Surgical Intensive Care Unit Research Articles

Developmental care education in Australian surgical neonatal intensive care units: A cross-sectional study of nurses’ perceptions

BackgroundNurse perceptions of developmental care practices have been researched globally for almost 30 years. Yet, there is a lack of research exploring this subject in the specialised setting of the surgical neonatal intensive care unit (sNICU). This research explores the effect of developmental care education programs on sNICU nurses’ perceptions of developmental care. ObjectiveTo determine perceptions and attitudes towards developmental care in a specialty neonatal setting. DesignCross-sectional study. SettingsTwo surgical neonatal intensive care units in Australia. ParticipantsRegistered nurses permanently employed at the study sites between May 2021 to April 2022. MethodsA modified electronic survey explored sNICU nurse perceptions of developmental care organised around three themes: effects of developmental care on parents and infants, application of developmental care, and unit practices. Associations between site, nurse characteristics, developmental care education and nurses’ perceptions were explored using logistic regression [odds ratios (OR) and 95 % confidence intervals (CI)]. ResultsOf 295 sNICU nurses, 117 (40 %) participated in the survey. Seventy-five percent of respondents had attended a formal developmental care education program. High levels of agreement (>90 %) were reported regarding the benefits of developmental care for parents and infants. Exposure to developmental care education influenced perceptions of its application. Nurses without formal developmental care education were more likely to agree that it was consistently applied [OR:3.3, 95%CI:1.3–8.6], developmental care skills are valued [OR:2.7, 95%CI:1.1–6.8], and that their nursing peers offered support in its application ([OR:2.5, 95%CI:1.1–6.2]. ConclusionsThe results from our research suggest sNICU nurses have a high level of awareness of developmental care and its positive impacts. Despite differences between the surveyed units' developmental care education programs, the value of developmental care in reducing stress for infants and supporting families was collectively recognised. Future research in this setting should focus on evaluating the application of developmental care in this setting.

Diaphragm ultrasound: A predictor of extubation in head injury patients

Background: Timing is critical when determining if a patient can be successfully extubated. The criteria for obtaining the optimal time for extubation are bare minimum and subject to variability. There are not many studies that are done to use diaphragm function or diaphragm thickness (Tdi) to have any role in extubation outcome as success or failure. Aims and Objectives: The aims and objectives of the study are to apply diaphragmatic ultrasound as a predictor of extubation to reduce morbidity and mortality in these patients. Materials and Methods: This study was conducted as a prospective single-blind study among patients admitted in post-anesthesia care unit and surgical intensive care unit, Department of Anesthesiology at Trauma care Centre during the study period of June 2019–November 2021. The ultrasonographer was informed of the intensivist’s decision to start weaning. Tdi is measured at end expiration and end inspiration. The percent change in Tdi between end expiration and end inspiration (ΔTdi%) was calculated as (Tdi end inspiration–Tdi end expiration/Tdi end expiration) ×100. Results: Mean age was 46.2±15.2 years, ranging from 18 to 66 years. Tdi was above 30 in 64% cases, whereas Tdi% at end of expiration was above 0.17 cm in 62% cases. Weaning was successful in 78% cases whereas weaning failed in 22% cases. Weaning success rate was significantly associated with higher Tdi at end expiration (≥0.17 cm) (P<0.05). Conclusions: Timely weaning off is very important. Delayed weaning may lead to further infection and complications. Diaphragmatic ultrasound plays a vital role in extubating the patient. Ultrasound-guided Tdi and diaphragm motion can be used as a predictor for timely extubation. Diaphragmatic thickness reflects the strength of diaphragm and hence would help us to estimate a successful extubation.

Prognostic utility of adequate nutritional support in critically ill surgical patients as revealed by the modified nutrition risk in critically ill score

BackgroundThe modified Nutrition Risk in the Critically Ill (mNUTRIC) score was developed to identify patients most likely to benefit from nutritional therapies and to stratify or select subjects for clinical trials. However, the validity of the score and the association between that score and the prognosis of patients in surgical intensive care units (SICUs) remain unclear. This study explored whether the score was a useful prognostic indicator for SICU patients, and whether survival could be improved via nutritional interventions based on mNUTRIC status. MethodsThis retrospective observational study enrolled 123 patients admitted to our SICU for critical care from January 2018 to December 2019. Among these, mNUTRIC medical data were available for 116. In-hospital mortality rates were compared based on both mNUTRIC status and the adequacy of nutritional supplementation. ResultsmNUTRIC-high status (5 points or more) was apparent in 16 ​% of all critically ill surgical patients. In-hospital mortality was significantly higher in those with mNUTRIC-high scores (42.1 ​% vs. 15.5 ​%, P ​= ​0.023). Both groups exhibited less mortality when nutrition was adequate vs. inadequate (5.0 ​% vs. 40.9 ​% and 26.7 ​% vs. 100 ​%, respectively). In multivariate analysis, mNUTRIC-high scores and inadequate nutritional support were significant risk factors for in-hospital mortality (hazard ratios 7.336 and 13.636, P ​= ​0.027 and 0.002, respectively). ConclusionIn critically ill surgical patients, those identified as nutritionally high-risk using the mNUTRIC classification had poor in-hospital survival. Moreover, patients who received adequate nutritional support had a better prognosis than those who did not.

Impact of Bedside Laparotomy Simulation and Microlearning on Trauma Nurse Role Clarity, Knowledge, and Confidence.

The care of patients undergoing low-volume, high-risk emergency procedures such as bedside laparotomy (BSL) remains a challenge for surgical trauma critical care nurses. This study evaluates simulation and microlearning on trauma nurse role ambiguity, knowledge, and confidence in caring for patients during emergency BSL. The study is a single-center, prospective pretest-posttest design conducted from September to November 2022 at a Level I trauma center in the Mid-Atlantic United States using simulation and microlearning to evaluate role clarity, knowledge, and confidence among surgical trauma intensive care unit (STICU) nurses. Participants, nurses from a voluntary convenience sample within a STICU, attended a simulation and received three weekly microlearning modules. Instruments measuring role ambiguity, knowledge, and confidence were administered before the simulation, after, and again at 30days. From the pretest to the initial posttest, the median (interquartile range [IQR]) Role Ambiguity scores increased by 1.0 (1.13) (p <.001), and at the 30-day posttest, improved by 1.33 (1.5) (p <.001). The median (IQR) knowledge scores at initial posttest improved by 4.0 (2.0) (p <.001) and at the 30-day posttest improved by 3.0 (1.75) (p<.001). The median (IQR) confidence scores at initial posttest increased by 0.08 (0.33) (p =.009) and at the 30-day posttest improved by 0.33 (0.54) (p =.01). We found that simulation and microlearning improved trauma nurse role clarity, knowledge, and confidence in caring for patients undergoing emergency BSL.

Effect of COVID-19 Pandemic on Complications and Mortality in the Early Postoperative Period After Heart Transplantation

IntroductionThe coronavirus disease 2019 (COVID-19) outbreak directly impacted heart transplantation (HT) surgery activity. Reallocating resources and converting surgical intensive care units to COVID‐19 facilities led to reduced accessibility and quality of health care facilities to heart recipient patients. AimTo study the effect of the COVID-19 pandemic on heart transplantation activity and outcomes in the early postoperative period. MethodsRetrospective data analysis of patients undergoing orthotopic heart transplantation in our institution from March 2018 to February 2022. The patient population (N = 281) included 223 (79.4%) men and 58 (20.6%) women. The perioperative data of the prepandemic group, March 2018 to February 2020 (N = 130), and the pandemic group, March 2020 to February 2022 (N = 151), were compared. ResultsWe found differences in preoperative inotropic support between the groups (N = 43 (33.1%) vs N = 72 (47.7%), P < .05), respectively). The number of urgent HTs increased during the COVID-19 pandemic (N = 51 (39.2%), vs N = 72 (47.7%), P = .155). Analyzed groups did not differ according to renal, pulmonary, or neurology complications. Intensive care unit (ICU) standing time was longer in the pandemic group (6 days [3-12] vs 11 days [5-12], P < .001). ConclusionWe found that during the COVID-19 pandemic, the number of end-stage heart failure recipients requiring cardiac support increased. Extended time of ICU standing in the pandemic group may be related to the COVID-19 pandemic. Although some efforts have been made to reduce the impact of the pandemic, more research is required.

Clinical data analysis of 117 patients with ruptured abdominal aortic aneurysm

Objective: To examine the perioperative clinical features and prognosis of patients with ruptured abdominal aortic aneurysms (rAAA) who received surgical repair. Methods: The clinical data of rAAA patients who underwent surgical repair and were admitted to the Surgical Intensive Care Unit of Beijing Anzhen Hospital, Capital Medical University from August 2005 to November 2020 were retrospectively analyzed, including the general clinical features, surgical mode, intraoperative conditions, postoperative complications, and fatality rate. Results: There were 117 patients with rAAA, with a median age of 68 (62,77) years, including 93 men (79.5%) and 24 women (20.5%). The main clinical manifestation was abdominal pain (n=115, 98.3%). Among them, 65 (55.6%) patients underwent endovascular aneurysm repair (EVAR), while 52 (44.4%) underwent open surgical repair (OSR). The common postoperative complications include acute gastrointestinal dysfunction (n=116, 99.1%), shock (n=89, 76.1%), acute respiratory distress syndrome (n=85, 72.6%), pancreatic injury (n=56, 47.9%), coagulation dysfunction (n=55, 47.0%), disseminated intravascular coagulation (n=46, 39.3%), acute kidney injury (n=39, 33.3%), infection/sepsis (n=28, 23.9%), gastrointestinal bleeding (n=17, 14.5%), and abdominal compartment syndrome (n=12, 10.3%). The overall postoperative in-hospital fatality rate was 10.3% (12/117). Preoperative use of vasopressors and inotropes, retroperitoneal hematoma, and postoperative abdominal compartment syndrome, gastrointestinal hemorrhage, acute kidney injury, and diffuse intravascular coagulation significantly increased the fatality rate [5/11, 6/24, 5/16, 6/12, 6/17, 23.1%(9/39), 19.6%(9/46), respectively]. Conclusion: The postoperative mortality of rAAA patients is still high in the era of EVAR, especially in patients with preoperative existence of shock and retroperitoneal hematoma, and with postoperative abdominal compartment syndrome, coagulation dysfunction, and acute kidney injury. It is necessary to strengthen perioperative monitoring and management of these patients to reduce the fatality rate.

Using implementation science to decrease variation and high opioid administration in a surgical ICU.

High doses and prolonged duration of opioids are associated with tolerance, dependence, and increased mortality. Unfortunately, despite recent efforts to curb outpatient opioid prescribing because of the ongoing epidemic, utilization remains high in the intensive care setting, with intubated patients commonly receiving infusions with a potency much higher than doses required to achieve pain control. We attempted to use implementation science techniques to monitor and reduce excessive opioid prescribing in ventilated patients in our Surgical ICU. We conducted a prospective study investigating opioid administration in a closed SICU at an academic medical center over 18 months. Commonly accepted conversions were used to aggregate daily patient opioid use. Patients with a history of chronic opioid use and those being treated with an ICP monitor/drain, neuromuscular blocker, or ECMO were excluded. If the patient spent a portion of a day on a ventilator, that day's total was included in the "vent group." MMEs per patient were collected for each patient and assigned to the on-call intensivist. Intensivists were blinded to the data for the first seven months. They were then provided with academic detailing followed by audit & feedback over the subsequent 11 months, demonstrating how opioid utilization during their time in the SICU compared to the unit average and a blinded list of the other attendings. Student's T-tests were performed to compare opioid utilization before and after initiation of academic detailing and audit & feedback. Opioid utilization in patients on a ventilator decreased by 20.1% during the feedback period, including less variation among all intensivists and a 30.9% reduction by the highest prescribers. Implementation science approaches can effectively reduce variation in opioid prescribing, especially for high outliers in a SICU. These interventions may reduce the risks associated with prolonged use of high-dose opioids. Prospective pre-post-intervention, Level II.

Determination of the Knowledge Level of Surgical Intensive Care Nurses in Medical Device Induced Pressure Injury

Aim: The purpose of this study was to measure the level of knowledge and attitudes of nurses in surgical intensive care units (ICUs) about medical device-induced pressure injury. Method: The cross-sectional study was conducted with 227 surgical intensive care nurses in Turkey between November 2022 and June 2023. “Nurse Introduction Form” and “Pressure Ulcer Knowledge Level Assessment Tool Scale” were used as data collection tools. Since the scale score averages did not comply with normal distribution, Mann Whitney U and Kruskal Wallis tests were used in the statistical analysis of the data. Results: It was found that the majority of participants (n=227) were in the age range of 26-33 years (n=115), and 66.1% (n=113) had been working in the ICU for 1-5 years. 51.5% (n=117) of the participants reported having received training in medical device-related pressure injury. In the pressure ulcer knowledge level assessment tool, the mean of the "prevention of pressure ulcers" sub-dimension (mean: 4.74) was found to be the highest, while the total knowledge level score was 14.87±5.6 and it was found that the nurses had a moderate level of knowledge. Conclusion: The findings of the study indicated that nurses' knowledge of medical device-related pressure injuries was inadequate, but that their knowledge of pressure injury prevention increased with increasing levels of education.

The role of serum magnesium in the prediction of acute kidney injury after total aortic arch replacement: A prospective observational study.

Considerable morbidity and death are associated with acute kidney damage (AKI) following total aortic arch replacement (TAAR). The relationship between AKI following TAAR and serum magnesium levels remains unknown. The intention of this research was to access the predictive value of serum magnesium levels on admission to the Cardiovascular Surgical Intensive Care Unit (CSICU) for AKI in patients receiving TAAR. From May 2018 to January 2020, a prospective, observational study was performed in the Guangdong Provincial People's Hospital CSICU. Patients accepting TAAR admitted to the CSICU were studied. The Kidney Disease: Improving Global Outcomes (KDIGO) definition of serum creatinine was used to define AKI, and KDIGO stages two or three were used to characterize severe AKI. Multivariable logistic regression and area under the curve receiver-operator characteristic curve (AUC-ROC) analysis were conducted to assess the predictive capability of the serum magnesium for AKI detection. Finally, the prediction model for AKI was established and internally validated. Of the 396 enrolled patients, AKI occurred in 315 (79.5%) patients, including 154 (38.8%) patients with severe AKI. Serum magnesium levels were independently related to the postoperative AKI and severe AKI (both, P < 0.001), and AUC-ROCs for predicting AKI and severe AKI were 0.707 and 0.695, respectively. Across increasing quartiles of serum magnesium, the multivariable-adjusted odds ratios (95% confidence intervals) of postoperative AKI were 1.00 (reference), 1.04 (0.50-2.82), 1.20 (0.56-2.56), and 6.19 (2.02-23.91) (P for Trend < 0.001). When serum magnesium was included to a baseline model with established risk factors, AUC-ROC (0.833 vs 0.808, P = 0.050), reclassification (P < 0.001), and discrimination (P = 0.002) were further improved. Serum magnesium levels on admission are an independent predictor of AKI. In TAAR patients, elevated serum magnesium levels were linked to an increased risk of AKI. In addition, the established risk factor model for AKI can be considerably improved by the addition of serum magnesium in TAAR patients hospitalized in the CSICU.

Post-traumatic Fat Embolism in Intensive Care

Fat embolism syndrome (FES) is a group of clinical, biological and radiological symptoms resulting from obstruction of the microcirculatory network by microdroplets of insoluble fat. It is a complication most often observed in the aftermath of a polytrauma involving several long bone fractures, but it can also occur outside the traumatic context. The aim of this study was to examine the epidemiological, pathogenic, clinical, paraclinical, therapeutic and evolutionary aspects of fat embolism syndrome. This was a retrospective study including all cases of post-traumatic fat embolism collected in the surgical intensive care unit of the Chu Ibn Rochd in Casablanca over a period of 5 years. 24 cases of post-traumatic fat embolism were collected. Male sex, age less than 40 years and the presence of a femur fracture were the dominant characteristics of the epidemiological profile of the trauma patient presenting with this syndrome occurring mainly within 72 hours of the trauma. The clinico-biological presentation was dominated by respiratory distress, consciousness disorders, anaemia, thrombocytopenia and hypocholesterolaemia. The management of FES was symptomatic, combining early immobilisation of fracture sites, optimal analgesia and maintenance of an effective blood volume. 41.66% of patients required mechanical ventilation and 75% underwent osteosynthesis of their fracture sites. 25% developed ARDS and the mortality rate was 26.08%.

Prospective with historical control, case-matched cohort study of the tertiary survey beneficial in critically severe trauma patients

Background The tertiary survey is an evaluation process conducted after the primary and secondary surveys. It aims to identify missed injuries. This research aims to study the benefits of tertiary surveys in severely traumatized patients. Methods This prospective with historical control, case-matched cohort was conducted on critically-ill trauma patients who were admitted to the surgical intensive care unit (SICU) of Thammasat University Hospital. The study compared the period before and after the implementation of the tertiary survey. Tertiary survey record form was used in all severely traumatized patients with Injury Severity Score (ISS) &gt; 15 within the first 24 hours and before discharge from SICU between August 2022 and February 2023. The comparison data were retrieved from electronic medical records of patients admitted to SICU with ISS &gt; 15 between April 2020 and July 2022. Results We identified 55 type II missed injuries in 39 of 100 cases prior to implementation and 1 type II missed injury after implementation. Type II missed injury decreased from 31% to 4%, and the missed injury detection rate was 56% after implementing the tertiary survey. However, there is no statistically significant difference in morbidity and mortality rates from missed injuries before and after implementation. Conclusions Using tertiary surveys can reduce missed injury rates and increase missed injury detection rates. This research highlights the importance of implementing tertiary surveys as a routine part of trauma evaluation to improve patient care. However, there is no effect on the outcomes, which may require more sample size. Clinical Trials Registry (reference number TCTR20230625001).

Systemic inflammation and delirium during critical illness.

The purpose of this study was to determine associations between markers of inflammation and endogenous anticoagulant activity with delirium and coma during critical illness. In this prospective cohort study, we enrolled adults with respiratory failure and/or shock treated in medical or surgical intensive care units (ICUs) at 5 centers. Twice per day in the ICU, and daily thereafter, we assessed mental status using the Richmond Agitation Sedation Scale (RASS) and the Confusion Assessment Method-Intensive Care Unit (CAM-ICU). We collected blood samples on study days 1, 3, and 5, measuring levels of C-reactive protein (CRP), interferon gamma (IFN-γ), interleukin (IL)-1 beta (IL-1β), IL-6, IL-8, IL-10, IL-12, matrix metalloproteinase-9 (MMP-9), tumor necrosis factor-alpha (TNF-α), tumor necrosis factor receptor 1 (TNFR1), and protein C using validated protocols. We used multinomial logistic regression to analyze associations between biomarkers and the odds of delirium or coma versus normal mental status the following day, adjusting for age, sepsis, Sequential Organ Failure Assessment (SOFA), study day, corticosteroids, and sedatives. Among 991 participants with a median age (interquartile range, IQR) of 62 [53-72] years and enrollment SOFA of 9 [7-11], higher concentrations of IL-6 (odds ratio [OR] [95% CI]: 1.8 [1.4-2.3]), IL-8 (1.3 [1.1-1.5]), IL-10 (1.5 [1.2-1.8]), TNF-α (1.2 [1.0-1.4]), and TNFR1 (1.3 [1.1-1.6]) and lower concentrations of protein C (0.7 [0.6-0.8])) were associated with delirium the following day. Higher concentrations of CRP (1.4 [1.1-1.7]), IFN-γ (1.3 [1.1-1.5]), IL-6 (2.3 [1.8-3.0]), IL-8 (1.8 [1.4-2.3]), and IL-10 (1.5 [1.2-2.0]) and lower concentrations of protein C (0.6 [0.5-0.8]) were associated with coma the following day. IL-1β, IL-12, and MMP-9 were not associated with mental status. Markers of inflammation and possibly endogenous anticoagulant activity are associated with delirium and coma during critical illness.

Feasibility of Combining Functional Mobilisation with Resistance and Endurance Training for Mechanically Ventilated Patients in Intensive Care Unit Setting-A Pilot Study.

Background: Intensive-care-acquired weakness resulting in functional impairment is common in critical care survivors. This study aims to evaluate the feasibility of a combined early functional training with endurance and resistance training and its effect on the functional outcome. Methods: It is a pilot study performed in a 39-bed Medical and Surgical Intensive Care Unit (ICU). Patients who were premorbidly independent and were mechanically ventilated for ≥24 h were recruited to receive functional mobilisation (sit out of bed, ambulation), endurance (bed cycling), and resistance training (selected upper and lower limb muscle training using weights). The primary outcomes were feasibility of training, muscle strength, handgrip strength, quadricep strength, and Functional Status Score-Intensive Care Unit (FSS-ICU) collected at the first assessment in the ICU, at the ICU discharge, and at hospital discharge. Secondary outcomes were functional capacity (6-Minute Walk Distance) and quality of life measures, EQ-5D, at hospital discharge and at 3 months. Results: Out of the 11 patients, 6 (54.54%) patients achieved level 2 functional mobilisation, 2 (18.18%) patients achieved level 2 resistance training, and 1 (9.09%) patient achieved level 2 endurance training. There were no significant differences in the medical research council (MRC) score, quadricep strength, and handgrip strength between the first assessment in the ICU, at the ICU discharge, and at hospital discharge. However, there was a significant difference in FSS_ICU (p < 0.008) from the first assessment in the ICU up to hospital discharge. EQ-5D visual analogue scale also showed a change of 8.5% at 3-month follow-up. 6MWD showed significant difference (p < 0.043) at 3-month follow-up compared to that at hospital discharge. Conclusions: The study found low compliance to resistance and endurance training in patients with mechanical ventilation. However, functional mobilisation in terms of sit out of bed was possible in more than half of the recruited patients.

Auditing plasma transfusion in intensive care: Use of decision time interval analysis.

To present a new method for displaying blood utilization data based on analysis of decision time intervals (DTIs). Retrospective study of patients treated in a medical intensive care unit (ICU), surgical ICU, or postcardiac surgery ICU at an academic hospital between January 2018 and June 2023. Each patient's episode of care was divided into a series of DTIs. Transfusions during each time interval were recorded. In total, 16,562 patients received 6980 units of plasma and 21,034 units of red blood cells during 111,557 time intervals of care. Patients had international normalized ratio (INR) values ranging from less than 1.0 to more than 4.0. Data on plasma transfusion at different INR values were displayed as the number of transfusion episodes, number of units given, or the proportion of DTIs with transfusion. Clinicians transfused plasma on 1.5% of occasions when the INR was 1.5 or less and on 2.2% of occasions when the INR was less than 2.0. Plasma was transfused without red blood cells in only 0.75% of DTIs. Transfusion practice was statistically different among the 3 ICUs. Compared with traditional methods of displaying the results of blood audits, DTI analysis displays information regarding the decision both to transfuse and to not transfuse. Utilization reviews that display data based on decision time analysis reveal clinical practice patterns very different from those suggested by traditional displays of plasma audit data.

Instituting a Palliative Care Trigger in a Surgical Intensive Care Unit (SICU): Survey Results of SICU Team Members.

Increasing palliative care presence in the intensive care unit (ICU) improves symptom management, increases goals-of-care discussion, and reduces unnecessary procedures in ICU patients. An interdisciplinary study team developed a palliative care trigger program in a 17-bed surgical ICU (SICU). Surgical ICU patients who met 3 triggers (ICU length of stay > 10 days, repeat ICU admission, and metastatic cancer) automatically received a palliative care consult. The purpose of the current study was to survey SICU health care professionals before and after the institution of the palliative care trigger program. Overall, the palliative care trigger program was viewed positively by interdisciplinary team members with increased team communication and decreased resistance for the inclusion of palliative care in the SICU plan of care. The palliative care trigger program was successfully developed and implemented in a SICU and was accepted by the interdisciplinary team members caring for SICU patients. Team member feedback is being used to expand the palliative care trigger program to improve care for SICU patients.

Impact and Feasibility of Mechanical Ventilation at a Surgical Center in Sierra Leone: Experience From EMERGENCY's Hospital in Goderich.

Despite the large burden of critically ill patients in developing countries, mechanical ventilation (MV) is scarce in these low-resource settings. In the absence of data, issues like costs and lack of training are often felt to outweigh the benefits of potential MV implementation in such places. We aimed to investigate the impact and feasibility of MV in a surgical ICU in West Africa. This is a 7-month retrospective observational study (from October 25, 2022, to May 25, 2023), covering all patients consecutively admitted to ICU. The NGO EMERGENCY's hospital in Goderich, Freetown, Sierra Leone. The hospital is a referral center for acute care surgery. Critical patients admitted to the hospital's ICU. Following brief, practical training of the nursing staff, one basic mechanical ventilator was installed at the hospital's ICU, under the supervision of two intensivists. Only patients with a body weight of over 15 kg and who met the "extreme criteria" for MV received this life-saving therapy. Of the 195 files of patients admitted to ICU during the study period, 162 were analyzed. The median age was 16 (interquartile range 7-27) and 48.1% of the population were under 14 years. The most common cause of admission was trauma (58.6%), followed by acute abdomen (33.3%), caustic soda ingestion (6.2%), and burns (1.9%). Of the overall population, 26 patients (16%) underwent MV (88.5% trauma cases vs. 11.5% acute abdomen). Median time on MV was 24 hours (12-64). The mortality rate in the MV group was 30.8% (8/26), while in the overall study population, it was 11.7% (19/162). One potentially life-threatening event of tube obstruction was handled appropriately. This study strongly supports the implementation of MV in low-resource settings. In our experience, the consistent benefit of reduced mortality among critical patients largely outweighs the associated challenges.

Abbreviated Urine Collection Compared With 24-Hour Urine Collection for Measuring Creatinine Clearance in Adult Critically Ill Patients: A Systematic Review.

To evaluate the accuracy of abbreviated urine collection (≤12 hours) compared with 24-hour urine collection for measuring creatinine clearance (CrCl) in critically ill adult patients. We searched PubMed, Embase, Web of Science, Google Scholar, and ProQuest Dissertations and Thesis Global; screened reference lists of included studies; and contacted the authors when needed. English studies only were considered with no restriction on dates. After duplicate removal, 2 reviewers screened titles/abstracts, reviewed full-text articles, and extracted data independently. Studies that compared abbreviated versus 24-hour urine collection for measuring CrCl were included. We assessed the risk of bias using the QUADAS-2 tool. We extracted correlation coefficients, mean prediction errors (ME)-as a measure of bias, and root mean squared prediction errors (RMSE)-as a measure of precision. Five studies were included, comprising 528 adult critically ill adults from surgical, medical, and trauma intensive care units (ICUs). Three studies had high risk of bias, and 2 had low risk. The studies evaluated different durations of urine collection, including 30-minute, 2-hour, 4-hour, 6-hour, and 12-hour. Mean 24-hour CrCl ranged from 57 mL/min/1.73 m2 to 103 mL/min. Abbreviated urine collection led to CrCl that correlated well with the 24-hour measured CrCl (correlation coefficient ranged from 0.8 to 0.95). Mean prediction error ranged from 5 mL/min/1.73 m2 to 16 mL/min (from 8% to 25% of the 24-hour CrCl). Root mean squared prediction error calculated from 1 study was 30.5 mL/min/1.73 m2. Abbreviated urine collection is used to measure CrCl for renal drug dosing in critically ill patients, but its accuracy is not well-established. Abbreviated urine collection may overestimate CrCl compared with 24-hour urine collection. Larger, well-conducted studies are needed to evaluate the accuracy of CrCl measured using different durations of urine collection in critically ill patients.

VASOPRESSOR REDUCTION EFFECT OF POLYMYXIN B HEMOPERFUSION IN PATIENTS WITH PERITONITIS-INDUCED SEPTIC SHOCK: A PROPENSITY SCORE-MATCHED ANALYSIS.

Background : This study aimed to evaluate the effect of polymyxin B hemoperfusion (PMX-HP) in patients with peritonitis-induced septic shock who still required high-dose vasopressors after surgical source control. Methods : This retrospective study included adult patients admitted to the surgical intensive care unit (ICU) at Seoul National University Hospital between July 2014 and February 2021 who underwent major abdominal surgery to control the source of sepsis. Patients were divided into two groups based on whether PMX-HP was applied after surgery or not. The primary and secondary endpoints were the vasopressor reduction effect, and in-ICU mortality, respectively. Propensity score matching was performed to compare the vasopressor reduction effect. Results : A total of 338 patients met the inclusion criteria, of which 23 patients underwent PMX-HP postoperatively, whereas 315 patients did not during the study period. Serum norepinephrine concentration decreased over time regardless of whether PMX-HP was applied. However, it decreased more rapidly in the PMX-HP(+) group than in the PMX-HP(-) group. There were no significant differences in demographics including age, sex, body mass index, and most underlying comorbidities between the two groups. Risk factors for in-ICU mortality were identified by comparing patient characteristics and perioperative factors between the two groups using multivariate analysis. Conclusion : For patients with peritonitis-induced septic shock, PMX-HP rapidly reduces the requirement of vasopressors immediately after surgery but does not reduce in-ICU mortality. This effect could potentially accelerate recovery from shock, reduce sequelae from vasopressors, and ultimately improve quality of life after discharge.

MORTALITY CHARACTERISTICS OF MULTIPLE TRAUMA PATIENTS AT MILITARY HOSPITAL 103

Objectives: To determine mortality characteristics of multiple trauma patients who were treated at Military Hospital 103. Methods: A prospective, descriptive study on 196 multiple trauma patients who were admitted and treated at the Surgical Intensive Care Unit (SICU), Military Hospital 103. Patients' clinical and subclinical data were collected at the time of admission, during treatment, and at the time of discharge from the SICU. The data were encoded and processed according to statistical methods. Results: The majority of multiple trauma patients were aged 20 - 40 (38.8%), mainly men (80.1%), and the main cause was traffic accidents (66.8%). The 30-day mortality rate of multiple trauma admitted to the SICU was 40.8%. The mortality rate within 24 and 48 hours after admission was 15.8% and 21.9%, respectively, then it gradually decreased over time. The main causes of death within the first 24 hours were traumatic shock (10.7%) and severe traumatic brain injury (5.1%), but the main cause of death after 24 hours was multiple organ failure (9.7%). Injury Severity Score (ISS) (HR 1.95; 95%CI: 1.05 - 3.64), brain trauma (HR 0.25; 95%CI: 0.09 - 0.70) and shock when arrival (HR 0.41; 95%CI: 0.22 - 0.75) were risk factors for survival over time in multiple trauma patients (p &lt; 0.05). Conclusion: The mortality rate among multiple trauma patients was high. ISS, traumatic brain injury, and shock at the time of admission were risk factors for survival over time in patients with multiple traumas (p &lt; 0.05). The main causes of death within the first 24 hours were traumatic shock and severe traumatic brain injury, but after 24 hours was multiple organ failure.

Antibiotic Stewardship in Surgical Departments.

Antimicrobial resistance (AMR) has emerged as one of the leading public health threats of the 21st century. New evidence underscores its significance in patients' morbidity and mortality, length of stay, as well as healthcare costs. Globally, the factors that contribute to antimicrobial resistance include social and economic determinants, healthcare governance, and environmental interactions with impact on humans, plants, and animals. Antimicrobial stewardship (AS) programs have historically overlooked surgical teams as they considered them more difficult to engage. This review aims to summarize the evolution and significance of AS in surgical wards, including the surgical intensive care unit (SICU) and the role of diagnostic stewardship (DS). The contribution of AS team members is presented. The new diagnostic modalities and the new technologies including artificial intelligence (AI) are also reviewed.