Critical Care Setting Research Articles

Assessing the Impact of Simulation-Based Learning on Student Satisfaction and Self-Confidence in Critical Care Medicine.

Background: Simulation-based learning (SBL) is increasingly used in medical education to prepare students for clinical practice. This study aimed to evaluate the satisfaction and self-confidence of final-year medical students after attending SBL in critical care medicine. Methods: A cross-sectional study was conducted among 117 final-year medical students at Jazan University, Saudi Arabia. Participants attended SBL sessions focusing on critical care skills and scenarios. Data were collected using a self-administered questionnaire, which included demographic information and the Student Satisfaction and Self-Confidence in Learning Scale. Statistical analyses included descriptive and inferential statistics. Results: The study population comprised 61.54% females and 38.46% males, with a majority aged 24 years. Students who rated their overall learning experience as "Good" showed significantly higher satisfaction (4.20 ± 0.77) and self-confidence (4.20 ± 0.69) scores. The overall mean scores for satisfaction and self-confidence were 3.71 ± 0.88 and 3.70 ± 0.87, respectively. A strong positive correlation (p < 0.001) was found between satisfaction and self-confidence levels. The highest satisfaction and self-confidence scores were associated with the variety of learning materials and the instructors' helpfulness. Conclusion: The SBL intervention was effective in enhancing student satisfaction and self-confidence in critical care medicine. The strong correlation between satisfaction and self-confidence highlights the importance of well-designed SBL programs in preparing medical students for clinical practice in critical care settings.

Medication Errors in Pediatric Emergency Departments: A Systematic Review and Recommendations for Enhancing Medication Safety.

This systematic review aims to investigate the prevalence, preventability, and severity of medication errors in pediatric emergency departments (P-EDs). It also aims to identify common types of medication errors, implicated medications, risk factors, and evaluate the effectiveness of interventions in preventing these errors. A systematic review analyzed 6 primary studies with sample sizes ranging from 96 to 5000 pediatric patients in P-EDs. The review followed Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and included observational studies and randomized controlled trials involving patients aged 18 years and younger. Comprehensive searches in biomedical databases were conducted, and conflicts in record screening were resolved by a third reviewer using systematic review software. Medication errors in P-EDs are prevalent, ranging from 10% to 15%, with dosing errors being the most common, accounting for 39% to 49% of reported errors. These errors primarily stem from inaccurate weight estimations or dosage miscalculations. Inadequate dosing frequency and documentation also contribute significantly to medication errors. Commonly implicated medications include acetaminophen, analgesics, corticosteroids, antibiotics, bronchodilators, and intravenous fluids. Most errors are categorized as insignificant/mild (51.7% to 94.5%) or moderate (47.5%). Risk factors associated with medication errors in P-EDs include less experienced physicians, severely ill patients, and weekend/specific-hour ordering. Human factors such as noncompliance with procedures and communication failures further contribute to medication errors. Interventions such as health information technology solutions like ParentLink and electronic medical alert systems, as well as structured ordering systems, have shown promise in reducing these errors, although their effectiveness varies. Overall, this systematic review provides valuable insights into the complexity of medication errors in the P-ED, emphasizes the need for targeted interventions, and offers recommendations to enhance medication safety and reduce preventable errors in this critical health care setting.

Nurses’ perceptions on barriers for implementing pressure ulcers preventive measures among critically ill patients at a tertiary teaching hospital, Tanzania

ObjectivesTo explore nurse’s perceptions on barriers for Implementing Pressure Ulcers Preventive Measures among critically ill patients. Research DesignAn exploratory qualitative study design was employed. In-depth interviews were conducted with 15 nurses to explore their perceptions on barriers for preventing pressure ulcers among critically ill patient. Qualitative thematic analysis approach was used to analyze data. Study settingsMedical high dependent unit, surgical high dependent unit, medical Intensive Care unit and surgical intensive care units at tertiary teaching hospital. FindingsSeven themes emerged that describes nurses’ perceptions on barriers for implementing pressure ulcers preventive measures among patients with critical illness. The themes are: Restrictions from therapeutic interventions and severity of patient condition; Shortage of staff and equipment for pressure ulcer prevention; Unbalanced shift staffing and competing need for patient care; health care providers’ incompetence and carelessness; Lack of guidelines on implementing best practice for pressure ulcer prevention; Lack of accountability measures for negligence; and Minimal management’s commitment for PUs prevention. ConclusionThis study reveals contextual based barriers for effective prevention of ppressure ulcers among critically ill patients. Nurses should be continuously empowered with competence for pressure ulcers prevention. This should go along with staffing and equipping critical care settings for pressure ulcers prevention. Managerial oversight is required for effective implementation of pressure ulcer preventive measures. This should include development of guidelines and policies, establishing accountability measures for negligence, malpractice as well as initiating clinical audit for reflective learning purpose.

Chest X-rays and Lung Ultrasound Are Not Interchangeable in Intensive Care Practice.

Data comparing lung ultrasound (LUS) and chest X-rays (CXRs) have increased over the past years. However, there still is a lack of knowledge as to how these modalities compare with one another in the critical care setting, and several factors, including artificial study conditions, limit the generalizability of most published studies. Our study aimed to analyze the performance of LUS in comparison with CXRs in real-world critical care practice. This study presents new data from the prospective FASP-ICU trial. A total of 209 corresponding datasets of LUS and CXR results from 111 consecutive surgical ICU patients were subanalyzed, and categorial findings were compared. Statistical analysis was performed on the rates of agreement between the different imaging modalities. A total of 1162 lung abnormalities were detected by LUS in ICU patients compared with 1228 detected by CXR, a non-significant difference (p = 0.276; 95% CI -0.886 to 0.254). However, the agreement rates varied between the observed abnormalities: the rate of agreement for the presence of interstitial syndrome ranged from 0 to 15%, consolidation from 0 to 56%, basal atelectasis from 33.9 to 49.34%, pleural effusion from 40.65 to 50%, and compression atelectasis from 14.29 to 19.3%. The rate of agreement was 0% for pneumothorax and 20.95% for hypervolemia. LUS does not detect more lung abnormalities in real-world critical care practice than CXRs, although a higher sensitivity of LUS has been reported in previous studies. Overall, low agreement rates between LUS and CXRs suggest that these diagnostic techniques are not equivalent but instead are complementary and should be used alongside each other.

Muscle wasting assessed by ultrasound versus scoring systems as early predictor of outcomes of intensive care unit stay in critically ill patients

ABSTRACT Background A lot of outcome predictive tools are already in use in critical care setting with different degrees of reliability aiming for possible prevention or minimization of bad outcome and better resource management. Some critical illness sequelae significantly affect patient’s outcome and currently not included in the in-use predictive scoring system. Muscle wasting/weakness is one of these sequelae, and it was found to be an independent risk factor of poor outcomes. Objective This study was conducted to evaluate the degree of muscle wasting estimated by ultrasonography during ICU stay as a predictor of mortality, successful weaning of mechanical ventilation, ICU stay and hospital stay. Patients and Methods A prospective observational study was conducted in critical care units in Ain Shams University Hospitals, Cairo, Egypt over a period of 12 months. Results Decrease in muscle measurements was found to correlated to mortality in ICU with cutoff points from area under the curve for right QMT, left QMT, right RFCSA, left RFCSA, IEDT and EEDT were supposed to be:>9.77,>15, >16.67, >12.5, >12.63, >12.5, respectively, with best specificity and positive predictive value was found in right RFCSA (95.45, 87.5, respectively) while best sensitivity and negative predictive value was found in left RFCSA (65.38, 82, respectively). Significant negative correlation between vasoactive agent free period and maximum daily reduction in RFCSA, QMT, EIDT, and EEDT (P value = 0.001). Conclusion Daily reduction of the RFCSA and to lesser extent the QMT has significant correlation to mortality, prolongation of mechanical ventilation days and reduction in the vasopressor free days but has a poor correlation to the ICU and hospital stay. Pneumonia and renal disease had significant correlation with the muscle mass reduction. The left RFCSA found to be comparable to SOFA score as mortality predictor.

Health care professionals' experiences of pain management in the intensive care unit: a qualitative study.

Despite the existence of evidence-based guidelines for the assessment and management of pain in the critical care setting, the prevalence of acute pain remains high. Inadequate pain management is associated with longer duration of mechanical ventilation, reduced capacity for rehabilitation and long-term psychological sequelae. This study aimed to describe the experiences of pain management from healthcare professionals working in intensive care units. Healthcare professionals were recruited from intensive care units in London, UK using a purposive sampling technique. Semi-structured interviews were transcribed verbatim. Transcripts were analysed using an inductive thematic analysis technique. Thirty participants were recruited from eight diverse intensive care units. Five themes were identified. First, there was a lack of consensus in pain assessment in the ICU where nursing staff described more knowledge and confidence of validated pain measures than physicians, and concerns over validity and usability were raised. Second, there was a universal perception of resource availability impacting the quality of pain management including high clinical workload, staff turnover and availability of certain pain management techniques. Third, acknowledgement of the importance of pain management was highest in those with experience of interacting with critical care survivors. Fourth, participants described their own emotional reaction to managing those in pain which influenced their learning. Finally, there was a perception that, due to the complexity of the intensive care unit population, pain was de-prioritised and there were conflicting views as to whether standardised analgosedation algorithms were useful. This study provides evidence to suggest interdisciplinary training, collaboratively designed decision-making tools, prioritisation initiatives and research priorities are areas that could be targeted to improve pain management in critical care.

Relationship of imipenem therapeutic drug monitoring to clinical outcomes in critically ill patients: a retrospective cohort study.

The primary objective of this study was to evaluate the predictors associated with target concentration (non-)attainment of imipenem in critically ill patients. The secondary objective was to explore the correlation between achieving imipenem target concentrations and clinical outcomes of therapy. A retrospective cohort study was conducted in critically ill patients treated with imipenem. Clinical data were extracted from the patients' electronic medical records. The pharmacokinetic/pharmacodynamic target was defined as free imipenem concentrations above the minimum inhibitory concentration (MIC) of the pathogen at 100% (100%fT>MIC) of the dosing interval. Factors associated with the non-attainment of target concentrations were evaluated using binomial logistic regression. Kaplan-Meier analysis was used to investigate the correlation between (non-)attainment targets and 30-day mortality. A total of 406 patients were included, and 55.4% achieved the target of 100%fT>MIC. Regression analysis identified an initial daily dose of imipenem ≤ 2 g/day, augmented renal clearance, age ≤ 60 years, recent surgery, and absence of positive microbiology culture as risk factors for target non-attainment. Achieving the 100%fT>MIC target was significantly associated with clinical efficacy but not with 30-day mortality. Selective application of therapeutic drug monitoring in the early stages of imipenem treatment for critically ill patients can improve clinical outcomes. Further research should explore the potential benefits of TDM-guided dosing strategies for imipenem in critical care settings.

Management of Decreased Consciousness Caused by Hypovolemic Shock ec Postpartum Hemorrhage in Critical Care Setting

Introduction: Postpartum hemorrhage life-threatening condition, with a prevalence of approximately 1%-10% of all deliveries. Postpartum hemorrhage is one of the leading causes of maternal death.&#x0D; Case presentation: A 33-year-old female patient came to the emergency department with decreased consciousness 1 hour before hospital admission, with postpartum hemorrhage, placental abruption following cesarean section, and uterine atonia following B-Linch. The patient underwent a B-Linch operation after undergoing a cesarean section at a previous Hospital due to antepartum hemorrhage and placental abruption. The patient also experienced ongoing bleeding during the treatment due to uterine atonia. Following surgery, a post-operative laboratory evaluation revealed significant thrombocytopenia (platelets: 45.000/mm3) and anemia (Hb: 4,6 g/dl). &#x0D; Conclusion: The management of postpartum hemorrhage, especially with shock, requires comprehensive critical care management. Appropriate management with good multidisciplinary team involvement will improve patient outcomes and prevent multi-organ failure.

High-Flow Nasal Cannula Oxygen Therapy in the Management of Respiratory Failure: A Review.

High-flow nasal cannula (HFNC) oxygen therapy is gaining traction globally as a treatment for respiratory failure. There are several physiological benefits, and there is a growing body of evidence showing improved quality of life and patient comfort with HFNC, both in acute and home settings. Due to the increased burden of long-term respiratory conditions such as chronic obstructive pulmonary disease (COPD) on healthcare systems worldwide, the role of ward-based and post-discharge interventions in the prevention of hospital readmissions is an area of increasing interest.In this narrative review, we outline the physiological effects of HFNCand assess its applications in both the hospital andhome settings for acute and chronic respiratory failure. We also consider the evidence of non-invasive ventilation (NIV) versus HFNC in the hospital setting and the application of HFNC at home in stable hypercapnic respiratory failure to improve the quality of life and prevent readmissions. We also look at applications of HFNC in specific circumstances, such as the perioperative period, emergency department, and acute (mainly critical care) setting including in immunocompromised patients and palliative care.

Targeting zero medication administration errors in the pediatric intensive care unit: A Quality Improvement project

BackgroundMedication errors and adverse drug events have a significant impact on mortality and morbidity among hospitalized children, and are more likely to occur in critical care settings due to the fast-paced environment and patient vulnerability. There is no exception to this rule in our pediatric intensive care unit, a 28-bed unit at a tertiary care children's hospital in Riyadh, Saudi Arabia. Problem assessmentA medication administration error rate of 6.25–8.05/1000 patient days was reported in our unit (48 errors), taking into account only errors that reached patients. Toward improving patient safety, a project was launched to reduce medication errors. DesignMultidisciplinary quality improvement team reviewed baseline data and analyzed medication errors that occurred in 2019. Five Plan-Do-Study-Act cycles were implemented. As an outcome measure, the medication error rate was monitored. ResultsThe outcome measure of medication administration error rates was monitored quarterly. An improvement of 75% during the first quarter of 2021 to a rate of zero medication errors/1000 patient days during the first quarter of 2022. A decrease in medication errors was attributed to improved situational awareness and increased compliance with assisted technology. ConclusionMedication errors can be decreased by deploying various interventions utilizing human- and technology-based approaches. When it comes to reducing medication errors in the pediatric intensive care unit, a multidisciplinary approach is paramount. Implications for clinical practiceThis study suggests several ways to reduce medication errors. Implementing information technology systems and involving pharmacists in medication management can help prevent errors. Enhancing teamwork, communication, and collaboration among healthcare professionals is also important. Clinical risk management strategies, nursing interventions, and adherence to medication safety guidelines are essential, especially for pediatric and neonatal populations. Considering these clinical implications can guide healthcare professionals and organizations in addressing medication errors and enhancing patient safety.

Spiritual Care in PICUs: A U.S. Survey of 245 Training Fellows 2020-2021.

To understand the perspectives of pediatric fellows training in critical care subspecialties about providing spiritual care. Cross-sectional survey of United States National Residency Matching Program pediatric fellows training in critical care specialties. Online survey open from April to May 2021. A total of 720 fellows (165 cardiology, 259 critical care, and 296 neonatology) were contacted, with a response rate of 245 of 720 (34%). None. We assessed fellows' survey responses about spiritual care in neonatal and pediatric critical care units. Categorical data were compared using chi-square test or Fisher exact tests. The Wilcoxon rank-sum test was used to compare the percentage correct on ten multiple-choice questions about world religions. Free-text responses were independently coded by two research investigators. A total of 203 of 245 (83%) responding fellows had never received training about spiritual care and 176 of 245 (72%) indicated that they would be likely to incorporate spiritual care into their practice if they received training. Prior training was associated with increased familiarity with a framework for taking a spiritual history ( p < 0.001) and increased knowledge of spiritual practices that could influence medical care ( p = 0.03). Prior training was also associated with increased self-reported frequency of taking a spiritual history ( p < 0.001) and comfort in referring families to spiritual care resources ( p = 0.02). Lack of time and training were the most reported barriers to providing spiritual care. Providing spiritual care for families is important in critical care settings. In 2020-2021, in the United States, 245 pediatric critical care fellows responded to a survey about spiritual care in their practice and reported that they lacked training in this subject. An opportunity exists to implement spiritual care curricula into pediatric fellowship training.

Plasmapheresis in the ICU.

Therapeutic plasma exchange (TPE) is a treatment paradigm used to remove harmful molecules from the body. In short, it is a technique that employs a process that functions partially outside the body and involves the replacement of the patient's plasma. It has been used in the ICU for a number of different disease states, for some as a first-line treatment modality and for others as a type of salvage therapy. This paper provides a brief review of the principles, current applications, and potential future directions of TPE in critical care settings.

Dietary assessment methods for measurement of oral intake in acute care and critically ill hospitalised patients: a scoping review.

Quantification of oral intake within the hospital setting is required to guide nutrition care. Multiple dietary assessment methods are available, yet details regarding their application in the acute care setting are scarce. This scoping review, conducted in accordance with JBI methodology, describes dietary assessment methods used to measure oral intake in acute and critical care hospital patients. The search was run across four databases to identify primary research conducted in adult acute or critical care settings from 1st of January 2000-15th March 2023 which quantified oral diet with any dietary assessment method. In total, 155 articles were included, predominantly from the acute care setting (n = 153, 99%). Studies were mainly single-centre (n = 138, 88%) and of observational design (n = 135, 87%). Estimated plate waste (n = 59, 38%) and food records (n = 43, 28%) were the most frequent assessment methods with energy and protein the main nutrients quantified (n = 81, 52%). Validation was completed in 23 (15%) studies, with the majority of these using a reference method reliant on estimation (n = 17, 74%). A quarter of studies (n = 39) quantified completion (either as complete versus incomplete or degree of completeness) and four studies (2.5%) explored factors influencing completion. Findings indicate a lack of high-quality evidence to guide selection and application of existing dietary assessment methods to quantify oral intake with a particular absence of evidence in the critical care setting. Further validation of existing tools and identification of factors influencing completion is needed to guide the optimal approach to quantification of oral intake in both research and clinical contexts.

Effect of prolonged sedation with dexmedetomidine, midazolam, propofol, and sevoflurane on sleep homeostasis in rats

BackgroundSleep disruption is a common occurrence during medical care and is detrimental to patient recovery. Long-term sedation in the critical care setting is a modifiable factor that affects sleep, but the impact of different sedative–hypnotics on sleep homeostasis is not clear. MethodsWe conducted a systematic comparison of the effects of prolonged sedation (8 h) with i.v. and inhalational agents on sleep homeostasis. Adult Sprague–Dawley rats (n=10) received dexmedetomidine or midazolam on separate days. Another group (n=9) received propofol or sevoflurane on separate days. A third group (n=12) received coadministration of dexmedetomidine and sevoflurane. Wakefulness (wake), slow-wave sleep (SWS), and rapid eye movement (REM) sleep were quantified during the 48-h post-sedation period, during which we also assessed wake-associated neural dynamics using two electroencephalographic measures: theta-high gamma phase-amplitude coupling and high gamma weighted phase-lag index. ResultsDexmedetomidine-, midazolam-, or propofol-induced sedation increased wake and decreased SWS and REM sleep (P<0.0001) during the 48-h post-sedation period. Sevoflurane produced no change in SWS, decreased wake for 3 h, and increased REM sleep for 6 h (P<0.02) post-sedation. Coadministration of dexmedetomidine and sevoflurane induced no change in wake (P>0.05), increased SWS for 3 h, and decreased REM sleep for 9 h (P<0.02) post-sedation. Dexmedetomidine, midazolam, and coadministration of dexmedetomidine with sevoflurane reduced wake-associated phase-amplitude coupling (P≤0.01). All sedatives except sevoflurane decreased wake-associated high gamma weighted phase-lag index (P<0.01). ConclusionsIn contrast to i.v. drugs, prolonged sevoflurane sedation produced minimal changes in sleep homeostasis and neural dynamics. Further studies are warranted to assess inhalational agents for long-term sedation and sleep homeostasis.

Weighing the Weight of Bedridden Patient by using Strain Gauge (Weighing Scale) - Prototype

In today’s healthcare landscape, weighing beds plays a pivotal role in patient care and management. These specialized beds provide critical data on a patient’s weight, which is integral for monitoring health, tailoring treatment plans, and ensuring accurate medication dosages in bed rest patients, etc. They are particularly crucial in critical care settings, where precise weight measurements are essential for fluid balance and medication adjustments. Weighing beds also has a significant impact on preventive healthcare, enabling timely interventions and lifestyle recommendations based on weight-related health risks. In post-operative care, they assist in assessing factors like fluid retention, and guiding post-surgical interventions. Furthermore, in pediatric healthcare, weighing beds are indispensable for monitoring growth and development. Integration with electronic health records streamlines data management, enhancing efficiency for healthcare providers. Overall, weighing beds are indispensable tool in modern healthcare, contributing to comprehensive patient care and well-being. As the medication requirement of the bedridden patient depends on weight, overdose or underdose of the drug is expected to complicate the problems further. Till now, in the market, there were available detecting devices, but the main problem with them is those devices lift the patient totally or lift the bed totally; For this workforce is more required and also time-consuming and cost-effective. For bedridden patients, it is difficult to measure body weight due to lifting and equipment, as well as the need for a workforce. Some beds have inbuilt measuring sensors, but they are cost-effective for bed purchase. For this, there is a possible way to measure the patient’s weight by using a strain gauge sensor

Comparative Analysis of Machine Learning Algorithms for Heart Disease Prediction

Acute Respiratory Distress Syndrome (ARDS) is a life-threatening condition characterized by rapid onset of widespread inflammation in the lungs, leading to severe respiratory failure. Early detection of ARDS is crucial for timely intervention and improved patient outcomes. This paper proposes a novel approach for ARDS detection using machine learning algorithms applied to medical imaging and clinical data. The method integrates various features extracted from chest radiographs and patient information to create a predictive model for ARDS risk assessment. Additionally, this research investigates the potential of deep learning techniques in analyzing medical images to identify specific patterns indicative of ARDS onset. The proposed system demonstrates promising results in accurately identifying and predicting the likelihood of ARDS development, providing clinicians with a valuable tool for early diagnosis and intervention. This approach holds significant promise in enhancing clinical decision-making and improving patient care in critical care settings.

Doppler-based evaluation of intrarenal venous flow as a new tool to predict acute kidney injury: A systematic review and meta-analysis

Congestion is a common complication in the critical care setting, these patients are at increased risk of developing acute kidney injury (AKI). Congestive nephropathy (CN) has recently been described as a mechanism of worsening renal function, and evaluation of renal venous flow by pulsed Doppler (PD) is a useful tool to assess the presence of renal vein congestion. We comprehensively explore the ability of the PD in the evaluation of the intrarenal venous flow (IRVF) to predict the development of AKI in critically ill patients.We searched Pubmed-MEDLINE, Scopus, Embase, and Cochrane Library of Systematic Reviews (to 31th December 2021). We evaluated the association between Doppler-based Intrarenal venous flow demodulation and AKI. CN was defined as the presence of a pulsatile pattern (biphasic or monophasic) in the PD.A total of 4 articles (660 patients) were included in our systematic review, three of these in the metanalysis (413 patients): one study was excluded because its data were inadequate for pooling. Two studies originated in Europe and the other two in the United States. AKI occurrence ranged between 34 and 68%. Patients who developed AKI had a significant difference in PD pattern (continuous vs. pulsatile) in the IRVF (RR=0.46; 95% CI 0.28–0.76). Nevertheless, a large heterogeneity was observed among the studies (I2=68.7%; p=0.04).Albeit preliminary, these findings suggest that the presence of a pulsatile pattern in the PD of the IRVF may be involved in the development of AKI in the critically ill patient. The effect of alterations in the IRVF and renal function warrant further investigation.

Multilocus Sequence Typing of Emerging Azole-Resistant Candida auris Isolates from Critically Ill Patients in a New York City Medical Center

Abstract Candida auris has developed into a slow-moving global pandemic since its emergence in 2009, particularly as a source of nosocomial infection amongst immunocompromised and critically-ill patients. According to CDC data, C. auris emergence has accelerated in the US during the COVID-19 pandemic and has garnered particular attention for its high level of resistance to multiple classes of antifungals. C. auris has been categorized into five genetically diverse clades, each with unique antifungal drug resistance patterns. We have observed a sharp increase in cases identified at our tertiary medical center in New York City over the past three years. In this study, we designed a set of C. auris-specific oligonucleotides to determine the clonality of isolates through Multilocus Sequence Typing (MLST) of four genetic loci known to have a high level of divergence amongst Candida species. From 2020 through 2022 we identified 22 patients with C. auris bloodstream infection at our institution by Matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) and performed MLST on isolates that were available from 19 patients. We assessed four genetic loci: ITS1/ITS2, D1/D2, RPB1 and RPB2; ERG11 was included to assess for mutations associated with fluconazole resistance. We found that the number of blood stream infections increased from 2 cases in 2020 to 12 in 2022. Our MLST results showed that all C. auris isolates from blood and body fluids belong to CDC-defined Clade 1c, which carries the ERG11 gene mutation resulting the amino acid substitution K143R in 14-α-Demethylase associated with fluconazole resistance. These isolates also demonstrated fluconazole resistance by in vitro testing (19/19), amphotericin resistance was present in 44% of isolates with available data (7/16), and all isolates were susceptible to micafungin (19/19). Of 19 patients with blood cultures positive for C. auris, 13 (68%) were in a critical care setting at time of collection, 17 (89%) had been in an ICU during the same admission, and 8 (42%) expired within 3 months of C. auris positivity. MLST is considered a relatively fast and inexpensive method of sequence-based strain typing and has recently been applied to assessing the clonality of C. auris isolates. We show that the use of C. auris-specific oligonucleotides for sequencing, rather than those derived from other Candida species, produces high quality data for MLST, as well as the detection of specific mutations involved in antifungal resistance, such as ERG11. Further assessment is needed by the gold standard in sequence typing, Whole Genome Sequencing (WGS), to confirm our analysis of clonality here. MLST may therefore represent a useful tool in understanding the interrelatedness of invasive C. auris infections in hospitalized patients as well as inform clinical decision-making around infection control and empiric antifungal therapy.

1706. Risk factors for infections caused by extended spectrum beta lactamase (ESBL) producing and Carbapenem-resistant Enterobacterales (CRE) in pediatric critical care settings: A case control study

Abstract Background Infections due to Gram negative resistant bacterial pathogens are a major concern in intensive care units. The purpose of this study is to determine the risk factors for developing ESBL-producing and CRE infections in pediatric patients in critical care settings (PICU and NICU). Methods A retrospective case control study of infections due to ESBL-producing and CRE during a 5-year period (2016-2021) at Children’s Hospital of Michigan, Detroit. All patients had positive cultures during their PICU/NICU stay. Control cases were matched for age, infection site and year of infection but their cultures grew Enterobacterales that were non-ESBL or carbapenemase producers. Results A total of 58 patients with ESBL/Carbapenemase-producing Enterobacterales (cases) and 59 control patients were included. Majority of organisms were E. coli and Klebsiella species recovered from respiratory tract. There was no difference in both groups in regards to age, gender, race or length of hospital stay (p &amp;gt;0.3). There was no difference in prior hospital admission, PICU or NICU stay during the previous 6 months, indwelling devices, comorbid conditions, or surgery in the last 6 months (p &amp;gt;0.3). However, the presence of gastrostomy tube was more frequent in the cases group (29.3%) than the control group (15.3%) (p=0.078). Risk factors by univariate analysis included history of antibiotic use in last 6 months (93% in cases vs 73% in controls; p=0.006), cephalosporins use &amp;gt; 14 days (67% vs 31.2%; p=0.006),Trimethoprim/Sulfamethoxazole treatment duration &amp;gt; 14 days (11.1% vs 0%; p=0.012), carbapenem treatment duration &amp;gt; 14 days (14% vs 1.9%; p=0.027), and vancomycin use &amp;gt; 14 days (43.6% vs 21.6%; p=0.053). However, multivariate logistic regression analysis showed that antibiotic usage in the last 6 months was the single best predictor for cases with odds ratio of 5.02-fold (95% CI 1.56-16.13) (p=0.007). Conclusion Prior broad spectrum antibiotic usage was significantly associated with acquisition of ESBL and carbapenemase producing Enterobacterales. The study further underscores the need for optimizing antimicrobial stewardship practices to limit unnecessary and prolonged use of antibiotics to prevent the emergence of resistant pathogens. Disclosures All Authors: No reported disclosures

Point-of-care ultrasound for airway management in the emergency and critical care setting.

Airway management is a common procedure within emergency and critical care medicine. Traditional techniques for predicting and managing a difficult airway each have important limitations. As the field has evolved, point-of-care ultrasound has been increasingly utilized for this application. Several measures can be used to sonographically predict a difficult airway, including skin to epiglottis, hyomental distance, and tongue thickness. Ultrasound can also be used to confirm endotracheal tube intubation and assess endotracheal tube depth. Ultrasound is superior to the landmark-based approach for locating the cricothyroid membrane, particularly in patients with difficult anatomy. Finally, we provide an algorithm for using ultrasound to manage the crashing patient on mechanical ventilation. After reading this article, readers will have an enhanced understanding of the role of ultrasound in airway management.