Syndrome In Intensive Care Unit Research Articles

Study on Risk Factors and Receiver Operator Characteristic Curve of Iatrogenic Withdrawal Syndrome in Pediatric Intensive Care Units: A Retrospective Study.

The aims of this study were to investigate the independent risk factors associated with iatrogenic withdrawal syndrome in pediatric intensive care units (PICUs) and to establish receiver operator characteristic (ROC) curve to facilitate the diagnosis of iatrogenic withdrawal syndrome in clinical settings. Pediatric patients who received analgesic and sedative medication at a tertiary hospital in the southern Zhejiang region of China between January 2016 and December 2022 were selected for the study. Clinical case data were retrospectively analyzed to gather information including age, gender, weight, total dose of analgesic and sedative medication, total treatment duration, average maintenance dose, and other relevant parameters. Medically induced withdrawal symptom scores were assessed using the Sophia Observation Scale for Withdrawal Symptoms (SOS). Univariate and multivariate logistic regression analyses were conducted on the above indicators to identify the risk factors for iatrogenic withdrawal, and an ROC curve was constructed. The study encompassed a total of 104 pediatric patients, comprising 47 patients in the SOS score ≥4 group and 57 patients in the SOS score ≤3 group. The incidence of iatrogenic withdrawal was 45.19%. Univariate analysis identified cumulative total dose of fentanyl, average daily dose of fentanyl, average daily dose of midazolam, and patient weight (p < 0.05) as factors associated with iatrogenic withdrawal syndrome. The logistic multiple regression analysis revealed that the average daily dose of fentanyl was an independent risk factor for the occurrence of iatrogenic withdrawal syndrome in critically ill children (p < 0.05). ROC curve analysis indicated an area under the curve of 0.711 (95% CI: 0.610-0.811) with sensitivity and specificity of 73.7% and 61.7%, respectively. The average daily maintenance dose of fentanyl holds significant clinical value in diagnosing and evaluating the prognosis of iatrogenic withdrawal syndrome and can provide a scientific foundation for enhancing sedative and analgesic management in clinical practice.

Post-operative sepsis-induced acute respiratory distress syndrome: risk factors for a life-threatening complication.

Prevalence and mortality of the acute respiratory distress syndrome (ARDS) in intensive care units (ICU) are unacceptably high. There is scarce literature on post-operative sepsis-induced ARDS despite that sepsis and major surgery are conditions associated with ARDS. We aimed to examine the impact of post-operative sepsis-induced ARDS on 60-day mortality. We performed a secondary analysis of a prospective observational study in 454 patients who underwent major surgery admitted into a single ICU. Patients were stratified in two groups depending on whether they met criteria for ARDS. Primary outcome was 60-day mortality of post-operative sepsis-induced ARDS. Secondary outcome measures were potential risk factors for post-operative sepsis-induced ARDS, and for 60-day mortality. Higher SOFA score (OR 1.1, 95% CI 1.0-1.3, p = 0.020) and higher lactate (OR 1.9, 95% CI 1.2-2.7, p = 0.004) at study inclusion were independently associated with ARDS. ARDS patients (n = 45) had higher ICU stay [14 (18) vs. 5 (11) days, p < 0.001] and longer need for mechanical ventilation [6 (14) vs. 1 (5) days, p < 0.001] than non-ARDS patients (n = 409). Sixty-day mortality was higher in ARDS patients (OR 2.7, 95% CI 1.1-6.3, p = 0.024). Chronic renal failure (OR 4.0, 95% CI 1.2-13.7, p = 0.026), elevated lactate dehydrogenase (OR 1.7, 95% CI 1.1-2.7, p = 0.015) and higher APACHE II score (OR 2.7, 95% CI 1.3-5.4, p = 0.006) were independently associated with 60-day mortality. Post-operative sepsis-induced ARDS is associated with higher 60-day mortality compared to non-ARDS post-operative septic patients. Post-operative septic patients with higher severity of illness have a greater risk of ARDS and worse outcomes. Further investigation is needed in post-operative sepsis-induced ARDS to prevent ARDS.

Prognostic prediction of sepsis patient using transformer with skip connected token for tabular data

Sepsis is known as a common syndrome in intensive care units (ICU), and severe sepsis and septic shock are among the leading causes of death worldwide. The purpose of this study is to develop a deep learning model that supports clinicians in efficiently managing sepsis patients in the ICU by predicting mortality, ICU length of stay (>14 days), and hospital length of stay (>30 days). The proposed model was developed using 591 retrospective data with 16 tabular data related to a sequential organ failure assessment (SOFA) score. To analyze tabular data, we designed the modified architecture of the transformer that has achieved extraordinary success in the field of languages and computer vision tasks in recent years. The main idea of the proposed model is to use a skip-connected token, which combines both local (feature-wise token) and global (classification token) information as the output of a transformer encoder. The proposed model was compared with four machine learning models (ElasticNet, Extreme Gradient Boosting [XGBoost]), and Random Forest) and three deep learning models (Multi-Layer Perceptron [MLP], transformer, and Feature-Tokenizer transformer [FT-Transformer]) and achieved the best performance (mortality, area under the receiver operating characteristic (AUROC) 0.8047; ICU length of stay, AUROC 0.8314; hospital length of stay, AUROC 0.7342). We anticipate that the proposed model architecture will provide a promising approach to predict the various clinical endpoints using tabular data such as electronic health and medical records.

Clinical Profile and Outcome of Patients Presenting with Guillain - Barre Syndrome in a Medical Intensive Care Unit of a Tertiary Care Hospital

Clinical Profile and Outcome of Patients Presenting with Guillain - Barre Syndrome in a Medical Intensive Care Unit of a Tertiary Care Hospital

Patients Aged 90 Years and Above With Acute Coronary Syndrome in the Cardiac Intensive Care Unit: Management and Outcomes

Limited data exist regarding outcomes after coronary angiography (CAG) and percutaneous coronary intervention (PCI) in patients aged ≥90 years admitted to the cardiac intensive care unit (CICU) with acute coronary syndrome (ACS). We studied sequential CICU patients ≥90 years admitted with ACS from 2007 to 2018. Three therapeutic approaches were defined: (1) No CAG; (2) CAG without PCI (CAG/No PCI); and (3) CAG with PCI (CAG/PCI). In-hospital mortality was evaluated using multivariable logistic regression. All-cause 1-year mortality was evaluated using Kaplan-Meier and multivariable Cox proportional hazards analysis. The study included 239 patients with a median age of 92 (range 90 to 100) years (57% females; 45% ST-elevation myocardial infarction; 8% cardiac arrest; 16% shock). The No CAG group had higher Day 1 Sequential Organ Failure Assessment scores, more co-morbidities, worse kidney function, and fewer ST-elevation myocardial infarctions. In-hospital mortality was 20.8% overall and did not differ between the No CAG (n = 103; 21.4%), CAG/No PCI (n = 47; 21.3%), and CAG/PCI (n = 90; 20.0%) groups, before or after adjustment. Overall 1-year mortality was 52.5% and did not differ between groups before or after adjustment. Median survival was 6.9 months overall and 41.2% of hospital survivors died within 1 year of CICU admission. CICU patients aged ≥90 years with ACS have a substantial burden of illness with high in-hospital and 1-year mortality that was not lower in those who underwent CAG or PCI. These results suggest that careful patient selection for invasive coronary procedures is essential in this vulnerable population.

The relationship of complete blood count on the outcome of childhood patients with Dengue Shock Syndrome (DSS) in the Pediatric Intensive Care Unit (PICU) Dr. Soetomo General Hospital

Dengue Hemorrhagic Fever (DHF) is an acute infectious disease caused by the dengue virus which is spread through the bite of female mosquitoes of the Aedes Aegypti and Aedes Albopictus species. DHF cases often attack children under 15 years of age and if not treated properly it will turn into Dengue Shock Syndrome (DSS). Supporting examinations are needed to diagnose and monitor the condition of DSS patients, one of which is a complete blood test. This study aims to determine the relationship between a complete blood profile and the parameters: platelet count, leukocyte count, hematocrit value, and hemoglobin level on the outcome of pediatric patients with DSS in the Pediatric Intensive Care Unit (PICU) at the Regional General Hospital (RSUD) Dr. Soetomo. This research is a descriptive analytical observational study with a cross sectional approach using medical record data from pediatric patients with DSS in the PICU of Dr. RSUD. Soetomo Surabaya for the 2015-2022 period. The sample consisted of 40 samples in accordance with the inclusion and exclusion criteria taken using total sampling technique. In this study, a significant relationship was found between age, hemoglobin and leukocytes and the mortality outcome of pediatric DSS patients. The values obtained were &lt;0.05 (age), 0.048 (hemoglobin), and 0.048 (leukocytes). Apart from that, there is also a significant relationship between platelets and the outcome of treatment duration for pediatric DSS patients.

Predictors of prone position use in patients with COVID-19 acute respiratory distress syndrome in intensive care units: A cross-sectional study

Background &amp; Aim: Clinical recommendations for ventilation management in patients with COVID-19 acute respiratory distress syndrome suggest the use of prone position as complementary therapy, however, there is wide variability in its use. The purpose of this study is to identify the predictor factors for using the prone position for patients hospitalized in intensive care units with COVID-19 acute respiratory distress syndrome.&#x0D; Methods &amp; Materials: A Cross-sectional study was carried out, including adult patients with COVID-19 acute respiratory distress syndrome hospitalized in intensive care units of four hospitals in Colombia. A multiple logistic regression model was constructed in which the main outcome was the prone position in intensive care, and the independent variables included sociodemographic characteristics, history, health status, progress, and treatment.&#x0D; Results: A total of 473 patients were included in this study; 59.8% (n=283) received prone position therapy within 24-96 hours of hospitalization in intensive care. Out of the total of eligible variables in the logistics-regression model, factors in favor of the prone position were PCR&gt;10mg/L (OR=3.33), private healthcare network (OR=1.99), hypertension (OR=1,76), cough or dyspnea symptoms at intensive care admission (OR=2.69 and OR=1.91), oxygen saturation &lt;90% (OR=1.84). Factors against the prone position were heart disease (OR=0.34), FiO2&gt;50% (OR=0.32), and TP&gt;13 seconds (OR=0.53).&#x0D; Conclusion: Patients with COVID-19 acute respiratory distress syndrome with a higher probability of prone position in intensive care were those with PCR&gt;10mg/L, cough, dyspnea, and private healthcare network. The predictors identified in this study could help standardize the prone position therapy.

Literature Review of Burnout Syndrome in Intensive Care Unit (ICU) Staffs During The COVID-19 Pandemic

Introductions: Burnout syndrome becomes a special concern for health workers during COVID-19 pandemic that has been exposed to increased workload and intense working hours with COVID-19 patients, stating having a high risk of getting infected with COVID-19 as well. Methods: This literature review paper reviewed scientific journals with prevalence and burnout syndrome profile data. The journals were obtained through the search engines GoogleScholar, the MEDLINE (PubMed) database and PsychINFO. From the search, there are 13 articles in total that meet the required data criteria. Results: Prevalence of burnout syndrome were found severely high in ICU settings, it reached more than 50% from most of the survey. Burnout syndrome rate can be influenced by working conditions, age and gender, time of work and working experience. Burnout syndrome can manifest as higher fatigue level and decrease of cognitive function that can increase the risk of medical mistake. Conclusions: High prevalence and severity of burnout syndrome oblige us to pay attention to symptoms that can affect professional intensive care unit staff and its service to patients. Further research should review prevention therapy and how to apply to health workers and also the prevalence of prevention that has been done in other studies.

Secondary bacterial infections & extensively drug-resistant bacteria among COVID-19 hospitalized patients at the University Hospital in Kraków

IntroductionHealthcare-associated infections (HAI) and bacterial antimicrobial resistance posed a therapeutic risk during the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to analyze the HAIs in COVID-19 patients in the Intensive Care Unit (ICU) and non-ICU at the University Hospital in Krakow (UHK) with an emphasis on the susceptibility of the most frequently isolated pathogens and the prevalence of extensively drug resistant (XDR) microorganisms.MethodsThis laboratory-based study was carried out at the University Hospital in Krakow in the ICU and non-ICUs dedicated to COVID-19 patients between May 2021 and January 2022. All isolates of Klebsiella pneumoniae were analyzed using PFGE protocol.Results292 independent HAI cases were identified, with the predominance of urinary tract infections (UTI), especially in the non-ICU setting. The most common ICU syndrome was pneumonia (PNA). The prevalence of XDR organisms was 22.6% in the ICU and 14.8% in non-ICUs among all isolates. The incidence of carbapenem-resistant Enterobacteriaceae infection was 24.8 cases per 10,000 hospitalizations and the carbapenem-resistant A. baumannii infection incidence was 208.8 cases per 10,000 hospitalizations. The prevalence of XDR strains was highest in Acinetobacter spp, in PNA cases. The PFGE typing demonstrated that almost all XDR strains varied widely from each other.ConclusionsIn this study, there was a high incidence of HAI in COVID-19 patients, especially when compared to Western Europe and the United States. Similarly, the prevalence of XDR microorganisms, especially XDR-A.baumannii, was also high. PFGE did not confirm the horizontal spread of any organism strains.

Sivelestat sodium for treatment of patients with COVID-19-associated acute respiratory distress syndrome in intensive care unit: a single-center retrospective cohort study

To investigate the effect of sivelestat sodium on survival, oxygenation index, and serum markers for infection in critically ill patients with COVID-19-associated acute respiratory distress syndrome (ARDS). This retrospectively study was performed among the critically ill patients with COVID-19-associated ARDS admitted in the intensive care unit (ICU) at Nanfang Hospital, Southern Medical University. We collected the clinical data of the patients on the first day of ICU admission and on the day of discharge and laboratory tests results of interleukin-6 (IL-6), C-reactive protein (CRP) and procalcitonin (PCT) and oxygenation index on days 1, 3 and 7 following ICU admission. Propensity-score matching was used to match the patients receiving sivelestat sodium to those without the treatment. Cox proportional hazards model and linear regression analysis were used to assess the association of sivelestat sodium treatment with in-hospital mortality and the length of hospital stay. A total of 199 patients with COVID-19-associated ARDS patients were included for data analysis. After propensity-score matching PSM, 35 patients receiving sivelestat sodium were matched to 70 patients without the treatment. Treatment with of sivelestat sodium was not associated with the reduction of in- hospital mortality (P=0.36), prolonged ICU stay (P=0.39), hospital stay (P=0.68) or improved oxygenation index (P>0.05) of the patients. No significant difference was found in serum CRP or PCT levels between the patients with and without sivelestat sodium treatment, but a significant reduction in IL-6 level was found in sivelestat sodium group (P=0.016). Sivelestat sodium treatment is not correlated with the reduction of mortality or length of hospital stay, but is associated with reduced serum IL-6 level in patients with COVID-19-associated ARDS.

Prevalence of suspected obesity hypoventilation syndrome in Hungarian Intensive Care Units during the COVID-19 pandemic.

The symptoms of obesity hypoventilation syndrome (OHS) may be present for years with concomitant progressive comorbidities, and the condition is frequently diagnosed late as a result of acute-on-chronic hypercapnic respiratory failure. Although some data exist on intensive care unit (ICU) prevalence, mortality and morbidity of OHS, little is known about the ICU mortality of these chronic respiratory failure patients during the COVID-19 pandemic. We performed a cross-sectional observational study in five Hungarian Intensive Care Units for 4 months during the COVID-19 pandemic. All ICU patients were screened for OHS risk factors by treating physicians. Risk factors were defined as obesity (body mass index [BMI] ≥ 30 kg/m2 ) and at least one of the following: Epworth Sleepiness Score ≥ 6; symptoms of right heart failure; daytime or night-time hypoxemia; presence of loud snoring; witnessed apnoea. We calculated prevalence, mortality and factors associated with unfavourable outcome. A total of 904 ICU patients were screened for OHS risk factors. Overall 79 (8.74 ± 5.53%) patients were reported to have met the criteria for suspected OHS with a mortality rate of 40.5%; 69% (54 patients) of the cohort displayed at least 3 symptoms related to OHS before their acute illness. COVID-19 infection was associated with higher mortality in OHS-suspected patients, independently of actual BMI. Despite the increased risk of obese patients, suspected OHS did not show higher prevalence than expected during the COVID-19 pandemic in critically ill patients. COVID-19 infection however was a risk for mortality in these patients, independent of actual BMI.

Mental health support to perinatal women with COVID-19 pneumonia, intensive care unit and post-intensive care syndromes

Intensive care unit syndrome and post-intensive care unit syndrome became one of urgent and global problems of current medicine. Their development is associated, among other causes, with the specific environment and modalities of an ICU in combination with COVID-19 pneumonia which could have adverse effect on the mental health of patients. This cross-sectional, hospital-based study was conducted in December 2020 - January 2022 in the cohort of 677 perinatal women with mental health disorders associated with severe and critical COVID-pneumonia. They were recruited at the Maternity Hospital ICU of the National Specialized Versatile Medical Center Zangiota-1 in Tashkent, Uzbekistan. Most patients had post-traumatic stress disorder (56.6%; 383 of 677). Generalized anxiety disorder was diagnosed in 26.7% (181 of 677) while depressive conditions were found in 16.7% (113 of 677) of cases. In the postpartum period, PTSD, anxiety, and depression combinations were identified in 46.1% (312 of 677) of cases according to the PHQ-ADS combined scale; it was typical for women with severe and critical COVID-19 in trimester 3 of pregnancy. The therapy for mental health disorders in perinatal women was focused on reducing the frequency of threats of pregnancy loss, ICUS, and PICS development. Psychotherapy was supplemented with sedative and metabolic drugs. After discharge from the hospital ICU (n=613), an individual rehabilitation program was made for each of them. By month 8 all women have been successfully rehabilitated and had no signs of mental health disorders. An effective therapeutic tactics for mental health disorders and differentiated psychotherapy as well as delivery in a specialized medical center may improve significantly the pregnancy outcomes and shorten the rehabilitation period.

Longitudinal Associations Among Symptoms of Family Intensive Care Unit Syndrome.

Family intensive care unit (ICU) syndrome, a comorbid response to another person's stay in the ICU, is characterized by emotional distress, poor sleep health, and decision fatigue. This pilot study examined associations among symptoms of emotional distress (anxiety and depression), poor sleep health (sleep disturbance), and decision fatigue in a sample of family members of patients in the ICU. The study used a repeated-measures, correlational design. Participants were 32 surrogate decision makers of cognitively impaired adults who had at least 72 consecutive hours of mechanical ventilation within the neurological, cardiothoracic, and medical ICUs at an academic medical center in northeast Ohio. Surrogate decision makers with a diagnosis of hypersomnia, insomnia, central sleep apnea, obstructive sleep apnea, or narcolepsy were excluded. Severity of symptoms of family ICU syndrome was measured at 3 time points in 1 week. Zero-order Spearman correlations of the study variables were interpreted at baseline and partial Spearman correlations of study variables were interpreted 3 days and 7 days after baseline. The study variables showed moderate to large associations at baseline. Baseline anxiety and depression were associated with each other and with decision fatigue at day 3. Baseline sleep disturbance was associated with anxiety, depression, and decision fatigue at day 7. Understanding the temporal dynamics and mechanisms of the symptoms of family ICU syndrome can inform clinical, research, and policy initiatives that enhance the provision of family-centered critical care.

Clinical profile, cardiac involvement and outcome of children admitted with multisystem inflammatory syndrome in PICU at GB Pant children hospital Srinagar

Background: Multisystem inflammatory syndrome in children (MIS-C) is a severe hyper inflammatory post infectious complication of acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, which typically occurs 2-6 weeks after exposure to SARS-CoV-2. Aim was to determine the clinical profile, cardiac involvement and outcome of children admitted with multisystem inflammatory syndrome in pediatric intensive care unit. Methods: This prospective observational study was conducted in pediatric intensive care unit over period of two years. After informed consent from parents, all those patients meeting inclusion criteria were subjected to complete history, general and systemic physical examination. Routine baseline investigations included CBC, LFT, KFT, ABG, serum calcium and phosphorous, and other investigations like echocardiography, COVID-19 RAT and RTPCR and various inflammatory markers like serum ferritin, pro-calcitonin, CRP and ESR whenever required were done. Results: In our study out of 77 MIS-C patients 40 were males and 37 were females with a male female ratio of 1.1:1. The mean average age was 7.4 years. Out of them 47 (61%) patients had a history of COVID-19 infection/contact with positive COVID-19 cases 3 to 4 weeks before presentation. In our study gastrointestinal, respiratory, and cardiac systems were mostly involved. Rash and conjunctival congestion was seen in 81% of MIS-C patients. On echocardiography out of 77 MIS-C patients, 15 (19.5%) had pericardial effusion, 25 (32.5%) had coronary artery dilatations and 32 patients (41.5%) had left ventricular systolic dysfunction with LVEF &lt;55%. Conclusions: Pediatric multisystem inflammatory syndrome is a serious and life-threatening illnesses having a significant impact on morbidity and mortality.

Analysis of risk factors of mortality in infants and toddlers with moderate to severe pediatric acute respiratory distress syndrome

Objective: To identify the risk factors in mortality of pediatric acute respiratory distress syndrome (PARDS) in pediatric intensive care unit (PICU). Methods: Second analysis of the data collected in the "efficacy of pulmonary surfactant (PS) in the treatment of children with moderate to severe PARDS" program. Retrospective case summary of the risk factors of mortality of children with moderate to severe PARDS who admitted in 14 participating tertiary PICU between December 2016 to December 2021. Differences in general condition, underlying diseases, oxygenation index, and mechanical ventilation were compared after the group was divided by survival at PICU discharge. When comparing between groups, the Mann-Whitney U test was used for measurement data, and the chi-square test was used for counting data. Receiver Operating Characteristic (ROC) curves were used to assess the accuracy of oxygen index (OI) in predicting mortality. Multivariate Logistic regression analysis was used to identify the risk factors for mortality. Results: Among 101 children with moderate to severe PARDS, 63 (62.4%) were males, 38 (37.6%) were females, aged (12±8) months. There were 23 cases in the non-survival group and 78 cases in the survival group. The combined rates of underlying diseases (52.2% (12/23) vs. 29.5% (23/78), χ2=4.04, P=0.045) and immune deficiency (30.4% (7/23) vs. 11.5% (9/78), χ2=4.76, P=0.029) in non-survival patients were significantly higher than those in survival patients, while the use of pulmonary surfactant (PS) was significantly lower (8.7% (2/23) vs. 41.0% (32/78), χ2=8.31, P=0.004). No significant differences existed in age, sex, pediatric critical illness score, etiology of PARDS, mechanical ventilation mode and fluid balance within 72 h (all P>0.05). OI on the first day (11.9(8.3, 17.1) vs.15.5(11.7, 23.0)), the second day (10.1(7.6, 16.6) vs.14.8(9.3, 26.2)) and the third day (9.2(6.6, 16.6) vs. 16.7(11.2, 31.4)) after PARDS identified were all higher in non-survival group compared to survival group (Z=-2.70, -2.52, -3.79 respectively, all P<0.05), and the improvement of OI in non-survival group was worse (0.03(-0.32, 0.31) vs. 0.32(-0.02, 0.56), Z=-2.49, P=0.013). ROC curve analysis showed that the OI on the thind day was more appropriate in predicting in-hospital mortality (area under the curve= 0.76, standard error 0.05,95%CI 0.65-0.87,P<0.001). When OI was set at 11.1, the sensitivity was 78.3% (95%CI 58.1%-90.3%), and the specificity was 60.3% (95%CI 49.2%-70.4%). Multivariate Logistic regression analysis showed that after adjusting for age, sex, pediatric critical illness score and fluid load within 72 h, no use of PS (OR=11.26, 95%CI 2.19-57.95, P=0.004), OI value on the third day (OR=7.93, 95%CI 1.51-41.69, P=0.014), and companied with immunodeficiency (OR=4.72, 95%CI 1.17-19.02, P=0.029) were independent risk factors for mortality in children with PARDS. Conclusions: The mortality of patients with moderate to severe PARDS is high, and immunodeficiency, no use of PS and OI on the third day after PARDS identified are the independent risk factors related to mortality. The OI on the third day after PARDS identified could be used to predict mortality.

Evaluating maternal-infant feeding interactions in dyads with opioid exposure

PurposeThe purpose of this study was to describe maternal-infant feeding interactions among dyads with opioid exposure. DesignAn exploratory descriptive design was used to describe feeding interactions between mothers with opioid use disorder (OUD) and their infants being treated for neonatal opioid withdrawal syndrome (NOWS) in the neonatal intensive care unit (NICU) in a secondary analysis. MethodsEligible mothers had an infant in the NICU being treated for withdrawal, were English-speaking, and at least 18 years old. Videos were recorded in the infant's private room. There were 12 dyads analyzed for this study. The Mother-Infant Feeding Tool (MIFT) was used to assess regulatory processes in maternal-infant interactions. ResultsMothers spent most of the time monitoring the feeding, rather than being unfocused. Infants displayed dysregulated tone for about half of the feeding time. This is a preliminary study with further research needed to provide evidence of validity in this population.

Awareness and diagnosis for intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in neonatal (NICU) and pediatric intensive care units (PICU) – a follow-up multicenter survey

BackgroundConstantly elevated intra-abdominal pressure (IAH) can lead to abdominal compartment syndrome (ACS), which is associated with organ dysfunction and even multiorgan failure. Our 2010 survey revealed an inconsistent acceptance of definitions and guidelines among pediatric intensivists regarding the diagnosis and treatment of IAH and ACS in Germany. This is the first survey to assess the impact of the updated guidelines on neonatal/pediatric intensive care units (NICU/PICU) in German-speaking countries after WSACS published those in 2013.MethodsWe conducted a follow-up survey and sent 473 questionnaires to all 328 German-speaking pediatric hospitals. We compared our findings regarding awareness, diagnostics and therapy of IAH and ACS with the results of our 2010 survey.ResultsThe response rate was 48% (n = 156). The majority of respondents was from Germany (86%) and working in PICUs with mostly neonatal patients (53%).The number of participants who stated that IAH and ACS play a role in their clinical practice rose from 44% in 2010 to 56% in 2016. Similar to the 2010 investigations, only a few neonatal/pediatric intensivists knew the correct WSACS definition of an IAH (4% vs 6%). Different from the previous study, the number of participants who correctly defined an ACS increased from 18 to 58% (p < 0,001). The number of respondents measuring intra-abdominal pressure (IAP) increased from 20 to 43% (p < 0,001). Decompressive laparotomies (DLs) were performed more frequently than in 2010 (36% vs. 19%, p < 0,001), and the reported survival rate was higher when a DL was used (85% ± 17% vs. 40 ± 34%).ConclusionsOur follow-up survey of neonatal/pediatric intensivists showed an improvement in the awareness and knowledge of valid definitions of ACS. Moreover, there has been an increase in the number of physicians measuring IAP in patients. However, a significant number has still never diagnosed IAH/ACS, and more than half of the respondents have never measured IAP. This reinforces the suspicion that IAH and ACS are only slowly coming into the focus of neonatal/pediatric intensivists in German-speaking pediatric hospitals. The goal should be to raise awareness of IAH and ACS through education and training and to establish diagnostic algorithms, especially for pediatric patients.The increased survival rate after conducting a prompt DL consolidates the impression that the probability of survival can be increased by timely surgical decompression in the case of full-blown ACS.

Optimal design of $ PI^\rho D^\mu $-controller for artificial ventilation systems for COVID-19 patients

&lt;abstract&gt;&lt;p&gt;In light of the COVID-19 pandemic, many patients have suffered from Acute Respiratory Distress Syndrome (ARDS) in Intensive Care Units (ICUs) around the world. In the medical field, it is known that the so-called artificial ventilation device, which has become the mainstay of treatment of such syndrome, decreases mortality in critically ill COVID-19 patients. Due to the high reliability of this device, there is an emergency need to follow up the progress made on designing a robust controller for improving its performance. From this perspective, this work introduces different control design schemes for obtaining an optimal Fractional-order PID controller (or simply $ PI^\rho D^\mu $-controller) of the Artificial Ventilation (AV) system through two optimization algorithms: the Bacteria Foraging Optimization (BFO) and the Particle Swarm Optimization (PSO) algorithms. The realization of the controller is accomplished using four approximations: Oustaloup's approximation, the Continued Fractional Expansion (CFE) approximation and the $ 1^{st} $- and $ 2^{nd} $-order El-Khazali approximations. The validation of the controller design and the AV system behavior are verified via numerical simulation in order to demonstrate the effectiveness and the potency of all proposed schemes.&lt;/p&gt;&lt;/abstract&gt;

Study of Morbidity and Mortality of The Cardio-Renal Syndrome in The Pediatric Intensive Care Unit

Study of Morbidity and Mortality of The Cardio-Renal Syndrome in The Pediatric Intensive Care Unit

Role of Lung Ultrasound for Diagnosis of Acute Respiratory Distress Syndrome in Intensive Care Unit

Background: Acute respiratory distress syndrome (ARDS) necessitates rapid recognition for early intervention and favourable outcomes. The Berlin Definition may not be always helpful for ARDS diagnosis in critically ill patients, because of the inability to acquire adequate information from bedside chest X-rays. Lung ultrasound may be a reasonable alternative to chest X-ray for the identification of ARDS, but the effectiveness of lung ultrasound in ARDS diagnosis remains uncertain. Objective: To explore the efficacy of lung ultrasound (LUS) for the diagnosis of ARDS in ICU. Methods: This observational, cross-sectional study was conducted in the ICU, DMCH at the Department of Anaesthesia, Analgesia, Palliative, and Intensive Care Medicine from March 2017 to June 2019. Lung ultrasound was performed on acute hypoxic respiratory failure patients requiring mechanical ventilation. chest X-ray, arterial blood gas analysis, and echocardiography were done to fulfill the Berlin Definition. ARDS was diagnosed by the ‘CXR-based Berlin Definition’ and ‘LUS-based Berlin Definition’. Results: A total of 141 patients were assessed. Their median age was 35 years. Primary diagnoses were sepsis, pulmonary oedema, pneumonia, and trauma. A total of 62 (43.97%) patients fulfilled ‘CXR-based Berlin Definition’ and a total of 69 (48.93%) patients were diagnosed as ARDS by ‘LUS-based Berlin Definition’. Considering the ‘CXR-based Berlin Definition’ as the reference standard, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of ‘LUS-based Berlin Definition’ were 90.3%, 83.5%, 81.2%, 91.7%, and 86.5% respectively. Conclusion: Lung ultrasound can be an effective tool for the diagnosis of ARDS in the intensive care unit. Bangladesh Crit Care J September 2022; 10(2): 104-109