Ventilation In Intensive Care Unit Research Articles

Advancing ICU patient care with a Real-Time predictive model for mechanical Power to mitigate VILI

BackgroundInvasive Mechanical Ventilation (IMV) in Intensive Care Units (ICU) significantly increases the risk of Ventilator-Induced Lung Injury (VILI), necessitating careful management of mechanical power (MP). This study aims to develop a real-time predictive model of MP utilizing Artificial Intelligence to mitigate VILI. MethodologyA retrospective observational study was conducted, extracting patient data from Clinical Information Systems from 2018 to 2022. Patients over 18 years old with more than 6 h of IMV were selected. Continuous data on IMV variables, laboratory data, monitoring, procedures, demographic data, type of admission, reason for admission, and APACHE II at admission were extracted. The variables with the highest correlation to MP were used for prediction and IMV data was grouped in 15-minute intervals using the mean. A mixed neural network model was developed to forecast MP 15 min in advance, using IMV data from 6 h before the prediction and current patient status. The model’s ability to predict future MP was analyzed and compared to a baseline model predicting the future value of MP as equal to the current value. ResultsThe cohort consisted of 1967 patients after applying inclusion criteria, with a median age of 63 years and 66.9 % male. The deep learning model achieved a mean squared error of 2.79 in the test set, indicating a 20 % improvement over the baseline model. It demonstrated high accuracy (94 %) in predicting whether MP would exceed a critical threshold of 18 J/min, which correlates with increased mortality. The integration of this model into a web platform allows clinicians real-time access to MP predictions, facilitating timely adjustments to ventilation settings. ConclusionsThe study successfully developed and integrated in clinical practice a predictive model for MP. This model will assist clinicians allowing for the adjustment of ventilatory parameters before lung damage occurs.

Predictive value of fluid balance before extubation on its outcome in mechanically ventilated adults in the intensive care unit.

Although there are many reasons for extubation failure, maintaining negative or lower positive fluid balances 24 hours before extubation may be a key measure for successful extubation. To assess the predictive value of fluid balance before extubation and its outcome in mechanically ventilated cases in the intensive care unit (ICU). This retrospective cohort study involved collecting clinical data from patients undergoing mechanical ventilation in Lanzhou general adult ICU from January 2022 to December 2022. Based on extubation outcomes, the patients were divided into a successful extubation group and a failed extubation group. Their fluid balance levels 24 h before extubation were compared with analyse the predictive value of fluid balance on extubation outcomes in patients undergoing mechanical ventilation. In this study, clinical data from 545 patients admitted to a general adult ICU were collected. According to the inclusion and exclusion criteria, 265 (48.6%) patients were included, of which 197 (74.3%) were successfully extubated; extubation was unsuccessful in 68 (25.7%) patients. The total intake and fluid balance levels in patients in the failed extubation group 24 h before extubation were significantly higher than those in the successful extubation group, with a median of 2679.00 (2410.44-3193.50) mL versus 2435.40 (1805.04-2957.00) mL, 831.50 (26.25-1407.94) mL versus 346.00 (-163.00-941.50) mL. Receiver operating characteristic (ROC) curve analysis showed that the optimal cut-off value for predicting extubation outcomes was 497.5 mL (sensitivity 64.7%, specificity 59.4%) for fluid balance 24 h before extubation. The area under the ROC curve was 0.627 (95% confidence interval [CI] 0.547-0.707). Based on the logistic regression model, cumulative fluid balance >497.5 mL 24 h before extubation could predict its outcomes in mechanically ventilated patients in the ICU (OR = 5.591, 95% CI [2.402-13.015], p < .05). The fluid balance level 24 h before extubation was correlated with the outcome of extubation in mechanically ventilated patients in the ICU. The risk of extubation failure was higher when the fluid balance level was >497.5 mL. Tracheal intubation is a crucial life support technique for many critically ill patients, and determining the appropriate time for extubation remains a challenge for clinicians. Although there are many reasons for extubation failure, acute pulmonary oedema caused by continuous positive fluid balance and volume overload is one of the main reasons for extubation failure. Therefore, it is very important to study the relationship between fluid balance and extubation outcome to improve the prognosis of patients with invasive mechanical ventilation in ICU.

Indications and Short-Term Outcomes of Conventional Mechanical Ventilation in a Neonatal Intensive Care Unit of a Tertiary Care Hospital in a Developing Country

Background: Mechanical ventilation is an advanced intervention employed in neonatal intensive care units (NICUs) to assist neonates who require external ventilation for adequate gas exchange, while minimizing associated complications. Understanding the indications and short-term outcomes of mechanical ventilation is crucial for improving neonatal care, especially in developing countries with limited resources. Objective: To examine the indications and short-term outcomes of conventional mechanical ventilation in a neonatal intensive care unit of a tertiary care hospital in a developing country. Methods: This descriptive cross-sectional study was conducted from July 2022 to February 2023 in the Department of Paediatrics at Combined Military Hospital, Kharian. The study included 227 pediatric patients admitted to the NICU for mechanical ventilation, selected via consecutive non-probability sampling. Written informed consent was obtained from parents or guardians. Data collected included neonatal and pregnancy parameters, primary indication for mechanical ventilation, duration of mechanical ventilation, and length of hospital stay. Patients were monitored for complications such as pneumothorax, sepsis, and ventilator-associated pneumonia. Statistical analysis was performed using IBM SPSS Statistics for Windows, version 26.0. Quantitative variables were expressed as mean ± standard deviation or median and interquartile range, while qualitative variables were presented as frequencies and percentages. Comparisons were made using the Chi-square test, Fisher's exact test, independent samples t-test, or Mann-Whitney U test as appropriate, with a p-value of ≤0.05 considered significant. Results: The study included 128 males (56.4%) and 99 females (43.6%). The mean gestational age at birth was 36.4 ± 1.5 weeks, and the mean birth weight was 2994.1 ± 450.1 grams. Common indications for mechanical ventilation included pneumonia (26.4%), respiratory distress syndrome (24.7%), and sepsis (18.5%). The mean duration of mechanical ventilation was 7.1 ± 2.5 days, and the mean length of hospital stay was 13.4 ± 6.0 days. Complications were observed in 29.5% of patients, with ventilator-associated pneumonia (18.1%) being the most common, followed by sepsis (9.7%) and pneumothorax (5.3%). The overall mortality rate was 18.5%. Significant associations were found between mortality and duration of mechanical ventilation (p&lt;0.001), occurrence of complications (p&lt;0.001), and requirement for re-intubation (p&lt;0.001). Conclusion: The study highlights the significant association between prolonged mechanical ventilation, the development of complications, and increased mortality in neonates. Effective strategies to prevent and manage complications, as well as to limit the duration of mechanical ventilation, are essential to improve neonatal outcomes in resource-limited settings.

Effectiveness of Nursing Strategies on Risk for Pneumonia Among Patients Connected to Mechanical Ventilator in Intensive Care Unit

It has been reported that the incidence of nosocomial infections in the ICU is about 2–5 times higher than in the general in-patient hospital population. The study's objective was to evaluate the effectiveness of Nursing Strategies on Risk for Pneumonia among Patients connected to Mechanical Ventilator in Intensive Care Unit. The study adopted randomized controlled trial. Forty patients were enrolled in the study after screening using CPIS scale. If the score &lt;6 the patients were included in the study and eligibility criteria were age between 25 to 60 years, duration of ventilator 48 hours and medical patients with respiratory, renal, MODS, and sepsis diagnosis. Patients subjected to surgery and connected with non-invasive ventilation were excluded from the study. Standardized questionnaire such as demographic variables, clinical variables, and Clinical Pulmonary Infection Scoring (CPIS). The data was analyzed using descriptive statistics, independent ‘t’ test, paired t test and ANOVA were used to analyze the data. Seven (35%) of them were in the age group of 51-60 years in the study group, whereas six (30%) of the patients were in the age group of 61-70 years in the control group. 12(60%) of the patients were male and eight (40%) of them were female in the study group and 10(50%) of patients were male and female respectively in the control group. Regarding mode of ventilation, 12(50%) and six (30%) of patients ventilator setting were CMV and ASV respectively, in the study group, whereas seven (35%) and six (30%) of patients ventilator settings were ASV and CMV respectively in the control group. The pretest CPIS mean score was 4.40 with a standard deviation of 0.59 and the posttest III mean value was 2.60 with a standard deviation of 0.58 and the mean difference was 1.80 between the pretest and the posttest III, which was statistically significant at p&lt;0.001 in the study group. Nursing strategies such as demand suctioning, second hourly position change, changing ventilator flow sensor every 72 hours, and oral care every fourth hour with chlorhexidine help reduce ventilator-associated pneumonia.

Predictive Value of Neutrophil-to-Monocyte Ratio, Lymphocyte-to-Monocyte Ratio, C-Reactive Protein, Procalcitonin, and Tumor Necrosis Factor Alpha for Neurological Complications in Mechanically Ventilated Neonates Born after 35 Weeks of Gestation.

This prospective study investigated the association between elevated neutrophil-to-monocyte ratio (NMR), lymphocyte-to-monocyte ratio (LMR), C-reactive protein (CRP), procalcitonin, and tumor necrosis factor-alpha (TNF-alpha) and the risk of developing neurological complications in mechanically ventilated neonates. The aim was to evaluate these biomarkers' predictive value for neurological complications. Within a one-year period from January to December 2022, this research encompassed neonates born at ≥35 weeks of gestational age who required mechanical ventilation in the neonatal intensive care unit (NICU) from the first day of life. Biomarkers were measured within the first 24 h and at 72 h. Sensitivity, specificity, and area under the curve (AUC) values were calculated for each biomarker to establish the best cutoff values for predicting neurological complications. The final analysis included a total of 85 newborns, of which 26 developed neurological complications and 59 without such complications. Among the studied biomarkers, TNF-alpha at >12.8 pg/mL in the first 24 h demonstrated the highest predictive value for neurological complications, with a sensitivity of 82%, specificity of 69%, and the highest AUC (0.574, p = 0.005). At 72 h, TNF-alpha levels greater than 14.3 pg/mL showed further increased predictive accuracy (sensitivity of 87%, specificity of 72%, AUC of 0.593, p < 0.001). The NMR also emerged as a significant predictor, with a cutoff value of >5.3 yielding a sensitivity of 78% and specificity of 67% (AUC of 0.562, p = 0.029) at 24 h, and a cutoff of >6.1 showing a sensitivity of 76% and specificity of 68% (AUC of 0.567, p = 0.025) at 72 h. Conversely, CRP and procalcitonin showed limited predictive value at both time points. This study identifies TNF-alpha and NMR as robust early predictors of neurological complications in mechanically ventilated neonates, underscoring their potential utility in guiding early intervention strategies. These findings highlight the importance of incorporating specific biomarker monitoring in the clinical management of at-risk neonates to mitigate the incidence of neurological complications.

Post-COVID Trajectory of Pentraxin 3 Plasma Levels Over 6 Months and Their Association with the Risk of Developing Post-Acute Depression and Anxiety.

Clinical manifestations of coronavirus disease 2019 (COVID-19) often persist after acute disease resolution. Underlying molecular mechanisms are unclear. The objective of this original article was to longitudinally measure plasma levels of markers of the innate immune response to investigate whether they associate with and predict post-COVID symptomatology. Adult patients with previous severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection during the first pandemic wave who underwent the 6-month multidisciplinary follow-up were included. Plasma levels of pentraxin 3 (PTX3), the complement components C3a and C5a, and chitinase-3 like-protein-1 (CHI3L1) were measured at hospital admission during acute disease (baseline) and at 1 and 6 months after hospital discharge. Associations with post-COVID-19 sequelae at 6 months were investigated using descriptive statistic and multiple regression models. Ninety-four COVID-19 patients were included. Baseline PTX3, C5a, C3a, and CHI3L1 did not predict post-COVID-19 sequelae. The extent of the reduction of PTX3 over time (delta PTX3) was associated with lower depressive and anxiety symptoms at 6 months (both p < 0.05). When entering sex, age, need for intensive care unit or non-invasive ventilation during hospital stay, psychiatric history, and baseline PTX3 as nuisance covariates into a generalized linear model (GLM), the difference between baseline and 6-month PTX3 levels (delta PTX3) significantly predicted depression (χ2 = 4.66, p = 0.031) and anxiety (χ2 = 4.68, p = 0.031) at 6 months. No differences in PTX3 levels or PTX3 delta were found in patients with or without persistent or new-onset other COVID-19 symptoms or signs at 6 months. Plasma levels of C3a, C5a, and CHI3L1 did not correlate with PTX3 levels at either time point and failed to associate with residual or de novo respiratory or systemic clinical manifestations of the disease at 6 months. A lower reduction of plasma PTX3 after acute COVID-19 associates with the presence of depression and anxiety, suggesting an involvement of inflammation in post-COVID-19 psychopathology and a potential role of PTX3 as a biomarker.

HYBRID VASCULAR APPROACH REDUCES THE INTENSIVE CARE UNIT STAY IN PATIENTS WITH CHRONICALLY THREATENING LIMB ISCHEMIA AND MULTILEVEL ATHEROSCLEROTIC LESIONS

Chronic limb-threatening ischemia represents the fi nal stage of atherosclerosis and is often associated with signifi cantcardiovascular morbidity leading to high mortality. The hybrid approach combines surgical and endovascular techniques toachieve maximal revascularization of multilevel atherosclerotic lesions in the lower limb, with a shorter procedure time and less trauma compared to the classical method. It is also expected to reduce the length of hospital stay.The aim of the study is to analyze the relationship between the hybrid approach and the length of stay in the intensive careunit (ICU) compared to the classical vascular surgical approach in patients with chronic limb-threatening ischemia, multilevel atherosclerosis and high anesthesiological risk. Another endpoint is to compare the total ventilation time in the two groups.Material and methods. The study compares ICU length of stay and total mechanical ventilation time between two groups –a prospective group (n=48) of patients treated with hybrid revascularization and a control group (n=50) treated with classicalvascular revascularization. Patients included had multi- level atherosclerotic lesions (aorta- iliac, femur- popliteal and outfl ow) and chronic limb-threatening ischemia (Fontaine Grade III and IV). A database was created with subsequent statistical analysis using «SPSS» software. Tests used: Chi-square, p-value, frequencies. The chi-squared test was considered valid if the test statistic is chi-squared distributed under the null hypothesis, specifi cally Pearson’s chi-squared test. If the null hypothesis that there are no diff erences between classes in the population is true, the test statistic calculated from the observations follows a χ2 frequency distribution. If the p-value is greater than alpha, then we have not rejectedthe null hypothesis and assume that there is no signifi cant diff erence between the two samples. We set the signifi cance level at 0.05. The study protocol was approved by the Commission on Biomedical Ethics of the Bukovinian State Medical University (minutes of the Commission meeting No 4 from the 19.12.2023 year). The theme of the complex research work «Development, justifi cation and implementation of new approaches to the diagnosis and treatment of some acute surgical diseases, prediction of their course and prevention of complications (state registration number: 0121U110501, terms of execution: 01.2021-12.0225).Results. ICU length of stay and total ventilation time were analyzed in the two groups. Both ICU and total ventilation timeswere shorter with statistical signifi cance in the hybrid approach group. Therefore, the use of hybrid revascularization contributes to an accelerated stabilization of the patient’s condition. Therefore, the use of the hybrid vascular approach contributes to an accelerated stabilization of the patient’s condition. This reduces the duration of treatment, the cost of treatment. So, hybrid vascular approach is a promising way to treat limb ischemia. This approach needs further implementation in practice. The novelty added by the manuscript to the already published scientifi c literature: Hybrid revascularization itself represents a relatively new type of treatment for patients with multilevel atherosclerotic lesions. The analysis of the length of stay in the intensive care unit of patients undergoing hybrid revascularization compared to classic surgical revascularization adds to the current literature.Conclusions. ICU length of stay for patients with chronic limb-threatening ischemia and multilevel atherosclerosis, as wellas total mechanical ventilation time, is shorter with statistical signifi cance when hybrid revascularization is used compared with traditional vascular surgery.

Contextual design requirements for decision-support tools involved in weaning patients from mechanical ventilation in intensive care units

Weaning patients from ventilation in intensive care units (ICU) is a complex task. There is a growing desire to build decision-support tools to help clinicians during this process, especially those employing Artificial Intelligence (AI). However, tools built for this purpose should fit within and ideally improve the current work environment, to ensure they can successfully integrate into clinical practice. To do so, it is important to identify areas where decision-support tools may aid clinicians, and associated design requirements for such tools. This study analysed the work context surrounding the weaning process from mechanical ventilation in ICU environments, via cognitive task and work domain analyses. In doing so, both what cognitive processes clinicians perform during weaning, and the constraints and affordances of the work environment itself, were described. This study found a number of weaning process tasks where decision-support tools may prove beneficial, and from these a set of contextual design requirements were created. This work benefits researchers interested in creating human-centred decision-support tools for mechanical ventilation that are sensitive to the wider work system.

Underlying Mental Illness and Risk of Severe Outcomes Associated With COVID-19.

According to the Centers for Disease Control and Prevention, depression and schizophrenia, among other conditions, put individuals at high risk for severe COVID-19 infection. Patients at high risk often are eligible for outpatient therapies, such as antiviral and monoclonal antibody therapies, to prevent severe infection. However, depression and schizophrenia are not considered risk factors for severe COVID-19 infection at the Captain James A. Lovell Federal Health Care Center in North Chicago, Illinois, making patients with these conditions ineligible for outpatient therapy unless they have another high-risk condition. This retrospective cohort study assessed outcomes among patients with mild-to-moderate COVID-19 to determine whether depression and/or schizophrenia impacted the risk of severe disease or negative outcomes. The primary outcome was severe COVID-19 outcomes defined as hospitalization, admission to the intensive care unit, intubation or mechanical ventilation, or death within 30 days of infection. Patients with depression or schizophrenia had more hospitalizations and deaths, but this difference was not statistically significant (P = .36). Death within 30 days of COVID-19 infection only occurred in patients with depression or schizophrenia. Although there were more hospitalizations and deaths from COVID-19 within 30 days of infection among patients with depression and schizophrenia compared with individuals without these disorders, this finding was not statistically significant.

Device-Associated Infections in COVID-19 Patients: Frequency of Resistant Bacteria, Predictors and Mortality in Medellín, Colombia.

Increased antimicrobial use during the COVID-19 pandemic has raised concerns about the spread of resistant bacteria. This study analyzed the frequency of device-associated infections (DAI) caused by resistant bacteria, the predictors of these infections, and 30-day all-cause mortality in patients with and without COVID-19. A retrospective cohort study was conducted on DAI patients admitted to the ICU (intensive care unit) in 20 hospitals in Medellin, Colombia (2020-2021). The exposure assessed was the COVID-19 diagnosis, and outcomes analyzed were resistant bacterial infections and 30-day mortality. Clinical and microbiological information was collected from surveillance databases. Statistical analysis included generalized linear mixed-effects models. Of the 1521 patients included, 1033 (67.9%) were COVID-19-positive and 1665 DAI were presented. Carbapenem-resistant Enterobacteriaceae (CRE) infections predominated during the study (n = 98; 9.9%). The patients with COVID-19 had a higher frequency of metallo-beta-lactamase-producing CRE infections (n = 15; 33.3%) compared to patients without the disease (n = 3; 13.0%). Long-stay in the ICU (RR: 2.09; 95% CI: 1.39-3.16), diabetes (RR: 1.73; 95% CI: 1.21-2.49), and mechanical ventilation (RR: 2.13; 95% CI: 1.01-4.51) were CRE infection predictors in COVID-19 patients, with a mortality rate of 60.3%. CRE infections were predominant in COVID-19 patients. In pandemic situations, the strategies to control DAI should be maintained to avoid infections caused by resistant bacteria, such as length of stay in the ICU and duration of mechanical ventilation.

Incidence of Weaning Failure in Obese Patients in Intensive Care Unit.

Background The escalating prevalence of obesity worldwide presents unique challenges in critical care management, especially in the context of mechanical ventilation and weaning processes in intensive care units (ICUs). The present study aimed to determine the incidence of weaning failure in obese patients in an ICU. Methods A prospective observational study was carried out to gather data on patients in the ICU of Shifa International Hospital located in Islamabad, Pakistan. The target population consisted of adult patients who were both male and female, ages 18 years and above. These individuals required intubation procedures as well as mechanical ventilation during their hospitalization. The researchers followed these patients prospectively and observed their medical conditions closely to gather data about how obesity might impact critical care interventions and outcomes. Results The sample size was 288 bearing a median age of 61.0 with an interquartile range of 19 years. Older age manifested a significantly higher frequency of failed extubation (p=0.065). Higher body mass index (BMI) was significantly associated with failed extubation among the study population. It was found that a higher significant difference was associated with BMI > 30 kg/m2 (obese) in failed and successful extubation. One-half of the patients with failed extubation and only 16 (5.9%) patients with successful extubation had end-stage renal disease (p<0.001). It was found that patients who underwent failed extubation had notably increased ICU mortality (p=0.108), 28-day mortality (p=0.067), as well as mean ICU (p<0.001) and hospital stay (p=0.007). Conclusion Our study revealed some insightful correlations between obesity, age, comorbidities, length of hospitalization, ICU stay, and mortality rate in terms of weaning failure among the study population.

Risk factor profile and extubation outcomes in critically ill patients. A single-center prospective observational study

Background: The problem of extubation failure (EF) remains unexplored in low-resource settings, where predicting the extubation outcomes are more challenging. Aims and Objectives: This study investigates the incidence of EF and its predictors among patients who received mechanical ventilation (MV) in a tertiary care intensive care unit (ICU). Materials and Methods: This is a prospective observational study of 130 patients ≥18 years of age receiving MV for ≥48 h and tolerating spontaneous breathing trials in the ICU of a low-resource setting. We collected data on the baseline characteristics and clinical profiles. Patients were categorized into EF and extubation success (ES) groups. Multivariate logistic regression analyses were performed to identify independent predictors for EF. A p value of &lt;0.05 is considered statistically significant. Results: We included 130 patients, and 43 (35.3%) had developed EF. The identified predictors for EF: Moderate to copious secretions (adjusted odds ratio [AOR]: 3.426 [95% confidence interval [CI] 1.281–10.82]), age &gt;60 years of age ([AOR]: 4.135 [95% CI 1.294–11.93]), and prolonged duration of MV ≥10 days ([AOR]: 4.571 [95% CI 1.392–15.33]). Conclusion: Moderate to copious secretions, patients &gt;60 years of age, and prolonged duration of MV ≥10 days were the best predictors of EF.

Identifying avoidable causes of perinatal deaths in a district hospital in Lesotho.

Certain determinants can be associated with avoidable perinatal deaths, and audits are needed to establish what these determinants are, and what can be done to prevent such deaths. The study aimed at identifying and describing determinants associated with avoidable perinatal deaths at a district hospital in Lesotho and strategies to curb their occurrence. A retrospective descriptive study was conducted using 142 anonymised obstetric records from January 2018 to December 2020. A data collection tool was adopted from the Perinatal Problem Identification Programme. In this tool, avoidable determinants are referred to as 'factors' or 'problems'. A concerning number of perinatal deaths were secondary to avoidable patient factors, namely a delay in seeking medical care, inappropriate responses to antepartum haemorrhage, and inadequate responses to poor foetal movements. Medical personnel factors are also worth observing, namely incorrect use of partograph, insufficient notes to comment on avoidable factors and 'other' medical personnel problems. Ranking highest among administrative problems were the unavailability of intensive care unit beds and ventilators and inadequate resuscitation equipment. Administrative problems accounted for more perinatal deaths than the patient-related factors and medical personnel factors. There is an urgent need for periodic audits, health education for patients, staff competency and the necessary equipment to resuscitate neonates.Contribution:Avoidable determinants associated with perinatal deaths in a district hospital in Lesotho could be identified. This information provides an understanding of what can be done to limit avoidable perinatal deaths.

Association between weight-for-length percentile and ICU length of stay in patients with a single ventricleundergoing bidirectional Glenn repair: A retrospective cohort study.

Poor weight gain has been identified as an independent risk factor for increased surgical morbidity and mortality for patients with single-ventricle physiology undergoing staged surgical palliation. Conversely, excessive weight gain has also emerged as an independent risk factor predicting increased morbidity and mortality in a single-center study. Given this novel single-center concept, we investigated the impact of excessive weight on patients with single-ventricle physiology undergoing bidirectional Glenn palliation in a multicenter study model. Patients from the Pediatric Heart Network Single Ventricle Reconstruction Trial (n = 387) were analyzed in a retrospective cohort study examining the independent effect of weight percentile on intensive care unit (ICU) length of stay (LOS) and ventilator days. Locally estimated scatterplot smoothing (LOESS) regression was used to plot weight-for-length (WFL) percentiles by ICU LOS and ventilator days. Unadjusted and adjusted ordinal regression was used to model ICU LOS and ventilator days. Scatterplots and LOESS regression curves demonstrated increasing ICU LOS and ventilator days for increasing WFL percentiles. Unadjusted ordinal regression analysis of ICU LOS demonstrated a trend of increasing ICU LOS for increasing WFL percentiles that was not statistically significant (P = 0.11). A similar trend was demonstrated in adjusted ordinal regression that was not statistically significant (P = 0.48). Unadjusted and adjusted ordinal regression analysis of ventilator days did not reach statistical significance (P = 0.07). Excessive weight gain has a clinically relevant but not statistically significant association with increased ICU LOS and ventilator days for those patients in the >90th WFL percentile for age.

Machine learning modelling for predicting the utilization of invasive and non‐invasive ventilation throughout the ICU duration

AbstractThe goal of this work is to develop a Machine Learning model to predict the need for both invasive and non‐invasive mechanical ventilation in intensive care unit (ICU) patients. Using the Philips eICU Research Institute (ERI) database, 2.6 million ICU patient data from 2010 to 2019 were analyzed. This data was randomly split into training (63%), validation (27%), and test (10%) sets. Additionally, an external test set from a single hospital from the ERI database was employed to assess the model's generalizability. Model performance was determined by comparing the model probability predictions with the actual incidence of ventilation use, either invasive or non‐invasive. The model demonstrated a prediction performance with an AUC of 0.921 for overall ventilation, 0.937 for invasive, and 0.827 for non‐invasive. Factors such as high Glasgow Coma Scores, younger age, lower BMI, and lower PaCO2 were highlighted as indicators of a lower likelihood for the need for ventilation. The model can serve as a retrospective benchmarking tool for hospitals to assess ICU performance concerning mechanical ventilation necessity. It also enables analysis of ventilation strategy trends and risk‐adjusted comparisons, with potential for future testing as a clinical decision tool for optimizing ICU ventilation management.

Complicated Falciparum Malarial ARDS Requiring Noninvasive Support.

Severe plasmodium falciparum infection can induce respiratory distress and clinical ARDS in children, requiring intensive care admission and respiratory support. We present 3 cases of imported malarial acute respiratory distress syndrome requiring noninvasive ventilation in the pediatric intensive care unit, in the absence of any cerebral involvement. Radiological features and their relationship with severe hematological complications are also illustrated.

In vitro lung epithelial cell model reveals novel roles for Pseudomonas aeruginosa siderophores.

Multidrug-resistant Pseudomonas aeruginosa is a versatile bacterium that frequently causes lung infections. This pathogen is life-threatening to mechanically-ventilated patients in intensive care units and is a debilitating burden for individuals with cystic fibrosis. However, the role of P. aeruginosa virulence factors and their regulation during infection are not fully understood. Previous murine lung infection studies have demonstrated that the production of siderophores (e.g., pyoverdine and pyochelin) is necessary for full P. aeruginosa virulence. In this report, we provide further mechanistic insight into this phenomenon. We characterize distinct and novel ways these siderophores contribute to virulence using an in vitro human lung epithelial cell culture model.

Comparison of intravenous ketamine and fentanyl sedation in duration of mechanical ventilation in intensive care unit

Background and aims: To compare the duration of mechanical ventilation in patients receiving ketamine compared to fentanyl for sedation in mechanically ventilated patients in intensive care unit. Methods: One hundred and six patients requiring mechanical ventilation were randomized to receive continuous intravenous infusion of either ketamine (1 mg/kg bolus followed by 0.4 to 0.8 mg/kg/h) or fentanyl (1mcg/kg bolus followed by 0.3-0.5 mcg/kg/min) with the dose titrated to achieve Richmond Agitation Sedation Scale (RASS) score of 0 to -1 and Behavioral Pain Scale (BPS) score of 3 to 7. The primary outcome was the duration of mechanical ventilation. Secondary outcomes were sedation score, analgesia score and need of vasopressors. Results: The mean duration of ventilation was 2.5±0.6 days and 2.2±1.0 days (p=0.1) in patients receiving ketamine and fentanyl respectively. More patients required vasopressors: 27 (50.9%) vs 9 (17%) in patients receiving fentanyl compared to ketamine (p&lt;0.05). There were no significant changes in hemodynamic variables after the initiation of the study drug in both the groups. Infusion was discontinued for adverse effects in seven (13%) patients in both the groups. Conclusion: When compared with fentanyl, continuous ketamine infusion was tolerated similarly by critically ill adults, with similar duration of mechanical ventilation. Ketamine sedation was associated with decreased requirement for vasopressors.

Yang–Tobin Index and Integrative Weaning Index as Predictors of Successful Weaning from Mechanical Ventilation in Intensive Care Unit

Yang–Tobin Index and Integrative Weaning Index as Predictors of Successful Weaning from Mechanical Ventilation in Intensive Care Unit

Prolong Submersion in the Swimming Pool without Neurological Outcome

Abstract Drowning can be defined as a chain of events of respiratory disability due to submersion or immersion in liquid with sequelae such as irreversible brain damage, heart failure, and death. The main organ in a drowning subject is the brain, which has almost zero energy and oxygen stores and hence needs a continuous supply of blood to fulfill its need for oxygen and loss of laryngospasm. This leads to massive aspiration, lung atelectasis, and edema. This unique and miracle case was a child submerged in a swimming pool for a prolonged period without receiving CPR, traveling from the drowning place to the present hospital around 30 km. The patient came from a small village where there were no facilities of ambulance inbuilt basic facilities or advanced life support. He was on a mechanical ventilator in the pediatric intensive care unit in the present institute. He was unconscious on admission. Recovered from all complications and was discharged without any neurological abnormalities. A 13-year-old boy was admitted to the pediatric emergency department with a history of drowning in a swimming pool; he was a nonswimmer and went with his friends who were swimmers, where he accidentally fell into the water without notice from other friends. After not finding him around, his friends searched for him. They found him immersed in water at the bottom of the pool for about 10–15 min, not receiving cardiopulmonary resuscitation (CPR) as nobody was trained. The primary diagnosis was drowning without neurological complications. Therapeutic interventions included a mechanical ventilator, intravenous antibiotics, intravenous steroids, chest physiotherapy. On discharge patient had no neurological complication except limping of right foot. After 1 month of follow up, central nervous system examination was within the normal limits. No limping was seen. No neurological deficit was observed. Drowning is a common etiology of accidental mortality in the pediatric age group. Most victims not treated with CPR at the site develop permanent neurological deficits. Proper and effective management can improve many complications caused due to drowning. Guidelines should be strictly followed in private/public swimming pools to have all duties of lifeguards who are trained in CPR. Drowning patients should be managed in hospitals with well-equipped mechanical ventilators, including trained staff.