Trauma Intensive Care Unit Research Articles (Page 1)

Introduction: High-quality palliative care in trauma intensive care units is crucial but often hindered by prognostic uncertainty, time constraints, limited provider training, and cultural differences between acute care surgery and palliative care services. In response, the American College of Surgeons Committee on Trauma recommends early goals-of-care discussions for high-risk trauma patients. However, little is known about how these strategies are implemented in practice. We aimed to identify communication strategies in trauma critical care and evaluate their impact on patient and family-centered care. Methods: We conducted a literature search of PubMed, Embase, CINAHL, and Web of Science for studies published through October 2024. Inclusion criteria focused on adult trauma or surgical ICU patients and studies addressing palliative care, communication strategies, or goals-of-care discussions. Data from eligible studies were extracted and synthesized qualitatively, with themes identified using grounded theory analysis. Results: We identified 39 eligible studies. Thematic analysis identified five key themes: communication frameworks, interdisciplinary approaches, communication barriers, provider education, and impact on patient and family satisfaction. Communication frameworks including structured family meetings, use of communication checklists, and decision aids such as the Best Case/Worst Case Scenario tool improved shared decision-making. Several studies emphasized the importance of shared responsibility for patients between palliative care specialists and trauma providers. Conclusions: Evidence suggests that structured communication frameworks and early interdisciplinary involvement improve family satisfaction and patient-centered outcomes. Despite progress, standardized approaches to palliative communication in trauma ICU settings remain a challenge. Future efforts should focus on targeted education and standardized protocols.

Acute Kidney Injury (AKI), a leading organ failure cause in critical patients, demands early high-risk identification to enhance outcomes. Yet comparative analyses of diagnostic and prognostic machine learning (ML) models across multiple post-admission timeframes are lacking. Using MIMIC-IV, we carried out using the Boruta algorithm for feature selection, developing and comparing six ML models to predict AKI risk at 0-24, 24-48, 48-72, 0-48, and 0-72 h post-ICU admission. Model performance was evaluated using the Area Under the Curve (AUC) and confusion matrix. Decision Curve and calibration analyses assessed clinical applicability. We compared models with Sequential Organ Failure Assessment (SOFA) and SAPSII scores to evaluate the accuracy of the ML models. Finally, Shapley Additive Explanations (SHAP) values interpreted and visualized key features of the optimal model. Our study involved 2092 trauma Intensive Care Unit (ICU) patients. Using the 17 selected out of the 48 features among trauma patients 24 h after ICU admissions, among the six ML models and two scoring systems, all ML models outperformed SOFA and SAPS II, and the extreme gradient boosting (XGBoost) exhibited the best performance, achieving an AUC of 0.948 (95% CI [0.929-0.966]) for AKI prediction within 24 h of admission, with an AUC of 0.941 ([0.892-0.917]) and 0.878 ([0.863-0.892]) at 0-48 and 0-72 h period, respectively. However, their predictive accuracies were very limited at 24-48 h (AUC 0.602 [0.562-0.643]) and 48-72 h (AUC 0.490 [0.429-0.551]), respectively. Urine output per kilogram per hour at 6 and 12 h and age were the most important features identified through SHAP analysis. Our study found ML models excel in diagnosing AKI risk in ICU trauma patients but have limited prognostic accuracy at 24-48 and 48-72 h post-admission. Further research is needed to improve this using time-series ML models with optimal windows.

Background: Methocarbamol is a central nervous system depressant with antispasmodic properties used as a skeletal muscle relaxant as part of a multimodal analgesia regimen in critically ill patients. Intravenous (IV) methocarbamol contains polyethylene glycol (PEG) 300 and propylene glycol (PG) which have been associated with acute kidney injury (AKI). To mitigate AKI risk, IV methocarbamol is limited to 72 consecutive hours, followed by a 48-hour drug-free interval (DFI). Objective: To characterize the incidence of AKI in intensive care unit (ICU) patients receiving IV methocarbamol. Methods: This is a single-center, retrospective evaluation of adult trauma or surgical ICU patients who received at least 3 consecutive doses of IV methocarbamol. The primary outcome was the difference in SCr from day 1 through day 7 after IV methocarbamol initiation. Results: A total of 68 patients met inclusion criteria. Four patients were classified in the non-DFI group. There was no difference in the median (IQR) SCr (mg/dL) measured at any time point from day 1 through day 7 after IV methocarbamol initiation in the entire cohort [0.83 (0.71, 1.08) vs 0.74 (0.62, 1.33), P = 0.55]. There was no difference between the median (IQR) SCr (mg/dL) from day 1 through day 7 in patients that had no DFI [1.04 (0.89, 2.56) vs 1.20 (0.79, 2.92), P = 0.84]. Conclusion: No statistically significant change in SCr was observed over time in critically ill patients receiving IV methocarbamol regardless of DFI use.

IntroductionA tracheostomy is an important intervention for trauma patients referred to intensive care units (ICUs). Trauma patients often require prolonged intubation; timing of tracheostomy remains debated.The purpose of this study is to determine the impact of early tracheostomy on critical metrics such as mechanical ventilation duration, ICU length of stay (LOS) and ventilator acquired pneumonia (VAP) in trauma patients in ICU settings.MethodsWe conducted a retrospective cohort study of 383 trauma patients who underwent tracheostomy in a tertiary teaching hospital ICU (January 2018–December 2022). Inclusion: trauma patients with temporary tracheostomy; Exclusion: permanent tracheostomies. Early tracheostomy (ET) was defined as ≤7 days of mechanical ventilation, late (LT) as >7 days. The dataset includes demographic information, Acute physiology and chronic health evaluation II score, Simplified acute physiology score II, Glasgow coma scale score, Injury severity Score, type and cause of injuries, ICU outcomes, length of stay and rates of ventilator-associated pneumonia (VAP). Data were analyzed using Mann–Whitney U and Chi-square tests; significance at p < 0.05.. The study involved a comparison of the duration of mechanical ventilation, ICU LOS, VAP rates and extubation trials between patients who underwent ET and LT.ResultsOf the 804 patients who underwent tracheostomies from January 2018 to December 2022, 383 were trauma patients and were included in the study. There were no significant differences between the two groups in terms of age, sex, Acute physiology and chronic health evaluation II score, Simplified acute physiology score II and Injury severity score. The incidence of VAP was lower in the ET cohort (15.9%) than in the LT cohort (47.4%). The percentage of extubation trials was found to be higher in the LT cohort (43.1%) than in the ET cohort (9.3%), resulting in prolonged ICU LOS. Patients with an ET had a significantly shorter ICU LOS median of 15 days (IQR 13,17) and a mechanical ventilation median of 13 days (IQR 11,14) than LT patients who had an ICU LOS median of 33 days (IQR 30,36) and a mechanical ventilation median of 31 days (IQR 27,33) respectively.ConclusionImplementing an early tracheostomy protocol for trauma patients in the ICU is associated with a decreased incidence of VAP, shorter duration of mechanical ventilation and shorter ICU LOS while maintaining consistent ICU and hospital outcomes. The adoption of a standardized approach to perform early tracheostomy helps in improving resource utilization and patient outcomes in trauma patients.

Abstract Background and Aims Acute kidney injury (AKI) is a critical complication in trauma patients admitted to intensive care units (ICUs), significantly increasing morbidity and mortality. This study aimed to determine the incidence of AKI, identify associated risk factors, and evaluate its clinical impact in trauma patients admitted to the ICU in the only tertiary Trauma Center ICU of our country. Method A prospective observational study was conducted over 9 months, involving 120 trauma patients admitted to a university-affiliated ICU. AKI was diagnosed and staged according to the kidney disease: improving global outcomes (KDIGO) criteria inclusion criteria were age ≥18 years, baseline glomerular filtration rate (GFR) &amp;gt;90 mL/min (to exclude pre-existing chronic kidney disease), and survival beyond the first 3 days of ICU admission. Patients with direct renal trauma were excluded. Descriptive statistics characterized the patient cohort, and comparisons between AKI and non-AKI groups were conducted to assess differences in demographic, clinical, and laboratory variables. Multivariable logistic regression was used to identify potential risk factors, while correlations were analyzed between AKI and biochemical markers, antibiotic use, and nephrotoxic drugs. Results The cohort had a mean age of 54.5 years (±19.5 SD), with most patients being male (84.7%). Hypertension and obesity were observed in 34.5% of patients each, while diabetes mellitus and cardiovascular disease were present in 29.5% and 10.6%, respectively. Surgical interventions were performed in 13.9%, while critical care interventions included intubation (70.8%), inotropic drugs (19.4%), and nephrotoxic agents (9.7%). AKI occurred in 40.28% (60 patients) of patients, classified as KDIGO Stage I (23/60, 37.93 %), Stage II (25/60, 41.38 %), and Stage III (12/60, 20.69 %). Elevated white blood cell counts (&amp;gt;15×10³) and mean arterial pressure (&amp;gt;89 mmHg) within the first 24 hours were associated with an increased risk of AKI. Patients with AKI exhibited higher lactate levels (&amp;gt;2.2) and lower bicarbonate levels (&amp;lt;22 mmol/L) than those without AKI (P &amp;lt; 0.05). ICU stays were significantly prolonged in patients with AKI, with a median survival time of 14 days for AKI Stage I–III compared to 79 days for non-AKI patients. Logistic regression indicated that nephrotoxic agent use (OR: 2.8, 95% CI: 1.1–7.1), lactate levels (OR: 3.2, 95% CI: 1.3–8.4), and bicarbonate levels (OR: 2.1, 95% CI: 1.1–5) were potential predictors of AKI, although the limited sample size reduced statistical significance (P &amp;gt; 0.05). Combining a PLT/Albumin ratio at day 2 with a cutoff of 77.42 and lactate &amp;gt; 2.2 mmol/L in the first 24 hours showed excellent predictive performance for AKI occurrence after day 3, with an AUC of 0.87, sensitivity of 90%, and specificity of 85.7%, highlighting their potential as early biomarkers for AKI in critically ill trauma patients. Additionally, vancomycin and nonsteroidal anti-inflammatory drug use showed positive correlations with AKI (P &amp;lt; 0.05). Conclusion AKI was a common and severe complication in ICU trauma patients, with significant impacts on resource utilization and patient outcomes. Early identification of risk factors—such as elevated lactate levels, high white blood cell counts, and exposure to nephrotoxic medications—may enable timely interventions to mitigate AKI risk. Additionally, the PLT/Albumin ratio on day 2, combined with lactate levels &amp;gt;2.2 mmol/L within the first 24 hours, demonstrates strong predictive potential for AKI occurrence beyond day 3, with excellent diagnostic accuracy. Larger cohort studies are needed to confirm these findings and improve predictive models for clinical management.

Deep vein thrombosis (DVT) in critically ill patients is often undetected. However, it is unclear whether ultrasound surveillance for early detection of DVT in high-risk medical-surgical intensive care unit (ICU) patients improves patients' outcomes. The DETECT trial (Diagnosing deep-vein thrombosis early in critically ill patients) evaluates the effect of twice-weekly bilateral lower limb ultrasound compared to usual care on 90-day mortality of critically ill adult patients admitted to medical, surgical and trauma ICUs. The DETECT trial is an international, parallel-group, open-label, randomised trial, which will recruit 1800 critically ill adults from over 14 hospitals in Saudi Arabia and Kuwait. Eligible patients will be allocated to twice-weekly bilateral lower limb ultrasound or usual care. The primary outcome is 90-day mortality. Secondary outcomes include lower limb proximal DVT, pulmonary embolism and clinically important bleeding. The first patient was enrolled on 21 March 2023. As of 8 April 2025, 711 patients have been enrolled from 14 centres in Saudi Arabia and Kuwait. The first interim analysis was conducted on 14 May 2025. We expect to complete recruitment by December 2026. Institutional review boards (IRBs) of each participating institution approved the study. We plan to publish the results in peer-reviewed journals and present the findings at international critical care conferences. Clinicaltrials.gov: NCT05112705, registered on 9-11-2021.

Prevalence, Microbiological Cultures, and Outcomes of Intra-abdominal Sepsis in Intensive Care Unit Trauma Patients at Charlotte Maxeke Johannesburg Academic Hospital.

Advanced communication techniques can support seriously injured older adults facing a significant change in health trajectory or functional status. Optimal use of these techniques requires effective implementation among trauma team members in intensive care units (ICUs). To evaluate implementation of the Best Case/Worst Case-ICU (BC/WC-ICU) communication tool. This quality improvement study involved implementing the BC/WC-ICU in the context of a randomized clinical trial. Each site received 3 months of implementation training during 1 of 4 sequential waves from October 2023 to September 2024; ongoing implementation was evaluated until January 2025. Participants included such trauma team members as attendings, fellows, residents, advanced practice providers, and bedside nurses at 8 high-volume trauma centers across the United States. BC/WC-ICU is a communication tool used daily on rounds that includes team discussion of major 24-hour events and of the best- and worst-case scenarios for recovery, which are annotated on a graphic aid. Clinicians use the graphic aid to discuss prognosis with patients and families. Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM implementation outcomes) of the intervention. Two hundred eight trauma surgeons, intensivists, and fellows completed 1-on-1 training, and the intervention reached an estimated 1300 patient families. Clinicians reported the intervention effectively supported families through consistent messaging about prognosis that improved downstream decision-making and reduced moral distress. Mean (SD) site adherence ranged from 45% (30.4) to 100% (0), and graphic aid fidelity was high, with sites scoring a mean (SD) 6.22 (2.02) to 7.12 (1.39) on an 8-point rubric. Implementation was hindered by competing clinical tasks, fear of communicating prognosis, misunderstanding the tool, and a belief that BC/WC-ICU was not innovative, which generated hesitance about the intervention's utility. Long-term use of the intervention lagged at 12 months with the exception of 1 trauma center. This study found that implementation of BC/WC-ICU in trauma ICUs is feasible, supports prognostic communication, and can improve the clinician-family relationship. Future efforts to advance clinician-patient communication will need to consider identified barriers, including the rapid pace and high acuity of critical care and disincentives to prioritize communication.

Anemia is a common condition among critically ill patients. To address this, patient blood management (PBM) programs have been introduced to enhance anemia treatment while reducing the need for transfusions. This study assesses the implementation and effectiveness of an anemia management protocol across multiple intensive care units (ICUs), with a particular emphasis on its impact within the trauma ICU (TICU). We retrospectively reviewed ICU patients at AGH from 2016 to 2020. Adult patients (≥18 years) with an admission hemoglobin <12 g/dL were included. Statistical analyses compared patients receiving the anemia protocol management (AP) versus those receiving standard of care (nonanemia protocol [N-AP]). Out of 28,420 ICU admissions, 32% of TICU patients met the inclusion criteria, with 43% managed using the AP-significantly higher than in other ICUs (p < .001). Within the TICU, patients receiving the protocol had fewer daily blood draws (p = .04), lower transfusion rates (p = .001), and higher average hemoglobin levels (p = .03) compared to those not managed with the protocol. Over time, protocol use in the TICU increased from 15% in 2016 to 41% in 2020 (p < .001), which correlated with reductions in transfusions and blood draws. The adoption of a structured AP was linked to enhanced anemia management, decreased transfusion requirements, and fewer blood draws in ICU patients. The TICU showed the highest rate of protocol adoption and the most notable improvements. These results support the broader implementation of protocol-driven PBM approaches to optimize outcomes in ICU settings.

Guideline-based recommendations for post-hemostasis resuscitation in trauma patients remain limited. This study aimed to define an interpretable Markov Decision Process (MDP) to model intensive care unit (ICU) trauma resuscitation and evaluate its potential to support clinical decision-making using a previously established framework from sepsis care. Retrospective observational study. High-volume, Level I academic trauma center. Adult trauma patients admitted to the ICU between 2012-2019 with lactate ≥ 2 mmol/L. Resuscitation was framed as a sequential decision-making problem using an MDP and focused on intravenous fluid (IVF) and vasopressor (norepinephrine and vasopressin) administration. Resuscitation was defined as concluding 1-hour after the last intravenous fluid (IVF) bolus (≥250 ml) or vasopressor administration within the first 48 hours of ICU admission. A reinforcement learning (RL) agent was trained to recommend IVF and vasopressor treatments. Learned policy actions were compared to observed clinical practice using McNemar's test, and model performance was evaluated retrospectively. 4,305 subjects were included; 3,027 (70%) met the resuscitation endpoint (median resuscitation time: 22 hours). The learned policy aligned with clinical practice but differed significantly in vasopressor use, recommending norepinephrine less often (4%±6% vs. 12%, p<0.001) and vasopressin more frequently (13%±12% vs. 4%, p<0.001). IVF ≥250ml was recommended in 19%±12% of decisions vs. 13% in observed practice. Offline evaluation estimated the learned policy underperformed the behavior policy, consistent with prior findings in sepsis. This study presents a clinically grounded MDP framework for trauma resuscitation that enables RL to be applied retrospectively in critical care. The learned policy mirrored trends previously observed in sepsis, aligning with clinician behavior while exposing variation in vasopressor use. These findings validate the relevance of the proposed MDP in trauma care, demonstrate feasibility of applying RL in this context, and establish a foundation for future modeling, evaluation, and decision support.

Gastrointestinal bleeding (GiB) is associated with hypoperfusion, cytokine release, and alterations to the mucosal barrier frequently seen in the critical care population. Risk factors in the population at large have been well-studied, but few have specifically addressed the unique circumstances surrounding critically ill trauma patients. We aimed to evaluate the incidence and risk factors for GiB in the trauma critical care population. We retrospectively analyzed patients admitted to the trauma intensive care unit at a level 1 trauma center from 3/2019 to 7/2023. We included patients mechanically ventilated for > 48 hours. Patients with GiB were matched (1:3) by age to control patients for case-control analysis. We compared demographics, management, and outcomes between cohorts. We conducted a conditional logistic regression to identify GiB predictors. We reviewed 2,289 patients and identified 64 with a GiB. After matching, 256 patients met the inclusion criteria. The overall population was male (77%) and had a median age of 41, an Injury Severity Score of 22, and a mortality of 21%. Of 64 patients with GiB, 48 (75%) were clinically significant. Male sex (AOR=3.12, 95% CI 1.10-9.11, p=0.04), vasopressor use (AOR=3.16, 95% CI 1.25-8.02, p=0.02), corticosteroid use (AOR=2.45, 95% CI 1.06-5.67, p=0.04), need for renal replacement therapy (AOR=3.54, 95% CI 1.22-10.28, p=0.02), and enteral nutrition intolerance (AOR=3.86, 95% CI 1.49-9.99, p=0.01) were all identified as independent predictors for GIB. GiB remains a significant problem in critically ill populations. Identifying risk factors unique to the critical trauma patient may lead to earlier identification of susceptible patients and allow for more robust preventive measures to reduce incidence.

Background:Healthcare-associated infections (HAIs) remain a critical challenge, particularly in trauma patients admitted to intensive care units (ICUs), who are at increased risk due to invasive procedures and prolonged hospitalization. This study aimed to investigate the prevalence, types, causative pathogens, and antibiotic resistance patterns of nosocomial infections in trauma patients.Materials and Methods:In this retrospective cross-sectional study conducted from March 2019 to March 2020, 45 trauma patients who developed nosocomial infections 48 h after ICU admission were analyzed. Data were collected from the hospital records and the Iranian Nosocomial Infection Surveillance System.Results:Of 557 trauma patients admitted to the ICU, 45 (7.9%) developed 65 episodes of HAIs during the study, of which 12.3% (8/65) were polymicrobial. Ventilator-associated events (VAE) were the most common infection type (58.2%), followed by bloodstream (20.9%), surgical site (14.9%), and urinary tract infections (6%). Acinetobacter spp. was the most frequently isolated pathogen (49.4%), followed by Klebsiella spp. (27.7%). High levels of antibiotic resistance have been observed, particularly in Gram-negative bacteria. No statistically significant associations were found between infection type, trauma severity, or underlying comorbidities.Conclusion:VAE and multidrug-resistant Acinetobacter species are major concerns in trauma patients in the ICU. Strengthening infection prevention protocols, especially ventilator care practices, and implementing antimicrobial stewardship programs are essential for mitigating infection risk. Furthermore, enhanced surveillance systems, targeted antibiotic therapy guided by local antibiograms, and multicenter research collaborations are strongly recommended for addressing the emerging threat of antibiotic-resistant nosocomial infections.

Background and Objectives: Prognostic stratification in trauma patients admitted to the intensive care unit (ICU) remains a clinical challenge. While conventional scoring systems such as Acute Physiology and Chronic Health Evaluation II (APACHE II), Injury Severity Score (ISS), and Glasgow Coma Scale (GCS) are widely used, the utility of biochemical biomarkers in predicting mortality is still evolving. This study aimed to evaluate the prognostic value of key inflammatory and metabolic biomarkers: platelet-to-lymphocyte ratio (PLR), C-reactive protein-to-albumin ratio (CAR), serum lactate, base deficit, and neutrophil-to-lymphocyte ratio (NLR) in relation to ICU mortality in trauma patients. Materials and Methods: In this retrospective cohort study, data from 240 ICU-admitted trauma patients were analyzed. Group comparisons between survivors and non-survivors were conducted using t-tests or Mann–Whitney-U tests. Pearson correlation and ROC analyses were performed to assess relationships and discriminatory performance of biomarkers alongside clinical scores. Results: Non-survivors (n = 50) exhibited significantly higher CAR, lactate, and base-deficit values, and lower PLR (p < 0.05) compared to survivors (n = 190). CAR strongly correlated with CRP (r = 0.96), while lactate and base deficit were inversely correlated (r = –0.69). ROC analysis revealed that ISS (AUC = 0.86) and APACHE II (AUC = 0.77) had the highest discriminatory power, followed by lactate (AUC = 0.75). NLR did not demonstrate significant prognostic utility (p > 0.05). Conclusion: PLR, CAR, lactate, and base deficit are accessible, cost-effective biomarkers with significant prognostic value in ICU trauma care. Their integration with established scoring systems can enhance early risk stratification. NLR, however, may require time-sensitive and context-specific evaluation.

BackgroundThe ultrasound-guided axillary vein approach for central venous catheterization (UAVC) demonstrates high success rates and low complications; however, its utilization in trauma care settings remains limited. This study aimed to characterize UAVC practices in a trauma intensive care unit (TICU) at a tertiary teaching hospital, specifically investigating optimal catheter positioning, procedure-related complications, and risk factors associated with catheter inaccurate placement and venous thromboembolism (VTE) development.MethodsA retrospective analysis was performed on trauma patients who underwent UAVC between October 2021 and April 2023. This analysis was based on electronic medical records. Details of patients, procedures, and instances of catheter misplacement were carefully documented. The immediate complications after UAVC, including pneumothorax, hemothorax, hematoma, arteriovenous fistula, arterial dissection, and skin infection, were recorded. Moreover, late-onset complications such as VTE and catheter-related bloodstream infections (CRBSI) were also noted. Logistic regression was utilized to determine the independent risk factors for non-optimal catheter tip placement and VTE.ResultsA total of 132 UAVC cases were analyzed, with 113 (85.6%) performed by resident physicians and no immediate complications observed. The VTE incidence was 27.3%, particularly higher in elderly patients (≥ 65 years, 43.4%), and fever during TICU stay was noted in 55.3% of cases. Catheter-related infections occurred at a rate of 3.38 per 1,000 catheter days, with eight cases (6.06%) of catheter misplacement. Accurate placement was achieved in 29.8% of 121 patients, predominantly on the right side (40.4%). Factors influencing inaccurate placement included patient age [odds ratios (OR) 1.06, 95% confidence interval (CI) 1.02–1.10], obesity (OR 9.31, 95% CI 2.58–33.56), and left-side placement (OR 133.04, 95% CI 21.66–817.29), while patient age (>54 years), fever, and ventilation duration (>6.6 days) were associated with VTE development.ConclusionIn severely injured trauma patients, UAVC is associated with a high incidence of VTE and a low rate of optimal catheter tip positioning. Our findings underscore the necessity of standardized protocols to refine catheter tip placement and warrant further investigation through randomized controlled trials.

Background: Healthcare-associated infections (HAIs) remain a significant challenge in intensive care units (ICUs), especially in trauma settings where invasive interventions are frequent. This study aimed to assess the impact of a structured quality improvement project (QIP) on nosocomial infection rates and patient outcomes in a polytrauma ICU. Methods: We conducted a retrospective observational study at the "Pius Brînzeu" County Emergency Clinical Hospital, Timișoara. A total of 78 ICU trauma patients were included: 35 in the Pre-QIP group and 43 in the Post-QIP group. The QIP integrated evidence-based interventions, including hand hygiene reinforcement, individualized protective equipment, improved nurse staffing, and antimicrobial stewardship. Outcomes analyzed included nosocomial infection rate, ICU length of stay, antibiotic use, mechanical ventilation days, and mortality. Multivariable logistic, linear, and Poisson regression models were applied to control for confounding variables. Results: The Post-QIP group showed a significantly lower number of infections per patient (0.60 ± 0.95 vs. 1.41 ± 1.97, p = 0.03) and a trend toward lower mortality (0.19 vs. 0.34, p = 0.18). While ICU stay, antibiotic use, and ventilation days decreased post-QIP, these changes were not statistically significant. ISS and Charlson scores were consistent predictors of worse outcomes. Conclusions: Implementation of a targeted, multidisciplinary QIP was associated with improved infection control and patient outcomes. These results support the feasibility and value of structured infection prevention strategies in resource-constrained ICU settings.

As healthcare emerges as the world's fifth-largest carbon emitter, intensive care units (ICUs) represent environmental challenges due to their high resource consumption and energy demands. Reducing greenhouse gas (GHG) emissions is necessary to limit global warming. This study aimed to quantify the carbon footprint of ICU care during the first 24h of admission for trauma patients. By establishing a baseline "carbon cost" for ICU trauma care, we seek to provide a framework for future studies assessing sustainable care strategies. We conducted a prospective observational pilot study in a French trauma ICU, categorizing patients into three standardized care pathways. The GHG emissions have been quantified using a hybrid life cycle assessment approach across various scope categories. Statistical analyses included correlation testing between the different groups and severity scores. Total carbon footprints ranged from 86 to 248kg of CO2e per patient over the first 24h. Medications, medical devices, and transportation were the primary contributors, while energy and waste represented a smaller portion of the emissions. There was a significant positive correlation between emissions and severity scores. The carbon footprint of ICU care of a trauma patient during the first 24h is significant, and it is necessary to conduct assessments in each ICU to identify levers for environmental improvement. The carbon cost should be integrated into the standardization of care and research protocols to enable more sustainable care practices.

Clinical features and prognostic predictors for patients admitted to trauma intensive care unit due to fall from height in South Xinjiang

Background: Resistance to antibiotics is increasing. Hospital overuse of antibiotics is a significant contributor to antibiotic resistance. A rational use of antibiotics is necessary to optimize the outcome of critically ill patients. The study aimed to examine the utilization pattern of antibiotics in the intensive care units (ICUs) of a tertiary care public hospital. Methods: This observational study was conducted over eight months in the medical ICU (MICU), surgical ICU (SICU), and trauma ICU (TICU). Data regarding prescribed antibiotics, including name, content, dose, route of administration and duration of treatment, were used to describe the pattern and estimate the consumption. The defined daily dose (DDD)/100 bed-days of each prescribed antibiotic was calculated. Results: The three most frequently used antibiotics in all the ICUs were piperacillin + tazobactam (107 patients), Meropenem (74 patients), and Metronidazole (72 patients). The total utilization of antibiotics was 46.94, 53.91, and 38.84 DDD/100 bed-days in the TICU, SICU, and MICU wards, respectively. Antibiotics with the highest utilization (DDD/100 bed-days) in each ward were meropenem (13.47) in the SICU, piperacillin + tazobactam (10.64) in the TICU, and ceftriaxone (9.49) in the MICU. Conclusion: The present study results indicated that the percentage share of different antibiotic drugs varied according to the type of ICU and disease. Penicillin combinations, cephalosporin, and carbapenems were the most commonly used antibiotic groups in all ICUs. High consumption of broad-spectrum antibiotics underscores the importance of stewardship programs to overcome the growing resistance to available effective antibiotics in ICUs.

Benchmarking Ensemble Models to Predict Prolonged Hospital Stay in Traumatic Brain Injury: A Single-Institution Study.

BackgroundThoracic trauma accounts for 10% to 15% of trauma-related hospital admissions and contributes significantly to morbidity and mortality. Rib fractures, the most common thoracic injury, often result in pulmonary complications such as pneumonia and atelectasis due to impaired respiratory mechanics. Incentive spirometry (IS) is a widely used noninvasive technique aimed at improving pulmonary function after injury, yet patient compliance remains a challenge. Gamification of respiratory therapy has emerged as a promising approach to enhance engagement and adherence.ObjectiveThis paper presents the protocol for a study to evaluate the feasibility and safety of using gamified IS through the OmniFlow Breathing Therapy BioFeedback System in trauma patients. While preliminary observations related to potential clinical efficacy (eg, respiratory function and adherence) are of interest, structured clinical or physiological end points are not included in this protocol for a pilot study and are planned for future trials.MethodsThis protocol is for a single-center, prospective, observational phase 2 pilot study to be conducted at Wake Forest Baptist Medical Center. Adult patients (aged ≥18 years) admitted to the trauma intensive care unit with rib fractures and a Glasgow Coma Scale score of 15 are eligible for inclusion if their first intervention session can occur within 48 hours of admission. Patients requiring mechanical ventilation, those with baseline lung disease, and those with contraindications to IS are excluded. Enrolled patients participate in at least one gamified respiratory therapy session daily, lasting 15 to 20 minutes, with the possibility of additional sessions based on patient preference and tolerance. Primary end points include the feasibility of enrolling 20 patients and their participation in at least one session. Secondary end points evaluate patient adherence, number of completed sessions, and session interruptions due to predefined safety criteria (eg, pain score >8/10, oxygen desaturation <92%, new cardiac arrhythmia, or respiratory distress). If 5 consecutive patients fail to complete a session due to adverse events, the intervention is deemed unsafe.ResultsThe study was approved by the institutional review board and registered on ClinicalTrials.gov. Due to an unexpected delay in the initiation of the project, no patients were enrolled.ConclusionsOmniFlow offers a promising, much-needed solution for promoting adherence to breathing exercises among patients with thoracic trauma. This study protocol is designed to evaluate its safety and feasibility in patients with thoracic trauma and rib fractures. Looking ahead, incorporating multiplayer games into the platform could further enhance its effectiveness, allowing patients to engage in group activities while working toward their individual therapeutic goals.International Registered Report Identifier (IRRID)PRR1-10.2196/75871