BACKGROUND The need for an emergency upgrade of a hospitalized trauma patient from the floor to the trauma intensive care unit(ICU)is an unanticipated event with possible life-threatening consequences.Unplanned ICU ad...BACKGROUND The need for an emergency upgrade of a hospitalized trauma patient from the floor to the trauma intensive care unit(ICU)is an unanticipated event with possible life-threatening consequences.Unplanned ICU admissions are associated with increased morbidity and mortality and are an indicator of trauma service quality.Two different types of unplanned ICU admissions include upgrades(patients admitted to the floor then moved to the ICU)and bounce backs(patients admitted to the ICU,discharged to the floor,and then readmitted to the ICU).Previous studies have shown that geriatric trauma patients are at higher risk for unfavorable outcomes.AIM To analyze the characteristics,management and outcomes of trauma patients who had an unplanned ICU admission during their hospitalization.METHODS This institutional review board approved,retrospective cohort study examined 203 adult trauma patients with unplanned ICU admission at an urban level 1 trauma center over a six-year period(2017-2023).This included 134 upgrades and 69 bounce backs.Analyzed variables included:(1)Age;(2)Sex;(3)Comorbidities;(4)Mechanism of injury(MOI);(5)Injury severity score(ISS);(6)Glasgow Coma Scale(GCS);(7)Type of injury;(8)Transfusions;(9)Consultations;(10)Timing and reason for unplanned admission;(11)Intubations;(12)Surgical interventions;(13)ICU and hospital lengths of stay;and(14)Mortality.RESULTS Unplanned ICU admissions comprised 4.2%of total ICU admissions.Main MOI was falls.Mean age was 70.7 years,ISS was 12.8 and GCS was 13.9.Main injuries were traumatic brain injury(37.4%)and thoracic injury(21.7%),and main reason for unplanned ICU admission was respiratory complication(39.4%).The 47.3%underwent a surgical procedure and 46.8%were intubated.Average timing for unplanned ICU admission was 2.9 days.Bounce backs occurred half as often as upgrades,however had higher rates of transfusions(63.8%vs 40.3%,P=0.002),consultations(4.8 vs 3.0,P<0.001),intubations(63.8%vs 38.1%%,P=0.001),longer ICU lengths of stay(13.2 days vs 6.4 days,P<0.001)and hospital lengths of stay(26.7 days vs 13.0 days,P<0.001).Mortality was 25.6%among unplanned ICU admissions,31.9%among geriatric unplanned ICU admissions and 11.9%among all trauma ICU patients.CONCLUSION Unplanned ICU admissions constituted 4.2%of total ICU admissions.Respiratory complications were the main cause of unplanned ICU admissions.Bounce backs occurred half as often as upgrades,but were associated with worse outcomes.展开更多
BACKGROUND Stress-induced hyperglycemia(SIH)is common in critically ill patients and has been associated with adverse cardiovascular outcomes.Intensive insulin therapy(IIT)has been proposed to mitigate these risks by ...BACKGROUND Stress-induced hyperglycemia(SIH)is common in critically ill patients and has been associated with adverse cardiovascular outcomes.Intensive insulin therapy(IIT)has been proposed to mitigate these risks by achieving tighter glycemic control.AIM To evaluate the efficacy of IIT for managing SIH in critically ill patients and to explore its potential effect on cardiac function.METHODS A retrospective study was conducted at our hospital from January 2021 to December 2024,adhering to STROBE guidelines.A total of 186 critically ill pa-tients were divided into normal glycemia(n=85)and SIH(n=101)groups.The SIH cohort was further subdivided into conventional treatment(n=50)and IIT(n=51)groups.Hemodynamic parameters-including right atrial pressure(RAP),pulmonary artery pressure(PAP),pulmonary capillary wedge pressure(PAWP),cardiac output(CO),cardiac index(CI),and B-type natriuretic peptide(BNP)-were measured at baseline and post-treatment.Clinical outcomes such as intensive care unit(ICU)length of stay,mechanical ventilation requirements,and mortality were also recorded.Statistical analyses were conducted using inde-pendent samples t-tests and χ^(2)/Fisher’s exact tests.RESULTS SIH markedly worsened haemodynamics versus normal glycaemia:RAP 9.8±5.1 vs 6.1±3.5 mmHg,PAP 35.2±16.0 vs 26.2±10.3 mmHg,PAWP 16.0±7.0 vs 8.6±6.4 mmHg,CO 3.3±2.3 vs 6.0±3.3 L/min,CI 1.88±0.24 vs 2.70±0.50 L/min/m2,BNP 465±250 vs 180±53 pg/mL(all P<0.001).Within the SIH cohort,IIT outperformed conventional therapy:RAP 7.0±2.2 vs 8.3±3.9 mmHg(P=0.04),PAP 21.6±3.7 vs 29.3±6.5 mmHg(P<0.001),PAWP 10.2±5.4 vs 13.8±5.3 mmHg(P=0.001),CO 4.9±2.2 vs 4.0±1.4 L/min(P=0.022),CI 2.58±0.32 vs 2.11±0.31 L/min/m2,P<0.001),BNP 202±62 vs 346±171 pg/mL(P<0.001).Clinically,IIT shortened ICU stay(10.3±3.4 vs 14.5±2.6 days,P<0.001),reduced ventilator use(56.9%vs 76.0%,P=0.042),and lowered mortality(23.5%vs 42.0%,P=0.048).CONCLUSION IIT significantly reduced cardiac filling pressures,improved cardiac function,and was associated with favorable clinical outcomes in SIH patients,suggesting potential benefits of stricter glycaemic control in critically ill patients.However,given the retrospective design and absence of glucose-variability monitoring,these findings should be interpreted with caution.展开更多
Intensive care unit(ICU)acquired sarcopenia and myosteatosis are increasingly recognized complications of critical illness,characterized by a rapid loss of ske-letal muscle mass,quality,and function.These conditions r...Intensive care unit(ICU)acquired sarcopenia and myosteatosis are increasingly recognized complications of critical illness,characterized by a rapid loss of ske-letal muscle mass,quality,and function.These conditions result from a complex interplay of systemic inflammation,immobilization,catabolic stress,mitochon-drial dysfunction,and immune dysregulation,often culminating in impaired recovery,prolonged hospitalization,and increased long-term mortality.First identified in survivors of sepsis and prolonged mechanical ventilation,these muscle abnormalities were initially described using computed tomography-based assessments of muscle area and density.Subsequent advances in imaging,biomarker discovery,and functional testing have enabled earlier detection and risk stratification across diverse ICU populations.While nutritional optimization and early mobilization form the cornerstone of current prevention and treatment strategies,the emergence of novel approaches,including automated artificial intelligence-based screening,neuromuscular electrical stimulation,and targeted pharmacologic therapies,has broadened the clinical scope of interventions.Despite their significant prognostic implications,ICU-acquired sarcopenia and myosteatosis remain under-recognized in routine critical care practice.This mini-review aims to synthesize current knowledge regarding their pathophysiology,available diagnostic modalities,prognostic relevance,and the evolving landscape of therapeutic strategies for long-term functional recovery in critically ill patients.展开更多
BACKGROUND Hypernatremia represents a significant electrolyte imbalance associated with numerous adverse outcomes,particularly in cases of intensive care unit(ICU)-acquired hypernatremia(IAH).Nevertheless,its relevanc...BACKGROUND Hypernatremia represents a significant electrolyte imbalance associated with numerous adverse outcomes,particularly in cases of intensive care unit(ICU)-acquired hypernatremia(IAH).Nevertheless,its relevance in patients with septic shock remains uncertain.AIM To identify independent risk factors and their predictive efficacy for IAH to improve outcomes in patients with septic shock.METHODS In the present retrospective single-center study,a cohort of 157 septic shock patients with concurrent hypernatremia in the ICU at The First Affiliated Hospital of Soochow University,between August 1,2018,and May 31,2023,were analyzed.Patients were categorized based on the timing of hypernatremia occurrence into the IAH group(n=62),the non-IAH group(n=41),and the normonatremia group(n=54).RESULTS In the present study,there was a significant association between the high serum sodium concentrations,excessive persistent inflammation,immunosuppression and catabolism syndrome and chronic critical illness,while rapid recovery had an apparent association with normonatremia.Moreover,multivariable analyses revealed the following independent risk factors for IAH:Total urinary output over the preceding three days[odds ratio(OR)=1.09;95%CI:1.02–1.17;P=0.014],enteral nutrition(EN)sodium content of 500 mg(OR=2.93;95%CI:1.13–7.60;P=0.027),and EN sodium content of 670 mg(OR=6.19;95%CI:1.75–21.98;P=0.005)were positively correlated with the development of IAH.Notably,the area under the curve for total urinary output over the preceding three days was 0.800(95%CI:0.678–0.922,P=0.001).Furthermore,maximum serum sodium levels,the duration of hypernatremia,and varying sodium correction rates were significantly associated with 28-day in-hospital mortality in septic shock patients(P<0.05).CONCLUSION The present findings illustrate that elevated serum sodium level was significantly associated with a poor prognosis in septic shock patients in the ICU.It is highly recommended that hypernatremia be considered a potentially important prognostic indicator for the outcome of septic shock.展开更多
BACKGROUND Newborns are immediately admitted to the neonatal intensive care unit(NICU)after birth,and thus mothers suffer from the pain of mother-infant separation.Some mothers worry about alterations in their child’...BACKGROUND Newborns are immediately admitted to the neonatal intensive care unit(NICU)after birth,and thus mothers suffer from the pain of mother-infant separation.Some mothers worry about alterations in their child’s condition and the uncertainty and high medical costs of possible sequelae,which frequently cause anxiety,depression,and other adverse emotions.AIM To investigate the anxiety and depression status of mothers of children in the NICU and its related factors.METHODS A convenient sampling method is adopted.The research objects included the mothers of 191 children in the NICU of Suzhou Ninth Hospital Affiliated with Suzhou University from January 2023 to July 2024.The general information questionnaire,personal control scale,self-rating anxiety scale,and self-rating depression scale were utilized for investigation.Anxiety and depression status in mothers of children in the NICU and its related factors were analyzed.RESULTS The incidences of maternal anxiety and depression among 191 hospitalized children in the NICU were 32.98%(63/191)and 23.56%(45/191),respectively.Single-factor analysis reveals that family monthly income,individual sense of control,gestational age of the child,and the number of diseases in the child are associated with the anxiety and depression experienced by the mother of the child in the NICU(P<0.05).Multivariate logistic regression analysis revealed that family monthly income of<5000 yuan(RMB),poor individual control,gestational age of<32 weeks,and the number of diseases of≥3 kinds are all related factors for anxiety and depression in mothers of children admitted to the NICU(P<0.05).CONCLUSION Mothers of children admitted to the NICU demonstrated high anxiety and depression incidences.The nursing staff in the neonatal department established intervention measures for each related factor,strengthened communication and communication with the mother of the child,and did a good job in psychological counseling.展开更多
BACKGROUND Although critically ill pediatric patients can benefit from the use of sedation,it can cause side effects and even iatrogenic complications.Since pediatric patients cannot adequately express the intensity o...BACKGROUND Although critically ill pediatric patients can benefit from the use of sedation,it can cause side effects and even iatrogenic complications.Since pediatric patients cannot adequately express the intensity or location of the pain,discriminating the cause of their irritability and agitation can be more complicated than in adults.Thus,sedation therapy for children requires more careful attention.AIM To evaluate the association of the internal parental care protocol and the reduction in pediatric intensive care unit(PICU)postoperatively.METHODS This retrospective cohort study was carried out in the PICU of the tertiary medical center in Kazakhstan.The internal parental care protocol was developed and implemented by critical care team.During the pandemic,restrictions were also placed on parental presence in the PICU.We compare two groups:During restriction and after return to normal.The level of agitation was evaluated using the Richmond Agitation-Sedation Scale.Univariate and multivariate logistic regression analyses were performed to examine associations of parental care with sedation therapy.RESULTS A total of 289 patients were included in the study.Of them,167 patients were hospitalized during and 122 after the restrictions of parental care.In multivariate analysis,parental care was associated with lower odds of prescribing diazepam(odds ratio=0.11,95%confidence interval:0.05-0.25),controlling for age,sex,cerebral palsy,and type of surgery.CONCLUSION The results of this study show that parental care was associated only with decreased odds of prescribing sedative drugs,while no differences were observed for analgesics.展开更多
BACKGROUND Return of spontaneous circulation(ROSC)following cardiopulmonary resuscitation(CPR)is a critical determinant of survival in patients experiencing cardiac arrest.This study aimed to investigate the relations...BACKGROUND Return of spontaneous circulation(ROSC)following cardiopulmonary resuscitation(CPR)is a critical determinant of survival in patients experiencing cardiac arrest.This study aimed to investigate the relationship between the duration of CPR,the achievement of ROSC,and both short-term[intensive care unit(ICU)and in-hospital]and long-term survival outcomes in patients admitted to the medical intensive care unit(MICU)of Dr.Moopen’s Medical College Hospital,Wayanad,Kerala,India.AIM To assess how cardiopulmonary resuscitation duration impacts short-term and long-term survival in cardiac arrest patients in intensive care.METHODS A retrospective observational cohort study was conducted on adult patients who received CPR in the MICU between March 2023 and March 2024.Data were extracted from electronic medical records,including demographics,duration of CPR,ROSC achievement,and survival outcomes.Short-term survival was defined as survival to ICU discharge and in-hospital mortality,while long-term survival was assessed at six months post-arrest.Statistical analysis was performed using SPSS software,with Kaplan-Meier survival analysis and Cox regression used to identify predictors of mortality.RESULTS A total of 142 patients were included in the study.The median duration of CPR was 15 minutes.ROSC was achieved in 68 patients(47.9%).A significant association was observed between the duration of CPR and ROSC achievement(P<0.001).Patients who achieved ROSC early had significantly higher rates of short-term and longterm survival compared to those who did not(P<0.001).Each additional minute of CPR was associated with a 7%decrease in the odds of achieving ROSC.Longer CPR duration(HR:1.05,95%CI:1.02-1.08),absence of ROSC(HR:4.87,95%CI:2.31-10.28),older age(HR:1.03,95%CI:1.01-1.06)and unwitnessed arrest(HR:1.89,95%CI:1.05-3.41)were independent predictors of mortality.CONCLUSION Timely,effective cardiopulmonary resuscitation improves survival in intensive care.Duration significantly predicts return of circulation and outcomes.Further research should explore factors affecting resuscitation length and optimize treatment strategies.展开更多
Unplanned intensive care unit(ICU)admissions(UP-ICU)following initial general ward placement are associated with poor patient outcomes and represent a key quality indicator for healthcare facilities.Healthcare facilit...Unplanned intensive care unit(ICU)admissions(UP-ICU)following initial general ward placement are associated with poor patient outcomes and represent a key quality indicator for healthcare facilities.Healthcare facilities have employed numerous predictive models,such as physiological scores(e.g.,Acute Physiology and Chronic Health Evaluation II,Revised Trauma Score,and Mortality Probability Model II at 24 hours)and anatomical scores(Injury Severity Score and New Injury Severity Score),to identify high-risk patients.Although physiological scores frequently surpass anatomical scores in predicting mortality,their specificity for trauma patients is limited,and their clinical applicability may be limited.Initially proposed for ICU readmission prediction,the stability and workload index for the transfer score has demonstrated inconsistent validity.Machine learning offers a promising alternative.Several studies have shown that machine learning models,including those that use electronic health records(EHR)data,can more accurately predict trauma patients’deaths and admissions to the ICU than traditional scoring systems.These models identify unique predictors that are not captured by existing methods.However,challenges remain,including integration with EHR systems and data entry complexities.Critical care outreach programs and telemedicine can help reduce UP-ICU admissions;however,their effectiveness remains unclear because of costs and implementation challenges,respectively.Strategies to reduce UP-ICU admissions include improving triage systems,implementing evidence-based protocols for ICU patient management,and prioritizing prehospital intervention and stabilization to optimize the“golden hour”of trauma care.To improve patient outcomes and reduce the burden of UPICU admissions,further studies are required to validate and implement these strategies and refine machine learning models.展开更多
Objective The study aimed to develop machine learning(ML)models to predict the mortality of patients with acute gastro-intestinal bleeding(AGIB)in the intensive care unit(ICU)and compared their prognostic performance ...Objective The study aimed to develop machine learning(ML)models to predict the mortality of patients with acute gastro-intestinal bleeding(AGIB)in the intensive care unit(ICU)and compared their prognostic performance with that of Acute Physiology and Chronic Health EvaluationⅡ(APACHE-Ⅱ)score.Methods A total of 961 AGIB patients admitted to the ICU of Renmin Hospital of Wuhan University from January 2020 to December 2023 were enrolled.Patients were randomly divided into the training cohort(n=768)and the validation cohort(n=193).Clinical data were collected within the first 24 h of ICU admission.ML models were constructed using Python V.3.7 package,employing 3 different algorithms:XGBoost,Random Forest(RF)and Gradient Boosting Decision Tree(GBDT).The area under the receiver operating characteristic(ROC)curve(AUC)was used to evaluate the performance of different models.Results A total of 94 patients died with an overall mortality of 9.78%(11.32%in the training cohort and 8.96%in the vali-dation cohort).Among the 3 ML models,the GBDT algorithm demonstrated the highest predictive performance,achieving an AUC of 0.95(95%CI 0.90-0.99),while the AUCs of XGBoost and RF models were 0.89(95%CI 0.82-0.96)and 0.90(95%CI 0.84-0.96),respectively.In comparison,the APACHE-Ⅱmodel achieved an AUC of 0.74(95%CI 0.69-0.87),with a specificity of 70.97%(95%CI 64.07-77.01).When APACHE-Ⅱscore was incorporated into the GBDT algorithm,the ensemble model achieved an AUC of 0.98(95%CI 0.96-0.99)with a sensitivity of 85.71%and a specificity up to 95.15%.Conclusions The GBDT model serves as a reliable tool for accurately predicting the in-hospital mortality for AGIB patients.When integrated with the APACHE-Ⅱscore,the ensemble GBDT algorithm further enhances predictive accuracy and pro-vides valuable insights for prognostic evaluation.展开更多
BACKGROUND Atrial fibrillation(AF)represents a common arrhythmia with significant implications and may occur pre-,intra-,or postoperatively(POAF).After cardiac surgery POAF occurs in approximately 30% of patients,whil...BACKGROUND Atrial fibrillation(AF)represents a common arrhythmia with significant implications and may occur pre-,intra-,or postoperatively(POAF).After cardiac surgery POAF occurs in approximately 30% of patients,while non-cardiac/nonthoracic surgery has a reported incidence between 0.4% to 15%,with new onset POAF occurring at a rate of 0.4% to 3%.While AF has been extensively studied,it has not been well described in emergent non-cardiac surgery associated with increased surgical stress in an intensive care unit setting(ICU).AIM To investigate the incidence/predictors of POAF in emergent non-cardiac surgery and its associations with postoperative outcomes in the ICU.METHODS This retrospective study included patients≥18 years who underwent exploratory laparotomy or lower extremity amputation between October 2012 and September 2023 and were admitted in the ICU.Data of interest included occurrence of POAF,demographic characteristics,comorbidities,laboratory values,administered fluids,medications,and postoperative outcomes.Statistical analyses consisted of identifying predic-tors of POAF and associations of POAF with outcomes of interest.RESULTS A total of 347 ICU patients were included,16.4% had a history of AF,13.0% developed POAF,and 7.9%developed new-onset POAF.Patients with new-onset POAF were older(79.6±9.1 vs 68.1±14.8 years,<0.001),of white race(47.8%vs 28.8,P<0.001),hypertensive(87.0%vs 71.2%,P=0.011),had longer ICU length of stay(ICU-LOS)(13.4 vs 6.7 days,P=0.042),higher mortality(43.5%vs 17.6%,P=0.016)and higher rate of cardiac arrest(34.8%vs 14.6%,P=0.005)compared to patients without new-onset POAF.Multivariable analysis revealed increased POAF risk with advanced age(OR=1.06;95%CI:1.02-1.10,P=0.005),white race(OR=2.85;95%CI:1.26-6.76,P=0.014),high intraoperative fluid(OR>1;95%CI:1.00-1.00,P=0.018),and longer ICU-LOS(OR=1.04;95%CI:1.00-1.08,P=0.023).After adjusting for demographics,new onset POAF significantly predicted mortality(OR=3.07;95%CI:1.14-8.01,P=0.022).CONCLUSION POAF was associated with prolonged ICU-LOS,white race,and high intraoperative fluid.New-onset POAF was associated with increased risk of cardiac arrest and death in critically ill patients.展开更多
Intensive farming practices,aimed at maximizing crop yields through substantial inputs of labour,technology,and chemical fertilizers,have significantly transformed modern agriculture.However,these methods have raised ...Intensive farming practices,aimed at maximizing crop yields through substantial inputs of labour,technology,and chemical fertilizers,have significantly transformed modern agriculture.However,these methods have raised serious concerns regarding soil health,environmental sustainability,and long-term agricultural viability.This study examines the ecological impact of intensive farming on soil health in the KB Asifabad District of Telangana,India,where traditional and modern farming techniques coexist.The objectives include analysing socio-economic factors influencing farming methods,evaluating the impact of tilling techniques and fertilizer use on soil health,and promoting sustainable practices through education and policy recommendations.Findings reveal a strong reliance on chemical fertilizers,with 98.3% of farmers using them exclusively due to their perceived efficiency and rapid results.However,this overdependence has led to soil degradation,reduced microbial diversity,and environmental pollution.Conversely,despite its ecological benefits,natural manure remains underutilized due to scepticism and economic constraints.Mechanical tilling methods,while effective,have negatively impacted soil structure and fertility.The study highlights the necessity of transitioning to sustainable practices,integrating organic inputs,and adopting conservation techniques to restore soil health and ecosystem balance.This research provides practical pathways for achieving sustainable agriculture by integrating traditional knowledge with modern practices.It is particularly relevant for policymakers,agricultural extension services,and farming communities as it highlights the need for educational initiatives,financial incentives,and regulatory measures to ensure long-term soil fertility,environmental stewardship,and improved farmer livelihoods.展开更多
In order to enhance the guidance for Yuluxiang pear cultivation in hilly and mountainous regions, this study provides a comprehensive introduction to various aspects, including the establishment of high-standard orcha...In order to enhance the guidance for Yuluxiang pear cultivation in hilly and mountainous regions, this study provides a comprehensive introduction to various aspects, including the establishment of high-standard orchards and the reinforcement of integrated management techniques, in order to offer a valuable reference for fruit farmers engaged in scientific planting practices.展开更多
The intensive care unit(ICU)is a stressful environment for patients and their families as well as healthcare workers(HCWs).Distress,which is a negative emo-tional or physical response to a stressor is common in the IC...The intensive care unit(ICU)is a stressful environment for patients and their families as well as healthcare workers(HCWs).Distress,which is a negative emo-tional or physical response to a stressor is common in the ICU.Psychological first aid(PFA)is a form of mental health assistance provided in the immediate aftermath of disasters or other critical incidents to address acute distress and re-establish effective coping and functioning.The aim of this narrative review is to inform the development and utilization of PFA by HCWs in the ICU to reduce the burden of distress among patients,caregivers,and HCWs.This is the first such review to apply PFA to the ICU setting.展开更多
BACKGROUND Esophageal cancer patients had the highest intensive care unit(ICU)admitted rate in cancer patients.But their prognosis and evaluation methods were rarely studied.AIM To depict the short-term mortality outc...BACKGROUND Esophageal cancer patients had the highest intensive care unit(ICU)admitted rate in cancer patients.But their prognosis and evaluation methods were rarely studied.AIM To depict the short-term mortality outcome and identify the potential prognostic factors of esophageal cancer patients admitted into ICU.METHODS A multicenter cross-sectional study was performed from May 10,2021 to July 10,2021 at ICU departments of 37 cancer specialized hospitals in China.Patients aged≥14 years with ICU duration≥24 hours were included.Clinical records of patients with primary esophageal cancer diagnosis were reviewed.Patients were separated into groups according to the 90 days survival.Characteristics between groups were compared.Single and multi-variate regression tests were applied to analyze the correlated factors of ICU outcomes.Predictive values of disease severity scores were assessed using receiver operating characteristic curve analysis.RESULTS Total 180 esophageal cancer patients were included.The 90 days mortality was 22.2%.Patients with mortality outcome showed differences from those survived mostly in disease severity and unplanned transfer from clinical ward.The current evaluation tools,including Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II scores had low accuracy in prediction of short-term death.ICU admitted esophageal cancer patients have poor prognosis,especially those with acute illness.CONCLUSION The prognostic tools for these patients need to be further optimized.展开更多
Objective To explore the relationship between serum chloride levels and prognosis in patients with hepatic coma in the intensive care unit(ICU).Methods We analyzed 545 patients with hepatic coma in the ICU from the Me...Objective To explore the relationship between serum chloride levels and prognosis in patients with hepatic coma in the intensive care unit(ICU).Methods We analyzed 545 patients with hepatic coma in the ICU from the Medical Information Mart for Intensive Care IV(MIMIC-IV)database.Associations between serum chloride levels and 28-day and 1-year mortality rates were assessed using restricted cubic splines(RCSs),Kaplan-Meier(KM)curves,and Cox regression.Subgroup analyses,external validation,and mechanistic studies were also performed.Results A total of 545 patients were included in the study.RCS analysis revealed a U-shaped association between serum chloride levels and mortality in patients with hepatic coma.The KM curves indicated lower survival rates among patients with low chloride levels(<103 mmol/L).Low chloride levels were independently linked to increased 28-day and 1-year all-cause mortality rates.In the multivariate models,the hazard ratio(HR)for 28-day mortality in the low-chloride group was 1.424(95%confidence interval[CI]:1.041–1.949),while the adjusted hazard ratio for 1-year mortality was 1.313(95%CI:1.026–1.679).Subgroup analyses and external validation supported these findings.Cytological experiments suggested that low chloride levels may activate the phosphorylation of the NF-κB signaling pathway,promote the expression of pro-inflammatory cytokines,and reduce neuronal cell viability.Conclusion Low serum chloride levels are independently associated with increased mortality in patients with hepatic coma.展开更多
Background:While quantitative research has determined that emotional distress and psychiatric illness among frontline healthcare workers increased with the COVID-19 pandemic,detailed qualitative data describing their ...Background:While quantitative research has determined that emotional distress and psychiatric illness among frontline healthcare workers increased with the COVID-19 pandemic,detailed qualitative data describing their personal experiences are needed in order to make appropriate plans to address provider mental health in future pandemics.This study aims to further explore the psychological effects of the pandemic on COVID-19 ICU clinicians and administrators through focus groups.Methods:Two separate 2-h focus groups of physicians were conducted,one with frontline faculty clinicians and another with administrators.Qualitative data analysis was conducted.Results:In September and November 2023,volunteer samples were recruited from the pulmonary and critical care medicine division of The University of Texas Southwestern physicians who served during the pandemic primarily as clinicians(N=6)or in major administrative roles(N=5).Perceptions of both administrators’and clinicians’pandemic experiences were coded into the same 7 qualitative themes:planning,sense of community and isolation,disparities and inequalities,communication and listening,leadership,effects of the pandemic,and emotional/psychiatric/coping responses.Effects of the pandemic were the most coded theme in both groups;second was disparities and inequalities for clinicians and pandemic planning for administrators.Thematic content is summarized separately for clinicians and administrators,illustrated with representative quotes.Conclusion:This study adds detailed qualitative findings to enrich existing quantitative knowledge on frontline COVID-19 workers’emotional responses.Both clinicians and administrators identified helpful and non-helpful institutional responses.These findings are consistent with prior studies of disaster worker experiences and may help to inform efforts to address provider mental health in future pandemics.展开更多
BACKGROUND Cardiovascular(CV)complications are common in intensive care unit(ICU)patients after gastrointestinal surgery and are associated with increased mortality and prolonged hospital stay.The optimization of post...BACKGROUND Cardiovascular(CV)complications are common in intensive care unit(ICU)patients after gastrointestinal surgery and are associated with increased mortality and prolonged hospital stay.The optimization of postoperative nursing interventions,particularly pain management,is crucial for reducing such complications.AIM To investigate the effects of enhanced recovery nursing on CV complications after gastrointestinal surgery in ICU patients and associated risk factors.METHODS A retrospective analysis was conducted on 78 adult patients who underwent gastrointestinal surgery in the ICU of our hospital between February 2023 and September 2024.Among them,40 patients received standard care(control group),while 38 received enhanced recovery nursing(observation group).We compared the incidence of CV complications and nursing satisfaction between the two groups.Patients were divided into CV complication and non-complication groups based on complication occurrence,and logistic regression analysis was used to identify risk factors.RESULTS In the control and observation groups,the incidence of CV complications was 30.0%(12/40)and 18.4%(7/38),with a nursing satisfaction rate of 70.0%(28/40)and 92.1%(35/38),respectively.The postoperative pain score at 14 days was significantly lower in the observation group(0.27±0.15)compared to the control group(1.65±0.37),with all differences being statistically significant(P<0.05).Univariate analysis indicated significant differences in age,body mass index,hypertension,diabetes,smoking history,history of heart failure,and previous myocardial infarction(P<0.05).Multivariate logistic regression identified heart failure history,previous myocardial infarction,age,hypertension,and diabetes as independent risk factors,with odds ratios of 1.195,1.528,1.062,1.836,and 1.942,respectively(all P<0.05).CONCLUSION Implementing enhanced recovery nursing for ICU patients after gastrointestinal surgery is beneficial in reducing the incidence of CV complications and improving nursing satisfaction.展开更多
Transferring patients with critical illnesses from general wards to intensive care units (ICUs) is a crucial and time-sensitive process. This article presents strategies for improving the efficiency of patient transfe...Transferring patients with critical illnesses from general wards to intensive care units (ICUs) is a crucial and time-sensitive process. This article presents strategies for improving the efficiency of patient transfers, particularly in hospitals where intensive care units are located in buildings separate from general wards. Patient transfers comprise several steps: physicians issue orders, relatives are notified, equipment is prepared, and medical staff coordinate. We identified three factors that influence transfer time: preparation time for bed transfer, time required for shift handovers, and time required for between-ward patient movement. Unfamiliarity with transfer routes and long elevator wait times were factors that also influenced transfer time. The following strategies were proposed: develop a standardized material checklist, design key notes for patient transfers, and optimize transfer routes. These strategies reduced transfer times by 40% to 43%. This study demonstrates that by addressing logistical challenges and streamlining relevant procedures, hospitals can enhance safety and quality of care during patient transfers.展开更多
BACKGROUND Plasma concentration monitoring is crucial for optimizing vancomycin use,particularly in patients in the intensive care unit(ICU).However,the reference interval for vancomycin plasma concentration remains u...BACKGROUND Plasma concentration monitoring is crucial for optimizing vancomycin use,particularly in patients in the intensive care unit(ICU).However,the reference interval for vancomycin plasma concentration remains undetermined.AIM To evaluate the correlations of area under the curve(AUC_(0-24))and trough concentration(C_(min))with efficacy and nephrotoxicity in patients in the ICU.METHODS A total of 103 patients treated with vancomycin for methicillin-resistant Staphylococcus aureus infections were analyzed in this study.The associations of clinicodemographic characteristics(including sex,age,weight,infection sites,main etiologies of ICU cases,comorbidities,acute physiological chronic health evaluation II score,and mechanical ventilation)and pharmacokinetics(daily dose,C_(min),AUC_(0-24),and AUC_(0-24)/minimum inhibitory concentration)with efficacy and nephrotoxicity of vancomycin were evaluated with univariate and multivariate logistic regression analyses.AUC_(0-24)was calculated using VCM-TDM software based on vancomycin population pharmacokinetics and Bayesian feedback method.RESULTS Cmin over 9.4μg/mL and AUC_(0-24)exceeding 359.6μg×hour/mL indicated good efficacy against infection.Cmin below 14.0μg/mL predicted no significant nephrotoxicity.CONCLUSION In this study,the effective and safe concentration interval for vancomycin in patients in the ICU was Cmin 9.4-14.0μg/mL.Close attention should be paid to adverse effects and renal function during vancomycin treatment.展开更多
Objective:To determine the incidence,risk factors,antibiotic resistance patterns,and outcomes of various nosocomial infections in Intensive Care Unit(ICU)patients.Methods:The present prospective observational study wa...Objective:To determine the incidence,risk factors,antibiotic resistance patterns,and outcomes of various nosocomial infections in Intensive Care Unit(ICU)patients.Methods:The present prospective observational study was conducted in the multidisciplinary ICU of a tertiary care hospital for 6 months.Incidence,risk factors,and outcome parameters were calculated using Mann Whitney U test,Chi-square test,and stepwise univariate and multivariate logistic regression analysis.Results:The overall incidence of nosocomial infections was 23.5%(74/314).Ventilator-associated pneumonia was the most common infection(54.1%,52/96),followed by catheter-related bloodstream infections(22.9%,22/96).Stress ulcer prophylaxis(aOR 7.691,95%CI 2.202-26.860,P=0.001),endotracheal intubation(aOR 3.251,95%CI 1.251-8.420,P=0.015),Foley’s catheter(aOR 11.917,95%CI 1.335-106.410,P=0.027),and ICU stay>7 days(aOR 30.915,95%CI 10.062-94.980,P=0.001)were statistically significant risk factors associated with nosocomial infection in ICU patients.Gram-negative bacteria showed a high degree of resistance to most of antibiotics except colistin and tigecycline.Infected group's mortality was significantly greater than the uninfected group(21.62%vs.5.83%P<0.001)and had considerably longer ICU length of stay[21(12)vs.7(4)days,P<0.001]and duration of mechanical ventilation[20(11)days vs.0(5)days,P<0.001].Conclusions:This study highlights the high incidence rate of ventilator-associated pneumonia,with extensive drug resistance in ICU patients,highlighting the need for an optimized antimicrobial stewardship program to develop effective strategies for the management of nosocomial infections.Multifaceted interventions targeting modifiable risk factors are essential to reduce the occurences of these nosocomial infections in ICU patients.展开更多
文摘BACKGROUND The need for an emergency upgrade of a hospitalized trauma patient from the floor to the trauma intensive care unit(ICU)is an unanticipated event with possible life-threatening consequences.Unplanned ICU admissions are associated with increased morbidity and mortality and are an indicator of trauma service quality.Two different types of unplanned ICU admissions include upgrades(patients admitted to the floor then moved to the ICU)and bounce backs(patients admitted to the ICU,discharged to the floor,and then readmitted to the ICU).Previous studies have shown that geriatric trauma patients are at higher risk for unfavorable outcomes.AIM To analyze the characteristics,management and outcomes of trauma patients who had an unplanned ICU admission during their hospitalization.METHODS This institutional review board approved,retrospective cohort study examined 203 adult trauma patients with unplanned ICU admission at an urban level 1 trauma center over a six-year period(2017-2023).This included 134 upgrades and 69 bounce backs.Analyzed variables included:(1)Age;(2)Sex;(3)Comorbidities;(4)Mechanism of injury(MOI);(5)Injury severity score(ISS);(6)Glasgow Coma Scale(GCS);(7)Type of injury;(8)Transfusions;(9)Consultations;(10)Timing and reason for unplanned admission;(11)Intubations;(12)Surgical interventions;(13)ICU and hospital lengths of stay;and(14)Mortality.RESULTS Unplanned ICU admissions comprised 4.2%of total ICU admissions.Main MOI was falls.Mean age was 70.7 years,ISS was 12.8 and GCS was 13.9.Main injuries were traumatic brain injury(37.4%)and thoracic injury(21.7%),and main reason for unplanned ICU admission was respiratory complication(39.4%).The 47.3%underwent a surgical procedure and 46.8%were intubated.Average timing for unplanned ICU admission was 2.9 days.Bounce backs occurred half as often as upgrades,however had higher rates of transfusions(63.8%vs 40.3%,P=0.002),consultations(4.8 vs 3.0,P<0.001),intubations(63.8%vs 38.1%%,P=0.001),longer ICU lengths of stay(13.2 days vs 6.4 days,P<0.001)and hospital lengths of stay(26.7 days vs 13.0 days,P<0.001).Mortality was 25.6%among unplanned ICU admissions,31.9%among geriatric unplanned ICU admissions and 11.9%among all trauma ICU patients.CONCLUSION Unplanned ICU admissions constituted 4.2%of total ICU admissions.Respiratory complications were the main cause of unplanned ICU admissions.Bounce backs occurred half as often as upgrades,but were associated with worse outcomes.
文摘BACKGROUND Stress-induced hyperglycemia(SIH)is common in critically ill patients and has been associated with adverse cardiovascular outcomes.Intensive insulin therapy(IIT)has been proposed to mitigate these risks by achieving tighter glycemic control.AIM To evaluate the efficacy of IIT for managing SIH in critically ill patients and to explore its potential effect on cardiac function.METHODS A retrospective study was conducted at our hospital from January 2021 to December 2024,adhering to STROBE guidelines.A total of 186 critically ill pa-tients were divided into normal glycemia(n=85)and SIH(n=101)groups.The SIH cohort was further subdivided into conventional treatment(n=50)and IIT(n=51)groups.Hemodynamic parameters-including right atrial pressure(RAP),pulmonary artery pressure(PAP),pulmonary capillary wedge pressure(PAWP),cardiac output(CO),cardiac index(CI),and B-type natriuretic peptide(BNP)-were measured at baseline and post-treatment.Clinical outcomes such as intensive care unit(ICU)length of stay,mechanical ventilation requirements,and mortality were also recorded.Statistical analyses were conducted using inde-pendent samples t-tests and χ^(2)/Fisher’s exact tests.RESULTS SIH markedly worsened haemodynamics versus normal glycaemia:RAP 9.8±5.1 vs 6.1±3.5 mmHg,PAP 35.2±16.0 vs 26.2±10.3 mmHg,PAWP 16.0±7.0 vs 8.6±6.4 mmHg,CO 3.3±2.3 vs 6.0±3.3 L/min,CI 1.88±0.24 vs 2.70±0.50 L/min/m2,BNP 465±250 vs 180±53 pg/mL(all P<0.001).Within the SIH cohort,IIT outperformed conventional therapy:RAP 7.0±2.2 vs 8.3±3.9 mmHg(P=0.04),PAP 21.6±3.7 vs 29.3±6.5 mmHg(P<0.001),PAWP 10.2±5.4 vs 13.8±5.3 mmHg(P=0.001),CO 4.9±2.2 vs 4.0±1.4 L/min(P=0.022),CI 2.58±0.32 vs 2.11±0.31 L/min/m2,P<0.001),BNP 202±62 vs 346±171 pg/mL(P<0.001).Clinically,IIT shortened ICU stay(10.3±3.4 vs 14.5±2.6 days,P<0.001),reduced ventilator use(56.9%vs 76.0%,P=0.042),and lowered mortality(23.5%vs 42.0%,P=0.048).CONCLUSION IIT significantly reduced cardiac filling pressures,improved cardiac function,and was associated with favorable clinical outcomes in SIH patients,suggesting potential benefits of stricter glycaemic control in critically ill patients.However,given the retrospective design and absence of glucose-variability monitoring,these findings should be interpreted with caution.
文摘Intensive care unit(ICU)acquired sarcopenia and myosteatosis are increasingly recognized complications of critical illness,characterized by a rapid loss of ske-letal muscle mass,quality,and function.These conditions result from a complex interplay of systemic inflammation,immobilization,catabolic stress,mitochon-drial dysfunction,and immune dysregulation,often culminating in impaired recovery,prolonged hospitalization,and increased long-term mortality.First identified in survivors of sepsis and prolonged mechanical ventilation,these muscle abnormalities were initially described using computed tomography-based assessments of muscle area and density.Subsequent advances in imaging,biomarker discovery,and functional testing have enabled earlier detection and risk stratification across diverse ICU populations.While nutritional optimization and early mobilization form the cornerstone of current prevention and treatment strategies,the emergence of novel approaches,including automated artificial intelligence-based screening,neuromuscular electrical stimulation,and targeted pharmacologic therapies,has broadened the clinical scope of interventions.Despite their significant prognostic implications,ICU-acquired sarcopenia and myosteatosis remain under-recognized in routine critical care practice.This mini-review aims to synthesize current knowledge regarding their pathophysiology,available diagnostic modalities,prognostic relevance,and the evolving landscape of therapeutic strategies for long-term functional recovery in critically ill patients.
基金Supported by The National Natural Science Foundation of China,No.82072130Key Medical Research Projects in Jiangsu Province,No.ZD2022021Suzhou Clinical Medical Center for Anesthesiology,No.Szlcyxzxj202102。
文摘BACKGROUND Hypernatremia represents a significant electrolyte imbalance associated with numerous adverse outcomes,particularly in cases of intensive care unit(ICU)-acquired hypernatremia(IAH).Nevertheless,its relevance in patients with septic shock remains uncertain.AIM To identify independent risk factors and their predictive efficacy for IAH to improve outcomes in patients with septic shock.METHODS In the present retrospective single-center study,a cohort of 157 septic shock patients with concurrent hypernatremia in the ICU at The First Affiliated Hospital of Soochow University,between August 1,2018,and May 31,2023,were analyzed.Patients were categorized based on the timing of hypernatremia occurrence into the IAH group(n=62),the non-IAH group(n=41),and the normonatremia group(n=54).RESULTS In the present study,there was a significant association between the high serum sodium concentrations,excessive persistent inflammation,immunosuppression and catabolism syndrome and chronic critical illness,while rapid recovery had an apparent association with normonatremia.Moreover,multivariable analyses revealed the following independent risk factors for IAH:Total urinary output over the preceding three days[odds ratio(OR)=1.09;95%CI:1.02–1.17;P=0.014],enteral nutrition(EN)sodium content of 500 mg(OR=2.93;95%CI:1.13–7.60;P=0.027),and EN sodium content of 670 mg(OR=6.19;95%CI:1.75–21.98;P=0.005)were positively correlated with the development of IAH.Notably,the area under the curve for total urinary output over the preceding three days was 0.800(95%CI:0.678–0.922,P=0.001).Furthermore,maximum serum sodium levels,the duration of hypernatremia,and varying sodium correction rates were significantly associated with 28-day in-hospital mortality in septic shock patients(P<0.05).CONCLUSION The present findings illustrate that elevated serum sodium level was significantly associated with a poor prognosis in septic shock patients in the ICU.It is highly recommended that hypernatremia be considered a potentially important prognostic indicator for the outcome of septic shock.
文摘BACKGROUND Newborns are immediately admitted to the neonatal intensive care unit(NICU)after birth,and thus mothers suffer from the pain of mother-infant separation.Some mothers worry about alterations in their child’s condition and the uncertainty and high medical costs of possible sequelae,which frequently cause anxiety,depression,and other adverse emotions.AIM To investigate the anxiety and depression status of mothers of children in the NICU and its related factors.METHODS A convenient sampling method is adopted.The research objects included the mothers of 191 children in the NICU of Suzhou Ninth Hospital Affiliated with Suzhou University from January 2023 to July 2024.The general information questionnaire,personal control scale,self-rating anxiety scale,and self-rating depression scale were utilized for investigation.Anxiety and depression status in mothers of children in the NICU and its related factors were analyzed.RESULTS The incidences of maternal anxiety and depression among 191 hospitalized children in the NICU were 32.98%(63/191)and 23.56%(45/191),respectively.Single-factor analysis reveals that family monthly income,individual sense of control,gestational age of the child,and the number of diseases in the child are associated with the anxiety and depression experienced by the mother of the child in the NICU(P<0.05).Multivariate logistic regression analysis revealed that family monthly income of<5000 yuan(RMB),poor individual control,gestational age of<32 weeks,and the number of diseases of≥3 kinds are all related factors for anxiety and depression in mothers of children admitted to the NICU(P<0.05).CONCLUSION Mothers of children admitted to the NICU demonstrated high anxiety and depression incidences.The nursing staff in the neonatal department established intervention measures for each related factor,strengthened communication and communication with the mother of the child,and did a good job in psychological counseling.
文摘BACKGROUND Although critically ill pediatric patients can benefit from the use of sedation,it can cause side effects and even iatrogenic complications.Since pediatric patients cannot adequately express the intensity or location of the pain,discriminating the cause of their irritability and agitation can be more complicated than in adults.Thus,sedation therapy for children requires more careful attention.AIM To evaluate the association of the internal parental care protocol and the reduction in pediatric intensive care unit(PICU)postoperatively.METHODS This retrospective cohort study was carried out in the PICU of the tertiary medical center in Kazakhstan.The internal parental care protocol was developed and implemented by critical care team.During the pandemic,restrictions were also placed on parental presence in the PICU.We compare two groups:During restriction and after return to normal.The level of agitation was evaluated using the Richmond Agitation-Sedation Scale.Univariate and multivariate logistic regression analyses were performed to examine associations of parental care with sedation therapy.RESULTS A total of 289 patients were included in the study.Of them,167 patients were hospitalized during and 122 after the restrictions of parental care.In multivariate analysis,parental care was associated with lower odds of prescribing diazepam(odds ratio=0.11,95%confidence interval:0.05-0.25),controlling for age,sex,cerebral palsy,and type of surgery.CONCLUSION The results of this study show that parental care was associated only with decreased odds of prescribing sedative drugs,while no differences were observed for analgesics.
文摘BACKGROUND Return of spontaneous circulation(ROSC)following cardiopulmonary resuscitation(CPR)is a critical determinant of survival in patients experiencing cardiac arrest.This study aimed to investigate the relationship between the duration of CPR,the achievement of ROSC,and both short-term[intensive care unit(ICU)and in-hospital]and long-term survival outcomes in patients admitted to the medical intensive care unit(MICU)of Dr.Moopen’s Medical College Hospital,Wayanad,Kerala,India.AIM To assess how cardiopulmonary resuscitation duration impacts short-term and long-term survival in cardiac arrest patients in intensive care.METHODS A retrospective observational cohort study was conducted on adult patients who received CPR in the MICU between March 2023 and March 2024.Data were extracted from electronic medical records,including demographics,duration of CPR,ROSC achievement,and survival outcomes.Short-term survival was defined as survival to ICU discharge and in-hospital mortality,while long-term survival was assessed at six months post-arrest.Statistical analysis was performed using SPSS software,with Kaplan-Meier survival analysis and Cox regression used to identify predictors of mortality.RESULTS A total of 142 patients were included in the study.The median duration of CPR was 15 minutes.ROSC was achieved in 68 patients(47.9%).A significant association was observed between the duration of CPR and ROSC achievement(P<0.001).Patients who achieved ROSC early had significantly higher rates of short-term and longterm survival compared to those who did not(P<0.001).Each additional minute of CPR was associated with a 7%decrease in the odds of achieving ROSC.Longer CPR duration(HR:1.05,95%CI:1.02-1.08),absence of ROSC(HR:4.87,95%CI:2.31-10.28),older age(HR:1.03,95%CI:1.01-1.06)and unwitnessed arrest(HR:1.89,95%CI:1.05-3.41)were independent predictors of mortality.CONCLUSION Timely,effective cardiopulmonary resuscitation improves survival in intensive care.Duration significantly predicts return of circulation and outcomes.Further research should explore factors affecting resuscitation length and optimize treatment strategies.
文摘Unplanned intensive care unit(ICU)admissions(UP-ICU)following initial general ward placement are associated with poor patient outcomes and represent a key quality indicator for healthcare facilities.Healthcare facilities have employed numerous predictive models,such as physiological scores(e.g.,Acute Physiology and Chronic Health Evaluation II,Revised Trauma Score,and Mortality Probability Model II at 24 hours)and anatomical scores(Injury Severity Score and New Injury Severity Score),to identify high-risk patients.Although physiological scores frequently surpass anatomical scores in predicting mortality,their specificity for trauma patients is limited,and their clinical applicability may be limited.Initially proposed for ICU readmission prediction,the stability and workload index for the transfer score has demonstrated inconsistent validity.Machine learning offers a promising alternative.Several studies have shown that machine learning models,including those that use electronic health records(EHR)data,can more accurately predict trauma patients’deaths and admissions to the ICU than traditional scoring systems.These models identify unique predictors that are not captured by existing methods.However,challenges remain,including integration with EHR systems and data entry complexities.Critical care outreach programs and telemedicine can help reduce UP-ICU admissions;however,their effectiveness remains unclear because of costs and implementation challenges,respectively.Strategies to reduce UP-ICU admissions include improving triage systems,implementing evidence-based protocols for ICU patient management,and prioritizing prehospital intervention and stabilization to optimize the“golden hour”of trauma care.To improve patient outcomes and reduce the burden of UPICU admissions,further studies are required to validate and implement these strategies and refine machine learning models.
基金supported by the Cross Innovation Talent Project,Renmin Hospital of Wuhan University(No.JCRCYG-2022-005,No.JCRCZN-2022-017)the National Natural Science Foundation of China(No.82302418)+1 种基金the Knowledge Innovation Program of Wuhan,Science and Technology Innovation of Wuhan(No.2023020201010165)The Key Project of Education Foundation,Guang Zhou 21st Century Education Foundation(No.2023HX0054).
文摘Objective The study aimed to develop machine learning(ML)models to predict the mortality of patients with acute gastro-intestinal bleeding(AGIB)in the intensive care unit(ICU)and compared their prognostic performance with that of Acute Physiology and Chronic Health EvaluationⅡ(APACHE-Ⅱ)score.Methods A total of 961 AGIB patients admitted to the ICU of Renmin Hospital of Wuhan University from January 2020 to December 2023 were enrolled.Patients were randomly divided into the training cohort(n=768)and the validation cohort(n=193).Clinical data were collected within the first 24 h of ICU admission.ML models were constructed using Python V.3.7 package,employing 3 different algorithms:XGBoost,Random Forest(RF)and Gradient Boosting Decision Tree(GBDT).The area under the receiver operating characteristic(ROC)curve(AUC)was used to evaluate the performance of different models.Results A total of 94 patients died with an overall mortality of 9.78%(11.32%in the training cohort and 8.96%in the vali-dation cohort).Among the 3 ML models,the GBDT algorithm demonstrated the highest predictive performance,achieving an AUC of 0.95(95%CI 0.90-0.99),while the AUCs of XGBoost and RF models were 0.89(95%CI 0.82-0.96)and 0.90(95%CI 0.84-0.96),respectively.In comparison,the APACHE-Ⅱmodel achieved an AUC of 0.74(95%CI 0.69-0.87),with a specificity of 70.97%(95%CI 64.07-77.01).When APACHE-Ⅱscore was incorporated into the GBDT algorithm,the ensemble model achieved an AUC of 0.98(95%CI 0.96-0.99)with a sensitivity of 85.71%and a specificity up to 95.15%.Conclusions The GBDT model serves as a reliable tool for accurately predicting the in-hospital mortality for AGIB patients.When integrated with the APACHE-Ⅱscore,the ensemble GBDT algorithm further enhances predictive accuracy and pro-vides valuable insights for prognostic evaluation.
文摘BACKGROUND Atrial fibrillation(AF)represents a common arrhythmia with significant implications and may occur pre-,intra-,or postoperatively(POAF).After cardiac surgery POAF occurs in approximately 30% of patients,while non-cardiac/nonthoracic surgery has a reported incidence between 0.4% to 15%,with new onset POAF occurring at a rate of 0.4% to 3%.While AF has been extensively studied,it has not been well described in emergent non-cardiac surgery associated with increased surgical stress in an intensive care unit setting(ICU).AIM To investigate the incidence/predictors of POAF in emergent non-cardiac surgery and its associations with postoperative outcomes in the ICU.METHODS This retrospective study included patients≥18 years who underwent exploratory laparotomy or lower extremity amputation between October 2012 and September 2023 and were admitted in the ICU.Data of interest included occurrence of POAF,demographic characteristics,comorbidities,laboratory values,administered fluids,medications,and postoperative outcomes.Statistical analyses consisted of identifying predic-tors of POAF and associations of POAF with outcomes of interest.RESULTS A total of 347 ICU patients were included,16.4% had a history of AF,13.0% developed POAF,and 7.9%developed new-onset POAF.Patients with new-onset POAF were older(79.6±9.1 vs 68.1±14.8 years,<0.001),of white race(47.8%vs 28.8,P<0.001),hypertensive(87.0%vs 71.2%,P=0.011),had longer ICU length of stay(ICU-LOS)(13.4 vs 6.7 days,P=0.042),higher mortality(43.5%vs 17.6%,P=0.016)and higher rate of cardiac arrest(34.8%vs 14.6%,P=0.005)compared to patients without new-onset POAF.Multivariable analysis revealed increased POAF risk with advanced age(OR=1.06;95%CI:1.02-1.10,P=0.005),white race(OR=2.85;95%CI:1.26-6.76,P=0.014),high intraoperative fluid(OR>1;95%CI:1.00-1.00,P=0.018),and longer ICU-LOS(OR=1.04;95%CI:1.00-1.08,P=0.023).After adjusting for demographics,new onset POAF significantly predicted mortality(OR=3.07;95%CI:1.14-8.01,P=0.022).CONCLUSION POAF was associated with prolonged ICU-LOS,white race,and high intraoperative fluid.New-onset POAF was associated with increased risk of cardiac arrest and death in critically ill patients.
文摘Intensive farming practices,aimed at maximizing crop yields through substantial inputs of labour,technology,and chemical fertilizers,have significantly transformed modern agriculture.However,these methods have raised serious concerns regarding soil health,environmental sustainability,and long-term agricultural viability.This study examines the ecological impact of intensive farming on soil health in the KB Asifabad District of Telangana,India,where traditional and modern farming techniques coexist.The objectives include analysing socio-economic factors influencing farming methods,evaluating the impact of tilling techniques and fertilizer use on soil health,and promoting sustainable practices through education and policy recommendations.Findings reveal a strong reliance on chemical fertilizers,with 98.3% of farmers using them exclusively due to their perceived efficiency and rapid results.However,this overdependence has led to soil degradation,reduced microbial diversity,and environmental pollution.Conversely,despite its ecological benefits,natural manure remains underutilized due to scepticism and economic constraints.Mechanical tilling methods,while effective,have negatively impacted soil structure and fertility.The study highlights the necessity of transitioning to sustainable practices,integrating organic inputs,and adopting conservation techniques to restore soil health and ecosystem balance.This research provides practical pathways for achieving sustainable agriculture by integrating traditional knowledge with modern practices.It is particularly relevant for policymakers,agricultural extension services,and farming communities as it highlights the need for educational initiatives,financial incentives,and regulatory measures to ensure long-term soil fertility,environmental stewardship,and improved farmer livelihoods.
文摘In order to enhance the guidance for Yuluxiang pear cultivation in hilly and mountainous regions, this study provides a comprehensive introduction to various aspects, including the establishment of high-standard orchards and the reinforcement of integrated management techniques, in order to offer a valuable reference for fruit farmers engaged in scientific planting practices.
文摘The intensive care unit(ICU)is a stressful environment for patients and their families as well as healthcare workers(HCWs).Distress,which is a negative emo-tional or physical response to a stressor is common in the ICU.Psychological first aid(PFA)is a form of mental health assistance provided in the immediate aftermath of disasters or other critical incidents to address acute distress and re-establish effective coping and functioning.The aim of this narrative review is to inform the development and utilization of PFA by HCWs in the ICU to reduce the burden of distress among patients,caregivers,and HCWs.This is the first such review to apply PFA to the ICU setting.
文摘BACKGROUND Esophageal cancer patients had the highest intensive care unit(ICU)admitted rate in cancer patients.But their prognosis and evaluation methods were rarely studied.AIM To depict the short-term mortality outcome and identify the potential prognostic factors of esophageal cancer patients admitted into ICU.METHODS A multicenter cross-sectional study was performed from May 10,2021 to July 10,2021 at ICU departments of 37 cancer specialized hospitals in China.Patients aged≥14 years with ICU duration≥24 hours were included.Clinical records of patients with primary esophageal cancer diagnosis were reviewed.Patients were separated into groups according to the 90 days survival.Characteristics between groups were compared.Single and multi-variate regression tests were applied to analyze the correlated factors of ICU outcomes.Predictive values of disease severity scores were assessed using receiver operating characteristic curve analysis.RESULTS Total 180 esophageal cancer patients were included.The 90 days mortality was 22.2%.Patients with mortality outcome showed differences from those survived mostly in disease severity and unplanned transfer from clinical ward.The current evaluation tools,including Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II scores had low accuracy in prediction of short-term death.ICU admitted esophageal cancer patients have poor prognosis,especially those with acute illness.CONCLUSION The prognostic tools for these patients need to be further optimized.
文摘Objective To explore the relationship between serum chloride levels and prognosis in patients with hepatic coma in the intensive care unit(ICU).Methods We analyzed 545 patients with hepatic coma in the ICU from the Medical Information Mart for Intensive Care IV(MIMIC-IV)database.Associations between serum chloride levels and 28-day and 1-year mortality rates were assessed using restricted cubic splines(RCSs),Kaplan-Meier(KM)curves,and Cox regression.Subgroup analyses,external validation,and mechanistic studies were also performed.Results A total of 545 patients were included in the study.RCS analysis revealed a U-shaped association between serum chloride levels and mortality in patients with hepatic coma.The KM curves indicated lower survival rates among patients with low chloride levels(<103 mmol/L).Low chloride levels were independently linked to increased 28-day and 1-year all-cause mortality rates.In the multivariate models,the hazard ratio(HR)for 28-day mortality in the low-chloride group was 1.424(95%confidence interval[CI]:1.041–1.949),while the adjusted hazard ratio for 1-year mortality was 1.313(95%CI:1.026–1.679).Subgroup analyses and external validation supported these findings.Cytological experiments suggested that low chloride levels may activate the phosphorylation of the NF-κB signaling pathway,promote the expression of pro-inflammatory cytokines,and reduce neuronal cell viability.Conclusion Low serum chloride levels are independently associated with increased mortality in patients with hepatic coma.
文摘Background:While quantitative research has determined that emotional distress and psychiatric illness among frontline healthcare workers increased with the COVID-19 pandemic,detailed qualitative data describing their personal experiences are needed in order to make appropriate plans to address provider mental health in future pandemics.This study aims to further explore the psychological effects of the pandemic on COVID-19 ICU clinicians and administrators through focus groups.Methods:Two separate 2-h focus groups of physicians were conducted,one with frontline faculty clinicians and another with administrators.Qualitative data analysis was conducted.Results:In September and November 2023,volunteer samples were recruited from the pulmonary and critical care medicine division of The University of Texas Southwestern physicians who served during the pandemic primarily as clinicians(N=6)or in major administrative roles(N=5).Perceptions of both administrators’and clinicians’pandemic experiences were coded into the same 7 qualitative themes:planning,sense of community and isolation,disparities and inequalities,communication and listening,leadership,effects of the pandemic,and emotional/psychiatric/coping responses.Effects of the pandemic were the most coded theme in both groups;second was disparities and inequalities for clinicians and pandemic planning for administrators.Thematic content is summarized separately for clinicians and administrators,illustrated with representative quotes.Conclusion:This study adds detailed qualitative findings to enrich existing quantitative knowledge on frontline COVID-19 workers’emotional responses.Both clinicians and administrators identified helpful and non-helpful institutional responses.These findings are consistent with prior studies of disaster worker experiences and may help to inform efforts to address provider mental health in future pandemics.
文摘BACKGROUND Cardiovascular(CV)complications are common in intensive care unit(ICU)patients after gastrointestinal surgery and are associated with increased mortality and prolonged hospital stay.The optimization of postoperative nursing interventions,particularly pain management,is crucial for reducing such complications.AIM To investigate the effects of enhanced recovery nursing on CV complications after gastrointestinal surgery in ICU patients and associated risk factors.METHODS A retrospective analysis was conducted on 78 adult patients who underwent gastrointestinal surgery in the ICU of our hospital between February 2023 and September 2024.Among them,40 patients received standard care(control group),while 38 received enhanced recovery nursing(observation group).We compared the incidence of CV complications and nursing satisfaction between the two groups.Patients were divided into CV complication and non-complication groups based on complication occurrence,and logistic regression analysis was used to identify risk factors.RESULTS In the control and observation groups,the incidence of CV complications was 30.0%(12/40)and 18.4%(7/38),with a nursing satisfaction rate of 70.0%(28/40)and 92.1%(35/38),respectively.The postoperative pain score at 14 days was significantly lower in the observation group(0.27±0.15)compared to the control group(1.65±0.37),with all differences being statistically significant(P<0.05).Univariate analysis indicated significant differences in age,body mass index,hypertension,diabetes,smoking history,history of heart failure,and previous myocardial infarction(P<0.05).Multivariate logistic regression identified heart failure history,previous myocardial infarction,age,hypertension,and diabetes as independent risk factors,with odds ratios of 1.195,1.528,1.062,1.836,and 1.942,respectively(all P<0.05).CONCLUSION Implementing enhanced recovery nursing for ICU patients after gastrointestinal surgery is beneficial in reducing the incidence of CV complications and improving nursing satisfaction.
文摘Transferring patients with critical illnesses from general wards to intensive care units (ICUs) is a crucial and time-sensitive process. This article presents strategies for improving the efficiency of patient transfers, particularly in hospitals where intensive care units are located in buildings separate from general wards. Patient transfers comprise several steps: physicians issue orders, relatives are notified, equipment is prepared, and medical staff coordinate. We identified three factors that influence transfer time: preparation time for bed transfer, time required for shift handovers, and time required for between-ward patient movement. Unfamiliarity with transfer routes and long elevator wait times were factors that also influenced transfer time. The following strategies were proposed: develop a standardized material checklist, design key notes for patient transfers, and optimize transfer routes. These strategies reduced transfer times by 40% to 43%. This study demonstrates that by addressing logistical challenges and streamlining relevant procedures, hospitals can enhance safety and quality of care during patient transfers.
基金Supported by the Key Project Plan of Health and Medical Science Research in Hebei Provincial Health Commission,No.20190745.
文摘BACKGROUND Plasma concentration monitoring is crucial for optimizing vancomycin use,particularly in patients in the intensive care unit(ICU).However,the reference interval for vancomycin plasma concentration remains undetermined.AIM To evaluate the correlations of area under the curve(AUC_(0-24))and trough concentration(C_(min))with efficacy and nephrotoxicity in patients in the ICU.METHODS A total of 103 patients treated with vancomycin for methicillin-resistant Staphylococcus aureus infections were analyzed in this study.The associations of clinicodemographic characteristics(including sex,age,weight,infection sites,main etiologies of ICU cases,comorbidities,acute physiological chronic health evaluation II score,and mechanical ventilation)and pharmacokinetics(daily dose,C_(min),AUC_(0-24),and AUC_(0-24)/minimum inhibitory concentration)with efficacy and nephrotoxicity of vancomycin were evaluated with univariate and multivariate logistic regression analyses.AUC_(0-24)was calculated using VCM-TDM software based on vancomycin population pharmacokinetics and Bayesian feedback method.RESULTS Cmin over 9.4μg/mL and AUC_(0-24)exceeding 359.6μg×hour/mL indicated good efficacy against infection.Cmin below 14.0μg/mL predicted no significant nephrotoxicity.CONCLUSION In this study,the effective and safe concentration interval for vancomycin in patients in the ICU was Cmin 9.4-14.0μg/mL.Close attention should be paid to adverse effects and renal function during vancomycin treatment.
文摘Objective:To determine the incidence,risk factors,antibiotic resistance patterns,and outcomes of various nosocomial infections in Intensive Care Unit(ICU)patients.Methods:The present prospective observational study was conducted in the multidisciplinary ICU of a tertiary care hospital for 6 months.Incidence,risk factors,and outcome parameters were calculated using Mann Whitney U test,Chi-square test,and stepwise univariate and multivariate logistic regression analysis.Results:The overall incidence of nosocomial infections was 23.5%(74/314).Ventilator-associated pneumonia was the most common infection(54.1%,52/96),followed by catheter-related bloodstream infections(22.9%,22/96).Stress ulcer prophylaxis(aOR 7.691,95%CI 2.202-26.860,P=0.001),endotracheal intubation(aOR 3.251,95%CI 1.251-8.420,P=0.015),Foley’s catheter(aOR 11.917,95%CI 1.335-106.410,P=0.027),and ICU stay>7 days(aOR 30.915,95%CI 10.062-94.980,P=0.001)were statistically significant risk factors associated with nosocomial infection in ICU patients.Gram-negative bacteria showed a high degree of resistance to most of antibiotics except colistin and tigecycline.Infected group's mortality was significantly greater than the uninfected group(21.62%vs.5.83%P<0.001)and had considerably longer ICU length of stay[21(12)vs.7(4)days,P<0.001]and duration of mechanical ventilation[20(11)days vs.0(5)days,P<0.001].Conclusions:This study highlights the high incidence rate of ventilator-associated pneumonia,with extensive drug resistance in ICU patients,highlighting the need for an optimized antimicrobial stewardship program to develop effective strategies for the management of nosocomial infections.Multifaceted interventions targeting modifiable risk factors are essential to reduce the occurences of these nosocomial infections in ICU patients.
