Extracorporeal membrane oxygenation (ECMO) is increasingly being utilized for life-threatening cardiac and/or respiratory failure refractory to conventional treatment. Acute kidney injury (AKI) and fluid balance disorders commonly occur both before and during ECMO, with approximately half of cases receiving treatment with continuous renal replacement therapy (CRRT). Acute kidney injury, fluid balance disorders, and CRRT influence both short- and long-term outcomes in this population. The 36th Acute Disease Quality Initiative (ADQI) meeting was held in June 2025 to develop multidisciplinary international expert recommendations for AKI, fluid balance, and CRRT during ECMO across the age spectrum. This work encompassed five working groups: 1) epidemiology, risk factors, and outcomes of AKI and CRRT, 2) fluid management and outcomes, 3) indications for CRRT and fluid removal during ECMO, 4) best practices for performing CRRT during ECMO, and 5) biomarkers, extracorporeal blood purification, and drug pharmacokinetics and pharmacodynamics. As part of this work, knowledge gaps and research priorities were identified.
Abstract Background Previous studies have not demonstrated sufficient effects of intensive care unit (ICU) follow-up clinics on health-related quality of life. This may also be influenced by the design and implementation of these studies. Feasibility and context of such studies have yet to be sufficiently researched. It is therefore crucial to investigate these contextual factors. This study aimed to explore the experiences of patients, relatives, and healthcare professionals with both the randomised controlled trial (RCT) and the ICU follow-up clinic, to assess the feasibility and acceptability of the intervention and the study design from the perspectives of those involved. Methods This qualitative research was embedded in the process evaluation of a pilot RCT on an ICU follow-up clinic. We conducted 18 semi-structured interviews with former ICU patients, relatives and the clinical study team who participated in the PINA study and used field notes from the clinical study team. Data analysis was carried out using qualitative content analysis. Results The pilot RCT was well received by potential patients and their relatives, and the motivation to participate was high, as was the motivation of the clinical study team. The main benefits of the ICU follow-up clinic intervention named by participants were being taken seriously and receiving referrals that they would not typically get from a general practitioner. The offer of home visits for patients with long travel distances to the ICU follow-up clinic was highly appreciated. Conclusions It was feasible to integrate the perspectives of patients, relatives, and healthcare professionals within a pilot RCT on an ICU follow-up clinic. Across all stakeholder groups, the ICU follow-up clinic and the RCT trial design were considered acceptable and valuable, suggesting that such follow-up care meets patient needs and that a large-scale study appears feasible. Trial registration ClinicalTrials.gov US NLM, NCT04186468, Submission: 02/12/2019, Registration: 04/12/2019, https://clinicaltrials.gov/ct2/show/NCT04186468 .
We introduce a novel automated well plate sampling system (AmbiSampler) using laser ablation-rapid evaporative ionization mass spectrometry (LA-REIMS) for label-free high-throughput biochemical screening for small volume biological fluid samples and cell line panels from multiwell plates. The human blood serum samples featured intensive signals in the low m/z range including fatty acids and metabolites and in the higher (m/z > 600) range associated with complex lipids, peptides, and proteins. We demonstrate the current quantification performance of the system through blood serum samples spiked with labelled amino acid mix. Cell line analysis was demonstrated by analyzing the NCI60 human cell lines panel grown in multiwell plates. Without any sample preparation, these experiments yielded rich metabolic and lipidomic mass spectrometry profiles, with classification results showing a 98.7
BACKGROUND: Palliative care is a concept for all patients suffering from life threatening diseases. It is not limited to cancer patients or to the last few days of life. Current research on diseases and concomitant diagnoses in vascular surgery suggests a high need for palliative care. Specific palliative concepts for vascular medicine are still lacking. METHODS: We conducted a study on the subjective views of experts in vascular surgery in Germany using a qualitative interview method to examine various aspects of palliative care in vascular surgery. RESULTS: A total of 609 relevant text passages were identified and coded into seven main categories and 43 subcategories. The coding categories were as follows: description of the current situation of care in vascular surgery, identification of palliative vascular surgery patients’, description of palliative care symptoms requiring treatment, methods for identifying palliative vascular surgery patients, desired effects of palliative care interventions, barriers to implementation of palliative care, and the role and needs of relatives. CONCLUSIONS: The results of this study suggest that vascular surgery palliative patients may represent a specific group of patients, necessitating the development of a customised palliative care concept to the specific needs of this group. The specific requirements for the care of these patients and numerous barriers currently prevent adequate palliative care of these patients. The results of our study, which we were able to extract from interviews with experienced vascular surgeons and their insights into everyday clinical practice, confirm the conclusions drawn in published clinical studies and supplement them with further aspects, which together appear necessary for improved care of this patient group in the future. Central aspects to be considered include suitable training of vascular surgeons for a comprehensive understanding of palliative care, as well as advance care planning and written standards defining the situations in which palliative care should routinely be offered.
Periprosthetic joint infection (PJI) is a serious complication of total hip arthroplasty. Standard treatment for PJI is a two-stage revision surgery with antibiotic-loaded cement spacers to control infection and provide temporary joint stability. This study compares the radiological outcomes and complication rates between articulating and non-articulating hip spacers in patients undergoing treatment for PJI and native joint infections. We retrospectively reviewed 71 hip spacers (34 articulating, 37 non-articulating) in 38 patients treated between 2004 and 2022. Data on leg length discrepancy, femoral offset, infection control, and mechanical complications were obtained. For infection analysis, only patients treated exclusively with one spacer type were included. After excluding eight patients with mixed spacer types (29 spacers), 30 patients with 42 spacers were included in this subgroup. Articulating spacers were significantly better at preserving leg length, with a mean discrepancy of -3.7 mm compared to -16.9 mm for non-articulating spacers (p = 0.025). However, non-articulating spacers maintained femoral offset (1.1 vs. 0.7, p < 0.001) closer to physiological offset. The rate of mechanical complications was higher in the articulating spacer group, with spacer dislocations occurring in 45
