Background:Pediatric heart transplantation stays the gold standard treatment for end-stage heart failure, but outcomes are influenced by pre-transplant status and bridging strategies, particularly mechanical circulatory support (MCS). Objectives:To evaluate early outcomes following pediatric heart transplantation and assess the impact of pre-transplant MCS on survival and complications. Methods:We retrospectively analyzed all pediatric patients (<14 years) who underwent orthotopic heart transplantation at a single tertiary center between January 2020 and January 2025. Demographics, pre-transplant support, intraoperative data, and early outcomes were collected. Primary outcome was 30-day survival; secondary outcomes included acute rejection, infection, acute kidney injury (AKI), neurologic complications, and ICU/hospital length of stay (LOS). Comparative analyses were performed between patients having ECMO- and ventricular assist devises (VAD) using Fisher's exact and Wilcoxon rank-sum tests. Kaplan-Meier survival estimates were generated. Results:Thirty patients were transplanted (median age 9 years, 63.3% female). Most (96.7%) needed MCS, including 11 ECMO and 18 VAD. Thirty-day survival was 28/30 (93.5%, 95% CI 78-99). Acute rejection occurred in 3 (10%), infections in 4 (13.3%), AKI in 8 (26.7%), with two requiring CRRT, and neurologic complications in 3 (10.3%). Median ICU and hospital LOS were 20 and 37 days, respectively. ECMO patients had longer post-transplant ventilation (12 vs 6 days, p = 0.04) and ICU length of stay (LOS) compared to VAD patients. Total Ischemic time, and CPB times were associated with increased morbidity. Conclusions:Early outcomes after pediatric heart transplantation prove high short-term survival but substantial morbidity. ECMO bridging was associated with greater resource use than VAD. Improving donor heart ischemic time, donor-recipient matching, perioperative management, and early initiation of durable MCS may further improve outcomes.
Aim of the study: Short peripheral cannula (SPC)-related phlebitis occurs in 7.5% of critically ill patients, and mechanical irritation from cannula materials is a risk factor. Softer polyurethane cannulas reportedly reduce phlebitis, but the incidence of phlebitis may vary depending on the type of polyurethane. Differences in cannula stiffness may also affect the incidence of phlebitis; however, this relationship is not well understood. This study analyzed intensive care unit (ICU) patient data to compare the incidence of phlebitis across different cannula products, focusing on polyurethane. Material and Methods: This is a post-hoc analysis of the AMOR-VENUS study that involved 23 ICUs in Japan. We included patients aged ≥ 18 years, who were admitted to the ICU with SPCs. The primary outcome was phlebitis, evaluated using hazard ratios (HRs) and 95% confidence intervals (CIs). Based on the market share and differences in synthesis, polyurethanes were categorized into PEU-Vialon® (BD, USA), SuperCath® (Medikit, Japan), and other polyurethanes; non-polyurethane materials were also analyzed. Multivariable marginal Cox regression analysis was performed using other polyurethanes as a reference. Results: In total, 1,355 patients and 3,429 SPCs were evaluated. Among polyurethane cannulas, 1,087 (33.5%) were PEU-Vialon®, 702 (21.6%) were SuperCath®, and 276 (8.5%) were other polyurethanes. Among non-polyurethane cannulas, 1,292 (39.8%) were ethylene tetrafluoroethylene (ETFE) cannulas, and 72 (2.2%) used other materials. The highest incidence of phlebitis was observed with SuperCath® (13.1%). Multivariate analysis revealed an HR of 1.45 (95% CI 0.75-2.8, p = 0.21) for PEU-Vialon®, 2.60 (95% CI 1.35-5.00, p 0.01) for SuperCath®, 2.29 (95% CI 1.19-4.42, p = 0.01) for ETFE, and 2.2 (95% CI 0.46-10.59, p = 0.32) for others. Conclusions: The incidence of phlebitis varied among polyurethane cannulas. Further research is warranted to determine the causes of these differences.
Background: Beta-blockers have been reported to exert potential beneficial effects in sepsis in recent years. However, their clinical application in sepsis remains limited due to concerns regarding hemodynamic impacts. This study aims to explore whether premorbid use of beta-blockers is associated with improvements in cardiac function and favorable clinical outcomes among patients with sepsis. Methods: This single-center, retrospective cohort study was conducted in the Intensive Care Unit (ICU) ofa university-affiliated hospital. All patients diagnosed with sepsis admitted between August 2022 and March 2024 were enrolled. Exclusion criteria included age < 18 years, hospitalization duration < 48 hours, a history of severe underlying cardiac conditions, and incomplete clinical records. Primary outcomes included myocardial injury markers, echocardiographic parameters, and electrocardiographic indices to assess cardiac function. Secondary outcome was mortality. Results: Among 1005 septic patients, 228 had received premorbid beta-blockers. No significant difference in baseline disease severity was observed between the two groups. Patients with premorbid beta-blocker exposure had lower levels of cardiac troponin I (TnI, 87.9 [IQR, 23.4-306.0] vs 142.0 [IQR, 37.8-481.2]), lactic dehydrogenase (LDH, 274.0 [IQR, 175.0-496.0] vs 319.0 [IQR, 229.0-456.8]), and B-type natriuretic peptide (BNP, 267.9 [IQR, 118.1-1065.1] vs 509.3 [IQR, 184.8-1203.0]). Echocardiographic assessments revealed that premorbid beta-blockers were associated with a higher left ventricular ejection fraction (LVEF, 58% [IQR 52-60] vs 55% [IQR 50-60]). Additionally, premorbid beta-blockers were linked to lower 14-day (13.6% [IQR 9.1-18.1] vs 21.5% [IQR 18.6-24.4]), 28-day (17.5% [IQR 12.6-22.5] vs 27.4% [IQR 24.3-30.6]), and in-hospital (18.9% [IQR 13.7-24.0] vs 28.8% [IQR 25.6-32.0]) mortality rates. Conclusions: Among septic patients, premorbid beta-blockers are associated with preserved cardiac function and improved clinical outcomes. These findings highlight the need for prospective or randomized controlled trials to further explore the potential cardioprotective role of beta-blockers in sepsis.
Background: Acute kidney injury (AKI) is a common and serious complication in critically ill patients with non-kidney organ dysfunction. Early prediction of AKI is crucial for timely intervention and improved outcomes. This study aimed to identify readily available non-renal predictors of AKI and to develop an exploratory prediction model in a specific cohort of critically ill patients with COVID-19-related septic shock requiring mechanical ventilation. Materials and methods: This was a single-center, observational, retrospective cohort study conducted in the respiratory ICU of Hospital H+ Querétaro between April and December 2020. The study included 42 mechanically ventilated patients with septic shock secondary to SARS-CoV-2 infection and non-kidney organ dysfunction. AKI was defined using the KDIGO criteria. Trend analysis, bivariate and multivariate linear regression, were used to identify predictors of AKI and severe AKI. Results: AKI occurred in 23 (54.8%) patients, with 6 (14.3%) developing severe AKI. Trend analysis revealed differences in norepinephrine dose, hemoglobin, and lactate trends between groups. A simplified logistic regression model, validated internally with bootstrapping to prevent overfitting, identified a protective trend associated with higher hemoglobin levels on admission. Quantitative analysis of a forecasting model for daily renal function showed moderate predictive accuracy. Conclusions: This study identified several readily available non-kidney organ dysfunction variables that can predict AKI and its severity in critically ill patients with COVID-19-related septic shock. These findings may help in the early identification of at-risk patients and facilitate timely interventions to potentially improve outcomes. Further validation in larger and more diverse populations is warranted.
Introduction: Managing fluid balance in COVID-19 patients can be challenging, particularly if acute kidney injury (AKI) develops. Aim of the study: We study the relationship between fluid net input and output (FNIO) in COVID-19 patients with development of AKI, time to development of AKI, in-hospital length of stay (LOS), and in-hospital mortality. Material and Methods: Retrospective study of 403 patients with COVID-19. Data for FNIO were from day 1 through day 10 or earlier if AKI occurred. Results: AKI occurred in 22.8%, in-hospital mortality occurred in 26.3%, mean days to AKI were 7.7 (SD=6.3), and mean LOS was 11.5 (SD=13.2) days. In the multivariate logistic regression analyses, increased FNIO mean was significantly associated with slightly increased odds for mortality (OR=1.001, 95% CI:1.0001, 1.0011, p=0.02) but was not significantly associated with AKI. In the multivariate linear regression analyses, increased FNIO mean was significantly associated with lesser days to AKI (B=-6.63*10-5, SE=<0.001, p=0.003) in the whole sample, greater days to AKI in the subset of those with ICU treatment (B=<0.001, SE=<0.001, p<0.001), while FNIO mean was not significantly associated with LOS. Conclusions: Positive fluid balance was associated with faster onset of AKI and increased mortality. Fluid administration in patients with COVID-19 should be guided by routinely measuring FNIO. A restrictive fluid management regimen rather than usual care should be practiced.
Background:Advanced heart failure remains a leading cause of morbidity and mortality worldwide, with limited access to transplantation, particularly in Eastern Europe. Left ventricular assist device therapy offers improved survival and quality of life for end-stage disease. HeartMate 3, a modern form of mechanical circulatory support, is used as bridge-to-transplant or destination therapy. Despite increasing global experience with the HeartMate 3, clinical data from Romanian centers remain scarce. This study aimed to assess early clinical outcomes, postoperative complications, and quality of life after HeartMate 3 implantation at a single cardiovascular surgery center in Romania. Materials and methods:We conducted a retrospective observational cohort study including 13 patients with Advanced heart failure who underwent HeartMate 3 implantation between September 2023 and March 2025. Preoperative variables (demographics, comorbidities, INTERMACS profile, EuroSCORE II, echocardiographic findings) and postoperative outcomes were analyzed. Quality of life was assessed in 10 surviving patients using a 16-item structured telephone questionnaire addressing physical function, autonomy, social reintegration, and psychological well-being. Results:The cohort was predominantly male (84.6%); mean age 47.2 ± 12.3 years. Implant strategy: bridge-to-transplant 76.9%, destination therapy 23.1%. Early mortality was 23.1% (n = 3), occurring primarily in patients with EuroSCORE II >8% and INTERMACS I-II. The most frequent postoperative complications were significant perioperative bleeding (61.5%) and right ventricular failure (23.1%). Among survivors, all reported improved mobility, greater independence in activities of daily living, and better social reintegration; 7/10 rated overall quality of life as good or excellent. Psychological distress was frequent early after surgery but showed progressive improvement over time. Conclusions:HeartMate 3 implantation resulted in favorable early clinical outcomes and significant improvements in quality of life, aligning with international data. Optimizing outcomes with left ventricular assist device therapy relies on timely referral, rigorous patient selection, and comprehensive postoperative management, including psychological and social support.
A 47-year-old male with type 2 diabetes on metformin and hypertension presented with profound hypoxemia, severe metabolic acidosis (pH unrecordable, lactate 17 mmol/L), and progressive cardiac dysfunction in the setting of presumed sepsis. Despite maximal conventional therapy-including mechanical ventilation, broad-spectrum antimicrobials, and high-dose vasopressors-the patient developed refractory shock and multi-organ dysfunction. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) was initiated on hospital day 2 as hemodynamic bridge support, combined with continuous renal replacement therapy (CRRT). This intervention facilitated stabilization of hemodynamics, correction of acidosis, and improvement in organ function. The patient was successfully decannulated and survived to discharge, though with residual cardiomyopathy. Lactic acidosis in this case was likely multifactorial, with metformin exposure as one potential contributor amid acute kidney injury, hypoperfusion, and possible septic elements. This report describes the use of VA-ECMO as supportive therapy in a complex, refractory critical illness scenario, highlighting the importance of timely multidisciplinary escalation while emphasizing diagnostic challenges in attributing causality and the need for cautious patient selection in such high-risk interventions.
Introduction: Post-operative heart failure following cardiac surgery carries risk and can impact patient outcomes. Preoperative echocardiography can be useful for stratifying risk. Although there has been a historical focus on left ventricular ejection fraction (LVEF), the importance of left ventricular (LV) size, as measured by left ventricle end-diastolic diameter (LVEDD), may be an underappreciated echocardiographic factor which can help predict risk in patients undergoing cardiac surgery. Aim of the study: To investigate the association between LVEF and LVEDD with inotrope use, inotrope duration, and intensive care unit (ICU) length of stay (LOS) in patients undergoing cardiac surgery. Materials and methods: Retrospective cohort study including 2,965 adult patients undergoing non-emergent cardiac surgery at a single academic institution between February 2017 and October 2021. Primary outcomes were the use of inotropes and duration of inotrope therapy. The secondary outcome was ICU LOS. Results: In adjusted analyses, a one standard deviation increase in LVEF was associated with decreased odds of inotrope initiation (OR 0.45, 95% CI: 0.41 to 0.50; P < 0.001), while a one standard deviation increase in LVEDD was associated with increased odds of receiving inotropes (OR 1.18, 95% CI: 1.07 to 1.31; P = 0.001). Among those receiving inotropes, a one standard deviation increase in LVEF was associated with a 25% decrease in inotrope hours in adjusted analyses (0.75, 95% CI: 0.68 to 0.82; P < 0.001). An interaction was observed such that LVEDD modified the association between LVEF and ICU LOS (0.98, 95% CI: 0.95 to 0.99; P = 0.03). Conclusions: Preoperative LVEDD, particularly when combined with LVEF, can predict risk after cardiac surgery.
Aims: To determine the effect of administering oral protein and carbohydrate solutions the C-Reactive Protein (CRP), Interleukin-6 (IL-6), and Neutrophil-Lymphocyte Ratio (NLR) in patients planned any surgery Methods: a double-blind, randomized clinical study, at Ulin Regional Hospital, Banjarmasin with patients planned any surgery. This research had 80 patients in total (40 subjects in the control group and 40 subjects in the intervention group). Before surgery, 200 mL of a protein and carbohydrate solution per oral was given to the intervention group, while a placebo was given to the control group. Twenty-four hours after surgery, each subject’s levels of CRP, IL-6 and NLR were measured. Statistical Package for the Social Sciences Version 29 was used to analyze the data. Results: NLR at 24 hours postoperatively in the intervention group was lower than in the control group, but not statistically different (8.65±4.33 vs. 7.86±4.65, p=0.308). The IL-6 level at 24 hours postoperatively in the intervention group was significantly lower than in the control group (9.49 (6.03-22.65) vs. 20.08 (11.64-50.11), p=0.011). Although not statistically different, the CRP level at 24 hours postoperatively in the intervention group was lower than in the control group (15.10 (7.20-41.60) vs. 34.70 (11.87-71.55), p=0.056). There was no difference in postoperative nausea or vomiting between the two groups. Conclusion: Postoperative interleukin-6 levels have been demonstrated to decrease when oral protein and carbohydrate solutions are given to patients undergoing surgery; however, NLR and CRP levels have not been seen to decrease.
Background:This study aimed to evaluate the prognostic value of key admission biomarkers in predicting mortality among hospitalized COVID-19 patients and to establish optimal cut-off thresholds for clinical decision-making. Methods:Retrospective cohort study included 269 COVID-19 patients treated at Thu Duc City Hospital, Vietnam, during the peak of the fourth pandemic wave in 2021. Logistic regression identified independent predictors of mortality, and receiver operating characteristic (ROC) curve analysis assessed the diagnostic performance of biomarkers. The area under the ROC curve (AUROC), Sensitivity, Specificity and Accuracy Index were used to determine optimal cut-off values. Results:Among the 269 patients, 53 (19.7%) died and 216 (80.3%) survived. Non-survivors exhibited elevated D-dimer (4.48 μg/mL vs 0.93 μg/mL, p < 0.0001), neutrophil counts (6.8 × 109/L vs 3.5 × 109/L, p < 0.0001) and white blood cell counts (11.68 × 109/L vs. 7.87 × 109/L, p < 0.0001). Lymphocyte counts and fibrinogen levels were significantly lower in non-survivors (p < 0.05). Logistic regression identified D-dimer (OR = 1.05, 95% CI: 1.02-1.09, p = 0.001), neutrophil counts (OR = 1.32, 95% CI: 1.10-1.63, p = 0.005) and lymphocyte counts (OR = 0.51, 95% CI: 0.26-0.92, p = 0.033) as significant predictors of mortality. ROC analysis revealed that D-dimer (AUROC = 0.809) and neutrophil counts (AUROC = 0.726) demonstrated strong discriminatory power, with cut-off values of ≥1.126 μg/mL (sensitivity = 90.57%, specificity = 60.19%) and ≥6.715 × 109/L (sensitivity = 52.83%, specificity = 82.87%), respectively. Conclusion:These findings support the use of admission biomarkers to guide early interventions and improve patient outcomes in severe COVID-19 cases. Further studies are warranted to validate these results and explore their applicability in other settings.
Introduction:Severe COVID-19 is known to cause kidney injury via ACE2-mediated mechanisms, inflammation, and microvascular damage potentially leading to long-term renal impairment. Critically ill patients are particularly vulnerable to muscle loss and sarcopenia due to immobility, poor nutrition, and cytokine storm-induced catabolism. Post-COVID-19 syndrome often includes fatigue, muscle weakness, and reduced quality of life, yet evidence on long-term outcomes remains limited. This study evaluated kidney function, sarcopenia risk, and quality of life 12 months after intensive care unit (ICU) discharge in patients without pre-existing chronic kidney disease (CKD). Methods:This retrospective observational cohort included 82 patients without CKD admitted to the ICU between February 2020 and April 2022 who recovered from severe COVID-19. Data collected included serum creatinine, estimated glomerular filtration rate (eGFR), and sarcopenia risk assessed via the SARC-CalF (SARC-F combined with calf circumference). Functional outcomes were assessed by SF-36, pain by a Visual Analog Scale (VAS), and lower limb strength by the 30-second sit-to-stand test. Results:The mean age was 52 ± 12 years; 90% were male, 46% had hypertension, and 31% diabetes. At 12 months, patients showed low functional scores (SF-36: 47 ± 21), high pain prevalence (VAS: 57%), reduced lower limb strength (sit-to-stand: 8 ± 5 repetitions), and high sarcopenia risk (SARC-F: 46%). Higher sarcopenia scores correlated with poorer physical functioning (r = -0.60; p < 0.001) and greater pain (r = -0.44; p < 0.001). In 49 patients without hypertension, diabetes, or prior acute kidney injury (AKI), creatinine significantly increased (0.95 ± 0.2 to 1.10 ± 0.2 mg/dL; p = 0.007) and eGFR significantly declined (87 ± 22 to 77 ± 18 mL/min; p = 0.001), representing a mean reduction of 10 mL/min. Conclusion:Critically ill COVID-19 survivors experienced significant declines in kidney function, muscle strength, and functional capacity, alongside increased pain 12 months post-ICU discharge. These results underscore the need for multidisciplinary follow-up, incorporating nephrology, physiotherapy, and nutritional support.
Background: Accurate measurement of serum creatinine (SCr) is critical in estimating glomerular filtration rate (eGFR) and classifying kidney function. This study evaluated the analytical differences between the enzymatic and Jaffe methods for SCr measurement and their impact on eGFR estimation using two widely applied equations: CKD-EPI and EKFC. Methods: The study included 427 patients over 40 years old. SCr was measured using both enzymatic and Jaffe methods on the Alinity c platform. eGFR was calculated with the CKD-EPI (2009) and EKFC equations. Agreement between methods was assessed using Bland-Altman and Passing-Bablok regression. eGFR differences were analyzed using the Wilcoxon signed-rank test and multiple linear regression. Agreement in GFR category classification was evaluated using weighted kappa and Kendall’s tau. Results: While the mean difference between methods was small, both systematic and proportional biases were statistically significant. eGFR values differed significantly between methods in both sexes (p 0.01), regardless of the equation used. ΔeGFR was significantly associated with SCr values, but not with age. Although overall agreement in GFR categories was high (kappa > 0.91), method-dependent reclassification of patients was observed, which may influence CKD diagnosis and clinical decision-making. Conclusions: Even minor analytical differences between enzymatic and Jaffe SCr measurements can lead to clinically relevant discrepancies in GFR categorization. These findings highlight the need for harmonization in laboratory methods to ensure consistent reporting and patient management.
Introduction: Early risk stratification of critically ill patients is essential for optimizing intensive care unit (ICU) resource allocation and treatment decisions. Urinary liver-type fatty acid-binding protein (L-FABP) is a simple, noninvasive biomarker that may provide real-time information on organ dysfunction. However, its prognostic utility in patients admitted to the ICU from the emergency department remains unclear. Aim of the study: The aim of this study was to evaluate the prognostic value of L-FABP levels measured shortly after ICU admission in predicting 28-day mortality among patients admitted from the emergency department. Methods: This single-center retrospective observational study included patients admitted to the ICU between December 2020 and August 2022. Urinary L-FABP concentrations were measured at ICU admission (T0) and 3 hours later (T3). The primary outcome was 28-day in-hospital mortality. Prognostic performance was assessed using receiver operating characteristic curves and Cox proportional hazards models with inverse probability of treatment weighting. Results were compared with Acute Physiology and Chronic Health Evaluation (APACHE) II, Sequential Organ Failure Assessment (SOFA) scores, and lactate levels. Results: Data of 118 patients were included in the final analysis. Urinary L-FABP levels at T3 showed the highest AUC for predicting 28-day mortality (area under the curve [AUC] = 0.873), compared with APACHE II (AUC = 0.801), SOFA (AUC = 0.753), and the lactate level (AUC = 0.734). An elevated L-FABP (T3) level was independently associated with increased mortality (hazard ratio [HR] = 8.60, 95% confidence interval [CI]: 1.02-72.64, P = 0.047). The T3/T0 ratio showed only modest predictive value (AUC = 0.623). Conclusions: Urinary L-FABP levels measured 3 hours after ICU admission were an independent predictor of shortterm mortality. The marker's simplicity and bedside applicability suggest its potential utility not only in ICUs but also in emergency departments and triage decision-making.
Background: The prognostic abilities of malnutrition assessment tools for the critically ill are still controversial. This study aimed to assess the predictive ability of MUST, NRS-2002, and NUTRIC tools to predict malnutrition risk for enterally fed, mechanically ventilated patients in intensive care. Methods: In a multicenter, prospective, observational study, patients from five ICU units in Jordan were observed at two stages. During the first 24 hours of admission, MUST, NUTRIC, and NRS-2002 scores were obtained in addition to the demographic and admission characteristics. In the assessment stage, on day 6th of admission forward, the Bioelectrical Impedance Analysis (BIA), including body compositions and Phase Angle (PhA) were assessed. Machine Learning (ML), structural equation modeling (SEM), and area under the curve (AUC) were used for measuring malnutrition estimates. Results: A total of 709 patients were observed. At admission, NUTRIC, MUST, and NRS-2002 were congruent in identifying high malnutrition risk (45.1%, 46.4%, and 53.6%, respectively). In reference to PhA, MUST and NRS-2002 scored higher for sensitivity (77.6%, and 76.8%, respectively) and specificity (93.3%, and 90.7%, respectively). They reported acceptable correlation estimates by SEM (0.65, and 0.70, respectively), and ML (0.90, and 0.91, respectively). Further, MUST was the best to discriminate malnutrition, followed by NRS-2002 and NUTRIC (AUC= 0.76, 0.64, and 0.53, respectively). Conclusions: Alongside validated BIA technology, MUST and NRS-2002 functioned as reliable prognostic indicators of malnutrition risk in the ICU.
Introduction: Sepsis, a critical topic in the medical field, remains one of the deadliest pathologies in intensive care units. It involves an overzealous immune system, with a hyperinflammatory phase that overlaps with a subsequent hypoinflammatory phase. Aim of the study: To ease the burden on medical systems, this study aimed to assess the predictive value of clini-cal severity scores (Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and the Simplified Acute Physiology Score II (SAPS II)) and inflammatory biomarkers (neutrophile-to-lymphocyte-to-monocyte ratio (NLMR), and platelet-to-lymphocyte ratio (PLR), carboxyhemoglobin (COHb) and ferritin) in predicting outcomes of critically ill intensive care unit (ICU) patients. Material and methods: This prospective, observational study included 101critically ill patients, for whom we as-sessed the parameters on the first and fifth days after confirmation of either sepsis or septic shock in ICU, according to the Sepsis-3 Consensus. Results: Severity scores showed significant correlations on both day 1 and day 5 across all groups. APACHE II and SAPS II correlated with ferritin on day 5 in sepsis, septic shock, and non-survivors. The severity scores correlated with COHb on day 5 in survivors, and on day 1 in non-survivors. NLMR and PLR correlated consistently across groups, with additional associations between these ratios, ferritin, and COHb, particularly in non-survivors. Regarding mortality, NLMR on day 1 showed only modest predictive value, which declined to non-significant by day 5. In contrast, the SOFA, APACHE II, and SAPS II scores demonstrated good discriminatory ability on both days, confirming their strong and reliable performance in predicting mortality. Conclusions: The study shows that simple cellular ratios and severity scores correlate with ferritin, COHb, and each other, reflecting inflammation, oxidative stress, and organ dysfunction in sepsis. Because these markers are inexpen-sive and easy to monitor, they may enhance bedside risk stratification, though broader prospective studies are still required.
Objective: Is there a place for non-technical skills training in the ICU? And what teaching strategy should we implement in this process? This narrative review analyzes the benefits of teaching ethics in the ICU environment by applying high-fidelity simulation scenarios to real-life situations, thereby improving communication, moral reasoning, self-reliance, cooperation, and perceptual skills. Methods: In the literature, there are few publications on the training of ICU residents in non-technical skills and ethical dilemmas using high-fidelity simulations. After searching and scoping the database, we have identified 8 publications relevant to this narrative review. Results: In the reviewed studies, the main topics discussed and rehearsed using simulations were as follows: communicating an adverse event during anesthesia in one study, delivering bad news in two studies, the ethics of end-of-life care, and the do-not-resuscitate order in three studies, and ethical non-technical skills such as communications, teamwork and confidence in emergent real-life situations in four studies. Conclusions: Developing a more structured approach to teaching ethics-related events is important, particularly in critical care settings. All reviewed studies reached the same conclusion: high-fidelity simulation training is an educational strategy for ICU residents to develop a foundation in ethical considerations and moral reasoning by improving ethical non-technical skills, such as confidence, communication, teamwork, delivering bad news, and end-of-life care.
Introduction This is a unique case of fulminant respiratory failure secondary to a rare cause of rapidly progressing ILD; antisynthetase syndrome (ASS). Failure to deliver timely multi-modal treatment in these cases can lead to increased morbidity and mortality.Case presentation A previously healthy 27-year-old male presented to his local hospital with a 1-week history of malaise, shortness of breath and cough. Initial work up including bloods and imaging were suggestive of community acquired multi lobar pneumonia, for which he received treatment as per local guidelines. Unfortunately, despite broad empirical antimicrobial cover, he continued to deteriorate with worsening type-1 respiratory failure requiring intubation and subsequent institution of prone position ventilation. Extensive microbiological investigations yielded no positive results. On day 7 of admission immunological testing revealed an ENA screen positive for Jo-1 antibody and a diagnosis of ASS was made. Despite treatment with immunosuppression the patient's condition rapidly deteriorated and the decision to support with V-V ECMO was made following MDT consideration as there remained uncertainty as to the extent of reversibility of the underlying condition.Conclusions This patient recovered with combination of conventional immunosuppression, therapeutic plasma exchange and ECMO support. This case highlights Antisynthetase syndrome as a cause of reversible interstitial lung disease in the ICU and the importance of multi-disciplinary decision making and aggressive treatment approach in the management of such conditions.
Purpose:This narrative review aims to highlight the available evidence on fluid resuscitation in septic patients with heart failure, with a particular focus on heart failure with preserved ejection fraction. Methods:A PubMed search was conducted using the keywords "sepsis" (or sepsis, or septic shock), "heart failure" (or HF, or HFrEF, or HFpEF or congestive heart failure), and "fluid" (or resuscitation, or fluid resuscitation, or fluid management). The results were summarized in narrative review format. Results/Conclusions:The presence of HFpEF in septic patients appears to be associated with an increased risk of adverse outcomes. This population may benefit from a more individualized approach to fluid resuscitation. Emerging tools for assessing fluid responsiveness and characterizing septic cardiovascular physiology show promise, but further investigation is needed.
