 2017-2020 for adults hospitalized with UC &amp; NAFLD. The primary outcome was inpatient mortality. Secondary outcomes were cardiogenic shock, cardiac arrest, GIB, intubation, LOS &amp; total hospital charge. Multivariable logistic regression analysis was used to estimate clinical outcomes. RESULTS: There were 489870 hospitalizations with UC and 21695 (4.4%) had NAFLD. NAFLD &amp; non-NAFLD cohorts had a mean age of 57 vs. 57.2 yrs; males 55.1% vs 46%; Caucasians 73% vs 75.8%; Heart failure 15% vs 12%; Pulmonary Hypertension (PH) 3.9% vs 2.5%; Acute Kidney Injury (AKI) 35% vs 17%; obesity 13% vs 13.4%; Dyslipidemia 24 % vs 30.6%; anemia 26.8% vs 22.6%; Acute Coronary Syndrome (ACS) 5.3% vs 3.6%; stroke 1% vs 1.4%, respectively. CONCLUSION: The UC with NAFLD cohort showed significantly higher mortality, worse clinical outcomes &amp; resource utilization (Table 1). They were older and had more of PH, AKI, anemia, and ACS. NAFLD is associated with greater risk for MACE, GIB, &amp; ICU care. NALFD is an important risk factor among patients with UC that predicts adverse outcomes.

PATIENTS WITH CROHN'S DISEASE AFFECTED BY NON-ALCOHOLIC FATTY LIVER DISEASE HAVE A GREATER RISK OF MORTALITY AND WORSE CLINICAL OUTCOMES

Abstract Crohn's disease (CD) has a high prevalence rate and it affects millions of patients worldwide. Non-Alcoholic Fatty Liver Disease (NAFLD) is an emerging disease predisposing to adverse outcomes. There is limited evidence of clinical outcomes of NAFLD in patients with CD. We sought to investigate this population. METHODS: We queried NIS 2017-2020 for adults hospitalized with CD &amp; NAFLD. The primary outcome was inpatient mortality. Secondary outcomes were cardiogenic shock, cardiac arrest, GIB, intubation, LOS &amp; total hospital charge. Multivariable logistic regression analysis was used to estimate clinical outcomes. RESULTS: There were 792409 hospitalizations with CD and 26229 (3.3%) had NAFLD. NAFLD &amp; non-NAFLD cohorts had a mean age of 57.8 vs. 52.5 yrs (P&amp;lt;0.05); males 46.17 % vs 42.1% (P&amp;lt;0.05); Caucasians 82.42 % vs 77.1% (P&amp;lt;0.05); Heart failure 16.47% vs 10% (P&amp;lt;0.05); Pulmonary Hypertension (PH) 4% vs 2%; Acute Kidney Injury (AKI) 33.6% vs 16.1 (P&amp;lt;0.05)%; obesity 14.7% vs 12.8 % (P&amp;lt;0.05); Dyslipidemia 22.2% vs 22.2% (P=0.89); anemia 23.8% vs 20.1 (P&amp;lt;0.05)%; Acute Coronary Syndrome (ACS) 4.5 % vs 2.6% (P&amp;lt;0.05); stroke 1.2% vs 1.1 (P=0.49)%, respectively. CONCLUSION: The CD with NAFLD cohort showed significantly higher mortality, worse clinical outcomes &amp; resource utilization (Table 1). They were older, had more males, and Caucasians, and had higher rates of obesity, HF, PH, AKI, anemia, and ACS. NAFLD is associated with greater risk for MACE, GIB, &amp; ICU care. NALFD is an important risk factor among patients with CD that predicts adverse outcomes.

Time in ICU and post-intensive care syndrome: how long is long enough?

BackgroundOur understanding of post-ICU recovery is influenced by which patients are selected to study and treat. Many studies currently list an ICU length of stay of at least 24, 48, or 72 h as an inclusion criterion. This may be driven by established evidence that prolonged time in an ICU bed and prolonged ventilation can complicate post-ICU rehabilitation. However, recovery after short ICU stays still needs to be explored.MethodsThis is a secondary analysis from the tracking outcomes post-intensive care (TOPIC) study. One hundred and thirty-two participants were assessed 6-months post-ICU discharge using standardised and validated self-report tools for physical function, cognitive function, anxiety, depression and post-traumatic stress disorder (with clinically significant impairment on any tool being considered a complicated recovery). Routinely collected data relating to the ICU stay were retrospectively accessed, including length of stay and duration of mechanical ventilation. Patients with short ICU stays were intentionally included, with 77 (58%) participants having an ICU length of stay < 72 h.ResultsOf 132 participants, 40 (30%) had at least one identified post-ICU impairment 6 months after leaving ICU, 22 (17%) of whom had an ICU length of stay < 72 h.ConclusionMany patients with an ICU length of stay < 72 h are reporting post-ICU impairment 6 months after leaving ICU. This is a population often excluded from studies and interventions. Future research should further explore post-ICU impairment among shorter stays.

Sepsis Canada: Building a national research network for sepsis awareness

Sepsis Canada: Building a national research network for sepsis awareness Sepsis is a life-threatening condition estimated to affect 49 million people annually worldwide; yet it is not widely understood. In this article, we hear how Sepsis Canada is working to promote sepsis awareness through supporting research, public education, and cross-disciplinary training. In 2017 the World Health Assembly declared sepsis, defined as the life-threatening organ dysfunction due to infection, a global health priority. They emphasized the critical need for advancements in prevention, diagnosis, and clinical management. With a staggering cost exceeding $2.6 billion annually and a mortality rate ranging from 20-35% for those requiring ICU care, the impact of sepsis on the Canadian healthcare system has been immense. (1)

Thigh compartment syndrome: Outcomes in an urban level 1 trauma center

IntroductionThigh compartment syndrome (TCS) is a rare surgical emergency associated with a high risk of morbidity with mortality rates as high as 47 %. There is sparse literature discussing the management as well as outcomes of these injuries. The purpose of this study is to review a consecutive series of patients presenting to a single urban Level 1 trauma center with TCS to identify injury characteristics, clinical presentation, and outcomes associated with this injury. MethodsA trauma database was queried for all patients with a diagnosis of TCS at a single level 1 urban trauma center between January 1, 2011 and December 31, 2021. Demographic and injury variables collected included age, sex, BMI, mechanism of injury, and creatine phosphokinase levels (CPK). Hospital quality measures including time from admission to surgery, length of both hospital and ICU stay, complications, and cost of care were collected. Descriptive statistics are reported as median [interquartile range] or N (percent). ResultsThere were 14 patients identified with a diagnosis of TCS. All were men with an average age 33.5 [23.5 - 38] years and an average BMI of 26 [22.9–28.1]. The most common cause of injury was blunt trauma (71.4 %), and the remaining 28.6 % were gunshot wound injuries. Within the cohort, 6 (42.9 %) patients sustained a femoral shaft fracture, and 4 (28.6 %) patients sustained a vascular injury. The median initial CPK of patients within this cohort was 3405 [1232–5339] and reached a peak of 5271 [3013–13,266]. The median time from admission to diagnosis was 6.8 [0–236.9] hours. The median time from admission to the operating room was 8.2 [0.6–236.9] hours, and the median number of operating room visits was 3 [2 - 6]. Five patients (35.7 %) wounds were closed with split thickness skin grafting. There were 12 (85.7 %) patients who required ICU care. The median ICU length of stay was 7.5 days [4–15]. The median hospital length of stay was 16.5 days [13.25–38.0]. The median total charges for a patient with thigh compartment syndrome was $129,159.00 [$24,768.00 - $587,152.00]. The median direct variable cost for these patients was $86,106.00 For comparison, the median direct variable cost for patients with femur fractures without TCS at this institution was $8,497.28 [$1,903.52–$21,893.13]. No patients required readmission within 60 days. There were no mortalities. ConclusionTCS is a rare and life-threatening injury associated with significant morbidity. Despite rapid diagnosis and fasciotomy, the majority of the patients have prolonged hospital courses, ICU lengths of stay, and significant costs of treatment. Providers can reference the outcomes reported in this study when caring for TCS patients.

Short-term and medium-term clinical outcomes of multisystem inflammatory syndrome in children: a prospective observational cohort study

BackgroundEven though the incidence of Multisystem Inflammatory Syndrome in children (MIS-C) is decreasing cases are still reported across the world. Studying the consequences of MIS-C enhances our understanding of the disease’s prognosis. The objective of this study was to assess short- and medium-term clinical outcomes of MIS-C.MethodsProspective observational cohort study at Municipal Children’s Hospital Morozovskaya, Moscow, Russia. All children meeting the Royal College of Paediatrics and Child Health (RCPCH), Centers for Disease Control and Prevention (CDC), or the World Health Organization (WHO) MIS-C case definition admitted to the hospital between 17 May and 26 October 2020 were included in the study. All survivors were invited to attend a clinic at 2 and 6 weeks after hospital discharge.Results37 children median age 6 years (interquartile range [IQR] 3.3–9.4), 59.5% (22/37) boys were included in the study. 48.6% (18/37) of patients required ICU care. One child died. All children had increased levels of systemic inflammatory markers during the acute event. Echocardiographic investigations identified abnormal findings in 35.1% (13/37) of children. 5.6% (2/36) of children were presenting with any symptoms six weeks after discharge. By six weeks the inflammatory markers were within the reference norms in all children. The echocardiographic evaluation showed persistent coronary dilatation in one child.ConclusionsDespite the severity of their acute MIS-C, the majority of children in our cohort fully recovered with none having elevated laboratory markers of inflammation at 6 weeks, few (< 10%) reporting persistent symptoms at 6 weeks, and only one with persistent echocardiographic abnormalities.

One-year mortality rates after standardized management for emergency laparotomy: results from the Swedish SMASH study.

Patients who require an emergency laparotomy suffer from high mortality and morbidity rates. Studies have shown that the standardization of perioperative management reduces complications in the short term. The aim of the present study was to report long-term mortality rates for the SMASH (Standardized perioperative Management of patients operated with acute Abdominal Surgery in a High-risk and emergency setting) study, as well as short- and long-term outcomes for different age groups within the SMASH study. A prospective intervention study was introduced in 2018, with the aim of investigating the introduction of a standardized protocol for emergency laparotomy. For 42 months, intervention patients were managed according to the protocol and outcomes were then compared with those of historical controls. A total of 1344 unique patients were included (681 in the intervention group and 663 in the control group). The 90-day mortality rate was 14.1 per cent in the intervention group and 20.8 per cent in the control group (P = 0.002) and the 1-year mortality rate in adjusted analyses was 19.7 and 27.8 per cent respectively (P =< 0.001). An age-related subgroup analysis showed that the oldest patients (76 years and older, 260 in the intervention group and 240 in the control group) had a 1-year mortality rate of 29.6 and 43.8 per cent respectively (P = 0.004) and a mean duration of hospital stay of 9.9 and 11.6 days respectively (P = 0.027). Among older adults (61-75 years), the mean duration of hospital stay was 11.7 days in the intervention group compared with 15.1 days in the control group (P = 0.009) and the mean duration of ICU care was reduced to 4.49 days compared with 7.29 days (P = 0.046). The standardized protocol associated with an emergency laparotomy appears to be beneficial, even in the long term. For elderly patients, it appears to reduce mortality rates and the durations of hospital stay and ICU care.

Opioid use following cardio-thoracic intensive care: risk factors and outcomes: a cohort study

Opioid misuse has become a serious public health problem. Patients admitted to cardio-thoracic critical care are usually exposed to opioids, but the incidence and effects of chronic opioid use are not known. The primary objective was to describe opioid use after admission to a cardio-thoracic intensive care unit. Secondary objectives were to identify factors associated with chronic opioid usage and analyze risk of death. This cohort study included all cardio-thoracic ICU care episodes in Sweden between 2010 and 2018. Among the 34,200 patients included in the final study cohort, 4050 developed persistent opioid use after ICU care. Younger age, preadmission opioid use, female sex, presence of comorbidities and earlier year of ICU admission were all found to be associated with persistent opioid use. The adjusted hazard ratio for mortality between 6 and 18 months after admission among individuals with persistent opioid use was 2.2 (95% CI 1.8–2.6; P < 0.001). For opioid-naïve patients before ICU admission, new onset of chronic opioid usage was significant during the follow-up period of 24 months. Despite the absence of conclusive evidence supporting extended opioid treatment, the average opioid consumption remains notably elevated twelve months subsequent to cardio-thoracic ICU care.

External evaluation of the Dynamic Criticality Index: A machine learning model to predict future need for ICU care in hospitalized pediatric patients.

To assess the single site performance of the Dynamic Criticality Index (CI-D) models developed from a multi-institutional database to predict future care. Secondarily, to assess future care-location predictions in a single institution when CI-D models are re-developed using single-site data with identical variables and modeling methods. Four CI-D models were assessed for predicting care locations >6-12 hours, >12-18 hours, >18-24 hours, and >24-30 hours in the future. Prognostic study comparing multi-institutional CI-D models' performance in a single-site electronic health record dataset to an institution-specific CI-D model developed using identical variables and modelling methods. The institution did not participate in the multi-institutional dataset. All pediatric inpatients admitted from January 1st 2018 -February 29th 2020 through the emergency department. The main outcome was inpatient care in routine or ICU care locations. A total of 29,037 pediatric hospital admissions were included, with 5,563 (19.2%) admitted directly to the ICU, 869 (3.0%) transferred from routine to ICU care, and 5,023 (17.3%) transferred from ICU to routine care. Patients had a median [IQR] age 68 months (15-157), 47.5% were female and 43.4% were black. The area under the receiver operating characteristic curve (AUROC) for the multi-institutional CI-D models applied to a single-site test dataset was 0.493-0.545 and area under the precision-recall curve (AUPRC) was 0.262-0.299. The single-site CI-D models applied to an independent single-site test dataset had an AUROC 0.906-0.944 and AUPRC range from 0.754-0.824. Accuracy at 0.95 sensitivity for those transferred from routine to ICU care was 72.6%-81.0%. Accuracy at 0.95 specificity was 58.2%-76.4% for patients who transferred from ICU to routine care. Models developed from multi-institutional datasets and intended for application to individual institutions should be assessed locally and may benefit from re-development with site-specific data prior to deployment.

Severe COVID-19 infection: An institutional review and literature overview.

Our study aimed to describe the group of severe COVID-19 patients at an institutional level, and determine factors associated with different outcomes. A retrospective chart review of patients admitted with severe acute hypoxic respiratory failure due to COVID-19 infection. Based on outcomes, we categorized 3 groups of severe COVID-19: (1) Favorable outcome: progressive care unit admission and discharge (2) Intermediate outcome: ICU care (3) Poor outcome: in-hospital mortality. Eighty-nine patients met our inclusion criteria; 42.7% were female. The average age was 59.7 (standard deviation (SD):13.7). Most of the population were Caucasian (95.5%) and non-Hispanic (91.0%). Age, sex, race, and ethnicity were similar between outcome groups. Medicare and Medicaid patients accounted for 62.9%. The average BMI was 33.5 (SD:8.2). Moderate comorbidity was observed, with an average Charlson Comorbidity index (CCI) of 3.8 (SD:2.6). There were no differences in the average CCI between groups(p = 0.291). Many patients (67.4%) had hypertension, diabetes (42.7%) and chronic lung disease (32.6%). A statistical difference was found when chronic lung disease was evaluated; p = 0.002. The prevalence of chronic lung disease was 19.6%, 27.8%, and 40% in the favorable, intermediate, and poor outcome groups, respectively. Smoking history was associated with poor outcomes (p = 0.04). Only 7.9% were fully vaccinated. Almost half (46.1%) were intubated and mechanically ventilated. Patients spent an average of 12.1 days ventilated (SD:8.5), with an average of 6.0 days from admission to ventilation (SD:5.1). The intermediate group had a shorter average interval from admission to ventilator (77.2 hours, SD:67.6), than the poor group (212.8 hours, SD:126.8); (p = 0.001). The presence of bacterial pneumonia was greatest in the intermediate group (72.2%), compared to the favorable group (17.4%), and the poor group (56%); this was significant (p<0.0001). In-hospital mortality was seen in 28.1%. Most patients were male, obese, had moderate-level comorbidity, a history of tobacco abuse, and government-funded insurance. Nearly 50% required mechanical ventilation, and about 28% died during hospitalization. Bacterial pneumonia was most prevalent in intubated groups. Patients who were intubated with a good outcome were intubated earlier during their hospital course, with an average difference of 135.6 hours. A history of cigarette smoking and chronic lung disease were associated with poor outcomes.

Developing a decision model to early predict ICU admission for COVID-19 patients: A machine learning approach

Emergency department (ED) overcrowding is a significant problem in the US. This paper develops a decision model to mitigate ED overcrowding by helping hospitals proactively plan patient boarding processes. The information obtained after the initial assessment of COVID-19 patients in the ED, including patient demographics and medical history, is utilized to predict ICU admission earlier. The predicted information can be communicated with the inpatient unit to prepare an ICU bed for the patients who need ICU care. As a result, the boarding time when patients wait for an ICU bed to be ready can be reduced. The data used in this study included 100 features and 19,155 COVID-19 patients from an academic medical center located in the Southeast United States. Multiple feature selection methods along with Extreme Gradient Boosting (XGBoost) were utilized to develop the models. The parameters of the XGBoost models are optimized using simulated annealing (SA). Among the proposed models, the best model included ten features and resulted in an area under the curve (AUC) of 89.2%, which is the highest among the models proposed in the literature. The proposed prediction model allows hospital administrators to allocate ICU beds more efficiently, enhance patient flow, and mitigate ED overcrowding.

Clinical Characteristics and Outcomes of Elective Gynecologic Cases Using Modified Medically Necessary, Time Sensitive (MeNTS) Scoring System in the Prioritization of Surgery at the Philippine General Hospital during the COVID-19 Pandemic.

The use of a scoring system that integrates various factors helps in decision-making and triage for Medically Necessary, Time Sensitive (MeNTS) surgical procedures during the COVID-19 pandemic. This study aimed to determine the clinical characteristics and outcomes of cases who were screened and underwent elective gynecologic surgery at a tertiary hospital using the MeNTS tool for prioritization. A cross-sectional study was carried out using data collected through medical chart review of all gynecologic cases screened in a 6-month period, from June 18, 2020 to December 18, 2020. A total of 155 gynecologic cases were screened, with 134 (86.4%) MeNTS cases and 21 (13.5%) non-MeNTS cases. The median length of stay (5 days), the median operating room time (3 hours and 30 minutes), and median estimated blood loss (400 ml) were within the acceptable expected outcome as with the scoring system, albeit with some cases (53%) requiring blood transfusion attributed to low baseline hemoglobin levels. There were no cases with post-operative COVID-19 transmission, needing ICU care and intubation, nor mortalities reported. The MeNTS scoring system allowed efficient handling of the backlog of elective gynecologic cases with minimal morbidity and absence of mortality. The study supports the utility of this scoring system in addressing the need of the healthcare system not just to optimally utilize and fairly allocate hospital resources but also to ensure the safety of the patient with the best health service delivery during the pandemic.

The Impact of the COVID-19 Pandemic on One-Year Mortality in Geriatric Hip Fracture: A Retrospective Cohort Study.

The COVID-19 pandemic has profoundly impacted global healthcare systems, necessitating substantial shifts in patient care strategies. The pandemic's onset led to drastic operational changes in hospitals, including reduced bed capacity and staffing levels, which could have further influenced the mortality outcomes for geriatric patients. The study aimed to assess the impact of the COVID-19 pandemic on 1-year mortality rates of surgically treated geriatric hip fractures. This retrospective, single-center cohort study included 346 participants aged 65 and above who underwent surgical treatment for hip fractures. We compared mortality rates between the pre-COVID and COVID eras. Data included demographics, treatment, complications, and COVID-19 status. The independent samples t test and Chi-square tests (or Fisher's exact test) were used for comparisons for era cohorts. Survival probabilities were assessed using Kaplan-Meier, while multivariate analysis identified mortality predictors. 175 patients were included in the pre-COVID era, and 171 patients were included in the COVID era. During the COVID era, the 30-day mortality rate was 11.7% (compared to 13.7% in the pre-COVID era, p = 0.573), and the 1-year mortality rate was 43.9% (compared to 49.1% in the pre-COVID era, p = 0.325). The overall 1-year mortality rate was 46.5%. Patients who underwent surgery within 48hours had a higher 1-year survival rate (60.5%) compared to those with delayed surgery (51.2%), p = 0.031. Additionally, patients not admitted to the ICU had a higher 1-year survival rate (74.7%) than those who were admitted (44.9%), p < 0.001. 70.1% of the total deaths occurred within the first 90days. Elderly patients with hip fractures experienced high mortality rates before and during the pandemic. This study demonstrates that the 1-year mortality rates of geriatric hip fractures were not significantly affected by the pandemic. The findings emphasize the importance of pandemic preparedness and prompt surgeries and attentive ICU care in reducing mortality rates.

Comparing NGS-Based identification of bloodstream infections to traditional culture methods for enhanced ICU care: a comprehensive study.

Accurate identification of infectious diseases using molecular techniques, such as PCR and NGS, is well-established. This study aims to assess the utility of Bactfast and Fungifast in diagnosing bloodstream infections in ICU settings, comparing them against traditional culture methods. The objectives include evaluating sensitivity and specificity and identifying a wide range of pathogens, including non-culturable species. We collected 500 non-duplicate blood samples from ICU patients between January 2023 and December 2023. Specimens underwent traditional culture, MALDI-TOF, VITEK®2 compact system, and NGS-based Bactfast and Fungifast analyses. Out of the 500 samples, 26.8% (n=134) showed bacterial growth via traditional culture methods, while 4.8% (n=24) were positive for fungal growth. MALDI-TOF and VITEK®2 compact system yielded comparable results, identifying 26.4% (n=132) of specimens with bacterial growth. NGS-based Bactfast detected bacterial presence in 38.2% (n=191) of samples, including non-culturable bacteria missed by traditional methods. However, NGS-based Fungifast showed concordant fungal detection rates with culture methods. Among identified pathogens by culture method included Klebsiella pneumoniae 20.89% (n=28), Enterococcus faecalis 18.65% (n=25), Escherichia coli 15.67% (n=21), Pseudomonas aeruginosa 12.68% (n=17), Acinetobacter baumannii 10.44% (n=14), various Streptococcus species 7.46% (n=10), Mycobacterium tuberculosis 6.71% (n=9), Mycobacterium abscessus 4.47% (n=6), and Salmonella spp 2.98% (n=4). Non-culture-based NGS identified additional (n=33) pathogens, including Klebsiella pneumoniae 27.27% (n=9), Bacteroides fragilis 21.21% (n=7), Aerococcus viridans 15.15% (n=5), Elizabethkingia anopheles 12.12% (n=4), Aeromonas salmonicida 9% (n=3), Clostridium 9% (n=3), and Bacteroides vulgatus 6% (n=2). Candida albicans was reported in 5% (n=24) of samples by both methods. NGS-based Bactfast and Fungifast demonstrate high sensitivity in identifying a wide array of bacterial and fungal pathogens in ICU patients, outperforming traditional culture methods in detecting non-culturable organisms. These molecular assays offer rapid and comprehensive diagnostic capabilities, potentially improving clinical outcomes through timely and accurate pathogen identification.

Clinical Profile and Predictors of Intensive Care Admission in Neonicotinoid Poisoning in a Tertiary Care Hospital in South India.

Neonicotinoids are a newer class of pesticides that are believed to cause predominantly mild toxicity in humans. This study aimed to describe the clinical features of neonicotinoid poisoning and identify predictors of severe toxicity. This retrospective study included all patients with neonicotinoid poisoning admitted to a Tertiary Care Center in India over an 18-year period. Clinical and laboratory features were compared against outcomes to identify predictors of the need for intensive care admission. Twenty-eight patients were included in the study of which 28.6% had severe disease requiring ICU admission. A higher respiratory rate, blood lactate level, SOFA, and qSOFA scores as well as a lower Glasgow coma score at presentation predicted ICU admission. First-generation compounds and imidacloprid consumption were associated with longer ICU stays and a longer duration of invasive ventilation. Neonicotinoid compounds can cause significant toxicity with oral ingestion. Imidacloprid and other first-generation compounds were associated with more severe toxicity requiring intensive care. Simple clinical parameters assessed at presentation can be used to predict severe disease and the need for ICU care. Larger, prospective studies are required to confirm these findings. Sanga L, Jacob A, Jayakaran JAJ, Iyadurai R. Clinical Profile and Predictors of Intensive Care Admission in Neonicotinoid Poisoning in a Tertiary Care Hospital in South India. Indian J Crit Care Med 2024;28(1):66-69.

Critical Care in Older People in Low and Middle-Countries (LMICs): Comprehensive Geriatric Assessment (CGA) Protocol in Andes Mountains

Background: The number of older adults in ICU care is increasing. Nowadays, at least fifty percent of ICU patients are aged 65 years and older. The most frequent pathologies to be admitted to the ICU in older people include acute diseases, long-term conditions, and acute or chronic disease exacerbations. Furthermore, new clinical phenotypes, and geriatric syndromes (falls, frailty, immobility) result from the interaction of age-associated conditions and comorbidity. Severity of index disease, multimorbidity, premorbid functional status, frailty, nutritional status, and cognitive level are more important determinants of long-term outcome than chronological age. Comprehensive geriatric assessment (CGA) is a recognized and useful instrument in the management of elderly patients. Methods: We present a protocol for a clinical trial on the application ofCGA in ICU in the Andes Mountains in Colombia, a Low and Middle-Income Country (LMIC). This protocol could provide valuable information for the integration of geriatrics into critical care and provide practical information on how to implement CGA in this context. Results: The selection criteria of the tools to be used during the assessment of the patients were based on the available literature review and on reviews about interdisciplinary team interventions in acute care services based on the CGA. Conclusion: The care of critically ill elderly patients in the ICU is challenging due to factors such as frailty, psychosocial vulnerability, cognitive impairment, dependence on activities of daily living, and the presence of geriatric syndromes which are important conditions for adverse health outcomes in the future. CGA technology could be considered an excellent tool for managing older people in ICU.