Background Pressure assist ventilation (PAV) is considered superior to pressure support ventilation (PSV). We performed an updated systematic review and meta‐analysis to evaluate comparative effectiveness in terms of weaning outcomes. Methods We searched PubMed, Embase, and Cochrane for eligible randomized controlled trials (RCTs) published before October 2025 that directly compared clinical outcomes of PAV and PSV in mechanically ventilated adults. R program was used to calculate risk ratio (RR) and mean difference (MD) with 95% confidence intervals (CIs). Results After screening the titles, abstracts, and full texts, we included eight RCTs consisting of 1057 patients in our systematic review and meta‐analysis. PAV was associated with a higher rate of weaning success as compared to PSV (RR: 1.09; 95% CI, 1.01–1.18; p = 0.03; I 2 = 23%). PAV was associated with a lesser duration of ventilation (MD: −1.06; 95% CI, −1.82 to −0.29, p = 0.006; I 2 = 0%) and intensive care unit (ICU) stay (MD: −1.49; 95% CI: −2.43 to −0.54, p = 0.002; I 2 = 25%) as compared to PSV. However, no statistically significant benefit was observed for PAV over PSV with regard to rate of reintubation (RR: 0.82; 95%, CI: 0.58–1.16, p = 0.21, I 2 = 0%) and mortality (RR: 0.89; 95% CI: 0.63–1.25 p = 0.4 I 2 = 30%). Conclusion PAV is superior to PSV for weaning, showing increased success and shorter duration of ventilation and ICU stays, though reintubation and mortality rates were similar.
Right ventricular (RV) dysfunction is common in critical illness, yet RV afterload cannot be adequately characterized by pulmonary artery systolic pressure (PASP) alone. Bedside echocardiography can estimate right atrial and pulmonary artery pressures, suggest increased pulmonary vascular resistance, and assess RV–pulmonary arterial coupling while simultaneously evaluating RV size, systolic function, septal interaction, and forward flow. Peak tricuspid regurgitation velocity combined with right atrial pressure estimates RV systolic pressure and, in the absence of outflow obstruction, approximates PASP. Pulmonary regurgitation velocities provide complementary estimates of mean and end‐diastolic pulmonary artery pressure, whereas pulmonary artery acceleration time, RV outflow tract velocity–time integral, and systolic notching provide information regarding pulmonary vascular load and forward flow. A multiparametric assessment of RV systolic performance is essential because tricuspid annular plane systolic excursion, tissue Doppler systolic velocity, fractional area change, RV free‐wall strain, and three‐dimensional RV ejection fraction assess different aspects of contraction. The tricuspid annular plane systolic excursion/PASP ratio relates longitudinal systolic performance to pulmonary pressure but remains a surrogate of coupling, without a universal intensive care threshold. These measurements depend on image quality, loading conditions, and ventilatory support and may differ substantially from invasive hemodynamics in individual patients. Their greatest value lies in integrated physiologic assessment and serial reassessment after treatment. Echocardiography complements right heart catheterization, which remains necessary when precise hemodynamic classification or measurement of pulmonary artery wedge pressure, cardiac output, or pulmonary vascular resistance will change management.
Background and Aims Neonates admitted to neonatal intensive care units (NICUs) are frequently exposed to multiple medications, increasing the risk of potential drug–drug interactions (pDDIs). However, the clinical impact of these interactions remains poorly understood in this population. This study aimed to evaluate the occurrence of pDDIs in critically ill neonates and their association with clinical outcomes and laboratory parameters. Methods This prospective cohort study included 365 neonates admitted to a NICU in Brazil between March 2023 and March 2024. Pharmacotherapy was monitored daily for the identification of pDDIs using the UpToDate database. Interactions were grouped according to their potential clinical outcomes and analyzed for their association with clinical and laboratory parameters. The evaluated parameters included heart rate, respiratory rate, blood pressure, creatinine clearance, urine output, and blood urea nitrogen. Results A total of 255 neonates (69.9%) experienced at least one pDDI, most of which were classified as risk category C (88.0%). The most frequent mechanisms of pDDIs were associated with heart rate changes (27.4%), nephrotoxicity (18.3%), central nervous system (CNS) depression (14.8%), and hypotension (14.8%). Neonates with pDDIs associated with heart rate changes had higher heart rates (158.1 ± 16.7 vs. 148.7 ± 17.0 bpm; p < 0.001). Nephrotoxic pDDIs were associated with reduced creatinine clearance (14.4 ± 13.5 vs. 25.8 ± 18.2 mL/min/1.73 m 2 ; p < 0.001) and higher blood urea nitrogen levels (52.9 ± 36.2 vs. 27.6 ± 24.4 mg/dL; p < 0.001). pDDIs associated with hypotension significantly reduced mean arterial pressure (51.1 ± 11.5 vs. 58.3 ± 11.8 mmHg; p < 0.001). Conclusion pDDIs are frequent in NICUs and are associated with clinically relevant changes, particularly those involving an increased risk of higher heart rates, renal impairment, and hypotension.
Aim:The aim of this study is to determine the predictive power of the National Early Warning Score in identifying the outcomes of intensive care unit (ICU) patients. Methods:In this study, 300 patients hospitalized in the ICUs (medical and general) of two teaching hospitals affiliated with Tehran University of Medical Sciences were evaluated and followed up for 30 days between June 2023 and April 2024. The samples were selected by convenience sampling based on inclusion criteria. A checklist containing the components of early warning criteria introduced by Braden, SOFA and APACHE II, as well as outcomes of hospitalization in the ward, was used. The early warning criteria were assessed by the researcher at the time of admission, as well as 6 and 24 h after the admission of patients to ICU. The collected data were analysed by SPSS-27 and STATA-14 software using Kruskal-Wallis, Pearson and chi-square tests, as well as the area under the receiver operating characteristic (ROC) curve of early warning system. Results:The mean age of patients was 41 years (31-56), and 63.70% of them were male. Comparison of the area under the ROC curve of early warning tool showed that the early warning score in predicting death at the time of admission, 6 h after admission and 24 h after admission was 0.697, 0.712 and 0.87, respectively. Also, this score in predicting adverse outcomes at the time of admission, 6 h after admission and 24 h after admission was 0.700, 0.784 and 0.936, respectively. In other words, the early warning system had a good predictive power in indicating the occurrence of outcomes at all three times (at admission, 6 hours after admission and 24 h after admission), but the best time to predict death and adverse outcomes was estimated to be 24 h after admission. Conclusion:By evaluating the predictive power of early warning score in identifying the outcomes of patients hospitalized in ICUs, we found that the early warning score at 24 h after admission had a higher predictive power than other times.
Background:Physicians and nurses working in intensive care units (ICUs) are frequently exposed to emotionally demanding and high-stress situations, placing them at increased risk for anxiety. Eye movement desensitization and reprocessing (EMDR) has shown promise in reducing anxiety in various high-stress populations; however, its effectiveness among ICU staff remains underexplored. Objective:To evaluate the efficacy of EMDR in reducing anxiety severity among ICU physicians and nurses. Methods:This quasi-experimental study was conducted among 60 ICU staff members who were allocated to either an EMDR intervention group (n = 30) or a control group (n = 30). Anxiety severity was assessed using the Beck Anxiety Inventory (BAI) at baseline and post-intervention. The EMDR protocol consisted of eight sessions delivered twice weekly. Data were analyzed using paired t-tests and ANCOVA controlling for baseline anxiety. Internal consistency of the BAI was assessed using Cronbach's alpha. Results:All participants completed the study with no dropouts. Baseline characteristics were comparable between groups. The EMDR group showed a significant reduction in anxiety from baseline to post-intervention (p < 0.01), whereas the control group showed no significant change. ANCOVA revealed a significant effect of EMDR on post-intervention anxiety scores (F(1,57) = 4.21, p = 0.045). Cronbach's alpha for the BAI in this sample was 0.89. Conclusion:EMDR significantly reduced anxiety among ICU physicians and nurses. Given the high emotional burden in critical care settings, EMDR may be a valuable component of mental health support programs for healthcare professionals. Further randomized controlled trials with long-term follow-up are recommended.
