Duration Of Mechanical Ventilation Research Articles

Analysis of risk factors for post-prematurity respiratory disease in very preterm infants

Objective: To investigate the risk factors associated with post-prematurity respiratory disease (PPRD) in very preterm infants. Methods: A prospective cohort study was conducted, enrolling 369 very preterm infants who were admitted to the neonatal intensive care unit of Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, within one week of birth from January 2019 to June 2023. Data on maternal and infant clinical characteristics, neonatal morbidities, and treatments during hospitalization were collected. The very preterm infants were divided into 2 groups based on whether they developed PPRD. Continuous variables were compared using Mann-Whitney U test, while categorical variables were compared using χ² tests or continuity correction χ2 test. Multivariate Logistic regression analysis was used to identify the independent risk factors for PPRD in very preterm infants. Results: Among the 369 very preterm infants, 217 cases(58.8%) were male, with a gestational age of 30 (28, 31) weeks at birth and a birth weight of 1 320 (1 085, 1 590) g. Of these, 116 cases (31.4%) developed PPRD, while 253 cases (68.6%) did not. The very preterm infants in the PPRD group had a lower gestational age and lower birth weight (both, P<0.001). The PPRD group also had a higher proportion of males, lower Apgar scores at the 1th minute after birth and the 5th minutes after birth, a higher rate of born via cesarean delivery, and a higher incidence of bronchopulmonary dysplasia, more pulmonary surfactant treatment, longer durations of mechanical ventilation, longer total oxygen therapy, and lower Z-score for weight at discharge (all P<0.05). Multivariate Logistic regression analysis showed that gestational age (OR=0.85, 95%CI 0.73-0.99, P=0.037), born via cesarean delivery (OR=2.23, 95%CI 1.21-4.10, P=0.010), a duration of mechanical ventilation ≥7 days (OR=2.51, 95%CI 1.43-4.39, P=0.001), and a Z-score for weight at discharge (OR=0.82, 95%CI 0.67-0.99, P=0.040) were all independent risk factors for PPRD in very preterm infants. Conclusion: Very preterm infants with a small gestational age, born via cesarean section, mechanical ventilation ≥7 days, and a low Z-score for weight at discharge should be closely monitored for PPRD, and provided with standardized respiratory management after discharge.

Best practice peri-extubation bundle reduces neonatal and infant extubation failure after cardiac surgery.

Extubation failure after neonatal cardiac surgery is associated with increased intensive care unit length of stay, morbidity, and mortality. We performed a quality improvement project to create and implement a peri-extubation bundle, including extubation readiness testing, spontaneous breathing trial, and high-risk criteria identification, using best practices at high-performing centers to decrease neonatal and infant extubation failure by 20% from a baseline of 15.7% to 12.6% over a 2-year period. Utilising the transparency of the Pediatric Cardiac Critical Care Consortium database, five centres were identified as high performers, having better-than-expected neonatal extubation success rates with the balancing metric of as-expected or better-than-expected mechanical ventilation duration. Structured interviews were conducted with cardiac intensive care unit physician leadership at the identified centers to determine centre-specific extubation practices. Data from those interviews underwent qualitative content analysis which was used to develop a peri-extubation bundle. The bundle was implemented at a single-centre 17-bed cardiac intensive care unit. Extubation failure, defined as reintubation within 48 hours of extubation for anything other than a procedure, ventilator days and bundle compliance was tracked. There was a 41.4% decrease in extubation failure following bundle implementation (12 failures of 76 extubations pre-implantation; 6 failures of 65 extubations post-implementation). Bundle compliance was 95.4%. There was no difference in ventilator days (p = 0.079) between groups. Implementation of a peri-extubation bundle created from best practices at high-performing centres reduced extubation failure by 41.4% in neonates and infants undergoing congenital heart surgery.

Lung ultrasound on first postoperative day predicts out-of-hospital pulmonary complications following video-assisted thoracic surgery: A prospective cohort study.

The integration of enhanced recovery after surgery (ERAS) protocols into the peri-operative management of video-assisted thoracic surgery (VATS) has facilitated rapid patient recovery, enabling discharge within 48 h. However, postoperative pulmonary complications (PPCs) postdischarge pose significant concerns for patient welfare. Despite the established utility of lung ultrasound (LUS) in diagnosing the causes of dyspnoea, the effectiveness of quantitative LUS in predicting PPCs after VATS remains uncertain. To determine whether quantitative LUS performed 24 h after surgery can identify patients with a higher risk of developing PPCs within 30 days after discharge from hospital. Single-centre prospective cohort study. Academic tertiary care medical centre. Adults scheduled for elective VATS under general anaesthesia from November 2022 to January 2023. This primary aim was to verify the association between lung ultrasound score (LUSS) on postoperative day 1 (POD1) and PPCs. The secondary aim was to identify other relevant peri-operative factors closely related to PPCs and establish a model capable of predicting the risk of PPCs in patients undergoing fast-track VATS. Of the 200 recruited patients, 182 completed the LUS examination and 30-day follow-up. Of these, 66 (36.2%) developed various types of PPCs. These patients had a higher LUSS on POD 1 (P < 0.001), and more subpleural consolidation areas compared to those without PPCs (P < 0.001). Receiver-operating characteristics (ROC) analysis identified the optimal LUSS cut-off value at 6 points for predicting the occurrence of PPCs, with an area under the curve (AUC) of 0.838 (95% CI, 0.768 to 0.909). Patients with PPCs had higher rates of immune system diseases and ARISCAT score, longer hospital stay and procalcitonin levels, increased frequency of lobar resection, longer durations of surgical and mechanical ventilation, and greater incidence of unplanned hospital readmissions within 30 days postdischarge, compared with those without PPCs (all P < 0.001). Multivariable logistic regression analysis indicated that the comorbidity of immune system disease, along with postoperative 24 h LUSS, were independent risk factor for PPCs within 30 days after VATS. LUSS on POD 1 emerged as an independent risk factor for PPCs in fast-track VATS patients and reliably predicted the occurrence of PPCs within 30 days of hospital discharge. ClinicalTrials. gov No. ChiCTR2200065865.

Active cytomegalovirus infection in mechanically ventilated patients with sepsis

BackgroundActive cytomegalovirus (CMV) infection is associated with poor prognosis in septic patients with critical illness. Patients of septic category are highly likely to benefit from prophylactic antiviral therapy. Nevertheless, the clinical characteristics for CMV reactivation are lacking among septic patients requiring mechanical ventilation. The aim of this study was to investigate the incidence, risk factors, and clinical outcomes regarding active CMV infection in mechanically ventilated patients with sepsis.MethodsA single-center, retrospective cohort study conducted from January 2021 to December 2023 that included septic patients on mechanical ventilation at the intensive care unit (ICU) of a national hospital. Study participants were divided into active and non-active CMV infection groups based on CMV DNAemia within a 28-day hospitalization period in ICU. Clinical features, laboratory findings, treatment measures, and clinical outcomes were compared between the two groups.ResultsAmong 118 septic patients, 21 (17.8%) exhibited active CMV infection within 28-day ICU admission. Hemoglobin served as an independent risk factor and predictor for active CMV infection (P < 0.05). Moreover, the duration of mechanical ventilation and ICU stay in active CMV infection patients were significantly higher than in the comparison group (P < 0.05).ConclusionsActive CMV infection is common and associated with adverse clinical outcomes in mechanically ventilated patients with sepsis. A low level of hemoglobin is an independent risk factor for active CMV infection. Further prospective studies are warranted to assess the efficacy of initiating prophylactic and preemptive antiviral therapies among patients with sepsis disorders.

Soluble Urokinase Plasminogen Activated Receptor in Type 2 Diabetes Mellitus Patients Undergoing Coronary Artery Bypass Grafting: A Prospective Interventional Cohort Study

Objectives: Elevated levels of soluble urokinase plasminogen activator receptor (suPAR) increase mortality in various systemic diseases. This has been shown amply in recent literature. The primary aim of the study was to investigate that whether this increase in suPAR levels have same results in type 2 diabetes mellitus (T2DM) patients undergoing coronary artery bypass grafting (CABG). We also aimed to observe the duration of mechanical ventilation and length of stay in the intensive care unit in these patients as our secondary aim. Materials and Methods: Blood samples of adult patients having T2DM admitted for elective on-pump CABG surgery were collected after induction of anesthesia before skin incision (T1) and 48 h post-cardiopulmonary bypass (CPB) (T2) from the year 2022 to 2023. The study was conducted on 196 patients of either sex of age at least 18 years with T2DM with the American Society of Anesthesiologists status III to IV. Patients were randomly divided into 2 groups with alternative allocation. Patients of the study group (n = 96) were measured suPAR, high-sensitivity C-reactive protein (hsCRP), and blood sugar, while patients of the control group (n = 100) were measured hsCRP and blood sugar only. Threshold suPAR levels for predicting mortality in the immediate post-operative period were assessed through receiver operating characteristic curves and optimal values decided using Youden’s Index. Results: There was a significant rise in suPAR and hs-CRP levels before the start of surgery and 48 h post-CPB (P &lt; 0.001). Conclusion: In patients with T2DM undergoing on-pump CABG, increased pre-bypass, and especially 48-h post-CPB, levels of suPAR and hsCRP predict more mortality.

Nutritional support in critical care patients: Challenges, strategies, and recent advances

Nutritional support is a critical component of managing patients in intensive care units (ICUs). Critical illness triggers a hypermetabolic state, leading to significant nutritional demands and muscle wasting. Proper nutritional interventions can positively impact clinical outcomes, reduce the duration of mechanical ventilation, and improve overall recovery. However, delivering adequate nutrition to critically ill patients present several challenges, including the patient's unstable condition, varying metabolic needs, gastrointestinal dysfunction, and difficulties in achieving nutritional goals. Recent advances in understanding the nutritional requirements of ICU patients, the role of early enteral nutrition, and the development of specialized formulas have led to improved patient care. Strategies such as personalized nutrition, immunonutrition, and monitoring tools like indirect calorimetry have become essential components of ICU nutrition management. Additionally, managing critically ill patients with comorbidities, such as sepsis or multi-organ failure, requires tailored approaches to prevent malnutrition and overfeeding.This review highlights the key challenges associated with nutritional support in critical care, current strategies employed to optimize nutrition, and the recent advances in the field. Evidence-based practices with individualized care, nutritional support can enhance patient recovery, reduce ICU stay, and lower morbidity and mortality rates.

Advancing Prognostic Prediction in Pediatric Trauma: The Role of Inflammatory Markers.

This study aimed to evaluate the prognostic value of various inflammatory markers and indices derived from complete blood counts in predicting mortality among pediatric trauma patients admitted to the Pediatric Intensive Care Unit (PICU). We designed a single-center retrospective study that included 165 pediatric trauma patients in the PICU between January 2020 and June 2024. Of 165 patients, 108 (69.2%) were male and the mean age of all patients was 75.16±57.14 months. The mortality rate was found to be 5.45% (9 patients). The Lactate-to-Albumin Ratio (LAR) and Procalcitonin (PCT) demonstrated strong prognostic performance with area under the curve (AUCs) of 0.807 and 0.745, respectively. Notably, LAR and PCT correlated well with mortality and the duration of invasive mechanical ventilation and PICU stay. The Systemic Immune-Inflammation Index (SIRI), Neutrophil-to-Lymphocyte Ratio (NLR), CRP-to-Albumin Ratio (CAR), and Pan-Immune-Inflammation Value (PIV) were less effective individually but showed potential when combined with other indices. LAR, PCT, SIRI, NLR, CAR, and PIV were associated with mortality in pediatric trauma patients, with LAR and PCT demonstrating superior predictive value. Therefore, LAR and PCT may serve as reliable standalone markers for identifying critically ill pediatric trauma patients at risk of mortality.

Timing dilemma: a systematic review and meta-analysis of short-term mortality in patients with COVID-19 undergoing tracheostomy with varied timing, including 7, 10 and 14 days

ObjectiveTo analyse the effects of tracheostomy timing on COVID-19 outcomes by comparing mortality rates at different time points (7, 10 and 14 days).DesignSystematic review and meta-analysis.Data sourcesPubMed, Embase, Cochrane Library,...

Incidence and clinical outcomes of critically ill patients with augmented renal clearance: A retrospective cohort

Introduction: Although glomerular hyperfiltration in augmented renal clearance (ARC) results in suboptimal exposure to medications, its association with clinical outcomes is less clear. This study aimed to evaluate the incidence and clinical outcomes of ARC in an intensive care unit (ICU) population. Methods: This retrospective cohort included all ICU patients admitted between July 1, 2018, and June 30, 2019. The primary outcome was the incidence of ARC, defined as a creatinine clearance  of 130 mL/min/1.73 m2, for at least one day. Secondary outcomes included mechanical ventilation (MV) duration, ICU length of stay (LOS), in-hospital and 30-day mortality, acute kidney injury (AKI), and development of a multidrug-resistant (MDR) pathogen. Results: A total of 561 patients were included. The study population was 55% male (n=308), with a median age of 64 [IQR 53-74] years, a median baseline serum creatinine of 0.9 mg/dL [IQR 0.7-1.0], and primarily medical ICU population (n=396, 71%). The incidence of ARC was 25% (n=139). While there was no difference in MV duration, the ARC group had a longer ICU LOS (median [IQR] 6 [4-9] vs. 5 [4-8] days, p&lt;0.001), and more MDR pathogens (22% vs. 9%, p&lt;0.001). In-hospital mortality (6% vs. 12%, p=0.041), 30-day mortality (10% vs. 21%, p=0.005), and AKI (13% vs. 21%, p=0.027) were lower in patients with ARC. Conclusion: The incidence of ARC in this general ICU population was 25%. Differences in the clinical outcomes of patients with ARC should be further investigated.

Incidence and Associated Factors of Postoperative Delirium in Adults Undergoing Cardiac Surgery With Cardiopulmonary Bypass: A Prospective Cohort Study.

Delirium is one of the most common and serious complications after cardiac surgery with cardiopulmonary bypass (CPB). A comprehensive assessment of independent risk factors for postoperative delirium (POD) is essential for early detection and prevention. To investigate the incidence and independent associated factors of POD in adults undergoing cardiac surgery with CPB. Prospective cohort design. A total of 203 patients were enrolled in this study from October 2022 to December 2023 in China. Richmond agitation and sedation scale (RASS) and confusion assessment method-intensive care unit (CAM-ICU) were used for assessing delirium symptom. This study analysed various factors for POD, including demographic, physical, psychological, social, spiritual and environmental aspects. Using logistic regression analysis to identify the independent associated factors. A totla of 60.1% (n = 122) of patients had POD. Of these cases, 86 (70.5%) were hypoactive delirium, 4 (3.3%) were hyperactive delirium and 32 (26.2%) were mixed delirium. Advanced age (OR = 1.069, 95% confidence interval [CI]: 1.031-1.107; p < 0.001), preoperative depression (OR = 1.847, 95% CI: 1.246-2.736; p = 0.002), postoperative albumin level (OR = 0.921, 95% CI: 0.851-0.997; p = 0.042) and duration of mechanical ventilation (OR > 1.000, 95% CI: 1.000-1.001; p < 0.001) were independent predictors of POD. The incidence of POD in patients undergoing cardiac surgery with CPB was high. This study identified advanced age, preoperative depression, postoperative albumin level and duration of mechanical ventilation as significant and independent predictors of POD. The study's findings highlight the urgent necessity for improved clinical vigilance and proactive management strategies. No patient or public contribution.

Clinical Outcomes of Using Dexmedetomidine, ProDex and Popfol for Sedation during Mechanical Ventilation in Patients Hospitalized in the Intensive Care Unit: A Triple Blinded Clinical Trial

Background: Sedation plays a crucial role in the care of intensive care unit (ICU) patients, addressing the challenges presented by factors such as agitation, anxiety, and delirium, particularly during mechanical ventilation (MV). Dexmedetomidine and propofol are commonly used sedatives, each with its unique characteristics and side effects. Combining these agents has been proposed to optimize effectiveness and minimize adverse effects. This study aims to compare the efficacy of the dexmedetomidine-propofol combination with dexmedetomidine alone and propofol alone for sedation during mechanical ventilation in ICU patients. Methods: A triple-blinded clinical trial was conducted in Isfahan, Iran, involving patients eligible for spinal fusion surgery and mechanical ventilation. Patients were randomized into three groups: dexmedetomidine alone (DO), propofol alone (PO), and a combination of both drugs (DP) dexmedetomidine-propofol (ProDex). Various dosages and infusion protocols were carefully administered, and patients were assessed for demographic and clinical variables. Hemodynamic parameters and sedation levels were monitored, and statistical analysis was performed. Results: The study involved 87 patients, with the ProDex group demonstrating the shortest mechanical ventilation duration. Hemodynamic stability was observed in the ProDex group, with significantly lower systolic blood pressure and heart rate compared to other groups. Sedation scores did not differ significantly among groups, suggesting similar sedative effects. The ProDex group exhibited favorable outcomes despite differences in hemodynamic variables. Conclusion: The dexmedetomidine-propofol combination appears effective in minimizing side effects associated with monotherapy sedation, leading to favorable clinical outcomes. This study contributes valuable insights into optimizing sedation strategies for mechanically ventilated ICU patients.

Proportional modes to hasten weaning.

The purpose of this review is to examine the current state of the evidence, including several recent systematic reviews and meta-analyses, to determine if proportional modes of ventilation have the potential to hasten weaning from mechanical ventilation for adult critically ill patients, compared to pressure support ventilation (PSV), the current standard of care during the recovery and weaning phases of mechanical ventilation. Proportional assist ventilation (PAV) and neurally adjusted ventilatory assist (NAVA) are two commercially available proportional modes that have been studied in randomized controlled trials (RCTs). Although several feasibility studies were not powered to detect differences in clinical outcomes, emerging evidence suggests that both PAV and NAVA may reduce duration of mechanical ventilation, intensive care unit (ICU) length of stay, and hospital mortality compared to PSV, as shown in some small, primarily single-centre studies. Recent meta-analyses suggest that PAV shortens duration of mechanical ventilation and improves weaning success rate, and NAVA may reduce ICU and hospital mortality. The current state of the evidence suggests that proportional modes may hasten weaning from mechanical ventilation, but larger, multicentre RCTS are needed to confirm these preliminary findings.

Endoscopic treatment of intermediate bronchus rupture in a 4-year-old child with polytrauma

In the structure of children's injuries, thoracic trauma occurs in less than 10% of cases, but it is the second most likely cause of death of a child. The culprit of the fatal outcome may be a rupture of the bronchus, which disrupts adequate ventilation of the lungs. The purpose of our publication is to demonstrate a rare clinical case of successful endoscopic treatment of intermediate bronchus rupture in a 4-year-old child with polytrauma. Description of the observation. A 4-year-old boy was injured in an accident as a pedestrian. For the first 3 days, he was treated for polytrauma (ISS=41) in the hospital at the place of residence, where, according to emergency indications, drainage of the right pleural cavity with two drains for tension pneumothorax and laparotomy for intra-abdominal bleeding due to liver rupture were performed. The relative stabilization of the child's condition by the 3rd day of the post-traumatic period made it possible to transport him to our clinic (level 1 trauma center). Against the background of the therapy, stable stabilization of hemodynamics was achieved, but air blowing through the drains was preserved, complete expansion of the right lung parenchyma could not be achieved, and the gas composition of the blood remained subcompensated. On the 5th day of the posttraumatic period, LTBS was performed, which made it possible to diagnose a rupture of the intermediate bronchus measuring 3x9 mm and perform its occlusion with a positive effect. After 7 days, LTBS was performed with the removal of blockers. After the removal of the blockers, complete expansion of the right lung was noted, recurrence of the bronchopulmonary fistula was not noted. The duration of mechanical ventilation and hospitalization of the child was due to TBI. In the follow-up after 1 year, clinical laboratory, X-ray and endoscopic examination did not reveal respiratory pathology. Conclusion. The cause that disrupts adequate ventilation of the lungs and aggravates the course of the post-traumatic period in polytrauma may be bronchus rupture. In the presented case, intraluminal endoscopy made it possible to timely detect a rupture of a large bronchus and perform minimally invasive surgical treatment, which ensured further positive dynamics in the child's condition and a favorable outcome of polytrauma as a whole.

Evaluation of early extubation in the operating room for paediatric patients after congenital open-heart surgery.

Advances in surgical and perioperative care have reduced the need for prolonged mechanical ventilation in children following cardiac surgery. To evaluate the feasibility and assess the clinical outcomes of an early extubation strategy in the operating room for children undergoing congenital heart surgery, including neonates (age < 28 days). This is a retrospective analysis including congenital open-heart surgery cases. We excluded patients who remained open chest postoperatively or patients with severe hemodynamic instability and high inotropic support from the study. Study variables include age, gender, weight, preoperative cardiac diagnosis, preoperative diagnosis of genetic or chromosomal abnormalities, prematurity, preoperative mechanical ventilation (invasive or non-invasive), cardiopulmonary bypass time, circulatory arrest time, postoperative use of inotropes, duration of mechanical ventilation, postoperative respiratory complication, sepsis, bleeding or other complications, paediatric cardiac ICU stay, total hospital stay, incidence of failed extubation, and operative or postoperative mortality. This study included 163 patients who underwent congenital open cardiac surgery, out of these studied patients, 118 (72.4%) were extubated in the operating room. In total, 19.6% of studied patients had Down syndrome. Other genetic or chromosomal disorders were present among 8.6% of studied patients. There was a statistically significant difference between operating room extubation group and non-operating room extubation group regarding Risk Adjustment for Congenital Heart Surgery Score classification, postoperative paediatric ICU duration, postoperative hospital length of stay, vasoactive-inotrope score, duration of inotrope, open chest, and mortality. Extubation in the operating room after congenital open-heart surgery was successful in most of our patients, even following complex procedures.

Obesity is a risk factor for prolonged mechanical ventilation after tracheotomy.

To compare patient outcomes across body mass index (BMI) subgroups in the setting of recent tracheotomy. This retrospective chart review included patients over 18 years old who underwent tracheotomy placement between February 2017 and March 2020. Patients were divided into five groups based on BMI: underweight, normal weight, overweight, obese, and morbidly obese. Data were collected from the electronic medical record (EMR). Statistical analyses were completed via Kruskal-Wallis, Chi-square, log-rank tests, and Cox proportional hazards regression. If significant differences were found between groups, then subsequent pairwise comparisons of BMI were completed. There were 391 patients included in the study. There were significant differences in length of stay (p = .015) and duration of mechanical ventilation (p < .001) among the groups. This was mainly driven by comparisons between the normal weight and obese groups, with patients of normal weight having shorter hospital stays and shorter ventilation durations. With each increasing BMI category from normal weight, a greater proportion of patients were ventilator-dependent at the time of discharge (p < .001). Interestingly, after adjustment for comorbidities, the rate of tracheotomy change was 0.86 times lower for every increase in BMI category (95% CI 0.77-0.96). There was a significant difference among the BMI groups with respect to time to tracheotomy collar placement according to both the log-rank test (p < .001) and the Cox model with adjustment for the presence of heart failure (p = .011). Among patients undergoing tracheotomy, obese and morbidly obese patients have increased lengths of hospital stays. Additionally, they are dependent on ventilators for longer and are more likely to be ventilator-dependent at the time of discharge. It is important to understand how BMI impacts the hospital course for patients undergoing tracheotomy so that patients and their families can be better informed. Level 3.

Hypothermia on Admission Predicts Poor Outcomes in Adult Trauma Patients

BackgroundHypothermia is known to contribute to poor outcomes in trauma patients during acute phases. The aim of our study is to evaluate the effect of hypothermia on admission, upon in-hospital complications and mortality in adult trauma patients. MethodsWe performed a 5-year analysis of ACS-TQIP database (2017-2021). Patients with incomplete data, burns, inter-facility transfers, or documented as dead on arrival were excluded. Hypothermia (HT) was defined as a temperature of <35 degrees Celsius(°C), and Normothermia (NT) as ≥35°C to≤40°C measured at the time of patient arrival. Data were collected including demographic variables, mechanism of injury, injury severity, injury patterns, and shock index. Outcome variables were mortality, ICU length of stay (LOS), duration of mechanical ventilation, hospital LOS, and in-hospital complications. Multivariable regression analysis was performed. ResultsA total of 3,043,030 patients were included and 1% were hypothermic. HT patients were severely injured, developed in-hospital complications (17.1%vs.4.5%), had longer ICU LOS (4 (2-9) vs. 3 (2-5) days), hospital LOS (5 (2-12) vs. 4 (2-6) days), and higher mortality (23.4% vs. 2.3%). Hypothermia was independently associated with higher odds of mortality (OR:1.934 [1.858–2.013]). Subgroup analysis of patients with isolated traumatic brain injury revealed pre-hospital hypothermia to still be an independent predictor of mortality (OR: 1.728[1.600–1.867]). HT who underwent rewarming had a lower mortality, shorter hospital and ICU LOS. ConclusionPre-hospital hypothermia is independently associated with higher resource utilization, in-hospital complications, and mortality. Even in patients with isolated TBI, pre-hospital hypothermia increases the odds of mortality. Rewarming interventions can potentially improve outcomes among patients, even with mild hypothermia.

Implications of opioid-sparing medications in critically ill patients: A scoping review

ObjectiveThe purpose of this scoping review was to evaluate literature involving opioid-sparing medications in critically ill patients with a focus on clinically meaningful outcomes. DesignScoping review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. SettingIntensive care unit. Patients or participantsAdult patients in an intensive care unit setting. InterventionsNone. Main variables of interestPubMed and Cochrane Library were searched from October 1, 2019 to June 1, 2023. Inclusion criteria consisted of randomized controlled trials evaluating adjunctive analgesic use in adult patients in an intensive care unit setting. ResultsThere were 343 citations and titles identified in the initial search, with 328 remaining after removal of duplicates, 294 excluded at title and abstract screening, 34 available for full text review, and six included in the scoping review. Most studies reported modest reductions in opioid use as a secondary endpoint. Improvement in clinical outcomes such as reduction in duration of mechanical ventilation or delirium were reported in two trials with dexmedetomidine. ConclusionsIn recently published trials of adjunctive agents in critically ill patients, opioid-sparing effects were small. Data to support improvements in clinical outcomes remains limited.

Early tracheostomy in ventilated COVID-19 patients reduces incidence of ventilator-associated pneumonia

Tracheostomy can reduce mechanical ventilation (MV) duration, ICU and hospital length of stay (LOS), and ventilator-associated pneumonia (VAP) risk in critically ill patients. The timing of tracheostomy in COVID-19 patients has been studied, but its impact on VAP incidence has rarely been analyzed. This study investigated tracheostomy timing’s impact on VAP incidence, ventilation time, ICU and hospital LOS, and mortality in critically ill COVID-19 patients. It was conducted at the University Hospital in Wroclaw, Poland, from October 1, 2020, to June 30, 2021. Of 60 tracheostomized patients, 21 (35%) developed VAP. Early tracheostomy (≤ 13 days) resulted in 8/42 (19%) VAP cases, while late tracheostomy (> 13 days) had 13/18 (72%) VAP cases, showing a significantly lower VAP risk in the early group (p < 0.05). VAP incidence rates were 7.9 and 22.8 per 1000 patient-days for early and late groups, respectively. Early tracheostomy patients had shorter median MV duration (18 vs. 33 days, p < 0.05), ICU LOS (20 vs. 31 days, p < 0.05) and hospital LOS (25 vs. 47 days, p < 0.05). Early tracheostomy in critically ill COVID-19 patients significantly reduced VAP risk, MV duration, ICU, and hospital LOS.

Comparison of Immediate Outcomes of Pulmonary Valve-Sparing and Transannular Patch Techniques for Correction of Tetralogy of Fallot.

This study primarily aimed to compare the mechanical ventilation durations between pulmonary valve-sparing and transannular patch repair techniques in the surgical correction of Tetralogy of Fallot. Secondary objectives included comparison of demographic characteristics, cardiopulmonary bypass parameters, postoperative vasoactive inotrope requirements, incidence of cardiac conduction abnormalities, echocardiographic findings, intensive care unit and hospitalisation durations, reoperations rates, morbidity and mortality between the 2 approaches. This retrospective cohort study was conducted at the Royal Hospital, Muscat, Oman, between January 2016 and December 2019. This study included 102 paediatric patients who underwent complete surgical correction of Tetralogy of Fallot over 3 years, either by a pulmonary valve-sparing technique (Group 1, n = 43) or by transannular patch repair (Group 2, n = 59). Data for both primary and secondary outcomes were extracted from hospital records. Mechanical ventilation duration was significantly shorter in Group 1 (P = 0.039). Patients in Group 1 were generally older, with shorter cardiopulmonary bypass and aortic clamp times, lower inotrope scores, and shorter chest tube retention, intensive care unit and hospitalisation periods. Junctional ectopic tachycardia and severe pulmonary regurgitation were significantly more common in Group 2, while right ventricular outflow tract peak pressure gradients were higher in Group 1. Multivariate analysis identified patient weight as the only independent predictor of mechanical ventilation duration. Pulmonary valve preservation was associated with better early outcomes, including reduced mechanical ventilation duration, lower vasoactive inotrope scores, decreased postoperative arrhythmias and shorter hospital stay.

Comprehensive assessment and progression of health status during neurorehabilitation in survivors of critical illness: a prospective cohort study

BackgroundCritical illness survivors frequently suffer from long-term impairments, often described as post-intensive care syndrome (PICS). PICS encompasses physical, cognitive, and mental impairments. Additionally, the term intensive care unit (ICU)-acquired weakness (ICUAW) was coined for muscle weakness after critical illness. Research on the progression and outcome of individuals affected by PICS and ICUAW is scant. Thus we aimed to assess the health status and its progression during neurorehabilitation in critically ill patients using comprehensive outcome measures, describe the prevalence of PICS, and evaluate factors associated with rehabilitation outcomes.MethodsPatients with mixed reasons for critical illness who received ≥ 5 days of mechanical ventilation on the ICU and who were admitted to neurorehabilitation, were eligible to be included in this prospective cohort study. A number of outcomes (patient-reported, clinician-reported, and performance) were assessed after discharge from the ICU (V1) and shortly before discharge from inpatient neurorehabilitation (V2). The prevalence of PICS, defined as having at least one impairment in any PICS dimension), was calculated at V1 and V2. Multiple logistic regressions were conducted to identify factors associated with rehabilitation outcome (poor outcome = modified Rankin Scale > 2) and ICUAW at V2 (MRC sum score < 48).ResultsIn total, 250 critical illness survivors (62 ± 14 years, 34% female, median stay on ICU 55 days, median inpatient rehabilitation 65 days) were included. 11 participants (4.4%) died before V2. All outcomes improved significantly during rehabilitation except sensory impairment and pain. PICS was present in 96% at V1 and in 85% at V2, whereby mainly the physical domain (V1: 87%, V2: 66%; ICUAW with MRC sum score < 48) and the cognitive domain (V1:65%, V2:55%; Montreal Cognitive Assessment < 26) were affected. Mental impairment was lower (V1:48%, V2:29%; Hospital Anxiety and Depression Scale > 7), but still affected a considerable number of participants. Accordingly, health-related quality of life was rather low at discharge (0.64 ± 0.28, index value of EQ-5D-5L). MRC sum score at V1, duration of mechanical ventilation, and female gender were significantly associated with a poor rehabilitation outcome. Grip strength in % of reference at V1, age, female gender, and comorbidities were significantly associated with persistent ICUAW at discharge.ConclusionsDespite significant improvements during rehabilitation, survivors after critical illness experience a substantial burden of PICS and ICUAW at discharge from rehabilitation care. Survivors of critical illness require long-term follow-up, supportive structures, and tailored long-term multi-disciplinary therapies even after intensive rehabilitation.Trial registration: German Clinical Trials Register, DRKS00021753. Registered 03 September, 2020. https://drks.de/search/en/trial/DRKS00021753.