Background: Drug-related deaths worldwide are most commonly attributed to opioids. Opioids and other sedative drugs can cause respiratory depression and airway compromise, leading to hypoxia and death. Device technology and artificial intelligence used to detect drug overdose has the potential to improve outcomes. PneumoWave Ltd has developed a small chest-worn respiratory monitoring device to detect concerning breathing patterns and alert an emergency response. Objective: The aim of this study is to investigate the feasibility of using the PneumoWave device in hospital patients at risk of respiratory depression. Methods: This 18-month prospective observational study was performed at the Queen Elizabeth University Hospital, Glasgow. The study investigates the use of the device on 3 groups of patients at risk of respiratory depression due to drugs. This includes patients attending the emergency department (ED) due to sedative drug overdose, patients receiving procedural sedation and analgesia in the ED, and patients receiving general anesthesia in theaters. Consenting participants will have the PneumoWave sensor paired with end-tidal CO2 monitoring and regular recordings of vital signs. Usability will be tested by administering a questionnaire to the patient, the clinician, and the nurse. The primary end point is to determine the feasibility of gathering respiratory data from a wearable respiratory monitoring device in the ED. Statistical analysis includes comparison of biosensor data against reference physiology time course data. Results: Trial recruitment was completed on December 8, 2023. Twenty-five patients were enrolled in group 1 (acute toxicity); 39 patients in group 2 (procedural sedation), including 1 patient who was subsequently withdrawn; and 14 patients in group 3 (acute toxicity), with 2 patients withdrawn. Publication of the study results is anticipated by December 2025. Conclusions: This study will explore the feasibility of the PneumoWave device in a variety of clinical contexts in which risk of pharmacologically induced respiratory depression is present. This will provide valuable insight into the use of device technology in individuals at risk of illicit drug-related harm within the relative safety of a hospital setting. A limitation of the study procedure is exclusion of patients with intoxication after sedative drug overdose who lack the capacity to provide informed consent. This study has been designed to acquire feasibility data to demonstrate the potential for continuous respiratory monitoring to improve outcomes for patients who are at risk of drug-induced respiratory depression, inform product development, and inform the design of future pivotal clinical investigations.

Background: Despite high rates of cardiovascular disease in Scotland, the prevalence and outcomes of patients with cardiogenic shock are unknown. Methods: We undertook a prospective observational cohort study of consecutive patients with cardiogenic shock admitted to the intensive care unit (ICU) or coronary care unit at 13 hospitals in Scotland for a 6-month period. Denominator data from the Scottish Intensive Care Society Audit Group were used to estimate ICU prevalence; data for coronary care units were unavailable. We undertook multivariable logistic regression to identify factors associated with in-hospital mortality. Results: In total, 247 patients with cardiogenic shock were included. After exclusion of coronary care unit admissions, this comprised 3.0% of all ICU admissions during the study period (95% confidence interval [CI] 2.6%-3.5%). Aetiology was acute myocardial infarction (AMI) in 48%. The commonest vasoactive treatment was noradrenaline (56%) followed by adrenaline (46%) and dobutamine (40%). Mechanical circulatory support was used in 30%. Overall in-hospital mortality was 55%. After multivariable logistic regression, age (odds ratio [OR] 1.04, 95% CI 1.02-1.06), admission lactate (OR 1.10, 95% CI 1.05-1.19), Society for Cardiovascular Angiographic Intervention stage D or E at presentation (OR 2.16, 95% CI 1.10-4.29) and use of adrenaline (OR 2.73, 95% CI 1.40-5.40) were associated with mortality. Conclusions: In Scotland the prevalence of cardiogenic shock was 3% of all ICU admissions; more than half died prior to discharge. There was significant variation in treatment approaches, particularly with respect to vasoactive support strategy.

Severe acute pancreatitis (SAP) is a common pathology requiring critical care input. Patients often present with evidence of physiological dysfunction that may require organ support for optimization. Various scoring systems are available which can help in identifying those most at risk of morbidity and mortality. Complications can be significant, and may require surgical intervention for management. As such these patients should be managed with full multidisciplinary input to ensure appropriate targeted treatment. Underlying causes for SAP should be aggressively investigated to reduce the potential for recurrent episodes and where appropriate allow for secondary preventative measures. These patients often require prolonged and recurrent intensive care stays. Of those who are discharged, ongoing issues with chronic pain and nutrition are not uncommon and can lead to significant psycho-social challenges in the community.

ImportancePatients with septic shock undergo adrenergic stress, which affects cardiac, immune, inflammatory, and metabolic pathways. β-Blockade may attenuate the adverse effects of catecholamine exposure and has been associated with reduced mortality.ObjectivesTo assess the efficacy and safety of landiolol in patients with tachycardia and established septic shock requiring prolonged (>24 hours) vasopressor support.Design, Setting, and ParticipantsAn open-label, multicenter, randomized trial involving 126 adults (≥18 years) with tachycardia (heart rate ≥95/min) and established septic shock treated for at least 24 hours with continuous norepinephrine (≥0.1 μg/kg/min) in 40 UK National Health Service intensive care units. The trial ran from April 2018 to December 2021, with early termination in December 2021 due to a signal of possible harm.InterventionSixty-three patients were randomized to receive standard care and 63 to receive landiolol infusion.Main Outcomes and MeasuresThe primary outcome was the mean Sequential Organ Failure Assessment (SOFA) score from randomization through 14 days. Secondary outcomes included mortality at days 28 and 90 and the number of adverse events in each group.ResultsThe trial was stopped prematurely on the advice of the independent data monitoring committee because it was unlikely to demonstrate benefit and because of possible harm. Of a planned 340 participants, 126 (37%) were enrolled (mean age, 55.6 years [95% CI, 52.7 to 58.5 years]; 58.7% male). The mean (SD) SOFA score in the landiolol group was 8.8 (3.9) compared with 8.1 (3.2) in the standard care group (mean difference [MD], 0.75 [95% CI, −0.49 to 2.0]; P = .24). Mortality at day 28 after randomization in the landiolol group was 37.1% (23 of 62) and 25.4% (16 of 63) in the standard care group (absolute difference, 11.7% [95% CI, −4.4% to 27.8%]; P = .16). Mortality at day 90 after randomization was 43.5% (27 of 62) in the landiolol group and 28.6% (18 of 63) in the standard care group (absolute difference, 15% [95% CI, −1.7% to 31.6%]; P = .08). There were no differences in the number of patients having at least one adverse event.Conclusion and RelevanceAmong patients with septic shock with tachycardia and treated with norepinephrine for more than 24 hours, an infusion of landiolol did not reduce organ failure measured by the SOFA score over 14 days from randomization. These results do not support the use of landiolol for managing tachycardia among patients treated with norepinephrine for established septic shock.Trial RegistrationEU Clinical Trials Register Eudra CT: 2017-001785-14; isrctn.org Identifier: ISRCTN12600919

OBJECTIVES Soluble urokinase plasminogen activator receptor (suPAR) is a biomarker that has been implicated in several cardiac pathologies and has been shown to be elevated in critically ill populations. We measured plasma suPAR in a cohort of cardiac surgical patients to evaluate its ability to predict prolonged intensive care unit (ICU) and hospital length of stay and development of complications following surgery. We compared suPAR against EuroSCORE II and C-reactive protein (CRP). METHODS Ninety patients undergoing cardiac surgery were recruited with samples taken preoperatively and on postoperative days 1, 2 and 3. suPAR was measured using enzyme-linked immunosorbent assay. Area under the receiver operator curve (AUROC) was used to test predictive capability of suPAR. Comparison was made with EuroSCORE II and CRP. RESULTS suPAR increased over time (P < 0.001) with higher levels in patients requiring prolonged ICU and hospital stay, and prolonged ventilation (P < 0.05). suPAR was predictive for prolonged ICU and hospital stay, and prolonged ventilation at all time points (AUROC 0.66-0.74). Interestingly, this association was also observed preoperatively, with preoperative suPAR predicting prolonged ICU (AUROC 0.66), and hospital stay (AUROC 0.67) and prolonged ventilation (AUROC 0.74). The predictive value of preoperative suPAR compared favourably to EuroSCORE II and CRP. CONCLUSIONS suPAR increases following cardiac surgery and levels are higher in those who require prolonged ICU stay, prolonged hospital stay and prolonged ventilation. Preoperative suPAR compares favourably to EuroSCORE II and CRP in the prediction of these outcomes. suPAR could be a useful biomarker in predicting outcome following cardiac surgery, helping inform clinical decision-making. CLINICAL REGISTRATION West of Scotland Research Ethics Committee Reference: 12/WS/0179 (AM01).

INTRODUCTION Tracheostomy is a common surgical procedure used to create a secure airway in patients, now performed by a variety of specialties, with a notable rise in critical care environments. It is unclear whether this rise is seen in units with large head and neck surgery departments, and how practice in such units compares with the rest of the UK. METHODS A three-year retrospective audit was carried out between anaesthetic, surgical and critical care departments. All tracheostomy procedures were recorded anonymously. RESULTS A total of 523 tracheostomies were performed, 66% of which were in men. The mean patient age was 60 years. The majority (83%) were elective, performed for various indications, while the remaining 17% were emergency tracheostomies performed for pending airway obstruction. A fifth of the tracheostomies were percutaneous procedures. Most emergency tracheostomies (78%) were performed by otolaryngology. Three cricothyroidotomies were performed within critical care and theatres. Complications related to tracheostomy occurred in 47 cases (9%), most commonly lower respiratory tract infection. The mean time to decannulation was 12.8 days. CONCLUSIONS This paper discusses the findings of a comprehensive, multispecialty audit of tracheostomy experience in a large health board, with over 150 tracheostomies performed annually. Elective cases form the majority although there is a significant case series of emergency tracheostomies performed for a range of pathologies. Around a quarter of those requiring tracheostomy ultimately died, mostly as a result of advanced cancer.

Nutritional support is a vital intervention in the critically ill that can adversely affect survival and morbidity. Many patients presenting to critical care have a degree of nutritional deficiency either due to chronic ill health or their presenting complaint and these have to be addressed. Critical illness itself affects the nutritional needs of patients, progressing from profound catabolism to a degree of anabolism and support must reflect these changes. Challenges exist in both the calculation of requirements and the provision of appropriate support, and the use of the multidisciplinary team is essential to provide high quality support. Calculations of nutritional requirements are complicated both by the nature of critical illness and the limited access to sources of information. Nutritional support itself can cause morbidity, either via unrecognized refeeding syndromes, or by complications of the chosen route of support and an appreciation of the evidence base is essential to make the right choice for patients.

Acute kidney injury (AKI) affects up to 60% of intensive care unit (ICU) patients and is associated with mortality rates of between 15 and 60%. Up to two-thirds of patients with AKI go on to require renal replacement therapy (RRT). Without the ability to replace native renal function, mortality from the complications of fluid overload, refractory hyperkalaemia, and metabolic derangement would be far higher. From the 1960s, hollow-fibre dialysers became available as a form of RRT and were able to be mass produced, with Scribner starting the first outpatient dialysis centres in the USA. Haemofiltration, as a form of RRT, began in the 1970s and is now an indispensable tool used as part of modern critical care management. Despite improvements in technologies, there has been only slow improvement in mortality since the 1980s. The reasons postulated for this include the lack of diagnostic tools available to detect early AKI, delayed initiation of RRT, inadequate delivery of RRT, and the inability to replace kidney function fully with current RRT modalities. Little information exists on trends in the epidemiology of AKI; however, there are several reasons to suspect that its incidence is on the rise: the increasing age and comorbidities of the hospitalized population; an increase in the prevalence of risk factors for AKI such as chronic kidney disease and diabetes; and more widespread use of i.v. contrast for cardiovascular and other radiological procedures.

Learning Objectives: Comorbidity in patients in ICU has been shown to have an adverse effect on survival. While many scoring systems exist for assessing disease severity and estimating mortality in critically ill patients, they rarely take into consideration the full burden of comorbidity. Previous scoring systems have been developed for quantifying disease burden, but few have used drug history to directly measure this. This study aims to develop a prognostic tool based solely on patients’ repeat prescriptions, as a method of quantifying disease burden, and assess its ability to predict long term outcomes. Methods: The Medication-based Disease Burden Index (2006) was updated and modified. A retrospective search (using CareVue) for patients admitted to Glasgow Royal Infirmary ICU between 10/2007 and 11/2010 was carried out in order to obtain full drug histories from the time of admission. These patients were then individually scored using the modified MDBI. A second search was carried out using Clinical Portal to ascertain long-term survival. Survival analysis using Kaplan-Meier and Cox Proportional Hazards was carried out to illustrate any relationship between total score and survival probability, including correction for APACHE II score Results: 562 patients were included in the analysis. Survival probability dropped with increasing score: over 80% survival at 5 yr in those scoring zero, dropping to less than 40% in those with a high score. Log rank test was highly significant (p<0.0001). Hazard ratios for each of the 3 score groups showed an incremental increase in risk when compared to the zero score group, which was significant in each case (low score: HR 2.12(1.40–3.23) p<0.0001, medium score: HR 2.87(1.85–4.45) p<0.0001, high score: HR 5.16(3.08–8.64) p<0.0001). Results remained significant after adjusting for APACHE II score. Conclusions: This gives promising, significant evidence of a simple and useful predictive tool for quantifying comorbidity and the effect it has on long term survival following ICU admission. Further work is required to replicate its use in other populations, and in larger samples.