Intensive Care Unit Department Research Articles

Efficiency of therapeutic plasma exchange in critically ill systemic rheumatologic diseases: A single-center 9-year experience.

Therapeutic plasma exchange (TPE), an effective method to eliminate harmful soluble mediators associated with tissue injury, serves as a crucial intervention for systemic rheumatologic diseases (SRDs). However, its value in critically ill SRDs remains uncertain. This retrospective study aims to evaluate the efficacy of TPE in SRDs. Critically ill SRD patients admitted to the department of intensive care unit of a large tertiary hospital receiving TPE from January 2011 to December 2019 were included. A total of 91 critically ill SRD patients received TPE were enrolled. Their mean age was 47.67 ± 16.35 years with a female predominance (n = 68). Significant decrease in SOFA score post-TPE treatment was observed (p < 0.05). There were no TPE-related fatalities. Improvement was observed in 64 (70.32%) patients. This study shows favorable clinical outcomes. TPE may be an acceptable treatment option for critically ill SRD patients.

Inflammatory Biomarkers for Assessing In-Hospital Mortality Risk in Severe COVID-19-A Retrospective Study.

(1) Background: Our study aims to investigate the utility of inflammatory factors as prognostic indicators for disease severity and mortality in COVID-19 patients admitted to the Intensive Care Unit (ICU) Department of Pelican Clinical Hospital Oradea Romania. While elevated white blood cell (WBC) levels are associated with COVID-19 severity and mortality, they may not effectively predict the risk of death; (2) Methods: In our ICU department, we conducted assessments on the 10th and 14th days of COVID-19 patients' hospitalization, measuring the following markers: C-reactive protein (CRP) levels, procalcitonin (PCT) levels, granulocytes/lymphocytes (G/L) ratios, ferritin levels, age, and obesity status. We included a total of 209 eligible COVID-19 patients in the final analysis. Our goal was to identify biomarkers that could quickly identify high-risk patients with a potential for disease progression and mortality; (3) Results: Our study (a retrospective, single-center observational cohort study) demonstrated statistically significant differences in predicting mortality and disease severity based on G/L ratio (p < 0.0001), PCT (p < 0.0002), CRP (p < 0.0001), ferritin (p < 0.0001), age (p < 0.0001), and obesity (p < 0.0001); (4) Conclusions: Having a G/L ratio exceeding 20 units, along with elevated levels of PCR, PCT, and ferritin in older and obese patients on the 3rd day of ICU admission, represents significant risk factors for in-hospital mortality in severe COVID-19 patients.

Characteristics and outcomes of cancer patients admitted to intensive care units in cancer specialized hospitals in China

PurposeStandard intensive care unit (ICU) admission policies and treatment strategies for patients with cancer are still lacking. To depict the current status of admission, characteristics, and outcomes of patients with cancer in the ICU.MethodsA multicenter cross-sectional study was performed from May 10, 2021 to July 10, 2021, in the ICU departments of 37 cancer-specialized hospitals in China. Clinical records of all admitted patients aged ≥ 14 years and ICU duration > 24 h with complete data were included. Demographic information, clinical history, severity score at admission, ICU critical condition diagnosis and treatment, ICU and in-hospital outcomes and 90 days survival were also collected. A total of 1455 patients were admitted and stayed for longer than 24 h. The most common primary cancer diagnoses included lung, colorectal, esophageal, and gastric cancer.ResultsPatients with lung cancer were admitted more often because of worsening complications that occurred in the clinical ward. However, other cancer patients may be more likely to be admitted to the ICU because of postoperative care. ICU-admitted patients with lung or esophageal cancer tended to have more ICU complications. Patients with lung cancer had a poor overall survival prognosis, whereas patients with colorectal cancer appeared to benefit the most according to 90 days mortality rates.ConclusionPatients with lung cancer require more ICU care due to critical complications and the overall survival prognosis is poor. Colorectal cancer may benefit more from ICU management. This information may be considered in ICU admission and treatment strategies.

Study of the association between anemia and prognosis of moderate-to-severe traumatic brain injury

Objective: To investigate the impact of admission anemia on the prognosis of patients with moderate- to-severe traumatic brain injury (TBI). Methods: The clinical data of patients with moderate-to-severe TBI treated in the Department of Intensive Care Unit in our hospital from January 2020 to September 2022 were retrospectively analyzed. The patients were divided into admission non-anemia group (Hb ≥ 100 g/L) and admission anemia group (Hb&lt;100 g/L) based on hemoglobin (Hb) levels. The Glasgow Coma Scale (GCS) score, first blood analysis, arterial blood gas, blood pressure, injury mechanism, pupillary reflex at admission and others were compared, multivariate logistic was used to analyse independent risk factors for patient death. Results: One hundred and nine patients were included in the study, of which 17 died in the hospital and 52 had anemia at admission. Compared with patients in the admission non-anemia group, patients in the admission anemia group were younger, had lower admission GCS and trauma score (PTS) scores, higher mortality rates, and longer hospital stay (all P&lt;0.05).Univariate analysis showed that moderate-to-severe TBI patients with admission anemia, admission hyperglycemia, GCS&lt;8, PTS&lt;8, abnormal pupillary reflex, and other organ injuries had higher mortality rates (all P&lt;0.05) .Multivariate logistic regression analysis showed that admission anemia (OR=9.383, 95% CI=1.086~81.094, P=0.042), admission pupillary reflex abnormalities (OR=23.121,95% CI=3.680~145.270,P=0.001), and admission hyperglycemia (OR=15.181, 95% CI=2.019~114.160, P=0.008) are independent risk factors for death of Moderate-to-severe TBI patients. Conclusions: Admission anemia is an independent risk factor for death of moderate-to-severe TBI patients, and it can prolong the length of hospital stay for such patients.

Correlation between diaphragmatic-rapid shallow breathing index and lung ultrasound score in elderly patients with mechanical ventilation and its predictive value for weaning results

To investigate the correlation between diaphragmatic-rapid shallow breathing index (D-RSBI) and lung ultrasound score (LUS) in elderly patients with mechanical ventilation and its predictive value for weaning results. A retrospective study was conducted. The clinical data of elderly patients (age > 60 years old) with invasive positive pressure ventilation (IPPV) admitted to the department of intensive care unit (ICU) of the First Affiliated Hospital of Jinzhou Medical University from January 2021 to June 2022 were enrolled. According to the outcome of withdrawal, the patients were divided into successful and failed groups. The differences in gender, age, acute physiology and chronic health evaluation II (APACHE II), D-RSBI and LUS before weaning and extubation were compared between the two groups. Pearson correlation was used to analyze the correlation between D-RSBI and LUS. The predictive value of D-RSBI and LUS on weaning results of elderly patients with IPPV was analyzed by receiver operator characteristic curve (ROC curve). A total of 398 elderly patients with IPPV were enrolled, including 300 successful weaning patients and 98 failed weaning patients. There were no significant differences in gender and age between the failed group and successful group [male: 55.1% (54/98) vs. 59.0% (177/300), age (years old): 67.02±5.03 vs. 66.96±4.99, both P > 0.05]. APACHE II score in the failed group was significantly higher than that in the successful group (17.09±3.30 vs. 16.06±3.81, P < 0.05), and the D-RSBI and LUS score before extubation were significantly higher than those in the successful group [D-RSBI (time×min-1×mm-1): 2.19±0.33 vs. 1.60±0.22, LUS: 17.30±3.04 vs. 11.97±3.20, both P < 0.01]. All patients showed a significant positive correlation between D-RSBI and LUS score (r = 0.406, P = 0.000). ROC curve analysis showed that the area under the curve (AUC) of D-RSBI for predicting weaning outcomes in elderly IPPV patients was 0.920, with a 95% confidence interval (95%CI) of 0.881-0.958 and P = 0.000. When the cut-off value was 1.85 times×min-1×mm-1, the sensitivity was 88.7% and the specificity was 86.7%. The AUC of LUS score for predicting weaning outcome in elderly IPPV patients was 0.875, with a 95%CI of 0.839-0.912 and P = 0.000. When the cut-off value was 14.50, the sensitivity was 75.7% and the specificity was 84.7%. There is a significant correlation between D-RSBI and LUS score in elderly mechanically ventilated patients, both of them can predict weaning outcome in elderly patients with mechanical ventilation.

Changes in Early T-Cell Subsets and Their Impact on Prognosis in Patients with Sepsis: A Single-Center Retrospective Study.

To analyze the early changes in CD3+, CD4+, and CD8+T-cell subset counts in patients with sepsis and their correlation with prognosis to provide a feasible basis for clinical immunomodulation in sepsis. This is a single-center retrospective study. The study enrolled sepsis patients (meeting SEPSIS 3.0 definition) who were admitted to the Department of Intensive Care Unit at the First Hospital of Jilin University from July 5th, 2018 to December 5th, 2019 and were aged 18 years or above. In addition, these patients underwent cellular immune testing (CD3+, CD4+, CD8+ T lymphocyte counts, and CD4+/CD8+ ratio) within 24 hours of ICU admission. Patient's clinical data including age, gender, infection site, APACHE II score, SOFA score, length of ICU stay, mechanical ventilation time, ICU mortality, 28-day mortality, and 3-year survival status were collected. The prognostic indicators and survival of the decreased and nondecreased groups of different subsets of T lymphocyte counts and CD4+/CD8+ ratio were compared. A total of 206 patients were enrolled, with 76.7% having a decrease in CD3+ T lymphocyte count, 76.7% having a decrease in CD4+ T lymphocyte count, and 63.6% having a decrease in CD8+ T lymphocyte count. Furthermore, 21.8% had a lower CD4+/CD8+ ratio. Analysis showed that the CD3+ T lymphocyte count decreased group had a longer length of ICU stay [11 d (4, 21) vs. 7 d (4, 17), P=0.03], increased percentage of mechanical ventilation (67.5% vs. 51.0%, P=0.04), and extended mechanical ventilation time [144 h (48, 360) vs. 96 h (48, 144), P=0.04] compared to the nondecreased group. The 28-day mortality was higher in the decreased group of CD4+/CD8+ ratio compared to the nondecreased group (33.3% vs. 25.5%, P=0.29); however, the difference did not reach statistical significance. Logistic regression analysis revealed no significant correlation between the decrease in CD4+/CD8+ ratio and 28-day mortality (P=0.11). The 3-year follow-up revealed that the CD4+/CD8+ decreased group had a lower survival rate than the nondecreased group (33.3% vs. 53.4%, P=0.01). In the early stage of sepsis, most patients showed a decrease in CD3+, CD4+, and CD8+T-cell subsets, as well as in the CD4+/CD8+ ratio. The decrease in CD3+ and CD4+/CD8+ was related to some poor prognosis.

Interleukin-36 is overexpressed in human sepsis and IL-36 receptor deletion aggravates lung injury and mortality through epithelial cells and fibroblasts in experimental murine sepsis

BackgroundSepsis is defined as a life-threatening syndrome caused by an unbalanced host response to infection. The role of interleukin (IL)-36 cytokines binding to the IL-36 receptor (IL-36R) in host response during sepsis remains unknown.MethodsSerum IL-36 level was measured in 47 septic patients sampled on the day of intensive care unit (ICU) and emergency department admission, 21 non-septic ICU patient controls, and 21 healthy volunteers. In addition, the effects of IL-36R deletion on host inflammatory response in cecal ligation and puncture (CLP)-induced polymicrobial sepsis was determined.ResultsOn the day of ICU and emergency department admission, the patients with sepsis showed a significant increase in serum IL-36 levels compared with ICU patient controls and healthy volunteers, and the serum IL-36 levels were related to the severity of sepsis. Non-survivors of septic patients displayed significantly lower serum IL-36 levels compared with survivors. A high serum IL-36 level in ICU and emergency department admission was associated with 28-day mortality, and IL-36 was found to be an independent predictor of 28-day mortality in septic patients by logistic regression analysis. Furthermore, IL-36R deletion increased lethality in CLP-induced polymicrobial sepsis. Septic mice with IL-36R deletion had higher bacterial load and demonstrated more severe multiple organ injury (including lung, liver, and kidney) as indicated by clinical chemistry and histopathology. Mechanistically, IL-36R ligands released upon lung damage activated IL-36R+lung fibroblasts thereby inducing expression of the antimicrobial protein lipocalin 2. Moreover, they induced the apoptosis of lung epithelial cells.ConclusionsSeptic patients had elevated serum IL-36 levels, which may correlate with disease severity and mortality. In experimental sepsis, we demonstrated a previously unrecognized role of IL-36R deletion in increasing lethality.

SARS-CoV-2 infection during pregnancy - single-center retrospective study.

The SARS-CoV-2 virus infection has spread to almost all countries in the last two years. Pregnancy complicated with COVID-19 is a unique situation and challenge for doctors. The study aimed to evaluate obstetric results, and biochemical test results and to analyze the treatment used in pregnant patients complicated with COVID-19 infection. A retrospective analysis of 146 pregnant patients hospitalized at the Department of Obstetrics and Perinatology Jagiellonian University Medical College (JUMC) in Krakow was conducted from July 2020 to August 2021. In the analyzed group respiratory failure occurred in 19.19% of cases and intravascular coagulation syndrome (DIC) in 1.37%. One patient died (0.68%). 16.6% of cases were transferred to the Intensive Care Unit (ICU) and required intubation. The remaining cases were mild: 39.04% were asymptomatic, 41.78% reported cough, 30.82% dyspnoea and 23.97% myalgia. In the laboratory tests increased values of CRP and IL-6 were observed with normal levels of leukocytes. Additionally, a decreased level of total protein and an increased level of d-dimers were detected. 98.63% of patients received a prophylactic dose of low molecular weight heparin. 46.58% of cases needed additional antibiotic therapy. Cesarean sections were performed in 59.59% of cases. The children were born in good general condition. Vertical transmission of SARS-CoV-2 to the newborn has not been confirmed. Data from the above study show a significant effect of COVID-19 on pregnant patients. Almost one in five pregnant women occurred respiratory failure and most of them had to be transferred to the ICU department and had to be intubated.

Adult patients with tetanus in Anhui Province of China from 2013 to 2022: A retrospective study.

Tetanus is a highly fatal infectious disease with an incubation period of 7 to 8 days. The aim of this study was to identify risk factors for death in tetanus patients, develop a nomogram model for predicting mortality risk. This retrospective study included tetanus patients who were admitted to the intensive care unit department between January 2013 and December 2022. The patients were divided into 2 groups based on their final outcome, namely death group and survival group. Risk factors associated with mortality were analyzed using univariate and multivariate logistic regression analysis. Finally, a nomogram model was developed using the rms package. A total of 91 patients were enrolled in this study, including 54 males and 37 females. The average age of the tetanus patients was 52.88 ± 16.56 years, with a mean incubation period of 8.51 ± 3.97 days. The foot was the most common injury site (42.86%), and metal product stabbing was the leading cause of injury (48.78%). Ventilator-associated pneumonia was the most frequent complication (21.98%). Univariate and multivariate logistic regression analyses revealed that Ablett classification (odds ratio [OR], 21.999; 95% confidence interval [CI], 4.124-117.352), white blood cell count (OR, 6.033; 95%CI, 1.275-28.552), and autonomic nervous dysfunction (OR, 22.663; 95%CI, 4.363-117.728) as independent risk factors for tetanus patients. The C-index of the nomogram model was 0.942, with an area under the curve of the receiver operating characteristic curve at 0.942 (95%CI, 0.871-0.905). Ablett classification, white blood cell count, autonomic nervous dysfunctions were associated with the prognosis of patients with tetanus. The nomogram model developed based on risk factors has high accuracy.

The effect of increased positive end expiratory pressure on brain tissue oxygenation and intracranial pressure in acute brain injury patients

Cerebral hypoxia is an important cause of secondary brain injury. Improving systemic oxygenation may increase brain tissue oxygenation (PbtO2). The effects of increased positive end-expiratory pressure (PEEP) on PbtO2 and intracranial pressure (ICP) needs to be further elucidated. This is a single center retrospective cohort study (2016–2021) conducted in a 34-bed Department of Intensive Care unit. All patients with acute brain injury under mechanical ventilation who were monitored with intracranial pressure and brain tissue oxygenation (PbtO2) catheters and underwent at least one PEEP increment were included in the study. Primary outcome was the rate of PbtO2 responders (increase in PbtO2 > 20% of baseline) after PEEP increase. ΔPEEP was defined as the difference between PEEP at 1 h and PEEP at baseline; similarly ΔPbtO2 was defined as the difference between PbtO2 at 1 h after PEEP incrementation and PbtO2 at baseline. We included 112 patients who underwent 295 episodes of PEEP increase. Overall, the median PEEP increased form 6 (IQR 5–8) to 10 (IQR 8–12) cmH2O (p = 0.001), the median PbtO2 increased from 21 (IQR 16–29) mmHg to 23 (IQR 18–30) mmHg (p = 0.001), while ICP remained unchanged [from 12 (7–18) mmHg to 12 (7–17) mmHg; p = 0.42]. Of 163 episode of PEEP increments with concomitant PbtO2 monitoring, 34 (21%) were PbtO2 responders. A lower baseline PbtO2 (OR 0.83 [0.73–0.96)]) was associated with the probability of being responder. ICP increased in 142/295 episodes of PEEP increments (58%); no baseline variable was able to identify this response. In PbtO2 responders there was a moderate positive correlation between ΔPbtO2 and ΔPEEP (r = 0.459 [95% CI 0.133–0.696]. The response in PbtO2 and ICP to PEEP elevations in brain injury patients is highly variable. Lower PbtO2 values at baseline could predict a significant increase in brain oxygenation after PEEP increase.

Short-term survival survey and risk factors analysis of death in sepsis patients in intensive care unit

To analyze the 28-day survival status and influencing factors of adult patients with sepsis, providing reference for early diagnosis of sepsis prognosis and reducing sepsis mortality. A retrospective cohort study was conducted. A total of 160 adult patients with sepsis in the department of intensive care unit of the 940th Hospital of Joint Logistic Support Force of PLA from January 2021 to December 2022 were enrolled. The general information, laboratory examination results within 24 hours after admission, clinical treatment measures, and prognosis of patients were collected. Univariate analysis and binary multivariate Logistic regression were performed to screen the risk factors that might affect the short-term prognosis of patients with sepsis. Receiver operator characteristic curve (ROC curve) was plotted to analyze the predictive value of various risk factors on the short-term death risk of sepsis patients. A total of 160 patients with sepsis were enrolled, of whom 91 survived in 28 days, and 69 died with a mortality of 43.12%. Compared with the survival group, the patients in the death group were older, more severe, had higher blood lactic acid (Lac) level, and had more complications such as hypertension and multiple organ dysfunction syndrome (MODS). A total of 22 related factors were statistically significant: age, acute physiology and chronic health evaluation II (APACHE II) score, sequential organ failure assessment (SOFA) score, length of hospital stay, Lac, interleukin-6 (IL-6), fibrinogen (FIB), international normalized ratio (INR), ratio of prothrombin time (PT) to healthy people, prothrombin activity (PTA), PT, thrombin time (TT), oxygenation index (PaO2/FiO2), aspartate aminotransferase (AST), ratio of AST to alanine amninotransferase (ALT), serum creatinine (SCr), blood urea nitrogen (BUN), site of infection, history of hypertension, concurrent MODS, implementation of continuous renal replacement therapy (CRRT), and treatment with vasoactive drugs. Combined with the results of the univariate analysis, variables that might affect the short-term prognosis of septic patients were included in the multivariate Logistic regression analysis. The results showed that APACHE II score ≥ 20 [odds ratio (OR) = 1.106, 95% confidence interval (95%CI) was 1.003-1.219], Lac ≥ 5 mmol/L (OR = 1.430, 95%CI was 1.041-1.964), combined with hypertension (OR = 13.879, 95%CI was 1.082-178.016), concurrent MODS (OR = 98.139, 95%CI was 18.252-527.672) was an independent risk factor for 28-day death in adult septic patients (all P < 0.05). ROC curve analysis showed that the combination of the four indicators including APACHE II score, Lac, combined with hypertension, concurrent MODS, had predictive value for short-term outcomes in patients with sepsis. The area under the ROC curve (AUC) was higher than that of the 4 indicators alone [AUC (95%CI): 0.952 (0.918-0.986) vs. 0.745 (0.670-0.820), 0.816 (0.748-0.883), 0.608 (0.518-0.699), 0.868 (0.810-0.927)], the sensitivity was 94.2%, and the specificity was 90.1%. APACHE II score within 24 hours, Lac, combined with hypertension, and concurrent MODS are independent risk factors for short-term mortality in adult septic patients in ICU. The combination of these indicators can make meaningful early clinical judgments on the short-term prognosis of septic patients, thereby reducing the mortality.

Evaluating the Performance of Inpatient Wards in Hospitals Affiliated with Birjand University of Medical Sciences Using the Pabon-Lasso Model in the Years before and during the COVID-19 Pandemic

Background: Evaluating the performance of hospitals will increase effectiveness, efficiency, and quality of services provided and improves responding to the customer. Performance indicators are the most widely used tools for measuring the performance of hospitals. The prevalence of Covid-19 pandemic has affected health care systems at various levels with significant implications for health, the economy, and social structures. Therefore, the present study evaluates the performance of inpatient wards of hospitals affiliated with South Khorasan University of Medical Sciences in the years before and during the COVID-19 pandemic.&#x0D; Methods: The current study was cross-sectional, which was conducted during the years before (2018-2019) and during the outbreak of COVID-19 (2020-2021). The research population included all inpatient departments of hospitals affiliated with Birjand University of Medical Sciences (28 departments). The performance of services was analyzed using data collection form, and through the Pabon Lasso model, the efficiency of the hospital was analyzed. Excel 2018 was used to draw Paben Lasso diagram, describe the data, and check the process of change. Service performance and change process before and during the COVID-19 pandemic were examined using SPSS22 software and Paired sample t-test statistical test (The significance level was determined at 0.05).&#x0D; Results: The results of this study showed that in the years before and during the COVID-19 pandemic, the functional ratios of bed occupancy percentage decreased by 29.20 %, the average patient stay increased by 6.90 %, and the annual bed turnover rate decreased by 32.80%. The results of paired sample t-test with a significance level of 0.05 showed that there was a significant relationship regarding the internal wards and CCU (Coronary Care Unit) between 3 functional indicators: bed occupancy percentage, bed turnover rate and average patient stay; there was no significant relationship in the burn ward. After examining the wards of kidney and urinary tract surgery, ear, nose and throat surgery, orthopedics, psychiatry, pediatrics, infectious diseases, general surgery, open heart ICU (Intensive Care Unit), neurosurgery, and cardiovascular surgery, 2 functional indicators of bed occupancy percentage and bed turnover rate, in the ICU ward, the functional index of the percentage of bed occupancy, and in the neonatal wards, the NICU (Neonetal Intensive Care Unit), the average length of patient stay showed a significant relationship. After examining the efficiency of the wards, the number of efficient districts changed from 32.14 to 28.57 %, and the number of inefficient districts changed from 25 to 28.57 %. Moreover, positive changes in the efficiency status of the open heart and neonatal ICU departments and negative changes in the efficiency status of the pediatric, internal, psychiatric, and infectious wards were observed in the target period.&#x0D; Conclusion: With the arrival of COVID-19 pandemic, service performance and efficiency in hospitals affiliated with South Khorasan province decreased due to limited services to patients. During the years under study, on average, less than one third (30.36%) of hospital wards in the region were efficient, and had good performance; therefore, continuous periodic evaluation is recommended for policy makers to exploit the available resources using the Pabon Lasso model or other models.

Acid-Base Status &amp; Electrolyte Imbalance in Critically ill Ventilated Infants

Introduction: Children who are critically ill typically suffer from a disease process that impacts many organ systems. To improve the outcome, these children are treated in a pediatric intensive care unit. The primary focus of intensive care medicine is the care of patients who are facing immediate life-threatening conditions. The aim of this study was to determine the acid- base status &amp; electrolyte imbalance in critically ill ventilated infants. Methods: This was a prospective observational study and was conducted in the Department of Intensive Care Unit (ICU) of Bangladesh Shishu Hospital &amp; Institute, Dhaka, Bangladesh during the period from January 2020 to December 2020. In our study, we included 50 critically ill ventilated young infants in ICU of Bangladesh Shishu Hospital &amp; Institute. Results: In our study, we found that almost three fourth (74.0%) patients died and 13(26.0%) patients survived. Majority of our patients were ≤ 15 days and male. We found 22(59.5%) patients had PH level &lt;7.25 in death group and 6(46.2%) in survival group and PH level ≥7.15 was (81.1%) in death group and 10(76.9%) in survival group. Before extubation &amp; death metabolic acidosis was 19(51.4%) in dead group and 2(15.4%) in survival group. Significant relation was found between serum sodium level &lt;135 and outcome of ventilated patients [p=0.039, OR=0.19(0.04-0.89)]. Imbalance of single &amp; more than one electrolyte was found 43.24% &amp; 56.76% in death group and 61.5% &amp; 38.5% in survival group respectively. Conclusion: We found that arterial blood gas analysis &amp; serum electrolytes level provide valuable information for correction of acid–base imbalance associated with a pathological condition. Electrolyte imbalance, regardless of the basic disease etiology, is a significant prognostic indicator that must be rapidly treated in critically ill children to get a good outcome.

The efficacy of negative pressure wound therapy for surgical site infections and delayed wound healing in intensive care unit department of ha noi heart hospital from 2020 to 2021

Objective: Describe the clinical characteristics and the results of negative pressure wound therapy for surgical site infections and delayed wound healing.&#x0D; Methods: A descriptive, cross-sectional study was conducted between May, 2020 and May, 2021 to evaluate the effectiveness of negative pressure wound therapy among patients with delayed surgical wound healing and wound infection in intensive care unit department of Ha Noi Heart hospital.[1]&#x0D; Results: From May 2020 to May 2021, we studied a total of 15 patients with delayed wound healing and surgical wound infection using negative pressure wound therapy. Among them, there are 9 women (60%), 6 men (40%), The majority of patients was over the age of 60 (86.7%). After you have used VAC, 13/15 cases the wound was improved (86.7% proportion). VAC therapy over the wound was administered for an average of 9,4 days.&#x0D; Conclusion: Vacuum-Assisted Wound Closure Therapy is a reliable and safe option for patients with postoperative surgical site infections and delayed wound closure to help reduce hospital length of stay, improves financial and clinical outcomes.

Impact of qSOFA Score on the Outcome of Patients in ICU with Respiratory Tract Infection

Abstract Background The quick Sequential Organ Failure Assessment (qSOFA) score is a bedside prompt that may identify patients with suspected infections who are greater risk for poor outcome in the intensive care unit (ICU). Objectives To assess the impact of qSOFA score on the outcome of patients in ICU with respiratory tract infection. Patients and Methods This Observational prospective study study carried out at ICU department of Ain Shams University Hospitals and Al Mahala Chest Hospital during the period from 1 February 2020 till March 2021 and included 122 patients presented by respiratory infection. Diagnosis of infection based on clinical, laboratory, radiological and/or microbiological evidence in accordance with guidelines for diagnosis of infection. All patients subjected to full history, physical examination, full laboratory tests (including arterial blood gas, complete blood cell with differentiation, international normalized ratio, kidney function tests, liver function tests, random blood sugar, C-reactive protein, erythrocyte sedimentation rate, serum sodium and serum potassium), chest X-ray and/or computerized tomography of chest, sputum cytological analysis and sputum culture. Measurement of qSOFA done in all patients. Results The median of qSOFA score in survivors was 0 while in nonsurvivors 1 at admission and after 48 hours with a significant difference between both groups. In overall patients qSOFA cutoff 1 has sensitivity and specificity 70% &amp; 80.37%, respectively. Conclusion The qSOFA scores were associated with in hospital mortality, hospital admission, ICU admission, and hospital length of stay in patients likely to be admitted both with and without suspected infection, qSOFA is an easy tool that can be used to predict outcomes.

Predictors of Mortality among Ventilated Young Infants in Intensive Care Unit of a Tertiary Care Hospital

Introduction: The management of children with invasive ventilation in developing countries with limited resources is challenging. A large number of infants in intensive care unit require mechanical ventilation due to various conditions and have a high mortality. Aim of the study: To identify the predictors of mortality among ventilated young infant up to 2 months age in Intensive Care Unit of Bangladesh Shishu Hospital &amp; Institute. Methodology: The prospective observational study was conducted in the Department of Intensive Care Unit of Bangladesh Shishu Hospital &amp; Institute, from January 2020 to December 2020. Critically ill young infants upto 2 months age who required mechanical ventilation in Intensive Care Unit were included in this study. Data was collected on a structured proforma and included the basic demographic profile, presenting complaints, preliminary diagnosis, investigation results, mode of ventilation and initial ventilator parameters &amp; hospital stay and outcome. Permission from ethical review committee of the hospital was taken. Results: From 50 critically ill patients, mortality rate was 74.0%. Mean age was 14±10.1 days. Significant relation was found between the ventilated patients having FiO2, PIP, PEEP, HCO3, BE, serum sodium level, duration of ventilation and outcome respectively. Severe respiratory distress before death was found significantly related with outcome. Metabolic acidosis was found significant in death patients before ventilation and before death (75.7% &amp; 51.4%). Conclusion: The rate of mortality in the ICU was high. Initial high PIP, low HCO3, severe respiratory distress and prolong duration of ventilation (&gt;5days) were significant independent predictors of mortality.

Prevalence of extended-spectrum β-lactamase and carbapenem-resistant Klebsiella pneumoniae in clinical samples.

To assess the prevalence of these resistant strains in the overall isolates of Klebsiella pneumoniae (K. pneumoniae) in hospital settings. This retrospective study was conducted from November 2020 to November 2021. The identification and antibiotic susceptibility testing were performed using standard laboratory methods according to the EUCAST standards. The detection of ESBL and carbapenemase production was performed using phenotypic methods such as E-test, combined-disk test with various inhibitors (ROSCO Diagnostica A/S), chromogenic medium for the detection of ESBL/carbapenemase-producing Enterobacteriaceae (CPE) isolates, and the VITEK 2 Compact system (BioMerieux). 944 isolates of K. pneumoniae were detected in various clinical specimens. Among these, ESBL-producing strains were detected in 349/944 (37%), whereas carbapenem- resistant strains in 188/944 (20%) of the isolates. The remaining isolates (407/944 [43%]) belonged to the wild type. ESBL isolates were the most common in wound swabs (138 [39.5%]), whereas CRKP isolates in screening samples (110 [58.5%]). The majority of ESBL isolates were detected in surgical departments (105 [30.1%]), whereas CRKP isolates in adult intensive care unit departments (79 [42.%]). Our results show an increasing frequency of CRKP strains. This presents a significant issue in terms of infection prevention and control in hospital settings.

Frequency of Ventilator Associated Pneumonia in Patientsof ContinuousFeed versus Bolus Enteral Feed

Objective: To determine the frequency of ventilator associated pneumonia in continuous feed vs bolus enteral feeding. Study Design: Comparative cross sectional study. Place and Duration of Study: Department of intensive care unit, Services Hospital, Lahore and Services Institute of Medical Sciences, Lahore Pakistan, from Jan to Jun 2019. Methodology: In this study the cases of both genders with age more than 18 years were enrolled. Patients with Previous History of gastroesophageal reflux disease, Hiatus Hernia, Esophageal &amp; Abdominal Surgery, Gastrointestinal Bleed and those admitted already with Pneumonia, APACHE Score 20 or greater and those with Acute respiratory distress syndromewere excluded. The cases admitted in intensive care unit and requiring mechanical ventilation fulfilling inclusion and exclusion criteria were enrolled in this study. Continuous feed was offered to cases in Group A and bolus to those in B andwere looked for development of ventilator associated pneumonia. Results: In this study, eighty cases (40 per Group) were enrolled. There were 26(65%) vs 25(62.5%) males in Group A and B respectively. The mean age was 51.85±12.61 vs 51.48±10.92 with p=0.88 in Group A and B. Mean ICU stay in Group A and B was 6.40±5.07 and 5.50±2.63 (p=0.32). Ventilator associated pneumonia was observed in 4(10%) vs 6(15%) cases in Group A and B respectively (p=0.74). Mean time for development of ventilator associated pneumonia in Group A and B was 4.67±1.15vs 4.80±1.09 day with p= 0.60. Conclusion: Ventilator associated pneumonia was seen more in cases of bolus vs continuous fee

Design and application of decompression fixator to prevent HFNC facial pressure injury

As a new respiratory support technique, high-flow nasal cannula oxygen therapy (HFNC) has been widely used in clinical practice in recent years. During HFNC treatment, due to the long time and continuous wearing of nasal stopper and fasteners on the patient face, it is easy to cause medical device-related pressure injury on multiple facial skin. Moreover, when the patient's position changes greatly, because there is no good fixed design at the HFNC nasal stopper, it is easy to shift or turn the nasal stopper outward, causing abnormal ventilation and failure to achieve the purpose of clinical oxygen therapy. To overcome above problems, medical staff in the intensive care unit of department of infectious diseases, Tongji Hospital Tongji Medical College of HUST designed a new type of decompression fixator to prevent HFNC face pressure injury, and obtained national utility model patent (ZL 2022 2 0754626.1). The integrated design structure of the device has the functions of decompression of facial skin and fixation of nasal stopper, which can ensure the effect of oxygen therapy and improve the oxygen therapy experience and patient comfort, which is suitable for clinical promotion.

Incidence and trends of nosocomial infection in a tertiary general hospital in China from 2018 to 2021: a retrospective observational study.

This study aimed to investigate the current status and changing trend of nosocomial infection in a tertiary general hospital in China, to provide a reference for the prevention and control of healthcare-associated/acquired infection (HAI). A retrospective investigation of the clinical data of HAI patients in Dongying People's Hospital in China from January 1, 2018, to December 31, 2021, was carried out. The incidence of HAI in different units and sites, distribution of pathogenic microorganisms, and antimicrobial use were investigated. The incidence of HAI was 0.93%. It was on the rise from 2018 to 2020 but declined in 2021. The departments with the highest rate of HAI were the Intensive Care Unit (ICU), neurosurgery department, cardiothoracic surgery department, and hematology department. HAI often occurs in the lower respiratory tract, urinary tract, and in blood. The most common pathogenic microorganisms in cases of HAI were Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, and Staphylococcus aureus. The rate of bacterial culture delivery for therapeutic drugs has increased from year to year. This study shows that the incidence of HAI in the hospital is generally low. Gram-negative bacteria are still the main source of HAI. The rate of bacterial culture delivery for therapeutic use improved over the years and has gradually been standardized. It is necessary to focus on the management of HAI in the ICU, neurosurgery, cardiothoracic surgery, and hematology departments.