Despite invasive methods are the gold standard for intracranial pressure (ICP) measurement, several non-invasive techniques (nICP) have been proposed as surrogate, although their use remains insufficiently recognized in clinical practice. These include transcranial Doppler blood flow velocity assessment (arterial or venous), optic nerve sheath diameter (ONSD), automated pupillometry, measurement of skull expansion and compliance, brain imaging, double-depth ophthalmic artery blood flow velocity, and ultrasound time-of-flight. The main limitations of all indirect methods are calibration and zeroing, which constrain the absolute accuracy of non-invasive ICP monitoring. For transcranial Doppler-based methods, the 95
The identification and management of cardiogenic shock remain significant clinical challenges, as evidenced by persistently high mortality rates and the absence of standardized therapeutic strategies. This article provides a comprehensive overview of ongoing clinical trials in the treatment of cardiogenic shock, organized into three principal approaches aimed at improving patient outcomes: novel pharmacological therapies, optimized use of mechanical circulatory support, and advanced hemodynamic monitoring strategies. By synthesizing the available evidence, we highlight current research directions and discuss how emerging data may inform future clinical practice.
Anticoagulation during extracorporeal membrane oxygenation (ECMO) requires balancing thrombotic and bleeding risks, yet early coagulation dynamics may differ between venovenous (VV) and venoarterial (VA) support. This study prospectively characterized standard coagulation tests and viscoelastic profiles during the first 48 h of ECMO and related these to early bleeding and transfusion need. Multicenter, prospective cohort in four Belgian ICUs (03/2021–01/2023; NCT04912336). Adults initiated on VV- or VA-ECMO were enrolled immediately before cannulation and sampled at inclusion, + 2 h, + 24 h, and + 48 h. Laboratory tests (aPTT, PT/INR, fibrinogen, platelets, anti-Xa, D-dimer, AT), ROTEM, bleeding (BARC, GUSTO), and transfusions were recorded. Forty-three patients were included (23 VV, 20 VA). At inclusion, platelet counts were higher in VV than in VA (median 292 vs. 145·109/L). Thrombocytopenia was present at enrollment in 30
Sickle cell disease (SCD) causes pulmonary parenchymal and vascular complications with a major impact on mortality. Quantitative computed tomography (CT) assessment of pulmonary vascular “pruning” (rarefaction of small-caliber pulmonary vessels) may provide a non-invasive tool to better understand these complications. To evaluate vascular pruning in SCD and its association with clinical, functional respiratory, and imaging parameters. Non-contrast chest CT scans from 73 adult patients with SCD followed at Avicenne Hospital (Paris, France) were analyzed. Pulmonary vascular volumes were quantified using the blood volume in vessels with a cross-sectional area < 5 mm² (BV5) and the ratio of BV5 to total pulmonary blood volume (TBV), measured globally and in peripheral lung regions. These biomarkers were compared with pulmonary function tests (PFTs), CT parenchymal abnormalities, and clinical history of vascular disease. In 73 patients (mean age 33 ± 14 years; 38 women), linear opacities (78
PURPOSE:To design and implement a structured international quality improvement initiative addressing two critical areas: post-fracture osteoporosis treatment and fall prevention programs. METHODS:We developed a quality improvement initiative using the Plan-Do-Check-Act (PDCA) model across six European orthogeriatric units. After identifying common gaps, the intervention focused on three pillars: (1) education and training of multidisciplinary teams; (2) patient and caregiver engagement through flyers, posters, and videos; and (3) protocol standardization, through the development of Standard Operating Procedures and referral to fall-prevention clinics. Each orthogeriatric team selected a priority area based on local needs. We then collected process and outcome metrics and assessed them within each country's healthcare context. RESULTS:The project led to a set of educational materials and clinical protocols, enhancing training, empowering patients and professionals, and improving service quality. Trained healthcare workers were satisfied with the program, and most of the patients declared themselves to be more informed than before. The development and introduction of an osteoporosis algorithm increased treatment rates significantly in Portugal and Finland. Bone-health and fall-prevention clinics were launched within the geriatric medicine department in Malta and Italy, respectively. CONCLUSION:This low-cost, scalable initiative shows early promise for adaptation across diverse European healthcare systems. The initiative aims to expand to additional orthogeriatric units and to launch a suite of standardized orthogeriatric tools and protocols that could support wider implementation.
