Duration Of Intensive Care Unit Research Articles

Comparison of Acute Coronary Syndromes in the Earthquake Zone before and in the First Month after the Earthquake: A Single-center and Retrospective Analysis.

Earthquakes can significantly impact both the occurrence and the management of acute coronary syndromes (ACS). This study aimed to investigate the effects of an earthquake on patients with ACS by comparing their clinical and angiographic features before and after the event. We utilized a retrospective observational cohort design, involving 260 ACS patients who underwent coronary angiography. Data on patient characteristics, clinical variables, and procedural details were extracted from medical records. Statistical analyses were conducted to compare the ACS groups pre- and post-earthquake and to assess outcomes, which included in-hospital mortality and complications. After the earthquake, the ACS patients were older and predominantly male. The distribution of ACS subtypes remained similar between the groups. The use of anticoagulation before the procedure decreased after the earthquake, while the usage of other medications remained stable. The incidence of non-critical coronary arteries decreased post-earthquake, and there was a higher frequency of non-intervention in this group. Intervention in the left anterior descending coronary artery was more common after the earthquake. In-hospital mortality was associated with post-earthquake ACS, certain ACS subtypes, shock at admission, bifurcation stenting, and the no-reflow phenomenon. Complete revascularization was found to reduce mortality. The duration of intensive care unit stays was longer before the earthquake, while in-hospital mortality was higher after the earthquake. Gender differences were observed in coronary ectasia, with females being more affected post-earthquake. Earthquakes significantly influence the clinical and angiographic features of ACS cases, thereby affecting mortality rates and revascularization outcomes.

Impact of different corticosteroids on severe community-acquired pneumonia: a systematic review and meta-analysis

ObjectivesRandomised controlled trials (RCTs) have demonstrated conflicting results regarding the effects of corticosteroids on the treatment of severe community-acquired pneumonia (CAP). We aimed to investigate the efficacy and safety of...

Carbazochrome sodium sulfonate and tranexamic acid combination therapy to reduce blood transfusions after 24 h of injury: A retrospective study.

Reducing the blood transfusion volume is important in severe trauma. We hypothesized that carbazochrome sodium sulfonate (CSS) combined with tranexamic acid (TXA) would reduce blood transfusions in severe trauma. From April 2017 to March 2023, data were collected from patients (aged ≥16 years) admitted to our hospital for trauma and administered packed red blood cells (pRBC) and plasma transfusions within 12 h postinjury. Patients infused with CSS and TXA (CSS + TXA group) were compared with those infused with TXA alone (TXA group). The outcomes were blood product transfusion volumes within and after 24 h, the number of patients receiving >6 units of pRBC transfusion after 24 h, duration of intensive care unit and in-hospital stays, and 28-day in-hospital mortality. In total, 138 patients were included in the study. In the univariate analyses, the CSS + TXA group (n = 62) showed a significant reduction in the total pRBC transfusion volume, in-hospital days, and number of patients receiving >6 units of pRBCs in the delayed phase. Based on the multivariate logistics regression analysis, only the CSS + TXA group had a significantly lower adjusted odds ratio for receiving >6 units of pRBC transfusion after 24 h. During the in-hospital days, the CSS + TXA group did not experience an increased incidence of major complications when compared with the TXA group. In patients with trauma, treatment with CSS with TXA may reduce the requirement for blood transfusion after 24 h. Moreover, this treatment can improve admission outcomes without increasing complications.

Comparison of platelet activation in patients undergoing coronary bypass surgery with conventional and mini extracorporeal systems

Aim: The aim of this study was to compare platelet activation in patients undergoing coronary bypass surgery with conventional and mini extracorporeal systems. Material and Methods: Our study is a retrospective study and a total of 116 patient data were obtained. Patients were divided into two groups as conventional extracorporeal and mini extracorporeal system bypass patients. Equal numbers of patients (n=58) were included in both groups. The data of patients who underwent coronary bypass surgery with conventional and mini extracorporeal systems between January 2022 and December 2022 were included in the study. Results: In our study, no significant difference was found between patients bypassed with conventional and mini extracorporeal system in terms of pump time and cross-clamp time. Although the duration of intensive care unit stay and total hospitalization were found to be shorter in patients bypassed with the mini-extracorporeal (MECC) system than those bypassed with the conventional method, the difference between the groups was not significant. As a result of our study, it was observed that postoperative ejection fraction (EF) values significantly increased and hematocrite (HTC), hemoglobin (Hb), platelet (PLT) and procalcitonin (PCT) values significantly decreased in both groups of patients who underwent bypass with conventional and MECC system, and no significant difference was found between pre- and postoperative mean platelet volume (MPV) and platelet distribution width (PDW) values. As a result of our study, postoperative PLT and PCT values in the MECC group were found to be significantly higher than those in patients who underwent bypass with the conventional method. Conclusion: Considering the results obtained in our study, it is seen that the values in patients bypassed with the MECC system are more favorable than those bypassed with the standard method, but more studies on the subject are needed.

Prognostic significance of gastrointestinal dysfunction in critically ill patients with COVID-19.

To analyze in-hospital and 1-year morbidity and mortality associated with acute gastrointestinal dysfunction in critically ill patients with COVID-19 via a prespecified scoring system. Between March and July 2020, consecutive hospitalized patients with COVID-19 from a single institution were retrospectively analyzed by medical chart review. Only those who remained in the intensive care unit for more than 24 hours were included. Gastrointestinal dysfunction was assessed according to a predefined 5-point progressive gastrointestinal injury scoring system, considering the first 7 days of hospitalization. Laboratory data, comorbidities, the need for mechanical ventilation, the duration of intensive care unit stay, and subsequent in-hospital and 1-year mortality rates were also recorded. Among 230 patients who were screened, 215 were included in the analysis. The median age was 68 years (54 - 82), and 57.7% were male. The total gastrointestinal dysfunction scores were 0 (79.1%), I (15.3%), II (4.7%), III (0.9%), and IV (0%). Any manifestation of gastrointestinal dysfunction was present in 20.9% of all patients and was associated with longer lengths of stay (20 days [11 - 33] versus 7 days [4 - 16]; p < 0.001] and higher C-reactive protein levels on admission (12.8mg/mL [6.4 - 18.4] versus 5.7mg/mL [3.2 - 13.4]; p < 0.001). The gastrointestinal dysfunction score was significantly associated with mortality (OR 2.8; 95%CI 1.7 - 4.8; p < 0.001) and the need for mechanical ventilation (OR 2.8; 95%CI 1.7 - 4.6; p < 0.001). Both in-hospital and 1-year death rates progressively increased as gastrointestinal dysfunction scores increased. In the current series of intensive care unit patients with COVID-19, gastrointestinal dysfunction severity, as defined by a prespecified scoring system, was predictive of adverse in-hospital and 1-year outcomes.

Intraoperative Goal-Directed Perfusion in Cardiac Surgery with Cardiopulmonary Bypass: The Roles of Delivery Oxygen Index and Cardiac Index.

Goal-directed perfusion (GDP) refers to individualized goal-directed therapy using comprehensive monitoring and optimizing the delivery of oxygen during cardiopulmonary bypass (CPB). This study aims to determine whether the intraoperative GDP protocol method has better outcomes compared to conventional methods. We searched the PubMed, Central, and Scopus databases up to October 12, 2023. We primarily examined the GDP protocol in adult cardiac surgery, using CPB with oxygen delivery index (DO2I) and cardiac index (CI) as the main parameters. In all, 1128 participants from seven studies were included in our analysis. The results showed significant differences in the duration of intensive care unit (ICU) stays (p = 0.01), with a mean difference of -0.33 (-0.59 to 0.07), and hospital length of stay (LOS) (p = 0.0002), with a mean difference of -0.84 (-1.29 to -0.39). There was also a notable reduction in postoperative complications (p <0.00001), odds ratio (OR) of 0.43 (0.32-0.60). However, there was no significant decrease in mortality rate (p = 0.54), OR of 0.77 (0.34-1.77). Postoperative acute kidney injury and ICU and hospital LOS are significantly reduced when GDP protocols with indicators of flow management, oxygen delivery index, and CI are used in intraoperative cardiac surgery using CPB.

Predictors and Associations of Prolonged Tracheostomy in Pediatric Cardiac Surgical Patients

Objectives: To describe the predictors and associations of prolonged tracheostomy duration in pediatric cardiac surgical patients. Method: Prospective study. All pediatric patients below 10 years of age who underwent tracheostomy after cardiac surgery from January 2019 to December 2019, were subdivided into short and long groups according to the tracheostomy duration during the intrahospital stay if more than 21 days. Different variables were compared. Results:1084 pediatric patients who underwent cardiac surgery during study period, 41 (3.7%) received tracheostomy. LT group was associated with univentricular repair (p=0.03) and sepsis (p=0.04), longer days of ventilation (p=0.0005), higher number of extubation trials (p=0.02), higher accidental tracheostomy tube dislodgement (p=0.048), ventilator-associated pneumonia (p=0.013), more days of feed interruption (p=0.0089), higher days of hospital stay (p=0.0001) and intensive care unit stay (p=0.0001). ST was associated with significantly higher anticipated longer duration of ventilation and earlier liberation from the ventilator as an indication for tracheostomy than LT (p=0.02). Conclusions: Univentricular repair, sepsis, longer mechanical ventilation, longer duration of intensive care unit and hospital stay, a higher number of extubation trials, higher number of accidental tracheostomy tube dislodgement, ventilator-associated pneumonia, higher days of feed interruption were found to be significant associations with a long duration tracheostomy.

Correlation between serum phosphate and all-cause mortality in critically ill patients with coronary heart disease accompanied by chronic kidney disease: a retrospective study using the MIMIC-IV database.

The adverse clinical endpoints of cardiovascular and kidney diseases are correlated with increased serum phosphate levels. However, in critically ill patients with coronary heart disease (CHD) accompanied by chronic kidney disease (CKD), the prognostic value of serum phosphate remains unclear. Patients' medical records from the Medical Information Mart for Intensive Care IV database who had concomitant CKD and CHD were classified into four distinct groups in this large retrospective observational cohort study based on the quartiles of serum phosphate levels. Vital status and the duration of hospital and ICU stays within the short-term follow-up periods of 30 and 90 days constituted the primary outcomes. All-cause mortality in the intensive care unit (ICU) and hospital constituted the secondary outcomes. Further, the Cox proportional hazard and restricted cubic spline (RCS) regression models were employed to ascertain how serum phosphate levels correlated with the primary outcomes. In addition, the occurrence rate of the secondary outcomes across the four quartiles was determined utilizing the Kaplan-Meier method. Among the total 3,557 patients (67.6% male) included, the hospital and ICU all-cause mortality rates were 14.6% and 10%, separately. Higher quartiles of serum phosphate concentrations were associated with shorter short-term survival rates, as shown by the Kaplan-Meier curves. Additionally, the Cox proportional hazards analysis illustrated that serum phosphate was independently linked to a higher death risk in the hospital [HR, 1.10 (95% CI: 1.03-1.18), P = 0.007] and ICU [HR, 1.14 (95% CI: 1.07-1.22), P < 0.001]. Lastly, the RCS regression models suggested a robust non-linear correlation between serum phosphate concentrations and death risk in the ICU and hospital (both P for non-linearity <0.001). The prognostic value of serum phosphate is significant in critically ill patients with CHD accompanied by CKD. Furthermore, serum phosphate is potentially valuable for identifying patients with this concomitant condition.

Leucoglycemic index predicts post-operative vasopressor-inotropic requirement after adult cardiac surgery (LEUCOGLYPTICS): A retrospective single-center study.

Cardiac surgery often necessitates considerable post-operative vasoactive-inotropic support. Given an encouraging literature on the prognostic potential of leucoglycemic index (LGI) [serum glucose (mg/dl) × total leucocytes count (cells/mm3)/1000], we aimed to evaluate whether intensive care unit (ICU)-admission LGI can predict post-operative vasopressor-inotropic requirements following cardiac surgery on cardio-pulmonary bypass (CPB). The data of patients undergoing cardiac surgery at our tertiary care center between January 2015 and December 2020 was retrospectively reviewed. The vasopressor-inotropic requirement was estimated using the VIS (vasoactive-inotropic score) values over the first post-operative 72 hrs. Subsequently, VISi (indexed VIS) was computed as maxVIS[0-24hrs] + maxVIS[24-48hrs] +2 × maxVIS[48-72hrs]/10), and the study participants were divided into h-VISi (VISi ≥3) and l-VISi (VISi <3). Out of 2138 patients, 479 (22.40%) patients categorized as h-VISi. On univariate analysis: LGI, age, European System for Cardiac Operative Risk Evaluation score (EuroSCORE II), left-ventricle ejection fraction, prior congestive heart failure (CHF), chronic renal failure, angiotensin-converting enzyme inhibitors, combined surgeries, CPB and aortic cross-clamp (ACC) duration, blood transfusion, and immediate post-operative glucose were significant h-VISi predictors. Subsequent to multi-variate analysis, the predictive performance of LGI (OR: 1.09; 95% CI: 1.03-1.14; P = 0.002) prior CHF (OR: 2.35; 95% CI: 1.44-3.82; P = 0.001), CPB time (OR: 1.08; 95% CI: 1.02-1.14; P = 0.019), ACC time (OR: 1.03; 95% CI: 1.02-1.04; P = 0.008), and EuroSCORE II (OR: 1.14; 95% CI: 1.06-1.21; P < 0.001) remained significant. With 1484.75 emerging as the h-VISi predictive cut-off, patients with LGI ≥ 1484.75 also had a higher incidence of vasoplegia, low-cardiac output syndrome, new-onset atrial fibrillation, acute kidney injury, and mortality. LGI additionally exhibited a significant positive correlation with duration of mechanical ventilation and ICU stay (R = 0.495 and 0.564, P value < 0.001). An elevated LGI of greater than 1484.75 independently predicted a VISindex ≥3 following adult cardiac surgery on CPB.

Impact of Albumin Therapy in Critically Ill COVID-19 Patients: A Retrospective Cohort Study

Introduction: Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Due to the limited understanding of this disease, research has quickly extended towards identifying biomarkers to predict its prognosis and progression. Aim: To explore the impact of albumin infusion on critically ill COVID-19 patients. Materials and Methods: In this retrospective cohort study, a total of 150 severe COVID-19 patients aged 18 to 65 years were enrolled. These patients were categorised into the no albumin infusion group (n=61), consisting of those who did not undergo albumin transfusion during their treatment, and the albumin infusion group (n=89), comprising patients who received albumin transfusion as part of their treatment protocol. Assessments of hospitalisation included the Sequential Organ Failure Assessment (SOFA), and Acute Physiology and Chronic Health Evaluation (APACHE-II) scores obtained at baseline and day 5. Unpaired t-tests, Chi-square tests, and paired t-tests were used for analysis. Results: The mean values of Haemoglobin (Hb), eosinophils, Random Blood Sugar (RBS), Mean Corpuscular Volume (MCV), total protein, serum urea, serum bilirubin, Prothrombin Time (PT), International Normalised Ratio (INR), Interleukin 6 (IL-6), Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP), and D-dimer exhibited significant differences between the two groups. The average duration of vasopressor usage and Intensive Care Unit (ICU) stay were significantly reduced in the albumin infusion group (3.50±1.55 days and 8.70±4.20 days, respectively) compared to no albumin infusion group (4.33±1.05 days and 12.80±3.43 days, respectively). The albumin infusion group also displayed a lower incidence of Renal Replacement Therapy (RRT) and poorer ICU outcomes. Conclusion: The intravenous administration of albumin did not exhibit a significant impact on mortality. However, albumin transfusion in patients with severe COVID-19 who initially had albumin levels &lt;3 g/dL demonstrated a notable reduction in the requirement for vasopressors, RRT, and the length of ICU stay

Temperature management in acute type A aortic dissection treatment: deep vs. moderate hypothermic circulatory arrest. Is colder better?

The impact of different degrees of hypothermia in patients undergoing type A aortic dissection (TAAD) repair remains controversial. The purpose of this study was to compare the clinical outcomes of patients who received deep hypothermic circulatory arrest (DHCA) (<20°C) and those of patients who received moderate hypothermic circulatory arrest (MHCA) (20-28°C). Between January 2011 and December 2020, 143 patients underwent surgical treatment for TAAD with CA and unilateral antegrade selective cerebral perfusion (uSCP). In this retrospective analysis, we evaluated the clinical outcomes of 143 individuals (103 who received DHCA vs. 40 who received MHCA). The primary outcome was the composite of major events (CMEs) including delirium, acute kidney injury (AKI), and in-hospital mortality. The secondary outcomes were overall mortality, bleeding, rethoracotomy, and length of intensive care unit (ICU) stay, among other things. Compared with the MHCA group, the DHCA group presented a greater incidence of postoperative complications, as follows: AKI (26 (25.2%) vs. 3 (7.5%), p = 0.020), delirium (23 (22.3%) vs. 2 (5%), p = 0.014), re-exploration rate (21 (20.4%) vs. 2 (5.0%), p = 0.024), and prolonged intensive care unit (ICU) stay (7.8 (4.4, 14.1) vs. 5.7 (2.4, 10) days, p = 0.019). The median cardiopulmonary bypass time (255 (210, 280) vs. 210 (190, 251) min, p = 0.010) and median cross-clamp time (140 (110, 180) vs. 125 (100, 160) min, p = 0.023) were significantly longer in the DHCA group. The German Registry for Acute Aortic Dissection Type A (GERAADA) score was significantly higher in the MHCA group (22.7 ± 9.1 vs. 19 ± 7.2, p = 0.012). The adjusted odds ratio for CME in the MHCA group was 0.78 (95% CI: 0.52-1.17, p = 0.001). The use of MHCA demonstrated a protective effect on reducing postoperative delirium (OR: 0.28, 95% CI: 0.14-0.46, p < 0.01) and postoperative AKI (OR: 0.29, 95% CI: 0.14-0.49, p < 0.01). Overall survival after two years did not differ between the two groups (log-rank, p = 0.16). The principal findings of our study indicate that DHCA elevates the risk of postoperative AKI and delirium. As a result, the duration of hospitalization and intensive care unit stay was markedly extended. Consequently, MHCA should be favored over DHCA when the clinical circumstances permit, since DHCA remains a secure alternative in intricate dissection instances.

Determinants of delirium in elderly in-patients in a general ward setting in a teaching hospital: A case control study

Background: There is a dearth of research on risk factors of delirium among elderly inpatients in nonintensive low resource settings. Aim: To determine the risk factors of delirium in elderly inpatients in a nonintensive care unit setting. Materials and Methods: Sixty two elderly patients with delirium (cases) and 62 patients without delirium (controls) were administered a semi-structured proforma with socio-demographic variables and putative predisposing and precipitating risk factors and the Vellore screening instrument for dementia. Results: On univariate analysis, factors such as past cognitive impairment, history of nocturnal confusion and delirium, diminished daily living activities, severe medical illness, history of psychiatric illness, presence of dementia, infection, fever above 1000F, abnormal electrolytes abnormal RFT, leukocytes in urine, hypoxia, anticholinergics and benzodiazepines, emergency admission, use of physical restraints, bladder catheterization, more than routine investigations, intensive care unit admission, surgery, and duration of hospital stay more than 10 days were found to be significantly associated with delirium. On multivariate analysis with binary logistic regression, bladder catheterization (odds ratio [OR] = 13.85; confidence interval [CI] = 1.44-133.14), abnormal electrolytes (OR = 5.12; CI = 1.11-23.69), and hypoxia (OR = 75.52; CI = 4.64-1.134E3) were detected to be independently associated with delirium. Conclusion: Acute modifiable rather than long-term factors were risk factors for delirium among the elderly. An awareness of modifiable risk factors has the potential of developing targeted interventions for the early mitigation of delirium.

The Prevalence of Multidrug-Resistant and Extensively Drug-Resistant Infections in Respiratory Intensive Care Unit, Causative Microorganisms and Mortality.

This study aims to analyze the incidence of multidrug-resistant (MDR) retrospectively and extensively drug-resistant (XDR) infections, characteristics of patients with these infections, causative microorganisms, and mortality rates in a tertiary respiratory intensive care unit (ICU). Between 01.01.2022 and 31.12.2023, the data of patients treated in the third-level respiratory ICU were analyzed retrospectively. Adult patients over 18 years of age with MDR and XDR infections were included in the study. Demographic characteristics, age, gender, comorbid systemic diseases, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, mechanical ventilation support status, duration of ICU stay and prognosis of the patients were analyzed and recorded through the hospital information management system. The study included 261 patients. Of these patients, 184 (70.5%) were male, 77 (29.5%) were female, and their ages were 65.54 ± 14.43 years. The majority of the patients had chronic diseases such as chronic obstructive pulmonary disease, hypertension, coronary artery disease, malignancy, and diabetes mellitus. There was no statistically significant difference between the resistance status of Klebsiella spp. Pseudomonas spp. and Acinetobacter spp. and the prognosis of the patients (p>0.05). No statistically significant difference was found between MDR and XDR Klebsiella spp. Pseudomonas spp. and Acinetobacter spp. patients in terms of the need for invasive mechanical ventilation, non-invasive mechanical ventilation, respiratory support therapy with high flow, APACHE II score, SOFA score, length of stay in the ICU, and prognosis (p>0.05). Early detection and close monitoring of MDR, XDR, and PDR bacterial strains are vital to combat antimicrobial resistance. This study shows that MDR and XDR infections are a major health problem in ICUs and that these infections have significant negative effects on patient prognosis.

Prediction of post-traumatic stress disorder in family members of ICU patients: a machine learning approach.

Post-traumatic stress disorder (PTSD) can affect family members of patients admitted to the intensive care unit (ICU). Easily accessible patient's and relative's information may help develop accurate risk stratification tools to direct relatives at higher risk of PTSD toward appropriate management. PTSD was measured 90days after ICU discharge using validated instruments (Impact of Event Scale and Impact of Event Scale-Revised) in 2374 family members. Various supervised machine learning approaches were used to predict PTSD in family members and evaluated on an independent held-out test dataset. To better understand variables' contributions to PTSD predicted probability, we used machine learning interpretability methods on the best predictive algorithm. Non-linear ensemble learning tree-based methods showed better predictive performances (Random Forest-area under curve, AUC = 0.73 [0.68-0.77] and XGBoost-AUC = 0.73 [0.69-0.78]) than regularized linear models, kernel-based models, or deep learning models. In the best performing algorithm, most important features that positively contributed to PTSD's predicted probability were all non-modifiable factors, namely, lower patient's age, longer duration of ICU stay, relative's female sex, lower relative's age, relative being a spouse/child, and patient's death in ICU. A sensitivity analysis in bereaved relatives did not alter the algorithm's predictive performance. We propose a machine learning-based approach to predict PTSD in relatives of ICU patients at an individual level. In this model, PTSD is mostly influenced by non-modifiable factors.

Nutritional status associated with clinical outcomes in children with solid tumors: A retrospective cohort study from China.

To investigate the long-term changes in nutritional status in children with solid tumors during treatment and the relationship between nutritional status and clinical outcomes. This study was a retrospective medical records review of data from children who were diagnosed with solid tumors and followed up for more than 3 months from January 2016 to December 2021 in China. Patient demographics and clinical information, including nutritional status, parenteral nutrition use, intensive care unit (ICU) transfers, infection during hospitalization, hospitalization frequency, length of stay, hospitalization costs and antibiotic costs, were collected to analyze the nutritional status of children with different types of solid tumors, the dynamic changes in nutritional status during treatment, and the relationship between nutritional status and clinical outcomes. Among the 764 patients (383 males (50.1%); 381 females (49.9%); mean age: 2.58 years), 41.6% of the solid tumors were neuroblastomas, 17.1% were hepatoblastomas, and Wilms tumors as the third most common solid tumors (8.9%). The median follow-up duration was 6 months (range: 3-40 months). At diagnosis, the proportion of children who were undernourished (underweight and wasting) versus overweight or obese were 26.71% versus 5.21% (25.86% vs. 2.89% in the third month; 29.77% vs. 2.28% in the sixth month; 24.77% vs. 3.27% in the 12th month). The body mass index Z scores decreased from the initial values after the first month (-0.56 (-1.47, 0.23) vs. -0.44 (-1.29, 0.41)) but improved later and decreased again at 6 months. The children in the undernutrition group had longer hospital stays (p < 0.001), higher hospitalization costs (p < 0.001), higher antibiotic costs (p < 0.001), a higher risk of neutropenia (OR = 4.781 (95% CI: 1.571-14.553), p = 0.006), and a higher risk of ICU transfers (OR = 1.498 (95% CI: 1.010-2.224), p = 0.044). No significant differences in those associations by malnutrition and infection, ICU duration, or length of parenteral nutrition were observed. There is a considerable prevalence of malnutrition in children with solid tumors. Malnutrition is related to adverse clinical outcomes and increases in total hospital expenses and antibiotic costs.

Association Between Daily Toothbrushing and Hospital-Acquired Pneumonia

Hospital-acquired pneumonia (HAP) is the most common and morbid health care-associated infection, but limited data on effective prevention strategies are available. To determine whether daily toothbrushing is associated with lower rates of HAP and other patient-relevant outcomes. A search of PubMed, Embase, Cumulative Index to Nursing and Allied Health, Cochrane Central Register of Controlled Trials, Web of Science, Scopus, and 3 trial registries was performed from inception through March 9, 2023. Randomized clinical trials of hospitalized adults comparing daily oral care with toothbrushing vs regimens without toothbrushing. Data extraction and risk of bias assessments were performed in duplicate. Meta-analysis was performed using random-effects models. The primary outcome of this systematic review and meta-analysis was HAP. Secondary outcomes included hospital and intensive care unit (ICU) mortality, duration of mechanical ventilation, ICU and hospital lengths of stay, and use of antibiotics. Subgroups included patients who received invasive mechanical ventilation vs those who did not, toothbrushing twice daily vs more frequently, toothbrushing provided by dental professionals vs general nursing staff, electric vs manual toothbrushing, and studies at low vs high risk of bias. A total of 15 trials met inclusion criteria, including 10 742 patients (2033 in the ICU and 8709 in non-ICU departments; effective population size was 2786 after shrinking the population to account for 1 cluster randomized trial in non-ICU patients). Toothbrushing was associated with significantly lower risk for HAP (risk ratio [RR], 0.67 [95% CI, 0.56-0.81]) and ICU mortality (RR, 0.81 [95% CI, 0.69-0.95]). Reduction in pneumonia incidence was significant for patients receiving invasive mechanical ventilation (RR, 0.68 [95% CI, 0.57-0.82) but not for patients who were not receiving invasive mechanical ventilation (RR, 0.32 [95% CI, 0.05-2.02]). Toothbrushing for patients in the ICU was associated with fewer days of mechanical ventilation (mean difference, -1.24 [95% CI, -2.42 to -0.06] days) and a shorter ICU length of stay (mean difference, -1.78 [95% CI, -2.85 to -0.70] days). Brushing twice a day vs more frequent intervals was associated with similar effect estimates. Results were consistent in a sensitivity analysis restricted to 7 studies at low risk of bias (1367 patients). Non-ICU hospital length of stay and use of antibiotics were not associated with toothbrushing. The findings of this systematic review and meta-analysis suggest that daily toothbrushing may be associated with significantly lower rates of HAP, particularly in patients receiving mechanical ventilation, lower rates of ICU mortality, shorter duration of mechanical ventilation, and shorter ICU length of stay. Policies and programs encouraging more widespread and consistent toothbrushing are warranted.

Drug Utilization Research and Predictors of Outcomes in the Intensive Care Unit of a Tertiary Care Hospital: A Prospective Observational Study.

Multiple drugs are commonly prescribed to intensive care unit (ICU) patients owing to the disease profile, multiple organ dysfunction, prophylaxis, management of stress ulcers, nosocomial infections, etc. This study aimed to evaluate the drug utilization patterns and factors influencing mortality and duration of stay in ICU patients. Methodology: A prospective observational study was conducted in the ICUof our tertiary care hospital, Postgraduate Institute of Medical Sciences, Rohtak. Data was collected from treatment charts of patients using a structured pretested proforma. World Health Organization Anatomical Therapeutic Chemical/Defined Daily Dose (WHO ATC/DDD) methodology and core prescribing indicators were used to assess drug utilization data. The effect of different variables on mortality and duration of stay in the ICU was evaluated using regression analysis. An average of 8.78 drugs were prescribed per patient. Among the 922 prescriptions, anti-infectives, anti-inflammatory drugs, and drugs acting on the gastrointestinal tract were the most frequent medication classes prescribed. Polypharmacy and trade name prescribing were common. For most of the drugs, the prescribed daily dose corresponded to the WHO-DDD except ceftriaxone and levofloxacin. Age, presence of cardiac disorders, and Glasgow Coma Scale (GCS) score at admission directly correlated with mortality while the use of diuretics had a negative correlation with the duration of ICU stay. Conclusions: There is a need to rationalize drug therapy in the ICUwith regard to limiting polypharmacyand emphasizing generic drug name prescribing and adherence to the essential drug list. Antibiotic prescription patterns, in particular, deserve a special focus keeping in mind the multitude of factors demanding aggressive antibiotic use in critically ill intensive care patients.

Transcutaneous electrical acupoint stimulation improves pulmonary function by regulating oxidative stress during one-lung ventilation in patients with lung cancer undergoing thoracoscopic surgery: a randomized controlled trial

BackgroundOur aim was to evaluate the efficacy of transcutaneous electrical acupoint stimulation (TEAS) on oxidative stress induced by one-lung ventilation, lung function, and postoperative quality of recovery in patients with lung cancer.MethodsThe participants (n = 80) were assigned to the sham group and TEAS group. TEAS on bilateral Feishu (BL13), Zusanli (ST36), and Hegu (L14) was performed 30 minutes before induction of anesthesia and continued until the end of the surgery. In the sham group, the same acupoints were selected without electrical stimulation. PaO2/FiO2, intrapulmonary shunt ratio (Qs/Qt), alveolar-arterial oxygen tension (A-aDO2), and respiratory index (RI) were calculated to evaluate lung function before one-lung ventilation (T0), 30 min after one-lung ventilation (T1), 1 h after one-lung ventilation (T2), and 10 min after resuming two-lung ventilation (T3). The levels of malondialdehyde (MDA) and superoxide dismutase (SOD) were detected to estimate oxidative stress at T0, T1, T2, and T3. Secondary outcomes included removal time of thoracic drainage tube, duration of intensive care unit (ICU) stay, length of postoperative hospitalization, the incidence of postoperative pulmonary complications, and the Quality of Recovery-15 (QoR-15) score on postoperative day 1 and 2.ResultsTEAS significantly increased PaO2/FiO2 at T1 and T2, while Qs/Qt, A-aDO2, and RI decreased remarkably from T1 to T3 (P < 0.05). Meanwhile, TEAS obviously decreased MDA and increased SOD activity at T2 and T3 (P < 0.05). Furthermore, TEAS also markedly shortened the length of ICU stay and hospital stay after surgery, whereas the QoR-15 score on postoperative day 1 and 2 was significantly higher (P < 0.05).ConclusionsTEAS could reduce oxidative lung injury during one-lung ventilation, thereby protecting pulmonary function and effectively accelerating the early recovery of patients with lung cancer.Trial registrationChinese Clinical Trial Registry (ChiCTR2000038243).

Comparison of sedation efficacy of intravenous infusion of dexmedetomidine versus propofol in terms of opioid consumption in patients requiring postoperative mechanical ventilation after head and neck onco-surgeries – A randomized prospective study

Abstract Background: The conventional drug regimen of sedation for patients requiring mechanical ventilation in an intensive care unit (ICU) is propofol or midazolam. Dexmedetomidine is a newer drug for sedation with a better clinical profile. We conducted this study to compare the sedative efficacy of dexmedetomidine versus propofol in patients after head and neck cancer surgeries requiring mechanical ventilation. Methods: After ethics committee approval and written informed consent, 80 patients undergoing head and neck onco-surgery were recruited. The patients were randomly allocated to group I [1 mg/kg of bolus propofol over 15 minutes followed by infusion of 1 mg/kg/hour titrated by increasing or decreasing the infusion dose to Ramsay Sedation Score (RSS) 2–4] or group II (a loading dose of dexmedetomidine 1 mcg/kg over 15 minutes followed by a maintenance dose of 0.4 µg/kg/hour titrated to desired sedation level). The RSS, behavioral pain scale (BPS), heart rate, blood pressure, fentanyl consumption, additional sedative agent, extubation time, length of ICU stays, mechanical ventilation duration, side effects, and patient’s satisfaction were noted. Results: Total fentanyl required was 0.56 ± 0.13 µg/kg/hour in group II and 0.58 ± 0.18 µg/kg/hour in group I (P = 0.75). Extubation time, RSS, BPS, patient satisfaction, and ICU duration were similar in both the groups. The incidence of hemodynamic-related adverse effects were 41.67% in group II and 11.11% in group I (P = 0.006). Conclusion: The fentanyl requirement was comparable in both the groups in the postoperative period. Dexmedetomidine was associated with an increased incidence of bradycardia and hypotension as compared to the propofol group. Propofol should be the preferred sedative for postoperative mechanical ventilation after head and neck onco-surgeries.

REVISE: re-evaluating the inhibition of stress erosions in the ICU—statistical analysis plan for a randomized trial

BackgroundThe REVISE (Re-Evaluating the Inhibition of Stress Erosions in the ICU) trial will evaluate the impact of the proton pump inhibitor pantoprazole compared to placebo in invasively ventilated critically ill patients.ObjectiveTo outline the statistical analysis plan for the REVISE trial.MethodsREVISE is a randomized clinical trial ongoing in intensive care units (ICUs) internationally. Patients ≥ 18 years old, receiving invasive mechanical ventilation, and expected to remain ventilated beyond the calendar day after randomization are allocated to either 40 mg pantoprazole intravenously or placebo while mechanically ventilated.ResultsThe primary efficacy outcome is clinically important upper GI bleeding; the primary safety outcome is 90-day mortality. Secondary outcomes are ventilator-associated pneumonia, Clostridioides difficile infection, new renal replacement therapy, ICU and hospital mortality, and patient-important GI bleeding. Tertiary outcomes are total red blood cells transfused, peak serum creatinine concentration, and duration of mechanical ventilation, ICU, and hospital length of stay. Following an interim analysis of results from 2400 patients (50% of 4800 target sample size), the data monitoring committee recommended continuing enrolment.ConclusionsThis statistical analysis plan outlines the statistical analyses of all outcomes, sensitivity analyses, and subgroup analyses. REVISE will inform clinical practice and guidelines worldwide.Trial registrationwww.ClinicalTrials.gov NCT03374800. November 21, 2017.