The Journal of Critical Care Medicine Feed

Decisions, outcomes, and learning from what didn’t go wrong

Fri, 30 Jan 2026 00:00:00 GMT

Non-thyroidal illness (euthyroid sick) syndrome: Laboratory aspects and clinical significance in critically ill patients and other diseases – A narrative review

Fri, 30 Jan 2026 00:00:00 GMT

Formerly termed euthyroid sick syndrome, non-thyroidal sickness syndrome (NTIS) is a disorder that frequently occurs in acute or chronic illnesses that alter the levels of thyroid hormone and patterns, even in the absence of hypothalamic-pituitary-thyroid axis problems or diseases. The primary findings on the thyroid hormone panel in NTIS are elevated reverse T3 (rT3) and decreased triiodothyronine (T3) levels, which may be followed by other thyroid hormone abnormalities, such as thyroid-stimulating hormone (TSH) and thyroxine (T4). The incidence of NTIS increases among hospitalized patients with critical illness, and there is an associated increase in mortality. NTIS is also associated with worsening outcomes during and after treatment in patients hospitalized with infectious or non-infectious diseases, such as cardiovascular, kidney, lung, diabetes mellitus, autoimmune, and other diseases. In patients with critical illnesses admitted to the Intensive Care Unit (ICU), serial examination of a panel of thyroid function tests, including T3 and rT3, is necessary to estimate the phase of the disease (whether acute, chronic, or recovery) and can be used to predict the risk of mortality during treatment.

Right ventricular failure after LVAD support: A challenging case of bridge to heart transplantation in end-stage dilated cardiomyopathy

Fri, 30 Jan 2026 00:00:00 GMT

Introduction End-stage heart failure due to dilated cardiomyopathy remains a major indication for advanced mechanical circulatory support and heart transplantation. Left ventricular assist devices have emerged as a vital bridge to transplant, improving survival and functional status. However, right ventricular failure following LVAD implantation is a significant and potentially fatal complication, requiring careful management to optimize outcomes. Case presentation We present the case of a 46-year-old male with post-myocarditis dilated cardiomyopathy, severely reduced left ventricular ejection fraction (21%), severe functional mitral and tricuspid regurgitation, and NYHA class IV heart failure. Despite optimal medical therapy, including inotropic support, the patient progressed to multiorgan dysfunction necessitating renal replacement therapy. A HeartMate 3 LVAD was implanted as a bridge to transplantation. The postoperative course was complicated by severe right ventricular failure, requiring prolonged inotropic support and careful hemodynamic management. Despite these challenges, the patient successfully underwent orthotopic heart transplantation. His postoperative evolution was favorable, with stable graft function and good clinical recovery documented during follow-up. Conclusion Right ventricular failure remains a major complication following LVAD implantation, significantly impacting outcomes. While LVADs have revolutionized the management of end-stage heart failure, heart transplantation continues to represent the definitive therapy offering superior long-term survival.

Veno-venous ECMO for rapidly progressing interstitial lung disease: A multidisciplinary approach

Fri, 30 Jan 2026 00:00:00 GMT

Introduction This is a unique case of fulminant respiratory failure secondary to a rare cause of rapidly progressing ILD; antisynthetase syndrome (ASS). Failure to deliver timely multi-modal treatment in these cases can lead to increased morbidity and mortality. Case presentation A previously healthy 27-year-old male presented to his local hospital with a 1-week history of malaise, shortness of breath and cough. Initial work up including bloods and imaging were suggestive of community acquired multi lobar pneumonia, for which he received treatment as per local guidelines. Unfortunately, despite broad empirical antimicrobial cover, he continued to deteriorate with worsening type-1 respiratory failure requiring intubation and subsequent institution of prone position ventilation. Extensive microbiological investigations yielded no positive results. On day 7 of admission immunological testing revealed an ENA screen positive for Jo-1 antibody and a diagnosis of ASS was made. Despite treatment with immunosuppression the patient’s condition rapidly deteriorated and the decision to support with V-V ECMO was made following MDT consideration as there remained uncertainty as to the extent of reversibility of the underlying condition. Conclusions This patient recovered with combination of conventional immunosuppression, therapeutic plasma exchange and ECMO support. This case highlights Antisynthetase syndrome as a cause of reversible interstitial lung disease in the ICU and the importance of multi-disciplinary decision making and aggressive treatment approach in the management of such conditions.

Interruption of enteral tube feeding during chest physiotherapy in critically ill adults: A scoping review

Fri, 30 Jan 2026 00:00:00 GMT

Introduction Numerous reports indicate that the nutritional targets of critically ill patients are frequently not met. In daily clinical practice, it is often recommended to temporarily stop enteral tube feeding in patients on mechanical ventilation (MV) who are undergoing chest physiotherapy. This is because adverse events can occur and potentially cause vomiting and increase the risk of aspiration pneumonia. Aim of the study To identify, characterise, and analyse the available evidence on the interruption of enteral tube feeding in critically ill adult patients receiving MV before or during chest physiotherapy. Materials and Methods We conducted a scoping review following the recommendations of the Joanna Briggs Institute. We conducted a systematic search of MEDLINE (Ovid), Embase (Ovid), CENTRAL (Cochrane Library), CINAHL (EBSCOhost), and other search resources until March 2025. We included studies of any design that addressed the application of chest physiotherapy in adults on MV and receiving enteral tube nutrition. Study selection and data extraction were performed in duplicate, and disagreements were resolved by consensus. Results We include four studies that were published between 2018 and 2024. One observational study reported that enteral tube feeding was discontinued due to the application of chest physiotherapy in patients in prone and supine MV. In the other three studies, which contribute to a clinical practice guideline, discontinuation of enteral tube feeding is recommended 30 minutes before using the head-down position as a bronchial drainage manoeuvre. However, no studies report on the safety of chest physiotherapy when enteral tube feeding is either discontinued or continued. Conclusion There is no empirical evidence to justify routinely stopping enteral tube feeding during chest physiotherapy in MV patients. Future primary studies should report on the management of enteral tube feeding before or during chest physiotherapy interventions, as well as document any adverse events that may occur during its application.

Bimodal distribution of trauma-related acute kidney injury (TrAKI): A clinical review

Fri, 30 Jan 2026 00:00:00 GMT

Severe trauma remains the leading cause of mortality and disability among young adults. Trauma-related Acute Kidney Injury (TrAKI) has been associated with worse outcomes, increased healthcare costs, and higher morbidity among survivors. The review aims to evaluate, from a pathophysiological perspective, the risk factors for TrAKI at different time points of trauma treatment, highlighting the need for early diagnosis of the syndrome and the implementation of preventive measures. TrAKI is triggered at the time the injury occurs and further worsened by factors related to resuscitation process and potential complications. Severe trauma, due to hemorrhagic shock, is considered to act as the first hit. All subsequent necessary lifesaving procedures applied in trauma management, such as fluid resuscitation, massive transfusion and emergency surgery, could act as second hit, triggering “early” TrAKI, within 24–72 hours, due to renal hypoperfusion, hypoxia and reperfusion injury (R/I). The following critical care treatment, seems to act as the final third hit, resulting in “late” TrAKI appeared in 5–7 days or even later, caused by distal complications. The incidence of TrAKI shows a biphasic pattern, with an “early “peak within 2–3 days after trauma, and a “delayed” occurring a week or later. This distinction could be of clinical importance because of its disparate pathophysiology and outcome. Early recognition of risk factors and diagnosis of TrAKI could improve the application of preventive measures and therapeutic treatment, reducing its prevalence.

Warburg effect in B-cell lymphoma: A case report and proposed management plan

Fri, 30 Jan 2026 00:00:00 GMT

Introduction The Warburg effect is a rare but often fatal condition in patients with malignancies. This phenomenon, known as type B lactic acidosis, is defined by lactatemia without tissue hypoxia or hypoperfusion, in contrast to type A lactic acidosis, which usually results from either or both. Case presentation A male patient in his seventies with a newly diagnosed diffuse large B-cell lymphoma is admitted to the intensive care unit due to severe metabolic derangements with hypoglycemia and lactatemia. Extensive investigations ruled out alternative etiologies, strongly suggesting the Warburg effects as the underlying mechanism. Despite hemodynamic instability, chemotherapy was initiated and resulted in initial clinical improvement. Conclusion We propose a stepwise approach to improve the management of patients with suspected type B lactic acidosis.

Inhaled sevoflurane in critically ill COVID-19 patients: A retrospective cohort study

Fri, 30 Jan 2026 00:00:00 GMT

Background Managing sedation in critically ill COVID-19 patients is challenging due to high sedative requirements and organ dysfunction that alters drug metabolism. Inhaled sevoflurane offers a lung-eliminated alternative that may mitigate drug accumulation. Methods This single-center, retrospective cohort study analyzed 43 mechanically ventilated COVID-19 patients (March–November 2020). Patients received inhaled sevoflurane adjunctive to IV sedation (n=30) or IV sedation alone (n=13). The primary outcome was the cumulative dose of IV sedatives over 7 days. Secondary outcomes included time to extubation and antipsychotic use. Results There was no significant difference in the cumulative dose of IV sedatives between groups. However, the sevoflurane group had a significantly longer median duration of mechanical ventilation (206 [IQR 144–356] vs 144 [IQR 115–156] hours, p=0.005) and a higher requirement for antipsychotic medication (66.6% vs 15.3%, OR 18.6, p=0.011). Daily doses of propofol were lower in the sevoflurane group on specific days, but overall burden was unchanged. Conclusions In this cohort, adjunctive inhaled sevoflurane did not significantly reduce the cumulative burden of IV sedatives and was associated with delayed extubation and increased antipsychotic use. While sevoflurane is a feasible alternative, these findings suggest caution regarding weaning and delirium management in COVID-19 patients.

Transition from ICU to home care with long-term invasive ventilation using a single-limb BiPAP circuit

Fri, 30 Jan 2026 00:00:00 GMT

Background Patients with chronic respiratory failure caused by severe neuromuscular impairment often require long-term respiratory support. Invasive mechanical ventilation (IMV) via tracheostomy is usually provided in intensive care units (ICUs), but in carefully selected cases, it can be safely transitioned to home care. The use of a single-limb ventilator circuit (Single BiPAP circuit with Whisper Swivel II), intended initially for non-invasive ventilation (NIV), may represent a cost-effective and practical alternative for long-term home IMV. Case presentation We present a 50-year-old male with progressive neuromuscular disease and chronic respiratory failure, who required long-term IMV through a tracheostomy tube. After stabilization in the ICU, ventilation was maintained at home using a Single BiPAP circuit with Whisper Swivel II, combined with a mechanical insufflation-exsufflation (MIE) device for airway secretion clearance. The patient’s family received structured training in tracheostomy care, ventilator operation, and secretion management. Over 32-month period, the patient maintained stable respiratory function, experienced a marked reduction in infectious exacerbations, and preserved an acceptable quality of life. Conclusion In selected patients, long-term home IMV using a single-limb ventilator combined with an MIE device can be a safe, effective, and cost-efficient alternative to conventional ICU-based ventilation. Successful outcomes require structured patient and caregiver training, close follow-up, and coordinated multidisciplinary support.

Evidence-based fluid resuscitation of the septic HFpEF patient: A narrative review of the literature

Fri, 30 Jan 2026 00:00:00 GMT

Purpose This narrative review aims to highlight the available evidence on fluid resuscitation in septic patients with heart failure, with a particular focus on heart failure with preserved ejection fraction. Methods A PubMed search was conducted using the keywords “sepsis” (or sepsis, or septic shock), “heart failure” (or HF, or HFrEF, or HFpEF or congestive heart failure), and “fluid” (or resuscitation, or fluid resuscitation, or fluid management). The results were summarized in narrative review format. Results/Conclusions The presence of HFpEF in septic patients appears to be associated with an increased risk of adverse outcomes. This population may benefit from a more individualized approach to fluid resuscitation. Emerging tools for assessing fluid responsiveness and characterizing septic cardiovascular physiology show promise, but further investigation is needed.

Real-world clinical decision of andexanet alfa administration for intracranial hemorrhage during anticoagulant therapy using factor Xa inhibitor

Fri, 30 Jan 2026 00:00:00 GMT

Introduction Andexanet alfa shows excellent hemostatic efficacy in treating intracranial hemorrhage (ICH) during Xa inhibitor therapy. However, its optimal use remains uncertain. Aim of the study This study aims to evaluate our clinical experience in managing Xa inhibitor-related ICH to clarify its appropriate application. Material and methods This study was conducted as an observational, non-interventional study. We observed 63 cases of ICH in patients receiving anticoagulation therapy with apixaban, rivaroxaban, or edoxaban. After excluding 14 patients due to fatal outcomes or complete hemostasis, 49 patients were eligible for andexanet alfa administration. Results The mean age and hematoma volume was 78 years and the 35ml, respectively. Based on patient characteristics and severity, andexanet alfa was administered to 23 patients, while 26 patients received usual care. Hemorrhage enlargement was absent in 22 cases (92.8%) in the andexanet group and in 22 cases (84.6%) in the usual care group. Hemorrhage expansion occurred in three cases from the usual care group, one patient undergoing emergency surgery and another died from uncontrollable intraoperative bleeding. Two patients (8.7%) in the andexanet group experienced thromboembolic events as adverse reactions. At 3 months, the modified Rankin Scale (mRS) was 3 or lower in 39% of the andexanet group and 50% of the standard care group. Conclusions Although patient selection bias make it difficult to draw definitive conclusions, we recommend considering andexanet alfa administration for cases within several hours of the last Xa inhibitor dose to prevent neurological deterioration. Emergency surgical cases should also be eligible for andexanet alfa to ensure intraoperative safety. Further research is required to determine clinically appropriate indications for its use.

Pharmacokinetic-guided magnesium prophylaxis in cardiac surgery: A randomized trial demonstrating guideline-level reductions in atrial fibrillation, accelerated recovery, and systemic cost savings

Fri, 30 Jan 2026 00:00:00 GMT

Objective To evaluate the efficacy, safety, and cost-effectiveness of a perioperative magnesium (Mg) sulfate protocol in reducing postoperative atrial fibrillation (AF) incidence and ICU resource strain following cardiac surgery. Methods Design: Double-blind, single-center randomized controlled trial (RCT). Setting: Tertiary-care academic hospital. Participants: 130 adults undergoing elective cardiac surgery, randomized to Mg sulfate (n=65) or placebo (n=65). Interventions: The Mg group received a pharmacokinetic-guided regimen: 2 g intravenous bolus post-cardiopulmonary bypass, followed by 1 g/h infusion for 5 hours, then 200 mg/h for 19 hours, and oral supplementation (I g every 8 hours) for one week post-discharge. The placebo group received equivalent saline infusions and oral placebo. Results Primary outcome: AF incidence was 18.5% in the Mg group vs. 41.5% in placebo (unadjusted RR=0.45, 95% CI: 0.25–0.81; p=0.007). Secondary outcomes: Mg shortened ICU stay by 1.4 days (p<0.001), reduced mechanical ventilation duration by 3.2 hours (p<0.001), and demonstrated comparable safety profiles for hypotension and renal impairment. Subgroup analysis: CABG patients showed 65% risk reduction (OR=0.35, p=0.01). Cost-effectiveness: ICU stay reduction projected $3,500 savings per patient. Conclusions Perioperative Mg sulfate significantly reduces AF incidence, accelerates recovery, and lowers healthcare costs, supporting its integration into standardized postoperative protocols. This trial provides Level I evidence for Mg as a guideline-recommended intervention. These findings are promising and support the integration of Mg into standardized postoperative protocols; however, they require confirmation in larger, multicenter studies.

Impaired peripheral mononuclear cell metabolism in patients at risk of developing sepsis: A cohort study

Fri, 30 Jan 2026 00:00:00 GMT

Introduction Dysregulated immune responses are central to progression of sepsis and closely associated with impaired cellular metabolism. However, most existing studies have focused on late-stage sepsis, leaving metabolic alterations during earlier stages of infection poorly characterised. This study aimed to determine whether immune cell metabolic impairment is already present during uncomplicated infection, prior to the development of sepsis, and to evaluate its potential as an early indicator of immune dysfunction and risk of progression. Materials and methods Forty patients with sepsis (fulfilling Sepsis-3 criteria) and 27 patients with uncomplicated infection were recruited from the emergency department along with 20 healthy volunteers. Whole blood samples were collected to assess gene expression, cytokine levels, and cellular metabolic functions, including mitochondrial respiration, oxidative stress, and apoptosis in immune cells. Results Mitochondrial respiration was significantly impaired in immune cells from both uncomplicated infection and sepsis patients compared with healthy controls (p < 0.05), with more pronounced impairment in established sepsis. Downregulation of BCL2 and BBC3 gene expression was observed in sepsis patients (p < 0.05), but not in uncomplicated infection, potentially contributing to differences in the severity of metabolic impairment. Impaired mitochondrial respiration was significantly associated with increased mitochondrial oxidative stress (p < 0.05), which was elevated in uncomplicated infection and further increased in sepsis. Oxidative stress levels also correlated with tumour necrosis factor-α (r = 0.330) and the expression of CYCS, TP53, SLC25A24, and TSPO (rs = −0.4926, −0.4422, 0.4382, and 0.4835, respectively). Despite these metabolic alterations, no significant differences in immune cell apoptosis were observed between uncomplicated infection and sepsis patients. Conclusions Immune cell metabolic dysfunction is present in patients with uncomplicated infection before the clinical onset of sepsis. Early mitochondrial dysfunction and oxidative stress may represent promising targets for further investigation as early biomarkers of immune dysfunction and sepsis risk.

Late complications of the Rastelli procedure - infective endocarditis and homograft stenosis: A case report

Fri, 30 Jan 2026 00:00:00 GMT

Introduction Advances in surgical techniques have significantly improved the prognosis of patients with operated congenital heart malformations. However, late complications pose a challenge to therapeutic management. Although the Rastelli procedure has brought substantial benefits in the surgical correction of transposition of the great arteries in pediatric patients, it carries the burden of numerous complications into adulthood. Case presentation We present the case of a 35-year-old man diagnosed at birth with D-transposition of the great arteries, atrial septal defect, ventricular septal defect and severe pulmonary stenosis. His medical history revealed two previous operations: a Blalock-Taussing shunt at the age of 4 months and a Rastelli procedure at the age of 3 years. The patient presented to the emergency room with fever and congestive heart failure symptoms. Subsequent investigations revealed two late complications of the Rastelli procedure: stenosis of the homograft connecting the pulmonary artery to the right ventricle and infective endocarditis. Conclusions Although the clinical context may lead to the assumption that this is a case of congestive heart failure due to homograft stenosis, we must not overlook the possibility of overlapping infective endocarditis, which may also contribute to the development of heart failure.

Efficacy of inhaled antibiotics in children with ventilator-associated pneumonia: A systematic review and meta-analysis

Fri, 30 Jan 2026 00:00:00 GMT

Introduction The nebulization of antibiotics allows the delivery of high concentration of medication to the lungs without the systemic side-effects. Aims We performed a systematic review and meta-analysis to determine the efficacy and safety of inhaled antibiotics in children with ventilator-associated pneumonia (VAP). Data sources We searched Web of Science, SCOPUS, MEDLINE Complete, CINAHL and ClinicalTrials.gov trials registry until June 2025. This study was registered (CRD42024504982). Study selection We included studies published in the last ten years that recruited children under 18 years old with VAP and treated with inhaled antibiotics. We excluded studies of children with tracheostomy and bronchiectasis. Data extraction Type of intervention (inhaled ± intravenous (IV) antibiotics), clinical improvement, duration of mechanical ventilation (MV) and hospitalization, bacterial eradication, and adverse events were recorded. Results Seven articles (346 patients) reported the use of inhaled antibiotics in VAP, of which four were randomized controlled trials. These studies included premature infants, neonates and children. The commonest inhaled antibiotic used was colistin (six studies). Meta-analysis revealed that inhaled antibiotics + IV antibiotics versus IV antibiotics +/− inhaled normal saline(placebo) resulted in no significant reduction in duration of MV (MD 0.88 days, 95% CI −2.72, 4.49; p=0.63, I2 = 85%) and ICU stay (MD 0.34[−2.79,3.40]; p=0.83, I2 = 80%). Clinical success (RR 0.68, 95% CI 0.39, 1.21; p=0.19, I2 =24%), microbiological eradication (RR 1.93, 95%CI 0.97,3.78; p=0.06, I2 = 2%) and mortality (RR 0.91, 95% CI 0.67, 1.24; p=0.54, I2 =0%) were also not significantly different. Inhaled antibiotics were not associated with increased nephrotoxicity (RR 0.91, 95% CI 0.18, 4.61; p=0.91, I2 = 30%). Conclusion More robust studies are required to confirm the clinical efficacy of inhaled antibiotics in the treatment of VAP. Nonetheless, adjunctive inhaled antibiotics may be safe in children, although close monitoring is still required.

Evaluation of PRVC and SIMV ventilation techniques on hemodynamic metrics and arterial blood gases in ICU patients with multiple trauma: A randomized, triple-blind study

Fri, 31 Oct 2025 00:00:00 GMT

Background In the Intensive Care Unit (ICU), mechanical ventilation is frequently employed to assist critically injured patients with breathing. The two conventional methods are SIMV and PRVC. This research sought to evaluate these techniques, particularly concerning patient stability and the preservation of optimal blood gas levels. Methods We carried out a parallel-group, randomized, triple-blind clinical trial. One hundred two patients with multiple traumas admitted to the ICU were randomly allocated to either the SIMV group or the PRVC mode group. The main outcome was measured through blood hemodynamic parameters, blood pressure, and heart rate in mechanically ventilated patients with multiple traumas. The secondary outcome measured was the composition of arterial blood gases (pH, PaCO2, PaO2, HCO3, and SpO2). Result The average age in the SIMV and PRVC groups was 38.53±16.29 and 38.04±15.26 years, respectively, showing no statistical significance. Arterial blood gas parameters, including arterial blood pH, PaCO2, PaO2, HCO3, and SpO2, were similar in the SIMV and PRVC groups at the beginning of admission and 8 and 12 hours after admission, and there was no significant difference. Comparing vital signs including blood pressure (systolic, diastolic, and mean arterial pressure) and heart rate was similar in the SIMV and PRVC groups at the beginning of admission and 8 and 12 hours after admission. Conclusion No significant justification was identified to favor one approach over the other for trauma patients receiving ventilatory support. Both groups stayed consistent regarding vital signs and other health indicators.

Severe acute respiratory distress syndrome in a woman infected with Ascaris lumbricoides

Fri, 31 Oct 2025 00:00:00 GMT

Acute Respiratory Distress Syndrome [ARDS] is a critical condition characterized by severe respiratory failure due to widespread lung inflammation, which can arise from various causes including trauma, infections, and systemic diseases. Among the rare causes is infection with Ascaris lumbricoides, a helminth typically affecting the gastrointestinal tract but capable of causing severe respiratory complications. We present the case of a 41-year-old woman with acute respiratory distress and negative viral and bacterial tests, who was ultimately diagnosed with Ascaris lumbricoides-induced ARDS. Her management included mechanical ventilation, antimicrobial therapy, corticosteroids, and eventually anthelmintic treatment after discovering the parasite. Despite initial deterioration and severe hypoxemia, the patient improved significantly following anthelmintic therapy, allowing extubation on day 8 and ICU discharge on day 12. Helminth-induced ARDS, though rare, should be considered in critically ill patients, especially in endemic regions. Early identification and appropriate therapy can dramatically improve outcomes.

Nurses’ attitudes and knowledge about organ donation and transplantation in closed hospital wards

Fri, 31 Oct 2025 00:00:00 GMT

Objective Nurses in closed hospital wards, such as Intensive Care and isolation units, play a pivotal role in identifying potential donors and supporting families during sensitive decision-making moments. However, gaps in knowledge or negative attitudes among nurses can hinder donation efforts. This study aims to explore the knowledge and attitudes of closed-ward nurses regarding organ donation and transplantation, providing insights to enhance education, advocacy, and clinical practices in these critical settings. Methods Modern analysis was performed on the data collected from questionnaires distributed to nurses of … General Hospital. The study involved 108 nurses. The questionnaire used to collect the data was provided by the Department of Social Work of the … University and distributed in electronic form to hospital nurses. Results After analyzing the nurses’ responses, it emerged that 85.19% of nurses are positive about the idea of organ donation and declare themselves willing to become donors, motivated by their will to really help their fellow human beings. In contrast, 5.56% said they would not be willing to donate. The main cause of their refusal seems to be fear and the prejudices they have, but also the fact that there is no trust in the organizations responsible for transplants. Finally, regarding the knowledge of the nurses who participated in the survey, the average knowledge score on the scale 0–100 is 72. Conclusions There is a clear need for specialized training for nurses managing organ donation. The emotional burden and responsibilities they face are significant. Enhanced training supports their well-being and ensures a more compassionate, efficient process for donors and families, ultimately improving the experience for all involved.

Age-related differences in sepsis outcomes: A comparative analysis of elderly and very elderly ICU patients

Fri, 31 Oct 2025 00:00:00 GMT

Background The rapid aging of the global population has amplified the clinical and economic burden of sepsis, a leading cause of morbidity and mortality in the elderly. Within this demographic, the “very elderly” (≥80 years) represent a particularly vulnerable subgroup. This study evaluates and compares the outcomes and prognostic factors of elderly (65–79 years) and very elderly ICU patients with sepsis or septic shock. Methods A retrospective observational study was conducted in a single-center ICU, including 251 patients aged ≥65 years diagnosed with sepsis or septic shock. Patients were categorized as elderly (65–79 years, N=162) or very elderly (≥80 years, N=89). Data on demographics, comorbidities, laboratory results, infection sources, treatments, and outcomes were collected. Prognostic factors for mortality were analyzed using binary logistic regression. Results The very elderly group exhibited higher rates of dementia, immobility, and fungal infections, while malignancy was more prevalent in the elderly group. ICU length of stay was longer in the very elderly group (median 8 vs. 6 days, P=0.027). ICU mortality was lower in the very elderly group, showing a trend toward significance but not reaching statistical significance (70.8% vs. 82.1%, P=0.056). Shared predictors of mortality included higher SOFA scores, malignancy, hospital-acquired sepsis, invasive mechanical ventilation, and acute kidney injury. Conclusion This study highlights differences in sepsis outcomes between elderly and very elderly patients. The findings underscore the importance of developing and implementing age-specific management strategies to improve outcomes in these high-risk populations. These insights contribute to a more tailored and effective approach to geriatric critical care.

Epidemiological insights into carbapenem resistant infections in critical care settings: A molecular and clinical investigation

Fri, 31 Oct 2025 00:00:00 GMT

Objective This study aimed to investigate the prevalence and genetic relatedness of multidrug-resistant Gram-negative bacilli, particularly those resistant to carbapenems, in patients admitted to intensive care units. It also sought to explore associations between bacterial colonization or infection and clinical outcomes, including comorbidities, treatment regimens, and mortality. Methods Between November 2022 and December 2023, screening and pathological samples were collected from patients at a tertiary hospital. Screening samples included rectal and pharyngeal swabs, while pathological samples comprised respiratory tract secretions. Bacterial identification and antibiotic susceptibility testing were performed using standard microbiological methods. Genetic similarity among isolates was assessed using a molecular fingerprinting technique to detect potential clonal spread. Results A total of 62 carbapenem-resistant strains were identified, with Acinetobacter baumannii and Klebsiella pneumoniae being the most prevalent. Pathological isolates exhibited higher resistance levels than screening isolates. Most patients had multiple comorbidities, with cardiac, renal, and pulmonary conditions being the most common. A significant association was found between prolonged intensive care unit stay and increased mortality. However, no significant correlation was observed between the number of comorbidities or antibiotic classes used and mortality. Molecular analysis revealed clonal clusters of Acinetobacter and Klebsiella strains, suggesting nosocomial transmission. Conclusions The findings underscore the importance of early screening, molecular surveillance, and stringent infection control measures in intensive care settings.