Percepción de los familiares de pacientes críticos en relación a la comunicación que le brinda el profesional de enfermería de la unidad de cuidados intensivos / Perception of the relatives of critically ill patients in relation to the communication pro-vided by the nursing professional of the intensive care unit

Introducción: cuando un individuo es hospitalizado en UCI para control y monitorización permanente de su salud, su cuidado está orientado específicamente a la asistencia plena de médicos y personal de enfermería. La complejidad de estos cuidados genera una crisis situacional y emocional en la familia que causa ansiedad, estrés, miedo y duda. La forma en la que el enfermero intervenga con el familiar en situaciones críticas es lo que va a determinar la percepción de los mismos hacia el cuidado de enfermería, en tanto la comunicación y el apoyo emocional forma parte de la competencia profesional y contribuye al cuidado holístico del paciente y familia. Objetivo: Determinar la percepción de los familiares de pacientes, respecto a la comunicación que le brinda el profesional de enfermería en la unidad de cuidados críticos. Materiales y método: Se realizó un estudio de tipo cuantitativo, descriptivo y de corte transversal. La muestra estuvo constituida por 40 familiares adultos responsables del paciente hospitalizado en la unidad de terapia intensiva, durante los meses Junio - septiembre del 2023. El instrumento de recolección de información fue un cuestionario de "Percepción de los familiares de los Pacientes Críticos, respecto a la intervención de Enfermería durante su Crisis Situacional"; el mismo fue utilizado y validado por la autora Franco Canales Rosa aplicado en el Hospital Nacional Edgardo Rebagliati, Abril de 2003. Resultados:Los resultados muestran que la percepción global de los familiares, es favorable, respecto a la comunicación verbal, comunicación no verbal y el apoyo emocional[AU]

Introduction: health is the condition in which every living being enjoys absolute well-being both physically and mentally and socially, when it is affected either by a pathology or by general accidents; Given the physical condition of the individual, he or she is often hospitalized in the ICU for permanent control and monitoring. Your care is specifically oriented towards the full assistance of Doctors and Nurses. The complexity of this care generates a situational and emotional crisis in the immediate family that causes anxiety, stress, fear and doubt. The way in which the nurse supports the family member in critical or distressing situations is what will determine the perception of the family members towards the nurses, since communication and emotional support are part of the professional competence and contribute to the holistic care of the patient. patient and family. It is a care that is reflected in the feeling that the nurses have that when they do it, the families are very grateful and that, without a doubt, it is their job. Objective: Determine the perception of the patient's relatives regarding the communication provided by the nursing professional in the critical care unit of a private institution. Materials and Methods: A quantitative, descriptive and cross-sectional study was carried out. The sample was made up of 40 adult relatives responsible for the patient hospitalized in the Adult intensive care unit, during the months of June - September 2023. The information collection instrument was a questionnaire on "Perception of relatives of Critical Patients, regarding to Nursing intervention during their Situational Crisis"; It was used and validated by the author Franco Canales Rosa applied at the Edgardo Rebagliati National Hospital, April 2003. Results:The results show that the overall perception of family members is favorable, regarding verbal communication, non-verbal communication and emotional support[AU]

Introdução: saúde é a condição em que todo ser vivo goza de absoluto bem-estar tanto físico quanto mental e social, quando é acometido por alguma patologia ou por acidentes gerais; Dada a condição física do indivíduo, muitas vezes ele é internado em UTI para controle e monitoramento permanente. O seu atendimento é especificamente orientado para a assistência integral de Médicos e Enfermeiros. A complexidade desse cuidado gera uma crise situacional e emocional na família imediata que causa ansiedade, estresse, medo e dúvidas. A forma como o enfermeiro apoia o familiar em situações críticas ou angustiantes é o que determinará a percepção dos familiares em relação aos enfermeiros, uma vez que a comunicação e o apoio emocional fazem parte da competência profissional e contribuem para o cuidado holístico do paciente. paciente e família. É um cuidado que se reflete no sentimento que os enfermeiros têm de que quando o fazem as famílias ficam muito gratas e que, sem dúvida, é o seu trabalho. Objetivo: Determinar a percepção dos familiares do paciente quanto à comunicação prestada pelo profissional de enfermagem na unidade de terapia intensiva de uma instituição privada. Materiais e Métodos: Foi realizado um estudo quantitativo, descritivo e transversal. A amostra foi composta por 40 familiares adultos responsáveis pelo paciente internado na Unidade de Terapia Intensiva Adulto, durante os meses de junho a setembro de 2023. O instrumento de coleta de informações foi um questionário sobre "Percepção dos familiares de Pacientes Críticos, quanto à intervenção de Enfermagem durante a sua crise situacional"; Foi utilizado e validado pelo autor Franco Os resultados mostram que a percepção geral dos familiares é favorável, no que diz respeito à comunicação verbal, à comunicação não verbal e ao apoio emocional.Canales Rosa apl i c a d o n o Hospital Nacional Edgardo Rebagliati, abril de 2003. Resultados: Os resultados mostram que a percepção geral dos familiares é favorável, no que diz respeito à comunicação verbal, à comunicação não verbal e ao apoio emocional.

Outcomes of intracranial hemorrhage in critically ill patients with acute leukemia: Results of a retrospective cohort study.

Background: Admission to the intensive care unit (ICU) is frequently required for patients with acute leukemia (AL) because of life-threatening complications such as intracranial hemorrhage (IH). In this study, we evaluated the impact of IH on survival and neurological outcomes in this population. Methods: This was a single-center retrospective cohort study including adult patients with AL requiring ICU admission and experiencing IH between 2002 and 2019 at Saint Louis Hospital. Leukemia type was determined according to the French-American-British classification. Brain imaging (either computed tomography or magnetic resonance imaging) was available for all the patients. The primary endpoint of the study was to describe the clinical and biological characteristics and evaluate the mortality and neurological outcome of patients hospitalized in the ICU with newly diagnosed AL and IH. The secondary endpoint was to identify predictive factors of IH in these patients. Results: Thirty-five patients with AL were included, median age of the patients was 59.00 (interquartile range [IQR]: 36.00-66.00) years. Twenty-nine patients (82.9%) had acute myeloid leukemia, including 12 patients with acute promyelocytic leukemia. Thrombocytopenia was constant, and 48.5% of patients had disseminated intravascular coagulation (DIC). At ICU admission, the median Sequential Organ Failure Assessment score was 5 (IQR: 3-9). The median time between AL onset and IH was 2.0 (IQR: 0.0-9.5) days. The ICU and hospital mortality rates were 60.0% (n =21) and 65.7% (n=23), respectively. In univariate analysis, mechanical ventilation and stupor were associated with mortality, but DIC and acute promyelocytic leukemia were not. Upon multivariate analysis, stupor or coma was the only factor significantly associated with a poor outcome (odds ratio = 8.56, 95 % confidence interval: 2.40 to 30.46). Conclusion: IH is associated with a high mortality rate in AL patients, with stupor or coma at the onset of intracranial bleeding being independently associated with poor outcomes.

Dermatological Manifestations of Disseminated Bacillus Calmette-Guerin Infection in the Intensive Care Unit.

We report a case of disseminated Bacillus Calmette-Guerin (BCG)-itis with zosteriform skin eruption, purpura, and livedo racemosa in a 70-year-old critically ill patient who has a history of in situ bladder carcinoma treated with intravesical BCG instillations for the last three years. He presented with fever, fatigue, and a painful lesion on his back, initially diagnosed as herpes zoster. Despite antiviral treatment, he exhibited persistent fever, an inflammatory syndrome, and mild liver enzyme elevation. Initial imaging revealed findings consistent with pneumonia, for which antibiotics were prescribed with no improvement. A subsequent fluorodeoxyglucose (FDG) PET scan identified hypermetabolic lesions in the liver, prompting a biopsy that showed non-caseating granulomas. Skin biopsies from the zosteriform papular eruption on the back and purpura with livedo racemosa on the right foot revealed non-caseating granulomas. Specific Wade Fite staining performed on skin biopsies indicated evidence of mycobacterial infection. Additionally, cultures and Ziehl-Nielsen staining of blood and bone marrow confirmed Mycobacterium bovis infection, establishing the diagnosis of disseminated BCG-itis. Treatment with rifampicin, ethambutol, and moxifloxacin, and a later switch to isoniazid, along with corticosteroids, resolved the skin lesions and improved the patient's condition. This case underscores the diagnostic challenges and the importance of considering disseminated BCG-itis in patients treated with prior intravesical BCG instillations for in situ bladder carcinoma presenting with persistent fever, multi-organ involvement, and diverse skin manifestations including zosteriform papules, purpura, and livedo racemosa.

ECG Abnormalities, Diastolic Blood Pressure, and Adverse Events After Systemic to Pulmonary Artery Shunt in Infants with Congenital Heart Disease.

All patients with Systemic to Pulmonary Artery (SPA) shunt as the index surgical procedure at a single center were studied to determine the association between post-operative ECG repolarization abnormalities, diastolic blood pressure (DBP), and adverse outcomes. Postoperative ECGs were categorized into three grades, Grade 2 defined as ST elevation/depression ≥ 2 mm in ≥ 2 precordial or ≥ 1 mm in ≥ 2 limb leads; Grade 1-T-wave inversion or flattening in ≥ 3 leads; and Grade 0-no criteria for grades 1 or 2. For each patient, time with invasive DBP below 25, 25-29, 30-34, or above 34 mmHg in the first 24 h was calculated. The primary outcome was a pre-discharge composite of death, cardiac arrest, ECMO, unplanned shunt reintervention, and necrotizing enterocolitis after 24 h of surgery. Of the 109 patients included in final analysis, 17 (15.6%) had the composite outcome. Grade 2 ECG abnormality occurred in 12%, and Grade 1 in 37%. There was no association between ECG abnormalities and adverse events. Increasing time with DBP < 30 was not associated with adverse outcomes, while increasing time with DBP 30-34 was associated with decreased odds, and increasing time with DBP > 34 mmHg was associated with increased odds of adverse outcomes on multivariable analysis accounting for indexed shunt size and chromosomal abnormalities. In conclusion, after SPA shunt placement, ECG repolarization abnormalities and low DBP within 24 h were common and not associated with adverse outcomes. Sustained elevation of DBP above 34 mmHg was not protective, especially in patients with high indexed shunt size and chromosomal abnormalities.

Thoracic Trauma: Current Approach in Emergency Medicine.

Chest trauma is the leading cause of death in people under 40. It is estimated to cause around 140,000 deaths each year. The key aims are to reduce mortality and the impact of associated complications to expedite recovery and to restore patient's conditions. The recognition of lesions through appropriate imaging and early treatment already in the emergency department are fundamental. The majority can be managed in a non-surgical way, but especially after traumatic cardiac arrest, a surgical approach is required. One of the most important surgical procedures is the Emergency Department Thoracotomy (EDT). The aim of this review is to provide a comprehensive synthesis about the management of thoracic trauma, the surgical procedures, accepted indications, and technical details adopted during the most important surgical procedures for different thoracic trauma injuries. Literature from 1990 to 2023 was retrieved from multiple databases and reviewed. It is also important to emphasize the medico-legal implications of this type of trauma, both from the point of view of collaboration with the judicial authority and in the prevention of any litigation.

Case report: Selective operative management of zone 3 carotid artery transection.

INTRODUCTION: Penetrating carotid artery injury is rare and particularly uncommon in zone 3 of the vessel. Due to anatomical challenges to open operative management in zone 3, there are minimal treatment recommendations for this highly morbid condition. The urgency associated with understanding proper management of this traumatic injury is further supported by the nearly 100 % rate of fatality in untreated penetrating carotid artery injuries. PRESENTATION OF CASE: A 17-year-old male presented with a bullet wound to the right temple. He was intubated for airway protection given left-sided tracheal deviation secondary to a right neck hematoma. His Glasgow Coma Scale (GCS) was 11 on initial presentation, E3V2M6. The patient remained hemodynamically stable and underwent a CT angiogram of the head and neck. Imaging revealed a complete transection of the cervical (zone III) right internal carotid artery (RICA), a large pseudoaneurysm of the RICA distal to carotid bifurcation, and comminuted mandibular fracture. Collateral blood flow was preserved to the right hemisphere. Multi-disciplinary discussions deemed risks of operative intervention outweighed the benefits in the immediate peri-trauma period as the increased risk of hemispheric stroke, exsanguination, and death was thought to be prohibitive. Therefore, treatment of delayed intervascular stenting of the RICA was performed as opposed to emergent open RICA ligation or repair. DISCUSSION: Treatment decisions for zone 3 CAI rely on the patient's hemodynamic stability, with surgical ligation favored for immediate hemorrhage control in unstable cases, while stable patients may undergo observation or delayed endovascular intervention. Balancing the need for hemostasis to prevent further blood loss with the potential benefits of anticoagulation to maintain cerebral perfusion underscores the decision-making required in managing such cases. CONCLUSION: The rarity and challenge of ICA injury at this anatomical location presents unique challenges. Our description of observation and delayed revascularization outlines the precarious, yet validated, treatment method for hemodynamically stable patients.

Anaphylactic reaction to tranexamic acid infusion in a six-year-old child: a case report.

BACKGROUND: Tranexamic acid (TXA) is commonly considered a safe drug to mitigate bleeding during and after various surgical settings among adults and children. In recent decades, anaphylaxis induced by TXA has been increasingly reported in adults. However, among pediatrics, there are fewer reported cases. CASE PRESENTATION: We report a case of a 6-year-old female who experienced anaphylaxis after receiving intravenous TXA following unilateral cleft lip and palate repair surgery. She exhibited clinical symptoms involving the cardiovascular system, respiratory system, and skin. Following the administration of epinephrine, corticosteroid, and anti-histamine, the patient's symptoms were relieved. A few months after discharge, an intradermal test, yielded a positive result, confirming TXA as the culprit drug. CONCLUSION: Our report emphasizes the importance of considering anaphylaxis as a potential adverse reaction to TXA in pediatric patients, showing the criticality of rapid diagnosis and appropriate management for a successful outcome.

The Management and Outcomes of Septic Shock Among Surgical Patients at the Jimma University Medical Center, Jimma, Ethiopia: A Prospective Study.

Background and objective Sepsis and septic shock are major healthcare issues in surgical patients admitted to the surgery ward or ICU, affecting millions of people worldwide annually, with a mortality rate between one in three and one in six of those affected. The incidence and mortality of sepsis vary greatly by region, with the highest prevalence in Sub-Saharan Africa, Oceania, South Asia, East Asia, and Southeast Asia. Of all sepsis cases in 2017, 33.1 million people suffered from ill health due to underlying infectious diseases, and 15.8 million suffered from underlying injuries or non-communicable diseases.  Methods This prospective observational study was conducted at the Jimma University Medical Centre (JUMC) in Jimma town in southwest Ethiopia, from April 2023 to October 2023. All surgical patients aged ≥15 years who presented with or developed septic shock at the Jimma University Medical Centre were included. Results The study involved a total of 61 patients. The median age of the patients was 45 years [interquartile range (IQR): 40-60 years], and 77% (n=47) of the patients were male. The most frequent source of infection in this study was community-acquired infection (83.3%, n=49). The most common focus of sepsis was the intra-abdominal infection of the digestive system (82%, n=50). Lactate level testing and blood cultures before administering antibiotics were not done for all septic shock patients. Source control surgery was performed in 52.5% (n=32) of patients after developing septic shock, and 84.4% (n=27) of surgeries were performed within 24 hours. The 30-day mortality rate was 80.3%, with an ICU mortality rate of 78.94%. The median length of stay in the ICU was three days (IQR: 1-5 days), and the median length of hospital stay was six days (IQR: 2-15 days). Conclusions The mortality rate in our cohort was higher compared to that in studies from high-income and low-income countries. There was poor adherence and compliance with the Surviving Sepsis Campaign (SSC) (the one-hour bundle) guidelines. The length of stay in hospitals and ICUs was lower compared to studies from high-income countries due to the high early mortality rates.

Identification of host endotypes using peripheral blood transcriptomics in a prospective cohort of patients with endocarditis.

OBJECTIVES: Host responses to infection are a major determinant of outcome. However, the existence of different response profiles in patients with endocarditis has not been addressed. Our objective was to apply transcriptomics to identify endotypes in patients with infective endocarditis. METHODS: A total of 32 patients with infective endocarditis were studied. Clinical data and blood samples were collected at diagnosis and RNA sequenced. Gene expression was used to identify two clusters (endocarditis endotype 1 [EE1] and endocarditis endotype 2 [EE2]). RNA sequencing was repeated after surgery. Transcriptionally active cell populations were identified by deconvolution. Differences between endotypes in clinical data, survival, gene expression, and molecular pathways involved were assessed. The identified endotypes were recapitulated in a cohort of COVID-19 patients. RESULTS: A total of 18 and 14 patients were assigned to EE1 and EE2, respectively, with no differences in clinical data. Patients assigned to EE2 showed an enrichment in genes related to T-cell maturation and a decrease in the activation of the signal transducer and activator of transcription protein family pathway, with higher counts of active T cells and lower counts of neutrophils. A total of 14 patients (nine in EE1 and five in EE2) were submitted to surgery. Surgery in EE2 patients shifted gene expression toward a EE1-like profile. In-hospital mortality was higher in EE1 (56% vs 14%, P = 0.027), with an adjusted hazard ratio of 12.987 (95% confidence interval 3.356-50). Translation of these endotypes to COVID-19 and non-COVID-19 septic patients yielded similar results in cell populations and outcome. CONCLUSIONS: Gene expression reveals two endotypes in patients with acute endocarditis, with different underlying pathogenetic mechanisms, responses to surgery, and outcomes.

When Pain Relief Turns Perilous: Uncovering the Hidden Dangers and Advanced Management of Benzocaine-Induced Methemoglobinemia.

Benzocaine-induced methemoglobinemia is a rare complication associated with benzocaine, a local anesthetic known for its rapid pain relief. Acquired methemoglobinemia occurs when hemoglobin is oxidized to a ferric state, impairing oxygen binding. This condition can lead to respiratory distress and potentially fatal outcomes if not promptly diagnosed and treated. We present the case of a 61-year-old Caucasian female admitted with respiratory distress after lumbar stenosis surgery. She developed acute hypoxemic respiratory failure due to pneumonia. Although initially responsive to antibiotics and oxygen, her condition worsened overnight despite non-invasive bilevel-positive airway pressure (BiPAP) therapy. The use of benzocaine spray for throat pain led to suspected methemoglobinemia. She was treated with high-dose vitamin C and methylene blue, resulting in significant improvement. This case report aims to raise awareness among healthcare workers and emphasizes that timely recognition and management are crucial for better outcomes.

Efficacy and safety of esketamine hydrochloride adjunct to sufentanil in non-surgical patients under mechanical ventilation in the ICU (SENSATION trial): protocol for a multicentre, single-blind, randomised controlled trial.

INTRODUCTION: Pain is common in patients receiving mechanical ventilation in the intensive care unit (ICU). Intravenous opioids are recommended as first-line therapy for pain management; however, opioids have adverse side effects. Based on low-quality evidence, low-dose ketamine is therefore recommended as an opioid adjunct to reduce opioid consumption. Esketamine is an alternative to ketamine with greater efficacy and fewer side effects. However, evidence on the use of esketamine in patients receiving mechanical ventilation is lacking. This study investigates the efficacy and safety of esketamine as an adjunct to sufentanil for analgesic therapy in non-surgical ICU patients under mechanical ventilation. METHODS AND ANALYSIS: This ongoing multicentre, single-blind, randomised controlled trial is being conducted at six ICUs in China. 132 non-surgical patients under mechanical ventilation will be randomly assigned to the standard care and S-ketamine groups at a 1:1 ratio. Patients in the standard care group received a minimal dose of sufentanil as the sole analgesic agent. Patients in the S-ketamine group received a minimal dose of sufentanil in addition to an esketamine infusion at a fixed rate of 0.2 mg/kg/hour for analgesia. The primary outcome is mean hourly sufentanil consumption during the treatment period. ETHICS AND DISSEMINATION: This study was approved by the Ethics Committee of Chongqing University Cancer Hospital (CZLS2022067-A). Participants are required to provide informed consent. The results of this trial will be reported in peer-reviewed journals and presented at conferences. TRIAL REGISTRATION NUMBER: ChiCTR2200058933.

Critical care unit bed availability and postoperative outcomes: a multinational cohort study.

BACKGROUND: Critical care beds are a limited resource, yet research indicates that recommendations for postoperative critical care admission based on patient-level risk stratification are not followed. It is unclear how prioritisation decisions are made in real-world settings and the effect of this prioritisation on outcomes. METHODS: This was a prespecified analysis of an observational cohort study of adult patients undergoing inpatient surgery, conducted in 274 hospitals across the UK and Australasia during 2017. The primary outcome was postoperative morbidity at day 7. Logistic regression models were used to evaluate the relationship between critical care admission and patient and health system factors. The causal effect of critical care admission on outcome was estimated using variation in critical care occupancy as a natural experiment in an instrumental variable analysis. RESULTS: A total of 19,491 patients from 248 hospitals were eligible for analysis, of whom 2107 were directly admitted to critical care postoperatively. Postoperative morbidity occurred in 2829/19,491 (15%) patients. Increasing surgical risk was associated with critical care admission, as was increased availability of critical care beds (odds ratio (95%CI) 1.04 (1.01-1.06), p = 0.002) per available bed; however, the probability of admission varied significantly between hospitals (median odds ratio 3.05). There was no evidence of a difference in postoperative morbidity with critical care admission (odds ratio (95%CI) 0.91 (0.57-1.45), p = 0.710). DISCUSSION: Postoperative critical care admission is variable and related to bed availability. Statistical methods that adjust for unobserved confounding lowered the estimates of harm previously reported to have been associated with postoperative critical care admission. Our findings provide a rationale for a clinical trial which would evaluate any potential benefits for postoperative critical care admission for patients in whom there is no absolute indication for admission.

The Intra-Aortic Balloon Pump as a Rescue Device: Do we need to shift our strategy for cardiogenic shock rescue after cardiac surgery?

OBJECTIVE: The intra-aortic balloon pump (IABP) is widely used to rescue patients from complications following cardiac surgery. With improvements in rescue strategies over the past decade, the appropriateness of IABP must be reexamined. This study assesses the risk factors, outcomes, and predictors of survival of rescue IABP. METHODS: Patients receiving isolated, rescue IABP during or after cardiac surgery from 2012 to 2020 were studied. All adult patients undergoing cardiac surgery except transplantation and primary mechanical circulatory support (MCS) procedures were included. RESULTS: Of 10,591 patients, 397 (3.7%) patients received peri-operative IABP with rescue IABP instituted in 182 (45.8%). The indications for rescue IABP were post-cardiotomy shock (66, 36.3%), failure to wean cardiopulmonary bypass (58, 31.9%), myocardial ischemia (30, 16.5%), cardiac arrest (25, 13.7%), and ventricular arrhythmia (3, 1.6%). The in-hospital failure to rescue rate was 17.6% (32/182) with a 90-day and one-year survival of 80.8% and 76.9%, respectively. The most common etiology of mortality was ongoing cardiogenic shock (26/42, 61.9%). IABP > 4 days and cardiac arrest as an indication for IABP were risk factors for one-year mortality (adjusted hazards ratio [aHR]: 2.68, 95% confidence interval [CI]: 1.31-5.50; aHR: 2.69, 95% CI 1.11-6.54, respectively). CONCLUSION: Rescue IABP following cardiac surgery is associated with increased early and one-year mortality. Prolonged IABP beyond 4 days or cardiac arrest as an indication portended a significantly worse prognosis. Rescue IABP may not be the optimal first-line temporary MCS for all patients, as the level of support provided might not match the severity of cardiogenic shock. Alternative MCS strategies should be considered early.

Hyperangulated versus Macintosh blades for intubation with videolaryngoscopy in ICU: the randomised multicentre INVIBLADE-ICU trial study protocol.

INTRODUCTION: Compared with the operating room, tracheal intubations in the intensive care unit (ICU) are associated with worsened glottic view, decreased first-time success rate and increase in the technical difficulty of intubation and incidence of complications. Videolaryngoscopes (VLs) have been proposed to improve airway management, and while recent studies have confirmed that VLs improve intubation conditions in this patient population, there remains a lack of clarity regarding the selection between a standard Macintosh blade or a hyperangulated one, to determine which yields the best outcomes. The purpose of this study was to compare successful intubation on the first attempt with the Macintosh VL versus the hyperangulated VL during tracheal intubation in ICU patients. We hypothesise that tracheal intubation using the hyperangulated VL will improve the frequency of successful intubation on the first attempt. METHODS AND ANALYSIS: The INtubation VIdeolaryngoscopy BLADE-ICU trial is a prospective, multicentre, open-label, interventional, randomised, controlled superiority study conducted in 29 ICUs in Spain. Patients will be randomly assigned in a 1:1 ratio to undergo intubation using a Macintosh VL (control group) or a hyperangulated VL (experimental group) for the first intubation attempt. The primary outcome is successful intubation on the first attempt. The secondary outcomes include the time to intubation, attempts for successful intubation, laryngoscopic vision assessed with the modified Cormack-Lehane scale, the need for adjuvant airway devices for intubation, difficulty assessed by the anaesthesiologist and complications during tracheal intubation. Enrolment began on 1 May 2024 and is expected to be completed in 2025. ETHICS AND DISSEMINATION: The study protocol was approved on 29 February 2024, by the Ethics Committee of Galicia (CEImG, code No. 2024-031).The results will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: NCT06322719.

The association of midregional pro-adrenomedullin (MR-proADM) at ICU admission and fluid overload in patients post elective cardiac surgery.

Postoperative fluid overload (FO) after cardiac surgery is common and affects recovery. Predicting FO could help optimize fluid management. This post-hoc analysis of the HERACLES randomized controlled trial evaluated the predictive value of MR-proADM for FO post-cardiac surgery. MR-proADM levels were measured at four different timepoints in 33 patients undergoing elective cardiac surgery. Patients were divided into FO (> 5% weight gain) and no-FO at ICU discharge. The primary outcome was the predictive power of MR-proADM at ICU admission for FO at discharge. Secondary outcomes included the predictive value of MR-proADM for FO on day 6 post-surgery and changes over time. The association between MR-proADM and FO at ICU discharge or day 6 post-surgery was not significant (crude odds ratio (cOR): 4.3 (95% CI 0.5-40.9, p = 0.201) and cOR 1.1 (95% CI 0.04-28.3, p = 0.954)). MR-proADM levels over time did not differ significantly between patients with and without FO at ICU discharge (p = 0.803). MR-proADM at ICU admission was not associated with fluid overload at ICU discharge in patients undergoing elective cardiac surgery. MR-proADM levels over time were not significantly different between groups, although elevated levels were observed in patients with FO.

Risk Factors and Predictors of Prolonged Mechanical Ventilation Following Cardiac Surgery: A Narrative Review.

The subset of patients requiring prolonged mechanical ventilation is significantly high worldwide, making it an important topic of continuous and ongoing research. Over the years, various articles have shown that there may be predictors of prolonged ventilation that could be applied in healthcare to make it more patient-centered. The available literature suggests that authors have different definitions of "prolonged" ventilation. However, most critical care units embrace caution if a patient needs mechanical ventilation for more than 48 to 72 hours. The major benefits of mechanical ventilation are an overall decrease in the work of breathing and the facilitation of relatively easier pumping from an ailing heart. An elevated risk of prolonged ventilation after cardiac surgery exists in patients with higher classes of heart failure (as classified by the New York Heart Association (NYHA) or Canadian Cardiovascular Society (CCS)), a pre-existing congenital or acquired cardiac abnormality, and patients with renal failure, to name a few. The impact on quality of life has also been widely studied; as mortality rates increase with factors like age and days dependent on ventilation. Patients undergoing prolonged ventilation constitute an administrative challenge for critical care units, highlighting how multiple patients in this bracket can overwhelm the healthcare system. The use of prediction models in this context can aid healthcare delivery tremendously. Using different predictors, we can craft tailor-made treatment options and achieve the goal of more ventilator-free days per patient.

Transitions and Long-Term Clinical Outcomes in Patients Admitted in Intensive Care Units Receiving Continuous Renal Replacement Therapy.

Introduction: Acute kidney injury (AKI) significantly disrupts vital renal functions and is a common and serious condition in intensive care units (ICUs). AKI leads to extended hospital stays, increases mortality rates, and often necessitates nephrology consultations. Continuous renal replacement therapy (CRRT) plays a central role in managing AKI, requiring a multidisciplinary approach involving nephrologists, intensivists, and anesthesiologists. This study examines the clinical profile and progression of AKI in ICU patients requiring CRRT, with a focus on CRRT indications and modalities. Materials and Methods: We conducted a single-center retrospective observational study on ICU patients with AKI requiring CRRT from January to December 2019. AKI diagnosis followed the RIFLE criteria, and patients who received CRRT for less than 36 h were excluded. Data collected included demographics, hemodynamic parameters, and renal function parameters, with follow-ups at 1 week, 1 month, 6 months, and 12 months. Statistical analyses evaluated outcomes and transitions between CRRT and other renal replacement therapies. Results: Among 123 evaluated patients, 95 met inclusion criteria. Fifteen patients received CRRT for less than 36 h, with an early mortality rate of 80%. The final cohort comprised 80 patients who underwent CRRT for over 36 h, with a mean age of 65.3 years (SD = 13.6) and a Charlson index of 6.4. Patients were categorized based on primary diagnosis into heart failure, cardiac surgery, sepsis, other surgeries, and miscellanea groups. Mortality rates were highest in the heart failure and miscellanea groups. Significant variability was observed in therapy transitions and long-term outcomes. Continuous venovenous hemodiafiltration (CVVHDF) was the most frequently used CRRT modality. Conclusions: This study highlights the variability in CRRT practices and the poor prognosis for critically ill patients with AKI requiring CRRT. Timely nephrology consultation and tailored treatment plans may improve patient outcomes and optimize CRRT utilization. Future research should focus on refining CRRT protocols and exploring preventive strategies for AKI.

A Nomogram for Predicting Postoperative Pulmonary Complications in Critical Patients Transferred to ICU After Abdominal Surgery.

OBJECTIVE: The purpose of this study was to investigate the risk factors associated with postoperative pulmonary complications(PPCs) in critically ill patients transferred to intensive care unit(ICU) after abdominal surgery and develop a predictive model for this disease. METHODS: Data for 3716 patients who were admitted to ICU after abdominal surgery in Peking University People's Hospital between January 2015 and December 2020 were retrospectively collected and analyzed to identify the risk factors and develop a nomogram prediction model. Data for patients admitted to ICU following abdominal surgery at Peking University People's Hospital from March 2021 to December 2022 were prospectively collected as a validation set to validate and assess the model. RESULTS: 10 independent risk factors for PPCs in critically ill patients transferred to ICU after abdominal surgery were identified. A nomogram prediction model was constructed for PPCs in this group patients, the area under ROC curve was 0.771[95%CI: 0.756,0.786] and 0.759[95%CI: 0.726,0.792] in the training set and validation set, respectively. CONCLUSIONS: In this study, independent risk factors for PPCs in critically ill patients transferred to ICU after abdominal surgery were identified. A nomogram prediction model for PPCs in critically ill surgical population was constructed using these factors, demonstrating a good predictive value.