Intensive Care Unit Patients Research Articles

Effect of an intensive care unit virtual reality intervention on relatives´ mental health distress: a multicenter, randomized controlled trial

BackgroundRelatives of intensive care unit (ICU) patients often endure symptoms of post-traumatic stress, anxiety, and depression during and after treatment of a family member’s hospitalization. The aim of this study was to evaluate the effect of ICU-specific virtual reality (ICU-VR) on mental health among relatives, 6 months after patient’s ICU discharge.MethodsThis multicenter, randomized controlled trial included relatives of ICU patients who were assigned to receive either standard care or standard care plus ICU-VR, by randomizing the ICU patients. Relatives were assessed up to 6 months after patient discharge from the ICU for post-traumatic stress, anxiety, depression, quality of life, relatives’ understanding of ICU care, and appreciation of ICU-VR.ResultsOne hundred relatives of 81 patients and 89 relatives of 80 patients were randomized to the intervention and control groups, respectively. Relatives’ median age was 48 years and 53% were female. Compared to the control group, relatives who received ICU-VR did not experience a decrease in post-traumatic stress (23% vs. 18%; p = 0.99), anxiety (22% vs. 30%; p = 0.35), or depression (17% vs. 23%; p = 0.44). There was no significant difference between median mental quality of life (50.2 vs. 52.6; p = 0.51), physical quality of life (56.1 vs. 54.3; p = 0.16), or understanding of ICU care between groups. Patients in the intervention group highly endorsed ICU-VR (90%), favoring it over traditional informational brochures and the majority (82%) stated it improved their understanding of ICU treatment.ConclusionICU-VR did not significantly improve mental health distress symptoms among relatives 6-months after a patient’s discharge. Relatives highly endorsed ICU-VR and self-reported that it improved their understanding of ICU treatment.

A Study to Assess the Practical Challenges Faced by Nursing Staff Towards Care of Critically Ill Obese Patients in the Adult Intensive Care Unit of a Tertiary Care Teaching Hospital of Jaipur, Rajasthan

Obesity is a rising global health challenge, particularly in critical care settings where nursing staff face unique difficulties in managing critically ill obese patients. This study assesses the practical challenges encountered by nursing staff in the Adult Intensive Care Unit (ICU) of a tertiary care teaching hospital in Jaipur, Rajasthan. Employing a descriptive cross-sectional research design, the study identifies physical, emotional, and logistical challenges, alongside resource inadequacies and training gaps. Results indicate significant physical strain, emotional stress, and resource deficits, emphasizing the need for specialized bariatric equipment, training, and systemic administrative support. The findings inform actionable strategies to enhance patient care quality and improve nurses' well-being. Keywords: Obesity, Intensive Care Unit, Nursing Challenges, Bariatric Care, Critical Care, Resource Allocation

The prevalence of thromboembolic events among COVID-19 patients admitted to a single centre intensive care unit (ICU): an epidemiological study from a Malaysian population.

Thromboembolic (TE) complications in COVID-19 patients are rising globally, contributing significantly to mortality, particularly in severe cases. However, their prevalence, characteristics, and impact on mortality in Malaysia remain unclear. This study aimed to determine the prevalence of thromboembolic (TE) events and associated mortality among COVID-19 patients admitted within a single centre intensive care unit (ICU). The proportions of patients with TE events who died, and factors associated with TE events were explored. In this retrospective cohort study, patients with PCR confirmed SARS-CoV-2 virus and who received thromboprophylaxis within February 2020-2021 were included. TE event is a combination of venous [(deep vein thrombosis (DVT), pulmonary embolism (PE)] and arterial (myocardial infarction (MI), stroke) thromboembolism. Mean (SD) age 56.6 (13.7), 63.5% were male, 61.6% Malays, median (IQR) 7 (3-14) days of ICU stay, 64.2%, 53.2% and 20.9% had underlying hypertension, diabetes and obesity respectively. In total, 240 (44.9%) developed TE event. Significantly higher proportions of COVID-19 patients who developed complications of DVT (2.5% vs. 0.2%; p = 0.013), PE (47.5% vs 34.0%; p = 0.006), stroke (12.3% vs. 1.5; p<0.001) and MI (16.4% vs. 4.6%; p<0.001) died. Predictors of TE events were age [HR 1.01 (95% CI 1.00-1.02)], obesity [HR 1.98 (95% CI 1.51-2.6)], D-dimer [HR 1.01 (95% CI 1.00-1.01)], and duration of ICU stay [HR 0.98 (95% CI 0.97-0.99)]. In severely ill COVID-19 patients, TE complications were common, and patients with DVT, PE, stroke, or MI faced increased mortality, even with thromboprophylaxis. Age, obesity, elevated D-Dimer levels, and longer ICU stays were significant predictors of TE events. Considering these findings, a more aggressive approach, combining thromboprophylaxis with enhanced anti-inflammatory treatments, may be necessary for high-risk COVID-19 ICU patients to reduce TE events and mortality.

Ventilator-Associated Pneumonia in Intensive Care Units: A Comparison of Pre-Pandemic and COVID-19 Periods

Background/Objectives: The COVID-19 pandemic has significantly increased the burden of ventilator-associated pneumonia (VAP) in intensive care units (ICUs) globally. However, epidemiological data on VAP in Slovak ICUs, particularly in the context of the pandemic, remain limited. This study aimed to evaluate the incidence, microbial profiles, and risk factors of VAP in Slovak ICU settings, particularly during the COVID-19 pandemic. Methods: A retrospective analysis of VAP data was conducted for respiratory intensive care unit (ICU) patients in a Slovak university hospital, comparing data from the pre-pandemic and pandemic periods. The CDC/NHSN definitions for VAP were applied, and statistical analyses were performed using STATISTICA 13.1. Results: A total of 803 patients were analyzed, representing 8385 bed days and 5836 mechanical ventilator days. VAP rates increased significantly during the pandemic by 111%, from 8.46 to 17.86 events per 1000 MV days (p &lt; 0.001). VAP rates in non-COVID-19 patients increased by 86% during the pandemic compared to pre-pandemic levels. Pandemic conditions also increased ICU mortality from 25.66% to 40.52% (p &lt; 0.001). VAP was identified as a critical determinant of ICU mortality, contributing to a 21.62% higher mortality rate among patients during the pandemic. Younger age, prolonged mechanical ventilation, and medical (vs. surgical) hospitalizations were associated with higher VAP incidence. Gram-negative bacteria dominated the pathogen profiles, with significant increases observed in Pseudomonas aeruginosa (183%), Klebsiella pneumoniae (150%), and Acinetobacter spp. (100%). Conclusions: The COVID-19 pandemic has significantly affected the incidence and epidemiology of VAP in Slovak ICUs, highlighting systemic vulnerabilities in HAI surveillance and IPC practices.

Upgrading Renal Replacement Therapy Machines in the ICU: A Comparative Observational Study of Heparin vs. Regional Citrate Anticoagulation

BACKGROUND: Continuous renal replacement therapy (CRRT) requires effective anticoagulation to prevent circuit clotting. This study compared heparin and regional citrate anticoagulation (RCA) in an Intensive Care Unit (ICU), focusing on patient safety, cost-effectiveness, and nursing perspectives. METHODS: This retrospective observational study included ICU patients undergoing CRRT with heparin (December 2021 - March 2022) and RCA (June 2022 - September 2022). Outcomes assessed were CRRT duration per patient, filter set cost, lifespan, and blood transfusion requirements. Data were extracted from electronic health records and analyzed using IBM SPSS Statistics Version 29. RESULTS: RCA significantly increased CRRT duration per patient (198 vs. 101 hours, p = 0.037) and filter lifespan (67 vs. 24 hours, p &lt; 0.001) compared to heparin. Filter cost per renal day decreased from £98.05 with heparin to £57.48 with RCA (p = 0.04). Blood transfusion requirements reduced from 0.59 to 0.27 transfusions per renal day, lowering daily transfusion costs from £84.96 to £39.58 with RCA. CONCLUSION: RCA demonstrated clinical and economic benefits in CRRT compared to heparin, including improved filter longevity, reduced transfusion requirements, and overall cost savings. CLINICAL SIGNIFICANCE: Implementation of RCA in CRRT can enhance treatment efficacy, reduce nursing interventions, and improve resource utilization in ICU settings.

Regional cerebral oxygen saturation during initial mobilization of critically ill patients is associated with clinical outcomes: a prospective observational study

BackgroundVital signs help determine the safety of early mobilization in critically ill patients in intensive care units. However, none of these variables directly assess cerebral circulation. Therefore, we aimed to investigate the relationship of regional cerebral oxygen saturation (rSO2) and vital signs with in-hospital death in critically ill patients.MethodsThis prospective study included critically ill patients admitted to the Uonuma Kikan Hospital Emergency Center who received physical therapy between June 2020 and December 2022. We continuously measured rSO2 during the initial mobilization using a wearable brain near-infrared spectroscopy device. With in-hospital death as the primary endpoint, the association between rSO2 and in-hospital death was assessed in Analysis 1 to determine the rSO2 cut-off value that predicts in-hospital death. In Analysis 2, patients were categorised into survival and non-survival groups to examine the temporal changes in vital signs and rSO2 associated with postural changes during mobilization.ResultsOf the 132 eligible patients, 98 were included in Analysis 1, and 70 were included in Analysis 2. Analysis 1 demonstrated that lower premobilization rSO2 was independently associated with in-hospital death (odds ratio 0.835, 95% confidence interval 0.724–0.961, p = 0.012). Receiver operating characteristic curve analysis identified an optimal rSO2 cut-off value of 57% for predicting in-hospital death (area under the curve 0.818, sensitivity 73%, specificity 83%). Analysis 2 showed that rSO2 changes during mobilization were unrelated to changes in vital signs, suggesting rSO2 as an independent prognostic marker.ConclusionsThe results suggest that rSO2 measured during initial mobilization is associated with in-hospital death in critically ill patients.

Individualized drug therapy and survival prediction in ICU patients with acute kidney injury: construction and validation of a nomogram

BackgroundAcute kidney injury (AKI) is defined by a sharp decrease in the estimated glomerular filtration rate (eGFR). However, the impact of medication history on the survival of AKI patients has received little attention. Hence, it is necessary to investigate the potential of medication history as a predictor of survival outcomes among AKI patients in the intensive care unit (ICU).MethodsCritically ill AKI patients were sourced from the MIMIC-IV database. To ascertain significant, drug-related, independent predictors of survival, univariate Cox analysis and stepwise Cox regression were performed. Based on the identified predictor, a nomogram was developed to estimate the individualized survival probability for AKI patients. Additionally, to address potential confounders among patients with medications referenced in the nomogram, a propensity score matching procedure was applied. Ultimately, a comparative analysis was performed to elucidate the prognostic disparities among these patient subgroups.ResultsThis study enrolled 1,208 patients and developed a nomogram incorporating oxygen flow rate, respiratory frequency, continuous venovenous hemodiafiltration status, age, and medication use (including ibuprofen, epinephrine, cefazolin, warfarin, and vasopressin). The predictive model demonstrated diagnostic accuracy, with AUC values for 1-year, 3-year, and 5-year survival among AKI patients of 0.827, 0.799, and 0.777 in the training dataset, and 0.760, 0.743, and 0.740 in the internal validation dataset, respectively. Kaplan–Meier survival analyses revealed significant differences in survival outcomes among AKI patients based on their exposure to different medications.ConclusionsIn summary, the developed prediction model demonstrated accuracy for AKI patients in the ICU and helped clinical decision-making. However, future studies will require external validation to confirm these findings.

Predicting the risk of invasive fungal infections in ICU sepsis population: the AMI risk assessment tool.

Invasive fungal infections (IFI) represent a significant contributor to mortality among sepsis patients in the Intensive Care Unit (ICU). Early diagnosis of IFI is challenging, and currently, there are no predictive tools for identifying sepsis patients who may develop IFI. Our study aims to develop a predictive scoring system to assess the risk of IFI in patients with sepsis admitted to the ICU. A retrospective collection of data from a total of 549 patients was conducted. Data-driven, clinically knowledge-driven, and decision tree models were used to identify predictive variables for risk of IFI in ICU patients with sepsis. Demographic data, vital signs, laboratory values, comorbidities, medication use, and clinical outcomes were all collected. The optimal model was selected based on model performance and clinical utility to establish a risk score. Among adult patients with sepsis admitted to the ICU, 127 patients (23.1%) developed IFI. The final data-driven model included four predictive factors, the clinically knowledge-driven model included three predictive factors, and the decision tree model included two. Based on the good performance and clinical utility of the clinically knowledge-driven model, it was chosen as the optimal risk scoring model (C-statistics: 0.79 (95% confidence interval (CI): 0.75-0.83); Hosmer-Lemeshow (H-L) test P = 0.884). The ICU sepsis patient invasive fungal infection risk (AMI) score, created based on the clinically knowledge-driven model, includes mechanical ventilation, application of immunosuppressants, and the types of antibiotics used. The C-statistics for this risk score was 0.79 (95% CI:0.75-0.84) with good calibration (H-L test P = 0.992 and see calibration curve: Fig.2). Moreover, in terms of clinical utility, the decision curve analysis for AMI showed a favorable net benefit. The application of the AMI score can effectively distinguish whether ICU sepsis patients will develop IFI, which is beneficial for clinicians to formulate targeted and timely preventive and treatment measures based on the risk of IFI.

Are contemporary antifungal doses sufficient for critically ill patients? Outcomes from an international, multicenter pharmacokinetics study for Screening Antifungal Exposure in Intensive Care Units-the SAFE-ICU study.

Appropriate antifungal therapy is a major determinant of survival in critically ill patients with invasive fungal disease. We sought to describe whether contemporary dosing of antifungals achieves therapeutic exposures in critically ill patients. In a prospective, open-label, multicenter pharmacokinetic study, intensive care unit (ICU) patients prescribed azoles, echinocandins, or polyene antifungals for treatment or prophylaxis of invasive fungal disease were enrolled. Blood samples were collected on two occasions, with three samples taken during a single dosing interval on each occasion. Total concentrations were centrally measured using validated chromatographic methods. Pharmacokinetic parameters were estimated using noncompartmental methods. Antifungal dosing adequacy was assessed using predefined PK/PD targets. We included 339 patients from 30 ICUs across 12 countries. Median age 62 (interquartile range [IQR], 51-70) years, median APACHE II score 22 (IQR, 17-28), and 61% males. Antifungal therapy was primarily prescribed for treatment (80.8%). Fluconazole was the most frequently prescribed antifungal (40.7%). The most common indication for treatment was intra-abdominal infection (30.7%). Fungi were identified in 45% of patients, of which only 26% had a minimum inhibitory concentration available. Target attainment was higher for patients receiving prophylaxis (> 80% for most drugs). For patients receiving treatment, low target attainment was noted for voriconazole (57.1%), posaconazole (63.2%), micafungin (64.1%) and amphotericin B (41.7%). This study highlights the varying degrees of target attainment across antifungal agents in critically ill patients. While a significant proportion of patients achieved the predefined PK/PD targets, wide variability and subtherapeutic exposures persist. ClinicalTrials.gov Identifier: NCT03136926, 2017-04-21.

The type VI secretion system as a potential predictor of subsequent bloodstream infection of carbapenem-resistant Klebsiella pneumoniae strains on intestinal colonization.

The type VI secretion system (T6SS) has been recognized as a novel virulence factor in Klebsiella pneumoniae. This study investigated the occurrence of T6SS genes in carbapenem-resistant Klebsiella pneumoniae (CRKP) strains during intestinal colonization and evaluated their effect on the development of bloodstream infections. The study encompassed 2,385 patients admitted to the intensive care unit (ICU) and subjected to routine screening for intestinal colonization with CRKP. PFGE was employed on CRKP strains isolated from both the patients' intestine and blood cultures, confirming their genetic similarity. PCR was employed to detect the presence of carbapenemase genes, T6SS genes, and virulence genes. Quantitative real-time PCR was conducted to assess the expression levels of the core genes associated with the T6SS. The correlation between T6SS expression and sBSI was further investigated. Approximately 10% (238/2385) of ICU patients tested positive for CRKP colonization. Among patients who tested positive, 10.1% (24/238) developed CRKP-sBSI. Patients carrying T6SS-positive CRKP isolates were more commonly linked to a history of invasive procedures, antibiotic use, and immunosuppression (P < 0.05), and were strongly associated with 28-day mortality (P < 0.001). It indicated that T6SS-positive CRKP strains exhibited a higher prevalence of virulence genes, such as rmpA and iucA, compared to T6SS-negative ones (P < 0.001). Compared to the strains isolated from simple colonization group, there was a significant increase in the mRNA expression of both hcp and vgrG genes (P < 0.05) of strains from the sBSI group, suggesting the key genes of the T6SS may play a significant role in the occurrence and progression of sBSI caused by CRKP. The presence of the T6SS in a CRKP strain from intestinal colonization can serve as a promising predictive marker for sBSI. Conducting screenings for CRKP in patients' intestinal flora and monitoring T6SS carriage can improve the prevention and management of CRKP bloodstream infections.

Are ICU Bedspaces Based in Evidence, and Do They Support Patient Sleep? A Narrative Review.

Objective: This narrative review summarizes some of the evidence guiding current intensive care unit (ICU) design, focussing on environmental factors impacting on sleep, and compares available evidence and recommendations to current ICU designs and builds. Background: The importance of sleep for recovery after illness is well known. However, hospitalized patients frequently experience poor and disrupted sleep. This is especially true for patients admitted to the ICU. There are many factors negatively impacting on ICU patients' ability to sleep. Some relate to their illness or pre-existing sleep problems; others relate to patient care activities. While the ICU bedspace may facilitate 24h care, there is growing awareness of the detrimental impact the bedspace environment (especially suboptimal lighting and excessive sound/noise) has on sleep quality, and important questions raised regarding how this may impact on recovery and health outcomes. Multiple guidelines and recommendations exist to guide ICU bedspace design. However, questions have been raised whether contemporary ICUs are evidence-based, and whether the available evidence is effectively translated into the built ICU. Methods: A comprehensive literature review was conducted, exploring the evidence supporting current ICU bedspace design and the impact of ICU design and environmental factors on patient sleep. Results and conclusion: This review summarizes the impact of the ICU bedspace environment on patient outcomes and describes features of the ICU bedspace design that may not adhere to best evidence and contribute to poor sleep. Suggestions on how ICU bedspaces can be improved to optimize sleep are provided.

Enhanced Prediction of Intensive Care Unit Length of Stay using a Stack Ensemble of Machine Learning Models

The Length of Stay (LoS) refers to the time between a patient's hospital admission and discharge. LoS is considered to increase as the complexity of the disease increases. A prolonged stay in the Intensive Care Unit (ICU) can consume clinical resources and be labor intensive. Models that correctly predict LoS are needed to help medical experts make better decisions. To define an ideal process system, healthcare models must consider the patient's condition, availability of beds, resources, etc. These predictions can also help insurance companies manage their budgets. Existing models deploy machines and deep learning techniques to predict LoS. However, there is a need for improvement, considering the features associated with the process. This study presents machine learning algorithms, such as SVM and a stack ensemble, with improved accuracy over existing models. Experiments were carried out on a benchmark dataset, MIMIC-III, specific to ICU patients. The SVM model achieved an accuracy of 93.88%, while the stack ensemble model showed an improved accuracy of 94.70%. The results show that combining machine learning models achieves better prediction rates, which helps healthcare professionals make better decisions.

Assessment of sleep quality using cardiopulmonary coupling and its predictive value for delirium in ICU patients.

To assess sleep quality in intensive care unit (ICU) patients using cardiopulmonary coupling (CPC) analysis and explore its predictive value for delirium. ICU patients (n=135) were divided into the delirium group (n=44) and control group (n=91) based on the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). CPC analysis was used to evaluate the sleep quality of all participants. Intergroup comparisons showed that total sleep time, stable sleep time, and sleep efficiency were significantly lower in the delirium group than in the control group, whereas unstable sleep time, rapid eye movement sleep time, wake-up time, stable sleep latency, and apnea-hypopnea index (AHI) were significantly higher in the delirium group than in the control group. Logistic regression analysis showed that advanced age and AHI were risk factors for delirium, whereas stable sleep time was a protective factor for delirium. Receiver operating characteristic (ROC) analysis showed that stable sleep time and stable sleep latency had a certain predictive value for delirium; the area under the ROC curve (AUC) for stable sleep time was higher (0.888 vs. 0.704). The cut-off value for stable sleep time was 0.65h, with a sensitivity of 84.1% and specificity of 81.3%. ICU patients with delirium have poorer sleep quality than patients without delirium. Stable sleep time derived from the CPC has a high predictive value for delirium and may serve as an objective indicator for its diagnosis.

Comparison of population pharmacokinetic modeling and machine learning approaches for predicting voriconazole trough concentrations in critically ill patients.

Despite the widespread use of voriconazole in antifungal treatment, its high pharmacokinetic and pharmacodynamic variability may lead to suboptimal efficacy, especially in intensive care unit (ICU) patients. Machine learning (ML), an artificial intelligence modeling approach, is increasingly being applied to personalized medicine. The effectiveness of ML models for predicting voriconazole blood concentrations in ICU patients, compared to traditional population pharmacokinetics (popPK) models, has been uncertain until now. This study aims to identify the most effective modeling strategy for voriconazole. We developed six ML models using 244 concentrations from 62 patients in our previous popPK dataset. Another additional dataset, consisting of 282 trough concentrations from 177 patients, was used to externally evaluate both ML models and five other published popPK models, utilizing prediction-based diagnostics, simulation-based diagnostics, and Bayesian forecasting. The XGBoost model exhibited superior predictive performance among the six ML models, achieving an R2 of 0.73. Its performance metrics (RMSE%: 127.21 %, median absolute prediction error: 29.65 %, median prediction error: 9.82 %, F20: 34.04 %, F30: 50.71 %) outperformed those of the best popPK model (RMSE%: 152.41 %, median absolute prediction error: 44.75 %, median prediction error: -0.99 %, F20: 23.40 %, F30: 36.88 %), suggesting greater accuracy and precision in predicting pharmacokinetics. Both ML and popPK models can be utilized for individualized voriconazole therapy. Our comparative study provides insights into the most effective methods for modeling and predicting voriconazole concentrations.

780 Use of midodrine to discontinue intravenous vasopressors in patients in intensive care units

780 Use of midodrine to discontinue intravenous vasopressors in patients in intensive care units

Biochemical and Familial Factors Influencing COVID-19 Disease Progression

Introduction: COVID-19 is a global pandemic that has caused significant mortality. The disease severity varies among individuals, and the factors influencing its course remain unclear. This study aimed to investigate the influence of biochemical parameters and familial data on COVID-19 outcomes. Methods: A retrospective analysis of 122 COVID-19 patients was conducted. Patients were categorized into two groups: outpatients with mild symptoms and those admitted to the intensive care unit (ICU) and intubated. Demographic data, biochemical levels of vitamin D, vitamin B12, and magnesium, and COVID-19 outcomes of first-, second-, and third-degree relatives were collected. Results: The ICU group had a higher proportion of males (75%) and older patients (average age: 63.18±12.89 years) than the outpatient group (40% males and an average age of 45.13±13.77 years). Both groups had similar BMI, vitamin D, and vitamin B12 levels. However, magnesium levels were significantly higher in the ICU group (mean 2.25±0.3 mg/dL) than in the outpatient group (mean: 1.98±0.2 mg/dL). A significant familial relationship was identified between COVID-19 outcomes and disease course. Among the ICU patients, 25% had first-degree relatives who died from COVID- 19, compared to only 10% of the outpatient patients. Similarly, second- and third-degree relatives of ICU patients had a higher mortality rate from COVID-19 than relatives of outpatient patients. Conclusion:: Age, gender, and magnesium levels may influence COVID-19 disease severity. Familial ties (genetic relatedness) may also play a role, suggesting potential genetic predisposition. Further research is needed to validate these findings and elucidate the underlying mechanisms

The effectiveness of probiotics or synbiotics in the prevention and treatment of diarrhea among critically ill adults: a systematic review and meta-analysis

Diarrhea is one of the most common complications among patients in the Intensive Care Unit (ICU). Alongside common medical products for managing diarrhea, attention has been directed toward natural approaches, such as the use of probiotics or synbiotics supplements. The purpose of this review is to evaluate the effectiveness of probiotics or synbiotics in the prevention and treatment of diarrhea, mortality, and length of ICU stay. In adherence to the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) statement, a systematic review and meta-analysis was conducted. Relevant articles were identified by searching PubMed, SpringerLink, and ScienceDirect databases. Quality assessment was done using Cochrane Collaboration's tool for randomized-controlled trials (ROB2). 6,305 articles were identified, of which 14 papers were included. Probiotics reduced the risk of diarrhea by 10%; however, the result was not statistically significant [Risk Ratio (RR) = 0.90; 95% Confidence Interval (CI): 0.77 to 1.05; P = 0.16; I2 = 29%; 13 studies]. No statistical significance was found among studies regarding reducing the duration of diarrhea, with considerable heterogeneity [RR = - 0.53; 95% CI: -1.46 to 0.41; P = 0.27; I2 = 71%, 5 studies]. Neither the length of ICU stays nor the mortality rate was affected by the use of probiotics or synbiotics. Probiotics or synbiotics appear to slightly reduce the incidence of diarrhea among ICU patients. However, this effect is considered statistically significant only after conducting sensitivity and subgroup analyses. Further high-quality clinical trials are required to evaluate the potential of probiotics or synbiotics in the treatment of diarrhea among critically ill patients.

Association of Lactate Levels and Mortality in Intensive Care Units

Most critically ill patients experience hemodynamic disorders that cause a decrease in blood perfusion, resulting in hypoxia that can increase lactate production. This study will examine the relationship between lactate levels and mortality in intensive care. This study uses a quantitative observational analytical method with a cross-sectional study design and using medical record data. Data analysis was carried out using an Independent T-test to see if there was a significant difference between lactate levels in the blood of dead and living subjects. This study, 154 subjects were obtained, consisting of 96 males (62.3%) and 58 females (37.7%). The average lactate level in the death group was 3.99, and the live group was 2.4 (p=0.004). Subjects with higher lactate levels have higher mortality rates. Lactate levels are one of the indicators of tissue oxygenation in critically ill patients. Hyperlactatemia is common in critically ill patients and can reflect an imbalance between local or systemic oxygen delivery and demand. Hyperlactatemia can cause lactic acidosis or metabolic acidosis and is associated with high mortality outcomes. Increased lactate levels are also associated with the development of Multiple Organ Dysfunction Syndrome (MODS). Subjects with high lactate levels are often associated with a variety of etiologies and poor prognosis, especially critical patients in the Intensive Care Unit (ICU). There was a relationship between blood lactate levels and mortality in ICU patients.

Determination of oxidative stress and copeptin levels of COVID-19 according to the clinical course.

COVID-19, caused by the novel coronavirus SARS-CoV-2, is characterized by hyperinflammation, which can trigger oxidative stress. At the same time, COVID-19 is accompanied by both psychological and physical stress. Copeptin, a novel stress marker, has been shown to predict disease outcomes in stress-induced diseases. In this study, we aimed to explore the potential of copeptin, with inflammatory and oxidative stress markers, in distinguishing between different clinical courses of COVID-19. This case-control study included 75 participants: 25 COVID-19 patients hospitalized in the intensive care unit (ICU), 25 non-ICU COVID-19 patients, and 25 healthy individuals. 64% of the ICU patients received corticosteroid treatment for 4-10 days before sampling. Serum concentrations of the study parameters were assessed by enzyme-linked immunosorbent assay (ELISA) and compared between the study groups. Serum IL-6 levels (p<0.001) were significantly higher in ICU patients compared to non-ICU patients and the control group. Serum MDA (p<0.001) and 4-HNE (p=0.027) concentrations were significantly lower in the ICU group in comparison with the other groups. Copeptin was not statistically significant. MDA (p=0.040) and 4-HNE (p=0.017) levels were significantly lower in the treated ICU group than the untreated one. Serum IL-6 levels were noticeably associated with COVID-19 severity. Corticosteroid therapy administration seemed to influence MDA and 4-HNE levels in the treated group, with no obvious influence on IL-6 and copeptin in the same cohort. This data suggests that in SARS-CoV-2 infection, corticosteroids may act through a rapid non-genomic mechanism.

Meta-analysis of risk factors for infection by multidrug-resistant organisms in intensive care unit patients

Meta-analysis of risk factors for infection by multidrug-resistant organisms in intensive care unit patients