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Background: The vasoactive–inotropic score (VIS) predicts unfavorable outcomes after cardiac surgery in both children and adults. In our adult population, we investigated whether preoperative levels of vitamin D can predict the VIS and whether both vitamin D and the VIS can predict adverse outcomes following major heart surgery. Methods: Between 1 October 2021 and 28 February 2022, 300 patients underwent major cardiac surgery at our institution. Eighty-three of them had their 25-OH vitamin D levels measured before surgery. For this cohort, we calculated the VIS based on doses of vasoactive and inotropic medications administered post-surgery. Utilizing receiver operating curves, the predictive accuracy of vitamin D levels and the VIS in predicting acute kidney injury was assessed. Results: The median age of the cohort was 66 (IQR 61–71) years, with 59% being male and a median BMI of 28.4 (IQR 25.2–31.6). The most common procedures were aortic valve replacement, mitral valve replacement, coronary artery bypass grafting, aortic valve and ascending aorta repair, and ASD correction. There was a significant difference in the postoperative VIS between patients with vitamin D deficiency, i.e., 20 ng/mL (3.5 vs. 1.3 p < 0.04). We also found a significant correlation between the VIS and the days of hospitalization (r = 0.335; p = 0.002), the days of stay in the intensive care unit (r = 0.547; p < 0.00001), and the mechanical ventilation time (r = 0.327; p = 0.025). Both vitamin D levels and the VIS predicted postoperative acute kidney injury (p < 0.05). Conclusions: Vitamin D deficiency is correlated with the VIS in adults undergoing major cardiac surgery. Both vitamin D levels and the VIS can predict unfavorable postoperative outcomes.

Background: Linezolid has been found to have considerable interindividual variability, especially in critically ill patients, which can lead to suboptimal plasma concentration. To overcome this shortcoming, several solutions have been proposed. These include using loading dose, higher maintenance doses, and dose stratification according to the patient’s particularities, therapeutic drug monitoring, and drug administration via continuous infusion (CI) instead of intermittent infusion (II). In the present study, we aim to compare the pharmacokinetic (PK) parameters of linezolid after administration as II versus CI to critically ill patients. Methods: In a prospective study conducted in an intensive care unit, we compared the same two daily doses of linezolid administered via II versus CI. The serum concentration was measured, and pharmacokinetic parameters were calculated. The pharmacokinetic/pharmacodynamic (PK/PD) indices for efficacy chosen were area under the concentration–time curve at steady state divided by the minimum inhibitory concentration over 80 (AUC24–48/MIC > 80). Results: Greater serum concentration variability was observed in the II group than in the CI group. The %T > MIC > 80% was achieved for MICs of 1 and 2 µg/mL 100% of the time, whereas for the II group, this was 93% and 73%, respectively. AUC24–48/MIC > 80 was reached in 100% of cases in the CI group compared with 87% in the II group for a MIC of 1 µg/mL. Conclusions: The two infusion methods may be used comparably, but utilizing CI as an alternative to II may have potential benefits, including avoiding periods of suboptimal concentrations, which may enhance safety profiles and clinical outcomes. Considering the relatively few studies performed on linezolid to date, which are increasing in number, the results of the present study may be of interest.

The use of biomarkers in cardiovascular surgery is an evolving field with promising potential; however, current research remains largely limited, requiring further validation for routine clinical application. This review explores the application of biomarkers in cardiovascular surgery, focusing on heart failure, cardiac ischemia, and organ dysfunction, including renal, cerebral, pulmonary, and splanchnic impairments. Additionally, it examines the significance of biomarkers in assessing the inflammatory state and oxidative stress during the perioperative period, particularly in the context of major surgical trauma and cardiopulmonary bypass (CPB). From January 2018 to June 2024, we reviewed 133 studies and four systematic reviews and meta-analyses using the Medline, Embase, and Central databases, screening for pre- or postoperative biomarker levels in patients undergoing cardiac surgery. Outcomes of interest were postoperative mortality, nonfatal myocardial infarction, stroke, congestive heart failure, and major adverse cardiovascular events (MACEs). Studies reporting multivariable-adjusted risk estimates were included. The findings revealed that cardiac troponins (cTns) and creatine kinase isoenzyme MB (CK-MB) remain the most widely utilized biomarkers for assessing myocardial injury post-surgery. These elevated biomarker levels were consistently associated with an increased risk of postoperative complications, including low cardiac output syndrome, prolonged ventilation, and mortality. Emerging biomarkers, such as heart-type fatty acid-binding protein (h-FABP) and high-sensitivity C-reactive protein (hs-CRP), demonstrated promising early detection and risk stratification results. In particular, h-FABP increased rapidly within one hour of myocardial injury, peaking at 4–6 hours and returning to baseline within 24 hours. This rapid clearance makes h-FABP a valuable tool for early myocardial injury detection, potentially allowing for timely interventions. Inflammatory biomarkers, including hs-CRP and pentraxin 3 (PTX3), were found to be associated with poor outcomes, such as increased morbidity and mortality. Elevated preoperative levels of these markers were indicative of a heightened inflammatory response, correlating with worse postoperative recovery and higher rates of complications. Furthermore, the neutrophil-to-lymphocyte ratio (NLR) emerged as a cost-effective and easily accessible predictor of postoperative outcomes. Elevated NLR values were linked to an increased risk of adverse events, including prolonged ventilation, low cardiac output syndrome, and overall mortality. Further, the practicality of measuring NLR through routine blood tests makes it viable for widespread clinical use. In conclusion, integrating biomarkers in cardiovascular surgery significantly advances predicting postoperative outcomes for cardiac surgery patients. Therefore, it is essential to categorize these biomarkers into two distinct groups in the future, inflammatory and non-inflammatory (related to organ damage), to improve understanding and enhance their clinical applicability. Future research should focus on standardizing the use of these biomarkers and exploring their combined predictive power to enhance risk stratification and improve patient prognosis.

This study investigates the association between the Functional Health Pattern Assessment Screening Tool (FHPAST) and frailty in hospitalized geriatric patients. One hundred and forty patients (mean age 78.2 years, age range 65–90) were screened for frailty using the Frail Scale during hospitalization in the geriatric unit. Among them, 57 patients were identified as prefrail (40.7%), and 83 were identified as frail (59.3%). A comparative analysis between groups in terms of the FHPAST components covering health risk, general well-being, and health promotion was performed. Correlations between FHAPST components, socio-demographic data, frailty criteria, as well as logistic regression to identify variables that better predict frailty were also sought. Frailty was mainly associated with difficulty urinating, limitations in performing activities of daily living and walking, physical discomfort, less positive feelings in controlling one’s own life, lower compliance with recommendations from the healthcare provider, and engagement in seeking healthcare services. Patients with difficulty urinating and walking had a probability of 4.38 times (OR = 4.38, CI 95% [1.20–15.94]), p = 0.025) and 65.7 times (OR = 65.7, CI 95% [19.37–223.17], p < 0.001) higher of being frail rather than prefrail. The relationship between frailty and prefrailty in hospitalized geriatric patients and components of nursing Functional Health Patterns (FHP) has yet to be explored. This study provides evidence of the most prevalent needs of frail geriatric patients in hospital settings.

Critically ill patients with rapidly deteriorating clinical status secondary to respiratory and cardio-vascular compromise are at risk for immediate collapse if the underlying pathology is not recognized and treated. Rapid diagnosis is of utmost importance regardless of the setting. Although there are data to support the use of point-of-care ultrasound in critical patients, there is no consensus about the best educational strategy to implement. We designed a curriculum based on the ABC (Airway, Breathing, Circulation) protocol that covers essential airway, lung, and cardiac ultrasound skills needed for fast diagnosis in critical patients and applied it in high-fidelity simulation-based medical education sessions for anesthesia and intensive care residents year one and two. After theoretical and practical assessments, our results show statistical differences in the theoretical knowledge and above-average results in practical assessment. Our proposed curriculum based on a simple ABC POCUS protocol, with an Airway, Breathing, and Circulation approach, is useful in teaching ultrasound basics regarding airway, lung, and cardiac examination using high-fidelity simulation training to anesthesia and intensive care residents, but further research is needed to establish the utility of Simulation-Based Medical Education in Point of Care Ultrasound in the critical patient.

COVID-19 produces cytokine-mediated persistent inflammation and is associated with elevated iron stores and low circulating iron. It is believed that central to the pathophysiological mechanism is interleukin 6 and hepcidin. A state of iron overload, termed hyperferritinemia, and inflammatory anemia take place. Both conditions are linked to a worse result in critically ill patients. Blocking the interleukin 6—hepcidin pathway with Tocilizumab could present favorable outcomes. The aim of this study was to evaluate if Tocilizumab influences survival, the occurrence of sepsis, anemia and transfusions in critically ill patients suffering from COVID-19. This prospective observational study focused on levels of interleukin 6, hepcidin and blood iron parameters in patients treated with Tocilizumab. Data were compared before and after therapy as well as between treated and control groups. Results indicate that there is no difference in terms of survival nor in the rate of anemia or sepsis occurrence. Hepcidin was elevated and anemia ensued after treatment, which could indicate alternative pathways. In conclusion, when the classic interleukin 6—hepcidin pathway is blocked, inflammation seems to use alternative routes. Further understanding of these pathways is required and new pharmacological therapies need to be developed to treat persistent inflammation.

Background and objectives: The prognoses of patients experiencing a prolonged stay in the intensive care unit (ICU) are often significantly altered by hospital-acquired infections (HAIs), the early detection of which might be cumbersome. The aim of this study was to investigate the roles of the neutrophil-to-lymphocyte (NLR), derived-NRL (d-NLR), platelet-to-lymphocyte (PLR), and lymphocyte-to-C-reactive protein (LCR) ratios in predicting the progression to septic shock and death. Materials and Methods: A retrospective analysis of a consecutive series of ninety COVID-19 patients with prolonged hospitalization (exceeding 15 days) admitted to the ICU was conducted. The prevalence of culture-proven HAIs throughout their hospital stays was documented. NLR, dNLR, PLR, and LCR were recorded on admission, day 7, and day 14 to assess their discriminative prowess for detecting further progression to septic shock or death. Results: The prevalence of HAIs was 76.6%, 50% of patients met the criteria for septic shock, and 50% died. The median time to the first positive culture was 13.5 days and 20.5 days for developing septic shock. Mechanical ventilation was a key contributing factor to HAI, septic shock, and mortality. On admission and day 7 NLR, dNLR, PLR, and LCR values had no prognostic relevance for events occurring late during hospitalization. However, day-14 NLR, dNLR, and PLR were independent predictors for progression to septic shock and mortality and have shown good discriminative capabilities. The AUCs for septic shock were 0.762, 0.764, and 0.716, while the values for predicting in-hospital death were 0.782, 0.778, and 0.758, respectively. Conclusions: NLR, dNLR, and PLR are quick, easy-to-use, cheap, effective biomarkers for the detection of a more severe disease course, of the late development of HAIs, and of the risk of death in critically ill patients requiring a prolonged ICU stay.

Inflammation in COVID-19 produces intracellular iron overload with low circulating iron available for metabolic processes. The accumulated intracellular iron generates reactive species of oxygen and results in ferroptosis, a non-programmed cell death. Since no organ is spared, iron dysmetabolism increases the mortality and morbidity. Hepcidin and the mediator interleukin 6 are believed to play a role in the process. Our aim is to evaluate the predictive values of serologic iron and inflammatory parameters in COVID-19 critically ill patients. Hence, 24 patients were included. Hepcidin and interleukin 6, along with routine blood parameters, were determined and outcomes, such as death, multiple organ damage (MOD), anemia, and need for transfusions, were assessed. The results of this pilot study indicate that iron metabolism parameters individually, as well as models consisting of multiple laboratory and clinical variables, may predict the outcomes. Further larger studies are needed to validate the results of this pilot stud. However, this paper identifies a new direction for research.

A judicious antibiotic therapy is one of the challenges in the therapy of critically ill patients with sepsis and septic shock. The pathophysiological changes in these patients significantly alter the antibiotic pharmacokinetics (PK) and pharmacodynamics (PD) with important consequences in reaching the therapeutic targets or the risk of side effects. The use of linezolid, an oxazolidinone antibiotic, in intensive care is such an example. The optimization of its therapeutic effects, administration in intermittent (II) or continuous infusion (CI) is gaining increased interest. In a systematic review of the main databases, we propose a detailed analysis of the main PK/PD determinants, their relationship with the clinical therapeutic response and the occurrence of adverse effects following II or CI of linezolid to different classes of critically ill patients or in Monte Carlo simulations.

Understanding of how the human organism functions has preoccupied researchers in medicine for a very long time. While most of the mechanisms are well understood and detailed thoroughly, medicine has yet much to discover. Iron (Fe), Copper (Cu), and Zinc (Zn) are elements on which organisms, ranging from simple bacteria all the way to complex ones such as mammals, rely on these divalent ions. Compounded by the continuously evolving biotechnologies, these ions are still relevant today. This review article aims at recapping the mechanisms involved in Fe, Cu, and Zn homeostasis. By applying the knowledge and expanding on future research areas, this article aims to shine new light of existing illness. Thanks to the expanding field of nanotechnology, genetic disorders such as hemochromatosis and thalassemia can be managed today. Nanoparticles (NPs) improve delivery of ions and confer targeting capabilities, with the potential for use in treatment and diagnosis. Iron deficiency, cancer, and sepsis are persisting major issues. While targeted delivery using Fe NPs can be used as food fortifiers, chemotherapeutic agents against cancer cells and microbes have been developed using both Fe and Cu NPs. A fast and accurate means of diagnosis is a major impacting factor on outcome of patients, especially when critically ill. Good quality imaging and bed side diagnostic tools are possible using NPs, which may positively impact outcome.

Purpose: To describe the correlation between clinically measured hyomental distance ratio (HMDRclin) and the ultrasound measurement (HMDRecho) in patients with and without morbid obesity and to compare their diagnostic accuracy for difficult airway prediction. Methods: HMDRclin and HMDRecho were recorded the day before surgery in 160 consecutive consenting patients. Laryngoscopy was performed by a skilled anesthesiologist, with grades III and IV Cormack−Lehane being considered difficult views of the glottis. Linear regression was used to assess the correlation between HMDRclin and HDMRecho and receiver operating curve analysis was used to compare the performance of the two for predicting difficult airway. Results: The linear correlation between HMDRclin and HDMRecho in patients without morbid obesity had a Pearson coefficient of 0.494, while for patients with morbid obesity this was 0.14. A slightly higher area under the curve for HMDRecho was oberved: 0.64 (5%CI 0.56−0.71) versus 0.52 (95%CI, 0.44−0.60) (p = 0.34). Conclusion: The association between HMDRclin and HDMRecho is moderate in patients without morbid obesity, but negligible in morbidly obese patients. These might be explained by difficulties in palpating anatomical structures of the airway.

An increased interest regarding the impact of frailty on the prognosis of cardiovascular disease (CVD) has been observed in the last decade. Frailty is a syndrome characterized by a reduced biological reserve that increases the vulnerability of an individual in relation to stressors. Among the patients with CVD, a higher incidence of frailty has been reported in those with heart failure (HF). Regardless of its conceptualizations, frailty is generally associated with negative outcomes in HF and an increased risk of mortality. Psychological factors, such as depression and anxiety, increase the risk of negative outcomes on the cardiac function and mortality. Depression and anxiety are found to be common factors impacting the heart disease and quality of life (QoL) in patients with HF. Depression is considered an independent risk factor of cardiac-related incidents and death, and a strong predictor of rehospitalization. Anxiety seems to be an adequate predictor only in conjunction with depression. The relationship between psychological factors (depression and anxiety) and frailty in HF has hardly been documented. The aim of this paper is to review the reported data from relevant studies regarding the impact of depression and anxiety, and their effects on clinical outcomes and prognosis in frail patients with HF.

The objective of this study was to develop and apply a novel multiplex panel of solid-phase proximity ligation assays (SP-PLA) requiring only 20 μL of samples, as a tool for discovering protein biomarkers for neurological disease and treatment thereof in cerebrospinal fluid (CSF). We applied the SP-PLA to samples from two sets of patients with poorly understood nervous system pathologies amyotrophic lateral sclerosis (ALS) and neuropathic pain, where patients were treated with spinal cord stimulation (SCS). Forty-seven inflammatory and neurotrophic proteins were measured in samples from 20 ALS patients and 15 neuropathic pain patients, and compared to normal concentrations in CSF from control individuals. Nineteen of the 47 proteins were detectable in more than 95% of the 72 controls. None of the 21 proteins detectable in CSF from neuropathic pain patients were significantly altered by SCS. The levels of the three proteins, follistatin, interleukin-1 alpha, and kallikrein-5 were all significantly reduced in the ALS group compared to age-matched controls. These results demonstrate the utility of purpose designed multiplex SP-PLA panels in CSF biomarker research for understanding neuropathological and neurotherapeutic mechanisms. The protein changes found in the CSF of ALS patients may be of diagnostic interest.

The aim of this study was to demonstrate the accuracy of NGAL in detecting acute kidney injury (AKI) after urogenital robotic surgery in general anesthesia. Methods: A prospective longitudinal observational study, which included patients scheduled for elective robotic surgery under general anesthesia. The serum and urine NGAL at induction, 6 hours and 12 hours were determined. Serum creatinine was measured preoperatively and daily 4 days postoperatively. AKI was defined as the absolute growth of serum creatinine by 0.3 mg/dl over baseline within 48 hours postoperatively. Results: 24 patients were enrolled in the study. AKI occurred in 38% of patients. Serum NGAL increased significantly at 6 hours and 12h, compared to baseline, with a higher increase in the group of patents without AKI. There were no significant results for urine NGAL. A link was observed between the values of serum NGAL, with associated significance p