Physical space of thirty pediatric intensive care units in the United States of America: a national survey.

Introduction: The design of Pediatric Intensive Care Unit (PICU) rooms significantly impacts patient care and satisfaction. The aims were first, to describe the current physical space across PICUs in the USA, and second, to identify what proportion of PICUs are compliant with current guidelines. Methods: A descriptive cross-sectional survey was conducted, targeting division chiefs and medical directors of PICUs nationwide. The survey collected data on unit type, construction and renovation dates, room sizes, and available amenities. According to the Guidelines for Design and Construction of Hospitals, PICU rooms are recommended to be single rooms, at least 200 sq ft, have a window and a private bathroom. Data were anonymized and reported as median and interquartile ranges or frequencies and percentages. Results: Thirty units responded. Among the respondents, 26 had general PICUs, 9 had cardiac ICUs, and 3 had intermediate care units, with some units containing multiple types of ICUs. The median annual admissions were 1,125, with a median occupancy rate of 78%. Twenty-three percent of units had at least one double room, and 3% had triple or quadruple rooms. The median room size was 265 sq ft (IQR 230; 304), the smallest room size was 220 sq ft (IQR 179; 275), and the largest single room size was 312 sq ft (IQR 273; 330). Thirty-seven percent of units had bathrooms in every room, while 80% had windows in every room. Additionally, 46% of units had dialysis capabilities in every room, and 7% had negative pressure capabilities in every room. The median building year was 2008 (IQR 2001;2014), with 36% of units having undergone at least one renovation. Larger rooms were associated with more recent build dates (p = 0.01). Only 30% of the PICUs met the guidelines for physical space. These compliant units were built at a median of 4 years ago (IQR 1; 8). Conclusion: This study highlights the variability in PICU room design and amenities across healthcare facilities. Many units still fall short of meeting the guidelines for room size, windows, and private bathrooms. Future research should investigate the relationship between room characteristics and patient outcomes to inform better design practices, with a goal of improving patient experiences and clinical outcomes.

Pediatric Sepsis - Sailing the Unchartered Waters with Omics.

How to cite this article: Baalaaji M. Pediatric Sepsis - Sailing the Unchartered Waters with Omics. Indian J Crit Care Med 2024;28(9):818-819.

Comparison of Modified ROX Index Score and ROX Index Score for Early Prediction of High Flow Nasal Oxygen Therapy Outcome in Patients with Acute Respiratory Failure: A Prospective Observational Cohort Study.

Background: We compared the modified ROX index and ROX index scores in earlier predictions of high-flow nasal oxygen (HFNO) therapy outcomes in patients with acute respiratory failure. Methods: We conducted a prospective observational study on 151 acute respiratory failure patients initiated on HFNO therapy. The primary objective of this research was to compare the modified ROX index and ROX index to investigate which score predicted HFNO treatment outcome earlier. Results: The modified ROX index score had better predictive power than the ROX score at different time points, especially one hour following the start of HFNO therapy (AUC 0.790; 95% CI: 0.717-0.863; p < 0.001). For the ROX Index at 1 hour, the ideal cut-off value for HFNO outcome was 4.36 (sensitivity: 72.6%, specificity: 53.9%), and for the modified ROX index at 1 hour, it was 4.63 (sensitivity: 74.2%, specificity: 69.7%). The presence of various comorbidities didn't show any change in ROX-HR cut-off values. Conclusion: The modified ROX index is a better predictor of the success of HFNO therapy than the ROX index. Furthermore, the presence of any comorbidities did not affect modified ROX index cut-off values or the outcome of HFNO therapy. How to cite this article: Sarkar AG, Sharma A, Kothari N, Goyal S, Meshram T, Kumari K, et al. Comparison of Modified ROX Index Score and ROX Index Score for Early Prediction of High Flow Nasal Oxygen Therapy Outcome in Patients with Acute Respiratory Failure: A Prospective Observational Cohort Study. Indian J Crit Care Med 2024;28(9):842-846.

Effect of Continuous Infusion vs Bolus Dose of Hydrocortisone in Septic Shock: A Prospective Randomized Study.

Aim and background: Corticosteroids are recommended for use in adult patients with septic shock requiring vasopressors for blood pressure maintenance. However, this predisposes them to hyperglycemia, which is associated with a poor outcome. This prospective randomized study compares the effect of continuous infusion with bolus hydrocortisone on blood glucose levels in septic shock. Materials and methods: Forty adult patients with sepsis and septic shock requiring vasopressor support were randomly allocated to either group C (continuous infusion of hydrocortisone 200 mg/day) or group B (intermittent bolus dose of hydrocortisone 50 mg IV 6 hourly). Blood glucose level (primary objective), number of hyperglycemic and hypoglycemic episodes, daily insulin requirement, shock reversal incidence, time to shock reversal, and nursing workload required to maintain blood glucose within the target range (82-180 mg/dL) were compared. Results: The mean blood glucose level was comparable in the two groups (136.5 ± 22.08 mg/dL in group C vs 135.85 ± 19.06 mg/dL in group B; p = 0.921). The number of hyperglycemic and hypoglycemic episodes (p = 1.000 each), insulin requirement/day (p = 1.000), and nursing workload (p = 0.751) were also comparable among groups. Shock reversal was seen in 7/20 (35%) patients in continuous group and 12/20 (60%) patients in bolus group (p = 0.113). Time to shock reversal (p = 0.917) and duration of ICU stay (p = 0.751) were also statistically comparable. Conclusion: Both the regimes of hydrocortisone, continuous infusion, and bolus dose, have comparable effects on blood glucose levels in patients with septic shock.The study was registered prospectively with ctri.nic.in (Ref. No. CTRI/2021/01/030342; registered on 8/1/2021). How to cite this article: Salhotra R, Sharahudeen A, Tyagi A, Rautela RS, Kemprai R. Effect of Continuous Infusion vs Bolus Dose of Hydrocortisone in Septic Shock: A Prospective Randomized Study. Indian J Crit Care Med 2024;28(9):837-841.

Assessment of the Level of Awareness and Degree of Implementation of Central Line Bundles for Prevention of Central Line-associated Blood Stream Infection: A Questionnaire-based Observational Study.

Aim: The objective of this study was to assess the extent of knowledge and application of central line bundles in the intensive care unit (ICU) of a tertiary care hospital for the purpose of avoiding central line-associated bloodstream infections (CLABSI). This assessment was conducted through the use of a questionnaire. Materials and methods: A cross-sectional study was conducted in the ICU, involving doctors and nurses. The study was observational in nature. The study employed a methodical validated questionnaire to evaluate the level of knowledge, attitude, and practice of central line bundles for the prevention of central line-associated bloodstream infections (CLABSI). The questionnaire was designed using preexisting awareness surveillance systems, infection control measures, and patient care practices that were specifically relevant to CLABSIs in the ICU. The data were analyzed utilizing SPSS. Results: The research involved a total of 93 healthcare professionals, consisting of 67 physicians and 26 nurses. The mean knowledge score among participants was 82%, with higher scores reported in individuals who had training in central line bundles. Healthcare professionals exhibited robust compliance with hand cleanliness, antiseptic skin preparation prior to insertion, aseptic draping of the patient, utilization of utmost sterile barriers, verification of central venous catheter (CVC) tip placement using chest X-ray or fluoroscopy, and preservation of a sterile environment. Conclusion: The study emphasized the significance of training in enhancing understanding and adherence to central line bundling protocols in ICUs. Participants exhibited a high level of knowledge and commitment to recommended practices, indicating that this training can have a favorable effect on CLABSI rates. How to cite this article: Singh S, Sharma A, Dhawan M, Sharma SP. Assessment of the Level of Awareness and Degree of Implementation of Central Line bundles for Prevention of Central Line-associated Blood Stream Infection: A Questionnaire-based Observational Study. Indian J Crit Care Med 2024;28(9):847-853.

Music therapy with adult burn patients in the intensive care unit: short-term analysis of electrophysiological signals during music-assisted relaxation.

Burn patients often face elevated pain, anxiety, and depression levels. Music therapy adds to integrative care in burn patients, but research including electrophysiological measures is limited. This study reports electrophysiological signals analysis during Music-Assisted Relaxation (MAR) with burn patients in the Intensive Care Unit (ICU). This study is a sub-analysis of an ongoing trial of music therapy with burn patients in the ICU. Electroencephalogram (EEG), electrocardiogram (ECG), and electromyogram (EMG) were recorded during MAR with nine burn patients. Additionally, background pain levels (VAS) and anxiety and depression levels (HADS) were assessed. EEG oscillation power showed statistically significant changes in the delta (p < 0.05), theta (p = 0.01), beta (p < 0.05), and alpha (p = 0.05) bands during music therapy. Heart rate variability tachograms high-frequencies increased (p = 0.014), and low-frequencies decreased (p = 0.046). Facial EMG mean frequency decreased (p = 0.01). VAS and HADS scores decreased - 0.76 (p = 0.4) and - 3.375 points (p = 0.37) respectively. Our results indicate parasympathetic system activity, attention shifts, reduced muscle tone, and a relaxed state of mind during MAR. This hints at potential mechanisms of music therapy but needs to be confirmed in larger studies. Electrophysiological changes during music therapy highlight its clinical relevance as a complementary treatment for ICU burn patients.Trial registration: Clinicaltrials.gov (NCT04571255). Registered September 24th, 2020. https//classic.clinicaltrials.gov/ct2/show/NCT04571255.

Association between delta anion gap/delta bicarbonate and outcome of surgical patients admitted to intensive care unit.

BACKGROUND: Patients undergoing high-risk surgeries with acid-based disorders are associated with poor outcomes. The screening of mixed acid-based metabolic disorders by calculating delta anion gap (AG)/delta bicarbonate (Bic) has a clinically relevant role in patients with high AG metabolic acidosis (MA), however its utility in individuals facing high-risk surgical procedures remains unclear. OBJECTIVE: Characterize metabolic acidosis using delta-AG/delta-Bic and its associations in patients undergoing high-risk surgeries with possible outcome-related complications. DESIGN: Prospective observational multicentric study. SETTING: Three tertiary hospitals in Brazil. PATIENTS: Patients undergoing high-risk surgeries, aged 18 years or older, requiring postoperative critical care. MAIN OUTCOME MEASURES: Patients undergoing high-risk surgeries monitored during the postoperative phase across three distinct intensive care units (ICUs), with assessment encompassing laboratory analyses upon admission and 24 h thereafter. Patients with MA and with elevated AG within 24 h were separated into 3 subgroups: [G1 - delta-AG/delta-Bic < 1.0] MA associated with hyperchloremia; [G2 - delta-AG/delta-Bic between 1.0 and 1.6] MA and no mixed disorders; and [G3 - delta-AG/delta-Bic > 1.6] MA associated with alkalosis. Primary endpoint was 30-day mortality. The secondary endpoints were cardiovascular, respiratory, renal, neurological, coagulation and infective complications. RESULTS: From the 621 surgical patients admitted to ICU, 421 (51.7%) had any type of acidosis. After 24 h, 140 patients remained with MA with elevated AG (G1: 101, G2: 18, and G3: 21). When compared to patients from subgroups 1 and 3, the subgroup with no mixed disorders 2 showed higher 30-day mortality (adjusted HR = 3.72; 95% CI 1.11-12.89, p = 0.001), cardiovascular complications (p = 0.001), ICU mortality (p = 0.03) and sum of all complications during the ICU period (p = 0.021). CONCLUSION: In the postoperative time, patients with metabolic acidosis and no mixed disorders present higher ICU-Mortality and higher cardiovascular postoperative complications when compared with patients with combined hyperchloremia or alkalosis. Delta-AG/delta-Bic can be a useful tool to evaluate major clinical outcomes in this population.

Impact of Shared Decision-Making on Family Satisfaction With Intensive Care Services: 'Share With Care' has a New Meaning in ICU.

Background: Physician's clinical inputs and informed bystander opinions are essential for successful intensive care unit (ICU) patient outcomes. There is insufficient data regarding the impact of shared decision-making on treatment outcomes and family satisfaction in Indian ICU settings. We aimed to determine the effect of shared decision-making factors on family satisfaction with ICU services. Patients and Methods: Family bystanders of 336 ICU patients with a stay >72 hours were conveniently surveyed across 13 months prospectively using Family Satisfaction in the Intensive Care Unit 24 Revised (FS-ICU 24R) questionnaire. We analyzed the responses to determine shared decision-making factors impacting family satisfaction. Results: Univariate analysis of ten variables of FS-ICU 24R questionnaire decision-making subscale revealed that consistency of information (OR 8.71, P < 0.001), honesty of information (OR 7.04, P < 0.001), and frequency of communication with doctors (OR 6.25, P < 0.001) were associated with highest odds of family involvement and satisfaction. Multivariable logistic regression showed that consistency of information (adjusted OR 3.85, P < 0.001) and frequent doctor communication (adjusted OR 2.22, P = 0.02) were independent predictors associated with family satisfaction. The number of decision-makers (P = 0.463) or family's prior ICU experience (P = 0.430) was not associated with family satisfaction. Conclusion: A consistent and honest effort to cater to the family's information needs and frequent physician-bystander interaction is essential for family's satisfaction with ICU services. This even outweighs other decision-making factors such as number of decision-makers and their prior ICU experience. Incorporating shared decision-making in counseling should be a continuing practice.Trial registry name: Clinical Trials Registry - India.Registration number: CTRI/2022/09/045571.

Evaluation of ventilator-associated pneumonia care practice in the intensive care units of a comprehensive specialized hospital in Northwest Ethiopia: a 1.5-year prospective observational study.

BACKGROUND: Nosocomial infections pose a global health threat, with Ventilator-Associated Pneumonia (VAP) emerging as a prominent hospital-acquired infection, particularly in intensive care units (ICU).VAP is the commonest form of pneumonia in ICUs, contributing significantly to morbidity and mortality rates, which can reach around 30%. Despite the substantial impact of VAP on healthcare, there is a lack of data on adherence to VAP prevention protocols in our hospital. Consequently, this study aims to assess the adherence to ventilator-associated pneumonia care bundles in critical care units at a comprehensive specialized hospital in northwest Ethiopia. METHODS: A hospital-based prospective observational study was conducted from July 3, 2022, to January 7, 2024. All adult patients who were on mechanical ventilators for more than 48 h during the study period were included. Data were collected using the Institute of Healthcare Improvement VAP prevention standards as checklists via direct observation and chart review. The data were entered and analyzed using SPSS version 20. RESULTS: A total of 300 surgical and medical ICU patients were observed. Among the patients, 66.3% were from the medical ICU. In terms of admission reasons, 22.3%, 15.7% and, 12% were attributed to infections excluding respiratory origin, respiratory disorders, and other causes, respectively. The rate of compliance with all components of the bundle was 70%. A 100% adherence rate was observed for the prophylaxis for peptic ulcer and deep vein thrombosis (DVT). The lowest adherence rate was observed in the practice of oral hygiene with 0.5% chlorhexidine solution (0%) followed by humidification with heat and moisture exchangers (23.3%). Endotracheal tube cuff pressure measurement and use of endotracheal tubes with subglottic suction were not applicable. CONCLUSION: The study revealed suboptimal compliance with the VAP care bundle, indicating unsatisfactory overall practice. Specific attention is warranted for subglottic suction, cuff pressure measurement, humidification, oral care with chlorhexidine, and sedation vacation.

Prokinetic agents in adult intensive care unit patients (PATIENCE)-An international inception cohort study protocol.

BACKGROUND: Feeding intolerance is common in critically ill patients and can lead to malnutrition. Prokinetic agents may be used to enhance the uptake of nutrition. However, the evidence on the effectiveness and safety of prokinetic agents is sparse, and there is a lack of data on their use in intensive care units (ICU). METHODS: We will conduct an international 14-day inception cohort study of 1000 acutely admitted adult ICU patients. Data will be collected from ICU admission and daily during ICU stay for up to 90 days. The primary outcome will be the proportion of ICU patients who receive prokinetic agents. Secondary outcomes include mortality, days alive without life support, days alive out of ICU, days alive out of hospital (all within 90 days) and the number of patients with one or more serious adverse events. RESULTS: We will present data on the use of prokinetic agents descriptively and use Cox regressions with death and ICU discharge as competing events to evaluate the association between patient characteristics and the use of prokinetic agents. We will use extended Cox models with time-varying covariates and linear regression models to assess the associations between the use of prokinetic agents and the secondary outcomes. CONCLUSION: The outlined international cohort study will provide valuable epidemiological data on the use of prokinetic agents in adult, acutely admitted ICU patients.

Effects of visit restriction in the COVID-19 pandemic: Experiences and perceptions of intensive care nurses.

BACKGROUND: The visit restrictions imposed as a result of COVID-19 precluded the entrance of the patient's family into the confines of the intensive care unit. AIM: This study evaluated the experiences of intensive care nurses (ICNs) regarding COVID-19 visit restrictions and their opinions on these restrictions. STUDY DESIGN: From May 2023 to July 2023, semi-structured interviews with 15 ICNs from intensive care units in a tertiary public hospital in Türkiye were conducted. Data were analysed using qualitative content analysis with an inductive approach. Reporting of the study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. RESULTS: The analysis revealed two main themes, 'widespread negative impacts of visit restrictions' and 'adaptive strategies to the visitation ban', and seven sub-themes supporting the main themes. Nurses perceived that the visit restrictions imposed during the COVID-19 pandemic had a severe negative effect on patients, their relatives, themselves and the care environment. They also did not support visit restriction in future pandemics. CONCLUSIONS: The COVID-19 visitation policy weakened the involvement of family members in patient care and created serious challenges in the intensive care setting. The study revealed an urgent need for patient-centred, family-sensitive and consistently applied protocols in future pandemics. RELEVANCE TO CLINICAL PRACTICE: In future pandemics, strategies such as the benefit-benefit ratio of the visit, the provision and use of adequate personal protective equipment, and vaccination requirements should be considered in visiting decisions of patients hospitalized because of infection. Participation of nurses responsible for patient care in decisions regarding visitor practices should be supported.

Corrigendum: Frailty index and risk of delirium in hospitalized patients: a two-sample Mendelian randomization study.

[This corrects the article DOI: 10.3389/fmed.2024.1361437.].

What Enables Implementation of Pain Management Interventions in Intensive Care Units and Why: A Realist Evaluation to Refine Program Theory.

AIM: To uncover perspectives and refine 12 initial program theories concerning the implementation of pain management interventions in intensive care units. Contexts enabling implementation are delineated, and causal mechanisms within these contexts are described. DESIGN: A realist evaluation approach was employed. METHODS: Fourteen purposively selected Australian nurses of variant roles were virtually and individually interviewed between July and September 2023. Participants were presented with initial program theory, and their perspectives were collated. Data were analysed using an integrated approach of context (C), mechanism (M), outcome (O) categorisation coding, CMO configurations connecting and pattern matching. FINDINGS: Pain management interventions work if perceived to be beneficial, precise, comprehensive and fit for purpose. Nurses should be willing to change attitudes and update knowledge. Unit leaders should nurture the development of nurses' professional identity, access to learning, autonomy and self-determination. Organisations should change the infrastructure, provide resources, mitigate barriers, develop shared mental models, update evidence and institute quality assurance. Adherence to interventions is affected by the outcomes of implementation and intrinsic merits of interventions. In these contexts, confidence is boosted; feelings of empowerment, self-efficacy, reflective motivation, trust, awareness and autonomy are developed; and capacity is built. Furthermore, frustration from the variability of practices is reduced, accountability and ownership are augmented, yielding positive implementation outcomes. IMPLICATIONS FOR THE PROFESSION: Findings have implications on nurses, team leaders and organisations concerned with implementation. IMPACT: The findings provided a fortified understanding of conditions favouring successful implementation of pain management interventions. Actions should be undertaken at an individual, unit and organisation level to ensure successful implementation. REPORTING METHOD: RAMESES II Reporting Standards for Realist Evaluations informed presentation of study. PATIENT OR PUBLIC CONTRIBUTION: Intensive care nurses contributed insights to refine the program theory.

Accuracy of ChatGPT responses on tracheotomy for patient education.

OBJECTIVE: To investigate the accuracy of information provided by ChatGPT-4o to patients about tracheotomy. METHODS: Twenty common questions of patients about tracheotomy were presented to ChatGPT-4o twice (7-day intervals). The accuracy, clarity, relevance, completeness, referencing, and usefulness of responses were assessed by a board-certified otolaryngologist and a board-certified intensive care unit practitioner with the Quality Analysis of Medical Artificial Intelligence (QAMAI) tool. The interrater reliability and the stability of the ChatGPT-4o responses were evaluated with intraclass correlation coefficient (ICC) and Pearson correlation analysis. RESULTS: The total scores of QAMAI were 22.85 ± 4.75 for the intensive care practitioner and 21.45 ± 3.95 for the otolaryngologist, which consists of moderate-to-high accuracy. The otolaryngologist and the ICU practitioner reported high ICC (0.807; 95%CI: 0.655-0.911). The highest QAMAI scores have been found for clarity and completeness of explanations. The QAMAI scores for the accuracy of the information and the referencing were the lowest. The information related to the post-laryngectomy tracheostomy remains incomplete or erroneous. ChatGPT-4o did not provide references for their responses. The stability analysis reported high stability in regenerated questions. CONCLUSION: The accuracy of ChatGPT-4o is moderate-to-high in providing information related to the tracheotomy. However, patients using ChatGPT-4o need to be cautious about the information related to tracheotomy care, steps, and the differences between temporary and permanent tracheotomies.

Pharmacokinetic Research in Pediatric Extracorporeal Therapies: Current State and Future Directions.

Extracorporeal life support (ECLS), including extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT), are life-saving therapies for critically ill children. Despite this, these modalities carry frustratingly high mortality rates. One driver of mortality may be altered drug disposition due to a combination of underlying illness, patient-circuit interactions, and drug-circuit interactions. Children receiving ECMO and/or CRRT routinely receive 20 or more drugs, and data supporting optimal dosing is lacking for most of these medications. The Pediatric Paracorporeal and Extracorporeal Therapies Summit (PPETS) gathered an international group of experts in the fields of ECMO, CRRT, and other ECLS modalities to discuss the current state of these therapies, disseminate innovative support strategies, share clinical experiences, and foster future collaborations. Here, we summarize the conclusions of PPETS and put forward a pathway to optimize pharmacokinetic (PK) research in this population. We must prioritize specific medications for in-depth study to improve drug use in ECLS and patient outcomes. Based on frequency of use, potential for adverse outcomes if dosed inappropriately, and lack of existing PK data, a list of high priority drugs was compiled for future research. Researchers must additionally reconsider study designs, emphasizing pooling of resources through multi-center studies and the use of innovative PK modeling techniques. Finally, the integration of validated PK models into clinical practice must be streamlined to deliver optimal medication use at the bedside. Focusing on the proposed list of highlighted medications and key methodological considerations will maximize the impact of future research.

Improving Pediatric Critical Care Nurses' Practice in Implementing the Full Outline of Unresponsiveness Coma Scale.

Introduction: Clinical estimation of consciousness is the most fundamental and crucial component of neurological examinations for pediatric patients in the pediatric intensive care unit (PICU). The full outline of unresponsiveness (FOUR) Coma Scale assesses four variables: eye response, motor response, brainstem reflexes, and respiratory pattern. A score of 0 represents non-function in each category, whereas a score of 4 indicates normal functioning. The FOUR Coma Scale is easy to apply and is currently the most widely used scale for assessing consciousness, particularly in intubated children. Objectives: This study aimed to improve pediatric critical care nurses' practice in implementing the FOUR Coma Scale. Methods: A quasi-experimental research design (pre/post-test design) was employed on a convenience sample composed of 45 male and female nurses who participated in the study and provided direct care for critically ill children at the Medical Pediatric Intensive Care Unit affiliated with the Mansoura University Children's Hospital, Mansoura University, Egypt. All the participants completed the FOUR Coma Scale knowledge and practice assessment questionnaire. Results: Majority of the nurses were females and had bachelors' degrees in nursing (94.6% and 71.1%, respectively). Moray Coma Scale was used to assess level of consciousness (LOC) by more than half the number of nurses (55.6%) in the PICU. All PICU nurses had poor knowledge and practice scores in the pre-intervention phase, and this percentage statistically significantly improved in the post-intervention phase (P = .001). Conclusion: The mean score of nurses' knowledge and practice on the FOUR Coma Scale significantly improved after the implementation of instructional intervention.

Efficacy and Safety of Esmolol in Neonatal Cardiac Surgery with Cardiopulmonary Bypass (CPB) for d-Transposition of the Great Arteries (d-TGA).

OBJECTIVE: D-Transposition of the great arteries (d-TGA) is the most common congenital heart disease requiring surgical correction within the neonatal period. Sinus tachycardia often persists postoperatively, potentially affecting cardiac function. This study aimed to investigate the efficacy and safety of the short-acting beta-1-selective beta-blocker esmolol in controlling heart rate in neonatal cardiac surgery with cardiopulmonary bypass (CPB). METHODS: A retrospective cohort study was conducted on neonates undergoing surgery for d-TGA. The study cohort included 112 patients, divided into an esmolol intervention group (n = 57) and a control group (n = 55). Baseline characteristics, hemodynamic parameters and outcome measures were assessed. RESULTS: In the esmolol group, median heart rate at ICU admission was significantly higher compared to the control group (155 vs. 147 bpm, p = 0.018). After a median time of 11 h, heart rate was lower among the esmolol patients (135 vs. 144 bpm, p < 0.001). There were no differences in other hemodynamic parameters between the two groups. Patients treated with esmolol required longer catecholamine support while no difference regarding survival, duration of invasive ventilation and ICU stay were noticed. CONCLUSION: No relevant hemodynamic difference was seen between neonates treated with perioperative esmolol and the control group and outcome did not differ. This indicates non-inferiority of perioperative betablocker therapy in young age. Prospective and placebo-controlled assessment of perioperative esmolol therapy in neonates is needed.

Frequently Touched Sites in the Intensive Care Unit Environment Returning 100 Colony-Forming Units per Surface Area Sampled Are Associated With Increased Risk of Major Bacterial Pathogen Detection.

BACKGROUND: A threshold for surface hygiene has not been defined for the healthcare arena. We aimed to identify the magnitude of bacterial contamination of frequently touched sites in the intensive care unit (ICU) environment that could be used to guide quality improvement initiatives. METHODS: Nineteen patients in a mixed ICU environment (providing care for medical and surgical patients) were followed from admission for 72 hours in 2010. Baseline cultures of frequently touched environmental sites were obtained at time zero following active decontamination and at 12, 24, 48, and 72 hours without further disinfection. We tested for an association of environmental reservoirs returning ≥ 100 colony-forming units (CFU) per surface area sampled with major bacterial pathogen detection. RESULTS: There were 446 ICU room, day, and reservoir combinations sampled from 19 patients. There were pathogens detected in 40% (79/199) of samples with ≥ 100 CFU vs. 14% (35/247) of samples returning < 100 CFU. The relative risk was 2.80 (95% CI: 1.97-3.98, P <0.0001). The odds ratio adjusted for time in hours was 3.11 (95% CI: 1.84-5.34, P < 0.0001). CONCLUSIONS: Frequently touched ICU environmental sites returning ≥ 100 CFU are associated with major bacterial pathogen detection. This threshold for surface hygiene can be used to ensure compliance with ICU environmental cleaning protocols and to guide quality improvement initiatives.

AN OUTBREAK OF EXTENSIVELY DRUG-RESISTANT ACINETOBACTER BAUMANNII IN A BELGIAN TERTIARY BURN WOUND CENTER.

The burn intensive care unit (ICU) of the Queen Astrid Military Hospital experienced an outbreak with an extensively drug-resistant Acinetobacter baumannii (XDR-Ab) strain, which began when all burn wound patients from all over Belgium were sent there as part of the national COVID-19 action plan. The purpose of this study is to report on the investigation and strategies that were implemented to contain the outbreak. Between October 2020 and May 2021, five of the 72 patients admitted to the ICU met the acute outbreak case definition (attack rate 7%). Their median age was 46 years and their median total body surface area burned was 39%. All patients developed at least one XDR-Ab infection, with in total three pulmonary, three bloodstream and five burn wound infections. One patient died. All XDR-Ab isolates were only susceptible to colistin. Whole genome sequencing of the isolates from the first two patients revealed an identical A. baumannii ST2 genotype, suggesting an outbreak. XDR-Ab-positive patients were cohorted with dedicated staff. The infection control team intensified its training on hand hygiene, excreta management and bio-cleaning procedures. Concurrently, 30 environmental samples were collected, which proved negative for XDR-Ab. Spatio-temporal associations were found for all XDR-Ab-positive patients, suggesting cross-transmission via staff's hands. We describe an XDR-Ab outbreak in a burn ICU over a seven-month period, in a context of increased workload. This series underlines the importance of a correct staff-to-patient ratio, especially in outbreak situations.

L'unité de soins intensifs (USI) pour brûlés de l'Hôpital Militaire Reine Astrid a connu une épidémie avec une souche d'Acinetobacter baumannii extrêmement résistante aux antibiotiques (XDR-Ab), qui a commencé pendant la période où tous les patients brûlés de Belgique y étaient référés à la suite du plan national COVID-19. Le but de cette étude est de décrire l'enquête épidémiologique et les stratégies utilisées pour contenir l'épidémie. Entre octobre 2020 et mai 2021, cinq des 72 patients admis à l'USI ont répondu à la définition de cas (taux d'attaque 7%). L'âge médian était de 46 ans, la surface corporelle brûlée médiane de 39%. Tous les patients ont développé au moins une infection par XDR-Ab : trois pneumonies, trois bactériémies et cinq infections de brûlures. Un patient est décédé. Tous les isolats XDR-Ab n'étaient sensibles qu'à la colistine. Le séquençage du génome entier des isolats des deux premiers patients a révélé un génotype identique d'A. baumannii ST2, suggérant une épidémie. Les patients XDR-Ab positifs ont été cohortés avec du personnel dédié. L'équipe d'hygiène hospitalière a intensifié sa formation sur l'hygiène des mains, la gestion des excréta et les procédures de bio-nettoyage. Simultanément, 30 échantillons environnementaux ont été collectés, qui étaient négatifs pour XDR-Ab. Des liens spatio-temporels ont été trouvés pour tous les patients XDR-Ab positifs, suggérant une transmission croisée manuportée. Nous décrivons une épidémie de XDR-Ab dans une USI pour brûlés sur une période de sept mois, dans un contexte de charge de travail accrue. Cette série souligne l'importance d'un ratio personnel-patients approprié, en particulier dans les situations d'épidémie.

Monitoring of Klebsiella pneumoniae Infection and Drug Resistance in 17 Pediatric Intensive Care Units in China from 2016 to 2022.

Objective: To investigate the characteristics and drug resistance patterns of Klebsiella pneumoniae (K. pneumoniae) infection in pediatric intensive care unit (PICU). Methods: K. pneumoniae strains from 17 domestic PICUs were analyzed for overall condition and drug resistance using WHO-NET software. Results: From 2016 to 2022, there was a linear increase in the detection rate of K. pneumoniae (P<0.05), with a total of 2591 (9.7%) strains detected. The primary sites of K. pneumoniae detection were the respiratory tract (71.1%), blood (8.6%), and urinary tract (7.1%). K. pneumoniae's resistance to penicillin drugs exceeded 90%, and are over 50% to cephalosporins. Resistance to cefoperazone-sulbactam decreased from 51.7% to 25.7%, and ranged from 9.1% to 20.8% for ceftolozane-tazobactam. Carbapenem-resistant K. pneumoniae strains constituted 32.3%. Resistance to imipenem and meropenem have decreased to 33.8% and 40.2%, while increased to 35.2% for ertapenem. Levofloxacin and amikacin resistance rates have decreased to 25.7% and 9.1%, but remain high at 63.8% for moxifloxacin and 44.6% for ciprofloxacin. K. pneumoniae demonstrated the lowest resistance rates to polymyxin B (0.9%), tigecycline (2.2%), and polymyxin E (3.1%). No strain of K. pneumoniae was resistant to both polymyxin B and meropenem. However, some strains showed co-resistance to meropenem with other antibiotics, including tigecycline (2%), imipenem (16%), amikacin (27%), colistin (37%), and levofloxacin (41%). Conclusion: The rates of isolation and drug resistance of K. pneumoniae in PICU have significantly increased over 7 years. Careful antibiotic use, infection control strategies, and appropriate antibiotic combinations are crucial in addressing this problem.