Intensive Care Unit Patients Research Articles

MANEJO DA ENFERMAGEM AO PACIENTE COM LESÃO POR PRESSÃO NA UNIDADE DE TERAPIA INTENSIVA

Objective: This study aims to objective investigate the correct nursing management practices for patients with pressure injuries in the intensive care unit in the scientific literature. Methods: This study is an integrative review of the literature, based on the virtual libraries BVS and SCIELO with the databases: LILACS, MEDLINE and PUBMED. A temporal study was carried out over the last 5 years due to the updates and wealth of information on the topic addressed. Results: 738 articles were identified in the consulted databases. First, the title was read according to the descriptors in each database. After reading the titles, 116 articles were selected for reading the abstract and categorized according to the inclusion and exclusion criteria. Next, the complete reading of 25 articles was screened and those that were relevant were selected. Final considerations: However, it is important to emphasize that even though pressure injuries are considered a public health problem, numerous practices and methods are adopted to improve the care of these patients in intensive care units and in the prevention and treatment of those affected by pressure injuries.

Problems during hospitalisation of morbidly obese patients in intensive care units. A narrative review.

Background: The frequency of hospitalisation of patients with morbid obesity (Body Mass Index - BMI ≥ 40 kg/m2) is constantly increasing. The hospitalisation in the Intensive Care Units (ICUs) of such a group of patients, in addition to the common problems in care and treatment encountered in the rest of the hospital wards, additionally brings distinct challenges to be faced by the staff.Aim of the study: This review aims to clarify the distinctive physiological characteristics of morbidly obese patients and the resulting challenges during ICU hospitalisation, while also presenting appropriate therapeutic approaches and interventions.Material and methods: Based on the available medical literature and the authors' clinical experience, we have selected articles using PubMed, NIH (National Institutes of Health), SpringerMedizin, and Semantic Scholar, along with guidelines from the Medycyna Praktyczna website, WHO data, and book sources. We reviewed 693 articles, 3 books, and the websites of WHO and Medycyna Praktyczna. The final selection comprised 34 articles (32 in English, 1 in German, 1 in Polish), published between 2004 and 2023, with 12 published after 2020.Results: Morbid obesity disrupts the physiological homeostasis of the body, noticeably affecting the respiratory, cardiovascular or gastrointestinal systems, and is associated with the occurrence of a number of diseases. This necessitates specific distinctions in the intubation procedure, mechanical ventilation strategy as well as drug dosing. In addition, it should be noticed that life-threatening conditions such as acute respiratory distress syndrome (ARDS) or sepsis occur among patients hospitalised in the ICU, requiring additional modifications to the therapy.Conclusions: Morbidly obese ICU patients due to their anatomical and physiological characteristics belong to individuals at risk of difficult intubation requiring specific positioning, preoxygenation and the use of videolaryngoscopes, as well as implementing an appropriate mechanical ventilation strategy. Additionally, altered drug metabolism and distribution in these patients necessitate distinct dosing protocols for effective treatment.

Nursing Knowledge and Preventive Practices of Ventilator-Associated Pneumonia as Perceived by Intensive Care Nurses in Hail City, KSA

Context: Ventilator-associated Pneumonia (VAP) is a recognized nosocomial infection and a leading cause of high morbidity and mortality. Intensive Care Unit (ICU) nurses are in the best position to put the known evidence-based strategies into practice to prevent VAP. Aim: The study assessed nursing knowledge and preventive practices of ventilator-associated pneumonia as perceived by intensive care nurses in Hail City, Saudi Arabia. Methods: Data were collected using a descriptive cross-sectional research design. The study was conducted in intensive care units of Government hospitals in Hail City on a convenient sample of all available critical care nurses who met the inclusion criteria during the data collection period. The sample size (n) for this analysis was 84. Data were collected using a structured interview questionnaire including sociodemographic data and nurses' knowledge of VAP. The second tool is nurses’ practice observational checklist regarding VAP prevention. Results: revealed that age median (IQR) is 30(6), median years of experience (IQR) 6(6), 67.9% had received VAP prevention training, and 78.6% had received information for preventing VAP. The study also reveals that 38.09% of the nurses had poor knowledge regarding VAP prevention, and they had a good median (IQR) 6(4) in the preventive practice of VAP. Age, experience in nursing, in the ICU, training on VAP prevention, and receiving information on preventing VAP significantly affected nurses' knowledge about preventing VAP in ICU patients. Experience in ICU and educational institutions as source of information and more than one source of information significantly affect the nurses' total preventive practice regarding VAP. Correlation analysis between overall knowledge and practice indicates no statistically significant correlation (the p-value for the correlation was 0.060). Conclusion: Over one-third of the nurses had poor knowledge regarding VAP. The study recommended that there should be in-service training and periodic educational programs targeting nurses to improve nurse’s knowledge and practices regarding VAP guidelines by the Ministry of Health.

Characteristics of oral mucosal pressure injuries in children with orotracheal intubation in intensive care units: An observational study.

Tracheal intubation can be used for ventilation to ensure an unobstructed respiratory tract, and it is the most common respiratory support technique used in paediatric intensive care unit (PICU) patients. Orotracheal intubation is usually the preferred method of tracheal intubation. However, it can cause stress-related damage to the oral mucosa. Identifying the factors that cause oral mucosal pressure injury (OMPI) can prevent its occurrence in children with oral endotracheal intubation. To examine the characteristics of OMPI in children who underwent orotracheal intubation in the PICU and to assess their influencing factors. An observational, prospective study. Data were gathered from the PICU of a tertiary hospital in China between January 2023 and October 2023. The patient data were obtained from the 'General Information Questionnaire', 'Paediatric Critical Illness Score', 'STRONGkids Scale' and 'OMPI Staging and Assessment Tools'. Data analysis was subsequently performed using univariate and logistic regression analyses. A total of 187 children who underwent orotracheal intubation were analysed. During the observation period, 44.92% (n = 84) of the children developed OMPI. It comprised 63.10% (n = 53) of stage I injuries, 33.33% (n = 28) of stage II injuries and 3.57% (n = 3) of stage III injuries. The common injury sites were the lower jaw (48.81%), upper jaw (29.76%), tongue (20.24%) and joints (10.71%). The logistic regression analysis results revealed that high critical illness (OR = 0.835, 95% CI: 0.726-0.961), long intubation time (OR = 1.043, 95% CI: 1.021-1.067), prone ventilation (OR = 6.708, 95% CI: 1.421-31.670), hypothermia (OR = 5.831, 95% CI: 1.208-28.149), use of dental pads (OR = 5.520, 95% CI: 1.150-26.487) and low albumin levels (OR = 6.238, 95% CI: 1.285-30.281) were the main contributing factors for OMPI in children with orotracheal intubation (p < .05). The occurrence of OMPI in children who underwent orotracheal intubation in the PICU was notable and was predominantly observed in stages I and II. Consequently, clinical nursing personnel should proactively recognize risk factors and administer timely interventions to mitigate the occurrence of OMPI in such children. The incidence of OMPI in children who underwent orotracheal intubation was relatively high. Nurses and doctors should closely monitor the risk factors for orotracheal intubation in children to prevent the occurrence of OMPI.

Comparison of Trends of Procalcitonin and Neutrophil to Lymphocyte Ratio in Patients of Sepsis in Intensive Care Unit.

This study examines the trends of procalcitonin (PCT), neutrophil-to-lymphocyte ratio (NLR), and sequential organ failure assessment (SOFA) scores in intensive care unit (ICU) sepsis patients from different infection sources. Elevations in PCT and NLR reflect infection severity and predict sepsis prognosis. Combining them may enhance diagnostic accuracy and prognostic capabilities, despite variations in cut-off values. The study emphasizes the significance of these biomarkers in improving sepsis management and patient outcomes. This was a prospective observation study of ICU sepsis patients from different infection sources. Procalcitonin and NLR levels were measured on days 0, 2, and 4 of admission. Sequential organ failure assessment scores on these days were also analyzed. The cut-off values were obtained for predicting the prognosis of sepsis ICU patients. The study included 100 sepsis patients with an equal distribution of males and females and a mean age of 72 years. Procalcitonin showed a significant decrease over time, while NLR initially increased before decreasing on day 4, and SOFA scores showed no significant changes. Deceased patients had significantly higher PCT and SOFA scores on days 2 and 4. Receiver operating characteristic curve analysis showed promising predictive results for PCT on day 4 and SOFA scores on days 2 and 4. Understanding the trends of PCT and NLR concerning the infection source can provide deeper insights into their diagnostic and prognostic capabilities. This comparative analysis of PCT, NLR, and SOFA score trends contributes to the improvement of patient outcomes through accurate assessment of sepsis severity and progression, early diagnosis, and timely intervention. Jayara A, Mascarenhas J, Gandhi B, Nimbolkar J. Comparison of Trends of Procalcitonin and Neutrophil to Lymphocyte Ratio in Patients of Sepsis in Intensive Care Unit. Indian J Crit Care Med 2024;28(10):942-951.

Bench assessment of PC-CMVs modes in transport and emergency ventilators under ICU conditions

Although there has been an increase in bench test evaluation of mechanical ventilators in recent years, a publication gap remains in assessing Pressure Control Continuous Mandatory Ventilation Modes with a set point targeting scheme PC-CMVs. This study evaluates the operational variability in PC-CMVs of eleven transport and emergency ventilators used in ICU units in Brazil during the COVID-19 pandemic. The assessment involved a comprehensive set of test scenarios derived from existing literature and the NBR ISO 80601-2-12:2014 standard. Nine parameters were computed for five consecutive breaths, offering a comprehensive characterization of pressure and flow waveforms. Most ventilators had Inspiratory pressure and PEEP values that fell outside of the tolerance ranges. Notably, three mechanical ventilators failed to reach the target pressures within the specified inspiratory times during test scenarios with a higher time constant (τ). We observed significant differences among emergency and transport ventilators in all assessed parameters, indicating a performance difference in PC-CMVs modes. The current results might help clinicians determine which ventilator models are suitable for specific clinical situations, particularly when unfavorable circumstances compel doctors to use ventilators that may not provide adequate support for patients in intensive care units.

Incidence, characteristics and risk factors of endotracheal tube-related pressure injuries in intensive care units.

Medical devices commonly used for the treatment and care of critically ill patients can cause pressure injuries in intensive care units (ICUs). The endotracheal tube (ETT) is one of the most common medical devices to cause pressure injuries. This study investigated the incidence of, characteristics of and risk factors for ETT-related pressure injuries for ICU patients. This study adopted a prospective descriptive research design. The sample consisted of 146 endotracheally intubated patients. Data were collected using a patient information form, an Endotracheal Tube-Related Pressure Injuries Assessment Form, the Braden Risk Assessment Tool and the Nutritional Assessment Test. The study revealed that 80.14% of the patients developed ETT-related pressure injuries. Over half of the ETT-related pressure injuries appeared on Day 3 or 4 (56.41%). High body mass index was found to be associated with the development of ETT-related pressure injuries (OR: 1.15, 95% CI: 1.05-1.26, p = .003). None of the other variables were statistically significant in the development of pressure injuries. The incidence of ETT-related pressure injuries was quite high in the internal, surgical and anaesthesia ICUs. High body mass index was associated with the development of ETT-related pressure injuries. Intensive care nurses should implement interventions to prevent ETT-related pressure injuries in critically ill patients receiving mechanical ventilation support. ETT-related pressure injuries are common in ICU patients. High body mass index was associated with the development of ETT-related pressure injuries in critically ill patients. The skin and mucosa should be assessed for the development of ETT-related pressure injuries during the daily assessment of the patients receiving mechanical ventilation support. The ETT should be repositioned regularly, and the most suitable ETT fixation method should be used.

Ceftolozane/Tazobactam treatment for patients with hospital-acquired and ventilatory-associated bacterial pneumonia in Canada in 2022–2024: results from the CLEAR registry

ABSTRACT Background We report results from the national CLEAR (Canadian Leadership on Antimicrobial Real-Life Usage) registry on the usage of ceftolozane/tazobactam in Canada from 2022 to 2024. Research design and methods The authors reviewed the final data using the national ethics approved CLEAR study. Thereafter, the literature is surveyed regarding the usage of ceftolozane/tazobactam to treat patients with HABP and VABP via PubMed (up to May 2024). Results Ceftolozane/tazobactam was primarily used as directed therapy to treat HABP and VABP caused by Pseudomonas aeruginosa. It was primarily used alone, or in combination with another agent, to treat resistant and multidrug-resistant (MDR) P. aeruginosa infections. Despite primarily being used to treat severely ill patients in intensive care units, its use was associated with relatively high microbiological/clinical cure rates, along with an excellent safety profile. Several reports attest to the microbiological/clinical efficacy and safety of using ceftolozane/tazobactam to treat HABP and VABP. Conclusions In Canada, ceftolozane/tazobactam is primarily used as directed therapy alone, or in combination, to treat MDR P. aeruginosa infections. Though mostly used to treat severely ill patients in the ICU, ceftolozane/tazobactam use in HABP and VABP is associated with relatively high microbiological/clinical cure rates and an excellent safety profile.

Platelet count has a nonlinear association with 30-day in-hospital mortality in ICU end-stage kidney disease patients: a multicenter retrospective cohort study

This study addresses the relationship between platelet count and 30-day in-hospital mortality in End-Stage Kidney Disease (ESRD) patients in the intensive care unit (ICU), a topic with limited existing evidence. Utilizing data from the US eICU-CRD v2.0 database (2014–2015), a retrospective cohort study was conducted involving 3700 ICU ESRD patients. We employed binary logistic regression, smooth curve fitting, and subgroup analyses to explore the association between platelet count and 30-day in-hospital mortality. The 30-day in-hospital mortality rate was 13.27% (491/3700), with a median platelet count of 188 × 109/L. After adjusting for covariates, we observed a relationship between platelet count and 30-day in-hospital mortality (OR = 0.98, 95% CI 0.97, 0.99). Subgroup analyses supported these findings. More importantly, a nonlinear association was detected, with an inflection point at 222 × 109/L. The effect sizes (OR) on the left and right sides of the inflection point were 0.94 (0.92, 0.96) and 1.03 (1.00, 1.05), respectively. The most significant finding of this study is the revelation of a nonlinear relationship between baseline platelet count and 30-day in-hospital mortality in ICU patients with ESRD. This discovery explicitly suggests that when ESRD patients are admitted to the ICU, a platelet level closer to 222 × 10⁹/L may predict a lower 30-day in-hospital mortality risk.

Association of diaphragmatic dysfunction with duration of mechanical ventilation in patients in the pediatric intensive care unit: a prospective cohort study

BackgroundMechanical ventilation (MV) can cause diaphragmatic injury and ventilator induced diaphragmatic dysfunction (VIDD). Diaphragm ultrasonography (DU) is increasingly used to assess diaphragmatic anatomy, function and pathology of patients receiving MV in the pediatric intensive care unit (PICU). We report the poor contractile ability of diaphragm during ventilation of critically ill patients in our PICU and the association to prolonged length of MV and PICU stay.MethodsPatients who received MV within 24 h of admission to the PICU, expected to undergo continuous MV for more than 48 h and succeeded to extubate were included in the study. DU monitoring was performed daily after the initiation of MV until extubation. Diaphragm thickening fraction (DTF) measured by DU was used as an indicator of diaphragmatic contractile activity. Patients with bilateral DTF = 0% during DU assessment were allocated into the severe VIDD group (n = 26) and the rest were into non-severe VIDD group (n = 29). The association of severe VIDD with individual length of MV, hospitalization and PICU stay were analyzed.ResultsWith daily DU assessment, severe VIDD occurred on 2.9 ± 1.2 days after the initiation of MV, and lasted for 1.9 ± 1.7 days. Values of DTF of all patients recovered to > 10% before extubation. The severe VIDD group had a significantly longer duration (days) of MV [12.0 (8.0-19.3) vs. 5.0 (3.5–7.5), p < 0.001] and PICU stay (days) [30.5 (14.9–44.5) vs. 13.0 (7.0-24.5), p < 0.001]. The occurrence of severe VIDD, first day of severe VIDD and length of severe VIDD were significantly positively associated with the duration of MV and PICU stay. The occurrence of severe VIDD on the second and third days after initiation of MV significantly associated to longer PICU stay (days) [43.0 (9.0–70.0) vs. 13.0 (3.0–40.0), p = 0.009; 36.0 (17.0-208.0) vs. 13.0 (3.0–40.0), p = 0.005, respectively], and the length of MV (days) was significantly longer in those with severe VIDD on the third day after initiation of MV [16.5 (7.0–29.0) vs. 5.0 (2.0–22.0), p = 0.003].ConclusionsDaily monitoring of diaphragmatic function with bedside ultrasonography after initiation of MV is necessary in critically ill patients in PICU and the influences and risk factors of severe VIDD need to be further studied. (355 words)

Bacterial and Viral Co-Infections in COVID-19 Patients: Etiology and Clinical Impact.

Mixed infections can worsen disease symptoms. This study investigated the impact of mixed infections with viral and bacterial pathogens in patients positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Using the in-house multiplex PCR method, we tested 337 SARS-CoV-2 positive samples for co-infections with three bacterial and 14 other viral pathogens. Between August 2021 and May 2022, 8% of 337 SARS-CoV-2-positive patients had bacterial co-infections, 5.6% had viral co-infections, and 1.4% had triple mixed infections. The most common causes of mixed infections were Haemophilus influenzae (5.93%) and respiratory syncytial virus (RSV) (1.18%). Children < 5 years old had more frequent co-infections than adults < 65 years old (20.8% vs. 16.4%), while adults showed a more severe clinical picture with a higher C-reactive protein (CRP) level (78.1 vs.16.2 mg/L; p = 0.033), a lower oxygen saturation (SpO2) (89.5 vs. 93.2%), and a longer hospital stay (8.1 vs. 3.1 days; p = 0.025) (mean levels). The risk of a fatal outcome was 41% in unvaccinated patients (p = 0.713), which increased by 2.66% with co-infection with two pathogens (p = 0.342) and by 26% with three pathogens (p = 0.005). Additionally, 50% of intensive care unit (ICU) patients had a triple infection, compared with only 1.3% in the inpatient unit (p = 0.0029). The risk of death and/or ICU admission was 12 times higher (p = 0.042) with an additional pathogen and increased by 95% (p = 0.003) with a third concomitant pathogen. Regular multiplex testing is important for prompt treatment and targeted antibiotic use.

Deep longitudinal lower respiratory tract microbiome profiling reveals genome-resolved functional and evolutionary dynamics in critical illness

The lower respiratory tract (LRT) microbiome impacts human health, especially among critically ill patients. However, comprehensive characterizations of the LRT microbiome remain challenging due to low microbial mass and host contamination. We develop a chelex100-based low-biomass microbial-enrichment method (CMEM) that enables deep metagenomic profiling of LRT samples to recover near-complete microbial genomes. We apply the method to 453 longitudinal LRT samples from 157 intensive care unit (ICU) patients in three geographically distant hospitals. We recover 120 high-quality metagenome-assembled genomes (MAGs) and associated plasmids without culturing. We detect divergent longitudinal microbiome dynamics and hospital-specific dominant opportunistic pathogens and resistomes in pneumonia patients. Diagnosed pneumonia and the ICU stay duration were associated with the abundance of specific antibiotic-resistance genes (ARGs). Moreover, CMEM can serve as a robust tool for genome-resolved analyses. MAG-based analyses reveal strain-specific resistome and virulome among opportunistic pathogen strains. Evolutionary analyses discover increased mobilome in prevailing opportunistic pathogens, highly conserved plasmids, and new recombination hotspots associated with conjugative elements and prophages. Integrative analysis with epidemiological data reveals frequent putative inter-patient strain transmissions in ICUs. In summary, we present a genome-resolved functional, transmission, and evolutionary landscape of the LRT microbiota in critically ill patients.

The INTOXICATE study: methodology and preliminary results of a prospective observational study

BackgroundThere is currently no practice-based, multicenter database of poisoned patients admitted to intensive care units (ICUs). The INTOXICATE study, endorsed by the ESICM and EAPCCT, aimed to determine the rate of eventful admissions among acutely intoxicated adult ICU patients.MethodsEthical approval was obtained for this multicenter, prospective observational study, and data-sharing agreements were signed with each participating center. An electronic case report form was used to collect data on patient demographics, exposure, clinical characteristics, investigations, treatment, and in-hospital mortality data. The primary outcome, ‘eventful admission’, was a composite outcome defined as the rate of patients who received any of the following treatments in the first 24 h after the ICU admission: oxygen supplementation with a FiO2 > 40%, mechanical ventilation, vasopressors, renal replacement therapy (RRT), cardiopulmonary resuscitation, antidotes, active cooling, fluid resuscitation (> 1.5 L of intravenous fluid of any kind), sedation, or who died in the hospital.ResultsSeventy-eight ICUs, mainly from Europe, but also from Australia and the Eastern Mediterranean, participated. A total of 2,273 patients were enrolled between November 2020 and June 2023. The median age of the patients was 41 years, 72% were exposed to intoxicating drugs. The observed rate of patients with an eventful ICU admission was 68% (n = 1546/2273 patients). The hospital mortality was 4.5% (n = 103/2273).ConclusionsThe vast majority of patients survive, and approximately one third of patients do not receive any ICU-specific interventions after admission in an intensive care unit for acute intoxication. High-quality detailed clinical data have been collected from a large cohort of acutely intoxicated ICU patients, providing information on the pattern of severe acute poisoning requiring intensive care admission and the outcomes of these patients.Trial registration: OSF registration ID: osf.io/7e5uy.

Relationship between SARS-CoV-2 infection and ICU-acquired candidemia in critically ill medical patients: a multicenter prospective cohort study

BackgroundWhile SARS-CoV2 infection has been shown to be a significant risk-factor for several secondary bacterial, viral and Aspergillus infections, its impact on intensive care unit (ICU)-acquired candidemia (ICAC) remains poorly explored.MethodUsing the REA-REZO network (French surveillance network of ICU-acquired infections), we included all adult patients hospitalized for a medical reason of admission in participating ICUs for at least 48 h from January 2020 to January 2023. To account for confounders, a non-parsimonious propensity score matching was performed. Rates of ICAC according to SARS-CoV2 status were compared in matched patients. Factors associated with ICAC in COVID-19 patients were also assessed using a Fine-Gray model.ResultsA total of 55,268 patients hospitalized at least 48 h for a medical reason in 101 ICUs were included along the study period. Of those, 13,472 were tested positive for a SARS-CoV2 infection while 284 patients developed an ICAC. ICAC rate was higher in COVID-19 patients in both the overall population and the matched patients’ cohort (0.8% (107/13,472) versus 0.4% (173/41,796); p < 0.001 and 0.8% (93/12,241) versus 0.5% (57/12,241); p = 0.004, respectively). ICAC incidence rate was also higher in those patients (incidence rate 0.51 per 1000 patients-days in COVID-19 patients versus 0.32 per 1000 patients-days; incidence rate ratio: 1.58 [95% CI:1.08–2.35]; p = 0.018). Finally, patients with ICAC had a higher ICU mortality rate (49.6% versus 20.2%; p < 0.001).ConclusionIn this large multicenter cohort of ICU patients, although remaining low, the rate of ICAC was higher among COVID-19 patients.

Hospital Re-Admission Prediction Using Named Entity Recognition and Explainable Machine Learning.

Early hospital readmission refers to unplanned emergency admission of patients within 30 days of discharge. Predicting early readmission risk before discharge can help to reduce the cost of readmissions for hospitals and decrease the death rate for Intensive Care Unit patients. In this paper, we propose a novel approach for prediction of unplanned hospital readmissions using discharge notes from the MIMIC-III database. This approach is based on first extracting relevant information from clinical reports using a pretrained Named Entity Recognition model called BioMedical-NER, which is built on Bidirectional Encoder Representations from Transformers architecture, with the extracted features then used to train machine learning models to predict unplanned readmissions. Our proposed approach achieves better results on clinical reports compared to the state-of-the-art methods, with an average precision of 88.4% achieved by the Gradient Boosting algorithm. In addition, explainable Artificial Intelligence techniques are applied to provide deeper comprehension of the predictive results.

Association of glycemic variability and prognosis in patients with traumatic brain injury: A retrospective study from the MIMIC-IV database

BackgroundElevated glycemic variability (GV) often occurs in intensive care unit (ICU) patients and is associated with patient prognosis. However, the association between GV and prognosis in ICU patients with traumatic brain injury (TBI) remains unclear. MethodClinical data of ICU patients with TBI were obtained from the Medical Information Mart for Intensive Care (MIMIC) -IV database. The coefficient of variation (CV) was utilized to quantify GV, while the Glasgow Coma Scale (GCS) was employed to evaluate the consciousness status of TBI patients. Pearson linear correlation analysis, linear regression, COX regression and restricted cubic spline (RCS) were used to investigate the relationship between CV and consciousness impairment, as well as the risk of in-hospital mortality. ResultA total of 1641 ICU patients with TBI were included in the study from the MIMIC-IV database. Pearson linear correlation and restricted cubic spline (RCS) analysis results showed a negative linear relationship between CV and the last GCS (P = 0.002) with no evidence of nonlinearity (P for nonlinear = 0.733). Multivariable linear regression suggested a higher CV was associated with a lower discharge GCS [β (95 %CI) = −1.86 (−3.08 ∼ −0.65), P = 0.003]. Furthermore, multivariable COX regression indicated that CV ≥ 0.3 was a risk factor for in-hospital death in TBI patients [HR (95 %CI) = 1.74 (1.15–2.62), P = 0.003], and this result was also consistent across sensitivity and subgroup analyses. ConclusionHigher GV is related to poorer consciousness outcomes and increased risk of in-hospital death in ICU patients with TBI. Additional research is needed to understand the logical relationship between GV and TBI progression.

Polysialic acid driving cardiovascular targeting co-delivery 1,8-cineole and miR-126 to synergistically alleviate lipopolysaccharide-induced acute cardiovascular injury

Infection-induced cardiovascular damage is the primary pathological mechanism underlying septic cardiac dysfunction. This condition affects the majority of patients in intensive care unit and has an unfavorable prognosis due to the lack of effective therapies available. Vascular cell adhesion molecule-1 (VCAM-1) plays a vital role in coordinating the inflammatory response and recruitment of leukocytes in cardiac tissue, making it a potential target for developing novel therapies. MicroRNA-126 (miR-126) has been shown to downregulate VCAM-1 expression in endothelial cells, reducing leukocyte adhesion and exerting anti-inflammatory effects. Therefore, this work described a polysialic acid (PSA) modified ROS-responsive nanosystem to targeted co-delivery 1,8-Cineole and miR-126 for mitigating septic cardiac dysfunction. The nanosystem consists of 1,8-Cineole nanoemulsion (CNE) conjugated with PEI/miR126 complex by a ROS-sensitive linker, with PSA on its surface to facilitate targeted delivery via specific interactions with selectins on endothelial cells. CNE has demonstrated protective effects against inflammation in the cardiovascular system and synergistic anti-inflammatory effects when combined with miR-126. The targeted nanosystem successfully delivered miR-126 and 1,8-Cineole to the injured heart tissues and vessels, reducing inflammatory responses and improving cardiac function. In summary, this work provides a promising therapy for alleviating the inflammatory response in sepsis while boosting cardiovascular protection.

Thrombotic Safety of Angiotensin II for Distributive Shock in the Cardiothoracic Intensive Care Unit.

Background: Angiotensin II (ATII) has been shown in the literature to increase the risk of thrombosis. Little data exists in patients with mechanical circulatory support (MCS) due to exclusion from landmark trials. Objective: Evaluate the thrombotic risk of ATII in patients in the cardiothoracic intensive care unit (CTICU) with distributive shock. Methods: Retrospective study including adult patients admitted to the CTICU with temporary MCS. This study evaluated patients ≥18 years old on temporary MCS in the CTICU between September 1st, 2018 and August 30th, 2022. Patients that received ATII were compared to a control group for the outcome of an index thrombotic event. The outcomes were compared using the Fischer's exact or chi-squared test. Results: A total of 75 patients primarily admitted for cardiac surgery were included, of which 41 (54.7%) received ATII. The rates of overall thrombosis were higher in the ATII group compared to the control, though the outcome was not statistically significant (41.5% vs 20.6%; P = 0.05). Individual thrombotic components of the composite outcome were not statistically significant between groups. Conclusion: Numerically higher rates of thrombosis were seen in patients on MCS that received ATII, though the outcome was not statistically significant. This retrospective study provides a single-center, real-world safety perspective on the use of ATII in MCS.

Prognostic value of red blood cell distribution width-to-albumin ratio in ICU patients with coronary heart disease and diabetes mellitus.

The red blood cell distribution width (RDW)-to-albumin ratio (RAR) has emerged as a potentially valuable prognostic indicator in diverse medical conditions. However, the prognostic significance of RAR in intensive care unit (ICU) patients with coronary heart disease (CHD) and diabetes mellitus (DM) remains uncertain and requires further investigation. This study aims to investigate the prognostic significance of RAR in ICU patients with coexisting CHD and DM through a retrospective cohort analysis using data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database (version 2.2). The study population included patients aged 18 years or older who were diagnosed with both CHD and DM. The primary endpoint was 1-year mortality, and the secondary endpoints included 30-day mortality, 90-day mortality, hospital length of stay (LOS), and ICU LOS. A total of 3416 patients, of whom 64.64% were male, were included in the study. The 30-day mortality, 90-day mortality, and 1-year mortality were 7.08%, 7.44%, and 7.49%, respectively. After adjusting for confounding factors, multivariate Cox proportional risk analysis demonstrated that high RAR levels were associated with an increased risk of 30-day mortality (HR, 1.53 [95% CI 1.17-2.07], P = 0.006), 90-day mortality (HR, 1.58 [95% CI 1.17-2.13], P = 0.003), and 1-year mortality (HR, 1.58 [95% CI 1.17-2.13], P = 0.003). Furthermore, the restricted cubic spline (RCS) model indicated a linear relationship between RAR and 1-year mortality. The results suggest that RAR holds potential as a valuable prognostic biomarker in ICU patients with both CHD and DM. Elevated RAR levels were found to be significantly associated with increased mortality during hospitalization, facilitating the identification of individuals at higher risk of adverse outcomes. These findings underscore the importance of incorporating RAR into risk stratification and overall management strategies for ICU patients with coexisting CHD and DM.

METS-IR as an important predictor of neurological impairment severity in patients with severe cerebral infarction: a multicenter study based on the Chinese population.

Insulin resistance (IR) is linked to an increased risk of neurological impairment following a stroke and may contribute to poor neurological prognosis in affected patients. The metabolic score for the insulin resistance index, shortened as the METS-IR, generally serves as a surrogate index for IR. However, its association with the severity of neurological impairment in patients with severe cerebral infarction (CI) in neurological intensive care units (ICU) has not been fully established. Patients with a diagnosis of CI, admitted to the neurological ICUs of Yangzhou University's Affiliated Hospital and Xuzhou Medical University's Affiliated Hospital, were included in the study. A multivariate logistic regression model and restricted cubic splines (RCS) were employed to explore the relationship between the METS-IR index and the severity of neurological impairment in these patients. The predictive capabilities of the METS-IR index and the triglyceride-glucose (TyG) index for outcome measures were compared through the ROC curve. Furthermore, a decision curve analysis was executed, and the integrated discrimination improvement (IDI) index was computed to evaluate the enhancements in predictive performance and clinical utility of various scoring systems with the inclusion of the METS-IR index. Subgroup analysis was conducted regarding age, BMI, and smoking status. The study ultimately included 504 participants. Adjusted logistic regression and RCS results showed that as the METS-IR index increases, the risk of neurological impairment in patients with severe CI consistently grows (P for overall = 0.0146, P-nonlinear: 0.0689). The METS-IR index's predictive capability for neurological impairment (AUC = 0.669) was superior to that of the TyG index (AUC = 0.519). From the study results, the METS-IR index can serve as an important predictor for neurological impairment in ICU patients with severe CI. It can aid in the identification and early intervention of neurological impairment in these patients.