Respiratory Intensive Care Unit Research Articles

Male systemic lupus erythematosus, rapidly progressive glomerulonephritis, and iatrogenic acute bone marrow failure: a case report

Lupus nephritis (LN) is a significant complication of systemic lupus erythematosus (SLE), marked by kidney inflammation due to autoimmune activity, leading to proteinuria, hematuria, and potentially renal failure. Rapidly progressive glomerulonephritis (RPGN) is a rare, critical manifestation of LN characterized by a rapid decline in kidney function. This condition can lead to irreversible renal damage and is often fatal without prompt treatment. In this case, a 62-year-old man initially presented with fever, cough, and body aches, which were treated as an acute upper respiratory infection. Despite initial improvement, he developed persistent nausea, vomiting, and signs of renal dysfunction. Laboratory investigations revealed anemia, high erythrocyte sedimentation rate (ESR), electrolyte imbalances, and elevated creatinine. Imaging and endoscopy ruled out malignancy, and a differential diagnosis of multiple myeloma was excluded through plasma protein electrophoresis. Serological tests confirmed SLE, and subsequent renal biopsy revealed LN with RPGN features. Despite aggressive treatment with corticosteroids and cyclophosphamide, the patient’s condition rapidly deteriorated, leading to respiratory distress and intensive care unit (ICU) admission. He ultimately succumbed to his illness, underscoring the unpredictable and severe nature of RPGN in LN. This case highlights the importance of early diagnosis and intensive management to prevent rapid disease progression and improve patient outcomes.

Respiratory hospitalizations and ICU admissions among children with and without medical complexity at the end of the COVID-19 pandemic.

Decreased severe respiratory illness was observed during the first 2 years of the COVID-19 pandemic, with a relatively smaller decrease among children with medical complexity (CMC) compared to non-CMC. We extended this analysis to the third pandemic year (April 1, 2022, to March 31, 2023) when pandemic public health measures were loosened. A population-based repeated cross-sectional study evaluated respiratory hospitalizations among CMC and non-CMC (<18 years) in Ontario, Canada. Among the 67,517 CMC and 3,006,504 non-CMC in Ontario, there were more CMC respiratory hospitalizations compared with the expected prepandemic levels (n = 3145 hospitalizations, corresponding to rate ratio [RR], 1.20; 95% confidence interval [CI], 1.16-1.25) with an even larger relative increase among non-CMC (n = 6653, RR, 1.36; 95% CI, 1.34-1.38). Increased intensive care unit admissions for respiratory illness were also observed (CMC: RR, 1.44; 95% CI, 1.31-1.59; non-CMC: RR, 2.02; 95% CI, 1.89-2.16). Understanding respiratory surge drivers may provide insights to protect at-risk children from respiratory morbidity.

Comparing the outcome of using high-flow nasal cannula oxygen therapy versus noninvasive ventilation for chronic obstructive pulmonary disease patients with acute hypercapnic respiratory failure

BackgroundNoninvasive ventilation (NIV) is frequently employed as a treatment option for acute hypercapnic respiratory failure (AHRF) resulting from chronic obstructive pulmonary disease (COPD). Limited research has substantiated the claims made in recent studies regarding the feasibility of employing high flow nasal cannula (HFNC).AimOur study assessed the outcome of using HFNC versus NIV for COPD patients with AHRF.Patients and methodsEighty COPD patients with AHRF were confined to the respiratory intensive care unit (RICU) at Ain-Shams University Hospitals from December 2021 to 2023 and subdivided into two groups (40/group), where the first group was placed on NIV while the second group was placed on HFNC. Data during their hospital stay as demographic data, vital data, arterial blood gases, device duration, treatment failure, and mortality were recorded.ResultsThe majority were males with mean age 63.75 ± 9.05 years along with treatment failure and complications 25%, 12.5.% in NIV versus 45%, and zero% in HFNC, respectively, with longer hospital stay in NIV 10–15 days to 7–10 days in HFNC, and with no difference in mortality rate in both groups.ConclusionBoth modalities NIV and HFNC were effective for treating COPD with AHRF. However, NIV group was significantly superior than HFNC along with apparently faster improvement in ventilatory and respiratory status especially in high CO2 level while less complications and duration of hospital stay in HFNC with no difference in mortality in both groups.

COVID-19 throughout pandemic waves and virus variants: a real-life experience in an Italian hospital.

New therapies and vaccines changed the management of COVID-19. The aim of this retrospective study was to describe characteristics, in-hospital mortality and its predictors in patients with moderate/severe COVID-19, considering the 4 different pandemic waves and viral variants' prevalence from February 2020 to January 2022. Among 1135 patients included, 873 (77%) had at least one comorbidity, 177 (16%) were immunocompromised. From waves 1 to 4, patients with severe respiratory failure and ICU admission decreased over time (p < 0.001), like the length of in-hospital stay (p < 0.001). Despite a reduction of in-hospital mortality from 19% to 11%, increased risk of death was related to older age and immunocompromising conditions, especially during the 4th wave (HR = 5.07 and HR = 10.86, p < 0.001 respectively) while remdesivir treatment in the 3rd wave (HR = 0.41, p = 0.010) and positive serology (aHR = 0.66, p = 0.027) were protective for survival. These data support the need for tailoring vaccine campaign for future COVID-19 waves.

Social support mediates social frailty with anxiety and depression

BackgroundAnxiety and depression are prevalent comorbidities in patients with chronic obstructive pulmonary disease (COPD). However, existing research has yielded conflicting findings regarding the effects of social frailty on anxiety and depression. The primary aim of this study is to validate the relationship between social frailty and social support with anxiety and depression in patients with acute exacerbations of COPD (AECOPD) and to investigate whether social support could explain the variations in prior study outcomes for patients with AECOPD.MethodsOf the 315 patients hospitalized with AECOPD at the respiratory intensive care unit of a large tertiary care institution in Sichuan Province of China, between August 2022 and June 2023 who were surveyed, 306 were included in the analysis after excluding missing data. We conducted a logistic regression analysis to examine the associations of social frailty and social support with anxiety and depression and performed mediation analyses to examine whether social support mediates the relationship of social frailty with anxiety and depression.ResultsThe logistic regression analysis revealed that social frailty did not associate anxiety or depression in patients with AECOPD. The mediation analysis supported this idea and indicated that while social frailty does not directly influence anxiety or depression, it can through social support.ConclusionsThe findings suggest that while social frailty may not directly impact anxiety or depression in patients with AECOPD, social support plays a crucial mediating role. Enhancing social support can indirectly alleviate anxiety and depression among these patients. Enhancing social support networks should thus be prioritized by healthcare providers and family members to improve mental health outcomes in this patient population.

Whole genome sequencing insight into carbapenem-resistant and multidrug-resistant Acinetobacter baumannii harboring chromosome-borne blaOXA-23.

Carbapenem-resistant Acinetobacter baumannii (CRAB) poses a significant threat to hospitalized patients as effective therapeutic options are scarce. Based on the genomic characteristics of the CRAB strain AB2877 harboring chromosome-borne blaOXA-23, which was isolated from the bronchoalveolar lavage fluid (BALF) of a patient in a respiratory intensive care unit (RICU), we systematically analyzed antibiotic resistance genes (ARGs) and the genetic context associated with ARGs carried by CRAB strains harboring chromosome-borne blaOXA-23 worldwide. Besides blaOXA-23, other ARGs were detected on the chromosome of the CRAB strain AB2877 belonging to ST208/1806 (Oxford MLST scheme). Several key genetic contexts associated with the ARGs were identified on the chromosome of the CRAB strain AB2877, including (1) the MDR region associated with blaOXA-23, tet(B)-tetR(B), aph(3'')-Ib, and aph(6)-Id (2); the resistance island AbGRI3 harboring armA and mph(E)-msr(E) (3); the Tn3-like composite transposon containing blaTEM-1D and aph(3')-Ia; and (4) the structure "ISAba1-blaADC-25." The first two genetic contexts were most common in ST195/1816, followed by ST208/1806. The last two genetic contexts were found most frequently in ST208/1806, followed by ST195/1816.IMPORTANCEThe blaOXA-23 gene can be carried by plasmid or chromosome, facilitating horizontal genetic transfer and increasing carbapenem resistance in healthcare settings. In this study, we focused on the genomic characteristics of CRAB strains harboring the chromosome-borne blaOXA-23 gene, and the important genetic contexts associated with blaOXA-23 and other ARGs were identified, and their prevalent clones worldwide were determined. Notably, although the predominant clonal CRAB lineages worldwide containing the MDR region associated with blaOXA-23, tet(B)-tetR(B), aph(3'')-Ib, and aph (6)-Id was ST195/1816, followed by ST208/1806, the CRAB strain AB2877 in our study belonged to ST208/1806. Our findings contribute to the knowledge regarding the dissemination of CRAB strains and the control of nosocomial infection.

Hemophagocytic lymphohistiocytosis (HLH) secondary to tuberculosis: A case series

Hemophagocytic lymphohistiocytosis (HLH) is an exaggerated but ineffective immune response secondary to infections, inflammatory conditions, or malignancies. HLH is characterized by macrophage and T-cell activation resulting in phagocytosis of erythrocytes, lymphocytes, and platelets and an exuberant cytokine response respectively leading to catastrophic systemic manifestations. The clinical and biochemical profile of HLH significantly overlaps with that of sepsis, which may lead to misdiagnosis. Tuberculosis (TB) is an important infectious cause of HLH with a reported mortality of more than 50%. HLH may be misdiagnosed in patients with tuberculosis as the reticuloendothelial system is extensively involved in both disseminated TB and HLH. We present a series of four cases of TB-HLH admitted to the respiratory intensive care unit in a tertiary care hospital.

Identifying Prevalence and Potential Predictors of Do-Not-Attempt-Resuscitation Orders to Facilitate Preoperative Discussions on Code Status.

Do Not Attempt Resuscitation (DNAR) orders allow patients with life-threatening conditions to decline resuscitation efforts should the need arise. The American Society of Anesthesiologists (ASA) recommends discussions with patients on their code status to clarify and honor their goals of care perioperatively. This project sought to determine the prevalence of DNAR orders and to identify the demographics and potential clinical predictors of DNAR status at the beginning and end of admission, which would help anesthesiologists at our center facilitate these discussions. Factors associated with DNAR status at beginning and at end of hospital stay were determined through univariate logistic regressions. For DNAR status at beginning and end of hospital admission, variables assessed were age at arrival, race, sex, palliative consult, use of palliative care service, length of stay in days, presence of surgery, presence of emergent surgery, care level, and medical service. Approximately 2.4 percent of the sample had an active DNAR order at the beginning of their hospital admission compared to 7.4 percent at the end of hospital admission. Factors significantly associated with DNAR status at the beginning of the hospital stay were consistent with prior literature (age, palliative care consult or service). However, factors significantly associated with DNAR status at the end of hospital stay that were notable included length of stay, undergoing emergent surgery, higher level of care, and being on the oncology service and medical respiratory intensive care unit. This retrospective study allows anesthesiologists at our institution to identify patients who may benefit from a more comprehensive perioperative discussion about code status based on certain clinical characteristics, which may improve quality of care by preventing unwanted resuscitative measures that do not align with a patient's goals of care.

Clinical impact of metagenomic next-generation sequencing of bronchoalveolar lavage fluids for the diagnosis of pulmonary infections in respiratory intensive care unit

BackgroundThe real-world clinical impact of mNGS on BALF in the respiratory intensive care unit (RICU) is not yet fully understood. MethodsWe investigated the clinical impact of mNGS on BALF samples obtained from 92 patients admitted to the RICU over a 2-year period. We utilized both mNGS and culture methods to evaluate the effectiveness of mNGS in diagnosing pulmonary infections. The clinical impact of mNGS were evaluated by the clinician committees. ResultsAmong the 92 diagnosed patients, 78 cases (84.7 %) were determined to have infectious diseases caused by pathogenic microorganisms, and the bacterial infections constituted the most prevalent diagnostic category. For mixed infection, the most common type was the Pneumocystis jironecii and cytomegalovirus co-infection. The mNGS results had a positive impact on the clinical management of 43 cases (46.7 %). Moreover, 19 cases (44.2 %) of positive clinical impacts were solely based on new diagnoses made possible by mNGS results. These new diagnoses were particularly helpful for identifying rare pathogens, which could not be detected by conventional diagnostic methods. ConclusionsThe BALF mNGS has a positive real-world impact in RICU. Clinician committee play a critical role in ensuring the appropriate use of mNGS.

Readmission rate among survived patients with acute respiratory failure: 1-year study

ContextCritically ill patients, especially those with respiratory failure associated with multiple comorbidities, are at risk of recurrent ICU admission and consuming a significant portion of medical resources.AimTo study the risk factors and common etiologies of readmission among surviving patients with acute respiratory failure in Mansoura University’s respiratory intensive care unit during the year 2023.Settings and designThis was a retrospective cohort study.Patients and methodsThis study included all patients with acute respiratory failure who were admitted to Mansoura University’s respiratory intensive care unit (RICU), from January 2023 to December 2023. Deceased patients after initial admission or those with incomplete data were not included in the study. All data related to patient’s demographics, type of respiratory failure, type of respiratory support, associated comorbidities, length of ICU stay, and causes of readmission were collected from the registration system database.ResultsEight-hundred-thirty (830) cases that were admitted to the Mansoura University’s RICU with respiratory failure in the year 2023 were enrolled in the study, and 84 cases (10.1%) of them were readmitted. COPD exacerbation was the most common cause of readmission (35.7%) followed by pneumonia (21.4%) and OSA exacerbation (20.2%). Results showed that the significant independent predictors of readmission were being male [AOR (95% CI): 1.8 (1.01–3.1), p: 0.046], having organ failure (renal/liver) [AOR (95% CI): 29.9 (7.9–113.4), p ≤ 0.001], and length of ICU stay more than 12 days [AOR (95% CI): 4.8 (2.6–8.6), p ≤ 0.001]. Also, the type of respiratory failure and the type of respiratory support received were significantly associated with readmission in the univariate analysis; however, they were insignificant in the multivariate analysis.ConclusionThe rate of readmission was not high (only 10.3%). The most common causes of readmission were COPD exacerbation, followed by pneumonia and OSA exacerbation, respectively. Type of respiratory failure, male gender, the presence of other organ failure, and length of ICU stay are significant independent predictors of readmission in Mansoura University’s RICU during the year 2023. Therefore, higher-risk individuals should receive attention and careful assessment before discharge from the ICU to reduce the rate of readmission.Trial registrationClinicalTrials.gov identifier: NCT06291636.

Two-year survival after scheduled extubation in patients with pneumonia or ARDS: a prospective observational study

PurposeTo report two-year survival after scheduled extubation in patients with pneumonia or acute respiratory distress syndrome (ARDS).MethodsThis was a prospective observational study performed in a respiratory ICU of a teaching hospital. Pneumonia or ARDS patients who successfully completed a spontaneous breathing trial were enrolled. Data were collected before extubation. Patients were followed up to two years by phone every 3 months.ResultsA total of 230 patients were enrolled in final analysis. One-, 3-, 6-, 12-, and 24-month survival was 77.4%, 63.8%, 61.3%, 57.8%, and 47.8%, respectively. Cox regression shows that Charlson comorbidity index (hazard ratio: 1.20, 95% confidence interval: 1.10–1.32), APACHE II score before extubation (1.11, 1.05–1.17), cough peak flow before extubation (0.993, 0.986–0.999), and extubation failure (3.96, 2.51–6.24) were associated with two-year mortality. To predict death within two years, the area under the curve of receiver operating characteristic was 0.79 tested by Charlson comorbidity index, 0.75 tested by APACHE II score, and 0.75 tested by cough peak flow. Two-year survival was 31% and 77% in patients with Charlson comorbidity index ≥ 1 and < 1, 28% and 62% in patients with APACHE II score ≥ 12 and < 12, and 64% and 17% in patients with cough peak flow > 58 and ≤ 58 L/min, respectively.ConclusionsComorbidity, disease severity, weak cough and extubation failure were associated with increased two-year mortality in pneumonia or ARDS patients who experienced scheduled extubation. It provides objective information to caregivers to improve decision-making process during hospitalization and post discharge.

End-tidal-to-arterial PCO2 ratio as a prognostic value in mechanically ventilated patients at respiratory intensive care unit

Background Dead space refers to the part of each tidal volume that does not contribute to gas exchange. It serves as an indicator of lung function efficiency. Aim To evaluate the end-tidal-to-arterial PCO2 ratio and Acute Physiological and Chronic Health Assessment (APACHE IV) scoring system as prognostic values in mechanically ventilated patients at the respiratory intensive care unit (ICU). Patients and methods This prospective cohort research was done on 40 mechanically ventilated patients due to different respiratory causes who were admitted at the respiratory ICU at Ain Shams University hospitals. Results This study found that decreasing end tidal PCO2 (PETCO2)/arterial carbon dioxide (PaCO2) is associated with higher mortality amongst mechanically ventilated cases in respiratory ICU. A significant negative association between APACHE IV score and end-tidal to arterial PCO2 ratio following 1 h and after 24 h of mechanical ventilation. APACHE IV score showed a significant relation with mortality, being higher in survivors than nonsurvivors. Conclusion PETCO2/PaCO2 is a relevant prognostic value that reflects dead space ventilation among mechanically ventilated patients in respiratory ICU. APACHE IV score is a good mortality predictor in respiratory ICU.

Clinical application study of midline catheter in vasopressor therapy

To evaluate the safety and necessity of vasopressor infusion through midline catheter. A convenient sampling method was used for a controlled study. A total of 88 adult patients who used vasopressors admitted to respiratory intensive care unit (RICU) of Fenyang Hospital in Shanxi Province from June 2022 to June 2023 were enrolled as the research subjects. A total of 44 patients who were infused with vasopressors through peripherally inserted central venous catheter (PICC) from June to December 2022 were enrolled as the PICC group, and 44 patients who were infused with vasopressors through midline catheter from January to June 2023 were enrolled as the midline catheter group. Both groups of patients used the modified Sedinger technique under the guidance of B-ultrasound for puncture and catheter placement. The middle 1/3 site between the cubital fossa and the axilla was selected. The catheters were 5 Fr double lumen. After catheter placement, the patients were followed until catheter removal, death, or 30 days (whichever came first). Based on the Infusion therapy standards of practice revised by American Infusion Nurses Society (INS), and combined with the results of previous preliminary tests, the safety evaluation was conducted on incomplete catheter obstruction, catheter-related bloodstream infection (CRBSI), phlebitis, thrombus within the catheter during extubation, redness of the puncture site (but no infection), and exudation of the puncture site in the two groups of patients. There were no statistical differences in gender, age, catheter indwelling time, and primary disease between the two groups, indicating that the baseline data of the two groups were balanced and comparable. No CRBSI or phlebitis occurred in both groups during the observation period after catheterization. One patient in both groups had exudation at the puncture site [both were 2.27% (1/44)]. Compared with the PICC group, the incidence of incomplete catheter obstruction, thrombus within the catheter during extubation, redness of the puncture site (but no infection) in the midline catheter group were lowered [incomplete catheter obstruction: 4.55% (2/44) vs. 6.82% (3/44), thrombus within the catheter during extubation: 0% (0/44) vs. 2.27% (1/44), redness of the puncture site (but no infection): 0% (0/44) vs. 4.55% (2/44)], the overall incidence was significantly decreased [6.82% (3/44) vs. 15.91% (7/44), P < 0.01]. Administering vasopressor through a midline catheter can reduce the incidence of catheter-related complications, decrease the rate of central venous catheterization, and reduce the financial burden on patients.

Combined Thoracoscopic Surgery and High-Frequency Ventilation Induce Severe Traumatic Brain Injury and Chest Trauma Recovery

Background: Traumatic injuries, especially combined injuries involving multiple body regions, have become a significant concern in industrialized nations due to their rising frequency and severity. Among these, chest injuries, particularly closed chest injuries, present critical challenges due to their high mortality rates and frequent occurrence in combined trauma cases. Effective management of such injuries is crucial to improving patient outcomes. Methods: This study analyzed the outcomes of 107 patients with combined severe traumatic brain injury (TBI) and chest trauma treated at the Russian Research Center for Emergency Medicine between 2017 and 2022. Patients were categorized based on respiratory support methods: Group I (52 patients) received artificial pulmonary ventilation (APV) with synchronized intermittent mandatory ventilation volume-controlled (SIMV VC), while Group II (55 patients) was managed with a combination of SIMV VC and high-frequency jet ventilation (sHFJV). Diagnostic and clinical assessments included neurological examinations, radiological imaging, and invasive monitoring. Surgical interventions involved video-assisted thoracoscopy (VATS) for managing chest injuries. Results: Initial assessments revealed severe conditions across both groups. After 12 hours of respiratory support, Group II patients exhibited significant improvements in oxygenation, blood gas parameters, and reduced pulmonary shunt compared to Group I. Group II also experienced shorter durations of respiratory support and ICU stays, and a lower mortality rate (5.45% vs. 17.3% in Group I). Thoracoscopic interventions were successfully performed with reduced postoperative complications and shorter hospital stays in Group II. Conclusion: The combination of SIMV VC and sHFJV significantly improves respiratory outcomes, reduces the duration of mechanical ventilation, and shortens ICU stays compared to SIMV VC alone. Thoracoscopic procedures prove effective for managing select cases of chest trauma. Careful patient evaluation is essential to ensure hemodynamic stability before opting for thoracoscopic interventions. This study underscores the importance of advanced diagnostic tools and minimally invasive techniques in optimizing the management of severe chest trauma and improving overall patient outcomes.

Application of enteral nutrition adjusted by intra-abdominal pressure combined with 24-h gastric residual volume monitoring in patients with nasogastric feeding in respiratory intensive care unit

Application of enteral nutrition adjusted by intra-abdominal pressure combined with 24-h gastric residual volume monitoring in patients with nasogastric feeding in respiratory intensive care unit

Serum C-reactive protein to albumin ratio as a potential risk indicator of pneumonia caused by Chlamydia psittaci: a multicenter retrospective study.

The aim of the study was to describe psittacosis pneumonia and to assess the predictive value of the C-reactive protein/albumin ratio in psittacosis pneumonia for severity. Data on psittacosis pneumonia cases diagnosed using metagenomic sequencing were collected from three hospitals in Shanghai, China from Oct. 2019 to Oct. 2022. Serum levels of C-reactive protein and albumin were measured and the C-reactive protein to albumin ratio (CAR) was calculated. Spearman's correlation analysis, ordered logistic regression analysis, and receiver operating characteristic curve analysis were conducted to examine the correlation and predictive ability of the three indicators on the severity of the disease. A total of 27 patients with psittacosis pneumonia were enrolled, with an average age of 62 years and 70.4% being male. 44.4% of patients had a clear history of contact with poultry or birds. The predominant symptom was fever (100%). Patients treated in the respiratory intensive care unit (RICU) had a higher likelihood of experiencing wheezing (88.9% versus 33.3%, P=0.013) and chest tightness (88.9% vs. 33.3%, P=0.013) than those in the general ward (Non-RICU). The proportion of patients with pleural effusion was significantly higher in the RICU compared to the Non-RICU (88.9% vs. 38.9%, P=0.019). The RICU group had a significantly higher CAR than the Non-RICU group (9.41 vs. 4.05, P=0.017). This result was accompanied by higher intubation and ventilator support (33.3% vs. 0.0%, P=0.029), higher PCT and CRP levels and lower albumin and PaCO2 levels in the RICU than in the Non-RICU. Logistic regression analysis indicated that CAR (OR 1.49; 95% CI 1.07-2.06, P=0.017) was risk factor for prolonged hospitalization (> 14 days). Elevated serum CAR levels were found to be associated with a greater risk of severe psittacosis pneumonia. Consequently, it may serve as an uncomplicated and useful diagnostic tool for clinicians to promptly and precisely ascertain the severity of psittacosis pneumonia, ultimately aiding them in devising the most optimal therapeutic plan.

Design and Implementation of an Intensive Care Unit Command Center for Medical Data Fusion.

The rapid advancements in Artificial Intelligence of Things (AIoT) are pivotal for the healthcare sector, especially as the world approaches an aging society which will be reached by 2050. This paper presents an innovative AIoT-enabled data fusion system implemented at the CMUH Respiratory Intensive Care Unit (RICU) to address the high incidence of medical errors in ICUs, which are among the top three causes of mortality in healthcare facilities. ICU patients are particularly vulnerable to medical errors due to the complexity of their conditions and the critical nature of their care. We introduce a four-layer AIoT architecture designed to manage and deliver both real-time and non-real-time medical data within the CMUH-RICU. Our system demonstrates the capability to handle 22 TB of medical data annually with an average delay of 1.72 ms and a bandwidth of 65.66 Mbps. Additionally, we ensure the uninterrupted operation of the CMUH-RICU with a three-node streaming cluster (called Kafka), provided a failed node is repaired within 9 h, assuming a one-year node lifespan. A case study is presented where the AI application of acute respiratory distress syndrome (ARDS), leveraging our AIoT data fusion approach, significantly improved the medical diagnosis rate from 52.2% to 93.3% and reduced mortality from 56.5% to 39.5%. The results underscore the potential of AIoT in enhancing patient outcomes and operational efficiency in the ICU setting.

Comparative analysis of lysophospholipid metabolism profiles and clinical characteristics in patients with high vs. low C-reactive protein levels in acute exacerbations of chronic obstructive pulmonary disease

BackgroundThe precise role of lysophospholipids (LysoPLs) in the pathogenesis of acute exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD) remains unclear. In this study, we sought to elucidate the differences in serum LysoPL metabolite profiles and their correlation with clinical features between patients with low versus high CRP levels. MethodsA total of 58 patients with AECOPD were enrolled in the study. Patients were classified into two groups: low CRP group (CRP < 20 mg/L, n = 34) and high CRP group (CRP ≥ 20 mg/L, n = 24). Clinical data were collected, and the LysoPL metabolite profiles were analyzed using Liquid Chromatography-Mass Spectrometry (LC-MS) and identified by matching with the LipidBlast library. ResultsNineteen differential LysoPLs were initially identified through Student's t-test (p < 0.05 and VIP > 1). Subsequently, four LysoPLs, LPC(16:0), LPE(18:2), LPC(22:0), and LPC(24:0), were identified by FDR adjustment (adjusted p < 0.05). These four lysoPLs had a significant negative correlation with CRP. Integrative analysis revealed that LPC (16:0) and LPC (22:0) correlated with less hypercapnic respiratory failure and ICU admission. ConclusionAECOPD patients with high CRP levels demonstrated a distinctive LysoPL metabolism profile, with LPC (16:0), LPE(18:2), LPC(22:0), and LPC(24:0) being the most significantly altered lipid molecules. These alterations were associated with poorer clinical outcomes.

Correlation Analysis between Urinary Catheter Indwelling Time and Nosocomial Urinary Tract Infection.

Indwelling urinary catheter is closely associated with the occurrence of urinary tract infection (UTI). Herein, we further explored the correlation of urinary catheter indwelling time and UTI. Retrospectively, the medical data of nosocomial patients (n = 681) were collected during two quarters of April 2023 to June 2023 (the second quarter, 23.4-23.6, n = 330) and July 2023 to September 2023 (the third quarter, 23.7-23.9, n = 351). The baseline data and incidence of catheter-related UTI were analysed. The total hospitalisation days and indwelling urinary catheter days of patients in five departments were assessed, namely, coronary care unit (CCU), respiratory intensive care unit (RICU), surgical intensive care unit (SICU), neurology intensive care unit (NICU) and cardiac surgical intensive care unit (CSICU) departments. The correlation between hospitalisation days/indwelling urinary catheter days and the occurrence of UTI was evaluated by Spearman correlation analysis. In the CCU, RICU, SICU, NICU and CSICU departments, the number of patients was 463, 83, 29, 91 and 15, respectively. During 23.4-23.6, the incidence of catheter-associated UTI (CAUTI) was 0, 2.85, 6.12, 0 and 12.99 per 1000 urinary catheter days in CCU, RICU, SICU, NICU and CSICU, respectively. During 23.7-23.9, the incidence of CAUTI was 2.98, 6.13, 8.66, 0 and 0 per 1000 urinary catheter days in CCU, RICU, SICU, NICU and CSICU, respectively. Notably, hospitalisation days/indwelling urinary catheter days were positively correlated with the occurrence of CAUTI in each quarter (p < 0.05). There was a positive correlation between urinary catheter indwelling time and the occurrence of UTI.

Comparative Study between Different Levels of Positive End - Expiratory Pressure in non- Acute Respiratory Distress Intensive Care Unit Patients

Comparative Study between Different Levels of Positive End - Expiratory Pressure in non- Acute Respiratory Distress Intensive Care Unit Patients