Introduction: To compare EORTC/MSGERC and BM-AspICU diagnostic criteria for invasive aspergillosis and analyse clinical, mycological, and radiological features affecting patient outcomes. Materials and Methods: We conducted a retrospective study on 56 invasive aspergillosis patients who met inclusion criteria (age >18 years and confirmed diagnosis via histopathology, cultures, or galactomannan). Patients were categorized using EORTC/MSGERC and BM-AspICU criteria. Clinical, microbiological, radiological data, and outcomes were analysed. Results: of 56 patients, 47 had invasive pulmonary aspergillosis, 7 had invasive rhinosinusitis, 1 had disseminated, and 1 had cerebral aspergillosis. Mean age was 51.5 years, with 75% (42) males. Aspergillus fumigatus was common species (47.3%) isolated. Computed tomography scans of invasive pulmonary aspergillosis often showed nonspecific infiltrates (31.9%). Voriconazole was most used antifungal (80.4%). Mortality was 23.2% (n=13) in total and in intensive care unit patients with invasive pulmonary aspergillosis was 46.1% (n=12). 75% (9/12) of deceased patients initially classified as pulmonary colonizers by EORTC/MSGERC were reclassified as probable (n=3) or possible (n=6) invasive aspergillosis cases by BM-AspICU, difference was statistically significant (p=0.019). Intensive care unit admission was 55.3% (median stay: 8 days), higher in viral pneumonia (p = 0.003). Univariate analysis of invasive pulmonary aspergillosis patients showed significant mortality correlations with shock (p=0.001), acute kidney injury (p=0.003), invasive mechanical ventilation (p=0.001) and intensive care unit stay (p=0.026). Multivariate analysis identified shock as an independent predictor of mortality. Conclusion: In our study, BM-AspICU criteria demonstrated a stronger correlation with mortality compared to EORTC/MSGERC criteria. Morbidity and mortality were associated with viral pneumonia, shock, acute kidney injury, invasive mechanical ventilation and intensive care unit stay.

Background: A subset of patients undergoing complete atrioventricular septal defect (AVSD) repair underwent prolonged postoperative mechanical ventilation, contributing to extended intensive care unit and hospital stays. This study evaluated perioperative predictors of prolonged ventilation following complete AVSD repair and explored the utility of Brixia scores for early risk stratification. Methods: We performed a retrospective review of complete AVSD repairs in patients who were <12 months of age at a single academic hospital. Patients with heterotaxy syndrome and airway abnormality were excluded. Demographic, perioperative, partial pressure of oxygen (PaO2) and fraction of inspired oxygen (FiO2) ratios (P/F ratio), imaging, and echocardiographic data were collected. Factors associated with prolonged duration of mechanical ventilation (≥24 h) were identified. Results: We included 129 patients for analysis. Patients were divided based on the duration of mechanical ventilation (≥24 and <24 h). The prolonged mechanical ventilation group had a significantly lower median [interquartile range] P/F ratio after cardiopulmonary bypass (102.0 [70.0-180.0] vs 172.5 [79.4-265.0], P = .048). Factors associated with prolonged mechanical ventilation from the multivariable analysis were preoperative Brixia scores and first 24-h postoperative fluid balance. Conclusions: Perioperative factors can be used to identify patients with an increased risk of prolonged ventilation after complete AVSD repairs. The P/F ratios and Brixia scores are useful as early predictors. Postoperative fluid management is a modifiable factor to reduce mechanical ventilation duration.

Respiratory muscle ultrasound as a key predictor of successful weaning from mechanical ventilation in critically ill obstetric patients: a prospective observational study.

Music has been proposed as a simple, non-invasive intervention to modulate stress responses in patients undergoing invasive mechanical ventilation (IMV). Its potential impact on cortisol levels represents a promising approach to mitigating physiological stress in intensive care. To examine the effectiveness of music interventions in reducing cortisol levels and, consequently, modulating the stress response in mechanically ventilated patients in intensive care units (ICUs). A systematic review was conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD42023409196). Five electronic databases were searched without date restrictions. Eligible studies were randomised controlled trials (RCTs) assessing music interventions in adult patients receiving IMV, with serum cortisol as the primary outcome. Risk of bias was assessed using the Cochrane RoB 2 tool. Owing to substantial heterogeneity, findings were synthesised narratively. Five RCTs (n = 208) met the inclusion criteria. Three reported significant reductions in cortisol following music interventions, while two found no differences. Variability in music type, intervention duration, sedation status and measurement timing contributed to inconsistent results. Risk of bias was low in two studies, whereas three were rated as raising some concerns. Current evidence on the effect of music on cortisol in mechanically ventilated patients is limited and inconsistent. Findings remain contradictory, preventing firm conclusions about efficacy. Future multicentre trials with standardised protocols and rigorous control of confounders are required. This review highlights a major gap in evidence regarding the biological impact of music in IMV patients. Results from five small, heterogeneous RCTs are inconclusive, and some of them are limited by methodological concerns. Thus, current evidence is insufficient to support changes in clinical practice. While music remains a low-risk intervention of interest, its actual effect on physiological stress has yet to be demonstrated. Large-scale, high-quality studies are needed before clinical recommendations can be made. PROSPERO ID: CRD42023409196.

The COVID-19 pandemic challenged healthcare infrastructure and delivery, particularly during peak periods. How these disruptions affected care and outcomes for non-COVID patients in intensive care units (ICUs) remains unclear. To evaluate whether COVID-19 burden at the institutional and ICU level impacted ICU mortality among mechanically ventilated (MV) non-COVID patients across a health system. Clinical data for ICU patients admitted within the University of Pittsburgh Medical Center system from March 2020 through December 2022 were included. High and low periods of COVID-19 were defined based on the average COVID-19 positivity rate across UPMC hospitals with high periods defined as months when the average positivity rate ≥10 %. A mixed-effects logistic regression evaluated the association between COVID-19 periods and ICU mortality with random intercepts for hospital and patient. Secondary models evaluated variation by ICU subtype and institution type. Models adjusted for demographic, clinical, and ICU characteristics. Among 19,727 MV non-COVID ICU admissions, 10,798 occurred during high COVID-19 periods and 8929 during low periods. Baseline characteristics were similar with the largest age group being 60-69 years (28.1 % low vs 28.6 % high). Patients were predominantly White males admitted to quaternary hospitals. Admission during high COVID-19 periods was associated with higher ICU mortality (OR=1.19, 95 % CI: 1.08,1.31) particularly in MICUs (OR=1.18, 95 % CI: 1.14,1.22) and quaternary hospitals (OR=1.19, 95 % CI: 1.09,1.29). High COVID-19 periods were associated with increased odds of ICU mortality among MV non-COVID-19 patients. These findings underscore the need for system-wide surge planning and incorporation of case-mix and workload measures in future evaluations.

National survey on practices of French intensivists in weaning from mechanical ventilation.

A review of indoor air quality (IAQ) in classrooms: The effect of particulate matter (PM), gaseous pollutants, and airborne pathogens.

Venoarterial extracorporeal membrane oxygenation versus off-pump lung transplantation: Interim analysis of a prospective, randomized clinical trial.

The triple burden of sex disparities in critical care mechanical ventilation.

Diaphragmatic ultrasound in guiding weaning from invasive mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease.

We conducted a systematic review and meta-analysis to compare continuous ketamine infusion to other analgosedatives in critically ill children receiving invasive mechanical ventilation (IMV). We searched four electronic databases and trial registries to September 1, 2025. We searched published conference abstracts from two major critical care conferences (2022 to 2025). We preregistered the protocol on PROSPERO (CRD42025631768). Reviewers screened abstracts and full texts independently and in duplicate. We included randomized controlled trials (RCTs) and nonrandomized studies comparing ketamine to other analgosedatives in critically ill children receiving IMV. Independently and in duplicate, we conducted data extraction. We assessed risk of bias using the Risk Of Bias instrument for Use in SysTematic reviews for RCTs or Risk Of Bias In Nonrandomized Studies of Interventions tool, and certainty of evidence using Grading of Recommendations, Assessment, Development, and Evaluation. We pooled data using random-effects models. We included three RCTs and five nonrandomized studies (n = 1436 participants). Pooled analysis demonstrated that ketamine may have no effect on IMV duration (mean difference, 0.00 d; 95% CI, 0.03 d fewer to 0.03 d more; low certainty) and may reduce opioid exposure (mean difference, -8.88 µg/kg cumulative fentanyl equivalents; 95% CI, -6.99 to -10.77; low certainty). We found an uncertain effect of ketamine on delirium, withdrawal, length of stay, clinically important hypotension, and mortality compared with other analgosedatives. Long-term outcomes were not measured in included studies. There is a paucity of studies examining ketamine analgosedation in children receiving IMV, yielding mostly very low certainty evidence for patient-important outcomes due to imprecision and issues related to serious risk of bias of included studies. Methodologically rigorous RCTs are needed to better understand the potential role of ketamine analgosedation in the PICU.

To examine 11-year trends in adverse events (AEs) in a pediatric critical care unit (PCCU), assess the impact of the COVID-19 pandemic on patient safety, and evaluate associations between patient acuity and AE severity. Retrospective cohort study using interrupted time series analyses and mixed-effects multinomial regression. A single-center PCCU monitored via the Adverse Event Management System from January 2013 to December 2023. A total of 7290 critically ill and injured pediatric patients admitted to the PCCU over the study period. None (observational study). Exposure variables included the COVID-19 pandemic period, invasive mechanical ventilation and noninvasive ventilation. Demographics, length of stay (LoS), disposition, and AE severity were assessed. The baseline AE rate was 11.94 events per 100 cases. At pandemic onset, AE rates rose by 5.20 events per 100 cases (p = 0.004), then declined 0.81 events per 100 cases quarterly (p = 0.010). Post-pandemic, rates increased 1.94 events per 100 cases quarterly (p = 0.009). LoS decreased 0.01 days quarterly pre-pandemic (p = 0.009), was stable during the pandemic, then increased 0.25 days quarterly post-pandemic (p = 0.033). Higher Pediatric Index of Mortality 2 scores were associated with fewer "near miss" events and more "MinModSev" (minimal, moderate, or severe) AEs. Both mechanical ventilation (p = 0.039) and noninvasive ventilation (p = 0.015) increased the odds of "MinModSev" AEs. This PCCU experienced a transient increase in AEs during COVID-19, followed by recovery and a post-pandemic rise in both AE rates and LoS. Higher illness severity and respiratory support were associated with more severe AEs. These findings underscore the importance of data-driven monitoring systems to sustain patient safety during and after healthcare crises.

Factors influencing postoperative delirium in patients with congenital heart disease: A systematic review and meta-analysis.

To develop a method for detecting respiratory phases and their onset during intra-arrest ventilation with ongoing chest compressions based on explicit definitions for respiratory phase onsets, enabling automated processing at scale. An algorithm was developed that uses the product of airflow and airway pressure, and the product of flow and airway pressure slope. For experimental validation of the algorithm, ventilatory recordings from 13 pigs with mechanical ventilation were used. For each animal, 20 ventilations before induction of cardiac arrest (regular ventilation) and 20 ventilations during ongoing chest compressions with asynchronous ventilation (intra-arrest ventilation) were selected. Algorithm performance was analysed against investigator-validated annotations of respiratory phase onsets. The proposed algorithm yielded perfect classification of inspiratory and expiratory phases during regular and intra-arrest ventilation. For the determination of the exact timestamp of respiratory phase onsets, the algorithm had an F1-score of 1 in regular ventilation and 0.971 during intra-arrest ventilation. We propose an algorithm to detect respiratory phases and their exact onsets robust to chest compressions, which exhibits excellent results on a validation dataset. The concept incorporates the inherent relationship of airflow and airway pressure to differentiate between airflow due to artificial ventilations and airflow due to chest compressions.

A comparison of methods for the derivation of classroom ventilation rates from CO2 measurements

Introduction: Acute Meningoencephalitis (AME) is a lifethreatening condition in young children, particularly in lowresource settings, with overlapping features of meningitis and encephalitis. Despite advances in diagnostics and vaccination, evolving pathogens like dengue virus and Orientia tsutsugamushi contribute to high morbidity and mortality due to delayed diagnosis and treatment. Aim: To assess short-term outcomes, and predictors of mortality of AME in children under five years of age. Materials and Methods: The present prospective observational study was conducted at King George’s Medical University, Lucknow,Uttar Pradesh, India, from January 2020 to September 2021. Total 101 children aged between 1 month to 5 years with AME were enrolled in this study after taking a written informed consent from their parents. Detailed clinical history (fever, seizures and its type, altered sensorium, headache, diarrhoea, vomiting, bleeding, swelling, rash) and demographic details were recorded. Outcomes were classified as complete recovery, recovery with neurological sequelae, or mortality. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 23 for Windows. Logistic regression analysis was performed to identify independent predictors of mortality. Results: Total 101 children were enrolled with AME, with a mean age of 37.92±18.32 months, with 66 (65.3%) of the cases being male and a male-to-female ratio of 1.9:1. Out of 101 cases 69 (68.3%) were successfully treated and discharged. Among the 69 children who were discharged, 39 ( 56.5%) cases were fully conscious and recovered completely. However, 30 (43.5%) cases had some degree of altered sensorium at discharge. Of these, three children (4.3%) required nasogastric (RT) feeding, and two children (2.8%) were discharged with both tracheostomy and RT feeds in place. Persistent neurological sequelae were noted in several cases: seizures in five children (7.2%), visual and hearing impairments in five children (2.8%) each, and focal neurological deficits in two children (2.8%). The overall mortality rate was 9.9%, with factors such as immunisation status, Glasgow Coma Scale (GCS) score, renal dysfunction, and the need for mechanical ventilation associated with worse outcomes. Conclusion: According to the results of the present study key predictors of mortality in children with AME included severe GCS scores, renal dysfunction, and the need for mechanical ventilation. Early diagnosis, immunisation, and prompt treatment are crucial for improving outcomes.

Lung retransplantation (ReTx) is the only definitive treatment for advanced chronic lung allograft dysfunction (CLAD). ReTx outcomes are historically inferior to those of primary transplant. Identification of clinically significant risk factors could guide candidate selection and resource allocation to optimize outcomes. We conducted a single-center, retrospective cohort study of all lung transplants performed at Columbia University Medical Center (CUMC) from 2005 to 2023. The primary outcomes of survival and freedom from CLAD after ReTx were analyzed using Cox regression models. We identified 51 lung retransplant recipients and compared them with 1149 primary lung transplant recipients. ReTx accounted for 3.9% of all transplants, and almost all were for CLAD-BOS.One-, three-, five-, and ten-year survival after ReTx was 96%, 72%, 55%, and 28%, respectively (median = 5.61 [3.30-8.51] years). Characteristics associated with worse survival following ReTx included age ≥ 55 (adjusted HR 2.6; 95% CI, 1.39-5.02) and early-onset CLAD following ReTx (HR 4.86; 95% CI, 1.94-12.2). Pretransplant mechanical ventilation or ECMO support, type of surgical procedure, and the interval between primary and re-transplantation were not significantly associated with survival. Overall, our center's outcomes after lung ReTx were more favorable than those previously reported, likely due to more restrictive candidate selection. These findings highlight the importance of careful patient selection. Multicenter prospective studies are needed to further refine risk stratification and optimize ReTx outcomes.

Electrical Risk Score derived from standard ECG predicts mortality in sepsis patients presenting to the emergency department.

The use of extracorporeal membrane oxygenation (ECMO) during lung transplantation has progressively expanded and, in many centers, replaced conventional cardiopulmonary bypass. However, it remains unclear whether central or peripheral veno-arterial (VA) ECMO provides superior postoperative outcomes. This study aimed to compare central VA-ECMO (cVA-ECMO) and peripheral VA-ECMO (pVA-ECMO) during lung transplantation, with a focus on survival, primary graft dysfunction grade 3 (PGD3), postoperative ECMO support, and postoperative morbidity. Three databases were assessed through November 2025. Five retrospective observational studies including 866 patients were included. Overall survival was analyzed using reconstructed individual patient data derived from Kaplan-Meier curves. Random-effects models were applied for all pooled analyses. There was no significant difference in overall survival (HR 1.224, p=0.13) and in PGD3 at 72h incidence (OR 1.55; p=0.26) between cVA-ECMO and pVA-ECMO. However, pVA-ECMO was associated with a higher requirement for postoperative ECMO use (OR 6.05; p=0.04), longer duration of extracorporeal support (MD +1.61 days; p=0.01), prolonged mechanical ventilation (MD +2.73 days; p<0.01), and longer intensive care unit length of stay (MD +4.05 days; p<0.01). The risk of limb ischemia requiring invasive treatment was significantly higher with pVA-ECMO (OR 4.94; p=0.001). Although survival and PGD3 incidence were comparable, pVA-ECMO was associated with greater postoperative morbidity and vascular complications. These findings should be interpreted with caution, and cannulation strategy should be individualized according to patient risk profile, surgical context, and center-specific expertise rather than favoring one approach uniformly.

Moderately severe or severe acute pancreatitis (MSAP/SAP) is a crucial abdominal disorder. Enteral nutrition (EN) is a central issue after patients pass through the resuscitation stage. The preference for EN formulas and initial timing opportunities are controversial topics. We investigated the linkage between two types of EN formulas, short peptides and intact proteins, and initial time and SAP prognosis. 335 enrolled SAP patients were divided into three groups according to the EN formula accepted during two weeks of feeding. The groups were set as SPG (group fed by short peptide, SP), IPG (group fed by intact protein, IP) and CG (group converted from SP to IP at second week). Pearson's chi-square test and the Kruskal-Wallis test were used to compare the descriptive variables. Binary logistic regression was used to analyze the relationship between initial time and mortality. K-M survival curves and log-rank tests were used to evaluate long-term prognosis. Although the patients were either fed by SP, IP or a mixture of products (from the SP to the IP), the groups showed no difference in the serum albumin/prealbumin recovery, invasive mechanical ventilation or 90-day survival rate. Timely EN formula conversion from the SP to the IP may reduce the insulin dosage for glucose-impaired patients. The results also proved that EN started 3-5days after the onset of SAP was associated with lower mortality. Therefore, an optimal EN strategy can be summarized. First, the selection of the EN formula should be based on the patients' basic conditions, especially glucose level, rather than on the pancreatic rest theory. Second, the conversion from SP to IP made it easier for patients to tolerate the EN and decreased insulin use. Finally, the proper opportunity to commence EN was considered to be 3-5days after SAP onset.