BACKGROUND:Acute Respiratory Distress Syndrome (ARDS) is a critical condition characterized by severe hypoxemia and pulmonary edema, often resulting from pneumonia, sepsis, trauma, or aspiration. It affects 10-15% of ICU patients and is associated with high mortality rates (30-40%). Delirium, an acute cognitive impairment, is prevalent in critically ill patients, particularly in the ICU, and correlates with adverse outcomes. OBJECTIVE:This systematic review and meta-analysis aim to summarize the current evidence regarding the relationship between ARDS and delirium, focusing on the prevalence of delirium in ARDS patients, its impact on delirium development and mortality, potential correlations between the two conditions, and their clinical outcomes. METHODS:A systematic search was conducted across PubMed, Scopus, and Web of Science from inception until September 2024, leading to the identification of 838 records. Pooled risk ratios and prevalence were calculated using a random-effects model. The risk of bias was assessed using the revised Cochrane risk of bias tool for randomized trials (RoB2) and Risk of Bias in non-randomized studies of interventions (ROBINS-I) tool. RESULTS:Thirteen studies involving 10,052 patients with ARDS were included. The pooled prevalence of delirium among ARDS patients was 41% (95% CI: 23%-58%), with substantial heterogeneity. Meta-analysis showed a higher risk of delirium among ARDS patients compared with controls; however, this association was not statistically significant (RR 1.34, 95% CI: 0.63-2.83). No statistically significant associations were observed between delirium and comorbid depression or anxiety. Delirium in ARDS patients was consistently associated with prolonged ICU stay, longer mechanical ventilation, and adverse clinical outcomes. CONCLUSION:Patients with ARDS frequently experience delirium, resulting in extended ICU admissions, prolonged mechanical ventilation, and cognitive impairment. Hypoxia, inflammation, sedation, and psychological factors contributes to delirium risk in ARDS patients. A multidisciplinary approach incorporating sedative minimization, early mobilization, and psychological support may mitigate delirium and improve patient outcomes. PROSPERO REGISTRATION NUMBER: (CRD42024564895): https://www.crd.york.ac.uk/PROSPERO/view/CRD42024564895.

BACKGROUND:Extracorporeal Membrane Oxygenation (ECMO) is a critical rescue therapy complicated by high rates of nosocomial infections (NIs). While Western data abound, evidence from the Middle East remains limited. This study examined the epidemiological patterns, predictors, and outcomes of NIs among ECMO patients in Qatar. METHODS:This retrospective cohort study analyzed adult patients supported with ECMO at Hamad General Hospital (2014-2021). Clinical and microbiological data were retrieved according to ELSO definitions. Primary outcomes included mortality at ECMO weaning, ICU, and hospital discharge. Multivariable logistic regression and competing-risks models were employed to identify predictors of infection and survival. RESULTS:Among 172 patients (mean age 41.2 ± 13.3 years), 55.2% developed NIs (65.5 episodes/1,000 ECMO days), predominantly respiratory (51.2%) and bloodstream infections (30.2%). The microbial landscape was characterized by multidrug-resistant Pseudomonas aeruginosa, Klebsiella pneumoniae (18%), and Candida auris (7.4%). Multivariable analyses identified obesity and tracheostomy as independent factors associated with improved survival across all discharge tiers. Competing-risks regression further supported these findings, indicating that tracheostomy was associated with reduced infection-related mortality hazards, while obesity correlated with lower non-infection mortality risks. CONCLUSIONS:This inaugural Middle Eastern cohort highlights a substantial burden of nosocomial infections driven by a resistant Gram-negative and fungal pathogen profile. The observed survival advantages associated with obesity and tracheostomy suggest potential favorable phenotypes that warrant further prospective investigation to guide regional risk stratification and management strategies.

Nosocomial infections are common in patients receiving extracorporeal membrane oxygenation (ECMO), with ECMO cannula-site infections (ECMO-CSI) being the most frequent infections directly related to the ECMO run. These infections can significantly impact patient outcomes. Currently, no adult guidelines exist for the prevention, diagnosis, and/or treatment of peripheral ECMO-CSI, resulting in heterogeneity in both clinical practice and research findings. We conducted a Delphi study involving 39 international experts in ECMO management. The experts participated in four Delphi rounds to reach consensus on various aspects of ECMO-CSI complicating peripheral ECMO (central ECMO excluded), including definition, clinical suspicion, diagnostic methods, preventive measures, and treatment. Consensus was defined as ≥ 70

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.

BACKGROUND:Acute hypoxaemic respiratory failure (ARF) is the leading cause of intensive care unit (ICU) admission among immunocompromised patients. However, contemporary data regarding the epidemiology, management, and outcomes of ARF in this population remain scarce. We aimed to identify predictors of mortality and intubation in immunocompromised patients admitted to the ICU with ARF. METHODS:This retrospective observational study was conducted in 103 ICUs in 26 countries. Adults (≥18 years) with ARF and immunodeficiency were eligible for inclusion. Patient data, including information on the nature of underlying immunosuppression, the cause of ARF, and the oxygenation strategy, were obtained from electronic medical records or medical charts. The primary outcome was to report 30-day mortality and identify associated factors in patients with complete data for all variables. Cox proportional hazards models were used to identify variables associated with mortality, and differences between groups were compared with χ2 tests or two-sided Wilcoxon rank-sum tests, with p values of less than 0·05 considered significant. FINDINGS:9854 immunocompromised patients with ARF admitted to participating ICUs between Jan 1, 2017, and Dec 31, 2023, were included in the study. The median age was 64 years (IQR 54-71); 3941 (40·0%) patients were female and 5913 (60·0%) were male. The main causes of immunodeficiency were a haematological malignancy (4759 [48·3%] of 9854 patients) or solid malignancy (3818 [38·7%] patients). Infection was the leading cause of ARF (6610 [62·0%] of 9854 patients); 5288 (53·7%) patients had more than one contributing cause of ARF, and no cause was identified in 1490 (15·1%) patients. The median partial pressure of oxygen in arterial blood (PaO2)/fractional concentration of oxygen in inspired air (FiO2) ratio was 198 [IQR 141-208]. The 30-day mortality rate was 47·3% (4662 patients). Predictors of higher mortality were older age (hazard ratio 1·01 [IQR 1·00-1·02]), higher Charlson Comorbidity Index score (1·04 [1·01-1·07]), higher Frailty Index score (1·22 [1·16-1·28]), longer time from hospital to ICU admission (1·02 [1·01-1·03]), higher respiratory rate (1·02 [1·02-1·03]), coma at ICU admission (2·04 [1·72-2·43]), invasive fungal infection as cause of ARF (1·82 [1·45-2·28]), disease-specific infiltrates (1·73 [1·32-2·26]), unidentified cause of ARF (2·16 [1·74-2·68]), and use of vasoactive drugs (2·45 [2·10-2·86]) or renal replacement therapy (2·07 [1·74-2·48]). Protective factors included receipt of a solid organ transplant (0·62 [0·49-0·79]), systemic vasculitis or connective tissue disease (0·61 (0·47-0·78]), higher PaO2/FiO2 ratio (0·78 [0·72-0·84]), receipt of high-flow nasal oxygen therapy (0·78 [0·64-0·95]), and cardiogenic pulmonary oedema (0·67 [0·51-0·89]). INTERPRETATION:In this large international cohort of immunocompromised patients with ARF, we identified key risk and protective factors for mortality and intubation. These findings could improve outcomes by informing timely clinical decisions, goals-of-care discussions, and management in this vulnerable population. FUNDING:Kirsten and Freddy Johansen Foundation and Groupe de Recherche en Réanimation Onco-Hématologique.

Type 2 Diabetes (T2D) and hypertension (HTN) are common comorbidities in severe COVID-19, yet their specific impact on proteomic recovery remains unclear. This study analyzed plasma protein signatures of critical COVID-19 patients with and without these comorbidities (COVID-only group [COG] and COVID comorbid group [CTHG]) on the first and last days of ICU stay. Proteomic analysis revealed a systemic shift characterized by upregulated immune responses and downregulated metabolic processes at admission across all patients. Survival was fundamentally defined by the restoration of homeostasis; liver-derived proteins─including LPA, TTR, and AHSG─were initially suppressed but rebounded significantly in survivors. This homeostatic recovery was impaired in CTHG compared to COG, with CTHG survivors showing attenuated recovery of metabolic markers. Distinct mortality-associated signatures also emerged between groups. COG nonsurvivors exhibited liver failure and severe hemolysis marked by persistent suppression of haptoglobin (HP). In contrast, CTHG mortality was driven by lipid metabolism dysregulation, with CD5L and APOA2 levels dropping specifically in comorbid nonsurvivors, often accompanied by a paradoxical elevation in APOA4─likely reflecting impaired renal clearance rather than restored lipid homeostasis. These findings indicate that preexisting T2D and HTN hinder physiological resolution of metabolic and lipid dysregulation, providing proteomic evidence for distinct mortality risks associated with failure to restore metabolic homeostasis in comorbid COVID-19 patients.

OBJECTIVE:To investigate the long-term outcomes and prognostic factors of critically ill patients undergoing tracheostomy for prolonged mechanical ventilation within the specific sociocultural and healthcare context of the Middle East. DESIGN:A retrospective observational study of patients who underwent tracheostomy between January 1, 2017, and December 31, 2020. SETTING:Medical ICU of Hamad General Hospital, a tertiary academic healthcare institution in Doha, Qatar. PATIENTS:Adult critically ill patients requiring tracheostomy for prolonged mechanical ventilation. INTERVENTIONS AND MEASUREMENTS:Tracheostomies were performed via percutaneous or open surgical techniques. Primary outcomes included neurological status (Cerebral Performance Category) and functional disability (Modified Rankin Scale) at hospital discharge. Secondary outcomes included survival rates at ICU discharge, hospital discharge, and one-year post-discharge, as well as lengths of stay. Multivariable logistic regression was utilized to identify independent prognostic factors for mortality. RESULTS:The study included 395 patients with a mean age of 55 ± 17.4 years. The percutaneous technique was more prevalent (61.3%) and accompanied by a higher proportion of good neurological outcomes; however, this likely reflects patient selection bias rather than procedural superiority. Survival rates were 82.8% at ICU discharge, 63% at hospital discharge, and 29% at one year. Multivariate analysis revealed that septic shock and higher SOFA scores were independent predictors of ICU mortality. Diverging from Western literature, age and most comorbidities were not independent predictors of long-term mortality. Instead, mortality was primarily driven by acute physiological severity (higher APACHE II and SOFA scores) and specific admission diagnoses such as ARDS and stroke. CONCLUSIONS:This study highlights a distinct epidemiological profile in the Middle East, where outcomes are driven more by acute illness severity than by age or chronic frailty. The findings underscore the unique family-anchored post-discharge care model in this region, necessitating culturally adapted strategies to manage the long-term burden of tracheostomy. IMPLICATIONS FOR CLINICAL PRACTICE:Healthcare planning in this region must account for the younger patient demographic and the heavy reliance on family caregivers. Policy reforms should focus on strengthening home-based professional support to complement family involvement and improve long-term survival.

PURPOSE:To systematically develop and evaluate a contextually-adapted Respiratory Critical Care Nurse Specialist (RCCNS) protocol in healthcare settings structurally lacking Registered Respiratory Therapists (RTs). METHODS:A prospective, single-center, sequential multimethod design (scoping review, qualitative analysis, Delphi consensus) formalized the RCCNS protocol. This randomized, open-label, blinded-endpoint trial allocated critically ill patients in a 1:1 ratio to two parallel arms (n = 50 each) receiving either continuous RCCNS intervention or standard care. Inverse probability of treatment weighting (IPTW) equilibrated baseline covariates (age, prognostic scores, comorbidities). Endpoints included alive ICU discharge, 28-day post-hospital mortality, length of stay (LOS), and Ventilator-Associated Pneumonia (VAP), adjudicated primarily by Ventilator-Associated Condition (VAC) criteria maximizing objectivity. Firth's penalized Cox models, progressive sensitivity analyses, and causal mediation analysis evaluated intervention robustness and mechanisms. RESULTS:The protocol-driven intervention correlated with reduced early mechanical ventilation (80.0% vs. 96.0%, P = 0.014), median ICU LOS (12.0 vs. 29.0 days, P < 0.001), and objectively-adjudicated VAP (10.0% vs. 28.0%, P = 0.022). IPTW-adjusted Cox models yielded adjusted hazard ratios (aHR) of 1.45 (95%CI: 1.10-1.95) for alive ICU discharge and 0.62 (95%CI: 0.31-1.22) for 28-day mortality. Sensitivity models incorporating clinical trajectory proxies and terminal events yielded stable estimates, indicating mortality shifts lacked premature discharge biases. Causal mediation confirmed effects operated primarily via direct mechanisms (NDE OR 0.144, 95%CI: 0.052-0.430) independent of early VAP. CONCLUSION:The intervention did not significantly reduce 28-day mortality (primary outcome) versus standard care. However, exploratory secondary outcome analyses demonstrated significant ICU LOS and mechanical ventilation duration reductions. These findings do not support routine implementation for survival benefits but warrant adequately-powered multicenter trials. IMPLICATION FOR CLINICAL PRACTICE:In infrastructures lacking RTs, delegating advanced respiratory care requires systematic standardization. This study indicates that implementing a formally derived, protocol-driven Respiratory Critical Care Nurse Specialist intervention is associated with reduced intensive care LOS, decreased early mechanical ventilation, and lower VAP incidence, offering an evidence-based framework to optimize resource utilization. These exploratory causal findings merely generate hypotheses, requiring confirmation via adequately powered multicenter trials.

Intensive care units (ICU) patients are highly vulnerable to inaccurate drug dosing. Pharmacogenomics (PGx) studies the role of inherited genetic variation in drug metabolism and dose efficacy. To assess the prevalence of PGx variants that may influence therapeutic effect in the ICU, we carried out whole genome sequencing (WGS) of 210 Qataris in ICU care at Hamad Medical Corporation (HMC), Doha, Qatar and assessed the WGS for predicted deleterious variants of genes that metabolize 30 drugs commonly prescribed in the ICU. PGx variation was evaluated using two complementary approaches. First, variants with established functional interpretation were assessed using CPIC guidelines and star-allele haplotypes inferred by PharmCAT to estimate the prevalence of alleles associated with abnormal drug metabolism. Second, a broader exploratory analysis examined computationally predicted deleterious single-nucleotide variants in pharmacogenes that currently lack CPIC guidelines or defined star alleles, with these findings interpreted as descriptive of genomic variation rather than clinical metabolizer phenotypes.Of the ICU patients that received the 5 most commonly prescribed drugs (warfarin, phenytoin, midazolam, vancomycin, levetiracetam), 93% had deleterious metabolism-related variants. Ninety-one % of ICU patients carried at least one variant in a gene with known PGx relevance that could potentially impact the metabolism or activity of at least one medication they received. Most patients had ≥14 deleterious variants of genes that affect the metabolism of administered drugs. Comparison of the deleterious variants related to metabolism of ICU drugs with African/African American and European populations revealed significant population specificity in ICU related PGx variants. Together, these data suggest that population specific, PGx based on the individual’s genome likely plays a significant role in effective, safe dosing in the ICU setting.

Extracorporeal Membrane Oxygenation (ECMO) is a critical rescue therapy complicated by high rates of nosocomial infections (NIs). While Western data abound, evidence from the Middle East remains limited. This study examined the epidemiological patterns, predictors, and outcomes of NIs among ECMO patients in Qatar. This retrospective cohort study analyzed adult patients supported with ECMO at Hamad General Hospital (2014–2021). Clinical and microbiological data were retrieved according to ELSO definitions. Primary outcomes included mortality at ECMO weaning, ICU, and hospital discharge. Multivariable logistic regression and competing-risks models were employed to identify predictors of infection and survival. Among 172 patients (mean age 41.2 ± 13.3 years), 55.2

Purpose: This study aimed to analyze data from the Extracorporeal Life Support Organization (ELSO) registry to elucidate the epidemiology and outcomes of patients with tuberculosis necessitating extracorporeal membrane oxygenation (ECMO), an intervention typically employed in treating severe acute respiratory distress syndrome (ARDS), but infrequently reported in tuberculosis contexts. Methods: A retrospective analysis was conducted utilizing the ELSO registry data spanning from 2003 to 2022, specifically targeting patients with tuberculosis who underwent ECMO. Primary outcomes included survival to hospital discharge, while secondary outcomes encompassed pre-ECMO support, ECMO duration, complications, and discharge destinations. Univariate and multivariate Cox proportional hazard regression analyses were employed to identify factors influencing survival rates. Results: The analysis included 169 patients with tuberculosis, with a median ECMO support duration of 233 h. The weaning success rate was recorded at 62.7 %, and 55 % of patients achieved survival to hospital discharge. Complications arose in 69.8 % of cases, predominantly mechanical complications (46.6 %). Multivariate Cox regression analysis identified complications (HR: 0.448, 95 % CI: 0.222-0.748, P=0.001), =0.001), infections (HR: 0.483, 95 % CI: 0.241-0.808, P=0.001), =0.001), and prolonged intervals from admission to ECMO initiation (HR: 0.698, 95 % CI: 0.396-0.901, P=0.018) =0.018) as significant factors correlated with decreased survival likelihood. Conclusion: ECMO presents as a viable treatment option for patients with tuberculosis; however, timely initiation and meticulous management are critical to mitigate complications and enhance patient outcomes. Implication for clinical practice: Accurate identification of optimal ECMO initiation timing for eligible patients with tuberculosis can significantly enhance clinical outcomes in critical care settings, such as intensive care units.

Introduction. Pre-existing immunity to human coronaviruses (HCoVs) may shape the immune response in COVID-19 patients. Increasing evidence suggests that immune cross-reactivity between SARS-CoV-2 and other coronaviruses may determine clinical prognosis.Hypothesis. SARS-CoV-2 disease severity is influenced by pre-existing immunity to HCoVs, with distinct antibody profiles and cross-reactivity patterns.Aim. To investigate the antibody response of ICU and non-ICU SARS-CoV-2 patients against different HCoV proteins and assess the potential impact of pre-existing immunity on SARS-CoV-2 disease outcomes.Methodology. This study used a comprehensive HCoVs antigen bead array to measure antibody response to pathogenic Middle East respiratory syndrome coronavirus (MERS-CoV), SARS-CoV, SARS-CoV-2 and the four seasonal HCoVs in 70 ICU and 63 non-ICU COVID-19 patients.Results. Our analysis demonstrates an overall higher antibody response in ICU than in non-ICU COVID-19 patients. Interestingly, the anti-S1 IgG and IgA were significantly higher among ICU than in non-ICU patients. Similarly, the anti-S1 IgG against NL63 showed a lower response among ICU compared to non-ICU. Cross-reactivity was evident between SARS-CoV-2 and SARS-CoV antibodies but not with MERS-CoV and seasonal HCoVs. The subclass analysis of antibodies recognizing SARS-CoV-2 revealed that anti-S1 IgG1, IgG3, IgA1 and IgA2 were significantly higher in ICU compared to non-ICU. The predominant IgA subtype among SARS-CoV-2 patients was IgA1. We applied machine learning algorithms to subclass serological responses to build classifiers that could distinguish between ICU patients and patients with milder COVID-19. Out of 90 variables used in two different types of models, the variable of highest influence in determining the ICU status was IgG3 against SARS-CoV-2 S, and the top 8 variables of influence included the presence of IgG3 against S-trimer as well as IgA against SARS-CoV-2 S.Conclusion. Understanding the complexities of humoral immunity in various patients is critical for early medical intervention, disease management, selective vaccination and passive immunotherapy.

Rationale: Intensive care units (ICU) patients are highly vulnerable to inaccurate drug dosing. Pharmacogenomics (PGx) characterizes the influence of inherited genetic variation on drug metabolism, playing an important role in the consequences of a given drug dose. Objectives: To assess the genetic-based risk of inaccurate drug dosing in the ICU. Methods: We carried out whole genome sequencing (WGS) of 210 Qataris in ICU care at Hamad Medical Corporation (HMC), Doha, Qatar and assessed the WGS for predicted deleterious variants of genes that metabolize 30 drugs commonly prescribed in the ICU. Measurements and Main Results: Analysis of 210 Qatari ICU WGS identified 329 variants predicted deleterious associated with 85 genes known to affect metabolism of the 30 ICU drugs. Of the ICU patients that received the 5 most commonly prescribed drugs (warfarin, phenytoin, midazolam, vancomycin, levetiracetam), 93% had deleterious metabolism-related variants. Most (91%) patients carried at least one variant in a gene that that had the potential to affect the metabolism or activity of at least 1 drug that the patient received. Most patients had greater than or equal to 14 deleterious variants of genes that affect the metabolism of administered drugs. Comparison of the deleterious variants related to metabolism of ICU drugs with African/African American and European populations revealed significant population specificity in ICU related PGx variants. Conclusions: Together, these data suggest that population specific, pharmacogenomics based on the individual's genome likely plays a significant role in effective, safe dosing in the ICU setting. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement : These studies were supported, in part, by Qatar National Research Fund PPM 03-0314-190024 and Department of Genetic Medicine, Weill Cornell Medicine. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: IRB of Weill Cornell Medicine, Qatar gave ethical approval for this work I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the author

BACKGROUND:Low muscle mass assessed by the third lumbar vertebra (L3)-targeted abdominal computed tomography-scan (CT-scan) predicts short-term hospital mortality in the intensive care unit (ICU) patients. However, little is known regarding the relation between the L3 muscle and fat areas at ICU admission and 90-day clinical outcomes. AIMS:to determine the relation between skeletal muscle, subcutaneous, visceral, intramuscular, and total fat cross-sectional areas at ICU admission and 90-day mortality (main), between skeletal muscle and other clinical outcomes, and between body mass index (BMI) and 90-day mortality (secondary). METHODS:A retrospective observational study was performed in a 10-bed medical ICU. The inclusion criteria were: routine abdominal CT-scan <3 days post-admission, expected length of stay >48 h. CT-scan assessed skeletal muscle, subcutaneous, visceral and intramuscular fat areas (cm2) at the L3 level. Low skeletal muscle index (SMI) was defined as <38.5 (women) and <52.4 cm2/m2 (men). Actuarial survival curves, univariate analyses and multivariable Cox models were performed. RESULTS:Out of 200 screened patients, 141 were analyzed: age (mean ± standard deviation) 65.2 ± 14.9 years, 59 % of males, Simplified Acute Physiology Score (SAPS) II 61.7 ± 21.5, BMI, 27.9 ± 6.4. Kaplan-Meier analysis indicated worse survival in patients with low skeletal SMI (61 % (n = 39/64) vs. 44 % (n = 34/77), P = 0.04). Cox multivariable analysis indicated that age ≥65 years (hazard ratio (HR) = 1.79 [95 % confidence interval, 1.01 - 3.19], P = 0.047), SAPS II (HR = 1.04 [1.02-1.05], P < 0.001), low SMI (normal vs. low, HR = 0.48 [0.29-0.82], P = 0.007) and subcutaneous fat index log (HR = 0.67 [0.51 - 0.89], P = 0.006), were independently associated with 90-day mortality. Visceral, intramuscular and total fat areas were not associated with 90-day mortality. Higher body mass index was associated with lower 90-day mortality (HR = 0.92 [0.88-0.96, P < 0.001], when the model excluded muscle and fat tissue levels. CONCLUSIONS:Lower skeletal muscle mass, subcutaneous fat and BMI at ICU admission are associated with higher 90-day mortality. Despite the Global Leadership Initiative on Malnutrition criteria were not used, these results suggest that protein-energy malnutrition at ICU admission is a strong marker of mortality.

Sepsis remains a leading cause of morbidity and mortality, yet routine diagnostics are slow, culture-dependent, and often lack the sensitivity or specificity required for early intervention. Prior studies rarely demonstrate clinical-grade performance on blood culture samples or in independent external cohorts. We address these gaps with a surface-enhanced Raman spectroscopy and deep learning workflow (SERS-DL) that performs sepsis instance recognition and causative pathogen identification directly from target-analyte enriched blood. We assembled a primary dataset of SERS spectra acquired from 653 analyte-enriched blood samples collected at a tertiary hospital in Qatar and an external blind cohort of 70 independent samples. After rigorous preprocessing and class-weighted augmentation of SERS spectra, we trained SuperRamanNet, a lightweight one-dimensional classifier based on super operational neural networks. In five-fold, sample-contained cross-validation, the system achieved 99.67% accuracy for binary sepsis recognition and 98.84% accuracy for six-class pathogen identification. On the external cohort, performance remained high at 98.28% for pathogen typing, indicating robust generalizability. Comparative benchmarks and ablation studies confirmed consistent gains over convolutional and operational baselines and quantified the impact of augmentation and architectural choices. Residual confusions were concentrated between control and Escherichia coli and among certain Gram-negative classes, underscoring the need for improved raw class balance during blood sample collection. Overall, this rapid, culture-free, and portable SERS-DL pipeline delivers near clinical-grade accuracy for sepsis detection and pathogen identification directly from blood. The compact model and streamlined workflow support point-of-care translation, with potential to accelerate triage, guide early therapy, and reduce the global sepsis burden.

Objectives: To evaluate the survival rates with favorable neurological outcomes among patients who experienced in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA). Design: This prospective cohort study assessed 554 adult patients with IHCA or OHCA referred to Hamad General Hospital, Qatar, between February 2015 and November 2021. Neurologic outcomes were measured using the Cerebral Performance Category (CPC) score. Survival rate and neurologic status were re-evaluated at 28 days, hospital discharge, and one year after cardiac arrest (CA). Findings: For all participants, the hospital discharge and one-year survival rates with a favorable neurological outcome (CPC <= 2) were 18.5% and 19.5%, respectively. Specifically, among patients with IHCA, the rates were 20.5 % and 19 %, while in patients with OHCA, the rates were 16.4 % and 19.9 %, respectively. Multivariate regression analysis indicated that factors male sex (OR: 2.129, 95 % CI: 1.168-3.881, P = 0.014), initial shockable rhythm (OR: 1.691, 95 % CI: 1.024-2.788, P = 0.041), and the use of ECPR (OR: 1.944, 95 % CI: 1.178-3.209, P = 0.009) were associated with increased likelihood of survival with favorable neurological outcomes at 28 days. Conversely, older age, presence of comorbidities, infection, higher APACHE II score, longer hospital stays, and undergoing tracheostomy were linked to decreased chances of survival with favorable neurological outcomes at different time points. Conclusion: Survival with good neurological outcomes after OHCA was 20.3 %, 16.4 %, and 19.9 % at 28 days, hospital discharge, and one year, respectively. Among patients with IHCA, survival with good neurological outcomes was 20.5 %, 20.5 %, and 19 % at 28 days, hospital discharge, and one year, respectively.

Thrombocytopenia is a recognized risk factor for bleeding during extracorporeal membrane oxygenation (ECMO). This study determines the incidence, risk factors, and clinical relevance of thrombocytopenia and platelet transfusions during venovenous (VV) ECMO. The multicenter, prospective observational PROTECMO study included 652 adult patients who received VV ECMO for respiratory failure. Thrombocytopenia was classified as mild (100–149·109/L), moderate (50–99·109/L), or severe (< 50·109/L). Bleeding events were evaluated using a modified Bleeding Academy Research Consortium score. Cox proportional hazards and logistic regression analyses were done to identify predictors, and quantify the association between platelet counts and bleeding risk. A total of 182 patients (27.9

Pneumonia remains a significant global health concern, particularly among those requiring admission to the intensive care unit (ICU). Despite the availability of international guidelines, there remains heterogeneity in clinical management. The D-PRISM study aimed to develop a global overview of how pneumonias (i.e., community-acquired (CAP), hospital-acquired (HAP), and Ventilator-associated pneumonia (VAP)) are diagnosed and treated in the ICU and compare differences in clinical practice worldwide. The D-PRISM study was a multinational, survey-based investigation to assess the diagnosis and treatment of pneumonia in the ICU. A self-administered online questionnaire was distributed to intensive care clinicians from 72 countries between September to November 2022. The questionnaire included sections on professional profiles, current clinical practice in diagnosing and managing CAP, HAP, and VAP, and the availability of microbiology diagnostic tests. Multivariable analysis using multiple regression analysis was used to assess the relationship between reported antibiotic duration and organisational variables collected in the study. A total of 1296 valid responses were collected from ICU clinicians, spread between low-and-middle income (LMIC) and high-income countries (HIC), with LMIC respondents comprising 51