ICU Days Research Articles

Management and Outcomes of Delayed Cerebral Ischemia Associated with Vasospasm Post Nontraumatic Subarachnoid Hemorrhage: A Retrospective Cohort Study in the National Neurosurgical Center in Ireland

Abstract Background Delayed cerebral ischemia (DCI) is the leading cause of adverse outcome in patients who survive the initial phase of subarachnoid hemorrhage (SAH). While guidelines recommend induced hypertension as a first-line treatment for DCI, there is no high-level evidence confirming outcome benefit. Methods Patients admitted with nontraumatic SAH over 3 years period were identified. Demographics, clinical/radiological presentation, aneurysm repair method, and Glasgow outcome score (GOS) 3 months postdischarge were recorded. A subgroup of patients who suffered clinically significant vasospasm were identified, and their hypertensive therapy and outcomes were examined. Results A total of 532 patients were admitted with SAH; 68 developed vasospasm. The vasospasm subgroup was divided based on vasopressor treatment—norepinephrine alone (n = 27) versus norepinephrine plus vasopressin (n = 35). No correlation was found between percentage of days that mean arterial pressure (MAP) targets were met and GOS outcome. Patients treated with both agents had worse GOS outcomes at than those treated with norepinephrine alone. Conclusion In our study, 12.8% of patients SAH developed vasospasm. Twenty-seven patients were treated with norepinephrine alone and 35 were treated with norepinephrine plus vasopressin to achieve augmented MAP targets. There was no correlation between percentage of days that MAP targets were met and improved patient outcome. The 68 patients stayed a total of 783 days in ICU, with a mean length of stay of 11.5 days. Patients who required dual therapy to achieve MAP targets had significantly worse neurological outcomes.

Insights into Candida Colonization in Intensive Care Unit Patients: A Prospective Multicenter Study.

The skin mycobiota plays a significant role in infection risk, pathogen transmission, and personalized medicine approaches in intensive care settings. This prospective multicenter study aimed to enhance our understanding of intensive care units' (ICUs') Candida colonization dynamics, identify modifiable risk factors, and assess their impact on survival risk. Specimens were taken from 675, 203, and 110 patients at the admission (D1), 5th (D5), and 8th (D8) days of ICU stay, respectively. The patient's demographic and clinical data were collected. Candida isolates were identified by conventional culture-based microbiology combined with molecular approaches. Overall, colonization was 184/675 (27.3%), 87/203 (42.8%), and 58/110 (52.7%) on D1, D5, and D8, respectively. Candida colonization dynamics were significantly associated with ICU type (odds ratio (OR) = 2.03, 95% CI 1.22-3.39, p = 0.007), respiratory infection (OR = 1.74, 95% CI 1.17-2.58, p = 0.006), hemodialysis (OR = 2.19, 95% CI 1.17-4.10, p = 0.014), COVID-19 (OR = 0.37, 95% CI 0.14-0.99, p = 0.048), and with a poor 3-month outcome (p = 0.008). Skin Candida spp. colonization can be an early warning tool to generate valuable insights into the epidemiology, risk factors, and survival rates of critically ill patients, and should be considered for epidemiological surveillance.

Lower Admission Prealbumin and Albumin Levels in Unhoused Burn Patients Is a Marker for Poorer Outcomes.

Unhoused (UH) individuals experience burn injuries at a higher rate than domiciled individuals, and have poorer outcomes following injuries. One such mechanism proposed for worsened outcomes is secondary to poor nutrition. Access to proper nutrition and food insecurity are major barriers. Malnutrition has been shown to decrease wound tensile strength, increase infection rates, and prolong healing. The purpose of this study was to understand if albumin and prealbumin could help determine outcomes in UH patients and identify at-risk patients earlier in their hospital course. A retrospective chart review was conducted of UH patients from 2015 through 2023 at a large urban safety net hospital. Data collected included admission laboratory values including albumin and prealbumin. Outcomes studied included length of stay (LOS), Intensive Care Unit (ICU) days, ventilator days, and mortality. Data analysis for the effect of albumin and prealbumin included a zero-truncated negative binomial model for LOS, a negative binomial hurdle model for ICU LOS and ventilator days, and logistic regression for mortality. Three hundred and eighty-five patients met inclusion criteria and of these, 366 had albumin and 361 had prealbumin information. Adjusting for age, gender, and total body surface area, the fewest days in the hospital and lowest odds of admission to the ICU occurred for those with admission albumin values of approximately 3.4-3.5 g/dL. Each unit (g/dL) decrease in albumin was associated with 3.19 times the odds of death (95% CI: 1.42, 7.69). Each unit (mg/dL) decrease in prealbumin was associated with 1.19 times the odds of death (95% CI: 1.06, 1.35). Decreased admission albumin and prealbumin levels are associated with worse burn outcomes in UH patients. These nutritional biomarkers may aid in determining which UH patients are suffering from food insecurity at injury onset. Obtaining these values on admission may help burn providers target nutritional goals in their most vulnerable patients.

#699 Diagnostic accuracy of the Modified Renal Angina Index (mRAI) for predicting acute kidney injury among critically ill Filipino adults

Abstract Background and Aims The proposed mRAI (modified renal angina index) (Fig. 1) predicts moderate to severe AKI within the first 7 days of ICU stay which outperforms serum creatinine and urine output. The use of the mRAI in AKI may be warranted to improve predicted performance of AKI biomarkers. The study aims to evaluate the diagnostic accuracy of modified renal angina index in predicting Acute Kidney Injury (AKI) among Critically ill Adult Filipino patient in a Tertiary Institution and its association with in hospital MAKE (Major Adverse Kidney Events). Method A retrospective cohort study including all adult critically ill patients, they were dichotomized into “low” (<10) or “high risk” (>10) based on the mRAI score upon the 1st ICU admission (Day 0-24 hr) during the hospital stay. Inclusion criteria: age >18 years old, ICU patients between 2019-2022. Exclusion criteria: Chronic Kidney Disease (Egfr <30 ml/min), Transplant recipients, HIV/Cancer, <48 hrs ICU stay, little changes in creatinine (<2x from baseline between Day 0-24 hr ICU admission). The composite outcome is achieved if at least one is met during the index of hospitalization: All-cause mortality prior to discharge or after ICU admission, New onset of renal replacement therapy (RRT), persistent renal dysfunction. The sensitivity, specificity, predictive values and area under the curve is used to determine diagnostic accuracy of the mRAI Scoring and its association with in Hospital MAKE. Simple and multiple logistic regression analysis is used to control the effect of confounders in determining the association of mRAI to AKI. SPSS version 20 will be used in the analysis. Results Using a cut off score of 10, the mRAI show 84.29% sensitivity, 76.06% specificity, 77.63%, PPV 83.08% NPV 80.14% and AUC 80.14% in predicting moderate to severe AKI (Fig. 2). A mRAI of >10 is associated with in hospital MAKE showing a 97.14% sensitivity, 67.61% specificity, 74.73% PPV, 96.0% NPV, and AUC 82.27% (Fig. 3). Among the high risk group there were 68 (97.1%) who had MAKE, 62 (88.6%) new onset RRT, 12% (17.1%) died within 7 days of ICU admission, 64 (91.4%) persistent renal dysfunction (Fig. 4). Conclusion The proposed score can be applied among critically ill adult Filipino patients which is an easy bedside tool for identification of moderate to severe AKI. mRAI constitutes a sensitive test with a high negative predictive, affirming its capability being a screening test, complementary to laboratory parameters and clinical judgement. We also found out that a mRAI score of >10 is associated with In-Hospital Major Adverse Kidney Events.

#1651 Urinary oxygen partial pressure: closely associated with hourly urine output induced by furosemide in patients with acute renal injury

Abstract Background and Aims Urine oxygen level, an indicator of kidney medullar oxygenation, is promising for predicting the onset of acute kidney injury (AKI). Furosemide, a commonly used diuretic in ICU, significantly increases urine output and is believed to change kidney medullar oxygenation. We monitored the longitudinal change of urinary oxygen partial pressure during bolus or pump administration of furosemide, aiming to describe the reaction pattern in an AKI-susceptible patient population. Method The prospective observational pilot study included seven adult patients in the ICU because of cardiac surgery or sepsis. We monitored the continuous urinary oxygen partial pressure for 8-24 hours through a device placed between the urinary catheter and collecting bag during furosemide administration, recorded hourly urine output simultaneously from a urine bag, and followed the patients in the hospital for the onset and development of AKI. Results We recruited three female patients and four male patients with an average age of 54 years and a medium of 5 days in ICU with an AKIN stage I of AKI during their hospital stay. None of them developed more severe stage AKI or required any kidney replacement therapy. We found a reverse correlation pattern between hourly urine output and urinary oxygen partial pressure. Specifically, the urine oxygen level dropped during urine volume increase caused by furosemide bolus administration and abolished by furosemide administration through a pump with more stable urine output. The paired t-test showed a significant increase in average urine oxygen level (mean difference = 21.2 mmHg, p = 0.044) recorded during the “high hourly urine output” period compared to the “low hourly urine period”. Conclusion We first found a drop in urinary oxygen partial pressure during the high urine output period elicited by bolus furosemide administration. It shed light on the confounding factors in AKI predicating during possible furosemide administration.

Monitoring monocyte HLA-DR expression and CD4 + T lymphocyte count in dexamethasone-treated severe COVID-19 patients

BackgroundA 10-day dexamethasone regimen has emerged as the internationally adopted standard-of-care for severe COVID-19 patients. However, the immune response triggered by SARS-CoV-2 infection remains a complex and dynamic phenomenon, leading to various immune profiles and trajectories. The immune status of severe COVID-19 patients following complete dexamethasone treatment has yet to be thoroughly documented.ResultsTo analyze monocyte HLA-DR expression (mHLA-DR) and CD4 + T lymphocyte count (CD4) in critically ill COVID-19 patients after a dexamethasone course and evaluate their association with 28-day ICU mortality, adult COVID-19 patients (n = 176) with an ICU length of stay of at least 10 days and under dexamethasone treatment were included. Associations between each biomarker value (or in combination) measured at day 10 after ICU admission and 28-day mortality in ICU were evaluated. At day 10, the majority of patients presented decreased values of both parameters. A significant association between low mHLA-DR and 28-day mortality was observed. This association remained significant in a multivariate analysis including age, comorbidities or pre-existing immunosuppression (adjusted Hazard ratio (aHR) = 2.86 [1.30–6.32], p = 0.009). Similar results were obtained with decreased CD4 + T cell count (aHR = 2.10 [1.09–4.04], p = 0.027). When combining these biomarkers, patients with both decreased mHLA-DR and low CD4 presented with an independent and significant elevated risk of 28-day mortality (i.e., 60%, aHR = 4.83 (1.72–13.57), p = 0.001).ConclusionsBy using standardized immunomonitoring tools available in clinical practice, it is possible to identify a subgroup of patients at high risk of mortality at the end of a 10-day dexamethasone treatment. This emphasizes the significance of integrating immune monitoring into the surveillance of intensive care patients in order to guide further immumodulation approaches.

Antibiotic regimens tailored by clinical pharmacist supported by intensivist enhance rational use of antibiotics

ABSTRACT Background High antibiotics utility rates have been observed in surgical intensive care units (SICU). The present study was performed to evaluate the effect of engaging a clinical pharmacist in SICU on rational use of antibiotic treatment. Methods This retrospective quasi-experimental experiment involved 505 patients, over a period of one year, admitted to emergency department surgical/trauma ICU of a large tertiary care hospital. Before and during pharmacist participation periods of six months, 226 and 153 patients, respectively, are compared. Results Antibiotics consumption pattern changed with a decrease in total antibiotic consumption from 101.42 to 94.1 Defined Daily Dose/100 patients’ days after the clinical pharmacist participation, in addition to, a statistically significant rise (p = 0.001) in percentage of appropriateness of the prescribed antibiotic therapy from 72.1% to 86.3%. Time to control infection (days) was not statistically different (p = 0.825) in both periods. The average ICU days of stay was statistically significant longer (p = 0.046) during pharmacist attendance (4.42 ± 5.61) in comparison with period without pharmacist attendance (3.31 ± 3.66). The difference in ICU mortality rate was not statistically significance (p = 0.217). Cost per stay increased by 65% during pharmacist intervention period. Conclusions Antibiotic management with pharmacist participation as a part of multidisciplinary team with intensivist can promote rate of the appropriateness of the prescribed antibiotic therapy, lower utility of antibiotic consumption, but with a longer ICU stay, no mortality reduction, and higher expenses per stay. Trial Registry ClinicalTrials.gov: NCT04931914.

Prediction model of pressure injury occurrence in diabetic patients during ICU hospitalization——XGBoost machine learning model can be interpreted based on SHAP

BackgroundThe occurrence of pressure injury in patients with diabetes during ICU hospitalization can result in severe complications, including infections and non-healing wounds. AimsThe aim of this study was to predict the occurrence of pressure injury in ICU patients with diabetes using machine learning models. Study designIn this study, LASSO regression was used for feature screening, XGBoost was employed for machine learning model construction, ROC curve analysis, calibration curve analysis, clinical decision curve analysis, sensitivity, specificity, accuracy, and F1 score were used for evaluating the model's performance. ResultsOut of the 503 ICU patients with diabetes included in the study, pressure injury developed in 170 cases, resulting in an incidence rate of 33.8 %. The XGBoost model had a higher AUC for predicting pressure injury in patients with diabetes during ICU hospitalization (train: 0.896, 95 %CI: 0.863 to 0.929; test: 0.835, 95 % CI: 0.761–0.908). The importance of SHAP variables in the model from high to low was: 'Days in ICU', 'Mechanical Ventilation', 'Neutrophil Count', 'Consciousness', 'Glucose', and 'Warming Blanket'. ConclusionThe XGBoost machine learning model we constructed has shown high performance in predicting the occurrence of pressure injury in ICU patients with diabetes. Additionally, the SHAP method enables the interpretation of the results provided by the machine learning model. Relevance to clinical practiceImprove the ability to predict the early occurrence of pressure injury in diabetic patients in the ICU. This will enable clinicians to intervene early and reduce the occurrence of complications.

Multi-modal single-cell sequencing of circulating mononuclear cells deconvolutes outcome-specific immune responses in trauma patients

Abstract Immune dysfunction plays a key role in contributing to high morbidity and mortality after trauma. To identify the immune cell subsets associated with a specific clinical trajectory (SR vs. FR, slow vs. fast recovery), we isolated the peripheral blood mononuclear cells from 16 trauma patients, including 8 SR patients (ICU days > 7) and 8 FR patients (ICU days < 7) at 72 hours after injury, along with 4 age and sex matched healthy controls. A total of 20 samples were subjected to DOGMA-seq, a tri-modal single-cell assay that measures gene expression, open chromatin accessibility, and surface protein expression simultaneously in the same cells. Integrated analysis revealed patient group-specific changes in T cells and monocytes. SR patients had lower numbers of cytotoxic T cells (CTLs) and these remaining CTLs were less cytotoxic. We identified a subset of monocytes overrepresented in FR patients. We extracted the genes specifically upregulated in this subset and queried a published whole blood transcriptome dataset of 167 trauma patients. These genes were positively correlated with T cell activation pathways, and were also correlated with a quicker recovery in this bulk dataset. Thus, we were able to validate our findings derived from DOGMA-seq from 16 trauma patients in a much larger cohort. Our analysis provides a landscape of immune responses in trauma patients based on clinical trajectories and characterizes the outcome-specific changes across cell types.

Temporal associations of plasma levels of the secreted phospholipase A2 family and mortality in severe COVID-19.

Previous research suggests that group IIA-secreted phospholipase A2 (sPLA2-IIA) plays a role in and predicts lethal COVID-19 disease. The current study reanalyzed a longitudinal proteomic data set to determine the temporal relationship between levels of several members of a family of sPLA2 isoforms and the severity of COVID-19 in 214 ICU patients. The levels of six secreted PLA2 isoforms, sPLA2-IIA, sPLA2-V, sPLA2-X, sPLA2-IB, sPLA2-IIC, and sPLA2-XVI, increased over the first 7 ICU days in those who succumbed to the disease but attenuated over the same time period in survivors. In contrast, a reversed pattern in sPLA2-IID and sPLA2-XIIB levels over 7 days suggests a protective role of these two isoforms. Furthermore, decision tree models demonstrated that sPLA2-IIA outperformed top-ranked cytokines and chemokines as a predictor of patient outcome. Taken together, proteomic analysis revealed temporal sPLA2 patterns that reflect the critical roles of sPLA2 isoforms in severe COVID-19 disease.

Risk of Post-Intubation Laryngotracheal Stenosis With Respect to COVID-19 Status in a Large Multicenter Cohort Cross-Sectional Study.

Occurrence of post-intubation laryngotracheal stenosis (LTS) with respect to COVID-19 status. Retrospective cross-sectional inpatient database. Eleven Midwest academic and community hospitals, United States. Adults, mechanically ventilated, from January 2020 to August 2022, who were subsequently readmitted within 6 months with a new diagnosis of LTS. None. Six thousand eight hundred fifty-one COVID-19 negative and 1316 COVID-19 positive patients were intubated and had similar distribution by age (median 63.77 vs. 63.16 yr old), sex (male, 60.8%; n = 4173 vs. 60%; n = 789), endotracheal tube size (≥ 7.5, 75.8%; n = 5192 vs. 75.5%; n = 994), and comorbidities. The ICU length of stay (median [interquartile range (IQR)], 7.23 d [2.13-16.67 d] vs. 3.95 d [1.91-8.88 d]) and mechanical ventilation days (median [IQR], 5.57 d [1.01-14.18 d] vs. 1.37 d [0.35-4.72 d]) were longer in the COVID-19 positive group. The occurrence of LTS was double in the COVID-19 positive group (12.7%, n = 168 vs. 6.4%, n = 440; p < 0.001) and was most commonly diagnosed within 60 days of intubation. In multivariate analysis, the risk of LTS increased by 2% with each additional ICU day (hazard ratio [HR], 1.02; 95% CI, 1.02-1.03; p < 0.001), by 3% with each additional day of ventilation (HR, 1.03; 95% CI, 1.02-1.04; p < 0.001), and by 52% for each additional reintubation (HR, 1.52; 95% CI, 1.36-1.71; p < 0.001). We observed no significant association COVID-19 status and risk of LTS. The occurrence of post-intubation LTS was double in a COVID-19 positive cohort, with higher risk with increasing number of days intubated, days in the ICU and especially with the number of reintubations. COVID-19 status was not an independent risk factor for LTS.

Early Enteral Nutrition and Clinical Outcomes in COPD Patients Requiring Mechanical Ventilation

Early commencement of enteral nutrition (EEN) in critically ill patients requiring mechanical ventilation may improve outcomes. But there is a lack of enough data regarding EEN effects on COPD exacerbation patients’ outcomes. This retrospective study involved 129 COPD exacerbation patients who received invasive mechanical ventilation in ICU. The clinical outcomes were compared based on the timing of enteral nutrition (&lt;48h vs &gt;48h) during 60 days of ICU stay. We surveyed and analyzed mortality, pleural effusion, ventilator-associated pneumonia, weaning failure, cardiac arrhythmias, GI bleeding, electrolyte imbalances, renal dysfunction and length of ICU stay. All analyses were performed using SPSS software version 22.0. 129 COPD-exacerbated patients (EEN group n=66; DEN group n=63) who met the inclusion criteria were enrolled in the study. EEN group had a lower death rate (39% vs 44.4%) than the DEN group, but no significant difference was found in the overall mortality during the 60-day follow-up (P 0.561). The EEN group also had lower ICU stay and pleural effusion rate than the DEN group (P:0.006 and 0.020 respectively). No significant differences were found in other outcomes. Early enteral nutrition might be associated with shorter ICU stay and lower odd ratio of acquisition of pleural effusion in COPD patients requiring invasive mechanical ventilation. EEN could not decrease mortality rate compared with DEN in the current study.

Outcome of Acinetobacter baumannii Ventilator Associated Pneumonia in Upper Egypt: does the resistance profile play a role?

Abstract Background Ventilator-associated pneumonia (VAP) due to drug resistant Acinetobacter baumannii (A. baumannii) is a challenging nosocomial problem associated with increased morbidity and risk of mortality. Objective This study aimed to investigate plasmid mediated quinolone resistance genes (PMQR) as a mechanism of resistance transmission, risk factors and outcome of A. baumannii VAP. Methods This prospective cohort study included 100 VAP patients between October 2020 and December 2022. Microbiological confirmation of A. baumannii. was done and PMQR genes were exposed by polymerase chain reaction (PCR). Pneumonia severity index (PSI), risk factors for developing drug resistant A. baumannii VAP, and the outcome were studied. Results The proportions of drug sensitive (DS), multidrug (MDR), extensive drug (XDR), and pan drug (PDR) resistant A. baumannii were 14%, 35%, 50%, and 1%, respectively. Majority of PSI classes IV and V showed XDR (66%) and PDR (100%) isolates. Detection of qnrA, qepA and aac(6′)-Ib-cr genes was predominant in PSI classes IV and V. The in-hospital mortality for MDR, XDR, and PDR was 22.7%, 70.5%, and 2.3%, respectively. ICU duration, prior use of carbapenems and use more than 2 antibiotics prior to VAP were risk factors for developing MDR A. baumannii while septic shock, multilobar chest radiography (CXR) infiltration and PSI class were predictors of in-hospital mortality. Conclusions VAP caused by MDR, XDR and PDR isolates of A. baumannii which harbors qnrA, qepA and aac(6’)-Ib-cr PMQR genes showed higher PSI classes and increased in-hospital mortality. The number of PMQR genes in A. baumannii isolates, ICU days, use of more than 2 antibiotics, and use of carbapenem prior to VAP, were independent risk factors for the development of drug resistant A. baumannii VAP.

Respiratory Morbidity and Mortality of Traumatic Cervical Spinal Injury.

Traumatic cervical spinal injuries can severely affect respiratory function and cause significant morbidity and mortality. The typical respiratory morbidity in cervical spine injury is Atelectasis, Ventilator-associated pneumonia, acute respiratory distress syndrome and delayed weaning, etc. The study aims to see the prevalence of respiratory morbidity as well as mortality associated with cervical spine injury. Cross sectional study based on retrospective data was conducted on the X Sciences with the existing hospital record during the period of 3 years to find out the prevalence respiratory morbidity like Ventilatory Associated Pneumonia, delayed weaning, ARDS, atelectasis of traumatic cervical spine injury, determine the prevalence, type, and impact of respiratory morbidity and mortality in this population. Total no 76 patients data meeting the inclusion criteria included in study. Male patients were more prone to develop traumatic cervical spinal injuries (SCI). The prevalence of respiratory morbidity in term of VAP(57.89), delayed weaning(46.05) and Atelectasis(22.36) was high. Patients with Asia A Neurology has higher association for VAP and delayed weaning, while Asia E Neurology patients had no respiratory morbidity. The study found a significant positive association between respiratory morbidity with hospital stay, and ventilator days (p-value: 0.019 and 0.048). A total of 15 patients died, 28.95% were discharged on request and 40.8% leaving the hospital against medical advice. The prevalence of respiratory morbidity higher in cervical spine injury. Furthermore, it has associated with prolonged ICU and ventilator days and increase in mortality.

Prediction of mortality in COVID-19 acute respiratory distress syndrome patients during the critical first three days in ICU

Prediction of mortality in COVID-19 acute respiratory distress syndrome patients during the critical first three days in ICU

Improvement in ICU Mortality From Sepsis Associated With Recuperation From Septic Multiple-Organ Failure: A Retrospective, Single-Center, Cohort Study.

Although mortality due to sepsis has decreased in recent decades, there are few studies on the timing of death during ICU stay. Characteristics of patients related to changes over the years of ICU death and changes in the timing of ICU death will provide new insights for future sepsis management. This was a single-center, retrospective study. Patients admitted to the ICU for sepsis between 2005 and 2019 were included in the study. The study period was divided into three five-year intervals, and the timing of death in the ICU was divided into early-stage (1-3 ICU days), mid-stage (4-14 ICU days), and late-stage (15 or more ICU days). Patient characteristics related to ICU death at three five-year intervals and the timing of death were evaluated. ICU mortality for sepsis has decreased over time (2005-2009, 30.2%; 2010-2014, 21.0%; 2015-2019, 12.1%; p<0.01). In the timing of death, only mid-stage mortality decreased. Multiple-organ failure (OR, 4.53; 95% CI, 2.79-7.48) and hematological malignancies (OR, 2.48; 95% CI, 1.19-5.07) were associated with ICU mortality over entire study periods. Only multiple-organ failure was associated with ICU mortality at the five-year intervals (OR, 5.94; 95% CI, 2.73-13.7 for 2005-2009; OR, 4.01; 95% CI, 1.82-9.31 for 2010-2014; OR, 2.58; 95% CI, 1.05-6.59 for 2015-2019). Mid-stage mortality of multiple-organ failure decreased (2005-2009, 12.8%; 2010-2014, 7.6%; 2015-2019, 1.6%; p=0.02). However, early- and late-stage mortality of multiple-organ failure did not change. Improvement in mid-stage mortality in septic patients with multiple-organ failure can contribute to the improvement of overall ICU mortality in patients with sepsis.

Efficacy observation, complications and nursing of enteral nutrition suspension in patients with acute ischemic stroke

Objective This study focuses on exploring the efficacy observation, complications and nursing aspects of using enteral nutrition suspension in patients with acute ischemic stroke. Methods This study retrospectively analyzed clinical data from 188 patients with acute ischemic stroke treated in the Neurology Department of our hospital from October 2022 to September 2023. Patients who received intermittent enteral nutrition and nursing interventions were included in the control group (n=96), while patients who received continuous enteral nutrition and nursing interventions were included in the treatment group (n=92). Relevant indicators data changes before and after treatment were recorded for each patient, along with the occurrence of complications in both groups, and statistical analysis was conducted. Results The treatment group had fewer days in the ICU and total hospitalization days compared to the control group, with p < .05. Patients in the treatment group had higher levels of serum albumin and serum prealbumin than those in the control group, with p < .05. The occurrence of abdominal pain, diarrhea, constipation, bloating and acid reflux in the treatment group was lower than in the control group, with p < .05. There was no significant difference in the occurrence of adverse outcomes at discharge, death at discharge, cerebral hemorrhage, lung infection and gastrointestinal bleeding between the two groups (p > .05). Conclusion The application of enteral nutrition suspension in patients with acute ischemic stroke effectively provides the necessary nutrients, maintains nutritional balance, promotes tissue repair and recovery and reduces the length of hospital stay.

A machine learning approach for diagnostic and prognostic predictions, key risk factors and interactions

AbstractMachine learning (ML) has the potential to revolutionize healthcare, allowing healthcare providers to improve patient-care planning, resource planning and utilization. Furthermore, identifying key-risk-factors and interaction-effects can help service-providers and decision-makers to institute better policies and procedures. This study used COVID-19 electronic health record (EHR) data to predict five crucial outcomes: positive-test, ventilation, death, hospitalization days, and ICU days. Our models achieved high accuracy and precision, with AUC values of 91.6%, 99.1%, and 97.5% for the first three outcomes, and MAE of 0.752 and 0.257 days for the last two outcomes. We also identified interaction effects, such as high bicarbonate in arterial blood being associated with longer hospitalization in middle-aged patients. Our models are embedded in a prototype of an online decision support tool that can be used by healthcare providers to make more informed decisions.

Enhanced recovery after surgery (ERAS) novel protocol for management of esophageal replacement in children: A single surgeon's experience of 116 cases

BackgroundPerioperative management of esophageal replacement is challenging due to significant disturbance in internal milieu of the body. To mitigate mediastinal dissection induced systemic inflammatory response, there is an unmet need to design and test a goal directed, resource conscious protocol for enhanced recovery, which will serve as a template to reduce morbid surgical complications and length of hospital stay. MethodsA retrospective cohort study was designed by convenience sampling method to group patients to compare outcomes of pediatric esophageal replacement using conventional protocol vs enhanced recovery after surgery novel protocol. Primary outcome measure was post-operative total length of stay in hospital. Secondary outcome measures were frequency of cardio-pulmonary complications, anastomotic leaks, infections, mortality, and initiation of early enteral jejunostomy feeding. ResultsA total of 116 children with corrosive esophageal injury [n = 21(19%)] and esophageal atresia [n = 95(81 %)] were analyzed in this study. Novel protocol group(n = 62) when compared to conventional protocol group (n = 54) had lower mean total length of stay days (13.05 ± 7.92 days vs.21.96 ± 6.5 days p < 0.0001), shorter mean ICU days (5.74 ± 4.16 days vs 7.13 ± 3.16 days; p ≤ 0.048) and Novel protocol group had lower cardiac [3/62 (5 %) vs 12/54(22 %) p = 0.012]; and pulmonary [4/62 (6.5 %) vs 13/54(24 %) p = 0.007] complications. Novel protocol group had lower mean days to initiation of enteral feeding (3.13 ± 0.71 vs 5.45 ± 0.75 days; p < 0.0001) and lower rates of post-operative infections [5/62(8 %) vs 18/54 (33 %); p = 0.001]. ConclusionsEnhanced recovery after surgery novel protocol has the potential to change clinical practice due to mitigation of major complications.

Association between glycemic variability and short-term mortality in patients with acute kidney injury: a retrospective cohort study of the MIMIC-IV database

Acute kidney injury (AKI) represents a significant challenge to global public health problem and is associated with poor outcomes. There is still considerable debate about the effect of mean blood glucose (MBG) and coefficient of variation (CV) of blood glucose on the short-term mortality of AKI patients. This retrospective cohort study aimed to explore the association between glycemic variability and short-term mortality in patients with AKI. Data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database were analyzed, including 6,777 adult AKI patients. MBG and CV on the first day of ICU admission were calculated to represent the overall glycemic status and variability during the ICU stay in AKI patients. The primary outcome indicator was ICU 30-day mortality of AKI patients. Multivariate Cox regression analysis and smoothed curve fitting were used to assess the relationship between blood glucose levels and mortality. Eventually, the ICU 30-day mortality rate of AKI patients was 23.5%. The increased MBG and CV were significantly correlated with ICU 30-day mortality (hazards ratio (HR) = 1.20, 95% confidence interval (CI) 1.14–1.27; HR = 1.08, 95% CI 1.03–1.13). The smoothed curve fitting showed a U-shaped relationship between MBG on the first day of ICU admission and ICU 30-day mortality (inflection point = 111.3 mg/dl), while CV had a linear relationship with 30-day ICU mortality. Thus, we conclude that MBG and CV were significantly associated with short-term mortality in intensive care patients with AKI. Tighter glycemic control may be an effective measure to improve the prognosis of patients with AKI.