Objectives To evaluate perioperative changes in cutaneous microcirculation and microvascular reactivity using hyperspectral imaging (HSI) with a standardised vascular occlusion test (VOT) in cardiac surgery with cardiopulmonary bypass (CPB), and to explore associations with vasoactive support, systemic markers and outcomes. Design Prospective, monocentric, hypothesis-generating observational pilot study. Setting Single-centre university hospital. Participants Twenty-nine adults undergoing elective cardiac surgery with CPB; 25 with complete datasets were analysed. Interventions Palmar HSI (TIVITA® Tissue) before induction (T0), after induction (T1) and after skin closure (T2), yielding tissue oxygenation (StO₂) and Near-Infrared Perfusion Index (NPI). A standardised VOT (5-min arterial occlusion) at T1 and T2 assessed reactive hyperaemia amplitude and time to peak (PORH_ttp). Measurements and Main Results 600 HSI measurements were obtained. StO₂ and NPI increased after induction and decreased at T2 despite stable macrocirculation, without correlating with macrocirculatory variables. At T2, StO₂ correlated negatively with norepinephrine equivalents (r=−0.43), lactate (r=−0.61), procalcitonin (r=−0.67) and CPB time (r=−0.65), whereas associations with interleukin-6 and syndecan-1 were weak. After CPB the hyperaemic StO₂ amplitude was preserved (Δ +30 vs +31%), whereas the NPI response was markedly attenuated (Δ +12 vs +28 AU) and PORH_ttp was prolonged (71.6±36.5 vs 46.3±17.6 s). Three patients requiring mechanical circulatory support showed lower HSI values and worse outcomes. Conclusions HSI-based VOT detected microcirculatory alterations after CPB — preserved superficial oxygenation amplitude with blunted deeper perfusion and delayed reactive hyperaemia — that static HSI parameters alone did not capture. These hypothesis-generating findings require prospective validation before HSI can complement established haemodynamic monitoring.

OBJECTIVES:To determine whether butyrylcholinesterase (BChE) activity independently predicts in-hospital mortality in critically ill adults and to derive a prognostic threshold from patient-level data. DATA SOURCES:Six databases (PubMed, MEDLINE, Embase, Scopus, Web of Science, Cochrane CENTRAL) were searched from inception to data lock. The protocol was registered with PROSPERO (CRD42024558631); reporting followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses of individual participant data (IPD). STUDY SELECTION:Eligible studies were observational cohorts of critically ill adults measuring BChE by the Ellman or Worek method. Six prospective European and South American ICU cohorts contributed 482 adults (92.9% with sepsis; in-hospital mortality, 39%). Risk of bias was appraised with the Quality in Prognosis Studies tool. DATA EXTRACTION:Deidentified IPD from corresponding authors and one public repository were checked for integrity, harmonized, and converted to U/L. Variables included demographics, sepsis status, severity indices (Sequential Organ Failure Assessment, Acute Physiology and Chronic Health Evaluation II), and biochemical markers. DATA SYNTHESIS:Analyses included receiver operating characteristic curves (DeLong area under the curve [AUC], bias-corrected bootstrap), multivariable logistic regression, generalized estimating equation models, Kaplan-Meier and Cox regression, and random-effects meta-analysis (Hartung-Knapp). Admission BChE was lower among non-survivors, with moderate discrimination (pooled AUC, 0.72; 95% CI, 0.65-0.83; DeLong AUC, 0.671; 95% CI, 0.644-0.697). Higher Day-1 BChE was independently associated with lower mortality (odds ratio [OR] per 100 U/L, 0.979; 95% CI, 0.967-0.990; p < 0.001), with a significant ICU day interaction (p = 0.029) and attenuation by Day 4. BChE below 1615 U/L predicted higher mortality (hazard ratio, 1.69; 95% CI, 1.11-2.59; log-rank p = 0.015). Meta-analysis confirmed the inverse association (pooled OR per 1 sd, 0.22; 95% CI, 0.06-0.73; p = 0.023). CONCLUSIONS:BChE enzymatic activity was an integrative, time-dependent prognostic marker of in-hospital mortality, particularly in sepsis. Reduced ICU admission levels and persistently suppressed trajectories identified higher-risk patients. BChE may complement organ dysfunction scores; the 1615 U/L threshold is exploratory and requires prospective external validation.

BACKGROUND:Patients with sepsis are highly susceptible to detrimental nosocomial infections. During bacterial infection, natural killer (NK) cells release Interferon (IFN) γ that drives the elimination of invading pathogens. Interleukin (IL) 12 in synergy with other cytokines increases sensing and uptake of nutrients by NK cells for metabolic adaptation required for induction of IFN-γ production. We hypothesised that inappropriate function of NK cells was associated with nosocomial infections during human sepsis and linked to altered metabolic adaptation. METHODS:We performed a longitudinal exploratory study on circulating human NK cells during sepsis and evaluated adaptation of nutrient sensing, activation of the metabolic hub mammalian target of rapamycin (mTOR) C1, and IFN-γ production upon exposure to Staphylococcus aureus as a model for an opportunistic pathogen in vitro. The involvement of cell-intrinsic and extrinsic pathways in NK cell function was addressed. FINDINGS:Expression of the IL-12 receptor (p < 0.001) and downstream production of IFN-γ (p < 0.01) after exposure to S. aureus were suppressed in NK cells for at least 14 days after sepsis diagnosis, particularly in patients who developed secondary infections (p < 0.01). Mechanistically, suppression of NK cells was independent from environmental cues but was cell-intrinsic and associated with impaired activation of mTORC1 and with reduced expression of nutrient transporters required for anabolic metabolism. Inhibition of AMP kinase (AMPK) restored mTORC1 activity (p < 0.01) and increased the production of IFN-γ (p < 0.01) in NK cells from septic patients. INTERPRETATION:Defective metabolic regulation is associated with persistent NK cell dysfunction during human sepsis and might represent a potential therapeutic target to improve immune competence and decrease the risk for nosocomial infections. FUNDING:The study was supported by the "Research and Training" program "ELAN" for medical students of the medical faculty of the University Duisburg-Essen and by the German Research Foundation DFG (FL391_6-1 to SBF).

COVID-19-associated coagulopathy is characterized by complex alterations in haemostasis. While thrombin generation assays (TGA) provide a global assessment of coagulation potential, data on thrombin generation in critically ill COVID-19 patients, particularly those requiring extracorporeal membrane oxygenation (ECMO), remain limited. To describe thrombin generation, viscoelastic coagulation profiles, and contact pathway-related markers in critically ill COVID-19 patients and to explore their association with disease severity during the first week of intensive care treatment. In this prospective single-center observational study, 48 critically ill patients with COVID-19-associated acute respiratory distress syndrome were included. TGA parameters, rotational thromboelastometry (ROTEM), and contact pathway-related markers were assessed on days 1, 3, and 7 after ICU admission. Associations with disease severity were explored using the Sequential Organ Failure Assessment (SOFA) score. Analyses were exploratory and primarily descriptive. Endogenous thrombin potential (ETP) was inversely correlated with SOFA score on day 1 (r = − 0.43), day 3 (r = − 0.49), and day 7 (r = − 0.31). Peak thrombin showed similar inverse correlations on days 1 and 3. No significant differences in thrombin generation parameters were observed according to SIC status or SAC categories 24 h after ICU admission. ROTEM analyses demonstrated increased clot firmness together with elevated lysis indices and mildly prolonged EXTEM clotting times. Contact pathway-related markers, including factor XI, factor XII, and plasma kallikrein, were inversely associated with disease severity, while factor Xa activity decreased during the observation period. In this cohort of critically ill COVID-19 patients, thrombin generation parameters were inversely associated with disease severity, whereas no association was observed with SIC or SAC-defined coagulopathy. Viscoelastic testing demonstrated increased clot firmness and elevated lysis indices, while contact pathway-related markers decreased with increasing disease severity. These findings provide a descriptive characterization of coagulation abnormalities in critically ill COVID-19 patients and should be interpreted in the context of frequent ECMO support and systemic anticoagulation.

Bleeding and thromboembolic events (BTE) increase the mortality of COVID-19 acute respiratory distress syndrome (ARDS) treated with extracorporeal membrane oxygenation (ECMO). The current analysis aimed to assess frequency and determinants of BTE according to their location and severity in a retrospective analysis of the German ECMO COVID-19 registry. Logistic regression was applied to identify factors influencing ICU survival as well as variables associated with risks of BTE. In total, 708 of 945 patients (75%) suffered from BTE. Overall, 1,348 events were registered, including 406 (30%) major bleeding and 258 (19%) major thromboembolic events. Most common major bleeding locations were intracranial (n = 133, 10%) and pulmonary bleeding (n = 116, 9%). In-ICU survival was 35, 46% without BTE and 22% with major bleeding (p < 0.05). In summary, major bleeding was a core outcome-determinant of COVID-19 ECMO mortality with intracranial major bleeding as the most devastating complication (OR: 5.3; CI: 2.9-9.9; p < 0.001). Neither major thromboembolism nor minor BTE impacted ICU-mortality. Potentially modifiable factors associated with major bleeding included prolonged duration of ECMO >14 days (OR: 2.9; CI 1.8-4.7; p < 0.001) and platelet counts <100.000/μL ≥ 72 h (OR: 2.0; CI 1.1-3.6; p = 0.018). Hence, prevention, early recognition and treatment of major bleedings are key to increase the survival of COVID-19 ECMO. In this regard, our data indicate that the implementation of early weaning strategies to minimize duration of ECMO therapy and prevention of prolonged thrombocytopenia with platelet counts <100.000/μl ≥ 72 h could decrease the risk of devastating bleeds and could ameliorate survival. Clinical trial registration:Registered in the German Clinical Trials Register (study ID: DRKS00022964), retrospectively registered, September 7th 2020, https://drks.de/DRKS00022964.

Impaired microcirculation is a cornerstone of sepsis development and leads to reduced tissue oxygenation, influenced by fluid and catecholamine administration during treatment. Hyperspectral imaging (HSI) is a non-invasive bedside technology for visualizing physicochemical tissue characteristics. Machine learning (ML) for skin HSI might offer an automated approach for bedside microcirculation assessment, providing an individualized tissue fingerprint of critically ill patients in intensive care. The study aimed to determine if machine learning could be utilized to automatically identify regions of interest (ROIs) in the hand, thereby distinguishing between healthy individuals and critically ill patients with sepsis using HSI. HSI raw data from 75 critically ill sepsis patients and from 30 healthy controls were recorded using TIVITA® Tissue System and analyzed using an automated ML approach. Additionally, patients were divided into two groups based on their SOFA scores for further subanalysis: less severely ill (SOFA ≤ 5) and severely ill (SOFA > 5). The analysis of the HSI raw data was fully-automated using MediaPipe for ROI detection (palm and fingertips) and feature extraction. HSI Features were statistically analyzed to highlight relevant wavelength combinations using Mann–Whitney-U test and Benjamini, Krieger, and Yekutieli (BKY) correction. In addition, Random Forest models were trained using bootstrapping, and feature importances were determined to gain insights regarding the wavelength importance for a model decision. An automated pipeline for generating ROIs and HSI feature extraction was successfully established. HSI raw data analysis accurately distinguished healthy controls from sepsis patients. Wavelengths at the fingertips differed in the ranges of 575–695 nm and 840–1000 nm. For the palm, significant differences were observed in the range of 925–1000 nm. Feature importance plots indicated relevant information in the same wavelength ranges. Combining palm and fingertip analysis provided the highest reliability, with an AUC of 0.92 to distinguish between sepsis patients and healthy controls. Based on this proof of concept, the integration of automated and standardized ROIs along with automated skin HSI analyzes, was able to differentiate between healthy individuals and patients with sepsis. This approach offers a reliable and objective assessment of skin microcirculation, facilitating the rapid identification of critically ill patients.

Introduction:Oncologic esophagectomy is a two-cavity procedure with considerable morbidity and mortality. Complex anatomy and the proximity to major vessels constitute a risk for massive intraoperative hemorrhage. Currently, there is no conclusive consensus on the ideal anesthesiologic countermeasure in case of such immense blood loss. The objective of this work was to identify the most promising anesthesiologic management in case of intraoperative hemorrhage with regards to tissue perfusion of the gastric conduit during esophagectomy using hyperspectral imaging.Material and methods:An established live porcine model (n=32) for esophagectomy was used with gastric conduit formation and simulation of a linear stapled side-to-side esophagogastrostomy. After a standardized procedure of controlled blood loss of about 1 l per pig, the four experimental groups (n=8 each) differed in anesthesiologic intervention, that is, (I) permissive hypotension, (II) catecholamine therapy using noradrenaline, (III) crystalloid volume supplementation, and (IV) combined crystalloid volume supplementation with noradrenaline therapy. Hyperspectral imaging tissue oxygenation (StO2) of the gastric conduit was evaluated and correlated with systemic perfusion parameters. Measurements were conducted before (T0) and after (T1) laparotomy, after hemorrhage (T2), and 60 min (T3) and 120 min (T4) after anesthesiologic intervention.Results:StO2 values of the gastric conduit showed significantly different results between the four experimental groups, with 63.3% (+/- 7.6%) after permissive hypotension (I), 45.9% (+/- 6.4%) after catecholamine therapy (II), 70.5% (+/- 6.1%) after crystalloid volume supplementation (III), and 69.0% (+/- 3.7%) after combined therapy (IV). StO2 values correlated strongly with systemic lactate values (r=-0.67; CI -0.77 to -0.54), which is an established prognostic factor.Conclusion:Crystalloid volume supplementation (III) yields the highest StO2 values and lowest systemic lactate values and therefore appears to be the superior primary treatment strategy after hemorrhage during esophagectomy with regards to microcirculatory tissue oxygenation of the gastric conduit.

(1) Background: Sepsis is a severe systemic inflammatory condition characterized by rapid clinical deterioration and organ dysfunction. The cholinergic system has been implicated in modulating the inflammatory response. Acetylcholinesterase (AChE), an enzyme primarily responsible for the hydrolysis of acetylcholine, has been proposed as a potential early indicator of sepsis onset. However, the exact role of non-neuronal AChE activity in sepsis and its correlation with disease severity and patient outcomes remain unclear. This study aimed to investigate the involvement of AChE activity in sepsis and evaluate its association with disease severity and clinical outcomes. (2) Methods: A prospective study included 43 septic patients. AChE activity was measured at sepsis detection, as well as 7 and 28 days later. Inflammatory biomarkers, disease severity scores, and patient outcomes were evaluated. (3) Results: AChE activity remained stable for 7 days and decreased at 28 days. However, there was no correlation between initial AChE activity and inflammatory biomarkers, disease severity scores, ICU stay, or hospital stay. (4) Conclusions: Non-neuronal AChE activity may not reliably indicate early sepsis or predict disease severity.

Traumatic injury induces sterile inflammation, an immune response often associated with severe organ dysfunction. The cholinergic system acts as an anti-inflammatory in injured patients. Acetylcholinesterase (AChE), an enzyme responsible for the hydrolysis of acetylcholine, plays an essential role in controlling cholinergic activity. We hypothesized that a change in the AChE activity might indicate the severity of the traumatic injury. This study included 82 injured patients with an Injury Severity Score (ISS) of 4 or above and 40 individuals without injuries. Bedside-measured AChE was obtained on hospital arrival, followed by a second measurement 4–12 h later. C-reactive protein (CRP), white blood cell count (WBCC), and Sequential Organ Failure Assessment (SOFA) score were simultaneously collected. Injured patients showed an early and sustained increase in AChE activity. CRP remained unaffected at hospital admission and increased subsequently. Initially elevated WBCC recovered 4–12 h later. AChE activity directly correlated with the ISS and SOFA scores and predicted the length of ICU stay when measured at hospital admission. An early and sustained increase in AChE activity correlated with the injury severity and could predict the length of ICU stay in injured patients, rendering this assay a complementary diagnostic and prognostic tool at the hand of the attending clinician in the emergency unit.

Neutrophil granulocytes (NGs) are among the key players in the defense against Aspergillus fumigatus (A. fumigatus). To better elucidate a pathophysiological understanding of their role and functions, we applied a human cell model using NGs from healthy participants and septic patients to evaluate their inhibitory effects on the growth of A. fumigatus ex vivo. Conidia of A. fumigatus (ATCC® 204305) were co-incubated with NGs from healthy volunteers or septic patients for 16 h. A. fumigatus growth was measured by XTT assays with a plate reader. The inhibitory effect of NGs on 18 healthy volunteers revealed great heterogeneity. Additionally, growth inhibition was significantly stronger in the afternoon than the morning, due to potentially different cortisol levels. It is particularly interesting that the inhibitory effect of NGs was reduced in patients with sepsis compared to healthy controls. In addition, the magnitude of the NG-driven defense against A. fumigatus was highly variable among healthy volunteers. Moreover, daytime and corresponding cortisol levels also seem to have a strong influence. Most interestingly, preliminary experiments with NGs from septic patients point to a strongly diminished granulocytic defense against Aspergillus spp.

Hyperspectral imaging (HSI) is a non-invasive technology that provides information on biochemical tissue properties, including skin oxygenation and perfusion quality. Microcirculatory alterations are associated with organ dysfunction in septic COVID-19 patients. This prospective observational study investigated associations between skin HSI and organ dysfunction severity in critically ill COVID-19 patients. During the first seven days in the ICU, palmar HSI measurements were carried out with the TIVITA® tissue system. We report data from 52 critically ill COVID-19 patients, of whom 40 required extracorporeal membrane oxygenation (ECMO). HSI parameters for superficial tissue oxygenation (StO2) and oxygenation and perfusion quality (NPI) were persistently decreased. Hemoglobin tissue content (THI) increased, and tissue water content (TWI) was persistently elevated. Regression analysis showed strong indications for an association of NPI and weaker indications for associations of StO2, THI, and TWI with sequential organ failure assessment (SOFA) scoring. StO2 and NPI demonstrated negative associations with vasopressor support and lactate levels as well as positive associations with arterial oxygen saturation. These results suggest that skin HSI provides clinically relevant information, opening new perspectives for microcirculatory monitoring in critical care.

Objective To optimize anastomotic technique and gastric conduit perfusion with hyperspectral imaging (HSI) for total minimally invasive esophagectomy (MIE) with linear stapled anastomosis. Summary Background Data Esophagectomy is the mainstay of esophageal cancer treatment but anastomotic insufficiency related morbidity and mortality remain challenging for patient outcome. Methods A live porcine model (n=50) for MIE was used with gastric conduit formation and linear stapled side-to-side esophagogastrostomy. Four main experimental groups differed in stapling length (3 vs. 6 cm) and anastomotic position on the conduit (cranial vs. caudal). Tissue oxygenation around the anastomotic site was evaluated using HSI and was validated with histopathology. Results The tissue oxygenation (ΔStO2) after the anastomosis remained constant only for the short stapler in caudal position (−0.4± 4.4%, n.s.) while it dropped markedly in the other groups (short-cranial: -15.6± 11.5%, p=0.0002; long-cranial: -20.4± 7.6%, p=0.0126; long-caudal: -16.1± 9.4%, p<0.0001) Tissue samples from deoxygenated stomach as measured by HSI showed correspondent eosinophilic pre-necrotic changes in 35.7± 9.7% of the surface area. Conclusions Tissue oxygenation at the anastomotic site of the gastric conduit during MIE is influenced by stapling technique. Optimal oxygenation was achieved with a short stapler (3 cm) and sufficient distance of the anastomosis to the cranial end of the gastric conduit. HSI tissue deoxygenation corresponded to histopathologic necrotic tissue changes. These findings allow for optimization of gastric conduit perfusion and anastomotic technique in MIE. Level of Evidence Not applicable. Translational animal science. Original article.

Visual discrimination of tissue during surgery can be challenging since different tissues appear similar to the human eye. Hyperspectral imaging (HSI) removes this limitation by associating each pixel with high-dimensional spectral information. While previous work has shown its general potential to discriminate tissue, clinical translation has been limited due to the method’s current lack of robustness and generalizability. Specifically, the scientific community is lacking a comprehensive spectral tissue atlas, and it is unknown whether variability in spectral reflectance is primarily explained by tissue type rather than the recorded individual or specific acquisition conditions. The contribution of this work is threefold: (1) Based on an annotated medical HSI data set (9059 images from 46 pigs), we present a tissue atlas featuring spectral fingerprints of 20 different porcine organs and tissue types. (2) Using the principle of mixed model analysis, we show that the greatest source of variability related to HSI images is the organ under observation. (3) We show that HSI-based fully-automatic tissue differentiation of 20 organ classes with deep neural networks is possible with high accuracy (> 95%). We conclude from our study that automatic tissue discrimination based on HSI data is feasible and could thus aid in intraoperative decisionmaking and pave the way for context-aware computer-assisted surgery systems and autonomous robotics.

Abstract Background Severe COVID-19 induced acute respiratory distress syndrome (ARDS) often requires extracorporeal membrane oxygenation (ECMO). Recent German health insurance data revealed low ICU survival rates. Patient characteristics and experience of the ECMO center may determine intensive care unit (ICU) survival. The current study aimed to identify factors affecting ICU survival of COVID-19 ECMO patients. Methods 673 COVID-19 ARDS ECMO patients treated in 26 centers between January 1st 2020 and March 22nd 2021 were included. Data on clinical characteristics, adjunct therapies, complications, and outcome were documented. Block wise logistic regression analysis was applied to identify variables associated with ICU-survival. Results Most patients were between 50 and 70 years of age. PaO2/FiO2 ratio prior to ECMO was 72 mmHg (IQR: 58–99). ICU survival was 31.4%. Survival was significantly lower during the 2nd wave of the COVID-19 pandemic. A subgroup of 284 (42%) patients fulfilling modified EOLIA criteria had a higher survival (38%) (p = 0.0014, OR 0.64 (CI 0.41–0.99)). Survival differed between low, intermediate, and high-volume centers with 20%, 30%, and 38%, respectively (p = 0.0024). Treatment in high volume centers resulted in an odds ratio of 0.55 (CI 0.28–1.02) compared to low volume centers. Additional factors associated with survival were younger age, shorter time between intubation and ECMO initiation, BMI > 35 (compared to < 25), absence of renal replacement therapy or major bleeding/thromboembolic events. Conclusions Structural and patient-related factors, including age, comorbidities and ECMO case volume, determined the survival of COVID-19 ECMO. These factors combined with a more liberal ECMO indication during the 2nd wave may explain the reasonably overall low survival rate. Careful selection of patients and treatment in high volume ECMO centers was associated with higher odds of ICU survival. Trial registration Registered in the German Clinical Trials Register (study ID: DRKS00022964, retrospectively registered, September 7th 2020, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00022964. Graphical abstract

In dieser Rubrik stellen wir Standard Operating Procedures (SOPs) für perioperativ und intensivmedizinisch relevante Prozesse vor. Die Form ist eher im Sinne einer Schablone zu verstehen als – durchaus subjektiv gefärbte – Anregung, eigene, auf lokale Gegebenheiten adaptierte stationsinterne SOPs zu entwerfen und zu implementieren.

Superinfections with Aspergillus spp. in patients with Coronavirus disease 2019 (CAPA: COVID-19-associated pulmonary aspergillosis) are increasing. Dexamethasone has shown beneficial effects in critically ill COVID-19 patients. Whether dexamethasone increases the risk of CAPA has not been studied exclusively. Moreover, this retrospective study aimed to identify risk factors for a worse outcome in critically ill COVID-19 patients. Data from 231 critically ill COVID-19 patients with or without dexamethasone treatment from March 2020 and March 2021 were retrospectively analysed. Only 4/169 (6.5%) in the DEXA-group and 13/62 (7.7%) in the Non-DEXA group were diagnosed with probable CAPA (p = 0.749). Accordingly, dexamethasone was not identified as a risk factor for CAPA. Moreover, CAPA was not identified as an independent risk factor for death in multivariable analysis (p = 0.361). In contrast, elevated disease severity (as assessed by Sequential Organ Failure Assessment [SOFA]-score) and the need for organ support (kidney replacement therapy and extracorporeal membrane oxygenation [ECMO]) were significantly associated with a worse outcome. Therefore, COVID-19 treatment with dexamethasone did not increase the risk for CAPA. Moreover, adequately treated CAPA did not represent an independent risk factor for mortality. Accordingly, CAPA might reflect patients' severe disease state instead of directly influencing outcome.

A biomarker for risk stratification and disease severity assessment in SARS-CoV-2 infections has not yet been established. Point of care testing (POCT) of butyrylcholinesterase (BChE) enables early detection of systemic inflammatory responses and correlates with disease severity in sepsis and burns. In acute care or resource-limited settings, POCT facilitates rapid clinical decision making, a particularly beneficial aspect in the management of pandemic situations. In this prospective observational study, POCT-measured BChE activity was assessed in 52 critically ill COVID-19 patients within 24 h of ICU admission and on the third and seventh day after ICU admission. Forty (77%) of these patients required venovenous extracorporeal membrane oxygenation (vvECMO). In critically ill COVID-19 patients, BChE activity is significantly decreased compared with healthy subjects, but also compared with other inflammatory conditions such as sepsis, burns, or trauma. POCT BChE activity reflects the severity of organ dysfunction and allows prediction of 28-day mortality in critically ill COVID-19 patients. Implementing early POCT BChE measurement could facilitate risk stratification and support admission and transfer decisions in resource-limited settings.

Infections with SARS-CoV-2 spread worldwide early in 2020. In previous winters, we had been treating patients with seasonal influenza. While creating a larger impact on the health care systems, comparisons regarding the intensive care unit (ICU) courses of both diseases are lacking. We compared patients with influenza and SARS-CoV-2 infections treated at a tertiary care facility offering treatment for acute respiratory distress syndrome (ARDS) and being a high-volume facility for extracorporeal membrane oxygenation (ECMO). Patients with COVID-19 during the first wave of the pandemic (n = 64) were compared to 64 patients with severe influenza from 2016 to 2020 at our ICU. All patients were treated using a standardized protocol. ECMO was used in cases of severe ARDS. Both groups had similar comorbidities. Time in ICU and mortality were not significantly different, yet mortality with ECMO was high amongst COVID-19 patients with approximately two-thirds not surviving. This is in contrast to a mortality of less than 40% in influenza patients with ECMO. Mortality was higher than estimated by SAPSII score on admission in both groups. Patients with COVID-19 were more likely to be male and non-smokers than those with influenza. The outcomes for patients with severe disease were similar. The study helps to understand similarities and differences between patients treated for severe influenza infections and COVID-19.

Sepsis is a leading cause of mortality and critical illness worldwide. While robust biomarkers for early diagnosis are still missing, recent work indicates that hyperspectral imaging (HSI) has the potential to overcome this bottleneck by monitoring microcirculatory alterations. Automated machine learning-based diagnosis of sepsis based on HSI data, however, has not been explored to date. Given this gap in the literature, we leveraged an existing data set to (1) investigate whether HSI-based automated diagnosis of sepsis is possible and (2) put forth a list of possible confounders relevant for HSI-based tissue classi cation. While we were able to classify sepsis with an accuracy of over 98 % using the existing data, our research also revealed several subject-, therapyand imaging-related confounders that may lead to an overestimation of algorithm performance when not balanced across the patient groups. We conclude that further prospective studies, carefully designed with respect to these confounders, are necessary to con rm the preliminary results obtained in this study.