Prone positioning is recommended for patients with acute respiratory distress syndrome not only to improve oxygenation, but also to reduce lung stress, and lower mortality. The association between improved oxygenation during prone position and reduced mortality is still controversial. In previous studies, oxygenation improvement during the first prone positioning cycle was linked to lower intensive care unit (ICU) mortality, especially with prolonged duration. However, physiological data during subsequent cycles were lacking. This study aims to explore the association between ICU mortality and physiological responses to prone positioning—such as arterial oxygenation, dead space, and respiratory mechanics—and to assess how the cumulative time spent in prone or supine positions across all studied cycles influences outcomes. International registry including adult patients who underwent prone positioning for acute hypoxemic respiratory failure due to COVID-19. We measured the difference for arterial partial pressure of oxygen to inspired fraction of oxygen ratio (PaO2/FiO2) and ventilatory ratio between baseline supine position and at either the end of cycle of prone position (Delta-PP) or re-supination (Delta-PostPP), focusing on the cycles following the first one. We included 1523 patients from 53 centers. Both Delta-PP and Delta-PostPP for PaO2/FiO2 were significantly higher in ICU survivors than in ICU non-survivors for all the analyzed prone positioning cycles (p ≤ 0.001 for all comparisons). Delta-PP and Delta-PostPP for ventilatory ratio were significantly lower in ICU survivors than in ICU non-survivors for all the analyzed prone positioning cycles (p < 0.05 for all comparisons). No difference in the overall time spent in prone position was found between ICU survivors and non-survivors [61 (38, 84) h vs 58 (32, 85) h, respectively, p = 0.175]. The cumulative length of prone position was associated with ICU mortality only for the second prone positioning cycle [OR (95

OBJECTIVE:This systematic review aims to assess the prevalence and incidence of pressure injury associated with non-invasive ventilation (NIV) in adult patients treated for acute respiratory failure (ARF). INTRODUCTION:Facial pressure sores are a common complication of NIV, impairing skin integrity, patient comfort, and therapy efficacy. However, the ranges of incidence and prevalence reported in the literature are very wide. ELIGIBILITY CRITERIA:This review will include analytical observational and experimental studies reporting prevalence and/or incidence of pressure sores in adults treated with NIV for hypoxemic or hypercapnic ARF using oronasal, full-face, or hybrid masks. Any study or study arm testing interventions to reduce pressure sores will be excluded. Studies on pediatric patients and adult patients treated with other interfaces (ie, helmets) will also be excluded. METHODS:This systematic review will be conducted in accordance with the JBI and PERSyst methodology for systematic reviews of prevalence and incidence. Searches will be conducted in PubMed, Cochrane Library, Web of Science, Embase, national health-agency surveillance systems, Centers for Disease Control and Prevention data, gray literature, and clinical trial registers to identify unpublished studies. No language limitations will be applied provided an English abstract is available. Two reviewers will independently select studies, and data will be extracted using a customized form. Narrative synthesis will be conducted and, where appropriate, pooled prevalence and incidence proportion will be calculated using the DerSimonian and Laird method. Methodological quality will be assessed using JBI's Critical Appraisal Tool for Prevalence and Incidence Studies. REVIEW REGISTRATION:PROSPERO CRD42024604191.

Real-world data describing contemporary hyperbaric oxygen therapy (HBOT) practice in Italy are limited. This study aimed to describe current clinical indications and therapeutic modalities of HBOT at the national level. We conducted a multicentre, prospective, observational national study, promoted by Italian Society of Anesthesia Analgesia, Resuscitation and Intensive Care (SIAARTI). We included consecutive patients who underwent HBOT in 10 study centres within a period of 12 weeks, for any treatment indication. The primary outcome of the study was the proportion of treatments by clinical indication and urgency of treatment. Overall, 327 patients were included across 10 centres, of which 73.7

ABSTRACT We described the case of a 54‐year‐old woman with no history of immunodeficiencies admitted to the ICU of our university hospital due to acute respiratory failure and ARDS secondary to severe community‐acquired pneumonia (sCAP) caused by RSV infection. During hospitalization she received protective mechanical ventilation and organ support. After 9 days, she was successfully discharged. We also surveyed available literature and found 27 relevant articles reporting data on critically ill patients admitted to ICU with RSV lower respiratory tract infection. Early identification of RSV infection as cause of sCAP, along with prompt diagnosis of associated complications, such as ARDS, contributed to the successful management of this case. The reviewed literature confirms a growing interest in severe RSV infections in adults, although evidence on optimal management strategies and specific therapies remains limited.

Clinical effectiveness of high-flow nasal therapy (HFNT) over conventional oxygen therapy (COT) in patients with mild COVID-19-related acute hypoxaemic respiratory failure (AHRF) remains uncertain. The COVID-HIGH trial did not demonstrate statistically significant benefits of HFNT over COT. However, the trial was slightly underpowered, and the event rate lower-than-expected. Bayesian methods provide deeper insight by incorporating prior knowledge and quantifying uncertainty intuitively. This analysis aimed to quantify the probability of benefit or harm associated with HFNT, adopting a Bayesian approach. We performed a Bayesian reanalysis of the COVID-HIGH trial (NCT, which randomised 364 patients with PaO₂/FiO₂ between 200–300 mmHg to receive HFNT or COT. The primary outcome was escalation of respiratory support (continuous positive airway pressure, noninvasive ventilation or invasive mechanical ventilation) within 28 days. A key secondary outcome was clinical recovery at day 14. Bayesian logistic models with noninformative and informative priors were used to estimate the posterior probability of treatment effects. Escalation of respiratory support occurred in 23.6

The SIS-NET ICU study aimed to describe the epidemiology of severe community-acquired pneumonia (CAP) among patients admitted to Italian intensive care units (ICUs). This study also aimed to describe the clinical and microbiological characteristics, outcomes, and treatments received by the included patients. We conducted a prospective, observational, multicenter study. We included patients consecutively admitted to the ICUs of 13 participating centers during the study period for acute respiratory failure due to CAP. The study period spanned from January to November 2025. The analyses aimed to describe the epidemiological and clinical characteristics, diagnostic pathways, factors associated with ICU mortality, and type of respiratory support during the ICU stay. We included a cohort of 150 patients with a mean age of 63 years and a male predominance (61

BACKGROUND:Randomized controlled trials (RCTs) are the gold standard for evaluating medical interventions, including regional anesthesia (RA). However, growing evidence suggests that not statistically significant studies may be unreported, skewing the existing core of evidence. This study evaluates the prevalence of significant results in RA RCTs and explores possibly associated factors. METHODS:We analyzed RCTs from 136 journals in the "Anesthesia and Pain Medicine" category (Scopus CiteScore). Of 4524 articles retrieved, 1079 RA RCTs were included following manual review. Studies were classified as "statistically significant" ot "not statistically significant" based on primary outcome significance (p < 0.05). Logistic regression identified factors associated with statistical significance, with model performance metrics evaluated. RESULTS:Among the 1079 RCTs, 241 (22.3%) reported not statistically significant results. Factors associated with statistically significant findings included studies focused on RA techniques (OR 2.28; 95% CI: 1.12-4.63), those investigating pediatric populations (OR 3.39; 95% CI: 1.19-9.66) and studies not receiving fundings (OR 0.67; 95% CI 0.46-0.98). Monocentric studies (95.8%) and non-active comparators (40.4%) were common, potentially influencing outcomes. Performance metrics (AUC: 0.690) indicated robust model reliability. CONCLUSION:A high proportion of RA RCTs report statistically significant results, and these outcomes are associated with study design and comparator choice.

The optimal mean arterial pressure (MAP) target in high-risk hypertensive patients undergoing major abdominal surgery remains unclear. The HISTAP trial evaluated whether targeting an intraoperative MAP ≥ 80 compared with ≥ 65 mmHg reduces postoperative organ dysfunction and 30-day mortality, in this population. HISTAP was a multicenter, randomized trial conducted at 18 Italian centers between March 2023 and April 2025. The study included patients aged ≥ 60 years with chronic hypertension requiring home therapy, undergoing elective major abdominal surgery and having at least one additional high-risk criterion. The intraoperative MAP was targeted to ≥ 80 mmHg (Treatment group) or ≥ 65 mmHg (Control group). The primary outcome was a composite endpoint including postoperative mortality and at least one major organ dysfunction. Of 636 randomized patients, 6 were excluded since surgery was canceled after randomization, 630 completed the trial and were included in the intention-to-treat analysis (median age, 74 years [IQR, 69–79]). Mean intraoperative MAP was 77 ± 7 mmHg in the Control group and 88 ± 9 mmHg in the Treatment group. The primary composite outcome occurred in 48.9

BACKGROUND:Cesarean section (CS) rates have increased globally, necessitating effective anesthesia management. Single-shot spinal anesthesia has limitations due to its duration and the dose-limiting adverse effects of local anesthetics. OBJECTIVES:To evaluate the effectiveness and safety of intrathecal adjuvants combined with local anesthetics in the perioperative management of CS pain. DESIGN:Systematic review with network meta-analysis. DATA SOURCES:PubMed, Cochrane Library for Clinical Trials, and Embase. ELIGIBILITY CRITERIA:We included women undergoing CS under single-shot spinal anesthesia with any intrathecal drug or placebo added to a long-acting local anesthetic. We selected single- or double-blind, parallel-group, randomized controlled trials (RCTs) reported in English. We excluded crossover, non-randomized, up-and-down dose-finding studies and clinical trials comparing the same drugs in all study arms. RESULTS:We included 166 RCTs with 14 925 patients assigned to 32 interventions. Buprenorphine and diamorphine were the highest-ranked treatments for reducing pain intensity at 24 hours, though not statistically significant. Morphine alone or in combination with meperidine, neostigmine, epinephrine, or nalbuphine significantly increased the duration of effective analgesia and reduced opioid consumption. Dexmedetomidine and morphine significantly prolonged the motor block duration. The safety profile of intrathecal adjuvants was generally adequate. CONCLUSIONS:While the strength of evidence, overall, was very low to low, our study suggests that while none of the interventions significantly reduced pain intensity at 24 hours, several significantly prolonged effective analgesia and reduced postoperative opioid consumption. Dexmedetomidine and morphine prolonged the duration of motor block. None of the intrathecal adjuvants evaluated significantly increased the occurrence of severe adverse events. Future large-scale RCTs are essential to provide more robust evidence. PROSPERO REGISTRATION NUMBER:CRD42024479424.

Ventilator-associated pneumonia (VAP) remains a major complication in mechanically ventilated critically ill patients. Although several preventive strategies have been proposed and incorporated into international guidelines, emerging evidence and evolving epidemiology warrant updated statements. The Italian Society of Anaesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) developed an expert consensus statement to provide pragmatic guidance for VAP prevention. This consensus statement was developed in accordance with SIAARTI methodology for consensus-based documents. A multidisciplinary panel of 10 experts was appointed and identified key items through a modified Delphi process. Consensus was defined as ≥ 75

BACKGROUND:Candidaemia remains a common, life-threatening infection among intensive care unit (ICU) patients, with high mortality, particularly in patients with delayed diagnosis and treatment. OBJECTIVES:This international, multicentre, prospective, observational study aimed to identify risk factors for candidaemia in ICU patients and to develop an easy-to-use predictive tool, the CanDi-Score, for early initiation of empirical antifungal treatment. PATIENTS/METHODS:All adults over 18 years hospitalised for more than 48 h in the ICUs were included in the study and followed for 30 days. Data on demographics, comorbidities, clinical severity scores including APACHE II and SOFA scores, Charlson comorbidity index (CCI), established risk factors for candidaemia and their time-dependent effects such as total parenteral nutrition (TPN), mechanical ventilation (MV), and central venous catheter (CVC) were collected. Univariate and multivariate logistic regression analyses were used to identify factors associated with candidaemia development, and fast backwards variable selection was used. To account for between-centre heterogeneity, sensitivity analyses were performed using mixed-effects logistic regression models including centre-specific random intercepts. A nomogram model was constructed using independent risk factors identified in multivariable analysis, and its predictive performance was evaluated with Area Under the Curve (AUC), sensitivity, and specificity. RESULTS:A total of 2,704 ICU patients, including 204 with candidaemia, were enrolled. Patients with candidaemia had higher APACHE II (19 vs. 13) and CCI scores (6 vs. 5; both p < 0.001), and more frequently had chronic renal failure, haemodialysis, malignancy, recent gastrointestinal surgery, and neutropenia (all p ≤ 0.05). Patients were randomly split into development (80%) and validation (20%) cohorts. Multivariate analysis identified higher CCI, concurrent infection, neutropenia, ICU stay > 14 days, MV > 3 days, CVC duration and TPN > 14 days as independent risk factors. The risk associated with CVC increased substantially with prolonged use (OR: 0-7 days: 3.69; 8-21 days: 8.58; > 21 days: 17.21). The model demonstrated good performance in both the development and validation cohorts, with sensitivity, specificity, and AUC values of 79.6%, 76.5%, and 0.86 (95% CI: 0.83-0.88) in the development cohort, respectively, and comparable predictive performance in the validation cohort. The score model was demonstrated by a nomogram. CONCLUSIONS:Given the high mortality of candidaemia in ICU patients, the CanDi-Score may serve as a valuable tool for early prediction and timely empirical antifungal treatment. Key predictors include CCI, presence of concurrent infections, the duration of CVC use, and TPN administration. CanDi-Score provides clinicians with a practical approach to identify high-risk patients and guides decision-making for the early initiation of antifungal treatment.

Background/Objectives: The use of IgM- and IgA-enriched intravenous immunoglobulins (eIg) in septic shock remains controversial due to the lack of high-quality evidence, despite indications from observational studies and meta-analyses suggesting potential benefit. Identifying patients who may respond favorably and determining whether extended treatment could be useful are ongoing challenges. This study evaluates baseline predictors and early treatment-related trends associated with outcomes in septic shock patients receiving eIg, with particular focus on immunoglobulin levels and norepinephrine (NE) requirements. Methods: This observational analysis used data from the multicenter SORRISO registry, including 248 septic shock patients treated with eIg from 2015 to 2022. Baseline clinical and biochemical variables were recorded at the start of eIg infusion (D0). Trends in IgA, IgG, IgM, lactate, and NE dose were assessed between D0 and D4. Restricted cubic spline (RCS) models examined non-linear associations with mortality, and Kaplan–Meier analyses evaluated 28‑day survival according to parameter trends. Statistical significance was defined as p < 0.05. Results: RCS curves showed no prognostic value at D0 for INR, CRP, PCT, IgA, or IgG. Lactate (p = 0.005) and platelet count (p = 0.001) demonstrated significant associations with mortality, while IgM (p = 0.076) and NE (p = 0.059) approached significance. Of 209 evaluable patients, NE requirements decreased in 191 (NE‑DOWN) and increased in 18 (NE‑UP). Survival was 67% in the NE‑DOWN group vs. 23% in NE‑UP (p < 0.0001). No D0 variable reliably predicted NE trajectory. In conclusion, among septic shock patients treated with eIg, increasing NE requirements during the first four days were strongly associated with higher mortality. Baseline biomarkers did not predict vasopressor trends.

The MICROINHALO trial investigated whether personalized management of endotracheal tube cuff pressure (Pcuff) based on exhaled CO2 measurement combined with automatic subglottic space drainage (SSD) may prevent tracheal colonization in critically ill intubated patients. This cluster-randomized, international, open-label trial (NCT05403320) enrolled adult patients at 10 ICUs. They were randomly assigned to receive either an endotracheal tube equipped with automatic Pcuff management and SSD, or a conventional one with manual Pcuff management and manual SSD. The primary endpoint of the study was the rate of bacterial tracheal colonization (> 103 CFU/mL) on day 3 after intubation. Among 270 randomized patients, 250 were included in the analysis: 127 allocated to the automatic management group and 123 to the manual management group. Bacterial tracheal colonization on day 3 occurred in 47 (37

PURPOSE:High-acuity critical care environments impose extreme environmental and cognitive demands on healthcare teams. Yet, existing human factor models and individual burnout scales insufficiently explain acute, collective neurocognitive failures. The purpose of this scoping review is to inductively synthesize the existing literature to propose a novel conceptual framework: Cognitive Resource Impairment and Systemic Integration Syndrome (CRISIS) in critical care teams. METHOD:Guided by PRISMA 2020, we conducted a scoping review and inductive thematic synthesis of multidisciplinary literature (inception-December 2025). To overcome nomenclatural fragmentation, we queried five databases (PubMed, Scopus, Web of Science, Embase, PsycINFO) via a 'construct-intersection' strategy, targeting the convergence of acute environmental stressors and team cognition. Of 325 initial records, 25 heterogeneous studies, spanning empirical clinical data, high-fidelity simulation, and sociotechnical theory, remained after excluding duplicates, patient-centered delirium, and individual burnout lacking systemic team-level correlates. Finally, the Mixed Methods Appraisal Tool (MMAT) weighted these studies, prioritizing high-quality mechanistic data to triangulate the syndrome's synthesis. RESULTS:The synthesis identifies CRISIS not as professional dissatisfaction, but as an acute "neurocognitive lockdown" precipitated by specific environmental toxicity (e.g., cumulative noise >60 dB, alarm floods, and stochastic workflow interruptions). Distinct from the diachronic, emotional depletion of burnout, CRISIS manifests as a reversible, synchronic, functional decompensation of the Team Neural Network (Shared Mental Models). The proposed sociotechnical model frames these stressors as non-linear engineering constraints that trigger immediate decision failure. CONCLUSION:CRISIS represents a functional "neurocognitive lockdown" of the ICU team neural network, distinct from chronic occupational syndromes. Patient safety relies not on longitudinal resilience training, but on "Systemic Resource Infusion", immediate, structural overrides like leadership-mandated cognitive time-outs, to restore network integrity and prevent progression toward irreversible medical error. IMPLICATION FOR CLINICAL PRACTICE:CRISIS is ontologically distinct from burnout's diachronic attrition, representing a synchronic, functional "neurocognitive lockdown" of the Team Neural Network precipitated by environmental toxicity. Patient safety relies not on individual resilience, but on Systemic Resource Infusion-immediate, structural overrides reconstituting collective cognition and preventing the non-linear trajectory toward decision failure.

The Original Article was published on March 19, 2025 “Renaming the problem: Why ‘non-recommended journals’ is preferable to ‘predatory’ in academic publishing” Barw Medical Journal. 2025;3(5):33-41. Following correspondence received by the editorial office regarding authorship confirmation and reference accuracy, the journal conducted an editorial review in accordance with the guidance of the Committee on Publication Ethics. Authorship correction During this process, two individuals listed as authors informed the journal that they had not approved the final version of the manuscript prior to submission. After communication with the corresponding author and available co-authors, the authorship list has been revised accordingly. The corrected author list is provided below. Corrected author list: Frederick M. Tiesenga, Daniel Rodger, Benjamin Saracco, Baichang Zhong, Andrea Cortegiani, Sjaak Pouwels, Rawezh Qadir M. Salih, Ayman M. Mustafa, Michele Meoli, Svitlana Fiialka, Khritish Swargiary, Purvi Raj Bhagat, Suad Kunosic, Rosa Rodriguez-Sánchez, Kaushik Bhattacharya, Marco Cascella, Mohmedhanif Nashipudi, Bharat Gurnani, Kirandeep Kaur, P. Paramashivaiah, B.T Sampath Kuma, Givheart Dano, Mallikarjun Dora, Bolaji David Oladokun, Manzoor V. Babu, AR. Saravanakumar, Usman Muhammed Song, Vemma Mae R. Guinto, Karthik N. Rao, Alireza Akbari, Arslan Sheikh, Punnya Angadi, Johnkennedy Nnodim, Jafaru Aliyu Shinkafi, Sanjeev Rastogi, Kunle Oparinde, Klimis Ntalianis, Saeeda Abdullah, Atanu Chandra, Collence Chisita, Mohd Amzari Tumiran, Haneen Ali Haleem, Harsh Deora Reference correction Reference number 28 cited an article that has since been deleted as it was a duplicate (not retracted). This reference has been replaced by its original one: Kakamad F. H., Mohammed S. H., Najar K. A., Qadr G. A., Ahmed J. O., Mohammed K. K., et al. Kscien's list; a new strategy to discourage predatory journals and publishers. International Journal of Surgery Open. 2019, 23, 54-56. https://doi.org/10.1016/j.ijso.2019.11.001 These corrections do not affect the scientific content or conclusions of the article. The original article remains unchanged, and readers are advised to consult this notice for the corrected information.

Background High-quality cardiopulmonary resuscitation (CPR) is essential for improving outcomes after out-of-hospital cardiac arrest. The RITMICO study evaluated a newly developed double-click metronome, providing separate auditory cues for the compression and release phases, compared with a standard metronome. This secondary analysis investigated temporal changes in chest compression (CC) quality during prolonged manikin-based CPR simulations and explored factors associated with these trajectories. Methods 477 volunteers (54% male; mean age 34 ± 12 years) were included in the analysis. Compression depth, compression rate, and chest compression release velocity (CCRV) were recorded using an automated external defibrillator with CC quality analysis technology. Simulations were divided into 21 consecutive 5-second intervals, and median values for each metric were analyzed using linear mixed-effects models with subject-specific random effects. Results Compression depth and CCRV progressively declined over time, indicating early deterioration in CPR quality during prolonged compressions. Compared with the standard metronome, the double-click metronome produced consistently higher values for all CPR quality metrics throughout the simulation (all p < 0.05). It also delayed the decline of CCRV below the suggested threshold, indicating better preservation of chest recoil quality. Male participants maintained compression depth and CCRV longer than female participants. Conclusions CPR quality deteriorated early during prolonged simulated chest compressions, particularly with respect to chest recoil. The use of a double-click metronome was associated with better preservation of CPR quality over time and a later deterioration in CCRV. These findings support a potential role for the double-click metronome in maintaining CPR quality during prolonged resuscitation, although confirmation in real-world clinical settings is needed.

Objectives Bacteremia caused by carbapenem-resistant Acinetobacter baumannii (CRAB) is associated with high morbidity and mortality. The primary objective was to identify clinical and therapeutic factors associated with 14- and 30-day mortality following infection onset. Methods This was a prospective, observational, multicenter study conducted across 52 Italian centers. Over an 18-month period, adult hospitalized patients with CRAB bacteremia were enrolled. Results Among 398 patients with CRAB bacteremia, sources were mainly CVC-related or primary, with 14- and 30-day mortality rates of 22% and 27% respectively. Cox regression analysis identified male sex (p=0.006), and chronic kidney disease (p=0.016) as independent predictors of 14-day mortality, while colistin-containing regimen (p=0.014), and cefiderocol-containing-regimen (p<0.001) were associated with 14-day survival; male sex (p=0.027), septic shock (p=0.018), previous colonization by A. baumannii (p<0.001), and tigecycline-containing regimen (p=0.021) were independent predictors of 30-day mortality, while cefiderocol-containing-regimen (p<0.001) was associated with 30-day survival. Propensity score matching revealed that cefiderocol was significantly associated with 14-day survival and clinical success. The combination of cefiderocol plus Fosfomycin was also significantly associated with clinical success. Conclusion Our findings highlight key clinical and therapeutic determinants of mortality and survival in patients with CRAB bacteraemia, providing valuable insights for improving the management of this challenging infection.