The Journal of Critical Care Medicine Feed

Technology integration in intensive care medicine through clinical engineering and convergent biotechnology

Mon, 27 Jul 2026 00:00:00 GMT

Effect of tactile stimulation on the level of consciousness and vital signs of patients with traumatic brain injury: a quasi- experimental study

Mon, 27 Jul 2026 00:00:00 GMT

IntroductionPatients with traumatic brain injury (TBI) are subjected to multiple stressors, including environmental changes, medical treatment, and surgical procedures. Hospitalization in an unfamiliar setting, especially when separated from family members, can increase anxiety and stress, which may adversely influence vital signs and levels of consciousness. Tactile stimulation, when integrated with routine medical management, may contribute to improving patient outcomes. Therefore, the present study aimed to determine the effect of tactile stimulation on the level of consciousness and vital signs among patients with traumatic brain injury.Materials and MethodsA quasi-experimental study was conducted in the neurosurgery wards and intensive care units of a tertiary care hospital. A total of 40 patients with mild (Glasgow Coma Scale [GCS] score 13–15) and moderate (GCS score 9–12) traumatic brain injury were selected using a consecutive sampling technique and equally allocated into experimental and control group (n = 20 each). The experimental group received tactile stimulation in addition to conservative care daily at 8 a.m., 12 pm, and 4 p.m. for three consecutive days, with each session lasting 15–20 minutes. The control group received only conservative care. Data were collected using a sociodemographic and clinical profile, a vital sign monitoring sheet, and the Glasgow Coma Scale. Statistical analysis was performed using the Chi-square test, Fisher's exact test, Friedman test, and Mann–Whitney U test.ResultsBoth groups were comparable at baseline, with no statistically significant differences in socio-demographic and most clinical variables. The majority of patients had a GCS score of 9–12 at admission, and road traffic accidents were the predominant cause of injury. A statistically significant difference was observed only in the type of brain injury (p < 0.001). No statistically significant differences were found between the groups in vital signs or GCS scores across day 1, day 2, and day 3 following the intervention, indicating similar clinical outcomes.ConclusionThe findings indicate that no statistically significant differences were observed between experimental and control groups, indicating that the intervention had no significant effect on the measured clinical outcomes. The limited duration of intervention may have constrained its effectiveness.

Prioritized factors of severity prognosis in patients admitted for sepsis or septic shock in a resource-limited region of central Vietnam

Mon, 27 Jul 2026 00:00:00 GMT

ObjectivesThe early diagnosis and prognostication of severity in sepsis plays a crucial role in determining appropriate treatment strategies. This study aimed to assess the role of cheaper prognostic factors including lactate/albumin ratio and platelet count in patients with sepsis as they are correlated with the rate of multiorgan failure, and mortality rate.MethodsA cross-sectional study was conducted on 146 adult patients diagnosed with sepsis and septic shock according to the Sepsis-3 definition. All patients were admitted at either the intensive care unit of Hue University of Medicine and Pharmacy Hospital or Hue Central Hospital.ResultsAverage age of patients was 67 years-old, with 37.7% having sepsis and 62.3% with septic shock. The overall mortality rate in the study was 51.4% (75/146 patients). Forty six patients (32.5%) had thrombocytopenia, with mild, moderate, and severe decreases accounting for 8.9%, 21.2%, and 1.4%, respectively. The lactate/albumin ratio with a cutoff of 2.1 was the best prognostic factor for mortality with an AUROC of 0.76, sensitivity of 58.7%, and specificity of 88.7% compared to other biomarkers including lactate (AUROC = 0.71), albumin (AUROC = 0.74), platelet count (AUROC = 0.65), white blood cell count (AUROC = 0.48), procalcitonin (AUROC = 0.43), and BE (AUROC = 0.44). Multivariate regression analysis identified the L/A ratio, platelet count, SOFA score as significant predictors of mortality in sepsis.ConclusionThe lactate/albumin ratio with a cutoff of 2.1 is an available effective tool for severity prognosis of patients with sepsis/septic shock in developing countries.

Efficacy of gabapentin versus trospium chloride for prevention of catheter-related bladder discomfort inside the surgical intensive care unit: a prospective, randomised, controlled clinical study

Mon, 27 Jul 2026 00:00:00 GMT

IntroductionCatheter-related bladder discomfort (CRBD) after perioperative catheterisation of the urinary bladder (COUB) is not uncommon.Aim of the studyWe evaluated the efficacy of both oral gabapentin and trospium in preventing CRBD during the early postoperative period in patients admitted to the surgical intensive care unit (S-ICU).Material and Methods120 patients aged 20–65 years, ASA I, II or III who were admitted to S-ICU after undergoing elective spinal surgery (ESS) with COUB were included. They were randomly assigned to be administered either an oral 400 mg gabapentin capsule (Group G) or an oral 60 mg slow-release trospium chloride capsule (Group T) or nothing (Group C). The primary goal was the occurrence of CRBD and its severity at 1, 2, 6, 12, and 24 hours after the study drug administration (SDA).ResultsGroup G and group T had a statistically significant lower incidence of CRBD than group C at 1, 2, 6, 12, and 24 hours after SDA, respectively. Both had considerably lower severity than group C in the first two hours only (P= 0.001 and 0.001, respectively). Group T had non-significantly lower incidence and severity of CRBD than group G. Group G had significantly lower mean total fentanyl requirements for up to 24 hours after SDA than group T and group C (P < 0.001).ConclusionBoth oral gabapentin capsules and slow release trospium chloride capsules administered postoperatively, significantly decreased both the incidence of CRBD and its severity in the early postoperative period amongst S-ICU patients, without significant differences between the two drugs.

Necrotizing enterocolitis with gastric perforation in a 24-day old preterm neonate

Mon, 27 Jul 2026 00:00:00 GMT

IntroductionNeonatal gastric perforation (NGP) is a rare, life-threatening surgical emergency that predominantly affects premature and extremely low birth weight (ELBW) infants and remains associated with high mortality.Case presentationA 600 g female infant born at 25/26 weeks of gestational age developed necrotizing enterocolitis (NEC) during the third postnatal week and deteriorated with abdominal distension and pneumoperitoneum. Emergency laparotomy on day 24 revealed a single posterior gastric wall perforation with circumferential necrotic margins; the nasogastric tube tip was located at the defect. After minimal debridement and primary two-layer closure, the infant survived a prolonged intensive care course complicated by recurrent sepsis, cholestasis, bronchopulmonary dysplasia, and later adhesive obstruction requiring adhesiolysis.ConclusionsGastric perforation may represent an uncommon manifestation of severe NEC in ELBW infants. Delayed onset, necrotic margins, and systemic inflammatory deterioration may favor ischemic NEC-related injury over iatrogenic trauma. Early radiographic evaluation and prompt surgical exploration are crucial for survival.

Balanced crystalloids versus normal saline for initial fluid resuscitation in diabetic ketoacidosis: a systematic review and meta-analysis of randomized controlled trials

Mon, 27 Jul 2026 00:00:00 GMT

ObjectiveTo systematically synthesize evidence from RCTs that evaluate the efficacy and safety of balanced crystalloids compared with normal saline for initial fluid resuscitation of patients with DKA.MethodsThis systematic review and meta-analysis were performed considering PRISMA guidelines and was registered in PROSPERO. A comprehensive search was performed to identify RCTs comparing balanced crystalloids with normal saline in adults and children with DKA. The risk of bias was assessed by using Cochrane RoB 2 tool. A random-effects meta-analysis was performed using R software to calculate pooled Mean Differences for continuous outcomes and Odds Ratios for dichotomous outcomes with 95% Confidence Intervals.ResultsEleven RCTs were included. In the quantitative synthesis of six RCTs (n = 491) using continuous time-to-event data, balanced crystalloids were not associated with a statistically significant reduction in time to DKA resolution compared with normal saline (Mean Difference [MD] = −1.50 hours; 95% CI: −3.79 to 0.79; p=0.15), with moderate heterogeneity (I2 = 36.2%). The 95% prediction interval ranged from −5.44 to 2.44 hours. However, balanced crystalloids resulted in a significantly greater increase in serum bicarbonate at 12 hours (MD = +2.50 mmol/L; 95% CI: 1.51 to 3.48; p=0.004; I2 = 0.0%). Subgroup analyses by fluid type, DKA severity, and age group showed no significant subgroup differences.ConclusionInitial fluid resuscitation with balanced crystalloids was not associated with a shorter time to DKA resolution compared with normal saline, and they were associated with a rapid increase in serum bicarbonate levels; however, this biochemical improvement did not translate into a shorter time to DKA resolution or other clinical benefits. The choice of crystalloids for initial DKA resuscitation remains an area of clinical equipoise because of the substantial heterogeneity and methodological limitations of the available evidence, emphasizing the need for further high-quality research.

Efficacy of prehospital amiodarone on survival in adult out-of-hospital cardiac arrest: a retrospective observational study

Mon, 27 Jul 2026 00:00:00 GMT

Aim of the studyThis study sought to determine whether prehospital administration of amiodarone improves outcomes among adult patients with out-of-hospital cardiac arrest (OHCA) presenting with ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT). The analysis accounted for time-dependent confounding and resuscitation time bias using real-world registry data.Material and methodsWe conducted a multicenter, retrospective cohort study using a nationwide Japanese OHCA database, including adult nontraumatic shockable rhythms. The exposure was prehospital amiodarone administration at a given time, and the comparator was no amiodarone at the same time point. The comparison reflects amiodarone administration at that time versus no amiodarone, not ‘amiodarone versus never-amiodarone’. The primary and secondary endpoints were favorable neurological status and survival at 30 days. Patients were matched 1:3 using time-dependent propensity score matching, followed by generalized estimating equations to address intrahospital clustering. Sensitivity analyses included covariates with standardized mean differences greater than 0.25 after matching. Associations were expressed as risk ratios (RRs) with 95% confidence intervals (CIs).ResultsAmong 9,909 eligible patients, 56 (0.6%) remained after matching, including 19 (0.2%) who received amiodarone at the index time point. Median (IQR) age was 65 (52–76) years, and 81.8% were male. The median interval from first medical contact to drug administration was 27 (22–32) minutes. In models adjusted for timing variables and hospital clustering, amiodarone was not significantly related to favorable neurological recovery (RR, 0.45 [95% CI, 0.14–1.47]) or survival (RR, 0.74 [95% CI, 0.31–1.73]). Sensitivity analyses yielded consistent findings, though survival model convergence was limited.ConclusionsPrehospital administration of amiodarone in adult OHCA patients with shockable rhythms was not associated with improved neurological or survival outcomes. However, these findings should be interpreted with caution, and further studies are warranted to confirm and extend these observations.

Comparing length of stay between adult patients admitted to the intensive care unit with alcohol withdrawal syndrome treated with phenobarbital versus lorazepam

Mon, 27 Jul 2026 00:00:00 GMT

ObjectiveReview the use of phenobarbital and lorazepam to treat alcohol withdrawal syndrome (AWS) in the ICU, compare length of stay, examine medication use trends, implement provider training, and evaluate outcomes post-training.MethodsDesign - Retrospective observational study, Quality improvement. Setting - Tertiary care hospital with 36 ICU beds. Patients - Adults admitted to the ICU and placed on clinical institute withdrawal assessment (CIWA) protocol. Patients with epilepsy were excluded.ResultsDuring the 34-month baseline period, 713 patients were admitted to the ICU with alcohol use disorder (AUD) on CIWA, without epilepsy. 189 patients were treated with phenobarbital, 460 patients received only lorazepam, 64 patients received neither medication. All but 2 of the patients who received phenobarbital also received lorazepam. Compared to phenobarbital, lorazepam-only patients had shorter ICU LOS (p<0.001, 95% CI −2.36, −1.32) but higher mortality 13.91% vs. 4.76% (p=0.0008). We then developed and provided a training (which we refer to as an “intervention”) to all ICU providers encouraging consistent use of phenobarbital in the ICU when appropriate. During the 3-month post-intervention period 44 patients were admitted to the ICU with AUD on CIWA protocol. Of the 44 patients: 26 received phenobarbital, 12 received only lorazepam, 6 received neither medication. Significantly more patients were treated with only phenobarbital (57.69%)) compared to baseline (1.06%). Compared to patients treated with phenobarbital, patients treated with only lorazepam had a significantly higher mortality rate (33.33% vs. 7.69%, p=0.04).ConclusionsWe found significant variability in the use of phenobarbital and lorazepam for treatment of AWS in the ICU. After a quality improvement training for ICU physicians, there was less frequent concurrent use of benzodiazepines and barbiturates, no difference in ICU or hospital LOS, and significantly lower mortality rate for those treated with phenobarbital.

Intravenous insulin protocol reduces time to target glucose in critically ill trauma and burn patients

Mon, 27 Jul 2026 00:00:00 GMT

IntroductionGlycemic control is vital in the management of critically ill patients. Scientific evidence has proven that a drastic change in blood glucose levels can lead to adverse outcomes including increased hospital, ICU length of stay, morbidity, and mortality. Despite the challenges in developing standardized intravenous insulin protocols, institutions have successfully implemented protocols in various settings. Our tertiary care hospital has an established intravenous insulin protocol for the cardiac ICU. Given the complexity of managing critically ill patients, an intravenous insulin protocol for such patients was implemented in February 2022. The study aimed to evaluate the effectiveness of the newly implemented intravenous insulin protocol in glycemic control of critically ill trauma and burn patients.MethodsA single center retrospective chart review was conducted on 230 patients: 119 patients were extracted from the pre-protocol implementation and 111 patients post-protocol implementation periods. Ninety-nine patients were excluded due to on-admission diagnosis of diabetic ketoacidosis, hyperosmolar hyperglycemic state, or incomplete data. Data collection included: type of injury; body mass index, pre-existing comorbidities; insulin administration times; target glucose actualization; glycemic events; hospital and ICU length of stay, mortality rates in the ICU, hospital, and 30 days post-hospitalization.ResultsIn the post-implementation group, the time to reach target glucose was significantly reduced when compared to the pre-implementation group. The rates of glycemic events after achieving target glucose were similar with a slightly lower rate post-implementation. There were no differences in the length of stay or mortality rates during hospitalization or 30-days post-hospitalization between the groups. However, when comparing routes of insulin administrations, the intravenous insulin significantly showed better glucose control and reduced the rates of glycemic events than the subcutaneous route.ConclusionIntravenous insulin protocol demonstrated a significant reduction in the time to target glucose levels for the critically ill patients.

Brain-kidney crosstalk in subarachnoid hemorrhage patients

Mon, 27 Jul 2026 00:00:00 GMT

BackgroundA “crosstalk” between brain and kidney after Subarachnoid Hemorrhage (SAH) is suggested. A link can be the vascular autoregulation. It can be evaluated with cerebrovascular Pressure Reactivity index (PRx). It is not clear if augmented renal clearance (ARC) can be used as a marker of kidney dysregulation or if ARC is associated with brain autoregulation. Our aim was to evaluate correlation between ARC and PRx in SAH.MethodsPilot study of SAH patients admitted to a Neurocritical Care Unit (NCCU), at tertiary Portuguese hospital, submitted to multimodal brain monitoring. Fifteen patients were included over a period of two years. Daily observations from 15 patients were analysed, during the first 14 days after admission. Creatinine clearance was measured (MCC) using plasma creatinine and urinary creatinine in a 6-hour urine collection. Multimodal brain monitoring data included intracranial pressure, cerebral perfusion pressure, optimal perfusion pressure (optCPP; CPP level which makes autoregulation working optimally) and PRx.ResultsFifteen patients were included. Median age was 58 and initial Glasgow Coma Score 13, Hunt and Hess classification was ≥3 in 66%, and Fisher was 4 in 100%. ARC is highly prevalent since the admission. There was a positive correlation between the number of days in ICU and CPP (R2=0.37), optimal CPP (R2=0.23), and PRx (R2=0.25), indicating loss of autoregulation over time. There was no significant association between ARC and preserved autoregulation (R2=0.05) suggesting that ARC is itself a manifestation of kidney dysregulation. ARC doesn't correlate with noradrenaline or fluid balance. In multivariate analysis only age has an impact on MCC, with MCC expected to decrease by 1.328 for one year of life.ConclusionsARC is highly prevalent in SAH patients during the first two weeks after NCCU admission. Presence of ARC, evaluated with MCC, was not significantly associated with the presence of cerebral autoregulation.

Emergency anticancer therapy in intensive care medicine: A mainland China survey

Mon, 27 Jul 2026 00:00:00 GMT

ObjectiveTo identify intensivists‘ attitudes toward emergency anticancer therapy (EAT) in patients with cancer in intensive care units (ICUs).Material and methodsA 11-question survey was performed among intensivists in the Cancer Critical Care Medicine Committee of the Chinese Anti-Cancer Association and Critical Care Medicine Committee of Beijing Association of Oncology between November 11 and December 11, 2024. Response were compared between mixed and oncologic ICU physicians.ResultsIn total, 120 intensivists completed the survey. For 9 of 11 questions, the agreement rate exceeded 85%. There were 61.5% mixed ICU physicican and 35.5% oncologic ICU physicians in favor of compostion of the composition of a multidisciplinary team (MDT) composing of an intensivist, an oncologis and a pharmacist, respectively. However this difference was not significant (P=0.281).ConclusionsIntensivists in China generally hold positive attitudes toward emergency anticancer therapy in ICUs for critically ill patients with cancer-related organ dysfunction. However, opinions differ regarding the MDT composition between mixed and oncologic ICU physicicans.

Percutaneous tracheostomy in Costa Rican intensive care units: multicenter epidemiology, practices, and immediate complications

Mon, 27 Jul 2026 00:00:00 GMT

IntroductionThis study describes the epidemiological and clinical profile of ICU patients undergoing percutaneous tracheostomy in Costa Rica and identifies predictors of acute complications, addressing ongoing debates on timing, technique, and risk stratification.MethodsWe performed a prospective multicenter cohort study in eight CCSS hospitals (2019–2022), including adult ICU patients undergoing percutaneous tracheostomy. Demographic, clinical, and procedural data were collected, and multivariable logistic regression identified predictors of complications.ResultsA total of 516 patients were analyzed (mean age 53.2 ± 16.3 years; 68.2% male). The main indications were anticipated prolonged ventilation (32.4%), neurological deficits (26.7%), and ventilation >10 days (21.8%). The Ciaglia and Griggs techniques were used in 51.0% and 48.3% of cases, respectively. Capnography was applied in 74.2%, ultrasound in 17.7%, and bronchoscopy in 3.1%. First-pass success was achieved in 85.1%. Acute complications occurred in 28.3% of patients, predominantly minor bleeding (25.4%), while serious complications (airway loss, false passage, or bleeding requiring surgery) were rare (3.9%). No procedure-related deaths were observed. Independent predictors of complications included anticoagulation (OR 2.82), obesity (OR 2.10), coagulopathy (OR 2.29), prior neck surgery (OR 3.49), cervical immobilization (OR 4.68), and technical difficulty (OR 4.15 for any complication; OR 2.00 for serious complications). Airway management by physicians, compared with respiratory therapists, was also associated with higher risk (OR 1.52).ConclusionsPercutaneous tracheostomy was feasible in multiple ICUs of the CCSS with complication rates comparable to international cohorts. Risk factors for complications included anticoagulation and prior neck surgery. Wider adoption of adjunctive monitoring tools and structured multidisciplinary training may further enhance procedural safety. These findings should be interpreted in the context of an observational design and a broad definition of complications.

Evaluation of presepsin dynamics in septic patients with and without liver cirrhosis

Mon, 27 Jul 2026 00:00:00 GMT

BackgroundSepsis is associated with high short-term mortality, particularly in patients with decompensated liver cirrhosis. Conventional inflammatory biomarkers have limited prognostic accuracy in this population. Presepsin has emerged as a promising biomarker; however, its dynamic behavior in early sepsis remains insufficiently characterized.ObjectivesTo evaluate the prognostic value of presepsin dynamics in sepsis, with and without underlying liver cirrhosis, and to compare it with established inflammatory markers.MethodsWe conducted an observational cohort study including two patient groups: patients with sepsis and de-compensated liver cirrhosis (Group A) and patients with sepsis without cirrhosis (Group B). Presepsin levels were measured at admission and after 48 hours, and delta presepsin was calculated. Prognostic performance was assessed using receiver operating characteristic (ROC) analysis and Cox proportional hazards regression. The primary endpoint was 28-day mortality.ResultsIn Group A, presepsin measured at 48 hours demonstrated superior prognostic performance compared with baseline levels (AUROC 0.91 vs. 0.78). Changes in presepsin further enhanced risk stratification, with a negative delta associated with improved survival, whereas an increase of ≥500 pg/mL was independently associated with higher mortality. (HR 5, 95% CI:1.64-15.26). In Group B presepsin showed moderate prognostic performance at baseline and 48 hours, whereas delta presepsin demonstrated limited overall accuracy, except in patients with positive delta values. Established biomarkers, including C-reactive protein and procalcitonin, showed inferior prognostic performance compared with presepsin in both cohorts.ConclusionsDynamic assessment of presepsin provides clinically relevant prognostic information in sepsis, particularly in patients with decompensated liver cirrhosis. Early changes in presepsin levels may enhance risk stratification beyond conventional inflammatory biomarkers.

Quality of life and patient safety: the impact of the work environment on the well-being of medical staff in ICU settings

Mon, 27 Jul 2026 00:00:00 GMT

Background and aimProfessional Quality of Life (ProQoL) is essential for understanding the well-being of the health-care professionals working in high-stress environments, such as the intensive care units (ICUs). - This study aimed to assess the influence of age, gender, hospital affiliation, and professional role on the ProQoL dimensions (Compassion Satisfaction – CS, Burnout – BO, Secondary Traumatic Stress – STS) and to analyze the relationship between the perceptions of patient safety (measured via the Safety Attitudes Questionnaire – SAQ) and the professional quality of life.MethodThis cross-sectional observational study included 247 healthcare professionals (April–November 2024) from 20 different hospitals, working in ICUs (nurses, attending physicians, medical residents -, and other staff). Participants filled out the ProQoL and SAQ questionnaires out of which only 10 SAQ items were used. Statistical analyses were performed using ANOVA, t-tests, and Pearson correlation coefficients.ResultsMedical residents and participants in the 20–30 age group reported having the highest burnout scores (28.37 ± 0.37), and the lowest level of compassion satisfaction score (36.65±0.61), while attending physicians had elevated levels of secondary traumatic stress (25.69±0.57). Positive perceptions of the work environment (safety, conflict resolution, workplace satisfaction) were negatively correlated with the burnout (r = −0.5888, p < 0.0001). Finally, the perception of a pleasant job and workplace positively correlates with the CS score (r=0.53 p˂0.0001).ConclusionsProfessional well-being varies significantly in terms of age, and position. These findings suggest that workplace strategies focusing on safety, teamwork, and workload balance may play a role in supporting the ICU staff well-being.

Artificial and biological membranes in acute kidney injury: a biomedical engineering framework on renal replacement therapy in critical care

Mon, 27 Jul 2026 00:00:00 GMT

Background: Acute kidney injury (AKI) is a common complication in critically ill patients and frequently requires renal replacement therapy (RRT). While comparisons between continuous renal replacement therapy (CRRT) and peritoneal dialysis (PD) have traditionally focused on clinical efficacy, less attention has been given to the membrane technologies underlying these modalities. This narrative review compares synthetic membranes used in extracorporeal therapies with the biological peritoneal membrane from a biomedical engineering perspective.A narrative review of the literature was conducted, integrating evidence from nephrology, critical care medicine, biomaterials science, and biomedical engineering. The review examines membrane transport mechanisms (diffusion, convection, ultrafiltration, and adsorption), membrane biocompatibility, transport behavior during critical illness, and emerging bioartificial renal technologies.Although synthetic and biological membranes rely on the same fundamental transport principles, they differ markedly in structure and function. Synthetic membranes provide predictable and controllable transport but are affected by blood-material interactions and membrane fouling. In contrast, the peritoneum is a living, adaptive membrane whose transport properties are influenced by vascular physiology, systemic inflammation, and endothelial integrity. These differences reflect distinct engineering approaches underlying CRRT and PD.A membrane engineering perspective provides a unified framework for comparing RRT modalities beyond conventional clinical outcomes. Artificial membranes emphasize precision and reproducibility, whereas biological membranes offer physiological integration and adaptability. Future renal support systems are expected to combine these complementary properties through hybrid technologies that more closely replicate native kidney function.

Association between steroid therapy and increased mortality in patients at risk for ARDS

Mon, 27 Jul 2026 00:00:00 GMT

BackgroundCorticosteroids are commonly used in critically ill patients with established risk factors for acute respiratory distress syndrome (ARDS), often for indications like sepsis or pneumonia, yet the choice of steroid and its impact on outcomes remain debated.MethodsWe conducted a retrospective analysis of 160 ICU patients with documented clinical risk factors for ARDS at the time of ICU admission to evaluate the effect of corticosteroid therapy on hospital mortality. Clinical characteristics, treatment variables, and outcomes were compared between patients who received corticosteroids and those who did not. A subgroup exploratory analysis further compared outcomes between dexamethasone and hydrocortisone users. Logistic regression models were used to identify mortality predictors.ResultsOf 160 patients, 91 (56.9%) received corticosteroids. Steroid-treated patients had higher Simplified Acute Physiology Score II (SAPS II) scores (54.4 vs. 48.0, p = 0.011), but no significant differences in age, partial pressure of arterial oxygen to fraction of inspired oxygen ratio (PaO2/FiO2), or mechanical ventilation use. Overall mortality was not significantly different between steroid and non-steroid users (42.9% vs. 33.3%, p = 0.221). Among steroid-treated patients, dexamethasone (n = 26) and hydrocortisone (n = 50) were the most frequently used agents. Mortality was significantly higher with hydrocortisone (58%) compared to dexamethasone (26.9%) (p = 0.010). In multivariate analysis, hydrocortisone use was associated with higher hospital mortality (adjusted OR = 4.41; 95% CI: 1.11–17.48; p = 0.035).ConclusionOverall corticosteroid use was not associated with improved survival in patients with documented clinical risk factors for ARDS; however, in an exploratory analysis, hydrocortisone use was associated with higher hospital mortality than dexamethasone. Given the retrospective observational design and real-world factors influencing corticosteroid selection, including illness severity, these findings should be interpreted with caution and support the need for prospective studies to clarify these associations.

The effect of oral protein and carbohydrate solution administration on NLR, IL-6 and CRP levels in patients undergoing surgery

Thu, 30 Apr 2026 00:00:00 GMT

AimsTo determine the effect of administering oral protein and carbohydrate solutions the C-Reactive Protein (CRP), Interleukin-6 (IL-6), and Neutrophil-Lymphocyte Ratio (NLR) in patients planned any surgeryMethodsA double-blind, randomized clinical study, at Ulin Regional Hospital, Banjarmasin with patients planned any surgery. This research had 80 patients in total (40 subjects in the control group and 40 subjects in the intervention group). Before surgery, 200 mL of a protein and carbohydrate solution per oral was given to the intervention group, while a placebo was given to the control group. Twenty-four hours after surgery, each subject's levels of CRP, IL-6 and NLR were measured. Statistical Package for the Social Sciences Version 29 was used to analyze the data.ResultsNLR at 24 hours postoperatively in the intervention group was lower than in the control group, but not statistically different (8.65±4.33 vs. 7.86±4.65, p=0.308). The IL-6 level at 24 hours postoperatively in the intervention group was significantly lower than in the control group (9.49 (6.03–22.65) vs. 20.08 (11.64–50.11), p=0.011). Although not statistically different, the CRP level at 24 hours postoperatively in the intervention group was lower than in the control group (15.10 (7.20–41.60) vs. 34.70 (11.87–71.55), p=0.056). There was no difference in postoperative nausea or vomiting between the two groups.ConclusionPostoperative interleukin-6 levels have been demonstrated to decrease when oral protein and carbohydrate solutions are given to patients undergoing surgery; however, NLR and CRP levels have not been seen to decrease.

Venoarterial extracorporeal membrane oxygenation as bridge support for refractory catecholamine-resistant shock and severe lactic acidosis in a patient with metformin exposure and multifactorial contributors: A case report

Thu, 30 Apr 2026 00:00:00 GMT

A 47-year-old male with type 2 diabetes on metformin and hypertension presented with profound hypoxemia, severe metabolic acidosis (pH unrecordable, lactate 17 mmol/L), and progressive cardiac dysfunction in the setting of presumed sepsis. Despite maximal conventional therapy—including mechanical ventilation, broad-spectrum antimicrobials, and high-dose vasopressors—the patient developed refractory shock and multi-organ dysfunction. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) was initiated on hospital day 2 as hemodynamic bridge support, combined with continuous renal replacement therapy (CRRT). This intervention facilitated stabilization of hemodynamics, correction of acidosis, and improvement in organ function. The patient was successfully decannulated and survived to discharge, though with residual cardiomyopathy. Lactic acidosis in this case was likely multifactorial, with metformin exposure as one potential contributor amid acute kidney injury, hypoperfusion, and possible septic elements. This report describes the use of VA-ECMO as supportive therapy in a complex, refractory critical illness scenario, highlighting the importance of timely multidisciplinary escalation while emphasizing diagnostic challenges in attributing causality and the need for cautious patient selection in such high-risk interventions.

Early outcomes of pediatric heart transplantation: Impact of mechanical circulatory support and perioperative challenges. A single-center retrospective study

Thu, 30 Apr 2026 00:00:00 GMT

BackgroundPediatric heart transplantation stays the gold standard treatment for end-stage heart failure, but outcomes are influenced by pre-transplant status and bridging strategies, particularly mechanical circulatory support (MCS).ObjectivesTo evaluate early outcomes following pediatric heart transplantation and assess the impact of pre-transplant MCS on survival and complications.MethodsWe retrospectively analyzed all pediatric patients (<14 years) who underwent orthotopic heart transplantation at a single tertiary center between January 2020 and January 2025. Demographics, pre-transplant support, intraoperative data, and early outcomes were collected. Primary outcome was 30-day survival; secondary outcomes included acute rejection, infection, acute kidney injury (AKI), neurologic complications, and ICU/hospital length of stay (LOS). Comparative analyses were performed between patients having ECMO- and ventricular assist devises (VAD) using Fisher's exact and Wilcoxon rank-sum tests. Kaplan–Meier survival estimates were generated.ResultsThirty patients were transplanted (median age 9 years, 63.3% female). Most (96.7%) needed MCS, including 11 ECMO and 18 VAD. Thirty-day survival was 28/30 (93.5%, 95% CI 78–99). Acute rejection occurred in 3 (10%), infections in 4 (13.3%), AKI in 8 (26.7%), with two requiring CRRT, and neurologic complications in 3 (10.3%). Median ICU and hospital LOS were 20 and 37 days, respectively. ECMO patients had longer post-transplant ventilation (12 vs 6 days, p = 0.04) and ICU length of stay (LOS) compared to VAD patients. Total Ischemic time, and CPB times were associated with increased morbidity.ConclusionsEarly outcomes after pediatric heart transplantation prove high short-term survival but substantial morbidity. ECMO bridging was associated with greater resource use than VAD. Improving donor heart ischemic time, donor-recipient matching, perioperative management, and early initiation of durable MCS may further improve outcomes.

The gut pathobiome: a new frontier in the management of the critically ill

Thu, 30 Apr 2026 00:00:00 GMT