Intensive Care Patients Research Articles

Pharmacological Insights and Clinical Applications of Ciprofol: A Narrative Review.

Ciprofol (HSK3486) is a novel intravenous anaesthetic developed as an alternative to propofol, offering a safer and more effective option in anaesthesia. It works primarily by modulating the gamma-aminobutyric acid (GABA) receptors in the central nervous system, leading to sedation and hypnosis. Ciprofol's unique pharmacological properties include a rapid onset of action, shorter duration, and reduced cardiovascular and respiratory depression compared to propofol, making it particularly suitable for outpatient and day surgery procedures.Molecular changes in ciprofol appear to be superior to those of other cibenzolines; it is more potent and has a stable hemodynamic effect. It has been used in primary surgery, inpatients and outpatients, and even for sedation of intensive care patients. The reported clinical data indicate that ciprofol is a powerful sedative that is characterised by a high-enough speed of emergence from the state of anaesthesia, which is necessary for outpatient conditions and intensive operating modes. It can be considered a new and important perspective in the technology of intravenous anaesthetics with its improved pharmacological characteristics and clinical effects. With the further accumulation of clinical data, ciprofol will undeniably become an essential agent in today's anaesthetic practice and contribute to an enhancement of healthcare efficiency by providing a more secure approach to numerous kinds of surgical interventions. The purpose of the current study is to provide a review of the pharmacology and clinical use of ciprofol, a new intravenous anaesthetic agent. Various studies demonstrate the functionality and safety profile of ciprofol, which solidifies it as a potential contender for propofol. Regarding respiratory depression, hypoxemia, and injection pain during hysteroscopy, ciprofol was shown to be a relatively safer option than propofol. Ciprofol can, therefore, be recommended for intravenous anaesthesia because of its effectiveness and safety, which has been clearly demonstrated. Randomised trials uniformly report the ability to achieve quicker onset of sedation and lower risk with the agent compared to propofol. These findings imply that ciprofol has many benefits concerning a variety of applications in patients due to a lower rate of adverse reactions and increased patient comfort.

Microorganisms Isolated from Blood Cultures of Intensive Care Patients and Follow-up of Antibiotic Susceptibilities in the Last Five Years

Amaç: Bu çalışmada, ikinci basamak bir devlet hastanesinin yoğun bakım ünitelerinde yatan hastaların kan kültürlerinden izole edilen mikroorganizmaların antimikrobiyal direnç profillerinin belirlenmesi amaçlandı.Gereç ve Yöntem: Nevşehir Devlet Hastanesi yoğun bakım ünitelerinde tedavi gören hastalardan 2018-2022 yılları arasında Mikrobiyoloji Laboratuvarı'na gönderilen örnekler konvansiyonel yöntemlerle ve otomatize sistemle çalışılarak, identifikasyon ve antimikrobiyal duyarlılık testleri yapılan örneklerin sonuçları geriye dönük olarak değerlendirildi.Bulgular: Tüm numunelerin %54,5'inde gram negatif bakteri üremesi, %40,7'sinde gram pozitif bakteri üremesi, %4,8'inde maya üremesi tespit edildi; Gram-negatif bakteriler arasında en fazla %28 (n=47) ile Acinetobacter baumanni; Enterococcus faecalis gram pozitif bakteri olarak maksimum %20,3 (n=34) oranında izole edildi. Metisilin direnci MSS'lerde %92,8 (26/28), Staphylococcus aureus'ta ise %33 (2/6) olarak belirlendi. Escherichia coli ve Klebsiella pneumonia izolatlarında sırasıyla %72 (13/18) ve %80 (20/25) oranında genişlemiş spektrumlu beta-laktamaz (ESBL) pozitifliği tespit edildi. A.baumanii izolatlarının tamamında (%100) karbapenem direnci gözlendi. E. coli ve K. pneumonia antibiyotiklerine en duyarlı olanlar sırasıyla imipenem, meropenem (%100) ve amikasindir. Tüm gram pozitif izolatlarda en duyarlı antibiyotikler linezolid ve glikopeptitlerdir.Sonuç: Ampirik tedaviyi yönlendirmek için her merkezin kendi kan kültürü sonuçlarını incelemesi, antimikrobiyal direnç durumunu sorgulaması ve sepsis ve bakteriyemi vakalarında mortaliteyi azaltmayı hedefleyerek akılcı antibiyotik seçimi yapması gerekmektedir.Anahtar Kelimeler:Kan kültürü, antibiyotik direnci, kan dolaşımı enfeksiyonları, yoğun bakım ünitesi

Comparative analysis of hemodynamic monitoring with pulmonary artery catheter and transthoracic echocardiography in patients with cardiogenic shock

Aim. To compare main central hemodynamic parameters obtained by pulmonary artery catheterization and transthoracic echocardiography (TTE).Material and methods. This prospective study included 20 patients with acute myocardial infarction complicated by true cardiogenic shock. In all patients, number of central hemodynamic parameters was measured using a Swan-Ganz catheter and TTE. Comparison of both methods was carried out by Spearman correlation analysis and Bland-Altman plots using the STATISTICA 8.0 program.Results. We found quite a lot of agreement between the parameters measured by the two methods in the same patient at approximately the same time. Thus, the cardiac index (CI) is well measured by both methods. At the same time, the correlation coefficient was significantly higher when measuring CI using VTI (r=0,81 vs r=0,81) compared to LV volumes. Therefore, we consider the first method to be preferable. The values of total peripheral vascular resistance (TPVR), estimated by right atrial pressure, did not reveal agreement between methods. At the same time, there was agreement in case of central venous pressure. Measurement of pulmonary wedge pressure did not show agreement in me thods. We believe that this is due to the fact that diastolic function assessment in intensive care patients in the focal TTE mode may be difficult and not sufficiently correct.Conclusion. TTE can be used to monitor central hemodynamics in cases of satisfactory and moderately reduced cardiac imaging. Both the results of CI measurement using the Bernoulli formula and left ventricular volumes, as well as measuring TPVR using central venous pressure, are statistically consistent. Measurement of TPVR using right atrial pressure and measurement of pulmonary wedge pressure did not demonstrate agreement between the different techniques. We believe that TTE can be used to monitor CI and TPVR in patients with myocardial infarction complicated by true cardiogenic shock.

Antibiotic stewardship with multiplex PCR for pneumonia in intensive care patients: A retrospective study.

Early initiation of targeted antibiotic therapy is important to achieve the best patient outcomes in intubated patients with pneumonia in the intensive care unit (ICU). This study aimed to investigate the applicability of multiplex polymerase chain reaction (PCR) in an ICU by comparing the test results to the results of conventional microbiological methods to assess the possible impact on antibiotic therapy. This retrospective study investigated adult patients with pneumonia on mechanical ventilation in the ICU. Tracheal aspirates were collected within 24h after intubation and the initiation of mechanical ventilation. Samples were initially tested by conventional microbiological methods and subsequently re-evaluated with rapid multiplex PCR on stored samples. Concordance between the two methods was assessed. An intensivist and a microbiologist retrospectively reviewed the patients' electronic health records for relevant clinical details to evaluate the potential impact of multiplex PCR results on antibiotic therapy. In this study, 76 patients were enrolled and 55 (72.4%) tested positive for 95 pathogens using multiplex PCR, while conventional microbiological methods identified 40 pathogens in 32 (42.2%) patients. Concordance between the two methods was observed in 42 (55.3%) patients. Multiplex PCR detected 39 additional pathogens in 31 (40.7%) patients. Retrospective analysis indicated potential antibiotic de-escalation in 35 (46.1%) patients and escalation in 4 (5.3%) patients. Multiplex PCR significantly reduced the turnaround time for test results. In ICU patients with suspected pneumonia, multiplex PCR identified a higher number of pathogens compared to CMM. A retrospective assessment indicates that the use of multiplex PCR could potentially have prompted the de-escalation of antibiotic therapy in nearly half of the patients. Therefore, multiplex PCR may serve as a supplement to CMM in guiding antibiotic stewardship.

Plate waste and malnutrition in intensive care patients

Objective: This study aimed to determine food waste rates in intensive care patients. Methods: In this cross-sectional study, 45 patients in the intensive care unit were assessed for malnutrition risk using NRS 2002. Food waste rates were calculated by weighing the weight of the food served and left on the plate. Energy density of foods was calculated. The patients’ energy and nutrient intakes were calculated. Evaluated according to the recommendations of the Türkiye Dietary Guidelines. Results: 55.55% of the patients had severe malnutrition. Patients cannot consume 38.17% of the food served. The highest waste rate is in vegetables and salads (75.35%). The energy density of patients’ food consumption is low. The patients’ energy and protein intake was 828.56 kcal/day and 32.13 g/day. Energy and nutrient intake are below recommended, except for sodium and vitamin B12. A moderate positive correlation was found between hand grip strength and energy (r=413, p=0.001) and protein (r=453, p=0.001) intake. Conclusion: Patients cannot consume approximately 40% of the food. Improved protein and energy intake increased muscle strength and performance. Since a decrease in food intake will cause malnutrition to worsen, there is a need to develop strategies to increase energy and protein intake in these patients.

In Vitro Safety Study on the Use of Cold Atmospheric Plasma in the Upper Respiratory Tract.

Cold atmospheric plasma (CAP) devices generate reactive oxygen and nitrogen species, have antimicrobial and antiviral properties, but also affect the molecular and cellular mechanisms of eukaryotic cells. The aim of this study is to investigate CAP treatment in the upper respiratory tract (URT) to reduce the incidence of ventilator-associated bacterial pneumonia (especially superinfections with multi-resistant pathogens) or viral infections (e.g., COVID-19). For this purpose, the surface-microdischarge-based plasma intensive care (PIC) device was developed by terraplasma medical GmbH. This study analyzes the safety aspects using in vitro assays and molecular characterization of human oral keratinocytes (hOK), human bronchial-tracheal epithelial cells (hBTE), and human lung fibroblasts (hLF). A 5 min CAP treatment with the PIC device at the "throat" and "subglottis" positions in the URT model did not show any significant differences from the untreated control (ctrl.) and the corresponding pressurized air (PA) treatment in terms of cell morphology, viability, apoptosis, DNA damage, and migration. However, pro-inflammatory cytokines (MCP-1, IL-6, and TNFα) were induced in hBTE and hOK cells and profibrotic molecules (collagen-I, FKBP10, and αSMA) in hLF at the mRNA level. The use of CAP in the oropharynx may make an important contribution to the recovery of intensive care patients. The results indicate that a 5 min CAP treatment in the URT with the PIC device does not cause any cell damage. The extent to which immune cell activation is induced and whether it has long-term effects on the organism need to be carefully examined in follow-up studies in vivo.

Interpretative structural modeling method: An analysis of influencing factors analysis on the adverse experiences of cardiac surgery patients in the intensive care units

ObjectiveTo construct an interpretation structure model of adverse experiences of cardiac surgery patients in intensive care unit, so as to provide a reference for optimizing the experience of critical patients step by step. MethodsLiterature review, semi-structured interviews, questionnaires and Delphi method were used to summarize and analyze the influencing factors of intensive care experience in cardiac surgery. The explanatory structural model was used to divide the influencing factors into levels and construct the explanatory structural model of adverse experience of cardiac surgery patients in intensive care. ResultsA hierarchical structure model containing 34 elements and 15 levels was constructed, which were divided into Surface level, middle level and root level. ConclusionThe intensive care experience of patients in cardiac surgery department is mainly affected by 34 factors. There are direct or indirect correlations between the influencing factors, and different levels have different effects.

Online Survey Study on the Needs of Former Intensive-Care Patients for the Development of a User-Friendly App.

The aim of this online-survey study is the development and evaluation of a mobile health application specifically designed to meet the needs of individuals who have previously undergone intensive-care treatment. User acceptance and perception play a crucial role in refining and optimizing the app's features and functionalities. By actively incorporating suggestions and insights from users, the goal is to enhance the overall usability and better cater to the diverse needs of individuals in post-intensive care recovery. This iterative approach ensures that the application remains responsive to the evolving requirements of its target audience. Overall, the emphasis is on creating a user-centric and adaptive tool for former intensive care patients, to develop a user-friendly mobile app.

Beyond the Bedside: Decoding Patient Profiles for Smarter Virtual Patient Observation.

Emerging evidence suggests that virtual patient observation (VPO) may help promote patient safety. The purpose of this study was to examine and describe the demographic and clinical characteristics of patients who incurred VPO. A retrospective analysis was conducted. Differences in total VPO hours between groups were examined, followed by a hierarchical regression to investigate the effect of predictor variables on VPO utilization variance. A total of 286 patient charts were reviewed. Mean VPO hours were higher in patients with an intensive care unit admission history. Adjusted for gender and history of dementia/Alzheimer's/memory impairment, the prediction of total VPO hours increased with the patient's intensive care unit admission history and overall hospital length of stay. Examining the prevalence and variability in the pattern of VPO utilization by specific patient characteristics is essential for identifying what patients could best benefit from this technology.

Determining the effects of erythrocyte suspension on total antioxidant status and total oxidative stress values in pediatric intensive care patients

Determining the effects of erythrocyte suspension on total antioxidant status and total oxidative stress values in pediatric intensive care patients

Decibel level of coughing as a predictor of extubation outcome in mechanically ventilated intensive care patients: A prospective, observational study

AimThis study aims to evaluate the feasibility and clinical utility of measuring cough decibel level as predictive markers for extubation outcomes in mechanically ventilated patients. DesignA prospective observational study. SettingThree interdisciplinary medical-surgical intensive care units across China. Main outcome measuresThe primary outcomes assessed were extubation results in patients. Secondary measures included the cough decibel level, semiquantitative cough intensity scores, and white card test results recorded prior to extubation. ResultsA total of 71 patients were included, 55 patients were in the extubation success group and 16 in the failure group. The mean age was 78(71,83) years, mainly male (73.2 %). Despite the baseline characteristics being mostly consistent across both groups, significant differences were noted in duration of mechanical ventilation, and intensive care units and hospital stay. Remarkably, the cough decibel was substantially lower in the extubation failure group compared to the other group (78.69 ± 8.23 vs 92.28 ± 7.01 dB). The Receiver Operating Characteristic curve analysis revealed that a cough decibel below 85.77 dB is the optimal threshold for predicting extubation failure, exhibiting an 80 % sensitivity and 91.67 % specificity. ConclusionThe study corroborates that the cough decibel level serves as a quantifiable metric in patients undergoing mechanical ventilation. It posits that the likelihood of extubation failure escalates when the cough decibel falls below 85.77 dB. Implications for clinical practiceQuantification of coughing capacity in decibels may be a good predictor of extubation outcome, thus offering assistance to healthcare professionals in evaluating the readiness of patients for extubation.

Hospital-Acquired Bloodstream Infections in the Adult Intensive Care Unit at Prince Mohammed bin Abdulaziz Hospital, Riyadh, Saudi Arabia.

Introduction Hospital-acquired infections, also called nosocomial infections, are infectious diseases acquired in healthcare facilities at least 48 hours after admission and can't be present at the time of admission. Nosocomial bloodstream infection is a serious medical complication from hospitalization, and it can be potentially preventable by taking certain precautions. Aim The aim of this study is to determine the prevalence of central line-related bloodstream infections (CLABSI) with different organisms between January 2022 and February 2024 at the intensive care unit (ICU) at Prince Mohammed bin Abdulaziz Hospital, Riyadh, Saudi Arabia. Patients and methods This retrospective cross-sectional study was conducted among ICU adult patients. The data were collected from medical and infection control records. All data for intensive care patients with positive blood cultures, except for the pediatric age group, were collected. Data were tabulated and cleaned in MS Excel, and subsequent data analyses were performed in IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States). Results Data from 21 patients were collected and analyzed. The mean age of the participants was 62.9 (SD 15.1) years.Femaleparticipants (61.9% (13)) were higher than males(38.1% (8)). All patients were inserted with a non-tunneled central venous catheter (CVC). The mortality rate was 76.2% (16). Vancomycin-resistant enterococci (VRE) was the most commonly detected organism in seven cultures(33.3%), followed by Candida species in six cultures(28.6%). Candida species were prevalent in younger patients (p=0.021) and those sensitive to medication (p=0.015). Survival analyses between age, gender, and organisms yielded insignificant results (p>0.05). Conclusion The major sources of bloodstream infection among adult ICU patients were VRE and Candida species. Mortality was common in this population, particularly among patients who were resistant to medication. Hence, strategies to reduce hospital-acquired bloodstream infections are warranted.

Weaning-associated interventions for ventilated intensive care patients: A scoping review.

Mechanical ventilation is a core intervention in critical care, but may also lead to negative consequences. Therefore, ventilator weaning is crucial for patient recovery. Numerous weaning interventions have been investigated, but an overview of interventions to evaluate different foci on weaning research is still missing. To provide an overview of interventions associated with ventilator weaning. We conducted a scoping review. A systematic search of the Medline, CINAHL and Cochrane Library databases was carried out in May 2023. Interventions from studies or reviews that aimed to extubate or decannulate mechanically ventilated patients in intensive care units were included. Studies concerning children, outpatients or non-invasive ventilation were excluded. Screening and data extraction were conducted independently by three reviewers. Identified interventions were thematically analysed and clustered. Of the 7175 records identified, 193 studies were included. A total of six clusters were formed: entitled enteral nutrition (three studies), tracheostomy (17 studies), physical treatment (13 studies), ventilation modes and settings (47 studies), intervention bundles (42 studies), and pharmacological interventions including analgesic agents (8 studies), sedative agents (53 studies) and other agents (15 studies). Ventilator weaning is widely researched with a special focus on ventilation modes and pharmacological agents. Some aspects remain poorly researched or unaddressed (e.g. nutrition, delirium treatment, sleep promotion). This review compiles studies on ventilator weaning interventions in thematic clusters, highlighting the need for multidisciplinary care and consideration of various interventions. Future research should combine different interventions and investigate their interconnection.

Malnutrition among Serious Trauma Patients in Intensive Care

Undernutrition is a frequent situation in intensive care, including serious trauma. Its prevalence is around 50%. It is associated with an increase in morbidity and mortality among patients hospitalized in intensive care. Our study focused on the evaluation of the nutritional status of serious trauma patients admitted to the intensive care unit of the IBN TOFAIL hospital. We used the BUZBY index (NRI) as screening tools. 35% of patients had a normal nutritional status when admitted to intensive care, 65% of patients were undernourished, including 30% who were severely undernourished. The prevalence on the 3rd day of hospitalization was 75% and 100% after 15 days of hospitalization. The worsening of nutritional status during hospitalization was 61.5%. It appears necessary to adopt a nutritional assessment and management of the patient admitted to intensive care in order to hope for an improvement in his prognosis and his chances of survival within the framework of an early rehabilitation program.

Limited impact of colistin resistance on mortality of intensive care patients with carbapenem-resistant bacteraemia

Increasing incidence of carbapenem-resistant Gram-negative bacteraemia (CR-GNB) has triggered increased use of polymyxins, likely fuelling the emergence and spread of colistin resistance. To estimate the excess clinical burden of colistin resistance in intensive care patients with CR-GNB. A cohort was constructed of patients with CR-GNB during their stay in the intensive care unit (ICU) of a university hospital in Greece, over a 4-year period (2020-2023). Competing risks survival analysis was performed to estimate the burden associated with colistin resistance. In 177 ICU patients with CR-GNB, 134 (76%) had colistin-resistant isolates, predominantly Acinetobacter baumannii (79%), identified by broth microdilution. Patients with colistin resistant infection were similar to those with colistin susceptible with respect to age, sex, APACHE II score, Charlson comorbidity index, Pitt bacteraemia score, prior surgery and the occurrence of polymicrobial cultures. However, patients in the colistin resistant group had lower mortality risk compared to the colistin susceptible (31% vs. 44%, P = 0.004 at 14 days; 46% vs. 56% at 28 days, P = 0.173; respectively). Multivariable regression analysis confirmed that colistin resistant CR-GNB was associated with significantly lower hazard of inpatient death compared to colistin susceptible infection at 14 days (cause-specific hazard ratio [csHR], 0.53; 95% CI 0.28 - 1.01) and 28 days (csHR, 0.55; 95% CI 0.31 - 0.95) of infection onset. Limited impact of colistin resistance on mortality was demonstrated in a large contemporary cohort of ICU patients with CR-GNB, possibly reflecting the recent shift away from colistin-based treatment regimens.

Prediction of sepsis mortality in ICU patients using machine learning methods

ProblemSepsis, a life-threatening condition, accounts for the deaths of millions of people worldwide. Accurate prediction of sepsis outcomes is crucial for effective treatment and management. Previous studies have utilized machine learning for prognosis, but have limitations in feature sets and model interpretability.AimThis study aims to develop a machine learning model that enhances prediction accuracy for sepsis outcomes using a reduced set of features, thereby addressing the limitations of previous studies and enhancing model interpretability.MethodsThis study analyzes intensive care patient outcomes using the MIMIC-IV database, focusing on adult sepsis cases. Employing the latest data extraction tools, such as Google BigQuery, and following stringent selection criteria, we selected 38 features in this study. This selection is also informed by a comprehensive literature review and clinical expertise. Data preprocessing included handling missing values, regrouping categorical variables, and using the Synthetic Minority Over-sampling Technique (SMOTE) to balance the data. We evaluated several machine learning models: Decision Trees, Gradient Boosting, XGBoost, LightGBM, Multilayer Perceptrons (MLP), Support Vector Machines (SVM), and Random Forest. The Sequential Halving and Classification (SHAC) algorithm was used for hyperparameter tuning, and both train-test split and cross-validation methodologies were employed for performance and computational efficiency.ResultsThe Random Forest model was the most effective, achieving an area under the receiver operating characteristic curve (AUROC) of 0.94 with a confidence interval of ±0.01. This significantly outperformed other models and set a new benchmark in the literature. The model also provided detailed insights into the importance of various clinical features, with the Sequential Organ Failure Assessment (SOFA) score and average urine output being highly predictive. SHAP (Shapley Additive Explanations) analysis further enhanced the model’s interpretability, offering a clearer understanding of feature impacts.ConclusionThis study demonstrates significant improvements in predicting sepsis outcomes using a Random Forest model, supported by advanced machine learning techniques and thorough data preprocessing. Our approach provided detailed insights into the key clinical features impacting sepsis mortality, making the model both highly accurate and interpretable. By enhancing the model’s practical utility in clinical settings, we offer a valuable tool for healthcare professionals to make data-driven decisions, ultimately aiming to minimize sepsis-induced fatalities.

Examining the Frequency of Hypomagnesemia in Multiple Trauma Patients Hospitalized in the Intensive Care Unit

Background: Electrolyte imbalance is one of the influential causes in determining the outcome of traumatic patients. One of the electrolytes that get less attention from healthcare providers is magnesium. Therefore, this study investigated the frequency of hypomagnesemia in trauma patients hospitalized in the intensive care unit. Methods: The descriptive-cross-sectional study was conducted after approval at Zahedan University of Medical Sciences on 118 patients with multiple traumas from 2021 to 2022. Patients were selected by convenience sampling method according to the inclusion criteria. Age, sex, weight, body mass index, level of consciousness, and level of blood serum electrolytes were measured and recorded on the first and fifth days after hospitalization. The data were analyzed and compared using descriptive statistics, chi-square, and independent t-test. Results: Of 118 patients studied, 81 (68.6%) were male, and 38 (31.4%) were female. On the fifth day after hospitalization, the mean serum magnesium level of the patients was 1.4 ± 0.81 mg/dL. 87 patients (73.7%) had normal magnesium serum levels, 27 patients (29.9%) had hypomagnesemia, and 4 patients (3.4%) had severe hypomagnesemia. No statistically significant relationship existed between hypomagnesemia and gender, age group, and comorbidity diseases. The level of other blood serum electrolytes on the fifth day after hospitalization, age, weight, body mass index, and status of consciousness was not statistically significant between the two groups of patients with hypomagnesemia and without hypomagnesemia. Conclusion: Trauma and the subsequent treatment measures lead to decreased magnesium serum levels in intensive care patients. Therefore, the normal serum level of other electrolytes should not be considered a diagnostic indicator for the normality of magnesium serum level. Magnesium should be measured along with other electrolytes to make a timely decision to replace magnesium supplements in a patient with hypomagnesemia.

Markers of systemic leukocyte activation for assessing acute and chronic systemic inflammation

The phenomenon of systemic leukocyte activation is a component of systemic inflammation (SI), known as the systemic inflammatory response (SIR). Currently, there are hundreds of molecular markers that can serve as criteria for systemic activation, including soluble receptor to IL-2 (sIL-2R) or CD25, β2-microglobulin, and eosinophil cationic protein (ECP). The objective of our study was to assess whether markers of systemic leukocyte activation can be used as criteria for acute and chronic systemic inflammation. Data from 121 patients with acute critical infectious conditions – intensive care patients with sepsis-2 (according to the 2001 consensus, without MODS) and sepsis-3 (2016 consensus, with MODS) – and 136 patients with non-infectious genesis (polytrauma with and without MODS) were analyzed to study acute SI. Additionally, data from 148 patients with immune-inflammatory rheumatic diseases were analyzed to study chronic SI. The reactivity level (RL) was calculated using the author’s method to assess the intensity of SIR. The development of SI was verified based on the measured concentrations of IL-6, IL-8, IL-10, TNFα, CRP, D-dimers, cortisol, myoglobin, and troponin I. Criteria for leukocyte activation phenomenon were sIL-2R 700 units/mL, β2-microglobulin 3000 ng/mL, and ECP 10 ng/mL. Based on the study results, TNFα, ECP, and β2-microglobulin were identified as the most stable indices for dividing groups with and without systemic vasculitis in both acute and chronic diseases. These indices indicate the typical character of systemic leukocyte activation and can be used to assess the intensity of the described phenomenon when integrated into the SI score. However, it is doubtful that these indices can be independently applied as criteria for the complex process of SI and even the SIR phenomenon. This is because the registration of threshold values for two criteria simultaneously during the acute process of SI was only observed in 40.2% of cases, and in chronic processes, it was only observed in 23.7%. These values were comparable to the group without acute SI. Additionally, all three additional criteria were only determined in acute SI in 20.5% of cases and in chronic SI in 3.4%.

Predictors of mortality for blunt trauma patients in intensive care: A retrospective cohort study

Background: Major trauma places substantial demand on critical care services, is a leading cause of death in under 40-year-olds and causes significant morbidity and mortality across all age groups. Various factors influence patient outcome and predefining these could allow prognostication. The aim of this study was to identify predictors of mortality from major trauma in intensive care. Methods: This was a retrospective study of adult trauma patients admitted to general intensive care between January 2018 and December 2019. We assessed the impact on mortality of patient demographics, patterns of injury, injury scores (Glasgow Coma Score (GCS), Charlson’s comorbidity index (CCI), Acute Physiology and Health Evaluation II (APACHE II), Injury Severity Score (ISS) and Probability of Survival Score (Ps19)), number of surgeries and mechanism of injury using logistic regression. Results: A total of 414 patients were included with a median age of 54 years (IQR 34–72). Overall mortality was 18.6%. The most common mechanism of injury was traffic collision (46%). Non-survivors were older, had higher ISS scores with lower GCS on admission and probability of survival scores. Factors independently predictive of mortality were increasing age (OR 1.06, p <0.001) and GCS <15 on admission (OR 7.21, p <0.001). Ps19 was the best predictor of mortality (p <0.001 for each score category), with an AUROC of 0.90. Conclusions: The significant mortality predictors were age, fall from <2 metres, injury of head or limbs, GCS <15 and Ps19. Contrary to previous studies CCI and APACHE II did not significantly predict mortality. Although Ps19 was found to be the best current prognostic score, trauma prognostication would benefit from a single validated scoring system incorporating both physiological variables and injury patterns.

The Wide Spectrum of Presentations of Cytomegalovirus Infection in Immunocompetent Hosts: An Exhaustive Narrative Review.

CMV is a ubiquitous DNA virus that establishes infection and results in 40-100% seropositivity. Viral replication occurs following an acquired primary infection (or reinfection) or by the reactivation of life-long latency. In immunocompetent patients, CMV infection is mostly asymptomatic or mild and self-limited. However, an extensive review of the literature published up to April 2024 reveals that despite immunocompetence, CMV can cause a very large variety of clinical syndromes in any part of the gastrointestinal tract (the most common pattern), the central or peripheral nervous system, and the eyes, as well as hematological, pulmonary, cardiac, and cutaneous disease. Not uncommonly, more than one system is involved, and though the disease is often self-limited, treatment with intravenous ganciclovir or oral valganciclovir may be required, and in isolated cases, fatalities may occur. Thus, a potential CMV infection should be considered in the differential of myriad syndromes in non-immunocompromised patients. Associated systemic symptoms (fever, sweats, and weight loss), lymphocytosis, and hepatitis are not uncommon and can be a useful clue. Some populations, such as critically ill patients in intensive care, pregnant women, elderly patients, and those with inflammatory bowel disease, may be more susceptible. Moreover, the potential of past, latent CMV infection (i.e., CMV seropositivity) to be associated with significant cardiovascular morbidity and all-cause mortality years later is intriguing and requires further study. All these data indicate the outstanding importance of developing a vaccine against CMV, which hopefully will become available in the foreseeable future. Meanwhile, a solid diagnosis of active CMV infection can be quickly established (or ruled out) by widely available serology tests and PCR amplification, and clinicians in all disciplines need to be more aware of the diverse guises of CMV infection and remember to consider it in any host, including an immunocompetent one.