Organ shortages remain a critical global challenge, and extracorporeal membrane oxygenation (ECMO) has emerged as a potential strategy to preserve organ perfusion and expand the donation after brain death (DBD) donor pool. In regions where donation after circulatory death (DCD) is not legally permitted, maximizing DBD donor utilization carries particular clinical and policy importance. However, evidence regarding organ-specific recovery rates and post-transplant graft outcomes in ECMO-supported DBD donors remains limited and heterogeneous. We conducted a two-center retrospective cohort study of all consecutive brain-dead organ donors managed at two tertiary referral centers between January 2012 and June 2025. Donors were stratified by ECMO exposure prior to organ procurement. Primary outcomes were organ-specific recovery rates and the number of organs recovered per donor. Kaplan–Meier analysis with log-rank testing was used to evaluate post-transplant recipient survival stratified by donor ECMO exposure and organ type. Of 210 donors (ECMO n=25, non-ECMO n=185), baseline demographics and cause of brain death were broadly comparable, although ECMO donors more frequently had antecedent cardiac arrest (76.0
Patients requiring prolonged mechanical ventilation (PMV) after tracheostomy represent a severely deconditioned population with high mortality and substantial healthcare burden. Weaning outcomes vary widely across centers, and evidence supporting standardized protocol in dedicated rehabilitation settings remains limited. We conducted a prospective, single-arm interventional trial at a specialized weaning unit (SWU) of a tertiary rehabilitation hospital. From January 2025 to October 2025, consecutive tracheostomized PMV patients were enrolled and managed with a standardized stepwise weaning protocol integrating spontaneous breathing trials, high-flow oxygen therapy, and noninvasive ventilator. The primary outcome was the 60-day weaning success rate, which was tested against a pre-specified historical benchmark (p₀ = 65 https://jianghongying.shinyapps.io/Weaning-for-PMV/ . A standardized weaning protocol delivered in a dedicated rehabilitation unit was associated with a 60-day weaning success rate that exceeded a pre-specified historical benchmark in PMV patients. The individualized calculated weaning score identifies clinical phenotypes for individualized decision-making; the accompanying web-based calculator is provided as an exploratory research tool and warrants external validation before any routine clinical application. ClinicalTrials.gov, NCT06642714.
Lung-protective ventilation (LPV) reduces mortality in ARDS, but adherence remains incomplete and women and shorter patients disproportionately receive tidal volumes above predicted-body-weight (PBW)-based targets. The relative associations of recorded sex and body height with this disparity remain uncertain. Retrospective single-centre cohort study (January 2013 to December 2023, RWTH Aachen University Hospital surgical ICU). Adults (≥ 18 years) with Berlin-definition ARDS receiving mechanical ventilation for ≥ 72 h were included. Patient-level adherence to lung-protective targets was described, and repeated-measure PBW-normalised tidal volume and mechanical power were analysed with linear mixed-effects models containing a patient-level random intercept and fixed effects for recorded sex, centred recorded height, age, BMI, SAPS II, SOFA, ARDS aetiology, linear relative ICU day and the lowest same-day PaO₂/FiO₂ ratio. Among 798 adults (263 women [33.0
Sepsis remains a major cause of morbidity and mortality, yet current strategies for identifying susceptible individuals provide limited discriminatory performance. Although serum uric acid (SUA) and gout have been implicated in inflammatory and immune dysregulation, the associations of clinical urate phenotypes with incident sepsis risk and prognosis remain incompletely understood. A prospective cohort analysis was conducted using UK Biobank data including 466,611 participants, in which clinical urate phenotypes (normal uric acid, asymptomatic HUA, and gout) were evaluated as primary exposures, with SUA quartiles and separate HUA and gout status analyses used as alternative exposure definitions, using multivariable Cox proportional hazards models, restricted cubic spline analyses, subgroup analyses, and sensitivity analyses including Fine-Gray competing-risk models. During a median follow-up of 14.53 years, 16,210 incident sepsis cases were identified. Compared with the normal uric acid group, asymptomatic HUA and gout were associated with higher sepsis risk after full adjustment, with HRs of 1.31 (95
Abstract Background Prognostic assessment at continuous kidney replacement therapy (CKRT) initiation remains challenging in ICU practice. CKRT recipients are heterogeneous; most have acute kidney injury (AKI), whereas a clinically important subset has end-stage kidney disease (ESKD). We evaluated whether pre-CKRT urine output in AKI and dialysis vintage in ESKD were associated with short-term prognosis after CKRT initiation. Methods We conducted a single-center retrospective cohort study of consecutive adults who started CKRT in a combined medical–surgical ICU between 2012 and 2021. Patients were classified at CKRT initiation as ESKD, oliguric AKI, or non-oliguric AKI. ESKD was defined as maintenance hemodialysis or peritoneal dialysis before ICU admission. Among patients with AKI, oliguric and non-oliguric AKI were defined as pre-CKRT urine output <0.5 and ≥0.5 mL/kg/h, respectively. The primary outcome was time to all-cause death within 90 days after CKRT initiation. We used Cox proportional hazards models adjusted for prespecified covariates measured at CKRT initiation. Within ESKD, we modeled dialysis vintage as a continuous variable using Cox models adjusted for APACHE II score and sepsis. Results Among 560 patients, 66 had ESKD, 305 had oliguric AKI, and 189 had non-oliguric AKI. Documented death within 90 days occurred in 236 patients (42.1%). Using ESKD as the reference, oliguric AKI was not associated with a different hazard of death within 90 days (adjusted hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.58–1.29), whereas non-oliguric AKI was associated with a lower hazard (adjusted HR, 0.63; 95% CI 0.41–0.99). Among patients with ESKD, longer dialysis vintage was associated with a higher hazard of death within 90 days (adjusted HR per 1-year increase, 1.07; 95% CI 1.02–1.11). Conclusions In ICU patients starting CKRT, pre-CKRT urine output in AKI and dialysis vintage in ESKD were associated with short-term prognosis. Non-oliguric AKI was associated with a lower adjusted hazard of death than ESKD, and longer dialysis vintage was associated with a higher hazard of death within ESKD. These findings require external validation in contemporary multicenter cohorts.
BACKGROUND:This study examined the relationship between operating room nurses' attitudes toward evidence-based nursing and their practices for preventing surgical site infections. METHOD:This descriptive correlational study was conducted in the operating rooms of two hospitals in Turkey. Of the 150 nurses in the target population, 109 voluntarily participated. Data were collected between January and May 2025 using the Evidence-Based Nursing Attitude Questionnaire and the Nursing Practices for the Prevention of Surgical Site Infection Scale. RESULTS:Nurses showed positive attitudes toward evidence-based nursing and high levels of surgical site infection prevention practices. A strong positive association was identified between attitudes and practices (r ≈ 0.80; p < .001). CONCLUSION:Positive attitudes toward evidence-based nursing were strongly associated with higher surgical site infection prevention practices, underscoring the importance of ongoing professional learning in operating room settings.
BACKGROUND:Venous thromboembolism (VTE) causes preventable harm, and risk-appropriate prophylaxis administration is often suboptimal because of inconsistent practices and gaps in knowledge. The authors disseminated a validated web-based interactive nurse education module on VTE prevention and evaluated nurses' perspectives. METHOD:A descriptive cross-sectional electronic post-education survey of trauma nurses was conducted at nine Level I to II centers in the Consortium of Leaders in the study Of Traumatic Thromboembolism (CLOTT) Network. Data were summarized descriptively and with conventional content analysis. RESULTS:Of 922 participants, 817 completed the post-education survey (88.6% response rate). A high proportion of positive ratings were received for applicability (96%), communication (95%), appropriateness (92%), engagement (87%), satisfaction (78%), and preference over other online clinical education modules (77%). Qualitatively, 53.7% responded positively (appropriateness and satisfaction), whereas 40.7% responded negatively (technology and variation in institutional electronic systems). CONCLUSION:Nurses rated the module as applicable to bedside practice. Feedback highlighted role-specific relevance and realistic scenarios and identified cross-site technology and workflow fit as considerations for broader dissemination.
BACKGROUND:Transgender and gender-diverse (TGD) individuals experience stigma and discrimination that contribute to health inequities. Many health care providers receive limited education on TGD-specific care. This study evaluated the impact of a trauma-informed digital storytelling (DST) continuing education (CE) module on health care professionals' attitudes, beliefs, and comfort regarding the care of TGD individuals. METHOD:A single-group pre-post study design was conducted with clinicians and allied health staff in a regional health system (n = 154). Participants completed the Transgender Attitudes and Beliefs Scale (TABS) before and after a 1-hour asynchronous module featuring digital stories from TGD individuals and a parent of a TGD child, plus open-ended reflections. RESULTS:Statistically significant improvements were observed in Interpersonal Conflict (median increase = 2.5), Sex/Gender Beliefs (median increase = 2.0), and total TABS scores (median increase = 4.5; all p < .001). CONCLUSION:Trauma-informed DST-based CE is feasible and may promote reflective learning and more inclusive attitudes toward TGD patient care.
BACKGROUND:Suicide is one of the leading causes of death among adolescents in the United States, highlighting the importance of early identification of suicide risk in health care settings. The Ask Suicide-Screening Questions (ASQ) instrument is a validated screening tool designed to identify suicide risk in pediatric populations. METHOD:A quality improvement project was conducted to develop and implement a standardized clinical workflow to support staff in the administration of the ASQ screening tool and improve screening compliance in an outpatient adolescent medicine clinic. The goal of the project was to increase screening compliance to 95% of eligible patients within 8 weeks of implementation. The interventions included implementing a clinical workflow and providing staff education. DISCUSSION:Screening compliance improved after implementation of the workflow and staff education, indicating that standardized processes and clear clinical guidance can improve adherence to suicide screening practices. CONCLUSION:These findings support the use of structured workflows and staff training to enhance suicide risk screening in outpatient pediatric settings.
BACKGROUND:Traditional educational methods often require protected time away from clinical duties, can be difficult to attend because of staffing or scheduling constraints, and may not consistently engage learners or meet individual learning needs. This article describes a gamified in situ microlearning approach to nursing professional development within the clinical practice setting that was designed to improve confidence and knowledge retention while maintaining staff satisfaction. METHOD:The educational intervention was provided in the clinical setting to avoid scheduling conflicts and interruptions in care. RESULTS:Education on 18 topics was provided over 12 months. The gamified microlearning was associated with increased self-reported confidence without negatively impacting satisfaction. CONCLUSION:Gamified in situ microlearning can serve as a valuable adjunct to nursing professional development.
BACKGROUND:The Certified Nurse Educator (CNE®) credential highlights competency in nursing education and is part of continuing education and professional development for nurse educators. There is limited research on the relationship between CNE certification and teaching, service, and scholarship (TSS). This pilot study explored the relationship of CNE certification and TSS. METHOD:A mixed-methods study survey approach was used with snowball sampling. The total study sample included 213 nursing educators who held the CNE credential, were currently in an academic or clinical teaching role, were at least 18 years old, and taught in the United States. RESULTS:Findings suggest that participants perceived connections between CNE certification and all three domains of academic role expectations, with the strongest relationship observed in teaching, followed by service and scholarship. Three subthemes emerged related to teaching: confidence, capability development, and validation of the educator role. Participants described increased comfort in course design, test construction, and student evaluation after CNE certification. CONCLUSION:The pilot study's findings contribute to the limited body of literature examining the role of the CNE credential in academic nursing and suggest that certification may relate to integrated faculty role development. Further research using longitudinal designs and objective measures of TSS outcomes may provide additional insight into how certification relates to sustained professional growth.
The ROX index (the ratio of peripheral oxygen saturation to the fraction of inspired oxygen, divided by respiratory rate) has been validated to predict high-flow nasal cannula (HFNC) failure, but whether acting on ROX to guide the timing of intubation improves patient outcomes is unknown. We estimated the per-protocol effect of ROX-guided strategies versus usual care on mortality after HFNC initiation. We emulated target trials using Medical Information Mart for Intensive Care IV (MIMIC-IV) electronic health record data. Adults initiated on HFNC within 7 days of intensive care unit (ICU) admission were eligible. Strategies were usual care or intubation within 2 h after ROX first fell below 3.85, 4.88, or time-varying thresholds (2.85 for hours 1–5, 3.47 for hours 6–11, and 3.85 from hour 12). We used clone-censor-weighting with pooled logistic regression, adjusted for baseline and time-varying covariates, to estimate 30-day mortality. We included 1,651 adults (median age, 66 years; women, 41
To describe the age-stratified clinical characteristics, ICU management, and in-hospital outcomes of adults admitted to Japanese ICUs with aspiration pneumonia. Multicenter, retrospective, observational cohort study. Multiple ICUs participated in the Japanese Intensive Care Patient Database (JIPAD), a nationwide registry of the Japanese Society of Intensive Care Medicine, from 2015 to 2023. Adults ≥ 18 years admitted to ICUs with a primary diagnosis of aspiration pneumonia. Among 3,906 eligible ICU admissions (median age, 76 years [IQR, 68–83]; 75.5
Abstract Objective This study aims to investigate the expression profiling characteristics of N6-methyladenosine (m6A) RNA modification regulators in sepsis, their associations with glycolytic metabolic reprogramming, and their preliminary prognostic value. Methods We integrated multiple sepsis transcriptomic cohorts (GSE65682, GSE95233, GSE54514) from the GEO database to systematically analyze the differential expression of 15 m6A regulators. Gene Set Variation Analysis (GSVA) scores, weighted gene co-expression network analysis (WGCNA) networks, and Spearman correlation analyses were utilized to assess the associations between m6A regulators and glycolytic activity. The regulation of glycolytic genes by m6A modifications was confirmed using ALKBH5 knockout models (GSE198316, GSE224650) and MeRIP-seq data (GSE225143). A prognostic model was developed by integrating CIBERSORT immune cell infiltration analysis, single-cell RNA sequencing data (GSE147363), and LASSO-Cox regression. Results Most m6A regulators are significantly downregulated in patients with sepsis, while IGF2BP2 and IGF2BP3 are upregulated. ALKBH5 clusters with IGF2BP2 within the same WGCNA module and exhibits a positive correlation with glycolytic activity (rho=0.592, P =1.0 × 10⁻ 29 ). The differentially expressed genes (DEGs) resulting from ALKBH5 knockout significantly overlap with sepsis-associated DEGs ( n =124; OR=2.48, P =5.10 × 10⁻ 11 ), which are enriched in the HIF-1 signaling pathway and glycolytic processes. Independent validation confirmed a directional consistency of 89.6%. MeRIP-seq data indicated m6A-mediated associations with glycolytic genes, including ENO1, GAPDH, HK2, and LDHA. Single-cell analysis demonstrated a positive correlation between ALKBH5 and most glycolytic genes in CD14+ monocytes. A prognostic model based on four m6A genes (HNRNPC, YTHDF1, YTHDF2, VIRMA) achieved a C-index of 0.750 in the training set and 0.709–0.718 in external validation sets. Conclusion These integrated analyses suggest that ALKBH5-associated m6A modification is correlated with sepsis-associated glycolytic reprogramming and support a biologically plausible, hypothesis-generating ALKBH5-associated glycolytic program that requires prospective and experimental validation. The m6A-based four-gene model showed preliminary prognostic potential for 28-day mortality, but its external reproducibility was incomplete and requires validation in larger, prospectively collected and clinically harmonized cohorts.
The original Sequential Organ Failure Assessment (SOFA-1) score is widely used to quantify organ dysfunction in critically ill patients, including those with septic shock. A recently updated, data-driven SOFA score (SOFA-2) revises component thresholds and incorporates contemporary organ support modalities. While SOFA-2 has been validated in intensive care unit populations, its performance in the emergency department (ED), particularly among patients with septic shock, is uncertain. We therefore sought to validate SOFA-2 in ED patients with septic shock. In this observational study, we analyzed two prospective septic shock registries. Adult ED patients with septic shock were included. SOFA-1 and SOFA-2 scores were calculated using the worst physiologic and laboratory values recorded within the first 24 h in the ED. We compared score distributions and examined mortality across score ranges. Discrimination for in-hospital, 28-day, and 90-day mortality was evaluated using the area under the receiver operating characteristic curve (AUROC). Calibration for in-hospital mortality was assessed using the calibration curve and Brier scores. Reclassification performance was evaluated using continuous net reclassification improvement (NRI) and integrated discrimination improvement (IDI). The study included 2669 patients in Cohort A and 1443 patients in Cohort B. SOFA-1 and SOFA-2 score distributions differed significantly. Mortality generally increased with higher SOFA-1 and SOFA-2 scores across all outcomes. SOFA-2 demonstrated significantly higher AUROCs than SOFA-1 for in-hospital, 28-day, and 90-day mortality in both cohorts (Cohort A: 0.734 vs. 0.702, 0.719 vs. 0.694, and 0.680 vs. 0.658; Cohort B: 0.719 vs. 0.671, 0.737 vs. 0.689, and 0.711 vs. 0.666; all p < 0.001). SOFA-2 showed generally closer agreement between predicted and observed in-hospital mortality and lower Brier scores. Continuous NRI (0.276–0.635) and IDI (0.024–0.062) also favored SOFA-2 across all mortality outcomes (all p < 0.001). In adjusted analyses, each 1-point increase in SOFA-2 was independently associated with higher mortality. Sensitivity analyses and pooled analyses showed consistent findings. Among ED patients with septic shock, SOFA-2 showed modestly improved discrimination, closer agreement between predicted and observed in-hospital mortality with lower overall prediction error, and more favorable continuous reclassification metrics compared with SOFA-1. These findings support the external validation of SOFA-2 in this population and warrant further evaluation in diverse ED settings.
Tachycardia is common in sepsis and is associated with poor outcomes. β-blockers have been used for heart rate (HR) control, but comparative evidence between short- and long-acting agents remains limited. The aim of this study was to compare the efficacy and safety of intravenous landiolol and a bisoprolol transdermal patch in patients with sepsis-related tachycardia. This multicenter retrospective cohort study included adult patients with sepsis-related tachycardia (HR ≥ 100 bpm) treated with landiolol or a bisoprolol transdermal patch at intensive care units (ICUs) participating in a Japanese ICU database, from January 2014 to March 2026. Propensity score matching (PSM) at a 1:1 ratio was performed to adjust for baseline differences between groups. The primary outcome was the proportion of patients who achieved HR control (60–94 bpm) at 24 h. The secondary outcomes included in-hospital mortality, bradycardia incidence, the proportion requiring increased norepinephrine-equivalent doses at 24 h, and trends in HR and mean arterial pressure (MAP) over 24 h. After PSM, data from 950 patients were analyzed (n = 475 in each group). HR control at 24 h did not differ between the two groups (landiolol: 56
Intensive care unit-acquired weakness (ICUAW) is frequent in critically ill adults and is associated with adverse outcomes, but early recognition is difficult because standard diagnosis relies on volitional strength testing. In this prospective multicentre cohort study across 16 tertiary ICUs in southwest China, adults expected to remain in the ICU for ≥ 3 days underwent quadriceps ultrasound and routine clinical assessment within 24 h of admission. ICUAW was defined by the first evaluable Medical Research Council (MRC) score during ICU stay. We developed and compared nine algorithms in a development cohort (n = 858) and performed temporal external validation in a later cohort (n = 345). ICUAW occurred in 579/858 (67.5
Prone positioning (PP) and inhaled nitric oxide (iNO) are widely utilized rescue therapies for severe hypoxemia during invasive mechanical ventilation. However, their combined effects on regional ventilation–perfusion (V/Q) matching remain incompletely characterized. This study utilized single-plane saline-contrast electrical impedance tomography (EIT) to achieve real-time bedside visualization and evaluate the relative spatial mechanisms of these interventions in patients with COVID-19-related ARDS. We conducted a prospective sequential physiological study in mechanically ventilated patients with moderate-to-severe COVID-19-related acute respiratory distress syndrome (ARDS). Relative regional ventilation, perfusion, and V/Q matching distributions were monitored across four predefined, fixed sequential conditions: supine position ventilation (SPV), SPV with iNO (20 ppm for 1 h; SPV + iNO), prone position ventilation after stabilization (PPV), and PPV with an additional 1 h of iNO (PPV + iNO). Primary analyses focused on prespecified within-patient contrasts, supplemented by exploratory difference-in-differences (DiD) analyses to evaluate position-dependent vascular responses. Twenty-eight patients completed all study phases. Hemodynamics and conventional respiratory mechanics remained remarkably stable across all four conditions. Systemic oxygenation improved progressively; both SPV + iNO and PPV significantly increased PaO2 and PaO2/FiO2 compared to SPV alone, while the addition of iNO during PPV (PPV + iNO) yielded further oxygenation improvements and reduced FiO2 requirements. Within the EIT-assessed thoracic slice, SPV + iNO produced the most widespread V/Q improvements, significantly reducing the global non-perfused fraction (−7.28
Osmotherapy is frequently used in neurocritical care to manage cerebral edema and intracranial hypertension. However, its association with subsequent new-onset acute kidney injury (AKI), and whether early serum sodium or chloride burden materially attenuates this association, remain uncertain. We conducted a retrospective cohort study using MIMIC-IV version 3.1. Adult first-ICU neurocritical care patients were analyzed with a 48-h landmark design. The primary risk set included patients who were alive, remained in the ICU, and were AKI-free at 48 h after ICU admission. The primary exposure was any osmotherapy, defined as mannitol or hypertonic saline administered within the first 48 ICU hours, compared with no osmotherapy. The primary outcome was incident AKI after the 48-h landmark through ICU day 7 or ICU discharge. Multivariable regression was used as the main adjusted model; propensity-score weighting, overlap weighting, doubly robust models, and modified Poisson regression were used as complementary estimators. Sodium/chloride burden analyses were conducted in the lab-complete subset. The final 48-h landmark cohort included 2,756 adult neurocritical care patients, of whom 624 (22.6
Delirium is common in the intensive care unit and associated with adverse outcomes. However, bedside indicators that flag patients at high risk for delirium the following day are lacking. Although physical restraint has been linked to delirium, many prior studies relied on cross-sectional, same-day assessments that cannot exclude reverse causation. This study aimed to evaluate whether cumulative previous-day physical restraint duration was a bedside signal for following-day delirium. We conducted a single-center retrospective observational cohort study using patient-days (00:00–24:00 h) as the unit of analysis, with the exposure and covariates derived from more granular, time-stamped nursing records aggregated into calendar-day units. The exposure was cumulative physical restraint duration on the previous day, reported per 8-h increase. The outcome was incident delirium on the following day, defined as an Intensive Care Delirium Screening Checklist (ICDSC) score ≥ 4. The primary analysis was restricted to patient-days without previous-day delirium (ICDSC 0–3). We fitted a generalized linear mixed model with a random intercept for each patient. The restraint duration was modeled using a natural cubic spline (degrees of freedom = 3). Of 1,482 patient-days from 281 patients, 263 patient-days were excluded due to coma. The primary analysis included 729 patient-days from 247 patients without previous-day delirium (115 incident delirium events, 15.8
