Aim: Critically ill hematologic patients (CIHPs) represent a distinct population in the intensive care unit (ICU), characterized by complex pathophysiology and high mortality rates. Prognostic assessment in this group remains challenging. This study aimed to evaluate the utility of acute illness severity and organ dysfunction scores in predicting ICU outcomes in CIHPs. Study Design: This retrospective, single-center study was conducted in a dedicated hematology ICU. The prognostic performance of commonly used acute illness severity and organ dysfunction scores (APACHE II, SAPS II, and SOFA) was evaluated in CIHPs. ICU mortality was assessed as the primary outcome. Additionally, early trajectories of these scores-particularly changes by ICU day 3-were analyzed for their association with prognosis. Results: A total of 107 patients were included. The median age of the patients was 62 (range: 53-70), and 69 (64.5%) were male. The ICU mortality rate was 40.2%. The most frequent underlying diagnoses were multiple myeloma (31.8%) and non-Hodgkin lymphoma (20.6%). Respiratory failure (68.2%) and sepsis (54.2%) were the leading reasons for ICU admission. Non-survivors had significantly higher APACHE II, SAPS II, and SOFA scores on both day 1 and day 3. Furthermore, non-survivors demonstrated a significant increase in all three scores over the first three ICU days. Among these parameters, the day 3 SOFA score was the strongest independent predictor of ICU mortality (OR 2.042, 95% CI 1.407-2.962; p = 0.001), suggesting that early organ dysfunction and its progression during the ICU stay are critical determinants of ICU mortality. Conclusions: Acute illness severity and organ dysfunction scores are valuable tools for predicting ICU outcomes in CIHPs. In particular, early SOFA score trajectories-especially the day 3 SOFA score-provide superior prognostic information and may support clinical decision-making in this high-risk population.
Aim: To investigate the association between ultrasound-derived rectus femoris and parasternal intercostal muscle thickness and weaning outcomes in mechanically ventilated, critically ill patients, as well as their relationship with post-extubation non-invasive mechanical ventilation requirements and 28-day mortality. Study Design: This prospective observational study included 69 mechanically ventilated adult patients undergoing spontaneous breathing trials in a medical intensive care unit. Demographic characteristics, clinical severity scores (modified Nutrition Risk in the Critically Ill [modified NUTRIC] score, Acute Physiology and Chronic Health Evaluation II [APACHE II], Sequential Organ Failure Assessment [SOFA], and Clinical Frailty Scale [CFS]), and ultrasonographic measurements of rectus femoris and parasternal intercostal muscle thickness were obtained at the 30th minute of the spontaneous breathing trial. Patients were classified into weaning success or failure groups based on the absence or presence of reintubation or death within seven days after extubation. Results: The mean rectus femoris thickness was 6.93 +/- 2.31 mm in the weaning success group and 5.96 +/- 2.41 mm in the weaning failure group (p>0.05). Parasternal intercostal muscle thickness was 4.49 +/- 1.25 mm and 4.18 +/- 1.48 mm in the respective groups (p>0.05). Muscle thickness was not associated with weaning success; however, both rectus femoris and parasternal intercostal muscle thicknesses were significantly lower in non-survivors compared with survivors at 28 days. Reduced rectus femoris thickness was also associated with an increased requirement for post-extubation non-invasive mechanical ventilation. In addition, higher modified NUTRIC scores were associated with both weaning failure and 28-day mortality. Conclusions: Ultrasound-based muscle thickness alone was not associated with weaning success; however, reduced rectus femoris and parasternal intercostal muscle thickness were associated with 28-day mortality and an increased requirement for post-extubation non-invasive mechanical ventilation. These findings suggest that ultrasound-based muscle assessment may provide useful prognostic insights for risk stratification in critically ill patients. Further multicenter studies are needed to validate standardized cut-off values and enhance clinical applicability.
Aim: Patient-ventilator asynchrony (PVA), commonly occurring in mechanically ventilated patients, is a significant issue that contributes to increased discomfort, prolonged ventilation, and higher mortality rates. Among various ventilatory modes, Synchronized Intermittent Mandatory Ventilation (SIMV) and Pressure Regulated Volume Control (PRVC) are frequently used, yet their comparative effects on PVA remain unclear. This study aims to evaluate and compare the relationship between SIMV and PRVC ventilatory modes and the type and incidence of asynchrony in trauma patients in the ICU. Study Design: This randomized, outcome-assessor-blinded clinical trial enrolled 100 mechanically ventilated trauma patients in the ICU of a hospital in southern Iran. Patients were randomly assigned to either SIMV or PRVC mode (n=50 in each group). Asynchrony was assessed over a span of 72 hours using standard waveform analysis. The overall incidence of asynchrony was chosen as the primary outcome, while specific types of asynchrony were considered secondary outcomes. Statistical analyses, including t-tests, chi-square tests, and ANOVA, were performed, with a significance level set at p<0.05. Results: Asynchrony was observed in 63% of the patients. Trigger asynchrony was the most prevalent type, affecting 37% of patients. There were no statistically significant associations between the incidence of asynchrony and patient age, gender, or ventilation mode (p>0.05). The rates and distribution of asynchrony were similar for both SIMV and PRVC modes. Conclusions: The significant occurrence of PVA underscores the need for careful, individualized adjustments to ventilator settings. The comparable results obtained with SIMV and PRVC modes suggest that optimizing trigger sensitivity may reduce the impact of mode selection, thus diminishing its importance in clinical decision-making.
Aim: Patients diagnosed with lung cancer may require intensive care due to sudden and severe clinical events; however, early survival outcomes vary widely. In this context, we investigated ICU mortality and analyzed admission-specific clinical characteristics associated with death in a healthcare setting where access to intensive care is not limited by predefined admission criteria. Study Design: The study population consisted of adult individuals with lung cancer who required intensive care from 2018 to 2022. Patient demographics, cancer-related features, indications for ICU admission, illness severity indices, requirements for organ-supportive therapies, and clinical outcomes were systematically evaluated. Associations between baseline variables and ICU mortality were examined using multivariable logistic regression analysis. Results: The study cohort comprised 351 critically ill patients with lung cancer. The median age was 66 years, and ICU mortality occurred in 76% of cases. The presence of metastatic disease independently increased the risk of death (OR 2.32, 95% CI 1.26-4.26). In contrast, patients admitted due to hypercapnic respiratory failure demonstrated a significantly lower mortality risk (OR 0.36, 95% CI 0.17-0.75). Higher illness severity scores were consistently associated with unfavorable outcomes. Conclusions: Despite significant advances in intensive care medicine, short-term outcomes for lung cancer patients admitted to the ICU remain unfavorable. Disease burden, reflected by metastatic status and severity scores, strongly influences outcomes, whereas patients admitted with hypercapnic respiratory failure demonstrate a more favorable prognosis.
