Intensive Care Unit Patients Research Articles

Effect of high-quality nursing interventions on the quality of life and cardiac index in acute coronary syndrome patients treated with drug-eluting stents: a randomized trial study

BackgroundNursing care is important and necessary for Acute Coronary Syndrome patients who have undergone angiography and stenting, to minimize complications. The purpose of this study was to assess the effects of High-Quality Nursing Interventions on the quality of life and cardiac index of Acute Coronary Syndrome patients, treated with drug-eluting stents.MethodsIn this randomized trial, 70 patients of the cardiac intensive care units in one of Jahrom university of medical sciences hospitals (Iran) were selected from July 2023 to October 2023 by the available method, and randomly allocated (stochastic assignment) to two intervention (High-Quality Nursing Interventions) and control groups (routine nursing care). Quality of life and Cardiac Index were measured by cardiac index calculation formula and the McNew Cardiac Quality Questionnaire, respectively. Data were analysed using SPSS version 19 software, Mann‒Whitney, chi‒square and Wilcoxon tests, with a significance level at a p < .05.ResultsA statistically significant difference demonstrated between the mean of the quality of life and cardiac index in the intervention group(p < .05).ConclusionsHigh-Quality Nursing Interventions improved quality of life and cardiac index of Acute Coronary Syndrome patients, treated with drug-eluting stents. Therefore, it is recommended to use this nursing approach in special cardiac care units.Trial registrationIRCT79432(2024.10.08), “Retrospectively registered”.

Inflammation severity, rather than respiratory failure, is strongly associated with mortality of ARDS patients in high-altitude ICUs

IntroductionIn high-altitude cities located above 2,500 m, hospitals face a concerning mortality rate of over 50% among intensive care unit (ICU) patients with acute respiratory distress syndrome (ARDS). This elevated mortality rate is largely due to the absence of altitude-specific medical protocols that consider the unique physiological adaptations of high-altitude residents to hypoxic conditions. This study addresses this critical gap by analyzing demographic, clinical, sex-specific, and preclinical data from ICUs in Bogotá, Colombia (2,650 m) and El Alto, Bolivia (4,150 m).MethodsA cohort of seventy ARDS patients, aged 18 and older, was evaluated within 24 h of ICU admission. Data collected included demographic information (age, sex), clinical characteristics (primary pathology, weight, height), vital signs, respiratory variables, cardiorespiratory parameters, blood count results, inflammatory markers, severity assessment scores, and comorbidities. Advanced statistical analyses, such as multivariate logistic regression and principal component analysis, were utilized to identify key clinical predictors of ARDS-related mortality.ResultsOur findings indicate that in high-altitude ICUs, monitoring inflammatory markers may be more beneficial for improving ARDS survival rates than emphasizing respiratory failure markers. Unexpectedly, we found no significant differences in clinical outcomes between altitudes of 2,650 and 4,150 m or between male and female patients.ConclusionThe study concludes that, in high-altitude settings, ARDS patient survival in ICUs is more closely associated with managing inflammatory responses than with focusing solely on respiratory parameters. Further large-scale studies are recommended to validate the impact of inflammatory marker monitoring on survival outcomes in high-altitude ICUs.

Delirium at the intensive care unit and long-term survival: a retrospective study

BackgroundDelirium is a common complication in patients at the intensive care unit (ICU) and is associated with prolonged ICU-stay and hospitalization and with increased morbidity. The impact of ICU-delirium on long-term survival is not clearly understood.MethodsThis retrospective single center observational study was conducted at the Institute of Intensive Care Medicine at the University Hospital Zurich, Switzerland. All adult ICU-survivors over a four-year period were screened for eligibility. ICU-delirium was defined based on the Intensive Care Delirium Screening Checklist (ICDSC), together with the coded diagnosis F05 in the International Classification of Diseases (ICD-2019). ICU-survivors who developed delirium during their ICU stay (group D) were compared with ICU-survivors who did not (group ND). Survival was evaluated according to data from hospital electronic health records up to four years from ICU-discharge. The survival analysis was reported using Kaplan-Meier curves and absolute risk differences (ARD). A multivariable logistic regression model was fitted with long-term survival at four years after ICU-discharge as outcome of interest, including several clinical conditions and interventions associated with long-term survival for ICU patients. For subgroup analysis, ICU-survivors were grouped based on age at the time of admission (45–54, 55–64, ≥ 65 years), and on relevant clinical conditions.ResultsA total of 9’604 patients fulfilled the inclusion criteria, of them 22.6% (n = 2’171) developed ICU-delirium. Overall, patients in the group D had a significantly lower probability of survival than patients in the group ND (p < 0.0001, ARD = 11.8%). In the multivariable analysis, ICU-delirium was confirmed as independently associated with long-term survival. After grouping for age categories, patients between 55 and 64 years of age in the group D were less likely to survive than patients in the group ND at every time point analyzed, up to four years after ICU discharge (p < 0.001, ARD = 7.3%). This difference was even more significant in the comparison between patients over 65 years (p < 0.0001, ARD 11.1%). No significant difference was observed in the other age groups.ConclusionsIn the study population, ICU-delirium was independently associated with a reduced long-term survival. Patients who developed ICU-delirium had a reduced survival up to four years after ICU discharge and this association was particularly evident in patients above 55 years of age.

Knowledge, attitudes, and practices among physicians and pharmacists toward antibiotic use in sepsis

BackgroundSepsis management in the Intensive Care Unit (ICU) presents a significant challenge within contemporary healthcare. The primary challenge lies in ensuring the timely and appropriate utilization of antibiotics. Inappropriate antibiotic use in sepsis management can result in a multitude of adverse outcomes. There has been insufficient focus on thoroughly understanding and resolving the issues related to the improper application of antibiotics in sepsis treatment by physicians and pharmacists. This gap in research is concerning, considering its potential implications for patient outcomes and public health. This study aimed to assess the knowledge, attitudes and practices (KAP) among physicians and pharmacists toward antibiotic use in sepsis.MethodsThis web-based cross-sectional study was conducted at Shanxi Bethune Hospital between June 2023 and October 2023. A self-designed questionnaire was developed to collect demographic information of physicians and pharmacists, and to assess their knowledge, attitudes and practices toward antibiotic use in sepsis.ResultsA total of 200 valid questionnaires were collected. Among the participants, 115 (57.5%) were female and 118 (59%) had experience with ICU patient management. The mean knowledge, attitudes and practices scores were 10.2 ± 1.14 (possible range: 0–12), 45.88 ± 4.00 (possible range: 10–50) and 48.38 ± 5.84 (possible range: 11–55), respectively. Multivariate logistic regression showed that attitudes (OR = 1.59, 95%CI: 1.34–1.87, p &amp;lt; 0.001), work experience of 15 years and above (OR = 7.17, 95%CI: 2.33–22.0, p = 0.001) were independently associated with proactive practices. For physicians, the structural equation model (SEM) demonstrated that attitudes directly affects practices, as indicated by a path coefficient of 0.91 (p &amp;lt; 0.001). For pharmacist, SEM showed that knowledge directly affect attitudes, with a path coefficient of 0.75 (p &amp;lt; 0.024), moreover, attitudes directly affect practices, with a path coefficient of 0.87 (p &amp;lt; 0.001).ConclusionThe findings revealed that physicians and pharmacists have sufficient knowledge, active attitudes, and proactive practices toward the antibiotic use in sepsis. Nonetheless, the findings also reveal the persistence of certain misconceptions, alongside notable shortcomings in both attitudes and practices. Comprehensive training programs are imperative for enhancing the practices of physicians and pharmacists in this field.

Procedural sedative effect of remimazolam in ICU patients on invasive mechanical ventilation: a randomised, prospective study

BackgroundInvasive procedures and environmental factors in the intensive care unit (ICU) may cause anxiety and discomfort in patients, who often require sedation therapy. The aim of this study was to assess the safety of remimazolam tosilate for procedural sedation in ICU patients receiving mechanical ventilation following endotracheal intubation. Eighty patients from a single centre were randomly assigned to either the propofol group or the remimazolam group. Blood tests were conducted to evaluate changes in lactate, blood lipids, liver and kidney function, and inflammatory markers, and patients’ vital signs were observed over several periods. This study compared the incidence of delirium, the impact on liver and kidney function, circulatory effects, and changes in blood lipids between the two groups. These findings have optimised the selection of medications, providing ICU patients with more options for sedation therapy.MethodsIn this single-centre randomised controlled trial, intubated patients were randomly assigned to the remimazolam group or the propofol group. Under the same analgesic regimen, the two groups received remimazolam and propofol for procedural sedation.ResultsOur primary outcome was the mean arterial pressure (MAP), which significantly differed on Days 4 and 7 (P = 0.021, control group vs. experimental group = 85.23 ± 11.24 vs. 94.36 ± 13.18, P = 0.023, 83.55 ± 8.94 vs. 92.66 ± 7.02). With respect to liver and kidney function, the ∆AST value in the remimazolam group was significantly lower than that in the control group on Day 7 (P = 0.023). There were significant differences in triglyceride (TG) levels on Days 4 and 7 (P = 0.020) and in the ∆LDL on Day 7 (P = 0.027). Furthermore, the rates of dyslipidaemia and delirium in the remimazolam group were lower than those in the propofol group (85.0%, n = 40 vs. 90.0%, n = 40; 27.5%, n = 40 vs. 55%, n = 40).ConclusionRemimazolam is a novel benzodiazepine that has demonstrated promising applications in general anaesthesia and procedural sedation; however, its use in ICU sedation is still in the early stages of research. Current evidence suggests that remimazolam is a safe sedative that is particularly well suited for patients with haemodynamic instability. Large sample-size randomised clinical trials are warranted.

The basis of bacteriological safety in the neonatal intensive care unit (literature review)

Background. According to world statistics, 7% of patients out of 100 in high-income countries and 15% of patients out of 100 in low- and middle-income countries develop infections related to medical care. As follows from the report of the World Health Organization, one in four cases of hospital sepsis that occurred in the intensive care unit is caused by hospital strains. On average, one in ten of these patients has a hospital-acquired infection that is fatal. The high-risk group includes patients in intensive care units, including newborns. In 2023, 28973 cases of neonatal infections (including intrauterine infection) were registered in medical organizations of the Russian Federation. The highest rates of neonatal morbidity were recorded in the Sverdlovsk Region (42.2%), the Trans-Baikal Territory (33.0%), the Novosibirsk Region (26.0%), the Chelyabinsk Region (22.4%), the Krasnoyarsk Territory (21.8%) and the Irkutsk Region (21.3%). Thus, infection prevention and control strategies aimed at both patients and their environment are of paramount importance in neonatal intensive care units.Objective. To summarize current relevant data on the prevention of hospital infections in neonatal intensive care units.Materials and methods. A literature review was conducted using the MEDLINE database (PubMed) as of December 2024 using keywords and a filter: randomized controlled trial, meta-analysis, systematic review.Results. This review summarizes the main data on the prevention of hospital infections in neonatal intensive care units. According to the literature, ensuring bacteriological safety in relation to the development of hospital infections depends on many factors: hand hygiene of medical personnel, organization of venous access control, disinfection of medical equipment and premises, compliance with the rules of asepsis and antiseptics when performing invasive manipulations, the introduction of modern approaches in the care of premature infants.Conclusion. There are many tasks in the intensive care unit that require innovative strategies to ensure the safe care of premature newborns. Joint efforts to standardize the processing of specialized equipment, maintain the cleanliness of the environment, comply with vascular access care protocols, adequate hand hygiene, and the active introduction of parents into newborn care are an integral part of the program aimed at preventing nosocomial infections. Active cooperation between the neonatal intensive care unit and the epidemiological service of the institution will allow us to develop a rational policy for risk management and monitoring of hospital infections.

Systemic inflammatory response index improves prognostic predictive value in intensive care unit patients with sepsis

Sepsis is a severe infectious disease with high mortality. However, the indicators used to evaluate its severity and prognosis are relatively complicated. The systemic inflammatory response index (SIRI), a new inflammatory indicator, has shown good predictive value in chronic infection, stroke, and cancer. The purpose of this study was to investigate the connection between sepsis and SIRI and evaluate its predictive usefulness. A total of 401 patients with sepsis were included in this study. Multiple linear regression and logistic regression analyses were performed to evaluate the relationship between SIRI and sepsis. The restricted cubic spline (RCS) method was employed to illustrate the dose-response relationship. The area under the curve (AUC) and decision curve analysis (DCA) were used to evaluate the prognostic value of SIRI. Multiple linear regression analysis revealed a significant positive correlation between SIRI and both blood cell count and Sequential Organ Failure Assessment (SOFA) score. Additionally, higher SIRI levels were significantly linked to a higher risk of sepsis worsening, according to logistic regression analysis. The RCS curve demonstrated that the risk of poor prognosis rose with increasing SIRI, particularly when SIRI exceeded 6.1. Furthermore, AUC and DCA results showed that SIRI had superior predictive value compared to traditional indicators. A higher SIRI is linked to a worse prognosis and more severe sepsis. SIRI may serve as a novel prognostic indicator in sepsis, though further clinical studies are necessary to confirm these findings.

The association of dysglycaemia metrics over the first 7 days of ICU stay with ICU mortality among patients with and without diabetes.

Dysglycaemia metrics, defined as hyperglycaemia, increased glucose variability, hypoglycaemia and reduced time in the targeted blood glucose range (TIR), are linked to higher mortality. The relationship between dysglycaemia metrics and intensive care unit (ICU) mortality over time for patients with and without diabetes remains inconclusive, posing challenges for ICU medical staff in accurately identifying and distinguishing various risk factors and taking timely and appropriate responses. To explore which dysglycaemia metrics within the first 7 days of ICU stay are associated with ICU mortality among patients with and without diabetes. This retrospective cohort study included 712 patients without diabetes and 222 patients with diabetes. Clinical data were collected within the first 7 days of ICU stay. Binary logistic regression models were built to analyse which dysglycaemia metrics (hyperglycaemia, coefficient of variation [CV], hypoglycaemia and TIR) on the first day, over the first 3, 5 and 7 days of ICU stay were associated with ICU mortality. In patients with diabetes, hyperglycaemia on the first day (OR: 4.90, 95% CI: 1.51-15.90, p = .008) and TIR <70% during the first 7 days of ICU stay (OR: 16.31, 95% CI: 1.50-176.89, p = .022) were associated with increased ICU mortality. In patients without diabetes, CV >20% on the first day (OR: 1.46, 95% CI: 1.03-2.07, p = .035), and TIR <70% during the first 3 (OR: 2.01, 95% CI: 1.35-2.98, p < .001) and 5 days (OR: 1.66, 95% CI: 1.09-2.54, p = .019) were associated with increased ICU mortality (p < .05). The proportion of hypoglycaemia did not significantly correlate with ICU mortality in patients with or without diabetes (p > .05). Specific dysglycaemia metrics are associated with ICU mortality between patients with and without diabetes. In patients with diabetes, hyperglycaemia on the first day and TIR <70% on the first 7 days with higher mortality. In patients without diabetes, CV >20% on the first day and TIR <70% in the first 3 and 5 days are associated with higher mortality. Monitoring these metrics may potentially help develop strategies to decrease ICU mortality through individualized glycaemic management. Close monitoring of dysglycaemia metrics, especially TIR, and personalized glucose management based on diabetic status may help identify high-risk ICU patients and improve targeted care strategies.

Aspergillus identification through bronchoscope in intensive care unit – a retrospective, databased cohort study

IntroductionInvasive pulmonary aspergillosis (IPA) increases the risk of mortality of critically ill patients. Diagnostic criteria specifically targeting patients in intensive care units(ICUs) have been developed to improve diagnostic sensitivity. This study investigated health outcomes among patients in ICUs with Aspergillus isolates identified using bronchoscopy.MethodsThis retrospective cohort study obtained data from the Chang Gung Research Database of Chang Gung Memorial Hospital. Patients admitted to the ICU between January 2017 and December 2022 who received bronchoalveolar lavage were enrolled. Patients with a fungus culture yielding Aspergillus spp. isolates or who had an Aspergillus galactomannan antigen index value of &amp;gt;1.0 were categorized into the Aspergillus-positive group.ResultsA total of 2372 patients were enrolled, and 146 patients (6.16%) tested positive for Aspergillus. Of the patients who tested positive for Aspergillus, 37.67% had a positive culture result, and 77.4% had a positive galactomannan antigen result. Patients with Aspergillus isolates were more likely to have a recent influenza infection, concurrent bacterial sepsis, and a cavitation and to die in hospital (in-hospital mortality rate 58.9% vs. 48.57%, P = 0.016).DiscussionIdentifying Aspergillus through bronchoscopy in the ICU is associated with higher mortality rates than in patients who test negative for Aspergillus. Galactomannan antigen from bronchoalveolar lavage may provide higher diagnostic sensitivity.

Early mobilization in the intensive care unit for patients with subarachnoid hemorrhage-areview

Early mobilization of critical ill patients in the intensive care unit (ICU) has apositive effect on outcome. Currently, due to concerns of cerebral vasospasm and rebleeding patients with subarachnoid hemorrhage (SAH) have aprolong bedrest for 12-14days. What effect does early mobilization have on vasospasm, clinical outcome, length of stay and ICU complication rate in patients with SAH compared to standard treatment? Asystematic literature search was conducted in MEDLINE via the PubMed® (U.S. National Library of Medicine®, Bethesda, MD, USA) and CINAHL® (EBSCO, Ipswich, MA, USA) databases. A total of 14studies were identified. Overall, the studies showed an improved functional outcome and areduction in the length of hospitalization and ventilation time. Only in one study did vasospasms occur more frequently and the outcome of patients with early mobilization was worse. Further research is needed to identify possible positive effects of early mobilization in patients with SAH and to be able to describe the risk-benefit ratio more precisely.

Polyamine Content of Enteral Nutrition Formulas: Effect of Daily Intake on the Feeding Tolerance of Patients During the First Week in the Intensive Care Unit

Enteral nutrition (EN) formulas are necessary for critically ill patients to meet their metabolic requirements. Polyamines (putrescine, spermidine, and spermine) are crucial dietary components, with spermidine being particularly interesting due to its multiple proposed benefits. The requirements for and intake of polyamines have yet to be investigated in adult patients hospitalised in intensive care units (ICUs) who are exclusively fed via commercial EN formulas. The aim of this study was to determine the polyamine content and other biogenic amines of EN formulas and the total intake and gastric residual volume (GRV) in adult ICU patients during their first seven days of hospitalisation. The amines were analysed in 16 EN formulas using high-performance liquid chromatography (HPLC). The clinical data of eight patients of both sexes aged 47 to 77 admitted to the ICU were analysed. Differences existed among the analysed EN formulas. The N-acetyl putrescine content was higher than that of the remaining amines. The daily intake of polyamines in the ICU was less than 100 μmol (the dietary intake is above 400 μmol). An inverse correlation existed between total daily polyamine intake and daily GRV, without effects from other biogenic amines being analysed. Polyamine intake in critically ill patients receiving EN is low and could impact these patients’ feeding tolerance. These findings underscore the need for further research to explore the clinical implications of increasing the polyamine content of EN formulas.

Analysis of mortality factors in ICU patients with sepsis and septic shock: a retrospective study

BackgroundSepsis and septic shock are critical conditions that pose significant challenges in intensive care units (ICUs), characterized by a dysregulated host response to infection, leading to organ dysfunction and high mortality rates. The increasing incidence of sepsis necessitates a thorough understanding of the factors influencing patient outcomes.AimThis study aims to analyze the mortality rates among ICU patients diagnosed with sepsis and septic shock, focusing on the role of organ dysfunction, age, and the Acute Physiology and Chronic Health Evaluation II (APACHE II) score.MethodsA retrospective analysis was conducted on 200 patients diagnosed with sepsis and septic shock admitted to the ICU over 2 years. Data were collected on patient demographics, including age, gender, comorbidities, and APACHE II scores calculated upon admission. Organ dysfunction was assessed based on clinical criteria, and mortality rates were tracked throughout the ICU stay. Statistical analyses were performed using SPSS software, with significance at p < 0.05.ResultsThe cohort consisted of 200 patients, with a mean age of 65 years (SD ± 12.3). The overall mortality rate was found to be 54.5%, with significant differences observed between survivors and non-survivors. The mean APACHE II score for the entire cohort was 20.35 (SD ± 6.5), with non-survivors exhibiting a mean score of 23.77 (SD ± 5.8) compared to 15.87 (SD ± 4.2) for survivors (p < 0.001). Cardiovascular dysfunction was prevalent in 75% of septic patients, contributing to a mortality rate of 54.5%. These findings underscore the importance of early identification and management of organ dysfunction to improve patient outcomes.ConclusionThis study highlights the critical role of APACHE II scores and cardiovascular dysfunction in predicting mortality among ICU patients with sepsis and septic shock. The high mortality rates associated with these factors emphasize the need for proactive management strategies and tailored interventions to enhance patient survival and improve overall outcomes in this vulnerable population.

What intensivists need to know about cytomegalovirus infection in immunocompromised ICU patients.

Advances in therapeutic care are leading to an increase in the number of patients living with overt immunosuppression. These patients are at risk of cytomegalovirus (CMV) infection and disease that can lead to or develop during ICU admission. This manuscript aims to describe the clinical presentation, risk factors, and management of CMV infection and disease in this patient population. We conducted a literature search in PubMed up to April 2024, focusing on CMV infection and disease in patients with overt immunosuppression (hematopoietic stem cell and solid organ transplantation, solid or hematologic malignancies, HIV infection, immunosuppressive drugs, including corticosteroids, and primary immunodeficiencies) admitted to the intensive care unit (ICU). As there is limited ICU-specific data on CMV in immunosuppressed patients, many of the findings were extrapolated from the general literature. CMV infection and disease in immunocompromised critically ill patients is associated with increased mortality and presents significant management challenges. Clinical manifestations are diverse, shaped by the underlying immune deficiency and primary disease. Pneumonia and encephalitis are among the most severe CMV end-organ diseases. CMV infection may also increase the risk of secondary infections and induce life-threatening conditions, such as thrombotic microangiopathy. Importantly, CMV reactivation is not synonymous with CMV disease, and qPCR testing of body fluids cannot reliably differentiate between viral shedding and tissue-invasive infection, which requires histopathological confirmation. Ganciclovir is commonly the first-line anti-viral, though maribavir shows potential for patients unresponsive to other antivirals. Identifying patients who require prophylactic or preemptive antiviral therapy is essential. CMV infection and disease in critically ill immunocompromised patients pose a unique challenge for intensivists. The broad spectrum of clinical presentations and the difficulty in distinguishing CMV-related symptoms from other causes require a high level of clinical suspicion. Accurate interpretation of nucleic acid load levels and careful evaluation of CMV's pathogenic role when it is found are critical. Further studies focusing specifically on CMV infection and disease in critically ill immunocompromised patients are needed to optimize management strategies.

Application of urinary peptide-biomarkers in trauma patients as a predictive tool for prognostic assessment, treatment and intervention timing

Treatment of severely injured patients represents a major challenge, in part due to the unpredictable risk of major adverse events, including death. Preemptive personalized treatment aimed at preventing these events is a crucial objective of patient management; however, the currently available scoring systems provide only moderate guidance. Biomarkers from proteomics/peptidomics studies hold promise for improving the current situation, ultimately enabling precision medicine based on individual molecular profiles. To test the hypothesis that peptide biomarkers could predict patient outcomes in severely injured patients, we initiated a pilot study involving consecutive urine sampling (on days 0, 2, 5, 10, and 14) and subsequent peptidome analysis using capillary electrophoresis coupled to mass spectrometry (CE-MS) of 14 severely injured patients and two additional intensive care unit patients. The urine peptidomes of these patients were compared to those of age- and sex-matched controls. Moreover, previously established urinary peptide-based classifiers, CKD273, AKI204, and Cov50, were applied to the obtained peptidome data, and the association of the classifier’s scores with a combined endpoint (death and/or kidney failure and/or respiratory insufficiency) was investigated. CE-MS peptidome analysis identified 191 significantly altered peptides in severely injured patients. A consistent increase in the abundance of peptides from A1AT, AHSG, and HBA1 was observed, while peptides derived from PIGR and UROM were consistently decreased. Most of the significant peptides (adjusted p < 0.05) were from COL1A1, and most were reduced in abundance. Two of the previously defined and validated peptidomic classifiers, CKD273 and AKI204, showed significant associations with the combined endpoint, which was not observed for the routine scores generally applied in the clinics. This prospective pilot study confirmed the hypothesis that urinary peptides provide information on patient outcomes and may guide personalized interventions in severely injured patients based on individual molecular changes. The results obtained allow the planning of a well-powered prospective trial investigating the value of urinary peptides in this context in more detail.

Evaluation of the effect of therapeutic plasma exchange on serum cytokine levels in pediatric intensive care unit

AbstractIntroductionTherapeutic plasma exchange (TPE) is crucial for saving lives when used appropriately. This study aimed to assess TPE's impact on tumor necrosis factor‐like weak inducer of apoptosis (TWEAK) protein and IL‐6 levels in critically ill pediatric patients.MethodsConducted between May 2022 and December 2022, the study observed pediatric intensive care unit (PICU) patients undergoing TPE, recording demographics, lab results, TWEAK, and IL‐6 levels pre‐ and post‐procedure.ResultsOf 41 patients, 53.7% were male, 51.2% had underlying conditions, and 39% showed sepsis symptoms. IL‐6 levels significantly rose post‐TPE (p: 0.006), while TWEAK protein levels dropped (p: 0.030). Positive correlations were found between interleukin‐6 (IL‐6) pre‐TPE and ventilation duration, ferritin levels (p &lt;0.05), and TWEAK pre‐TPE and organ failure indicators, D‐Dimer levels (p &lt;0.05). Prognosis showed no significant difference in IL‐6/TWEAK levels (p &gt;0.05).ConclusionSerum IL‐6 and TWEAK can indicate disease severity and inflammation level, but may not predict prognosis accurately.Clinical Trial RegistrationOur study has clinical study registration number B.10.1.TKH.4.34.H.GP.0.01/154 of the University of Health Sciences Ümraniye Training and Research Hospital.

Association of serum chloride levels with all-cause mortality among patients in surgical intensive care units: a retrospective analysis of the MIMIC-IV database

This study explores the association between serum chloride concentrations and all-cause mortality among patients in the Surgical Intensive Care Unit (SICU). Employing a retrospective cohort design, the study utilized data extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, specifically focusing on individuals admitted to the surgical/trauma ICUs. This dataset encompassed demographic profiles, laboratory findings, historical medical data, vital statistics, and variables pertinent to prognosis. Participants were divided into four groups based on their serum chloride concentrations. The primary outcomes assessed were mortality rates at 30, 90, and 180 days post-admission to the ICU. Analytical methods included Kaplan–Meier survival curves, Cox proportional hazards regression models, and Restricted Cubic Spline (RCS) analyses to delineate the relationship between serum chloride concentrations and patient outcomes. The study cohort comprised 10,996 patients, with observed mortality rates of 12.78% at 30 days, 17.14% at 90 days, and 20.32% at 180 days. Kaplan–Meier analyses revealed significant disparities in survival rates across the quartiles of serum chloride during the follow-up intervals (p < 0.001). The results from the multivariable Cox regression suggested a substantial inverse association between high serum chloride levels and decreased mortality at 30 days (hazard ratio [HR]: 0.96; 95%confidence interval [CI]: 0.95–0.97; P < 0.001), 90 days (HR: 0.97; 95% CI: 0.96–0.98; P < 0.001), and 180 days (HR: 0.97; 95% CI: 0.96–0.98; P < 0.001). Particularly, patients in the highest quartile of serum chloride faced significantly lower mortality risks compared to those in the lowest quartile (30 days HR = 0.65, 90 days HR = 0.71, 180 days HR = 0.69, P < 0.001). RCS analysis depicted an L-shaped curve demonstrating the dynamics between serum chloride concentrations and the risk of all-cause mortality across the 30-day, 90-day, and 180-day periods.Starting at a concentration of 104 mmol/L, a decrease in serum chloride levels was associated with an increased risk of mortality.These findings elucidate a marked nonlinear association between serum chloride levels and all-cause mortality in SICU patients, enhancing our comprehension of serum chloride’s impact on clinical outcomes in this setting.

Occupational Therapy Interventions and Early Engagement for Patients in Intensive Care: A Systematic Review.

Patients in intensive care units (ICUs) experience complex functional, physical, and cognitive needs that affect their engagement in activities of daily living (ADLs). Occupational therapy practitioners are uniquely positioned to address these needs to optimize patients' functional recovery. To examine occupational therapy-specific interventions as they relate to early engagement for patients in the ICU. CINAHL, PubMed, ProQuest, OTseeker, and Cochrane Library databases. The Cochrane methodology was used to collect, evaluate, and analyze articles, then reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines for conducting a systematic review. Articles published from January 2012 to December 2021 evaluating adults who received occupational therapy interventions in ICUs with Level 1b, 2b, or 3b evidence were included. Nine articles met the inclusion criteria and the research objective. Findings showed moderate evidence for ADLs, physical rehabilitation, and cognitive interventions in promoting functional outcomes for patients in the ICU. This systematic review introduces the term early engagement to describe occupational therapy-specific interventions for patients recovering in the ICU and supports occupational therapy's role in this setting. Further research is needed to strengthen the evidence for occupational therapy-specific interventions and early engagement in the ICU. Plain-Language Summary: Patients in the intensive care unit experience complex needs that affect their participation in activities of daily living (ADLs). Current research demonstrates moderate evidence for early engagement with ADLs, physical rehabilitation, and cognitive interventions performed by occupational therapy practitioners. This systematic review introduces the term early engagement, which captures how occupational therapy practitioners provide holistic interventions for patients in the intensive care unit to promote patient well-being and functional recovery.

Association between early ondansetron use and the risk of sepsis in intensive care unit patients: a secondary data of the Medical Information Mart for Intensive Care IV database

ObjectiveThis study planned to analyse the association between ondansetron use within 24 hours before intensive care unit (ICU) admission to within 48 hours after ICU admission and the risk of...

Prediction of acute kidney injury in intensive care unit patients based on interpretable machine learning.

Acute kidney injury (AKI) poses a lethal risk in intensive care unit (ICU) patients, where early detection is challenging. This study was to establish a prediction model for AKI 24 hours in advance for ICU patients and to help clinicians monitor patients at an early stage by key features. In this study, the Medical Information Mart for Intensive Care (MIMIC) databases were used to construct a dataset of critically ill patients. Predictive models were constructed using five machine learning algorithms based on MIMIC-IV data, and the best predictive model was selected by multiple model evaluation metrics. MIMIC-III data were used for external validation. We conducted an interpretability analysis of the model using SHapley Additive exPlanations (SHAP) to clarify key features and decision-making mechanisms. A total of 18,186 patient data were included in this study. The analysis combining calibration and decision curves demonstrated that the eXtreme Gradient Boosting (XGBoost) exhibited superior performance among the five algorithms, achieving an area under the receiver operating characteristic curve of 0.88. Interpretability analysis based on the XGBoost model showed diuretic use, mechanical ventilation, vasopressor use, age, and antibiotic use as the most important decision factors of the model. The SHAP summary plot was used to illustrate the effects of the top 19 features attributed to the XGBoost. The XGBoost algorithm can predict the occurrence of AKI more accurately. Interpretative analysis of the model reveals the mechanisms of key features, and reflects the individual differences between patients, providing an important clinical reference.

Detection of OqxA and OqxB Efflux Pump Genes in Multidrug Resistant Klebsiella Pneumoniae Isolated from Intensive Care Unit Patients

Detection of OqxA and OqxB Efflux Pump Genes in Multidrug Resistant Klebsiella Pneumoniae Isolated from Intensive Care Unit Patients