Intensive Care Patients Research Articles

Reliability and validity of the Turkish form of intensive care nursing activities score.

The purpose of this study was to examine the reliability and validity of the Turkish version of the Nursing Activities Score. To validate the Turkish version of the Nursing Activities Score, a sample comprising 30 adult intensive care patients and 30 nurses was employed. After a pilot study, the internal consistency, Cronbach's alpha coefficient, was found to be p = 0.718. Following the significant internal consistency obtained in the pilot study, the correlation between Nursing Activities Score internal consistency and Critical Nursing Situation Index scores was examined in 150 adult intensive care patients and 150 nurses. The assessment of inter-rater reliability showed a high level of agreement (99%) and an average Kappa index of 0.598 (p < 0.001). Concurrent validity was demonstrated through a statistically significant correlation between Nursing Activities Score and the Critical Nursing Situation Index (r = 0.71, p < 0.001) and multivariate regression analysis (R2 = 83%, p < 0.001). The validity is supported by the statistically significant relationship between Nursing Activities Score and Critical Nursing Situation Index. These results demonstrate that Nursing Activities Score is a valid and reliable tool for measuring nursing workload in Turkish intensive care units. Samsun University Samsun Training and Research Hospital, following ethics committee approval (Samsun University clinical research ethics committee (KAEK) 202312/2) and Clinical Trials (NCT04928040) registration.

THE ROLE OF BRONCHOSCOPY IN INTENSIVE CARE MEDICINE, CASE REPORT

Purpose. Airway maintenance, adequate ventilation, and pulmonary gas exchange are crucial for critically ill patients. The challenges of performing in intensive care patients often differ significantly from routine surgical procedures in the operating room. The aim of our study was to assess the effectiveness of bronchoscopic aspiration in improving respiratory function in a patient on prolonged artificial ventilation. Material/Methods. A 69-year-old male was admitted to the ICU six days after an open cystoprostatectomy, presenting with respiratory failure. Initial treatment included blind airway suctioning, nebulization, chest physiotherapy, and empirical antibiotics. Due to persistent atelectasis and respiratory failure, bronchoscopic aspiration was performed. A total of nine bronchoscopies with bronchoalveolar lavage (BAL) were conducted for aspiration and microbiological testing, guiding adjustments in antibiotic therapy. After 61 days in the ICU, the patient was transferred to the Department of Urology and later discharged. Results. Bronchoscopic aspiration significantly improved the patient's condition, with noticeable improvements after the first bronchoalveolar lavage (BAL). Pulmonary imaging on X-ray and blood oxygenation showed clear progress, with better lung function and enhanced ventilation parameters. These changes allowed for a reduction in oxygen concentration and improved gas exchange. After 61 days in the ICU, the patient was successfully transferred to the Department of Urology and later discharged in stable condition. Conclusions. Bronchoscopic aspiration is a highly effective method for improving ventilation and oxygenation in patients on prolonged mechanical ventilation. It plays a crucial role in managing airway obstructions atelectasis, and enhancing microbiological diagnostics.

PP076 Topic: AS09–Global Health/Resource Limited Setting/Health Inequalities/Impact of Global Warming/Other: EXPLORING INTENSIVE CARE PATIENT PROFILES AND SOCIOECONOMIC STATUS DURING A PATIENT SURGE EVENT

PP076 Topic: AS09–Global Health/Resource Limited Setting/Health Inequalities/Impact of Global Warming/Other: EXPLORING INTENSIVE CARE PATIENT PROFILES AND SOCIOECONOMIC STATUS DURING A PATIENT SURGE EVENT

Admission chest CT scan of intensive care patients with interstitial lung disease: Unveiling its limited predictive value through visual and automated analyses in a retrospective study (ILDICTO)

BackgroundClinical course prediction of patients with interstitial lung disease (ILD) admitted to the intensive care unit (ICU) for acute respiratory failure (ARF) can be challenging. This study aimed to characterize the prognostic value of admission chest CT-scan in this situation. MethodsWe retrospectively included ILD patients admitted to a French ICU for acute respiratory failure requiring oxygen. Patients with lymphangitis carcinomatosis and ANCA vasculitis were excluded. We analyzed every admission chest CT-scan using two different approaches: a visual analysis (grading the extent of traction bronchiectasis, ground glass and honeycomb) and an automated analysis (grading the extent of ground glass and consolidation with a dedicated software). The primary outcome was ICU mortality. ResultsBetween January 2014 and October 2020, 81 patients presented an acute respiratory failure with ILD on the admission chest CT-scan. In univariate analysis, only the main pulmonary artery diameter differed between patients who survived and those who died in ICU (30 vs 32 mm, p = 0.021). In multivariate analysis, none of the radiological funding was associated with ICU mortality. Visual and automated analyses did not yield different results, with a strong correlation between the two methods. However, the identification of an UIP pattern (and the presence of honeycomb) was associated with a poorer response to corticosteroid therapy. ConclusionOur study showed that the extent of radiological findings and the severity of fibrosis indices on admission chest CT scans of ILD patients admitted to the ICU for ARF were not associated with subsequent deterioration.

Сравнение методик пункционно-дилатационной трахеостомии Фрова и Григгс у пациентов с избыточной массой тела и ожирением: рандомизированное контролируемое исследование

INTRODUCTION: Tracheostomy is one of the most frequently performed operations in intensive care patients. This is due to the fact that in the population of intensive care patients, puncture tracheostomy has a number of advantages compared to surgical tracheostomy (ST). This determines the urgency of finding ways to reduce the risk of perioperative complications during puncture tracheostomy in intensive care patients, especially in overweight and obese patients. OBJECTIVE: To study the advantages and limitations of puncture dilation tracheostomy (PDT) performed using the Frova method under ultrasound control in intensive care patients with overweight and obesity, in comparison with the Griggs PDT method under fibrobronchoscopic (FBS) control. MATERIALS AND METHODS: The presented prospective study was conducted in the departments of anesthesiology and intensive care of the A.I. Burnasyan Federal Medical Biophysical Center FMBA from 2017 to 2021, which included 92 overweight and obese patients whose body mass index (BMI) was more than 25 kg/m2 and required tracheostomy. Two groups were identified: group (n = 48) — Frova tracheostomy under ultrasound control, group (n = 44) — Griggs tracheostomy under FBS control. RESUITS: Performing PDT using the Frova technique under ultrasound control is feasible and safe in intensive care patients with overweight and obesity, whereas with grade 3 obesity with a BMI of more than 41 kg/m2 and/or with a thickness of pretracheal soft tissues of more than 40 mm, PDT using the Frova technique should be abandoned and should be considered as absolute contraindications for performing PDT using the Frova method under ultrasound control. CONCLUSIONS: PDT using the Frova method under ultrasound control, when compared with the Griggs method with FBS control, can significantly reduce the incidence of intraoperative desaturation, arterial hypotension, intraoperative severe hemorrhagic complications, postoperative soft tissue infection around a tracheostomy wound.

Гиповолемический шок у взрослых. Клинические рекомендации Общероссийской общественной организации «Федерация анестезиологов и реаниматологов»

The article presents the main provisions of clinical guidelines for the diagnosis and treatment of hypovolemic shock in adults, approved by the All-Russian public organization "Federation of Anesthesiologists and Resuscitators" in 2024. The relevance of the problem is associated with a significant prevalence and high mortality rates in hypovolemic shock. The recommendations include issues of etiology, pathogenesis, clinical picture, methods of laboratory and instrumental diagnostics of hypovolemic shock. The features of intensive care for hypovolemic shock are presented, including approaches to the administration of vasopressor and inotropic drugs, recommendations for the choice of infusion and adjuvant therapy, including the correction of coagulopathy in hemorrhagic shock. The issues of resuscitation damage control strategy are discussed. The criteria for the quality of medical care for adult patients with hypovolemic shock and algorithms for the doctor's actions in the diagnosis and intensive care of patients with hypovolemic shock are presented.

Incidence of hospital – acquired in pneumonia in intensive care patients

Introduction: hospital-acquired pneumonia (HAP) is a serious infection that appears after 48 hours of hospital admission, with high morbidity and mortality in intensive care units (ICU). Data collection was performed through clinical records. Objective: to characterize the behavior of hospital-acquired pneumonia in intensive care patients.Method: an analytical, observational, retrospective study was conducted; the study variable is longitudinal. Data collection was performed through clinical records. Results: 14 patients with relevant data were included, as well as PubMed bibliography from the last 5 years. The findings highlight the need for rapid diagnostic methods and new antibiotics due to microbial resistance. The aim is to understand the risk factors and optimize the management of HAP in critically ill patients. Conclusion: the combination of bibliographic data and patient analysis highlights the complexity of HAP and underlines critical areas for future research. The development of rapid diagnostic methods, new antibiotics, and a better understanding of comorbidities could significantly improve management and outcomes for patients. With the integration of new technologies and personalized approaches, it is possible to optimize the prevention and treatment of this serious condition

Sublingual microcirculatory assessment on admission independently predicts the outcome of old intensive care patients suffering from shock

Shock is a life-threatening condition. This study evaluated if sublingual microcirculatory perfusion on admission is associated with 30-day mortality in older intensive care unit (ICU) shock patients. This trial prospectively recruited ICU patients (≥ 80 years old) with arterial lactate above 2 mmol/L, requiring vasopressors despite adequate fluid resuscitation, regardless of shock cause. All patients received sequential sublingual measurements on ICU admission (± 4 h) and 24 (± 4) hours later. The primary endpoint was 30-day mortality. From September 4th, 2022, to May 30th, 2023, 271 patients were screened, and 44 included. Patients were categorized based on the median percentage of perfused small vessels (sPPV) into those with impaired and sustained microcirculation. 71% of videos were of good or acceptable quality without safety issues. Patients with impaired microcirculation had significantly shorter ICU and hospital stays (p = 0.015 and p = 0.019) and higher 30-day mortality (90.0% vs. 62.5%, p = 0.036). Cox regression confirmed the independent association of impaired microcirculation with 30-day mortality (adjusted hazard ratio 3.245 (95% CI 1.178 to 8.943, p = 0.023). Measuring sublingual microcirculation in critically ill older patients with shock on ICU admission is safe, feasible, and provides independent prognostic information about outcomes.Trial registration NCT04169204.

The association of early passive mobilization with intracranial pressure in the adult intensive care unit: A prospective, cohort study.

Early mobilization are key components of the ABCDEF Care Bundle and critical treatments to reduce acquired muscle weakness, delirium and prolonged intensive care unit (ICU) stay. This study aimed to determine whether routine early mobilization related to intracranial pressure in intensive care patients on mechanical ventilation, using optic nerve sheath diameter measurement (ONSD). This study was planned as a prospective, cohort study in the third-step adult ICU of a faculty hospital. The study included only patients who were intubated and followed up on a mechanical ventilator and were clinically stable. Passive range of motion (PROM) exercises were performed daily by the physiotherapists as part of routine care from the day of hospitalization. ONSD was assessed before, during and 10 min after PROM exercises. The study included 20 eligible patients out of the 142 who were evaluated upon admission to the ICU. The median age of the patients was 65 years, and nine (45%) of them were female. The analyses showed that there was no statistically significant change in ONSD during and at the end of the PROM (ONSD right eye p:.621, Partial η2: 0.025, ONSD left eye p:.935, Partial η2: 0.004). Similarly, there was no statistically significant change in haemodynamic parameters in during and at the end of the PROM (Heart beat p:.849, Partial η2: 0.009, Systolic Pressure p:.435, Partial η2: 0.043, Diastolic Pressure p:.128, Partial η2:0.103, Saturation p:.103, Partial η2: 0.113 and Respiratory rate p:.071, Partial η2:0.130). This study suggests that daily extremity physiotherapy exercises can be safely applied without causing increased intracranial pressure or haemodynamic instability in intensive care patients followed up on mechanical ventilation, including patients with vasopressor therapy. Early mobilization, including PROM, is considered safe in terms of intracranial pressure for intubated patients in the ICU.

Clinical pharmacist interventions in nutrition-and drug-related problems in critically ill patients with renal dysfunction: a non-randomized controlled study

BackgroundCritically ill intensive care unit (ICU) patients often face life-threatening drug-related problems (DRPs) and malnutrition. Clinical pharmacists (CPs) play a crucial role in mitigating these issues and improving outcomes.AimThis study was designed to detect, prevent, reduce or resolve nutrition-related problems (NRPs) and DRPs in intensive care patients with renal dysfunction through clinical pharmacy services.MethodThis 9-month, prospective, non-randomized, controlled study was conducted in the ICU. During the intervention period (IP), CP recommendations addressing NRPs and DRPs were provided to the healthcare team. NRPs were evaluated using an expert-developed enteral nutrition consensus protocol, while DRPs were classified according to the Pharmaceutical Care Network Europe (PCNE) Classification for Drug-Related Problems Version 9.1.ResultsThe study included 60 patients with a median age of 73 years (IQR: 60.5–80). A total of 504 DRPs (8.4 per patient) were identified across all patients. DRPs were decreased by 50% during the IP compared to the observation period (OP) (p &amp;lt; 0.001). The most common causes of DRPs were ‘too low a drug dose’ (22.2%), ‘drug–drug interactions’ (17%), and ‘too high a drug dose’ (16.4%). Of the recommendations made to the prescribing physician, 140 (97.9%) were accepted. In the IP, targeted calorie and protein supplementation was fully achieved in more patients (p &amp;lt; 0.05). The most common recommendations included ‘changes in the rate of nutrition’ (66.7%), ‘vitamin supplementation’ (16.7%), and ‘changes in enteral nutrition products’ (7.7%).ConclusionThis study highlights the high incidence of DRPs and malnutrition risk in ICU patients with renal dysfunction, emphasizing the vital role of clinical pharmacists. Their collaboration with healthcare professionals significantly reduced both DRPs and NRPs.

Phenotypic Characterization of Intensive Care Patients With Infections: A Pilot Study of Host and Pathogen-Based Cluster Analysis

Phenotypic Characterization of Intensive Care Patients With Infections: A Pilot Study of Host and Pathogen-Based Cluster Analysis

Poor correlation of venous lactate with systemic oxygen saturation in the paediatric cardiac ICU: a pilot study.

Cardiac intensive care providers require a comprehensive understanding of cardiac output and oxygen delivery. The estimation of cardiac output in clinical practice often relies on thermodilution and the Fick principle. Central venous saturation and lactate levels are commonly used indicators for cardiac output assessment. However, the relationship between venous lactate levels and venous oxygen saturation in paediatric cardiac intensive care patients remains unclear. This is a single-centre retrospective pilot study aimed to investigate the correlation between venous lactate and venous oxygen saturation in paediatric patients. Data collected included venous saturation, heart rate, mean arterial blood pressure, arterial saturation by pulse oximetry, cerebral and renal near-infra-red spectroscopy values, and the presence of a functionally univentricular heart. Statistical analyses included Bayesian Pearson correlation and regression analyses. A total of 203 data points from 37 unique patients were included in the analysis. There was no significant correlation between serum lactate and venous saturation (correlation coefficient = -0.01; Bayes factor 10 = 0.06). Serum lactate also did not correlate with other haemodynamic metrics. Venous saturation showed correlations with arterial saturation and cerebral and renal near-infra-red spectroscopy. Regression analysis revealed that parallel circulation, arterial saturation, and cerebral near-infra-red spectroscopy were predictive of venous saturation. The following equation resulted from the regression analysis: 68.0 - (12.7 x parallel circulation) - (0.8 x arterial saturation) + (0.3 x cerebral near-infra-red spectroscopy). This model had a Bayes factor 10 of 0.03 and adjusted R-squared was 0.29. In paediatric cardiac intensive care patients, there is no significant correlation between venous lactate and venous saturation, suggesting that lactate may not be a reliable marker for assessing the adequacy of oxygen delivery in this population. Only a weak correlation could be identified once the venous saturation was 70% or lower. Additional research is needed to explore alternative markers for monitoring oxygen delivery in critically ill paediatric patients.

Intensive care due to myasthenia gravis: Risk factors and prognosis.

Exacerbation of myasthenia gravis (MG) with respiratory failure requires intensive care. We aimed to study the risk factors for intensive care unit admission for MG exacerbation and myasthenic crisis (MC) and the prognosis of people with MG (pwMG) thereafter. This retrospective study investigated patients in the Helsinki and Uusimaa hospital district during the years 2008-2021. PwMG (International Classification of Diseases, 10th revision code G70.0) were identified through a data repository search, followed by a chart review of patient records. Risk factors for intensive care due to MG exacerbation were evaluated as compared with the patients only treated in the outpatient clinic and those treated in the neurological ward for MG exacerbation. The outcomes of patients in intensive care for any reason were also compared with those of patients in intensive care for exacerbation of bronchial asthma. Of 577 pwMG, 35 (6.1%) needed intensive care for MG within a median of 5.3 months from diagnosis. The mean (±SD) age at MG diagnosis was higher in the intensive care group (60.5 [±16.1] years) compared to the outpatient (48.3 [±20.9] years; p < 0.001) and neurological ward groups (53.4 [±20.8] years; p = 0.044). Thymoma (odds ratio [OR] 4.8, 95% confidence interval [CI] 1.19-19.43; p = 0.028) and female sex (OR 2.1, 95% CI 1.02-4.48; p = 0.045) were independent risk factors for intensive care. In-hospital mortality was 4% for MC patients. Six-month mortality after intensive care for MG exacerbation (14.3%) was twice that for asthma exacerbation (7.7%). Our study shows an increased risk of intensive care treatment for patients with late-onset MG, female sex or thymoma, occurring usually within 6 months from diagnosis, which emphasises the importance of early treatment choices.

Electroencephalographic monitoring in detection and prediction of delayed cerebral ischemia due to non-traumatic subarachnoid hemorrhage

Intensive care of patients with acute non-traumatic subarachnoid hemorrhage primarily relies on diagnostics of delayed cerebral ischemia (DCI). The major difficulty in detecting DCI emerges upon suppression of wakefulness, when clinical assessment of growing neurological deficit becomes complicated. Widely used transcranial dopplerography allows solely to verify a vasospasm development not always leading to DCI exhibiting a multifactorial underlying mechanism. Electroencephalography (EEG) is the only broadly available instrumental tool ensuring a continuous monitoring of cerebral functional status including in subjects at intensive care unit. To date, non-specific EEG parameters pointing at development of acute cerebral injury were identified that provide varying diagnostic and predictive informative value in DCI. We reviewed publications aimed at assessing the data on visual and quantitative EEG parameters such as regional slowing, alpha rhythm spectral power and relative variability, alpha-to-delta power ratio, and detection of epileptiform activity. Having searched international and Russia-wide medical databases, we found only 7 publications quantitatively assessing diagnostic value of EEG monitoring, which showed that for DCI diagnosis its sensitivity ranged from 76% to 100%, and specificity – from 54% to 100%. We also present a clinical case with a 70-year-old female patient who underwent surgery for non-traumatic subarachnoid hemorrhage due to a ruptured aneurysm of the communicating segment of the right internal carotid artery. During the continuous videoEEG monitoring 2 days before clinical deterioration and appearance of ischemic changes in the right cerebral hemisphere on computed tomography scans, an ictal-interictal continuum pattern was noted to emerge. Future studies should be aimed at clarifying and validating the most informative DCI biomarkers including while recording EEG with intracranial electrodes that may contribute to development of automated algorithms for DCI detection.

Validity and reliability of the Endotracheal Suction Assessment Tool© in adult ICU patients: A methodological study

BackgroundNovice nurses often find endotracheal suctioning signs unfamiliar. The Endotracheal Suction Assessment Tool© (ESAT©) aids pediatric nurses in suctioning but lacks an adult equivalent. A valid and reliable ESAT© for assessing intensive care unit patients’ suction needs across different populations is necessary. AimTo test the validity and reliability of the ESAT© in adult ICU patients. MethodsThis methodological study assessed suction needs in patients at a tertiary adult ICU of a university hospital. Two independent observers used the ESAT© to determine suction needs. Data from 106 suction procedures were collected using a patient characteristics form, the ESAT©, and a suction monitoring form. The ESAT© includes eight respiratory and ventilation parameters and seven clinical consideration parameters. Hemodynamic and respiratory parameters were measured before, and one and five minutes after suction. Linguistic validity, content validity, and pilot testing were conducted. Interobserver agreement was evaluated, and psychometric evaluation was done using content validity index (CVI) and intraclass correlation coefficient (ICC). Data were analyzed with paired samples t-test and ANOVA. ResultsItem CVI ranged from 0.80 to 1.00, and scale CVI was 0.96. Inter-item correlation and ICC for inter-rater reliability were both 0.933 (95 % CI = 0.903–0.954, p < 0.001 for ICC). Cohen’s Kappa coefficients ranged from 0.690 to 1.000 (p < 0.001), indicating high consistency between raters for all tool items. All scale items showed near-perfect agreement except SpO2, which showed substantial agreement. ConclusionThe S-CVI was good, indicating near-perfect agreement among raters. ESAT© is highly reliable and valid for determining suction needs in adult intensive care patients. Implications for PracticeThe ESAT© aids autonomous decision-making for suctioning needs. Originally for novice pediatric nurses, the ESAT© was adapted for adult intensive care nurses. The ESAT© is valid and reliable for adult intensive care patients.

The effect of an open-heart surgery patient care protocol on post-sternotomy pain, anxiety and quality of care: A randomized controlled trial.

Open-heart surgery patients face many problems because of post-sternotomy pain. Care protocols can eliminate pain and pain-related problems by providing holistic care. The aim of this study was to examine the effect of an open-heart surgery patient care protocol developed in the study on post-sternotomy pain, anxiety and quality of care. The study was carried out as a double-blind randomized controlled trial. The sample size was calculated. Considering some attrition, the sample size was increased by 10% for each group, and a total of 68 participants, including 34 in each group, were included in the sample. Data were collected using a 'Patient Information Form', a 'Post-Sternotomy Pain Follow-up Form', the 'Numeric Rating Scale', the 'State Anxiety Inventory' and the 'Strategic and Clinical Quality Indicators in Postoperative Pain Management Questionnaire'. The patients in the experimental group were given care in accordance with the protocol, which was developed in the study, on postoperative days 0, 1 and 2. The statistical evaluation showed a significant difference between the mean scores of the experimental (F = 7.28; p < .001) and control groups (F = 2.42; p < .05) on the pain assessment scale. It was determined that the number of analgesics used in the experimental group was statistically significantly lower than in the control group. Intra-group comparisons showed that there was a difference between the mean pre-test and post-test state anxiety scale scores of the groups (p < .001). The experimental group had higher mean scores on the Strategic and Clinical Quality Indicators in Postoperative Pain Management Questionnaire than that of the control group (p < .001). The protocol developed in the study was found to be effective in reducing pain, the use of NSAIDs and opioids, and anxiety levels and increasing the level of quality of care. The protocol was original and feasible in that it included independent nursing interventions to improve the quality of care by reducing pain and anxiety. Particularly, the use of protocols in intensive care units was nurses' strongest resource in patient care management. Thus, the protocol, which was prepared for intensive care patients who most frequently experience pain and anxiety, was promising for nurses in improving the quality of care by reducing pain and anxiety. However, it is necessary to conduct further studies involving longitudinal follow-up in samples and institutions with similar conditions.

Risk factors for central line-associated bloodstream infection in the pediatric intensive care setting despite standard prevention measures.

Identify risk factors for central line-associated bloodstream infections (CLABSI) in pediatric intensive care settings in an era with high focus on prevention measures. Matched, case-control study. Quaternary children's hospital. Cases had a CLABSI during an intensive care unit (ICU) stay between January 1, 2015 and December 31, 2020. Controls were matched 4:1 by ICU and admission date and did not develop a CLABSI. Multivariable, mixed-effects logistic regression. 129 cases were matched to 516 controls. Central venous catheter (CVC) maintenance bundle compliance was >70%. Independent CLABSI risk factors included administration of continuous non-opioid sedative (adjusted odds ratio (aOR) 2.96, 95% CI [1.16, 7.52], P = 0.023), number of days with one or more CVC in place (aOR 1.42 per 10 days [1.16, 1.74], P = 0.001), and the combination of a chronic CVC with administration of parenteral nutrition (aOR 4.82 [1.38, 16.9], P = 0.014). Variables independently associated with lower odds of CLABSI included CVC location in an upper extremity (aOR 0.16 [0.05, 0.55], P = 0.004); non-tunneled CVC (aOR 0.17 [0.04, 0.63], P = 0.008); presence of an endotracheal tube (aOR 0.21 [0.08, 0.6], P = 0.004), Foley catheter (aOR 0.3 [0.13, 0.68], P = 0.004); transport to radiology (aOR 0.31 [0.1, 0.94], P = 0.039); continuous neuromuscular blockade (aOR 0.29 [0.1, 0.86], P = 0.025); and administration of histamine H2 blocking medications (aOR 0.17 [0.06, 0.48], P = 0.001). Pediatric intensive care patients with chronic CVCs receiving parenteral nutrition, those on non-opioid sedative infusions, and those with more central line days are at increased risk for CLABSI despite current prevention measures.

Metabolomic profiling of COVID-19 using serum and urine samples in intensive care and medical ward cohorts

The COVID-19 pandemic remains a significant global health threat, with uncertainties persisting regarding the factors determining whether individuals experience mild symptoms, severe conditions, or succumb to the disease. This study presents an NMR metabolomics-based approach, analysing 80 serum and urine samples from COVID-19 patients (34 intensive care patients and 46 hospitalized patients) and 32 from healthy controls. Our research identifies discriminant metabolites and clinical variables relevant to COVID-19 diagnosis and severity. These discriminant metabolites play a role in specific pathways, mainly “Phenylalanine, tyrosine and tryptophan biosynthesis”, “Phenylalanine metabolism”, “Glycerolipid metabolism” and “Arginine and proline metabolism”. We propose a three-metabolite diagnostic panel—comprising isoleucine, TMAO, and glucose—that effectively discriminates COVID-19 patients from healthy individuals, achieving high efficiency. Furthermore, we found an optimal biomarker panel capable of efficiently classify disease severity considering both clinical characteristics (obesity/overweight, dyslipidemia, and lymphocyte count) together with metabolites content (ethanol, TMAO, tyrosine and betaine).

Volume therapy: which preparation for which situation?

The most commonly used fluids for volume therapy are crystalloids and colloids. Crystalloids comprise 0.9% sodium chloride and balanced crystalloids (BC). Colloids can be divided into artificial colloids and human albumin (anatural colloid). Large studies show advantages for BC over 0.9% NaCl with respect to renal endpoints, probably due to the unphysiologically high chloride content of 0.9% NaCl. However, other studies, such as the BaSICS and PLUS trials, showed no significant differences in mortality in aheterogeneous population. Despite this, meta-analyses suggest advantages for BC. Therefore, BC should be preferred, especially in patients at increased risk of acute kidney injury, with acidemia and/or hyperchloremia. Except for specific indications (e.g., in patients with cirrhosis, sepsis resuscitation after initial volume therapy with BC), albumin should not be used. There is clear evidence of harm from hydroxyethyl starch in intensive care patients.

Parenteral nutrition customization in pediatrics: A descriptive cohort study.

The main objective of this study was to analyze the reasons for customizing parenteral nutrition (PN) in pediatric patients admitted to a quaternary hospital. We performed a descriptive cohort study on 264 hospitalized children receiving PN. Anthropometric, biochemical, and hospitalization data were collected from patient records. Unequivocal reasons for customizing PN were defined as situations precluding prescription of a standard adult/teenager PN and included renal and/or liver failure, energy-protein adequacy, and elevated mineral and triglyceride levels. A total of 264 patients, with a median age of 2.2 years (IQR: 0.3-9.0 years), comprising intensive care (n = 216; 81.8%) and malnourished (n = 91; 36.1%) patients, were evaluated. In the first 48 h, 87.9% (n = 232) of the sample required customized PN for energy-protein adequacy (210 of 232), maintained over subsequent days in most cases. Among patients requiring second individualization, mineral disturbance was the main reason observed, especially within the first 4 days of PN use (n = 21; 60%). Unequivocal reasons for customizing PN occurred in 97.4% (n = 226) of cases in the first 48 h; 96.2% (n = 177) of cases on the fourth day; and 90.1% (n = 92) of cases on the seventh day of PN use. An inverse correlation was found between weight/age z score and number of second individualizations (r = -0.222; P = 0.002). Customized PN proved essential, especially for younger, malnourished, and intensive care patients. Investment in training a Nutritional Multidisciplinary Therapy Team and acquiring a specific electronic system for prescribing PN is suggested.