Unit Discharge Research Articles

Risk stratification for postoperative hypoxemia among bariatric surgery patients.

Patients with obesity, especially those suffering from obstructive sleep apnea (OSA), are prone to postoperative respiratory hypoxemia. The PRODIGY (prediction of opioid-induced respiratory depression in patients monitored by capnography) Score is used to predict respiratory complications that factor in sleep-disordered breathing. Data on the impact of OSA on the frequency and timing of postoperative desaturation trends after bariatric surgery are lacking. This cohort study included 195 patients who underwent robotic-assisted bariatric surgery between June 2022 and December 2023. Patients underwent were classified by OSA status (yes/no) and PRODIGY Risk Score (high/intermediate/low). All patients received low or opioid sparing anesthesia and were continuously monitored postoperatively using the Masimo Rad-97 device (Masimo, Irvine, CA, USA). Postoperative monitoring averaged 14.5 hours, including tracking several variables and SpO<inf>2</inf> values. We documented desaturations and opioid usage in 2-hour intervals. Patients also underwent 30-day postoperative follow up. Descriptive statistics were analyzed based on OSA status and PRODIGY scores using Student's t-test, ANOVA, and Fisher's Exact Test. Most study patients (57.4%) had OSA, were significantly older, and were predominantly female. Patients with OSA had substantially more prolonged exposure to SpO<inf>2</inf> ranges between 80-95% and experienced more frequent desaturation events between 10 and 14 hours after Post-Anesthesia Care Unit (PACU) discharge. Patients with high PRODIGY scores (>15) had significantly more desaturation events compared to intermediate and low-score groups. Postoperative desaturation rates are significantly higher among patients with OSA with high PRODIGY scores, especially in the delayed postoperative period. Continuous extended postoperative monitoring is warranted for these high-risk patients after bariatric surgery.

Racial Disparities in Mother's Own Milk Feedings Persist after Discharge from the Neonatal Intensive Care Unit.

Objective: To investigate mother's own milk (MOM) feeding rates in the first year of life after neonatal intensive care unit (NICU) discharge for infants born <37 weeks gestational age and compare rates by race and ethnicity. Study Design: This was a retrospective study of preterm infants discharged from the NICU who sought care at a primary care clinic within our academic health system. Infant demographic characteristics and feeding at NICU discharge were extracted from the medical record. Post-discharge feeding history was extracted from health care maintenance (HCM) visit records at 2, 4, 6, 9, and 12 months for infants born between January 2018 and December 2019. Exclusion criteria included having a contraindication to MOM feeding or insufficient feeding documentation. Results: Of the 314 infants meeting inclusion criteria, 57% received any MOM and 24% received exclusive MOM at NICU discharge. At the 6-month HCM visit, MOM feeding rates decreased to 25% for any MOM and 12% for exclusive MOM. Statistically significant racial and ethnic differences in MOM feeding rates were observed at all HCM visits, with White infants having the highest and Black infants having the lowest MOM feeding rates. Conclusions: MOM feeding rates decreased from NICU discharge to the 12-month HCM visit. Disparities observed during the birth hospitalization persisted after discharge, with Black infants having consistently lower MOM feeding rates compared with Hispanic and White infants. These disparities highlight research opportunities to pinpoint factors contributing to the decline in MOM feedings and develop targeted interventions to address these disparities.

Wee Nuzzle: A QI Initiative to Promote Nonnutritive Breastfeeding for Preterm Infants.

Nonnutritive breastfeeding (NNBF) benefits preterm infants younger than 34weeks' gestational age (GA), but it is often delayed in those on noninvasive respiratory support. Our primary aim was to reduce the mean number of days to NNBF by 50% in infants born at less than 34weeks' and more than 30weeks' corrected GA within a 12-month period. Our global aim was to increase provision of human milk at discharge. This 1-year quality improvement (QI) initiative involved a multidisciplinary team employing a key driver diagram, fishbone analysis, and "Wee Nuzzle" guidelines, implemented through Plan-Do-Study-Act cycles. The first cycle focused on training health care providers, the second on integrating NNBF into medical progress notes, and the third on incorporating NNBF into the electronic medical record (EMR). Data were collected using EMR and the California Perinatal Quality Care Collaborative database. The initiative achieved its Specific, Measurable, Achievable, Realistic and Time bound (SMART) aim, reducing the mean time to first NNBF by 66%, from 12.0 to 4.1days. Additionally, the global aim of increasing human milk provision at discharge improved from 59% to 72%. This QI initiative effectively reduced the time to first NNBF attempt and increased human milk provision at discharge. Ongoing assessment of human milk exposure post-neonatal intensive care unit discharge is needed.

P-1201. Impact of Demographic Factors and Social Determinants of Health on RSV Immunoprophylaxis in Infants

Abstract Background In 2023, two highly effective forms of respiratory syncytial virus (RSV) immunoprophylaxis to prevent severe RSV disease in young children were approved: Abrysvo (vaccine in pregnancy) and nirsevimab (infant monoclonal antibody). However, challenges with supply and insurance reimbursement limited widespread availability during the 2023-2024 RSV season.Table.Demographics of NICU Infants Eligible for Immunoprophylaxis Methods From October 9, 2023 through March 31, 2024, all St. Louis Children’s Hospital Neonatal Intensive Care Unit (NICU) discharges were offered nirsevimab with no out-of-pocket cost, per CDC recommendations to prioritize infants at highest risk. Data abstraction followed by statistical analyses were performed to identify differences in demographic factors between the following groups: Group 1: Infants who received RSV monoprophylaxis (infant nirsevimab or maternal Abrysvo) prior to hospitalization Group 2: Infants who received RSV immunoprophylaxis (nirsevimab) during hospitalization Group 3: Infants who did not receive RSV immunopropylaxis Area Deprivation Index (ADI) maps were generated using ArcGIS Pro to identify the proportion of infants in the above groups from zip codes with higher or lower ADI. Area Deprivation Index for Patients who Received Previous RSV Immunoprophylaxis The state rank area deprivation index (ADI) overlaid with the total number and percentage of patients within that zip code who received RSV immunoprophylaxis prior to their NICU hospitalization. Results Of 667 eligible infants, 88% received RSV immunoprophylaxis prior to/during hospitalization. Differences in gestational age at birth, chronologic age at hospitalization, age at discharge, duration of hospitalization, and insurance type were observed between groups (Table). Infants who received immunoprophylaxis prior to their hospitalization were primarily clustered in areas with lower ADI (Figure 1). Infants who received immunoprophylaxis during their hospitalization were from areas with variable ADI (Figure 2). Infants who did not receive immunoprophylaxis were primarily clustered in areas with higher ADI, indicating higher social vulnerability (Figure 3). Area Deprivation Index for Patients who Received RSV Immunoprophylaxis During NICU Hospitalization The state rank area deprivation index (ADI) overlaid with the total number and percentage of patients within that zip code who received RSV immunoprophylaxis during to their NICU hospitalization. Conclusion Differences in demographics and ADI were identified in infants who received RSV immunoprophylaxis prior to or during their NICU hospitalization compared to those who did not. Future strategies to improve access and availability of RSV immunoprophylaxis that consider social determinants of health are critical to increase coverage and prevent severe RSV infections in infants. Area Deprivation Index for Patients who Did Not Receive RSV Immunoprophylaxis The state rank area deprivation index (ADI) overlaid with the total number and percentage of patients within that zip code who did not receive RSV immunoprophylaxis. Disclosures Jason G. Newland, MD, MEd, Moderna: Grant/Research Support|Pfizer: Grant/Research Support

Understanding the experience of the mothers’ ability to take care of their preterm infants related to in-hospital and post-discharge: a qualitative content analysis

BackgroundPreterm infants may experience many health and developmental issues, which continue even after discharge from the neonatal intensive care unit. Once home, the mother, as a non-professional and the primary caregiver will be responsible for the essential care of her preterm infant.PurposeUnderstanding the take care ability in mothers with preterm infants.MethodsThe content analysis method was used. The data were collected using in-depth and semi-structured interviews from April 2021 to February 2022. Eleven mothers, two fathers, two grandmothers, one neonatal nurse, and two neonatologists with a mean age of 36.05 ± 10.88 years were selected using purposeful and snowballing sampling in Tehran, Iran. Allocating adequate time for data collection, gathering data through different methods, peer checking by two qualitative researchers, long interaction with the settings, maximum variation sampling, appropriate quotations, and showing the range of facts fairly and honestly were considered to ensure the trustworthiness of this study. The data were analyzed through Lindgren et al.’s approach using MAXQDA software.ResultsBased on the findings and participants’ experiences in 18 deep interviews, the mothers with desirable care ability have adequate ability as described by 17 subcategories and are categorized into five dimensions. The care ability of the mothers of preterm infants upon neonatal intensive care unit discharge consisted of five categories including maternal identity, infant’s needs, cognitive ability, technical ability, and psychological ability.Implications for practice and researchIn the mothers of preterm infants, maternal identity and the infant’s needs are antecedents of the care ability concept. The care ability of the mothers with preterm infants is distinct from those of other caregivers. This is a multi-dimensional concept and trait related to maternal cognitive ability, technical ability, and maternal psychological ability. Professional neonatal nurses should assess their care ability from multiple perspectives: cognitive, technical, and psychological abilities. They should be considered in designing empowerment and engagement programs for the improvement of the care ability of the mothers of preterm infants. Both mothers and professional neonatal nurses should take responsibility for improving the mothers' ability to take care of their preterm infants.

Association of distorted memories, psychiatric symptoms, and quality of life in postoperative ICU patients after 12 months: A cross-sectional study.

Intensive care unit patients often experience memory disturbances, including missing or delusional memories. These memory distortions can contribute to the development of psychiatric disorders, such as anxiety and depression. In addition, distorted memories may adversely affect long-term quality of life. However, the association between distorted memories, psychiatric symptoms, and quality of life remains to be fully elucidated in intensive care unit patients. Accordingly, this study explored the relationship between memory distortion, psychiatric symptoms, and long-term quality of life in intensive care unit patients following scheduled surgery. Among 24 patients, 13 experienced memory distortions 12 months post-intensive care unit discharge. These patients exhibited significantly higher anxiety and depression symptoms 1 month after discharge. In addition, over 25% of patients reported low mental quality of life, and over 50% had low physical quality of life 1 year later. These findings suggest that memory distortions can negatively impact both mental and physical recovery, underscoring the need for interventions to preserve factual memory and enhance patient autonomy post-intensive care unit.

Influence of the Variability in Motor Unit Discharge Times and Neural Drive on Force Steadiness During Submaximal Contractions with a Hand Muscle.

Our purpose was to compare the influence of the spectral content of motor unit recordings on the calculation of electromechanical delay and on the prediction of force fluctuations from measures of the variability in discharge times and neural drive during steady isometric contractions with the first dorsal interosseus muscle. Participants (n = 42; 60 ± 13 yrs) performed contractions at 5% and 20% MVC. After satisfying inclusion criteria, high-density surface EMG recordings from a subset of 23 participants were decomposed into the discharge times of 530 motor units. The force and Cumulative Spike Train (CST) signals were cross-correlated with a novel filtering approach to determine the electromechanical delay. Force and CST signals were bandpass filtered with three bandwidths (0.75 - 5 Hz, 0.75 - 2 Hz, 2 - 5 Hz) to determine the influence of spectral content on the precision of the electromechanical-delay measurement. Subsequently, the variability in the discharge times of motor units was quantified as the coefficient of variation for interspike interval (CVISI) and the variability in neural drive was represented as the standard deviation of the cumulative spike train (SDCST). The main findings were that all frequencies (0.75 - 5 Hz) were needed to determine the electromechanical delay and that the force fluctuations were best explained by measures of variability in both discharge times and neural drive (CVISI and SDCST) at 5% MVC force but only the variability in neural drive (SDCST) at 20% MVC force. These findings indicate that the source of the force fluctuations during the steady submaximal contractions with the hand muscle differed for the two target forces.

Time Resolved Observation of Streamer Discharges in Dielectric Barrier Discharge by Highly Sensitive Camera and Image Analyzing Procedure

ABSTRACT In dielectric barrier discharge (DBD) type ozone generators, improving energy efficiency, or ozone generation efficiency, is an active field of research. In ozone generation by a DBD device, numerous micro-discharges consisting of streamer channel and surface discharge are generated in a discharge gap, and ozone is generated in these discharges. Since streamer channel and surface discharge are considered to affect ozone generation characteristics, it is important to quantitatively evaluate the generation aspects of these discharges. In this study, we developed a method to extract streamer channel and surface discharge from the grayscale value distribution of the micro-discharges photograph taken from the top side of the DBD device, which consists of a transparent high voltage electrode and a metal electrode, using an image-analyzing procedure and a high-sensitivity camera equipped an image intensifier. In the method, by applying appropriate thresholding methods, binary images of micro-discharges and streamer channels can be generated from the micro-discharge photograph. Statistical analysis of these binary images enabled the estimation of the average projected area diameters of streamer channels and the average lengths of surface discharges. This approach also allowed for time-resolved observations of the number of streamer channel per unit discharge area (streamer channel density), their average projected area diameter, and the average length of surface discharge. The findings from time resolved observation revealed that a positive correlation between the streamer channel density and the magnitude of the discharge current density. Moreover, the magnitude or polarity of the discharge current did not influence the average projected area diameter of streamer channels. However, the average length of surface discharge slightly decreased with increasing streamer channel density.

Hydraulic performance of a pre-aerated stilling basin: Experimental study.

Spillway chutes are critical in dam flood control, particularly in high dams where high water heads and large discharge in narrow canyons amplify the demand for safe discharging. For large unit discharges in spillways, aeration protection is essential to prevent cavitation erosion, but challenges arise from air duct choking in the traditional spillway and nonaerated regions in the stepped spillway. This paper introduces a novel spillway called the pre-aerated stilling basin spillway (PSBS). The primary distinction between PSBS and conventional spillways lies in the placement of aeration facilities. Conventional spillways feature a curved transition section that directly connects to the spillway. In contrast, the PSBS is equipped with a WES crest weir and a vertical sill of the same width, which converts supercritical to subcritical flow. This process strongly entrains air through hydraulic jumps at spillway entrances, thereby preventing cavitation damage. The study aims to experimentally investigate the flow regime, energy dissipation within the PSB, and the near-wall air concentration to ensure effective mitigation of cavitation damage downstream. The findings highlight the impact of the PSB on changing the jump type and relative local energy loss, influenced by the incoming Froude number, sill height, and sill length. Influenced by these factors, the variation in air concentration is crucial for reducing cavitation damage, necessitating potential adjustments in prototype applications to account for scale effects. Under such a pre-aeration approach, the air concentration along the downstream spillway warrants further investigation for the continuous optimization of the PSB's design and its integration with spillways.

Social Determinants of Health Affecting Retinopathy of Prematurity Follow-up Attendance.

To identify social determinants of health (SDOH) associated with follow-up attendance of pre-term infants with retinopathy of prematurity (ROP) after neonatal intensive care unit (NICU) discharge. This retrospective cohort study, conducted at a single academic tertiary care center, included preterm infants screened for ROP from July 2018 to December 2022. Sociodemographic and clinical data were collected from a preexisting NICU database. Residential ZIP code was used to derive community-level SDOH indices. Multivariable logistic regression was used to determine factors associated with ophthalmology follow-up attendance within 8 weeks to 1 year after NICU discharge. Forty-two percent (303 of 723) of patients attended follow-up in the designated interval. Infants with private insurance (odds ratio [OR]: 4.47, 95% CI: 1.98 to 10.1, P < .001), maternal non-Hispanic White identity (OR: 1.80, 95% CI: 1.15 to 2.81, P = .01), ROP treatment history (OR: 3.67, 95% CI: 2.05 to 6.57, P < .001), and longer NICU stay (weeks) (OR: 1.06, 95% CI: 1.03 to 1.08, P < .001) had higher odds of attending follow-up. In an interaction effect, privately insured patients had lower odds of follow-up with each higher quartile of Social Vulnerability Index Racial and Ethnic Minority Status (OR: 0.61, 95% CI: 0.44 to 0.84, P = .002). Social determinants of health, including individual and community-level factors, significantly impact access to ROP follow-up. The identified disparities and overall inadequate follow-up rate suggest a need for targeted interventions to improve vision health equity and follow-up adherence. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XXX-XXX.].

Investigation of the flow characteristics of slit check dams using novel models

Floods, which cause loss of life and property and destruction of the environment, have devastating effects on socio-economic welfare. Slit-check dams are essential structures for managing the transport of silt and woody debris, especially in events of significant floods. The current study presents the hydraulic characteristics of slit-check dams with different geometries for experimental and numerical tests. First, the Butterfly model was produced with a 3D printer and examined experimentally. Then, the Butterfly model was validated extensively using OpenFOAM (v7) software for the numerical analysis. Finally, the other models were examined numerically using the k-ε turbulence model. The changes in water surface profile, velocity profiles, energy dissipation rates, and streamlines were comprehensively examined and discussed. The results showed that slit-check dams caused hydraulic jumps and dissipated flow energy. The Arced and Rectangular models, in particular, demonstrated a significant performance for energy dissipation, which is essential for flood management. Water surface profiles are directly affected by discharge. Moreover, the cross-sectional length of the model in question significantly affects the water surface profile. Accordingly, an increase was observed in the velocity profiles along the slit-check dam. While the maximum velocity for all unit discharge was observed in the V-shaped model, the minimum velocities were observed for the Arced and Rectangular models. Thus, the energy absorption performance of Arced and Rectangular models is higher.

Efficacy in predicting mortality of patients with heart failure using heart rate before intensive care unit discharge: a retrospective cohort study from MIMIC-IV Database

ObjectiveHeart rate serves as a critical prognostic factor in heart failure (HF) patients. We hypothesise that elevated heart rate in critically ill HF patients on discharge from the intensive care...

Suspected heparin-induced thrombocytopaenia in pulmonary thromboendarterectomy: retrospective cohort.

Heparin is given for anticoagulation during and after pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension. Our objective was to add to the limited data available on the incidence, management and outcomes of suspected heparin-induced thrombocytopaenia after pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension. This retrospective single-centre study included consecutive patients with suspected heparin-induced thrombocytopaenia after pulmonary thromboendarterectomy done in 2005-2018. Confirmed heparin-induced thrombocytopaenia was defined as positive findings from both the antibody test and the platelet aggregation test. Patients with versus without confirmed heparin-induced thrombocytopaenia were compared, as well as patients with versus without heparin replacement therapy within the group with unconfirmed heparin-induced thrombocytopaenia. The platelet counts over time were compared to those in controls without suspected heparin-induced thrombocytopaenia. Heparin-induced thrombocytopaenia was suspected in 86 (6.3%) of 1360 patients and confirmed in 16 (16/86, 19%), all of whom received heparin replacement therapy and survived to intensive care unit discharge. Of the remaining 70 patients, 28 (40%) received heparin replacement therapy and less often experienced bleeding compared to the other 42 (3.6% vs 21.4%, P = 0.043). Intensive care unit mortality was 17/70 (24.3%) and was lower in the subgroup given heparin replacement therapy (10.7% vs 33.3%; P = 0.046). Confirmed heparin-induced thrombocytopaenia was associated with a sharp platelet-count drop on Day 5. In unconfirmed suspected heparin-induced thrombocytopaenia, the early platelet-count decline was similar to that in the controls without suspected heparin-induced thrombocytopaenia, but the baseline count was lower. Clinical features suggesting heparin-induced thrombocytopaenia after pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension were associated with excess mortality. Relay heparin replacement therapy was associated with lower mortality and fewer bleeding events.

Project Initiate: A Clinical Feasibility Trial of Equitable Access to Early Neurodevelopmental Therapy.

Background/Objectives: Despite evidence of the effectiveness of early intervention (EI) programs, eligible infants often experience delays in initiation of services or fail to receive services entirely. Disparities have been documented, including lower enrollment rates for infants with public insurance. The objective of this pilot study was to evaluate the feasibility of initiating home physical therapy (PT) services promptly after neonatal or cardiac intensive care unit (NICU/CICU) discharge for infants with public insurance and to assess early motor outcomes for children who received study therapy compared with a standard of care group. Methods: Infants were recruited if discharged from a study NICU/CICU, had public insurance, and were eligible for Illinois EI services. Infants living in Chicago (n = 46) received weekly home-based PT from a study therapist until 3-4 months corrected age (CA). Infants living outside Chicago received standard of care services and served as a control group (n = 14). At discharge, infants were referred to EI and underwent the Test of Infant Motor Performance (TIMP). Outcomes at 3-4 months CA included initiation rates for study PT and EI and follow-up TIMP testing. Results: By 3-4 months CA, 78% of the intervention group had received ≥1 PT session. In contrast, just 13% of the entire cohort had received any EI therapy. Infants who had 8-10 PT sessions in the first 3-4 months after discharge were more likely to have a change in the TIMP Z-score of >0.5 SD. Conclusions: Prompt transition to home therapy was feasible for infants with public insurance in an urban setting who may benefit most due to the potential for neuroplastic change. Addressing barriers identified in this study may assist in improving access to EI for young infants.

Critical Care Clinicians' Knowledge of Post-Intensive Care Syndrome.

The term post-intensive care syndrome refers to a group of symptoms that commonly occur after intensive care unit discharge, leading to worsening physical or mental health. The incidence of this syndrome is increasing. Critical care clinicians can play a pivotal role in improving patient outcomes through knowledge of post-intensive care syndrome risk factors and symptoms. To explore critical care clinicians' current knowledge of post-intensive care syndrome as a basis for developing critical care educational interventions. This quantitative, cross-sectional, observational pilot study was conducted to survey critical care physicians, nurses, nurse practitioners, and physician assistants at a university hospital on their knowledge of post-intensive care syndrome symptoms and risk factors and their confidence in their ability to recognize the condition. A total of 51 clinicians completed the survey. The overall levels of knowledge and confidence regarding post-intensive care syndrome risk factors and symptoms were low, with no significant differences found by clinician role. These findings support the need for interprofessional education on post-intensive care syndrome risk factors and early identification of symptoms in the critical care setting.

Optimal Timing for Postanesthesia Care Unit Discharge Using Physiological-Based Criteria in In-Patients Undergoing Low-Risk Surgery with General Anesthesia: A Prospective Observational Study

Objective: All postanesthesia patients must be monitored in the postanesthesia care unit (PACU) until they meet PACU discharge protocols. These included both physiological-based discharge (PBD) criteria and time-based discharge (TBD) criteria. The efficacy of using only PBD criteria to determine PACU discharge remains unclear. Therefore, this study aimed to determine the optimal timing for PACU discharge using PBD criteria alone for in-hospital patients undergoing low-risk surgeries. Material and Methods: This was a prospective observational study, involving 532 patients who had undergone elective low-risk surgery under general anesthesia (GA). At the PACU, the following data points were recorded: patient demographics, anesthesia and surgical data, the time required to meet PBD criteria, the actual PACU discharge time, complications during PACU admission, and causes of delayed PACU discharge. This study analyzed the comparison between the average time to meet PBD criteria and the ‘actual’ PACU discharge time. Results: A total of 532 patients admitted to the PACU were enrolled in this study. The mean PBD time was 12.6± 8.4 minutes, and the mean actual PACU time was 65.1±15.5 minutes: a difference that was statically significant [mean difference 52.5 (51.1, 54.0) minutes, p-value&lt;0.001]. No severe complications were observed. Severe pain was the most recorded complication during PACU admission. The highest cause of delayed PACU discharge was the unavailability of hospital patient transporters. Conclusion: The PACU discharge time for in-hospital patients undergoing low-risk surgery under GA, based on PBD criteria, was significantly shorter than that based on TBD criteria; additionally, no severe complications were reported.

Disparities in Trauma Care for Latino Patients: An Analysis by Trauma Center Verification Level.

Introduction Trauma is the leading cause of death for individuals under 45 in the United States (US), with significant disparities in outcomes among minority groups. Latinos, the largest ethnic minority in the US, often face barriers to optimal trauma care that may require additional resources. This study aimed to compare trauma outcomes for Latino patients treated at Level I versus Level II/III trauma centers (TCs). Methods We conducted a retrospective analysis using the National Trauma Data Bank (NTDB) from 2019 to 2021. Latino patients aged ≥ 18 years treated at Level I and Level II/III TCs were included. The primary outcome was in-hospital mortality, while secondary outcomes included length of stay (LOS), intensive care unit (ICU) LOS, ventilator days, in-hospital complications, and discharge disposition. Propensity score matching was used to control for age, sex, injury severity, and mechanism of injury. Statistical analyses were performed with a significance level of P < 0.05. Results The unmatched cohort included 221,050 Latino patients, with 139,286 treated at Level I and 81,764 at Level II/III TCs. After matching, 81,764 patients remained in each group. Level I TCs had lower mortality (1.26% vs. 1.48%; P < 0.05) and higher discharge-to-home rates (75.22% vs. 73.15%; P < 0.05) yet had longer hospital LOS (6.53 ±0.03 vs. 6.17 ±0.03; P < 0.05), ICU LOS (5.56 ±0.05 vs. 5.13± 0.04; P < 0.05), and more in-hospital complications (3.92% vs. 3.67%;P < 0.05). Conclusion Despite similar baseline characteristics, Latino patients treated at Level I TCs had better survival and disposition outcomes but experienced longer LOS and higher complication rates. While resource availability largely determines trauma verification level and may be responsible for disparities in care, more studies are needed to investigate further how verification level impacts care for Latino patients.

Using Compressed Virtual Reality Exposure Therapy for an Adult Critical Illness Survivor: A Case Report.

Nearly one-quarter of adult critical illness survivors develop posttraumatic stress disorder symptoms triggered by sensory stimuli after intensive care unit discharge. Intensive care unit delirium is a risk factor for posttraumatic stress disorder. Compressed virtual reality exposure therapy (C-VRET) incorporates sensory stimuli to reduce posttraumatic stress disorder symptoms through habituation. A critical illness survivor developed intensive care unit delirium and enrolled in a C-VRET trial to treat posttraumatic stress disorder. She reported self-isolation because of infection fears and posttraumatic stress disorder symptoms triggered by medical commercials and lawn equipment sounds. She repetitively checked her heart rate at night for fear of missing illness signs and waking up intubated. The participant completed therapy. Screening tests were administered before, 2 weeks after, and 3 months after therapy to measure posttraumatic stress disorder symptoms (Clinician-Administered PTSD Scale for DSM-5; range, 0-60), depression (Center for Epidemiologic Studies Depression Scale; range, 0-60), physical activity (International Physical Activity Questionnaire), and resiliency (Connor-Davidson Resilience Scale; range, 0-100). The participant's posttraumatic stress disorder symptom scores declined from 36 to 11 to 5; depression scores declined from 19 to 5 to 1; physical activity scores increased from 499 to 2013 to 4599; and resiliency scores increased from 70 to 76 to 83. This report highlights the severity of posttraumatic stress disorder symptoms in critical illness survivors and the importance of strategies to limit delirium and posttraumatic stress disorder. Compressed virtual reality exposure therapy may reduce posttraumatic stress disorder symptoms in critical illness survivors.

The neonatal gut microbiota: A role in the encephalopathy of prematurity.

Preterm birth correlates with brain dysmaturation and neurocognitive impairment. The gut microbiome associates with behavioral outcomes in typical development, but its relationship with neurodevelopment in preterm infants is unknown. We characterize fecal microbiome in a cohort of 147 neonates enriched for very preterm birth using 16S-based and shotgun metagenomic sequencing. Delivery mode strongly correlates with the preterm microbiome shortly after birth. Low birth gestational age, infant sex assigned at birth, and antibiotics associate with microbiome composition at neonatal intensive care unit discharge. We integrate these data with term-equivalent structural and diffusion brain MRI. Bacterial community composition associates with MRI features of encephalopathy of prematurity. Particularly, abundances of Escherichia coli and Klebsiella spp. correlate with microstructural parameters in deep and cortical gray matter. Metagenome functional capacity analyses suggest that these bacteria may interact with brain microstructure via tryptophan and propionate metabolism. This study indicates that the gut microbiome associates with brain development following preterm birth.

First Clinical Application of Aztreonam-Avibactam in Treating Carbapenem-Resistant Enterobacterales: Insights from Therapeutic Drug Monitoring and Pharmacokinetic Simulations.

Background: A novel fixed combination of aztreonam (ATM) and avibactam (AVI) offers promising potential to treat infections with carbapenem-resistant Enterobacterales (CRE) producing metallo-β-lactamases (MBL). This study aimed to assess the accuracy of population pharmacokinetic (PK) models for ATM-AVI in predicting in vivo concentrations in a critically ill patient with CRE infection during its first clinical use. Methods: A 70-year-old male with septic shock due to hospital-acquired pneumonia (HAP) caused by MBL-producing Klebsiella pneumoniae was treated with ATM-AVI. Trough and peak serum concentrations (32 samples over 7 days) were measured using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Population PK models were used to simulate complete concentration-time profiles. Bland-Altman analysis assessed model performance by comparing predicted and measured concentrations. Results: Median ATM trough concentrations (18.4 mg/L) remained above the minimum inhibitory concentration (MIC) of 1 mg/L for the pathogen. The Bland-Altman analysis demonstrated reasonable agreement between predicted and observed concentrations, with a relative bias (rBias) of -50.5% for ATM and -14.4% for AVI. ATM-AVI ratios remained stable. Clinical improvement and sterile blood cultures within 12 days led to intensive care unit (ICU) discharge. Conclusions: Population PK models for ATM-AVI accurately predicted in vivo concentrations in a severely ill patient with HAP. Therapeutic drug monitoring (TDM) with PK modeling ensured optimal antimicrobial exposure and contributed to clinical recovery.