Intensive Care Patients Research Articles

MDB-23. MULTICENTRE EVALUATION OF THE MANAGEMENT OF CHILDREN WITH HIGH RISK MEDULLOBLASTOMA: REAL WORLD PERFORMANCE OF THE SJMB03 AND COG99701 PROTOCOLS

Abstract BACKGROUND Several treatment protocols are used in the treatment of patients with high risk medulloblastoma (HRMB). In 2015 the UK Children’s Cancer and Leukaemia Group issued interim guidance recommending treatment as per the SJMB03 protocol, whilst also recognising that the COG99701 protocol may be used. Patients were defined as high risk, if metastatic at presentation, large cell anaplastic histology, MYC amplification, significant residual disease or MYCN amplification, the latter two, more recently only if other adverse features present. METHODS We present a retrospective multi-centre service evaluation of treatment of patients with HRMB at 5 tertiary paediatric oncology centres in the UK. Patients were included if treated for HRMB with SJMB03, COG-99701. Patients were excluded if treated for HRMB on other protocols, including the SIOP HRMB trial, or if initially treated for standard risk medulloblastoma and subsequently treated with these protocols due to upstaging or disease progression. Event free, and overall (EFS and OS) survival analyses were calculated from date of primary resection. RESULTS 59 patients were included (median age 8 years, range 3-19): 26 treated as per SJMB03, 33 as per COG-99701. 5-year OS was 83% (95% Confidence Interval, 73-94%) and 5-year EFS was 66% (54-80%). For patients treated as per SJMB03 5-year OS and EFS was 79% (65-97%) and 70% (55-92%)respectively. and for patients treated as per COG99701, 5-year OS and EFS was 86% (73-99%) and 60% (44-83%). There was a higher incidence of grade 3 & 4 ototoxicity (44% vs 6%) and a higher rate of admission to paediatric intensive care (36% vs 6%) in patients treated as per SJMB03 compared to those treated with COG97701 (p<0.05). CONCLUSIONS These real-world outcomes of patients treated in the UK for HRMB are consistent with the published literature for their outcomes for high risk medulloblastoma.

Continuous monitoring of left ventricular function in postoperative intensive care patients using artificial intelligence and transesophageal echocardiography

BackgroundContinuous monitoring of mitral annular plane systolic excursion (MAPSE) using transesophageal echocardiography (TEE) may improve the evaluation of left ventricular (LV) function in postoperative intensive care patients. We aimed to assess the utility of continuous monitoring of LV function using TEE and artificial intelligence (autoMAPSE) in postoperative intensive care patients.MethodsIn this prospective observational study, we monitored 50 postoperative intensive care patients for 120 min immediately after cardiac surgery. We recorded a set of two-chamber and four-chamber TEE images every five minutes. We defined monitoring feasibility as how often the same wall from the same patient could be reassessed, and categorized monitoring feasibility as excellent if the same LV wall could be reassessed in ≥ 90% of the total recordings. To compare autoMAPSE with manual measurements, we rapidly recorded three sets of repeated images to assess precision (least significant change), bias, and limits of agreement (LOA). To assess the ability to identify changes (trending ability), we compared changes in autoMAPSE with the changes in manual measurements in images obtained during the initiation of cardiopulmonary bypass as well as before and after surgery.ResultsMonitoring feasibility was excellent in most patients (88%). Compared with manual measurements, autoMAPSE was more precise (least significant change 2.2 vs 3.1 mm, P < 0.001), had low bias (0.4 mm), and acceptable agreement (LOA − 2.7 to 3.5 mm). AutoMAPSE had excellent trending ability, as its measurements changed in the same direction as manual measurements (concordance rate 96%).ConclusionContinuous monitoring of LV function was feasible using autoMAPSE. Compared with manual measurements, autoMAPSE had excellent trending ability, low bias, acceptable agreement, and was more precise.Graphical

Computed Tomography Effective Dose and Image Quality in Deep Learning Image Reconstruction in Intensive Care Patients Compared to Iterative Algorithms.

Deep learning image reconstruction (DLIR) algorithms employ convolutional neural networks (CNNs) for CT image reconstruction to produce CT images with a very low noise level, even at a low radiation dose. The aim of this study was to assess whether the DLIR algorithm reduces the CT effective dose (ED) and improves CT image quality in comparison with filtered back projection (FBP) and iterative reconstruction (IR) algorithms in intensive care unit (ICU) patients. We identified all consecutive patients referred to the ICU of a single hospital who underwent at least two consecutive chest and/or abdominal contrast-enhanced CT scans within a time period of 30 days using DLIR and subsequently the FBP or IR algorithm (Advanced Modeled Iterative Reconstruction [ADMIRE] model-based algorithm or Adaptive Iterative Dose Reduction 3D [AIDR 3D] hybrid algorithm) for CT image reconstruction. The radiation ED, noise level, and signal-to-noise ratio (SNR) were compared between the different CT scanners. The non-parametric Wilcoxon test was used for statistical comparison. Statistical significance was set at p < 0.05. A total of 83 patients (mean age, 59 ± 15 years [standard deviation]; 56 men) were included. DLIR vs. FBP reduced the ED (18.45 ± 13.16 mSv vs. 22.06 ± 9.55 mSv, p < 0.05), while DLIR vs. FBP and vs. ADMIRE and AIDR 3D IR algorithms reduced image noise (8.45 ± 3.24 vs. 14.85 ± 2.73 vs. 14.77 ± 32.77 and 11.17 ± 32.77, p < 0.05) and increased the SNR (11.53 ± 9.28 vs. 3.99 ± 1.23 vs. 5.84 ± 2.74 and 3.58 ± 2.74, p < 0.05). CT scanners employing DLIR improved the SNR compared to CT scanners using FBP or IR algorithms in ICU patients despite maintaining a reduced ED.

Association of the TyG index with prognosis in surgical intensive care patients: data from the MIMIC-IV

BackgroundThe triglyceride–glucose (TyG) index, a tool for assessing insulin resistance, is increasingly recognized for its ability to predict cardiovascular and metabolic risks. However, its relationship with trauma and surgical patient prognosis is understudied. This study investigated the correlation between the TyG index and mortality risk in surgical/trauma ICU patients to identify high-risk individuals and improve prognostic strategies.MethodsThis study identified patients requiring trauma/surgical ICU admission from the Medical Information Mart for Intensive Care (MIMIC-IV) database, and divided them into tertiles based on the TyG index. The outcomes included 28-day mortality and 180-day mortality for short-term and long-term prognosis. The associations between the TyG index and clinical outcomes in patients were elucidated using Cox proportional hazards regression analysis and RCS models.ResultsA total of 2103 patients were enrolled. The 28-day mortality and 180-day mortality rates reached 18% and 24%, respectively. Multivariate Cox proportional hazards analysis revealed that an elevated TyG index was significantly related to 28-day and 180-day mortality after covariates adjusting. An elevated TyG index was significantly associated with 28-day mortality (adjusted hazard ratio, 1.19; 95% confidence interval 1.04–1.37) and 180-day mortality (adjusted hazard ratio, 1.24; 95% confidence interval 1.11–1.39). RCS models revealed that a progressively increasing risk of mortality was related to an elevated TyG index. According to our subgroup analysis, an elevated TyG index is associated with increased risk of 28-day and 180-day mortality in critically ill patients younger than 60 years old, as well as those with concomitant stroke or cardiovascular diseases. Additionally, in nondiabetic patients, an elevated TyG index is associated with 180-day mortality.ConclusionAn increasing risk of mortality was related to an elevated TyG index. In critically ill patients younger than 60 years old, as well as those with concomitant stroke or cardiovascular diseases, an elevated TyG index is associated with adverse short-term and long-term outcomes. Furthermore, in non-diabetic patients, an elevated TyG index is associated with adverse long-term prognosis.

Biopsy-Proven Gastric Pathological Findings in Mechanically Ventilated Intensive Care Unit Patients.

Objectives Helicobacter pylori (H. pylori) is known to affect a large proportion of the world population. It plays a role in the pathogenesis of peptic ulcer (PU) and increases the likelihood of bleeding. In critically ill patients in intensive care units (ICUs), the risk of bleeding may be much higher due to many concomitant factors. The study aimed to determine the activation of H. pylori in mechanically ventilated (MV) intensive care patients and compare this with the general population. Methods This study was performed retrospectively by screening patients who underwent esophagogastroduodenoscopy and histopathological sampling in our hospital between January and June 2023. The study included 79 patients aged between 18 and 85 years. The patients were categorized into two groups: 35 patients in the ICU with mechanical ventilation (MV) support (EMV) and 44 patients who presented to the gastroenterology department due to dyspeptic symptoms and underwent endoscopy (ED). Age; sex characteristics; laboratory parameters such as hemoglobin (Hb), hematocrit (Htc), mean cellular volume (MCV), white blood cell (WBC), neutrophil, platelet, glucose, urea, creatinine, aspartate transaminase (AST), alanine transaminase (ALT), C-reactive protein (CRP), albumin, ferritin, thyroid-stimulating hormone (TSH), anti-hepatitis C virus (HCV), hepatitis B surface antigen (HBsAg), anti-HIV; and biopsy results (H. pylori positivity, intestinal metaplasia, and atrophy) were recorded. Results A total of 79 patients who underwent gastric biopsy were assessed. There were 35 patients in the EMV group and 44 patients in the ED group. There was no difference in gender and age distribution between the groups. Hb and Htc were significantly lower in EMV compared to ED (p=0.001). Hb was 9.4±1.7 g/dL in EMV and 10.8±2.1 g/dL in ED. Htc was 29.6±5.1 in EMV and 33.5±5.7 in ED. MCV, WBC, glucose, urea, AST, ALT, CRP, and ferritin values were statistically significantly higher in EMV (p<0.05). Albumin and creatinine levels were statistically significantly lower in EMV (p<0.05). There was no significant difference between the groups in terms of neutrophils, platelets, and TSH. In the EMV group, H. pylori activity was negative in 31 (88.6%) patients and positive in four (11.4%) patients. In the ED group, H. pylori activity was negative in 30 (68.2%) patients and positive in 14 (31.8%) patients. There was a statistically significant difference between the groups in terms of H. pylori positivity (p=0.032). Conclusions The prevalence of H. pylori in MV patients in the ICU is low compared to the average population. The incidence of atrophic gastritis and intestinal metaplasia is the same. The present study supports that ICU cases do not have a higher risk of gastric premalignant lesions compared to the average population.

Nationwide status of aeromedical pre-hospital and retrieval medicine in Australia.

To survey the current structure, capability and operational scope of pre-hospital and retrieval aeromedical teams across Australia. The medical directors of all Australian civilian adult aeromedical retrieval organisations with pre-hospital teams and/or doctors for inter-hospital critical care patient transport were contacted in a survey to qualitatively assess capacity and team structure. All 17 organisations contacted completed the survey. While there is diversity in team structure with the pairing of doctors, paramedics and nurses, capacity for patient care is generally homogenous. A doctor/paramedic model is the more common team structure for rotary-wing missions, and doctor/nurse for fixed-wing. Differences are mostly due to state government controlled aspects of their health services. An advanced degree of intensive patient care occurs outside of the hospital. Land and sea rescue is an important aspect of Australian aeromedical work. Aeromedicine in Australia has many consistent elements, but variable contexts have resulted in a diversity of operational models.

Network meta-analysis of non-pharmacological interventions for cognitive impairment after an ischemic stroke.

This study aims to evaluate the effectiveness of non-pharmacological interventions in improving cognitive function in patients with ischemic stroke through network meta-analysis. We searched databases including the Cochrane Library, PubMed, EmBase, and Web of Science for randomized controlled trials (RCTs) on non-pharmacological treatments to improve cognitive impairment following ischemic stroke. The publication date was up to 15 March 2023. Due to the insufficiency of included studies, supplementary searches for high-quality Chinese literature were performed in databases such as CNKI, WanFang Data, and VIP Chinese Science Journals Database. Two reviewers independently went through the literature, extracted data, and assessed the risk of bias in the included studies using the risk of bias assessment tool recommended by the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0. By utilizing R 4.2.3 RStudio software and the GeMTC package, a Bayesian network meta-analysis was conducted to assess the improvement in Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores under a variety of non-pharmacological interventions. A total of 22 RCTs involving 2,111 patients and 14 different non-pharmacological treatments were included. These interventions were transcranial direct current stimulation (tDCS), reminiscence therapy (RT), remote ischemic conditioning (RIC), physical fitness training (PFT), intensive patient care program (IPCP), moderate-intensity continuous training + high-intensity interval training (MICT + HIIT), medium intensity continuous training (MICT), grip training (GT), acupuncture, cognitive behavioral therapy (CBT), cognitive rehabilitation training (CRT), high pressure oxygen (HPO), moxibustion, and repetitive transcranial magnetic stimulation (rTMS). The results of the network meta-analysis indicated that rTMS had the highest likelihood of being the most effective intervention for improving MMSE and MoCA scores. The evidence from this study suggests that rTMS holds promise for improving MMSE and MoCA scores in patients with cognitive impairment following ischemic stroke. However, further high-quality research is needed to confirm and validate this finding.

Risk of central line-associated bloodstream infections during COVID-19 pandemic in intensive care patients in a tertiary care centre in Saudi Arabia.

This retrospective study compared central line-associated bloodstream infection (CLABSI) rates per 1 000 central line days, and overall mortality before and during the COVID-19 pandemic in adult, paediatric, and neonatal ICU patients at King Abdul-Aziz Medical City-Riyadh who had a central line and were diagnosed with CLABSI according to the National Healthcare Safety Network standard definition. The study spanned between January 2018 and December 2019 (pre-pandemic), and January 2020 and December 2021 (pandemic). SARS-CoV-2 was confirmed by positive RT-PCR testing. The study included 156 CLABSI events and 46 406 central line days; 52 and 22 447 (respectively) in pre-pandemic, and 104 and 23 959 (respectively) during the pandemic. CLABSI rates increased by 2.02 per 1 000 central line days during the pandemic period (from 2.32 to 4.34, p<0.001). Likewise, overall mortality rates increased by 0.86 per 1 000 patient days (from 0.93 to 1.79, p=0.003). Both CLABSI rates (6.18 vs. 3.7, p=0.006) and overall mortality (2.72 vs. 1.47, p=0.014) were higher among COVID-19 patients compared to non-COVID-19 patients. The pandemic was associated with a substantial increase in CLABSI-associated morbidity and mortality.

A scoping review of pain resulting from the endotracheal suctioning of paediatric intensive care patients.

This scoping review was conducted to summarise and map studies on pain resulting from endotracheal suctioning in paediatric intensive care patients. This scoping review conducted in June 2022 was performed by screening articles published in English. Scopus, PubMed, Cochrane, Web of Science, MedLine and Ovid databases were used for screening. The keywords 'endotracheal suctioning', 'pain', 'paediatric intensive care' and their synonyms were used in the search. During the review, 280 articles were accessed, and the full texts of 14 articles were evaluated for suitability. After some of the articles were excluded from the study, abstracts of nine articles were given below. It is recommended that a greater number of randomised controlled studies should be conducted, because the number of studies with a high level of evidence on the effect of endotracheal suctioning on the pain levels of patients in the paediatric intensive care unit is very few.

Assessing the use of enteral vs. parenteral feeding in sedated and ventilated patients in intensive care with COVID-19

Assessing the use of enteral vs. parenteral feeding in sedated and ventilated patients in intensive care with COVID-19

Interpretable machine learning model for predicting acute kidney injury in critically ill patients

BackgroundThis study aimed to create a method for promptly predicting acute kidney injury (AKI) in intensive care patients by applying interpretable, explainable artificial intelligence techniques.MethodsPopulation data regarding intensive care patients were derived from the Medical Information Mart for Intensive Care IV database from 2008 to 2019. Machine learning (ML) techniques with six methods were created to construct the predicted models for AKI. The performance of each ML model was evaluated by comparing the areas under the curve (AUC). Local Interpretable Model-Agnostic Explanations (LIME) method and Shapley Additive exPlanation values were used to decipher the best model.ResultsAccording to inclusion and exclusion criteria, 53,150 severely sick individuals were included in the present study, of which 42,520 (80%) were assigned to the training group, and 10,630 (20%) were allocated to the validation group. Compared to the other five ML models, the eXtreme Gradient Boosting (XGBoost) model greatly predicted AKI following ICU admission, with an AUC of 0.816. The top four contributing variables of the XGBoost model were SOFA score, weight, mechanical ventilation, and the Simplified Acute Physiology Score II. An AKI and Non-AKI cases were predicted separately using the LIME algorithm.ConclusionOverall, the constructed clinical feature-based ML models are excellent in predicting AKI in intensive care patients. It would be constructive for physicians to provide early support and timely intervention measures to intensive care patients at risk of AKI.

Repeat tracheal aspirate cultures in pediatric intensive care patients: Frequency, resistance, and antimicrobial use.

To evaluate the clinical impact and features associated with repeat tracheal aspirate (TA) cultures in children admitted to the intensive care unit. Retrospective cohort study. A 338-bed freestanding, tertiary pediatric academic medical center with pediatric medical intensive care unit (PICU) and cardiac intensive care units (CICU). Children ≤18 years of age who were admitted to either the PICU or CICU who had ≥2 TA cultures in a single intensive care admission. Patients with ≥2 TA cultures between 2018 and 2019 were included in this study. The following information was collected: patient demographics, clinical data summarizing patient condition at the time of culture collection, number of TA cultures per patient, antibiotic usage, and microbiologic data. Descriptive statistics established the frequency of TA collection, time between culturing, clinical reasoning for collection, antibiotic exposure, and development of multidrug-resistant organisms (MDRO). Sixty-three patients had repeat TA cultures and accounted for 252 TA cultures during the study period. Most patients with repeat TA cultures were admitted to the PICU (71%) and were male (65%). A median of 3 TA cultures per patient were obtained with 50% of repeat cultures occurring within 7 days from the previous culture. Sixty-six percent of patients had the same organism cultured on ≥2 TA cultures. Most antibiotics were not modified or continued to treat the results of the TA culture. Repeat TA cultures frequently show the same pathogens, and results do not often influence antibiotic selection or usage. Repeat TA cultures did demonstrate the development of MDROs.

Effect of Erythrocyte Suspension Transfusion on Thiol-Disulfide Homeostasis in Critically Ill Children

Objective: To investigate the potential relation between dynamic thiol homeostasis and blood transfusion in the pediatric intensive care unit. Methods: Blood samples were collected from pediatric intensive care patients before and after erythrocyte suspension transfusion and from donor blood additionally to measure thiol levels. The study involved 30 patients, including nine females, and a total of 90 blood samples from patients and donors were analyzed. Results: Prior to transfusion, Total Thiol (TT) and Native Thiol (NT) were 414.77 ± 156.14 (μmol/L) and 272.63 ± 115.75 (μmol/L), respectively, and post-transfusion, they were found to decrease to 398.07 ± 187.38 (μmol/L) and 258.97 ± 136.2 (μmol/L), respectively. However, no statistically significant difference was observed between pre- and post-transfusion values. In post-transfusion blood samples, there was a significant increase in Disulfide/TT and Disulfide/NT ratios, indicating an increase in oxidation (34.79 ± 92.34 and 51.89 ± 68.51, respectively), yet no statistical difference was noted. Conclusion: Transfusions administered in the Pediatric Intensive Care Unit were associated with a decrease in total and native thiol levels, indicative of increased oxidative stress, despite the lack of statistically significant differences. To mitigate the potential negative impact on patients with high oxidative properties after transfusions, strengthening the antioxidant defense system is recommended. Research should be planned to develop suitable strategies for enhancing the antioxidant defense system and ensuring patients' resilience to this condition.

Vancomycin Dosing and Its Association With Acute Kidney Injury in Pediatric Cardiac Intensive Care Patients Under 3 Months of Age.

The standard vancomycin regimen for term neonates is 45 mg/kg/day. However, the optimal starting vancomycin dosing for achieving therapeutic levels in young infants in cardiac intensive care units remains unknown. Moreover, data on the association of supratherapeutic vancomycin levels with acute kidney injury (AKI) are limited. Retrospective study of infants ≤3 months old, receiving vancomycin following congenital heart surgery at postoperative intensive care unit admission. Assessed were vancomycin dosing, achievement of therapeutic trough concentration of 10-20 mg/L and development of AKI, based on the modified Kidney Disease Improving Global Outcomes criteria. Inclusion criteria were met by 109 patients with a median age of 8 days (IQR: 6-16). The mean (SD) vancomycin dose required for achieving therapeutic concentration was 28.9 (9.1) mg/kg at the first postoperative day. Multivariate logistic regression identified higher preoperative creatinine levels and shorter cardiopulmonary bypass time as predictors of supratherapeutic vancomycin concentrations (c-index 0.788). During the treatment course, 62 (56.9%) developed AKI. Length of stay and mortality were higher in those who developed AKI as compared with those who did not. Multivariate logistic regression identified higher vancomycin concentration as a predictor for postoperative AKI, OR, 3.391 (95% CI: 1.257-9.151), P = 0.016 (c-index 0.896). Our results support a lower starting vancomycin dose of ~30 mg/kg/day followed by an early personalized therapeutic approach, to achieve therapeutic trough concentrations of 10-20 mg/L in cardiac postoperative term infants. Supratherapeutic concentrations are associated with an increased risk for AKI, which is prevalent in this population and associated with adverse outcomes.

Triggers of intensive care patients with palliative care needs from nurses’ perspective: a mixed methods study

PurposeTriggers have been developed internationally to identify intensive care patients with palliative care needs. Due to their work, nurses are close to the patient and their perspective should therefore be included. In this study, potential triggers were first identified and then a questionnaire was developed to analyse their acceptance among German intensive care nurses.MethodsFor the qualitative part of this mixed methods study, focus groups were conducted with intensive care nurses from different disciplines (surgery, neurosurgery, internal medicine), which were selected by convenience. Data were analysed using the “content-structuring content analysis” according to Kuckartz. For the quantitative study part, the thus identified triggers formed the basis for questionnaire items. The questionnaire was tested for comprehensibility in cognitive pretests and for feasibility in a pilot survey.ResultsIn the qualitative part six focus groups were conducted at four university hospitals. From the data four main categories (prognosis, interprofessional cooperation, relatives, patients) with three to 15 subcategories each could be identified. The nurses described situations requiring palliative care consults that related to the severity of the disease, the therapeutic course, communication within the team and between team and patient/relatives, and typical characteristics of patients and relatives. In addition, a professional conflict between nurses and physicians emerged. The questionnaire, which was developed after six cognitive interviews, consists of 32 items plus one open question. The pilot had a response rate of 76.7% (23/30), whereby 30 triggers were accepted with an agreement of ≥ 50%.ConclusionIntensive care nurses see various triggers, with interprofessional collaboration and the patient's prognosis playing a major role. The questionnaire can be used for further surveys, e.g. interprofessional triggers could be developed.

Measuring pain or discomfort during routine nursing care in lightly sedated mechanically ventilated intensive care patients: A prospective preliminary cohort study

BackgroundPain is routinely measured on mechanically ventilated ICU patients. However, the tools used are not designed to discriminate between pain and non-pain discomfort, a distinction with therapeutic implications. ObjectivesTo evaluate whether clinical measurement tools can discern both pain and non-pain discomfort. MethodsA prospective observational cohort study was conducted in a General ICU at a tertiary Medical Center in Israel. The Behavior Pain Scale (BPS) and Visual Analog Scale (VAS) of Discomfort were simultaneously assessed by a researcher and bedside nurse on thirteen lightly sedated patients during 71 routine nursing interventions in lightly sedated, mechanically ventilated, adult patients. Patients were asked whether they were in pain due to these interventions. ResultsStatistically significant increases from baseline during interventions were observed [median change: 1.00 (-1–5), 1.5(-4–8.5), p < 0.001] as measured by BPS and VAS Discomfort Scale, respectively. BPS scores ranged between 4 and 6 when the majority (53 %) of the patients replied that they had no pain but were interpreted by the clinicians as discomfort. Endotracheal suctioning caused the greatest increase in BPS and VAS, with no statistically significant differences in BPS and VAS Discomfort Scale scores whether patients reported or did not report pain. A BPS>6 had a higher sensitivity and specificity to reported pain (accuracy of 76 %) compared to a BPS of 4–6. ConclusionsStandard assessments are sensitive to pain caused by routine nursing care interventions. However, this study presents evidence that among lightly sedated ICU patients, moderate BPS scores could also measure non-pain discomfort. ICU nurses should be aware that signs of unpleasantness measured by a pain scale could reflect non-pain discomfort.

Determination of predisposing factors for prolonged intensive care in patients with exacerbation of chronic obstructive pulmonary disease

Objective: To determine the predisposing factors for lengthy intensive care unit stay of chronic obstructive pulmonary disease patients with acute exacerbation. Method: The retrospective study was conducted after approval from the ethics review committee of Atatürk Sanatorium Training and Research Hospital, Turkey, and comprised data from January 1, 2017, to August 31, 2022, related to acute exacerbation chronic obstructive pulmonary disease patients receiving intensive care unite treatment. Demographics, comorbidities, treatment, length of stay in hospital and in intensive care unit, and nutritional status were evaluated. Data of patients who spent &lt;10 days in intensive care unit formed Group 1, while those having spent 10 days or more formed Group 2 for comparison purposes. Data was analysed using SPSS 22. Results: Of the 460 patients, 366(79.6%) were in Group 1; 224(61.2%) males and 64(38.8%) females with mean age 70.81±11.57 years. There were 94(20.4%) patients in Group 2; 62(66%) males and 32(34%) females with mean age 72.38±10.88 years (p&gt;0.05). Inotropic agent support, need for haemodialysis, timeframe of invasive mechanical ventilation, length of stay in hospital, 1-month mortality, antibiotic use, use of diuretic agent, acute physiology and chronic health evaluation-ii score, nutrition risk in the critically ill score, history of lung malignancy, and pneumonic infiltration on chest radiograph were significantly more frequenttly observed in Group 2 patients (p&lt;0.05). Age, timeframe of invasive mechanical ventilation, and length of stay in hospital were the factors prolonging intensive care unit stay (p&lt;0.05). Conclusion: Higher age, longer invasive mechanical ventilation timeframe and hospital stay with acute exacerbation chronic obstructive pulmonary disease caused a prolonged stay in intensive care unit. Key Words: Acute exacerbation of chronic obstructive pulmonary disease, Mechanical ventilation time, Prolonged intensive care stay, Prolonged hospitalisation.

#2053 The third-day blood lactate levels and APACHE III are important for predicting mortality in intensive care unit patients: Physionet data

Abstract Background and Aims Intensive care patients had higher mortality and SOFA score is used for mortality prediction. The SOFA score was developed more than 25 years ago to monitor organ dysfunction. Nowadays, blood lactate levels indicate septic shock and work as a new vital sign. This study aimed to evaluate the blood lactate levels for prediction mortality and search for the best predictors for mortality. Method Physionet data (MIMIC3) were used for this retrospective analysis. A total of 13,357 intensive care unit patients were enrolled, they were admitted to the intensive care unit over 24 hours and aged 20 years old, were initially checked for blood lactate levels. We also analyzed 2,748 patients who were checked for blood lactate levels at baseline, the second day, and the third day. We classified patients into three groups according to initial blood lactate levels (group 0: &amp;lt;4 mmol/L, group 1: 4-7.99 mmol/L, group 2: &amp;gt;8 mmol/L). Results The total mortality rate (60.3% vs. 24.4%), 7-day mortality rate, and 30-day mortality rate were the highest in group 2 compared to group 0 among 13,357 intensive care patients. Charlson-comorbidity index, SOFA score, and APACHE III score were the highest in group 2 compared to group 0 among 13357 intensive care patients. The arterial pH, pC02, systolic blood pressure, and GFR were the lowest in group 2 compared to group 0 among 13357 intensive care patients. These findings were similarly found in 2,748 intensive care patients. The third-day blood lactate levels and APACHE III score showed a higher area under the ROC curves predicting total mortality, 7-day mortality, and 30-day mortality than initial blood lactate levels and SOFA score. The third-day blood lactate levels, third-day/initial blood lactate ratio, and APACHE III score were independently associated with total mortality, seven-day and 30-day mortality in 2,748 intensive care patients, but GFR, ventilator care and SOFA score were not. Conclusion The third-day blood lactate levels and APACHE III score were the best predictors for mortality in intensive care unit patients. Therefore, intensive care for reducing blood lactate levels is important to increase survival.

Effects of conservative versus liberal oxygen treatment in mortality of UCI patients

Background: The oxygen is a drug that is commonly used in clinical practice and whose therapeutic use has been adjusted over time. However, this practice confronts us with one of the transcendental problems, which is the inconsistency of the optimal oxygen level established in the clinical practice guidelines. Currently the treatment is liberal and leads to abnormally high levels of oxygen causing damage locally and systemically. The consequence of this is increased mortality in patients who are treated with high levels of oxygen. In view of this, conservative therapy was proposed to avoid hyperoxemia and mitigate its adverse effects. The optimal level of oxygen for the treatment of patients admitted to the intensive care unit remains uncertain. Material and methods: A comprehensive electronic search of the relevant literature on conservative and liberal treatment in intensive care unit inpatients was performed through medical databases as well as reference search engines such as Pubmed, Cochrane, trip, epistemonikos, Australian New Zealand clinical trial registry and clinicaltrial.gov. For this, the following keywords and MESH terms were used: “conservative oxygen therapy”, “conservative oxygen therapy and mortality”, “conservative oxygen therapy and critical care”, “conservative oxygen therapy and critically ill”. Randomized clinical trials, systematic reviews, and meta-analyses were identified without considering publication status, reported results, date or year of publication, and language. Results: Were included 21 systematic review and meta-analysis papers that compared liberal with conservative treatment and were within the inclusion criteria and 13 randomized clinical trials. Conclusion: Currently, the available evidence on targeted oxygen therapy in intensive care patients remains inconclusive. More randomized clinical trials are needed to determine the ideal oxygen target for intensive care patients and its impact on mortality

Cell free DNA as a new prognostic biomarker for COVID-19, A prospective cohort study

Predicting the need of hospitalization and intensive care in COVID-19 patients has been challenging with current diagnostic tests since the beginning of the pandemic. We aimed to test cell free DNA (cfDNA) as a novel biomarker for COVID-19 disease severity and mortality. cfDNA concentration was quantified by RT-PCR based test. One hundred and sixty-eight patients(85 outpatients, 61 inpatients,22 ICU) included the study. Mean initial plasma cfDNA levels were significantly different (p < 0.01) in outpatients (1.190,66 ng/ml), inpatients (8.258,10 ng/ml) and ICU patients (84.806,87 ng/ml). ROC analysis showed with 95 % specificity that patients with initial cfDNA concentrations ≥6.389 ng/ml need to be hospitalized and those ≥26.104 ng/ml require ICU referral. cfDNA concentration was correlated with neutrophil/lymphocyte ratio, lymphocyte level, CRP, AST, LDH, CK, fibrinogen, ferritin and D-dimer. Plasma cfDNA levels on admission, well correlating with disease severity and mortality in COVID-19 that found as a useful biomarker.