Intensive Care Physicians Research Articles

Early mobilization in intensive care unit in Latin America: A survey based on clinical practice.

The application of early mobilization (EM) in intensive care units (ICUs) has shown to improve the physical and ventilatory status of critically ill patients, even after ICU stay. This study aimed to describe the practices regarding EM in ICUs in Latin America. We conducted an observational, cross-sectional study of professionals from all countries in Latin America. Over 3 months, professionals working in ICU units in Latin America were invited to answer the survey, which was designed by an expert committee and incorporated preliminary questions based on studies about EM recommendations. As many as 174 health professionals from 17 countries completed the survey. The interventions carried out within each ICU were active mobilization (90.5%), passive mobilization (85.0%), manual and instrumental techniques for drainage of mucus secretion (81.8%), and positioning techniques (81%). The professionals who most participated in the rehabilitation process in ICUs were physiotherapists (98.7%), intensive care physicians (61.6%), nurses (56.1%), and respiratory therapists (43.8%). In only 36.1% of the ICUs, protocols were established to determine when a patient should begin EM. In 38.1% of the cases, the onset of EM was established by individual evaluation, and in 25.0% of the cases, it was the medical indication to start rehabilitation and EM. This report shows us that EM of critically ill patients is an established practice in our ICUs like in other developed countries.

Airway Management in Adult Intensive Care Units: A Survey of Two Regions in China.

The critical medicine residency training in China started in 2020, but no investigation on the practice of tracheal intubation in ICUs in China has been conducted. A survey was sent to the adult ICUs in public hospitals in Shenzhen (SZ) city and Xinjiang (XJ) province using a WeChat miniprogram to be completed by intensive care physicians. It included questions on training on intubation, intubation procedures, and changes in the use of personal protective equipment due to COVID-19. We analyzed 301 valid questionnaires which were from 72 hospitals. A total of 37% of respondents had completed training in RSI (SZ, 40% vs. XJ, 30%; p = 0.066), and 50% had participated in a course on the emergency front of the neck airway (SZ, 47% vs. XJ, 54%; p = 0.256). Video laryngoscopy was preferred by 75% of respondents. Manual ventilation (56%) and noninvasive positive pressure ventilation (34%) were the first-line options for preoxygenation. For patients with a high risk of aspiration, nasogastric decompression (47%) and cricoid pressure (37%) were administered. Propofol (82%) and midazolam (70%) were the most commonly used induction agents. Only 19% of respondents routinely used neuromuscular blocking agents. For patients with difficult airways, a flexible endoscope was the most commonly used device by 76% of respondents. Most participants (77%) believed that the COVID-19 pandemic had significantly increased their awareness of the need for personal protective equipment during tracheal intubation. Our survey demonstrated that the ICU doctors in these areas lack adequate training in airway management.

Case Report of Tetrodotoxin Poisoning from Lagocephalus sceleratus in Lebanon

The Indo-Pacific pufferfish Lagocephalus sceleratus is a tetrodotoxin-containing species believed to have entered the Mediterranean Sea through the Suez Canal. Tetrodotoxin (TTX) is primarily found in the liver, intestine, and ovaries of L. sceleratus. We report a case of a patient with TTX poisoning from L. sceleratus consumption in Lebanon. History of ingestion, clinical presentation, and exam findings were obtained during phone-based consultation with the patient and intensive care physician. A 46-year-old male presented to a hospital in Lebanon with perioral and extremity numbness as well as dizziness 1 h after ingestion of an L. sceleratus fish. He had caught and prepared the fish himself and had eaten a skinless piece of flesh. Over the following 6 h he also developed ataxia and generalized body numbness. His treatment included systemic hydrocortisone, antihistamine, activated charcoal, and fluids. He was admitted to the intensive care unit, where he developed self-limited, stable sinus bradycardia. He was discharged home on hospital day 5 with residual lightheadedness that improved over several days. This is one of the first reported cases of tetrodotoxin poisoning due to L. sceleratus in Lebanon. Public awareness regarding the toxicity of this species after any ingestion is essential to prevent toxicity and death.

Tumour lysis syndrome: modern aspects of the problem

Background. Acute tumor lysis syndrome (ATLS) complicates the treatment of highly aggressive leukemias and lymphomas in children and leads to death in 21.4 % of severe cases. ATLS is based on the death of tumor cells, so the volume of decay products exceeds the excretory capacity of the kidneys. The ATLS risk group includes patients with acute lymphoblastic leukemia accompanied by hyperleukocytosis (above 100 × 109/L) and non-Hodgkin’s lymphomas with a large tumor mass (stage III–Iv of the disease). The development of acute renal and then multiple organ failure require intensive monitoring of ATLS clinical and biochemical markers and the development of optimal patient management tactics jointly by an intensive care physician and a pediatric oncologist-hematologist.Aim. To summarize the literature and our own clinical experience in the diagnosis and treatment of ATLS in pediatric oncohematology.Materials and methods. The literature data on the diagnosis and treatment of ATLS in children with oncohematological diseases were analyzed. Summarized own clinical experience from January 2009 to January 2022.Results. Of 379 patients with acute lymphoblastic leukemia and non-Hodgkin’s lymphomas, who are at risk for developing ATLS, 350 (93.4 %) patients underwent conservative ATLS therapy, of which in 31 (8.8 %) cases, hemodiafiltration was required to eliminate tumor decay products. The average number of hemodiafiltration procedures is 3 (from 1 to 15). Nevertheless, despite the whole range of therapeutic measures, the addition of infectious and multiple organ complications caused death in 7 (22.6 %) of 31 patients. Most (5 out of 7) fatal cases occurred between 2009 and 2013, and the number of lethal cases because of ATLS from 2014 to 2022 years were only 2. In 24 (77.4 %) patients, the signs of ATLS were successfully managed, the patients continued antitumor treatment. when observing patients for 6 years (from 7 months to 13 years), there were no signs of disease relapse, as well as renal dysfunction.Conclusion. prevention and treatment of ATLS, including cytoreductive prephase, infusion therapy, allopurinol and rasburicase, and in case of ineffectiveness, hemodiafiltration is the basis of modern intensive therapy for hematological malignancies in children. Additional study of the pathogenetic mechanisms of ATLS development, identification of key targets of drug therapy, and a multidisciplinary approach in the treatment of an extremely unfavorable group of oncohematological patients with advanced stages of the tumor process are possible components for further increasing the effectiveness of ATLS therapy.

Imaging intensive care patients: multidisciplinary conferences as a quality improvement initiative to reduce medical error

BackgroundStrategies to identify imaging-related error and minimise its consequences are important in the management of critically ill patients. A new quality management (QM) initiative for radiological examinations has been implemented in an intensive care unit (ICU) setting. In regular multidisciplinary conferences (MDCs), radiologists and ICU physicians re-evaluate recent examinations. Structured bilateral feedback is provided to identify errors early. This study aims at investigating its impact on the occurrence of QM events (imaging-related errors). Standardised protocols of all MDCs from 1st of June 2018 through 31st of December 2019 were analysed with regard to categories of QM events (i.e. indication, procedure, report) and resulting consequences.ResultsWe analysed 241 MDCs with a total of 973 examinations. 14.0% (n = 136/973) of examinations were affected by QM events. The majority of events were report-related (76.3%, n = 106/139, e.g. misinterpreted finding), followed by procedure-related (18.0%, n = 25/139, e.g. technical issue) and indication-related events (5.8%, n = 8/139, e.g. faulty indication). The median time until identification of a QM event (time to MDC) was 2 days (interquartile range = 2). Comparing the first to the second half of the intervention period, the incidence of QM events decreased significantly from 22.9% (n = 109/476) to 6.0% (n = 30/497) (p < 0.0001). Significance of this effect was confirmed by linear regression (p < 0.0001).ConclusionsEstablishing structured discussion and feedback between radiologists and intensive care physicians in the form of MDCs is associated with a statistically significant reduction in QM events. These results indicate that MDCs may be one suitable approach to timely identify imaging-related error.

Burn Injury Management, Pathophysiology and Its Future Prospectives

For intensive care physicians, burns are a frequent and challenging patient complication. Specialist facilities prioritise patient stabilisation, infection prevention, and functional rehabilitation to the greatest extent possible. Researchers have been focusing on burns for decades, and thanks to their efforts, the mortality rate for burn patients, especially young patients and those with moderate burns, has been steadily declining. However, the intensivist often faces challenges that make it hard to provide care and stabilise patients. There may be unique complications associated with burn wounds that necessitate either delayed treatment or prolonged rehabilitation. Improvements in patient stabilisation and treatment have resulted from advances made in burn wound care thanks to research. This article discusses recent advances in the treatment of burn patients, focusing on the pathophysiology of burns and the management of burn wounds.

A Survey of Current Practices and Adherence to Coronavirus Disease Airway Management Guidelines Among Frontline Healthcare Professionals in a Resource-Limited Country.

The coronavirus disease 2019 (COVID-19) has brought anaesthesiologists, intensive care and emergency physicians to the forefront due to their airway management skills. The aim of survey was to determine current practice trends in COVID-19 airway management among frontline healthcare professionals of Pakistan and their adherence to standard principles proposed by most consensus guidelines. An online questionnaire was designed based on consensus guidelines from international societies. We contacted consultants and trainees nationwide working in anaesthesia, intensive care, and emergency departments through emails, phone calls, and social media platforms. A total of 285 individuals participated in this cross-sectional descriptive study. Intubations were largely performed by anaesthetists followed by emergency physicians. Deteriorating respiratory failure (89%) was the most frequent indication. Availability of trained staff, use of intubation checklist, limited staff presence during intubation, and use of appropriate personal protective equipment were positive findings. One-third reported that their workplace did not have negative pressure rooms for aerosol-generating procedures, and 63.3% responders do not perform airway assessment before intubation. The device of choice for the first attempt at laryngoscopy was Macintosh laryngoscope (51.6%) followed by videolaryngoscopes with disposable blades (24.2%). Availability of rescue devices in case of unanticipated difficult airway is variable; laryngeal mask airway (70.1%), bougie (82.2%), and stylet (68.7%) were present at majority places. Frequency of airway-related adverse events including hypoxemia (69.8%) and failed first attempt intubation (35.2%) was significant. This survey found satisfactory knowledge, comparable practices, and offers some important insights about airway management in COVID-19 patients by healthcare professionals of Pakistan.

Impact of a pharmacist‐driven antimicrobial stewardship program on the prescription of antibiotics by intensive care physicians in a Latin American hospital: A retrospective study

AbstractBackgroundThe implementation of antimicrobial stewardship programs (AMS) has shown to be an effective tool for the rational use of antimicrobials, but this has been challenging in several Latin American countries, due to limited resources, such as the lack of trained clinical pharmacists in infectious disease. This study aims to determine the impact of a pharmacist‐driven AMS on the prescription of antibiotics by intensive care physicians (ICPs) and the bacterial resistance patterns in a Latin American hospital.MethodsA retrospective observational study was conducted that compared the optimal selection and the consumption (days of therapy/1000 ICP patient‐days) of antibiotics in patients treated by intensive care unit (ICU) physicians, before and after AMS implementation, defined as pre‐AMS (January–December 2014) and post‐AMS (January 2020–March 2021) at Hospital Clínica Bíblica, Costa Rica. Bacterial resistance patterns were also compared.Results333 patients met the inclusion criteria (52% pre‐AMS and 48% post‐AMS). After a five‐year intervention, the optimal antibiotic selection prescribed by ICP was 43.1% (n = 75) in the pre‐AMS period and 86.8% (n = 138) in the post‐AMS period (43.7% absolute improvement, P &lt; 0.001). The prescription trends of some antibiotics showed an improvement, such as ertapenem in 45% (P &lt; 0.001) and levofloxacin in 59% (P &lt; 0.001). Also, there was an improvement in some empiric antibiotic prescriptions with the diagnosis, including an increase of 32% (P &lt; 0.001) in Community‐Acquired Pneumonia. There was a reduction in the consumption of antimicrobials including a decrease of 66.9% (P = 0.017) for vancomycin and 64.7% (P = 0.033) for meropenem. Regarding bacterial resistance, the study found a decrease of 11% (P = 0.048) in Pseudomonas aeruginosa resistant to meropenem and a reduction in the detection of extended‐spectrum beta‐lactamase in Escherichia coli (11% decrease; P = 0.007).ConclusionThe pharmacist‐driven AMS showed a positive impact on antibiotic selection and consumption in ICU patients. In addition, strategies implemented through the AMS could have had a beneficial impact on antibiotic resistance.

Burnout in Italian anesthesiologists and intensivists during the COVID-19 pandemic: a national survey.

COVID-19 pandemic added additional burden upon healthcare systems and anesthesiology and intensive care physicians (AI) who possessed crucial expertise for dealing with the pandemic. Aim of the study was to uncover specific burnout patterns among Italian AI, exploring the hypothesis that burnout has a multicluster structure. Differences in social and professional characteristics between burnout patterns were explored. One thousand and nine AI (658 women) members of the Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva (SIAARTI) working during COVID-19 pandemic participated. Sociodemographic, working information and burnout levels evaluated through Maslach Burnout Inventory (MBI) were collected. According to the MBI cutoff, 39.7% and 25.8% of participants scored high in emotional exhaustion and depersonalization respectively, and 44.2% scored low in personal accomplishment. Cluster analysis highlighted four burnout profiles: resilience, detachment, burnout, and emotional reserve. The results showed that AI in the Resilience and Emotional Reserve groups were significantly older and more experienced than those in the Detachment and Burnout groups. Additionally, more of the individuals in the Resilience group were working in intensive care units and departments dedicated to COVID-19 patients. The Detachment group was comprised of more AI working in operating units, while the Burnout group contained a higher number of AI working in COVID-19 departments. These findings highlight different burnout patterns in Italian AI: older age, more professional experience, and work in intensive care units and departments dedicated to COVID-19 seemed to be protective factors during the pandemic. This appears a first step to promote focused interventions.

Assessment of physicians' knowledge about brain death and organ donation and associated factors.

Precocity and assertiveness when diagnosing brain death are essential for identifying potential donors. To assess the knowledge of physicians about brain death and organ donation, cross-sectional web-based survey was carried out with physicians from different specialties. The knowledge about brain death and organ donation was assessed by a questionnaire with 12 multiple-choice or multiple-answer questions (possible range from 0 to 12). The nonparametric Mann–Whitney and Kruskal–Wallis tests were performed to verify the association between the physicians’ knowledge and others variables. The project was approved by the Research Ethics Committee of the Hospital das Clínicas, Faculty of Medicine of Ribeirão Preto, University of São Paulo, under number 4.022.657, and all patients agreed to participate and provided free prior-informed consent. Three hundred sixty physicians were included in this study, most of them have postgraduate (55%) and 59.2% were intensive care physicians. The median of responses was 5 (obtained range from 0 to 10). The participants were classified in 2 groups: with satisfactory knowledge (scores above 5) or without satisfactory knowledge (scores equal/below 5). There was better performance among participants who: completed graduation between 6 and 10 years (P < .012); were intensive care physicians (P < .002); had participated in training courses (P < .001); and those who had worked in intensive care unit (ICU) from 6 to 10 years (P < .023); had performed over 10 brain death protocols (P < .001), and felt safe to talk to family members about brain death (P < .001). The results showed that the participants had low knowledge about diagnosis of brain death and organ donation protocols despite the majority working in ICUs. Be an intensive care physician, had large time experience in ICU, and had performed brain death protocols were associated with unsatisfactory knowledge concerning the subject.

CLABSI Reduction Strategy: Utilizing Weekly Rounds with an Interdisciplinary Team.

Introduction: Central line-associated bloodstream infections (CLABSIs) in pediatric ICU patients lead to a wide variety of adverse outcomes, including increased mortality and morbidity, longer length of stay in the hospital, and greater healthcare costs.1 Pediatric cardiac ICU patients are at a significantly higher risk for these healthcare-associated infections because of an increase in risk factors, such as congenital anomalies, presence of surgical wounds, compromised immune function post cardiopulmonary bypass, and the presence of multiple invasive medical devices.2 After noting an increase in the pediatric cardiac ICU CLABSI rate, an interdisciplinary team was formed to approach the problem. Objectives: The primary aim was to decrease the pediatric cardiac ICU’s CLABSI rate by 25% in 8 months by engaging an interdisciplinary team with identifying and addressing CLABSI maintenance bundle concerns in real time on the unit. Methods: An interdisciplinary team with representatives from nursing, unit leadership, intensive care physicians, infection prevention, nurse practitioners, vascular access team, and quality improvement utilized initial Plan-Do-Study-Act (PDSA) cycles to develop a rounding tool that identified threats to the CLABSI prevention bundle with patient-specific interventions to consider implementing. Weekly interdisciplinary rounds were then conducted on all central lines. Additional PDSA cycles focused on addressing unit-specific gaps in education and increasing awareness of best practices for central line care and maintenance. These included addition and delineation of space to separate clean and dirty supplies, hygiene supplementations to the care bundle, eRecord handoff updates, and both in-person and online educational offerings. Results: Preliminary data suggested a decrease in CLABSI rate during the initial 4-month intervention period (Fig. 1). The focus on central line care has also led to more consistent and robust observations for bundle compliance. In 2021, zero CLABSIs were noted for the initial 4 months after intervention contributing to a unit record of 243 days CLABSI-free. We would like to call attention to 2 points in Figure 1. Point two represents the initiation of weekly interdisciplinary CLABSI rounds. Point three represents 2 premature infants, atypical for unit census, on extracorporeal membrane oxygenation with hemodialysis catheters that required off-label use of Prismaflex. Conclusions: Engagement of a microsystem’s interdisciplinary team to focus efforts on identifying and addressing real-time concerns to central lines has led to a short-term decrease in CLABSI rate. Sustaining this decrease in CLABSIs will require continual reassessment of the effectiveness of strategies utilized. Additional PDSA interventions as a result of the weekly rounds are being investigated, including the use of antimicrobial sheets for high-risk patients, the creation of unit-specific prepackaged sterile central line dressing kits, and transitioning from alcohol to chlorohexidine scrubs for hub accessing.Fig

A simple algorithm for differential diagnosis in hemodynamic shock based on left ventricle outflow tract velocity–time integral measurement: a case series

Echocardiography has gained wide acceptance among intensive care physicians during the last 15 years. The lack of accredited formation, the long learning curve required and the excessive structural orientation of the present algorithms to evaluate hemodynamically unstable patients hampers its daily use in the intensive care unit. The aim of this article is to show 4 cases where the use of our simple algorithm based on VTI, was crucial. Subsequently, to explain the benefit of using the proposed algorithm with a more functional perspective, as a means for clinical decision-making. A simple algorithm based on left ventricle outflow tract velocity–time integral measurement for a functional hemodynamic monitoring on patients suffering hemodynamic shock or instability is proposed by Spanish Critical Care Ultrasound Network Group. This algorithm considers perfusion and congestion variables. Its simplicity might be useful for guiding physicians in their daily decision-making managing critically ill patients in hemodynamic shock.

Postoperative Intensive Care Management of Aortic Repair.

Vascular surgery patients have multiple comorbidities and are at high risk for perioperative complications. Aortic repair surgery has greatly evolved in recent years, with an increasing predominance of endovascular techniques (EVAR). The incidence of cardiac complications is significantly reduced with endovascular repair, but high-risk patients require postoperative ST-segment monitoring. Open aortic repair may portend a prohibitive risk of respiratory complications that could be a contraindication for surgery. This risk is greatly reduced in the case of an endovascular approach, and general anesthesia should be avoided whenever possible in the case of endovascular repair. Preoperative renal function and postoperative kidney injury are powerful determinants of short- and long-term outcome, so that preoperative risk stratification and secondary prevention are critical tasks. Intraoperative renal protection with selective renal and distal aortic perfusion is essential during open repair. EVAR has lower rates of postoperative renal failure compared to open repair, with approximately half the risk for acute kidney injury (AKI) and one-third of the risk of hemodialysis requirement. Spinal cord ischemia used to be the most distinctive and feared complication of aortic repair. The risk has significantly decreased since the beginning of aortic surgery, with advances in surgical technique and spinal protection protocols, and is lower with endovascular repair. Endovascular repair avoids extensive aortic dissection and aortic cross-clamping and is generally associated with reduced blood loss and less coagulopathy. The intensive care physician must be aware that aortic repair surgery has an impact on every organ system, and the importance of early recognition of organ failure cannot be overemphasized.

Surgical treatment of thoracoabdominal aortic pathology - retrospective study of 300 patients.

Thoracoabdominal aortic surgery is a technically demanding and extensive treatment that has its place in the era of endovascular techniques. To ensure the best possible outcomes, it requires a well-coordinated team of surgeons, anaesthetists, intensive care physicians and other medical staff. The authors present a series of 300 patients operated on between 1 January 2003 and 15 March 2022. Although the group included sporadic cases of severe obliterating involvement of the visceral aorta, patients with thoracoabdominal aortic aneurysms (TAAA) constituted the vast majority. All known organ preservation procedures were used during the operations. The thoraco-phreno-retroperitoneal approach was chosen in almost all TAAA cases; the thoraco-phreno-transperitoneal approach was used only in two reoperations. In this cohort, type II thoracoabdominal aneurysm according to Crawford classification was most common (33%). This was followed by type IV (32%), type III (15.3%), type I (8.7%), type V (6.7%) and other thoracoabdominal aortic procedures (4.3%). Thirty-day mortality rate was 9.6% (2019 - 6%, 2020 - 9.5%, 2021 - 3.8%) in this group; surgical postoperative complications occurred in 36 patients (12%). Neurological complications were reported in 16 cases (5.3%), of which postoperative paraplegia was noted 6 times (2%). Temporary postoperative dialysis due to renal insufficiency was performed in 19 patients (6.3%) and 4 patients (1.3%) have entered the chronic dialysis programme. In 67 patients (23.3%), temporary tracheostomy was done postoperatively due to prolonged withdrawal from the lung ventilator. Surgical treatment of the thoracoabdominal aorta is one of the most extensive procedures in vascular surgery and the mortality and morbidity rates still remain relatively high. A multidisciplinary approach, sufficient experience and a dedicated team are essential for a successful outcome of these highly specialised operations.

Genetics follow up after rapid genomic sequencing in intensive care: current practices and recommendations for service delivery.

The delivery of rapid genomic sequencing (rGS) to critically unwell children in intensive care occurs at a time of immense pressure and stress for parents. Contact with families after result disclosure, particularly after hospital discharge, presents an opportunity to meet their psychological, medical and information needs as they evolve. This study explores the preferences and perspectives of health professionals and parents of genetics follow up after rGS. Semi-structured interviews were conducted with 30 parents, seven genetic counsellors (GCs) and four intensive care physicians with experience in rGS. Transcripts were analysed using reflexive thematic analysis. Current practices surrounding genetics follow up after rGS were highly variable, resulting in some families not receiving the ongoing care they needed. Reasons identified by families for wanting follow-up care represented only a subset of those identified by health professionals. While GCs routinely provided their details to allow parents to initiate further contact, this was not always sufficient for follow-up care. Health professionals identified both organisational and psychosocial barriers to conducting follow up. As rGS transforms the diagnostic pathway in rare disease, there is a need for a co-designed, standardised but flexible model for follow-up care with genetics professionals so that families' evolving needs are met.

Using Gated Recurrent Unit Networks for the Prediction of Hemodynamic and Pulmonary Decompensation.

This paper presents a new medical severity scoring system, used to assess the risk of hemodynamic and pulmonary decompensation for patients being treated in intensive care units. The score presented here includes drug circulatory support and ventilation mode data for the evaluation of the patient's biosignals and laboratory values. It is shown that Gated Recurrent Unit-based neural networks are able to predict the maximal severity class within a 24 hour prediction time-frame (hemodynamic: 0.85 AUROC / pulmonary: 0.9 AUROC), and can estimate the underlying decompensation score for prediction times of up to 24 hours with mean errors of 6.3% of the maximal possible pulmonary, and 9.6% of the hemodynamic score. These results are based on 60h observation period. Clinical Relevance- Hemodynamic and pulmonary decom-pensation are life threatening dynamic events that can lead to death of patients. Early detection of these incidents is essential in order to intervene therapeutically and to improve survival chances. In everyday intensive care physicians are confronted with a vast number of laboratory values and vital parameters. There is a risk that early stages of hemodynamic and pulmonary decompensation are misjudged. The implementation of robust warning systems could support physicians in detecting these critical events and initiate therapeutical intervention in time which would achieve significant reduction of patient mortality.

The Pharmacist's Role in the Implementation of FASTHUG-MAIDENS, a Mnemonic to Facilitate the Pharmacotherapy Assessment of Critically Ill Patients: A Cross-Sectional Study.

FASTHUG is a mnemonic used by intensive care physicians to ensure the proper management of patients admitted to an Intensive Care Unit (ICU). FASTHUG-MAIDENS is a modified version that incorporates key pharmacotherapeutic elements such as delirium management, drug dosing, and drug interactions for an appropriate medication assessment of critically ill patients. An analytical cross-sectional study of hospitalized patients was carried out to determine aspects related to the pharmacotherapeutic management of critically ill patients that required to be optimized, to design and implement a protocol based on the FASTHUG-MAIDENS mnemonic. A total of 435 evaluations were performed to assess the status of current critical patient management. The main parameters with opportunities to be improved were analgesia, feeding, and sedation. With the implementation of MAIDENS, the parameters of analgesia, sedation, and thromboprophylaxis showed an increase in the percentage of optimal management. Furthermore, 103 drug-related problems were detected, and most of them were associated with feeding (21.3%), glucose control (11.7%), and delirium (9.7%). The FASTHUG MAIDENS protocol implementation allows for the evaluation of more vital aspects in the management of critically ill patients. The daily review of patients admitted to the ICU by a clinical pharmacist (CP) using the FASTHUG-MAIDENS checklist instead of the FASTHUG mnemonic facilitates the identification of DRPs for the performance of possible interventions by the CP to improve the pharmacotherapeutic management.

Neonatologist-Performed Cranial Ultrasonography in the Neonatal Intensive Care Unit

Cranial ultrasound (CUS) is an initial screening imaging tool used to evaluate the neonatal brain. It is an accessible, inexpensive, and harmless technique that can be used at bedside as frequently as required. Timely focused CUS in the neonatal care unit can play a major role in the diagnosis, follow-up, and management of brain damage. Despite the increasing use of point-of-care ultrasonography by intensive care physicians, neonatologist-performed CUS remains unusual. This review aims to provide an overview of neonatal CUS to neonatologists, focusing on the optimal settings, standard planes of the brain, and main pathologies in preterm infants. Adding Doppler studies allows evaluation of the patency of intracranial arteries and veins, flow velocities, and indices. This may provide an opportunity for earlier targeted circulatory support to prevent brain injury and improve long-term neurodevelopmental outcomes.

The use of ultrasound in ICU: the new stethoscope of intensive care physicians

The use of ultrasound in ICU: the new stethoscope of intensive care physicians

Mechanical ventilation associated pneumonia during ECMO therapy. A challenge for the Intensive Care physician

Mechanical ventilation associated pneumonia during ECMO therapy. A challenge for the Intensive Care physician