Hospital Intensive Care Unit Research Articles

Acute Renal Failure in the Pediatric Intensive Care Unit: Incidence and Its Effects on Clinical Outcomes

Background: Renal dysfunction is a prevalent complication among patients admitted to intensive care units (ICUs), significantly impacting patient outcomes. Objectives: This study focuses on assessing the incidence of acute renal failure (ARF) in pediatric patients hospitalized in ICUs, exploring its occurrence and associated effects on patient outcomes. Methods: A prospective observational study was conducted to examine the incidence of ARF in pediatric patients admitted to a tertiary pediatric hospital's intensive care unit (PICU) in Iran from September 2019 to August 2020. Patients who developed ARF during their ICU stay were included in the study. Clinical and laboratory data were systematically collected upon admission and on a daily basis thereafter. This data collection aimed to elucidate differences in etiology, disease severity, and clinical practices, and to ascertain their impact on patient outcomes. Results: Out of 1145 pediatric ICU admissions, 4.3% experienced acute renal failure during their hospitalization. Of the 49 affected patients, information was available for 46 individuals, constituting the final analysis cohort. The staging of renal failure was categorized as follows: Stage I (45.7%), Stage II (19.6%), and Stage III (34.8%). Acute tubular necrosis emerged as the predominant cause of acute kidney injury (60.8%). The mortality rate among these patients was notably high at 39.1%, compared to the general PICU mortality rate of 7.1% during the study period. Non-survivors exhibited a higher prevalence of antibiotic use, particularly aminoglycosides and antifungal drugs. Additionally, resuscitation procedures were more frequently documented among non-survivors. Conclusions: Approximately 4.3% of pediatric ICU patients develop acute renal failure, with half of the cases manifesting within the initial 24 hours of hospitalization. Acute tubular necrosis stands out as the primary cause of acute kidney injury. A substantial proportion of patients (39.1%) succumb to the condition, particularly those subjected to resuscitation efforts or prescribed multiple antibiotics and antifungal drugs during hospitalization.

Exploring the thalamus L-sign: initial findings and associations with white matter injury in premature infants

BackgroundThe thalamus L-sign, characterized by damage to the lateral and posterior parts of the thalamus, has recently been identified as a potential marker of partial prolonged hypoxic-ischemic injury (HII). Although prematurity-related thalamic injury is well documented, its association with the thalamus L-sign is infrequently described.ObjectiveThe primary objective of this study was to further investigate the thalamus L-sign in premature birth and white matter injury.Materials and methodsA retrospective analysis of 246 brain magnetic resonance imaging (MRI) scans from preterm infants born before 37 weeks of gestation was conducted to explore the occurrence, characteristics, and associations of the thalamus L-sign with white matter injury.ResultsThe L-sign was detected in 12.6% of patients with periventricular leukomalacia (PVL), primarily in severe cases (57.9% of severe PVL). All cases were associated with posterior parieto-occipital PVL. Four patients exhibited unilateral or asymmetric L-signs, which were linked to high-grade intraventricular hemorrhage (IVH) or periventricular hemorrhagic infarction on the ipsilateral side, with the most severe white matter injury occurring on that side. No significant differences were observed regarding gestational age at birth, duration of neonatal intensive care unit hospitalization, percentage of IVH, hypoglycemia, or jaundice between patients with moderate-to-severe PVL with and without the thalamus L-sign.ConclusionThe thalamus L-sign may serve as a marker for severe parieto-occipital PVL and may be exacerbated and appear asymmetric in cases of ipsilateral IVH or periventricular hemorrhagic infarction.Graphical

The evaluation of the quality of life in survivors of critical illness after discharge from Intensive Care Unit (ICU): A prospective cohort study

Background: Admission to the Intensive Care Unit (ICU) constitutes a substantial psychophysical burden for patients and their relatives. Individuals who are critically ill and receive care in the ICU frequently exhibit numerous physical and mental issues stemming from the primary ailment, its complications, and subsequent treatments. Aim: This study aimed to assess the quality of life (QoL) for ICU patients in the first and third month after ICU discharge and identify any issues arising from their ICU hospitalization. Method and Material: This was a prospective cohort study. The study participants were adult medical or surgical patients admitted to ICUs in three public hospitals in the region of Attica in Greece, from August 2020 to December 2021. The short form (SF)-36 was used to measure QoL. Data collection was performed through telephone interviews during the first and third month after ICU discharge. Results: The study included 43 patients. The mean age was 59.63±13.06 years. The average value of the two main categories in the 1st month was: Physical health: 53.72 ± 15.92, and Mental health: 69.03 ± 26.02, while in the 3rd month, it was 62.42 ± 20.45 and 72.81 ± 16.47, respectively. The duration of mechanical ventilation, high-flow oxygen therapy, and spontaneous breathing in days seemed to be correlated with the “Physical Functioning”, “Pain”, and “Limitation of the role due to Physical health” subscales of SF-36, respectively (p-value <0.05). The total length of hospitalization seemed to have a statistically significant weak negative correlation with "Physical Function" and "Physical Health" subscales (p-value<0.05). Conclusions: An improvement in patients’ QoL was demonstrated three months after discharge from the ICU.

Evaluation of Serum Procalcitonin as a Diagnostic and Prognostic Biomarker for Sepsis in Major Burn Patients: A Prospective Study

Abstract Background Sepsis in burns worsens the patient’s prognosis and increases the risk of organ failure and death. Multiple organ dysfunction syndrome (MODS), which is a direct response to sepsis is the main reason for death in burn patients. Identifying early sepsis is very important, given that every 6 h delay in the diagnosis of sepsis reduces survival by 10%. Complexity in diagnosing sepsis in the burn is due to the systemic response to the burn itself clinically simulating sepsis. Aim of the Work The aim of this study is: To investigate the diagnostic validity of PCT in burn sepsis as an early diagnostic tool and to identify its prognostic value in major burn patients with sepsis. Patients and Methods The study was a prospective study carried out in the Burn Intensive Care Unit (ICU) of Ain Shams University Hospitals on 30 patients that were admitted from October 2021 to April 2022 with major burn (more than 20% of TBSA) were included and the Local Ethics Committee approved the study, and informed consent was obtained from all participants or their guardians. Results It had been revealed that the first 3 samples have no significant increase in PCT levels in relation to sepsis. However, the following 2 samples which had been withdrawn on day 5 show a significant increase in PCT levels, and these on day 7 on admission are highly significant with a median (IQR) range of 9 ng/dl and median (IQR) range of 13.2 ng/dl respectively. Moreover, it had been noted that the PCT level on admission was significant for the prognosis of death with a median (IQR) range of 1.65 ng/dl while in survivor patients the median was 0.45 ng/dl. Conclusion Our study demonstrated that PCT level in major burn patients is a promising diagnostic biomarker in detecting sepsis that could facilitate ideal management and initiate proper antimicrobial therapy and good prognostic value as an early predictor of mortality.

173 Pressure Sores in Spinal Patients Admitted to Intensive Care - a Retrospective Observational Study

Abstract Aim Spinal patients in the intensive care unit (ICU) have a high risk of developing pressure sores due to factors such as immobilisation and collar use. In a collaboration between the spinal surgery department and the ICU at a tertiary care hospital, this study aimed to assess the prevalence of pressure sores in spinal patients in the ICU as well as potential risk factors, to establish any required changes to patient care. Method NHS-mandated DATIX reports for all pressure sores in ICU were cross-referenced with a list of all spinal patients admitted to ICU between January 2018 and August 2022 (4-and-a-half years). We included pressure sores such as occipital, sacral, clavicular, hips. Exclusions were sores categorised below Grade 2 and those caused by intubation such as lips or mouth. Results 97 patients were included and fifteen (15.5%) developed grade 2 or above pressure sores in ICU. Admission age, days spent in hospital and days in ICU were significantly greater in those who developed pressure sores compared to those who did not (all P < 0.05). Advanced respiratory support time was also greater in those who developed pressure sores (P < 0.05). Conclusions Just over 1 in 7 spinal patients in the ICU developed pressure sores and clinicians should be aware of the potential risks for mutual benefits of patient comfort and the NHS cost burden. However, in comparison to other studies reporting percentages of 19.1% and 37.5%, the department appears to be doing comparatively well in preventing pressure sores.

Safety and Efficacy of N-Acetylcysteine as an Adjuvant Therapy in Critically Ill COVID-19 Patients

Abstract Background COVID-19 may cause pneumonia, acute respiratory distress syndrome, cardiovascular alterations, and multiple organ failure, which have been ascribed to a cytokinestorm, a systemic inflammatory response, and an attack by the immune system. Moreover, an oxidative stress imbalance has been demonstrated to occur in COVID- 19 patients. N- Acetyl-L-cysteine (NAC) is a precursor of reduced glutathione (GSH). Aim of the Work we retrospectively will investigate safety and efficacy of NAC dose given in paracetamol toxicity as an adjuvant therapy in critically ill COVID-19 patients with acute respiratory distress and determine whether NAC in high doses can avoid respiratory failure in patients with COVID-19. Patients and Methods This was a retrospective observational study in which all cases were collected from ICU of Ain shams university hospitals during COVID-19 outbreak. All data were extracted from clinical records. All patients initially admitted to ICU with SPO2 less than 94 % were included between December 2020 to February 2022. Exclusion Criteria included Need for immediate mechanical ventilation on admission, known allergy or hypersensitivity to NAC, end stage renal and liver diseases, heart failure and pregnancy. All patients with severe COVID-19 (confirmed or suspected received standard care, according to the institutional protocol. Results Patients were randomized into two equal groups (number (n)=40 each) as the N1(NAC) group who was given intravenously, initially 150 mg/kg in 200 mL of 0.9% NaCL for 60 minutes (first bag), followed by 50 mg/kg in 500 mL of 0.9% NaCL for 4 hours (second bag), and then 100 mg/kg in 1000 mL of 0.9%NaCL for 16 hours (third bag) and N2(Non NAC) group who received intravenously N-acetylcysteine (NAC) 600mg /12hr and The primary endpoint was the need for mechanical ventilation. Secondary endpoints were time of mechanical ventilation, admission to the intensive care unit (ICU), time in ICU, and mortality. There were no statistically significant differences between the two groups (p > 0.05) The effect of NAC on mechanical ventilations, mortality, ICU stays, and hospital stays is a matter of controverse in ARDS patients. We found that intravenous high dose of NAC did not improve oxygenation, mortality rate and did not reduce the requirement for mechanical ventilation when administered for COVID 19 patients with ARDS. Also, the duration of ICU and hospital stays were relatively prolonged in the NAC-treated patients. These might be due to prolonged survival time with NAC-treated patients, but not to be detected with the small single centered trial.. Conclusion Use of high doses of NAC administration can not affect the need of mechanical ventilation, rate of mortality, the need, duration of ICU admission and hospital stays for patients with severe COVID-19.

Effectiveness of decision aids on critically ill patients' outcomes and family members' knowledge, anxiety, depression and decisional conflict: A systematic review and meta-analysis.

Decision aids (DAs) have been proposed to support patients and families with disease information processing and decision-making, but their effectiveness for critically ill patients and their families is incompletely understood. To systematically synthesize evidence on the effectiveness of the DAs on the prognosis of critically ill patients and knowledge, anxiety, depression and decisional conflict of their family members. Systematic review and meta-analysis. We conducted a systematic search of literature using PubMed, Embase, Cochrane Library, Web of Science, Cumulative Index to Nursing and Allied Health Literature database, Scopus, PsycNet, CNKI and Wanfang Database from the inception of the databases until May 2023 to identify randomized clinical trials (RCTs) describing DAs interventions targeted at adult intensive care unit (ICU) patients or their families. We also searched grey literature in four databases: Chinese Clinical Trials Registry, Chinese Cochrane Center, Open Grey and GreyNet International. Seven RCTs were included in the review. Meta-analysis identified longer hospital length of stay (LOS) among all patients compared with usual care (mean difference [MD] = 5.64 days, 95% confidence interval, CI [0.29, 10.98], p = .04), but not in surviving patients (MD = 2.09 days, 95% CI [-3.70, 7.89], p = .48). However, there was no evidence of an effect of DAs on hospital mortality (RR = 1.25, 95% CI [0.92, 1.70], p = .15), ICU LOS (MD = 3.77 days, 95% CI [-0.17, 7.70], p = .06) and length of mechanical ventilation (MD = 0.88 days, 95% CI [-2.22, 3.97], p = .58). DAs led to a statistically significant improvement in family members' knowledge (standard mean difference = 0.84, 95% CI [0.12, 1.56], p = .02). We found no significant effect of DAs on anxiety, depression, post-traumatic stress disorder, decisional conflict and quality of communication of family members. This review provides effective evidence that DAs can potentially improve the knowledge level of family members while prolonging the hospital LOS among critically ill patients. Well-designed large-scale studies with DAs tailored to the individuals' preferences and existing cultural values are warranted.

Ultrasound Diaphragmatic Assessment as a Predictor of Successful Non-Invasive Mechanical Ventilation in Patients with Acute Exacerbation COPD: an Observational Study

Abstract Background Non-invasive ventilation (NIV) is successful as first-line treatment for patients admitted to hospital with hypercapnic respiratory failure due to AECOPD. Significant diaphragmatic muscle dysfunction (DD) exits in different disease-related and physiological conditions, including COPD. Ultrasonography is considered as a non- invasive and bedside method and commonly applied in intensive care unit (ICU) to assess diaphragmatic function. Objective To demonstrate the value of diaphragmatic ultrasound assessment for patients with AECOPD undergoing NIMV. Patients and Methods A population of 24 consecutive patients with AECOPD admitted to Ain Shams University Hospitals’ Intensive Care units (ICU) were enrolled. Change in diaphragmatic thickness fraction (ΔDTF) < 20% and diaphragm excursion< 10 mm during tidal volume was the predefined cut-off for identifying DD. Correlations between ΔDTF < 20%, diaphragm excursion< 10 mm and NIV failure and other clinical outcomes were investigated. Results 24 cases with AECOPD, 33.3% of them (8 cases) had diaphragm dysfunction (DD+) but after NICPAP 2 cases improved and only 6 cases remain with DD and 16 Patients without DD (DD−). DD+ patients had a higher risk for NIV failure than DD−patients (p < 0.011), and this finding was significantly associated with higher in-hospital, and 30-day mortality rates; longer mechanical ventilation duration; higher tracheostomy rate; and longer ICU stay. Conclusion AECOPD patients with diaphragmatic dysfunction as diagnosed by US showed higher incidence of NIMV failure, longer MV, ICU length of stay, In- hospital mortality, ICU and MV duration were significantly longer in group with DD. Insignificant difference was found considering mortality after 30 days in patients with or without diaphragm dysfunction.

D-Dimer as a Predictor of Disease Outcome in Intensive Care SARS-COV-2 Patients: A Retrospective Study

Abstract Background The novel coronavirus, designated SARS-COV-2, has caused a pandemic of respiratory illness termed coronavirus disease 2019 (COVID-19). One of the key issues has been the very high number of patients presenting to hospitals that clearly overwhelms the capacities available, especially the need for critical care support. Therefore, early and effective predictors of clinical outcomes has been urgently needed for risk stratification of COVID-19 patients. Objective To evaluate the value of D-dimer blood levels on intensive care unit (ICU) admission as a predictor of disease severity and mortality in COVID-19 ICU admitted patients. Patients and Methods The current study included the records of 465 patients who were admitted to Ain Shams University isolation hospitals ICU during the time period between 1/1/2021 and 1/6/2021. Results There are many studies that have tried to correlate between D dimer levels and COVID-19 outcome. by comparing these studies we find that the value of D-dimer levels as a predictor of disease outcome is quite obvious. Trying to find opposing literature to the previous findings is a difficult process as the great majority of the literature that tried to link D-dimer levels to COVID -19 outcomes have eventually come to the same conclusion which is proving that there is a significant relationship between D-dimer levels and disease outcome and that morbidity and mortality risk increases with elevated D-dimer levels. Conclusion In COVID-19 patients, D-dimer levels on admission to ICU and 48 hours afterwards can be a reliable indicator of the disease prognosis as high D-dimer levels are associated with increased need for mechanical ventilation and mortality with cutoff values 1.39 for initial D-dimer and 1.02 for D-dimer level after 48 hours.

Unmasking the escalation: a comparative analysis of diabetic ketoacidosis severity before and during the COVID-19 pandemic in a Tunisian pioneer study

ABSTRACT Background The severity of diabetic ketoacidosis (DKA) at diagnosis increased during the global COVID-19 pandemic. This study aimed to analyze the impact of the pandemic on the clinical and biological severity of DKA in patients with new-onset diabetes mellitus (DM) in Tunisia. Research design and methods The study included patients hospitalized for new-onset DKA 2 years prior and 2 years during the COVID-19 pandemic. Data was collected retrospectively, and DKA severity was classified based on biological parameters like potential of hydrogen (pH) and HCO3-. Results The results showed that DKA was more severe during COVID-19, as evidenced by lower potential of hydrogen (pH) (p = 0.006), and serum bicarbonate (HCO3-) levels (p = 0,005). Despite the higher severity of DKA was higher during COVID-19, intensive care unit hospitalizations remained equivalent (p = 0.359). The prevalence of hyponatremia was also higher during COVID-19 (p = 0.024). Conclusion The findings suggest that delayed diagnosis and COVID-19 May contribute to the increased severity of DKA and electrolyte imbalance during the pandemic. Further research is needed to better understand the underlying mechanisms and develop appropriate strategies to address this issue.

Baricitinib and Pulse Steroids Combination Treatment in Hyperinflammatory COVID-19: A Rheumatological Approach in the Intensive Care Unit.

Hyperinflammatory Coronavirus disease 2019 (COVID-19) and rapidly-progressive interstitial lung diseases (RP-ILD) secondary to inflammatory myopathies (IIM) present important similarities. These data support the use of anti-rheumatic drugs for the treatment of COVID-19. The aim of this study was to compare the efficacy of combining baricitinib and pulse steroids with the Standard of Care (SoC) for the treatment of critically ill COVID-19 patients. We retrospectively enrolled consecutive patients admitted to the Intensive Care Unit (ICU) with COVID-19-pneumonia. Patients treated with SoC (dexamethasone plus remdesivir) were compared to patients treated with baricitinib plus 6-methylprednisolone pulses (Rheuma-group). We enrolled 246 patients: 104/246 in the SoC and 142/246 in the Rheuma-group. All patients presented laboratory findings suggestive of hyperinflammatory response. Sixty-four patients (26.1%) died during ICU hospitalization. The mortality rate in the Rheuma-group was significantly lower than in the SoC-group (15.5 vs. 40.4%, p < 0.001). Compared to the SoC-group, patients in the Rheuma-group presented significantly lower inflammatory biomarker levels after one week of treatment. Higher ferritin levels after one week of treatment were strongly associated with mortality (p < 0.001). In this large real-life COVID-19 cohort, baricitinib and pulse steroids led to a significant reduction in mortality, paralleled by a prompt reduction in inflammatory biomarkers. Our experience supports the similarities between hyperinflammatory COVID-19 and the IIM-associated RP-ILD.

Major functions and importance of dental surgeons in the hospital environment and intensive care units: a concise systematic review

Major functions and importance of dental surgeons in the hospital environment and intensive care units: a concise systematic review

Operative and non-operative treatment of injury to solid abdominal organs in adult patients: a single center experience.

In major trauma, lesions of the parenchymatous organs are subject of a controversy as regards the choice between an operative management (OM) in the operating room and a non-operative management (NOM) associated or not with angiography/angioembolization (AG/AE). Retrospective study of all consecutive data of patients coded as "traumatic pathology" in the period between 2011 and 2021. Were enrolled 13740 entries of adult patients with abdominal injuries, including at least: either hepatic or splenic or renal injury of AAST-OIS I. The primary outcome was to establish the rate of efficacy, respectively of OM and NOM. The secondary outcome is to analyze General (CG) and Specific (CS) complications, mean ward and intensive care unit (ICU) hospital stays. One hundred sixty-two patients were included with 89 splenic injuries, 70 hepatic and 50 renal lesions; 35 treated with OM and 127 with NOM±AG/AE. The CGs registered in OM patients are seven (20%); seven SCs (20%); four GCs+SCs (11.4%). The average hospital stay was 24.91 days; mean ICU hospital stay of 10.74; five deaths. The CGs registered are 22 (17%); 12 SCs (9.4%); three GCs+SCs (2.3%). Average hospital stays 18 days; mean ICU hospital stay of 3.15; 6 deaths. Failure of the NOM strategy was recorded in nine patients with a success rate of 92.91%. In OM the presence of numerous high-grade lesions leads to a rapid stabilization. The NOM has reduced the hospital stay and UTI hospitalization in a feasible and safe way in selected CT.

Development and Validation of a Risk Mortality Prediction Model for Patients with Pulmonary Tuberculosis Complicated by Severe Community-Acquired Pneumonia in the Intensive Care Unit.

The mortality rate from pulmonary tuberculosis (PTB) complicated by severe community-acquired pneumonia (SCAP) in the intensive care unit (ICU) remains high. We aimed to develop a rapid and simple model for the early assessment and stratification of prognosis in these patients. All adult patients with PTB complicated by SCAP admitted to the ICU of a tertiary hospital in Chengdu, Sichuan, China between 2019 and 2021 (development cohort) and 2022 (validation cohort) were retrospectively included. Data on demographics, comorbidities, laboratory values, and interventions were collected. The outcome was the 28-day mortality. Stepwise backward multivariate Cox analysis was used to develop a mortality risk prediction score model. Receiver operating characteristic (ROC) and calibration curves were used to evaluate the model's predictive efficiency. Decision curve analysis (DCA) was used to validate the model's clinical value and impact on decision making. Overall, 357 and 168 patients were included in the development and validation cohorts, respectively. The Pulmonary Tuberculosis Severity Index (PTSI) score included long-term use of glucocorticoid, body mass index (BMI) <18.5 kg/m2, diabetes, blood urea nitrogen (BUN) ≥7.14 mmol/L, PO2/FiO2 <150 mmHg, and vasopressor use. The area under the ROC curve (AUC) values were 0.817 (95% CI: 0.772-0.863) and 0.814 for the development and validation cohorts, respectively. The PTSI score had a higher AUC than the APACHE II, SOFA, and CURB-65 score. The calibration curves indicated good calibration in both cohorts. The DCA of the PTSI score indicated the high clinical application of the model compared with the APACHE II and SOFA scores. This prognostic tool was designed to rapidly evaluate the 28-day mortality risk in individuals with PTB complicated by SCAP. It can stratify this patient group into relevant risk categories, guide targeted interventions, and enhance clinical decision making, thereby optimizing patient care and improving outcomes.

Psychological Stress in Parents Delivering Preterm Child and Effects of Psychological Intervention on Them

Background: Mothers and fathers may experience negative emotions as a result of an unusual early delivery and giving birth to high-risk newborns who require hospitalization in the neonatal intensive care unit (NICU) adds layers of stress on them. Hence, a variety of psychological and emotional services are required. Aim: The aim of this study was to identify common stressors in both parents of preterm children in the NICU and determine the effect of psychological intervention in the form of acceptance and commitment therapy (ACT) on stress in both parents. Materials and Methodology: A total of 60 parents of preterm children were randomly assigned to Intervention Group A and Control Group B. Group A received five sessions of ACT and routine counseling, while Group B received only routine nursing staff counseling. The Parental Stress Scale: Neonatal Intensive Care Unit (PSS: NICU) was used for pre- and postassessments to measure the parents’ stress levels on the 1st and 5th days, respectively. Results: Mothers’ stress levels in the NICU are significantly higher when they have a higher socioeconomic status, a higher education level, and a length of stay of more than 6 days, but significant stress is not found in fathers. ACT, when used along with routine counseling, is effective in reducing stress in both parents. Conclusion: ACT can be combined with routine counseling to help parents cope with depression, anxiety, and stress associated with preterm birth in the NICUs.

ACUTE LYMPHOBLASTIC LEUKEMIA IN CHILDREN HOSPITALIZED IN THE INTENSIVE CARE UNIT: A RETROSPECTIVE ANALYSIS

Relevance: The most common pediatric malignancy is acute lymphoblastic leukemia (ALL), with a prevalence of 4.2 per 100,000 children. Some patients diagnosed with ALL will require hospitalization in intensive care units (ICU) at some point in their treatment. The study aimed to identify significant clinical and laboratory parameters in prognosis to identify indicators of clinical deterioration in children with ALL and develop a scale for early detection of precursors of critical illness in children with ALL. Methods: This retrospective study included inpatient medical records of all patients (0-18 years old) diagnosed with ALL and hospitalized in the intensive care unit (ICU) for oncohematological patients at the Scientific Center for Pediatrics and Pediatric Surgery (Almaty, Kazakhstan). The study period was three years – 2020 to 2022. Results: The clinical and laboratory parameters of children with ALL were analyzed a day before admission to the ICU since those patients demonstrated worsening clinical status. This window of time was chosen to allow us to understand what were the precursors of early deterioration in children with ALL before hospitalization in the ICU. Study data were collected before hospitalization in the ICU during admission to the ICU, and there is data at transfer from the ICU depending on the outcome of the disease. During the study period, 188 patients with ALL were admitted to the ICU. Leukopenia and neutropenia were present in 60-80% of the patients, and elevated leukocyte count was observed in 30-40%, while normal leukocyte count was only 10%-20%. CRP and procalcitonin levels were elevated, showing the presence of inflammation. Conclusions: Based on the retrospective analysis of the data, it can be said that the presented data are harbingers of critical conditions in children with ALL. Neurological, respiratory, cardiac, renal, and other parameters are important for patient treatment and management.

Ultrasound Assessment of Changes on the Lungs during Respiratory Distress Syndrome in Newborns with Low Body Weight

Introduction: Respiratory distress syndrome (RDS) is a common pathology of premature newborns and one of the most common causes of hospitalization in intensive care units, as well as mortality among them. Aims of Study: To study the possibilities of ultrasound imaging for respiratory distress syndrome of varying severity in premature newborns. Patients and Methods: Lung Ultrasound was performed in 72 premature infants in whom an X-ray diagnosis of RDS was established. Results: In accordance with the radiological data of RDS I degree diagnosed in 13 (18,1±4,5%) patients, RDS II degree – in 31 (43,0±5,8%), RDS III degree – in 19 (26,4±5,2%) and RDS IV degree – in 9 (12,5±3,9%) premature infants. The results of lung ultrasound and chest x-ray in the diagnosis of stage I and IV RDS coincided in all cases. Moreover, the correlation coefficient between them had a high degree (0.924 and 0.950, respectively). Ultrasound revealed stage II RDS in 21 out of 31 preterm infants diagnosed by radiography. By ultrasound of the lungs, stage III RDS was diagnosed in 4 more premature infants than by X-ray (23 and 19). Conclusions: 1. The integrated use of lung ultrasound and chest X-ray significantly improves the quality of diagnosis and monitoring of lung lesions in premature infants with RDS with a significant reduction in radiation exposure to the patient. 2. Ultrasound is particularly useful for monitoring established radiographic lung pathology (eg, RDS, pneumonia) to reduce radiation exposure.

Six-year evaluation of device-associated nosocomial infections in intensive care units.

Invasive device-associated nosocomial infections commonly occur in intensive care units (ICUs). These infections include intravascular catheter-related bloodstream infection (CRBSI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infection (CAUTI). This study aimed to evaluate the factors associated with invasive device-associated nosocomial infections based on the underlying diseases of the patients and antibiotic resistance profiles of the pathogens causing the infections detected in the ICU in our hospital over a five-year period. Invasive device-associated infections (CRBSI, VAP, and CAUTI) were detected retrospectively by the laboratory- and clinic-based active surveillance system according to the criteria of the US Centers for Disease Control and Prevention (CDC) in patients hospitalized in the ICU of the tertiary hospital between 1 January 2018 and 30 June 2023. A total of 425 invasive device-associated nosocomial infections and 441 culture results were detected (179 CRBSI, 176 VAP, 70 CAUTI). Out of them, 57 (13.4%) patients had hematological malignancy, 145 (34.1%) had solid organ malignancy, and 223 (52.5%) had no histopathologic diagnosis of any malignancy. An increase in extended-spectrum beta lactamase (ESBL) and carbapenem resistance in pathogens was detected during the study period. Antibiotic resistance of the Gram-negative bacteria associated with invasive device-associated infections increased during the study period. Antimicrobial stewardship will reduce rates of nosocomial infections, reduce mortality, and shorten hospital stay. Long-term catheterization and unnecessary antibiotic use should be avoided.

Persistent Residual Lung Abnormalities (PRLAs) as Post COVID Lung Sequel in Recovered Severe Pneumonia Case with Lung Function Abnormality at Two Year Follow Up

Coronavirus related (SARS-CoV-2) global pandemic has caused significant mortality and morbidity globally in the last three years. Although, pandemic has waned since last year, we are not in great peace of relief due to lingering effects of COVID-19 persisted even after two years of illness. Radiological phenotypes are radiological patterns or observable characteristics of COVID-19 pneumonia. Radiological outcomes are initially interpreted as post covid lung fibrosis in short term follow-up of recovered COVID-19 cases in post covid care settings and during long term evaluation these abnormalities are defined as post covid sequalae’s. In present case report, 38-year male, presented in outdoor unit for shortness of breath on exertion with history of severe COVID-19 Pneumonia resulted into acute respiratory distress syndrome with hospitalization in intensive care unit one year back and required high flow nasal cannula (HFNC) with Non-invasive ventilatory support (NIV) for two weeks. He was offered oxygen supplementation at home with antibiotics for three months and no requirement of oxygen and some respiratory symptoms even after one year. His HRCT thorax documented at one year of discharge from hospital revealed typical interstitial opacities labelled as Persistent Residual lung abnormalities (RLAs) which are predominantly reticular and linear opacities in peripheral parts of lungs without honeycombing within typical pleural based areas with parenchymal bands and minimally altered lung architecture and preserved lung volume.

Gut colonization with multidrug resistant organisms in the intensive care unit: a systematic review and meta-analysis

BackgroundGut colonization with multidrug-resistant organisms (MDRO) frequently precedes infection among patients in the intensive care unit (ICU), although the dynamics of colonization are not completely understood. We performed a systematic review and meta-analysis of ICU studies which described the cumulative incidence and rates of MDRO gut acquisition.MethodsWe systematically searched PubMed, Embase, and Web of Science for studies published from 2010 to 2023 reporting on gut acquisition of MDRO in the ICU. MDRO were defined as multidrug resistant non-Pseudomonas Gram-negative bacteria (NP-GN), Pseudomonas spp., and vancomycin-resistant Enterococcus (VRE). We included observational studies which obtained perianal or rectal swabs at ICU admission (within 48 h) and at one or more subsequent timepoints. Our primary outcome was the incidence rate of gut acquisition of MDRO, defined as any MDRO newly detected after ICU admission (i.e., not present at baseline) for all patient-time at risk. The study was registered with PROSPERO, CRD42023481569.ResultsOf 482 studies initially identified, 14 studies with 37,305 patients met criteria for inclusion. The pooled incidence of gut acquisition of MDRO during ICU hospitalization was 5% (range: 1–43%) with a pooled incidence rate of 12.2 (95% CI 8.1–18.6) per 1000 patient-days. Median time to acquisition ranged from 4 to 26 days after ICU admission. Results were similar for NP-GN and Pseudomonas spp., with insufficient data to assess VRE. Among six studies which provided sufficient data to perform curve fitting, there was a quasi-linear increase in gut MDRO colonization of 1.41% per day which was stable through 30 days of ICU hospitalization (R2 = 0.50, p < 0.01).ConclusionsAcquisition of gut MDRO was common in the ICU and increases with days spent in ICU through 30 days of follow-up. These data may guide future interventions seeking to prevent gut acquisition of MDRO in the ICU.