Neuroworsening in Moderate Traumatic Brain Injury.

Patients with moderate traumatic brain injury (TBI) are at high risk for developing intracerebral complications and in particular neuroworsening (NW). NW can be unpredictable and may be an important risk factor for poor neurologic outcome and for increased mortality. NW is often a medical and surgical emergency, and it is, therefore, fundamental to identify patients at risk early because they require strict neuromonitoring and repeated neuroimaging. So far, there is no standardized and validated definition of NW. In this review, we aim to discuss the definition, risk factors, and management of patients with moderate TBI at high risk of NW.

Spontaneous breathing trial in the weaning process from mechanical ventilation in pediatrics: outcome and predictive factors. / Prueba de ventilación espontánea en el proceso de liberación de la asistencia ventilatoria mecánica en pediatría: resultados y factores predictores.

Introduction. spontaneous breathing trial (SBT) in weaning from pediatric invasive mechanical ventilation (IMV) is an endorsed practice, its positivity is based on clinical parameters; however, its results could be better documented. Objective. To describe the results of the SBT in the IMV weaning process. Population and methods. Retrospective analysis. Patients with ≥48 h in IMV from March 1, 2022 to January 31, 2024. Results. A total of493 SBT were analyzed in 304 patients; 71% (348) were positive, and 87% (302) resulted in successful extubations. The causes of negative SBT were increased work of breathing (70%), respiratory rate (57%), and heart rate (27%). In univariate analysis, respiratory distress as the reason for admission, peak inspiratory pressure before SBT and T-tube use, were predictors of negative SBT. In multivariate analysis, this association persisted for admission for respiratory cause, the higher programmed respiratory rate in IMV, as the T-tube modality. Those with negative SBT stayed more days in IMV (9 [7-12] vs. 7 [4-10]) and in PICU (11 [9-15] vs. 9 [7-12]). Conclusion. Positive SBT predicted successful extubation in a high percentage of cases. Respiratory distress on admission, higher programmed respiratory rate, and a higher proportion of T-tube mode were negative predictors of the test. Negative SBT was associated with more extended stays in IMV and PICU.

Introducción. La prueba de ventilación espontánea (PVE) en el proceso de liberación de la asistencia ventilatoria mecánica invasiva (AVMi) pediátrica es una práctica avalada; su positividad se sustenta en parámetros clínicos. Sin embargo, sus resultados están escasamente documentados. Objetivo. Describir los resultados de la PVE en el proceso de liberación de la AVMi. Población y métodos. Análisis retrospectivo. Pacientes con ≥ 48 h en AVMi del 1 de marzo de 2022 al 31 de enero de 2024. Resultados. Se analizaron 493 PVE en 304 pacientes; el 71 % (348) fueron positivas y el 87 % (302) redundó en extubaciones exitosas. Las causas de las PVE negativas fueron mayor trabajo respiratorio (70 %), frecuencia respiratoria (57 %) y frecuencia cardíaca (27 %). En el análisis univariado, la dificultad respiratoria como motivo de ingreso, la presión inspiratoria máxima previo a la PVE y el uso de tubo en T fueron predictores de PVE negativa. En el análisis multivariado, esta asociación persistió para el ingreso por causa respiratoria, la mayor frecuencia respiratoria programada en la AVM y la modalidad tubo en T. Quienes presentaron PVE negativas permanecieron más días en AVMi [9 (7-12) vs. 7 (4-10)] y en UCIP [11 (9-15) vs. 9 (7-12)]. Conclusión. La PVE positiva predijo la extubación exitosa en un alto porcentaje. La dificultad respiratoria al ingreso, la mayor frecuencia respiratoria programada y la mayor proporción de la modalidad tubo en T fueron predictores negativos para la prueba. La PVE negativa se asoció a mayor estadía en AVMi y UCIP.

Validation of SAPS 3 for predicting in-hospital mortality in patients with haematological malignancy requiring ICU management.

Prognostic systems predicting death risk may vary for patients with haematological malignancies needing ICU care. This study externally validated SAPS 3 using a retrospective cohort of adults with these conditions in the ICU. The score was calculated at admission using the general and South America-adjusted formulas. Mortality discrimination was assessed via AUC-ROC, and calibration by Hosmer-Lemeshow goodness-of-fit and graphical analysis with a calibration belt. The analysis included 273 admissions, with 119 deaths. Discriminative capacity was low (AUC-ROC 0.56, CI 95% 0.49-0.63). There was a poor correlation between expected and observed events across all risk deciles (Hosmer-Lemeshow 10.45, p = 0.0635). Similar results were found with the South America-adjusted formula. SAPS 3 does not effectively discriminate between survivors and non-survivors, underestimating risk in low-risk groups and overestimating it in high-risk groups. Mortality risk estimation in this scenario should rely on clinical judgment.

Postoperative complications after central nervous system tumor resection in pediatric patients admitted to an intensive care unit in Colombia.

Introduction: Central nervous system (CNS) tumors are the second most prevalent malignant neoplasms in childhood, with surgical resection as the primary therapeutic approach. The immediate postoperative period following CNS tumor resection requires intensive care to mitigate complications associated with high morbidity and mortality. Objective: The primary aim of this study is to comprehensively describe the postoperative complications observed in pediatric patients who underwent primary CNS tumor resection and were subsequently admitted to the pediatric intensive care unit (PICU) at Hospital Universitario Fundación Valle del Lili in Colombia. Methods: We conducted a cross-sectional observational analysis of pediatric patients who underwent surgery for CNS tumors and were admitted to our PICU from January 2011 to December 2021. Clinical, histopathologic, and postoperative complication data were collected. A descriptive statistical analysis was performed using measures of dispersion and central tendency with a 95% confidence interval. Results: A total of 114 patients were included, of whom 55.3% were male. The median PICU stay was 4 days (2-7). The most common tumor type was embryonal (25.4%), followed by low-grade glioma (20.1%) and high-grade glioma (14.9%). Mechanical ventilation was required in 24.5% of patients, with a median extubation time of 3 days (2-9). In the immediate postoperative period, 6.14% of patients experienced CNS hemorrhage and 3.5% experienced intracranial hypertension. Common complications included motor deficits, facial paralysis, and sensory deficits. The mortality rate was 3.5%. Conclusion: This study describes the postoperative complications, clinical challenges, and interventions observed in pediatric patients after CNS tumor resection in a resource-limited country. Our findings emphasize the importance of tailored interventions and multidisciplinary collaboration to optimize clinical outcomes. Future data comparison from centers sharing similar characteristics will play a crucial role in identifying best practices and enhancing outcomes globally.

Workload of physiotherapy procedures in the adult intensive care unit: a descriptive study in a Brazilian teaching hospital.

BACKGROUND: Physiotherapy techniques applied in intensive care units (ICU) aim to counteract functional decline and manage acute respiratory conditions. Treatment strategies vary depending on factors such as diagnosis, disease severity, and costs. Staffing resources and workload impact the duration and frequency of interventions. Understanding the workload of procedures may enhance patient care quality. OBJECTIVE: To determine the frequency, duration, and workload of physiotherapy procedures applied to adult ICU patients. Secondarily, we analyzed the time spent per shift on teaching-related and non-procedure-related activities. METHODS: Longitudinal panel study conducted in a 12-bed university hospital. Physiotherapy sessions applied to adult ICU patients were included. The list of procedures was derived using the Delphi method. The investigator followed physiotherapists to measure the duration of procedures and calculate a workload index for each (determined as duration x frequency). Duration of teaching-related and non-procedure-related tasks was also recorded. RESULTS: A total of 339 physiotherapy sessions were analyzed across 79 shifts, involving 181 patients and 19 physiotherapists. Procedures with the highest workload index were: out-of-bed mobilization, patient positioning, passive limb mobilization, active exercises, artificial airway suctioning, and equipment management. Time distribution across the shifts was as follows: direct patient care 40% (SD 12%), non-procedure-related activities 20% (SD 6%), and teaching-related activities 10% (range: 4%-19%). CONCLUSION: The procedures with the highest workload index were those directly related to rehabilitation, such as mobilization and exercises, and those not specific to patient condition, like positioning and equipment management. Physiotherapists spent most of their time in direct patient care, followed by indirect care activities and teaching.

Integrative and complementary practices in Intensive Care Units: An integrative review.

Objective: To synthesize the knowledge published in the literature on the use of Integrative and Complementary Health Practices in Adult Intensive Care Units. Design: An integrative literature review based on Ganong's theoretical-methodological framework. Setting: Data collection was carried out in January 2023 using the descriptors Intensive Care Units and Complementary Therapies, crossed using the Boolean operator "AND". Twenty-five studies were selected and uploaded to Endnote Web. QDA Miner Lite software was used to assist in the analysis of the results. Main outcome measures: The inclusion criteria were: complete original articles, available online and detailing Integrative and Complementary Health Practices applied in the setting of Adult Intensive Care Units. Excluded works included: publications in conference and event annals; literature review articles; editorials; and study protocols. Results: The studies date back to 1994, mostly constituted by quantitative clinical trials. Music therapy was prevalent, presented fewer difficulties in application and greater acceptance by participants. The combination of complementary practices also proved to be effective. Conclusions: There is a growing interest in the application of Integrative and Complementary Health Practices (ICHPs) in the Intensive Care Unit (ICU) setting. However, more research is needed to understand the impact of each practice. Moreover, nursing is essential for the effective implementation of ICHPs.

Outcomes within 100 days of hematopoietic cell transplantation in pediatric patients: insights from an intensive care unit in Colombia.

Introduction: Hematopoietic cell transplantation (HCT) has become an essential therapeutic modality for pediatric patients with malignant and non-malignant conditions. Despite its effectiveness, many patients experience post-transplant complications often leading into life-threatening conditions requiring specialized care in a Pediatric Intensive Care Unit (PICU). This study aims to describe clinical characteristics associated with mortality in pediatric HCT patients who needed PICU care within 100 days post-transplant in a resource-limited country. Methods: A retrospective cohort study was conducted involving pediatric HCT patients (<18 years old) admitted to our PICU from January 2012 to December 2021. Variables were characterized according to their nature, employing appropriate measures of central tendency and dispersion. The relationship between mortality and patient clinical characteristics was assessed using the Chi-square test or the Mann-Whitney U test, as applicable. A p-value of <0.05 was considered statistically significant. A Kaplan Meier survival curve was performed considering the days from HCT to death during PICU admission and a Cox regression analysis was conducted to analyze the association between PRISM III score and risk of death. Data analysis was executed utilizing the STATA SE v18 statistical software package. Of 316 HCTs, 69 patients required admission to the PICU. Haploidentical transplants from related donors were performed in 72.5% of these patients. The primary cause of PICU admission was infection, accounting for 68.1% (n = 47) of cases. Factors significantly associated with mortality included a PRISM III score > 20 (p < 0.002), mechanical ventilation (p < 0.007), renal replacement therapy (p < 0.002) and vasoactive support (p < 0.001). A total of 27 patients succumbed during their PICU stay. Kaplan Meier curve showed a survival rate of 51.6% at100-days post-transplant. A PRISM III score higher than 20 points was related with mortality (Hazard ratio 5.71 CI 95% 2.09-15.5). Discussion: This study examines critical factors associated with mortality in pediatric HCT recipients who required admission to our PICU within the first 100 days post-transplant. Our findings indicate that infectious complications, alongside the need for advanced cardiovascular, respiratory, and renal support are strongly correlated with mortality. These results underscore the importance of early risk factor identification and targeted interventions to optimize patient outcomes.

Association between type of feeding at hospital discharge and nutritional status of Brazilian very preterm infants: a multicenter study

Abstract Objectives To examine trends over time in diet and size of very preterm infants, and associations of diet with size at hospital discharge/transfer. Methods The authors studied 4062 surviving very preterm infants born < 32 weeks' gestational age and < 1500 g between January 2012 and December 2020 from 12 Brazilian Neonatal Intensive Care Units. Diet type at discharge/transfer was classified as exclusive human milk, exclusive formula, or mixed. Outcomes were weight and head circumference at hospital discharge and the change in each from birth to discharge. The authors used linear regression to estimate adjusted associations of diet type with infant size, overall, and stratified by fetal growth category (small vs. appropriate for gestational age). The authors also examined trends in diet and infant size at discharge over the years. Results Infants' mean gestational age at birth was 29.3 weeks, and the mean birth weight was 1136 g. Diet at discharge/transfer was exclusive human milk for 22 %, mixed for 62 %, and exclusive formula for 16 %. Infant size in weight and head circumference were substantially below the growth chart reference for all diets. Infants fed human milk and mixed diets were lighter and had smaller heads at discharge/transfer than infants fed formula only (weight z: −2.0, −1.8, and −1.5; head z: −1.3, −1.2 and −1.1 for exclusive human milk, mixed and exclusive formula respectively). Conclusion Results suggest high human milk use but gaps in nutrient delivery among hospitalized Brazilian very preterm infants, with little evidence of improvement over time.

D-PRISM: a global survey-based study to assess diagnostic and treatment approaches in pneumonia managed in intensive care.

BACKGROUND: Pneumonia remains a significant global health concern, particularly among those requiring admission to the intensive care unit (ICU). Despite the availability of international guidelines, there remains heterogeneity in clinical management. The D-PRISM study aimed to develop a global overview of how pneumonias (i.e., community-acquired (CAP), hospital-acquired (HAP), and Ventilator-associated pneumonia (VAP)) are diagnosed and treated in the ICU and compare differences in clinical practice worldwide. METHODS: The D-PRISM study was a multinational, survey-based investigation to assess the diagnosis and treatment of pneumonia in the ICU. A self-administered online questionnaire was distributed to intensive care clinicians from 72 countries between September to November 2022. The questionnaire included sections on professional profiles, current clinical practice in diagnosing and managing CAP, HAP, and VAP, and the availability of microbiology diagnostic tests. Multivariable analysis using multiple regression analysis was used to assess the relationship between reported antibiotic duration and organisational variables collected in the study. RESULTS: A total of 1296 valid responses were collected from ICU clinicians, spread between low-and-middle income (LMIC) and high-income countries (HIC), with LMIC respondents comprising 51% of respondents. There is heterogeneity across the diagnostic processes, including clinical assessment, where 30% (389) did not consider radiological evidence essential to diagnose pneumonia, variable collection of microbiological samples, and use and practice in bronchoscopy. Microbiological diagnostics were least frequently available in low and lower-middle-income nation settings. Modal intended antibiotic treatment duration was 5-7 days for all types of pneumonia. Shorter durations of antibiotic treatment were associated with antimicrobial stewardship (AMS) programs, high national income status, and formal intensive care training. CONCLUSIONS: This study highlighted variations in clinical practice and diagnostic capabilities for pneumonia, particularly issues with access to diagnostic tools in LMICs were identified. There is a clear need for improved adherence to existing guidelines and standardized approaches to diagnosing and treating pneumonia in the ICU. Trial registration As a survey of current practice, this study was not registered. It was reviewed and endorsed by the European Society of Intensive Care Medicine.

The impact of patient- and family-centered care interventions on intensive care unit outcomes: a meta-analysis of randomized controlled trials.

BACKGROUND: Patient and Family-Centered Care (PFCC) interventions are increasingly recognized as a viable approach to address various mental health issues among patients in Intensive Care Units (ICUs). Therefore, this review aims to estimate the effect of Patient and Family-Centered Care Interventions on specific outcomes in adult patients admitted to Intensive Care Units (ICUs). METHODS: We systematically searched four major databases for parallel arm Randomized Controlled Trials (RCTs). The PRISMA framework was used to report our review. We included studies involving adult patients (> 18-years) admitted to ICUs and examined the effects of any type of Patient and Family-Centered Care intervention (PFCC) on outcomes such as depression, anxiety, delirium, and length of hospital stay. Data extraction was performed independently by two authors in Medline, Google Scholar, and ScienceDirect, from inception to July 2024. Random effects model was used to pool the data. RESULTS: A total of 11 studies were included in our systematic review and meta-analysis, with a combined sample size of 3352 patients (PFCC group, n = 1681; usual care group, n = 1671). A random-effects model revealed a significant reduction in delirium prevalence in the PFCC group, with a pooled Risk Ratio (RR) of 0.54 (95% CI 0.36 to 0.81). However, no statistical significance was found for other outcomes such as depression, length of ICU stay, and anxiety. It is important to note that all the included studies were assessed to have either a high or unclear risk of bias. CONCLUSION: PFCC interventions may significantly reduce delirium rates among ICU patients; however, their effects on other outcomes, such as depression, anxiety, and length of stay, were not statistically significant.

Extracorporeal membrane oxygenation in critically ill patients with active hematologic and non-hematologic malignancy: a literature review.

Combined progress in oncology and critical care medicine has led to new aspirations and discussions in advanced life support modalities in the intensive care unit. Over the last decade, extracorporeal membrane oxygenation, previously considered unsuitable for oncologic patients, has become increasingly popular, with more diverse applications. Nevertheless, mortality remains high in critically ill cancer patients, and eligibility for extracorporeal membrane oxygenation can be extremely challenging. This scenario is even more difficult due to the uncertain prognosis regarding the underlying malignancy, the increased rate of infections related to intensive care unit admission, and the high risk of adverse events during extracorporeal membrane oxygenation support. With advances in technology and better management involving extracorporeal membrane oxygenation, new data on clinical outcomes can be found. Therefore, this review article evaluates the indicators for extracorporeal membrane oxygenation in different types of oncology patients and the possible subgroups that could benefit from it. Furthermore, we highlight the prognosis, the risk factors for complications during this support, and the importance of decision-making based on a multidisciplinary team in the extracorporeal membrane oxygenation indication.

Persistent carbapenem resistance in mechanically ventilated ICU patients: A before-and-after analysis of the COVID-19 surge.

BACKGROUND: The evolution of antimicrobial resistance among critically ill patients before, during, and after the COVID-19 surge remains unclear. METHODS: We retrospectively analyzed critically ill mechanically ventilated adult patients admitted to 8 Brazilian hospitals from Jan 1, 2018 to Apr 30, 2023. We stratified the patients into 3 periods: pre-surge (Jan 01, 2018-Mar 01, 2020), surge (Mar 01, 2020-Oct 01, 2021), and post-surge (after October 01, 2021). Positive cultures, pathogen prevalence, and resistance rates were analyzed using rate ratios (RR) with 95% confidence intervals (CI). RESULTS: Among 9,780 patients (3,718 pre-surge, 3,815 surge, 2,247 post-surge), those in surge period were younger (median: 70 vs 74 pre-surge vs 75 post surge) and had longer invasive mechanical ventilation duration (median 7 vs 5 days). Blood and respiratory cultures increased across periods (56.9 pre-surge vs 69.4 surge vs 70.4 patients/1,000 patient-days post-surge). Isolation of carbapenem-resistant gram-negatives increased during the surge (RR [95% CI]: 1.8 [1.5-2.2], decreased in post-surge (0.72 [0.6-0.9]), and remained higher than pre-surge (1.3 [1.0-1.6]). Resistance rates for Pseudomonas aeruginosa reduced in post-surge, whereas Klebsiella pneumoniae doubled during the surge, and remained elevated. CONCLUSIONS: Carbapenem resistance increased during the surge period. Although it decreased post-surge, it remained higher than pre-pandemic rates.

Early vs late ICU admission in patients with COVID-19 pneumonia.

INTRODUCTION: The type of admission to the Intensive Care Unit (ICU) influences the prognosis of patients with severe pneumonia and, in the case of patients with COVID-19 pneumonia, this is still unexplored. The objective of this study was to determine the differences between early and late ICU admission. METHODOLOGY: A retrospective cohort study of patients with COVID-19 pneumonia at two high-complexity hospitals in Colombia. Early ICU admission (EICUA) was defined as direct admission from the emergency department or within the first 24 hours of admission. Late ICU admission (LICUA) was defined as admission from the hospitalization service after 24 hours of arrival. A robust Cox regression was performed for the variable recovery time, to determine the impact of the ICU admission type in the hazard rate. RESULTS: 68.2% were EICUA patients and 31.8% were LICUA patients. Recovery and duration of hospital stay were significantly lower in EICUA than in LICUA (9 vs 15 days, p = 0.0001, and 10 vs 15.5 days, p < 0.0001, respectively). However, the duration of ICU stay (7 vs 9 days, p = 0.131) and the invasive mechanical ventilation requirement (48.9% vs 54.9%, p = 0.374) were not statistically significant. The 30-day follow-up showed no difference between the EICUA and LICUA (alive 97% vs 94.6%, p = 0.705). CONCLUSIONS: Mortality between EICUA and LICUA patients with COVID-19 pneumonia showed no statistically significant differences. However, the recovery time, the probability intensity of instant recovery, and the duration of hospital stay were better in EICUA than in LICUA. Neither EICUA nor LICUA affects the final status (death) of patients.

Cognitive and Functional Capacity Assessment of Individuals Who Were Admitted to the Intensive Care Unit Due to COVID-19: A Prospective Cohort Study.

AIM: The goal of this study was to identify changes in cognitive and functional capacity after hospital discharge in those infected with COVID-19 who were admitted to the ICU. METHODS: This is a prospective cohort study carried out with individuals who were admitted to a hospital, from July 2021 to May 2022. The evaluations happened in three moments: at hospital discharge, 30 days after discharge and 90 days after discharge. The instruments applied are the following: handgrip dynamometer, Montreal Cognitive Assessment Basic questionnaire (MoCA-B), Barthel Index (BI), timed up and go test (TUG), hospital anxiety and depressive scale (HADS) and 36-Item Short Form Health Survey questionary (SF-36). RESULTS: 74 individuals were eligible to participate in the study, 25 of which were followed for 90 days. Based on the results of the MoCA-b, there were no relevant cognitive changes after 3 months. According to the Barthel Index applied to each of the evaluations, the percentage of subjects that were classified as independent or minimally dependent was 48%, 92% then 96%, respectively, demonstrating that individuals can achieve a good degree of functional independence after 3 months. Despite that, the SF-36 demonstrated a score below the South Brazilian normal in some domains. CONCLUSION: The individuals studied did not present persistent cognitive changes after 3 months and functional capacity showed significant improvement during this period. However, when the assessment is about the self-perceived quality of life, the majority of domain values are still below expectations, deserving attention by the health professionals involved.

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.

Communication, Shared Decision-making and Goals of Care in the ICU through Electronic Health Records: A Scoping Review.

Introduction: The care of critically ill patients involves communication and shared decision-making with families and determination of goals of care. Analyzing these aspects through electronic health records (EHRs) can support research in ICUs, associating them with outcomes. This review aims to explore studies that examine these topics. Methods: A scoping review was conducted through a systematic literature search of articles in PubMed, Web of Science, and Embase databases using MESH terms up to 2024, conducted in ICU settings, focusing on communication with families, shared decision-making, goals, and end-of-life care. Results: A total of 10 articles were included, divided into themes: Records and family, and records in quality improvement projects. Variables based on records with common characteristics were identified. Outcome analysis was performed through questionnaires to family members, healthcare professionals or by analyzing care processes. The studies revealed associations between family members' perceptions and mental health symptoms and documented elements such as communication, therapeutic limitations, social and spiritual support. Studies evaluating quality communication improvement projects did not show significant impact on documented care, except for those that assessed improvements based on palliative care. Conclusion: The analysis of documented care for critically ill patients can be conducted from various perspectives. Processes amenable to improvement, such as communication with family members, definition of goals of care, limitations, shared decision-making, evaluated through EHRs, are associated with mental health symptoms and perceptions of families of critically ill patients. Documentation-based studies can contribute to improvements in patient- and family-centered care in the ICU. How to cite this article: de Aquino VW, da Silveira GF, Boniatti MM, Terres MS. Communication, Shared Decision-making and Goals of Care in the ICU through Electronic Health Records: A Scoping Review. Indian J Crit Care Med 2024;28(10):977-987.

Prevalence of the cefazolin inoculum effect (CzIE) in nasal colonizing methicillin-susceptible Staphylococcus aureus in patients from intensive care units in Colombia and use of a modified rapid nitrocefin test for detection.

The cefazolin inoculum effect (CzIE) has been associated with poor clinical outcomes in patients with methicillin-susceptible Staphylococcus aureus (MSSA) infections. We aimed to investigate the point prevalence of the CzIE among nasal colonizing MSSA isolates from ICU patients in a multicenter study in Colombia (2019-2023). Patients underwent nasal swabs to assess for S. aureus colonization on admission to the ICU, and some individuals had follow-up swabs. We performed cefazolin MIC by broth microdilution using standard and high inoculum and developed a modified nitrocefin-based rapid test to detect the CzIE. Whole-genome sequencing was carried out to characterize BlaZ types and allotypes, phylogenomics, and Agr-typing. A total of 352 patients were included; 46/352 (13%) patients were colonized with S. aureus and 22% (10/46) and 78% (36/46) with MRSA and MSSA, respectively. Among 36 patients who contributed with 43 MSSA colonizing isolates, 21/36 (58%) had MSSA exhibiting the CzIE. BlaZ type A and BlaZ-2 were the predominant type and allotype in 56% and 52%, respectively. MSSA belonging to CC30 were highly associated with the CzIE, and single-nucleotide polymorphism (SNP) analyses supported possible transmission of MSSA exhibiting the CzIE among some patients of the same unit. The modified nitrocefin rapid test had 100%, 94.4%, and 97.7% sensitivity, specificity, and accuracy, respectively. We found a high point prevalence of the CzIE in MSSA colonizing the nares of critically ill patients in Colombia. A modified rapid test was highly accurate in detecting the CzIE in this patient population.

Boosting the Beat: A Critical Showdown of Levosimendan and Milrinone in Surgical and Non-Surgical Scenarios: A Narrative Review.

Acute heart failure, advanced cardiac failure, cardiac surgery, and sepsis are conditions that require simultaneous treatment to stimulate contractility and/or reduce systemic vascular resistance, with levosimendan and milrinone being treatment options. This research's aim is to review the current indications and evidence for these medications across various scenarios. Evidence suggests that levosimendan is a non-inferior alternative to dobutamine and superior to milrinone in treating low cardiac output syndrome following cardiac surgery. In cases of septic shock, levosimendan has been linked to lower mortality rates compared to placebo, while milrinone's efficacy remains inconclusive. Furthermore, postoperative patients undergoing correction for congenital heart disease have shown reduced mechanical ventilation time and intensive care unit stays when treated with levosimendan, although differences exist between the populations assigned to each intervention. In conclusion, levosimendan, compared to milrinone, appears to offer better hemodynamic favorability in patients undergoing cardiac surgery. However, additional research is necessary to further understand its impact on hemodynamic outcomes, mortality, intensive care unit, and hospital stays in patients with cardiogenic shock of both ischemic and non-ischemic etiologies, as well as septic shock.

Predictive biomarkers of mortality in patients with severe COVID-19 hospitalized in intensive care unit.

Objectives: This study was performed to identify predictive markers of worse outcomes in patients with severe COVID-19 in an intensive care unit. Methods: Sixty patients with severe COVID-19, hospitalized in the Intensive Care Unit (ICU) between March and July 2021, were stratified into two groups according to the outcome survivors and non-survivors. After admission to the ICU, blood samples were collected directly for biomarker analysis. Routine hematological and biochemical biomarkers, as well as serum levels of cytokines, chemokines, and immunoglobulins, were investigated. Results: Lymphopenia, neutrophilia, and thrombocytopenia were more pronounced in non-surviving patients, while the levels of CRP, AST, creatinine, ferritin, AST, troponin I, urea, magnesium, and potassium were higher in the non-surviving group than the survival group. In addition, serum levels of IL-10, CCL2, CXCL9, and CXCL10 were significantly increased in patients who did not survive. These changes in the biomarkers evaluated were associated with increased mortality in patients with severe COVID-19. Conclusion: The present study confirmed and expanded the validity of laboratory biomarkers as indicators of mortality in severe COVID-19.

Effect of music therapy on short-term psychological and physiological outcomes in mechanically ventilated patients: A randomized clinical pilot study.

Background: Elevated anxiety levels are common in patients on mechanical ventilation (MV) and may challenge recovery. Research suggests music-based interventions may reduce anxiety during MV. However, studies investigating specific music therapy techniques, addressing psychological and physiological well-being in patients on MV, are scarce. Methods: This three-arm randomized clinical pilot study was conducted with MV patients admitted to the intensive care unit (ICU) of Hospital San José in Bogotá, Colombia between March 7, 2022, and July 11, 2022. Patients were divided into three groups: intervention group 1 (IG1), music-assisted relaxation; intervention group 2 (IG2), patient-preferred therapeutic music listening; and control group (CG), standard care. The main outcome measure was the 6-item State-Anxiety Inventory. Secondary outcomes were: pain (measured with a visual analog scale), resilience (measured with the Brief Resilience Scale), agitation/sedation (measured with the Richmond Agitation-Sedation Scale), vital signs (including heart rate, blood pressure, oxygen saturation, and respiratory rate), days of MV, extubation success, and days in the ICU. Additionally, three patients underwent electroencephalography during the interventions. Results: Data from 23 patients were analyzed in this study. The age range of the patients was 24.0-84.0 years, with a median age of 66.0 years (interquartile range: 57.0-74.0). Of the 23 patients, 19 were female (82.6%). No statistically significant differences between the groups were observed for anxiety (P=0.330), pain (P=0.624), resilience (P=0.916), agitation/sedation (P=0.273), length of ICU stay (P=0.785), or vital signs. A statistically significant difference between the groups was found for days of MV (P=0.019). Electroencephalography measurements showed a trend toward delta and theta band power decrease for two patients and a power increase on both beta frequencies (slow and fast) in the frontal areas of the brain for one patient. Conclusions: In this pilot study, music therapy did not significantly affect the anxiety levels in patients on MV. However, the interventions were widely accepted by the staff, patients, and caregivers and were safe, considering the critical medical status of the participants. Further large-scale randomized controlled trials are needed to investigate the potential benefits of music therapeutic interventions in this population.Trial Registration ISRCTN trial registry identifier: ISRCTN16964680.