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The purpose of this review is to provide a practical guide for the clinical care of patients with acute pancreatitis (AP) from the management of the early phases of disease to the treatment of local complications. AP is one of the most frequent causes of gastroenterological admission in emergency departments. It is characterized by a dynamic and unpredictable course and in its most severe forms, is associated with organ dysfunction and/or local complications, requiring intensive care with significant morbidity and mortality. Initial therapy includes adequate fluid resuscitation, nutrition, analgesia, and when necessary critical care support. In recent years, the development of minimally invasive tailored treatments for local complications, such as endoscopic drainage, has improved patients' acceptance and outcomes. Despite this, the management of AP remains a challenge for clinicians. The present review was conducted by the authors, who formulated specific questions addressing the most critical and current aspects of the clinical course of AP with the aim of providing key messages. [ABSTRACT FROM AUTHOR]

• Children report experiences synchronous with near death experiences in post intensive care. • Children report other extra sensory experiences such as bedside visions. • Children's NDE's carry features of transcendental experiences. • Younger children use a visual NDE semiosis that warrants further investigation. Near death experiences (NDEs) can occur during life-threatening events. In this article, we present preliminary findings from a case study series. We highlight experiences of children that are synchronous with the basic elements of near death experiences (NDEs) and discuss how children describe their own experiences. Children reported unsolicited NDE type experiences that included out of body experiences, bright lights, bedside visions, bi-location and visiting celestial places. The aim of the article is to show that children are an important research population for the study of near-death experiences. Children's near-death experiences are simple and carry transcendental features such as a peaceful darkness, a knowing awareness and time alterations. Children assign a subjective reality to their near-death experiences. Younger children may demonstrate a visual NDE semiosis which warrants further investigation. The aim of the article is to demonstrate the value for involving children in NDE research through participatory and creative research methods. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 disease is linked with several maternal and infant complications. Here, we conducted a study to examine the characteristics and outcomes of pregnant women who were admitted to the intensive care unit (ICU) due to COVID-19 complications. Methods: We performed a retrospective cohort study of symptomatic pregnant women with COVID-19 who were hospitalized at Ayatollah Rouhani Hospital, in Babol, northern Iran, from March 2019 to September 2021. We used a checklist to collect data from patient records, including maternal characteristics (age, body mass, gestational age, parity, blood type, residence, education, and comorbidities), disease symptoms, and laboratory criteria at admission and then compared these variables between pregnant women who required intensive care unit (ICU) admission and those who did not. We used SPSS 20 for data analysis and considered P<0.05 as significant. Results: We included 215 symptomatic PCR-positive pregnant women with COVID-19 who were hospitalized. The mean age of the women was 30.63±6.09 years and the mean gestational age was 27.77±9.96 weeks. The mean hospital stay was 5.38±5.20 days, and 21 (9.8%) women were admitted to the ICU for a mean of 6.28 ± 5.84 days. The levels of LDH and D-Dimer were significantly higher in the ICU group than in the non-ICU group (Pvalue< 0.000 and P-value=0.024, respectively). The ICU group also had a higher rate of cesarean section (P-value<0.000). There were no significant differences between the groups in terms of clinical symptoms, demographic characteristics, Moreover, none of the women hospitalized with COVID-19 had renal, hepatic, or cardiac disease. None of the infants tested positive for COVID-19 by PCR. Conclusion: Our findings suggest that pregnant women with COVID-19 are not at increased risk of disease progression or ICU admission. Furthermore, we propose that monitoring the levels of D-Dimer and LDH in pregnant women with COVID-19 could be useful for predicting the severity of the disease and the need for ICU care, which may have implications for maternal and fetal outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Ventilator-associated pneumonia refers to pneumonia that happens at least 48 hours after endotracheal intubation. It is associated with high economic costs, longer attributable lengths of stay in the hospital, and high mortality. Therefore, this study aims to determine the incidence and predictors of ventilator-associated pneumonia among adult intensive care unit admitted patients at Bahir Dar Specialized Hospitals. Methods: A retrospective follow-up study was conducted among 312 adult intensive care unit admitted patients. A data extraction checklist was used to collect the data. The collected data were coded, cleaned, and entered into EpiData version 3.1 and exported to SPSS version 22 and STATA version 14 for analysis. Descriptive analysis was done by using tables, text and percentages. Bivariable and multivariable log binomial analyses were conducted to identify predictors of ventilator-associated pneumonia. Variables having p-value < 0.05 were considered statistically significant. Results: The study found that 27.9% (95% CI: 23%– 33%) of patients developed ventilator-associated pneumonia and the incidence rate of VAP was 45.7 per 1000 ventilator days. Patient's stay more than or equal to 14 days (ARR: 13, 95% CI: 9.3– 31) and 7– 13 days on MV (ARR: 7.2, 95% CI: 6.2– 11), blood transfusion (ARR: 2.8, 95% CI: 1.1– 6.9), low GCS (ARR: 2.5, 95% CI: 1.3– 5.1), use of corticosteroid (ARR: 2.1, 95% CI: 1.1– 4.1), and supine head position (ARR: 8.1, 95% CI: 1.7– 40) were identified as independent predictors of ventilator associated pneumonia. Conclusion: Nearly one-fourth of the participants developed ventilator-associated pneumonia. Duration of ventilation, blood transfusion, corticosteroid use, supine head position, and low Glasgow coma scale were significant predictors of ventilator-associated pneumonia. [ABSTRACT FROM AUTHOR]

Introduction: Vitamin D deficiency (VDD) is prevalent worldwide and may influence the severity of infectious diseases, including COVID-19. This study aimed to evaluate the association between VDD and 30-day clinical outcomes in patients with COVID-19., Methods: We conducted a retrospective cohort study using data from the TriNetX database, which includes de-identified electronic health records of approximately 155 million patients from 131 healthcare organizations globally. Adult patients (aged ≥18 years) with their first documented COVID-19 infection between January 2022 and September 2024 were included. Patients were categorized based on their vitamin D status within three months prior to COVID-19 diagnosis: those with documented VDD (VDD group) and those without (controls). Outcomes assessed were all-cause mortality, all-cause hospitalization, the requirement for critical care services, and a composite outcome of these events at 30-day follow-up. Propensity score matching (PSM) was utilized to balance covariates such as age, sex, race, and comorbidities between the groups. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox regression analysis., Results: After PSM, the study included 68,814 patients, with 34,407 in both the VDD and control groups. VDD was associated with a slight but statistically significant increase in the hazard of experiencing the composite outcome (HR 1.05, 95% CI 1.01-1.10, P = 0.02). There was no significant difference in all-cause mortality (HR 1.06, 95% CI 0.92-1.22, P = 0.42) or all-cause hospitalization (HR 1.01, 95% CI 0.96-1.05, P = 0.80) between the groups. However, patients with VDD had a significantly higher hazard of requiring critical care services compared to controls (HR 1.28, 95% CI 1.16-1.41, P < 0.01)., Conclusion: Vitamin D deficiency is associated with an increased risk of requiring critical care services among COVID-19 patients, suggesting that VDD may contribute to greater disease severity. These findings underscore the potential importance of assessing and managing vitamin D deficiency in patients with COVID-19 to improve clinical outcomes., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Review Board of the Chi Mei Medical Center issued approval 11302-E01. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Chan et al.)

Background: The role of bacterial co-infection and superinfection among critically ill COVID-19 patients remains unclear. The aim of this study was to assess the rates and characteristics of pulmonary infections, and associated outcomes of ventilated patients in our facility. Methods: This was a retrospective study of ventilated COVID-19 patients between March 2020 and March 2021 that underwent BioFire®, FilmArray® Pneumonia Panel, testing. Community-acquired pneumonia (CAP) was defined when identified during the first 72 h of hospitalization, and ventilator-associated pneumonia (VAP) when later. Results: 148 FilmArray tests were obtained from 93 patients. With FilmArray, 17% of patients had CAP (16/93) and 68% had VAP (64/93). Patients with VAP were older than those with CAP or those with no infection (68.5 vs. 57–59 years), had longer length of stay and higher mortality (51% vs. 10%). The most commonly identified FilmArray target organisms were H. influenzae, S. pneumoniae, M. catarrhalis and E. cloacae for CAP and P. aeruginosa and S. aureus for VAP. FilmArray tests had high negative predictive values (99.6%) and lower positive predictive values (~60%). Conclusions: We found high rates of both CAP and VAP among the critically ill, caused by the typical and expected organisms for both conditions. VAP diagnosis was associated with poor patient outcomes. [ABSTRACT FROM AUTHOR]

Abstract Background An efficient surface cleaning strategy would first target cleaning to surfaces that make large contributions to the risk of infections. Methods In this study, we used data from the literature about methicillin-resistant Staphylococcus aureus (MRSA) and developed an ordinary differential equations based mathematical model to quantify the impact of contact heterogeneity on MRSA transmission in a hypothetical 6-bed intensive care unit (ICU). The susceptible patients are divided into two types, these who are cared by the same nurse as the MRSA infected patient (Type 1) and these who are not (Type 2). Results The results showed that the mean MRSA concentration on three kinds of susceptible patient nearby surfaces was significantly linearly associated with the hand-touch frequency (p

Background Maintaining patent airway with tracheal intubation is frequently indicated at ICUs. Many tools can help to assure that the endotracheal tube (ETT) is properly placed, but each one of these tools has its limitations and cannot be applied in every patient. Aim of this study The aim of the study was to assess the role of tracheal ultrasonography in confirming ETT placement in ICU patients. Patients and methods This study included 200 patients (120 men and 80 women with a mean age of 49.1±12.4) with an indication of intubation at the respiratory ICU at Zagazig University Hospitals from January 2016 to March 2018. Ultrasonography of the trachea and capnography were done in addition to clinical assessment to confirm correct placement of ETT with taking capnography as the gold standard method for detecting the place of ETT. Sensitivity and specificity of ultrasonography against capnography in confirming proper endotracheal intubation were calculated. Results Of the 200 patients studied, 177 patients had confirmed ETT in the trachea by both capnography and tracheal ultrasonography; seven patients had confirmed ETT in the trachea by capnography only, and 16 patients had ETT outside the trachea by both capnography and tracheal ultrasonography. The sensitivity and specificity tracheal ultrasound were 96.2 and 100%, respectively. The time (s) needed to confirm the ETT position by clinical assessment, tracheal ultrasonography, and capnography was 19.21, 15.13, and 12.89, respectively, with highly significant statistical difference between them (P

Background: The incidence of diastolic heart failure has increased over time. The evaluation of left-ventricular diastolic function is complex, ongoing, and remains poorly performed in pediatric intensive-care patients. This study aimed to review the literature and to provide an update on the evaluation of left-ventricular diastolic function in adults and children in intensive care. Data sources: We searched data from PubMed/Medline. Thirty-two studies were included. Four pragmatic questions were identified: (1) What is the physiopathology of diastolic dysfunction? (2) Which tools are required to evaluate diastolic function? (3) What are the echocardiographic criteria needed to evaluate diastolic function? (4) When should diastolic function be evaluated in pediatric intensive care? Results: Early diastole allows characterization of relaxation, whereas compliance assessments and filling pressures are evaluated during late diastole. The evolution of diastolic function differs between adults and children. Unlike in adults, decreased compliance occurs at the same time as delayed relaxation in children. Diastolic function can be evaluated by Doppler echocardiography. The echocardiographic criteria for ventricular relaxation include the E wave, E/A wave ratio, and isovolumic relaxation time. Ventricular compliance can be assessed by the E/e' wave ratio, atrial volume, and Ap wave duration during pulmonary vein flow. In adult intensive-care patients, the E/e' ratio can be used as an index of tolerance for volume expansion in septic patients and to adjust the inotropic support. Conclusion: Clinical studies would allow some of these parameters to be validated for use in children in intensive care. [ABSTRACT FROM AUTHOR]

Purpose: The coronavirus disease 2019 (COVID-19) outbreak has become a global public health concern; however, relatively few detailed reports of related cardiac injury are available. The aims of this study were to compare the clinical and echocardiographic characteristics of inpatients in the intensive-care unit (ICU) and non-ICU patients. Methods: We recruited 416 patients diagnosed with COVID-19 and divided them into two groups: ICU (n = 35) and non-ICU (n = 381). Medical histories, laboratory findings, and echocardiography data were compared. Results: The levels of myocardial injury markers in ICU vs non-ICU patients were as follows: troponin I (0.029 ng/mL [0.007–0.063] vs 0.006 ng/mL [0.006–0.006]) and myoglobin (65.45 μg/L [39.77–130.57] vs 37.00 μg/L [26.40–53.54]). Echocardiographic findings included ventricular wall thickening (12 [39%] vs 1 [4%]), pulmonary hypertension (9 [29%] vs 0 [0%]), and reduced left-ventricular ejection fraction (5 [16%] vs 0 [0%]). Overall, 10% of the ICU patients presented with right heart enlargement, thickened right-ventricular wall, decreased right heart function, and pericardial effusion. Cardiac complications were more common in ICU patients, including acute cardiac injury (21 [60%] vs 13 [3%]) (including 2 cases of fulminant myocarditis), atrial or ventricular tachyarrhythmia (3 [9%] vs 3 [1%]), and acute heart failure (5 [14%] vs 0 [0%]). Conclusion: Myocardial injury marker elevation, ventricular wall thickening, pulmonary artery hypertension, and cardiac complications including acute myocardial injury, arrhythmia, and acute heart failure are more common in ICU patients with COVID-19. Cardiac injury in COVID-19 patients may be related more to the systemic response after infection rather than direct damage by coronavirus. [ABSTRACT FROM AUTHOR]

Objectives: Data on the impact of refugees on Intensive Care Units (ICUs) are lacking in the literature, in particular for community-acquired (CA) infectious diseases, for which they are known to be at higher risk. We did a descriptive, multicenter study to analyze CA infections among refugee patients requiring ICU admission. Methods: Inclusion criteria were adult refugee patients admitted to an ICU due to CA infections. Anonymized data were collected between January 1, 2010 and December 30, 2015 across 10 referral centers. Results: 29.885 patients were admitted to the ICUs in the study period. 37 patients were included the study, the majority were from Syria (n = 31, 83.8%). Mean (SD) age of the patients was 45.92 ± 20.16 years. The 5-year prevalence rate was 123.8 per 100.000 patients in the ICUs. All patients had at least one comorbid condition. Forty-nine CA infections were diagnosed. The most common CA infection was pneumonia (49%) followed by urinary-tract infections (16.3%). 21 patients (56.7%) hospitalized in the ICU had trauma history. Mortality rate was high at 22 patients (59.5%) with 5 (22.7%) deaths directly attributed to CA infections. Conclusions: Refugees presented to ICUs with CA infections similar to the host populations (pneumonia and urinary-tract infections) but had high mortality rates (59.5%). It seems that Turkish ICUs were not congested with the refugee patients’ influx for CA infections. More research needs to be done to better understand how to deliver preventative and timely health care services to this group of patients.

Near death experiences (NDEs) can occur during life-threatening events. In this article, we present preliminary findings from a case study series. We highlight experiences of children that are synchronous with the basic elements of near death experiences (NDEs) and discuss how children describe their own experiences. Children reported unsolicited NDE type experiences that included out of body experiences, bright lights, bedside visions, bi-location and visiting celestial places. The aim of the article is to show that children are an important research population for the study of near-death experiences. Children's near-death experiences are simple and carry transcendental features such as a peaceful darkness, a knowing awareness and time alterations. Children assign a subjective reality to their near-death experiences. Younger children may demonstrate a visual NDE semiosis which warrants further investigation. The aim of the article is to demonstrate the value for involving children in NDE research through participatory and creative research methods., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: An efficient surface cleaning strategy would first target cleaning to surfaces that make large contributions to the risk of infections.Methods: In this study, we used data from the literature about methicillin-resistant Staphylococcus aureus (MRSA) and developed an ordinary differential equations based mathematical model to quantify the impact of contact heterogeneity on MRSA transmission in a hypothetical 6-bed intensive care unit (ICU). The susceptible patients are divided into two types, these who are cared by the same nurse as the MRSA infected patient (Type 1) and these who are not (Type 2).Results: The results showed that the mean MRSA concentration on three kinds of susceptible patient nearby surfaces was significantly linearly associated with the hand-touch frequency (p < 0.05). The noncompliance of daily cleaning on patient nearby high-touch surfaces (HTSs) had the most impact on MRSA transmission. If the HTSs were not cleaned, the MRSA exposure to Type 1 and 2 susceptible patients would increase 118.4% (standard deviation (SD): 33.0%) and 115.4% (SD: 30.5%) respectively. The communal surfaces (CSs) had the least impact, if CSs were not cleaned, the MRSA exposure to Type 1 susceptible patient would only increase 1.7% (SD: 1.3). The impact of clinical equipment (CE) differed largely for two types of susceptible patients. If the CE was not cleaned, the exposure to Type 1 patients would only increase 8.4% (SD: 3.0%), while for Type 2 patients, it can increase 70.4% (SD: 25.4%).Conclusions: This study provided a framework to study the pathogen concentration dynamics on environmental surfaces and quantitatively showed the importance of cleaning patient nearby HTSs on controlling the nosocomial infection transmission via contact route. [ABSTRACT FROM AUTHOR]

Purpose: To measure noise levels in the Saud Albabtain Cardiac Center cardiac surgical intensive-care unit (CSICU) at different locations to find out the prevalence of noise-induced hearing loss among female nurses. Methods: Ambient CSICU noise was measured using a sound-level meter and personal noise dosimeter during morning and night shifts (12 hours each) for 30 days. An audiometry test and questionnaire were used to test nursing responses to noise levels. Results: Mean 12-hour average noise levels at the station during night shift were 60.3±7.1 dB(A) and inside rooms 62.48±8.02 dB(A). However, during morning shift 64.1±8.4 dB(A) in the rooms was recorded, while 68.8±8.2 dB(A) was recorded at the station, with a significant difference between the shifts (p<0.0001). ICU monitors recorded the highest noise-source levels of 82.7±5.3 dB(A). The lowest significant source was the suction machines, with an average of 67.1±12.5 dB(A). A significant correlation between decibel loss and nurse experience was observed. Conclusion: Noise levels in the CSICU at Saud Albabtain Cardiac Center were higher than World Health Organization standards. CSICU nurses are exposed to noise levels that can affect their hearing capacity. Further research isneeded for effective medical device–alarm management. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the incidence and risk factors of contrast induced nephropathy (CIN) after contrast enhanced (CE) computed tomography (CT) in patients with renal dysfunction.Materials and Methods: Two hundred sixteen inpatients with estimated glomerular filtration rates (eGFR) <60 ml/min/1.73 m2 underwent CE CT using iodine doses of 420 or 480 mg I/kg. Data of all enrolled patients was collected for baseline serum creatinine level (SCr), post-CE CT SCr within 3 days after CE CT, and conditions considered risk factors for CIN [renal dysfunction, contrast media dose, advanced age, diabetes mellitus, no intravenous hydration, cardiac dysfunction (left ventricular ejection fraction <60%) and intensive-care unit (ICU) admission]. CIN was defined as an increase in SCr level of more than 0.5 mg/dl or more than 25% from baseline within 3 days post-CE CT without any other identifiable cause of acute kidney injury.Results: The incidence of CIN was 11/216 (5.1%) and was associated with cardiac dysfunction [odds ratio (OR) 6.540; 95% confidence interval (CI) 1.090-39.300; p = 0.040] and ICU admission (OR 11.500; 95% CI 2.050-64.100; p = 0.005).Conclusion: Our results suggested that cardiac dysfunction and ICU admission may be risk factors for CIN in patients with preexisting renal dysfunction. [ABSTRACT FROM AUTHOR]

Postpartum hypertension can significantly increase maternal morbidity and mortality, and hence it requires prompt interdisciplinary evaluation and interventions. We present a case of a gravid patient with significant comorbidities who required multiple treatments and care from several specialists following a complicated vaginal delivery. The outcome of this case depended on a focused differential diagnosis and interdisciplinary consultation with the several teams involved. This case report illustrates the importance of effective communication and an interdisciplinary approach in the management of postpartum hypertensive emergencies. Such an approach is crucial in reducing maternal complications following postpartum hypertension, as well as reducing the length of hospital stay to improve maternal and fetal outcomes., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Upadhyay et al.)

Objectives: Human studies on the role of mannose-binding lectin (MBL) in patients with invasive candidiasis have yielded conflicting results. We investigated the influence of MBL and other lectin pathway proteins on Candida colonization and intra-abdominal candidiasis (IAC) in a cohort of high-risk patients.Methods: Prospective observational cohort study of 89 high-risk intensive-care unit (ICU) patients. Levels of lectin pathway proteins at study entry and six MBL2 single-nucleotide polymorphisms were analyzed by sandwich-type immunoassays and genotyping, respectively, and correlated with development of heavy Candida colonization (corrected colonization index (CCI) ≥0.4) and occurrence of IAC during a 4-week period.Results: Within 4 weeks after inclusion a CCI ≥0.4 and IAC was observed in 47% and 38% of patients respectively. Neither serum levels of MBL, ficolin-1, -2, -3, MASP-2 or collectin liver 1 nor MBL2 genotypes were associated with a CCI ≥0.4. Similarly, none of the analyzed proteins was found to be associated with IAC with the exception of lower MBL levels (HR 0.74, p = 0.02) at study entry. However, there was no association of MBL deficiency (<0.5 μg/ml), MBL2 haplo- or genotypes with IAC.Conclusion: Lectin pathway protein levels and MBL2 genotype investigated in this study were not associated with heavy Candida colonization or IAC in a cohort of high-risk ICU patients. [ABSTRACT FROM AUTHOR]

Introduction Klebsiella pneumonia is one of the most prevalent bacteria that cause nosocomial infections, particularly in critically ill patients in the intensive care unit (ICU). Multi-drug-resistant Klebsiella pneumoniae (MDRKP) has become an urgent risk to public health as its prevalence has sharply surged around the globe in recent decades. Therefore, this research was conducted to evaluate shifts over a four-year period in drug susceptibility patterns among Klebsiella pneumoniae isolates from mechanically ventilated intensive care unit patients. Materials and methods This is a retrospective observational study conducted in a tertiary care multi-specialty hospital and teaching institute in North India and was approved by the institutional ethics committee. The research comprised Klebsiella pneumoniae isolates from endotracheal aspirates (ETA) of patients on mechanical ventilation admitted to the general intensive care unit (ICU) of our tertiary care facility. The data from January to June 2018 and January to June 2022 were collected. According to the antimicrobial resistance profile of the strains, they were categorized as susceptible, resistant to one or two antimicrobial categories, multidrug-resistant (MDR), extensively drug-resistant (XDR), or pan-drug-resistant (PDR). The criteria for MDR, XDR, and PDR were proposed by the European Centre for Disease Prevention and Control (ECDC). IBM Statistical Package for the Social Sciences (SPSS) for Windows, Version 24.0, Armonk, NY, IBM Corp., was used for data input and analysis. Results A total of 82 cases of Klebsiella pneumonia were included in the study. Of these 82 isolates, 40 were isolated over a period of six months from January to June 2018, and the remaining 42 were isolated from January to June 2022. Among the 2018 group, five strains (12.5%) were classified as susceptible, three (7.5%) as resistant, seven (17.5%) as MDR, and 25 (62.5%) as XDR. The highest percentages of antimicrobial resistance in the 2018 group were observed with amoxicillin/clavulanic acid (90%), ciprofloxacin (100%), piperacillin/tazobactam (92.5%), and cefoperazone/sulbactam (95%). In comparison, the 2022 group showed no strain as susceptible; nine strains (21.4%) were classified as resistant; three strains (7%) as MDR; and 30 strains (93%) were classified as XDR. There was a significant increase in resistance to amoxicillin, from 10% in 2018 to nil in 2022. Overall, the rate of resistant Klebsiella pneumonia (K. pneumonia) increased from 7.5% (3/40) in 2018 to 21.4% (9/42) in 2022, while XDR Klebsiella pneumonia among the mechanically ventilated ICU patients significantly increased from 62.5% (25/40) in 2018 to 71% (30/42) in 2022. Conclusion  K. pneumoniae antibiotic resistance is a real threat in Asia and requires close monitoring to be controlled. More careful attempts should be made to create a new generation of antimicrobials since the prevalence of resistance to existing medications is rising. Antibiotic resistance should be monitored and reported by healthcare institutions regularly., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Sharma et al.)

Objectives/hypothesis: There is limited data linking demographic determinants to clinical outcomes in facial trauma, particularly when comparing regional to national datasets; these are the aims of the present study.Study Design: Retrospective chart review.Methods: A 10-year, retrospective single-institutional chart review was undertaken at Children's Hospital Colorado (CHC) to characterize a pediatric population with facial fractures. A comparative analysis between the CHC and National Trauma Data Bank (NTDB) datasets was also conducted.Results: In the CHC dataset, increased hospital stay was positively predicted by bilateral mandible fracture, skull, intracranial, spine, thoracic, abdominal, and limb injuries. Predictors of increased intensive-care unit (ICU) stay included skull, spine, and limb injuries. The CHC cohort had younger subjects, more females, fewer African Americans, and more Hispanics than the NTDB dataset. They were more likely to be injured by nonviolent activities than by altercations. Divergent facial and associated injuries between the datasets were found. Multivariate models showed longer length of hospital stay for the CHC group (P = .0085), but the NTDB group had higher ICU admission (P = .04) and longer lengths of ICU stay (P = .007).Conclusion: The demographic disparities (age, ethnicity, mechanism of injury, and injury type) resulted in divergent injury patterns and likely influenced clinical outcomes.Level Of Evidence: 4. [ABSTRACT FROM AUTHOR]

Clin Microbiol Infect 2013; 19: 242-248 Abstract The impact of bloodstream infection (BSI) on admission to hospital on the outcome of patients with community-acquired sepsis (CAS) admitted to intensive-care units (ICU) is largely unknown. We selected 803 adult patients consecutively admitted with CAS to one of 17 Portuguese ICU, in whom blood cultures were collected before initiation of antibiotic therapy during a 12-month period. A BSI was identified on hospital admission in 160 (19.9%) patients. Those with and without BSI had similar mean Simplified Acute Physiology Score (SAPS) II and age. The presence of BSI was independently associated with mortality in ICU (adjusted odds ratio 1.86; 95% confidence interval 1.20-2.89; p 0.005). On the 4th day in ICU, patients with BSI were found to be significantly more dependent on vasopressor support (p 0.002) but not on ventilatory support. Cumulative ICU mortality was significantly higher in BSI patients from the 9th day onwards. A seasonal variation of BSI isolates was noted: gram-negative BSI were more common in the summer, whereas in the winter, gram-positive infections were more frequent (p 0.024), without mortality differences. [ABSTRACT FROM AUTHOR]

We aimed to establish that a bronchoscopic view can be as reliable as microbiology, and support an empirical tracheobronchial fungal infection ( TBFI) treatment decision. We retrospectively studied 95 respiratory failure patients with suspected TBFI admitted to the intensive-care unit ( ICU) in 2008 with sticky secretions, hyperaemic mucosa, and whitish plaques on bronchoscopic view. Patients not suspected of having TBFI were chosen as a control group ( n = 151). Broncheoalveolar lavage ( BAL) fluid was cultured, and biopsy samples were taken from the lesions. Biopsy samples positive for fungi were defined as 'proven', only BAL-positive (+ fungi) cases were 'probable TBFI', and BAL-negative (- fungi) cases were 'possible TBFI'. BAL (+ fungi) and BAL (- fungi) in the control group were defined as 'colonization' and 'no TBFI', respectively. The sensitivity, specificity and positive and negative predictive values of BAL (+ fungi) were 85.1% (63/74), 81.4% (140/172), 66.3% (63/95), and 92.7% (140/151), respectively. Biopsies were performed in 78 of 95 patients, and 28 were proven TBFI with fungal elements, and 100% were BAL (+ fungi). Probable TBFI was seen in 30 of 95 patients with BAL (+ fungi), and possible TBFI ( BAL(- fungi)) in 25 of 95. Among the 95 patients, microbiology revealed fungi (90.5% Candida species; 9.5% Aspergillus) in 63 (66.3%). In the controls, the colonization and no TBFI rates were 11 of 151 and 140 of 151, respectively. Observing sticky secretions, hyperaemic mucosa and whitish plaques by bronchoscopy is faster than and may be as reliable as microbiology for diagnosing TBFI. These findings are relevant for empirical antifungal therapy in suspected TBFI patients in the ICU. [ABSTRACT FROM AUTHOR]

There are significant variations in critical care practices, costs, and reimbursements in various countries. Of note, there is a paucity of reliable information on remuneration and reimbursement models for intensivists in India. This review article aims to analyze the existing reimbursement models in United States and United Kingdom and propose a frame-work model that may be applicable in India. [ABSTRACT FROM AUTHOR]

Information on the species causing Candida peritonitis, their in vitro susceptibility, antifungal strategies in this setting and patient outcome is still scarce. AmarCand was a prospective, non-interventional study in 271 adult intensive-care unit (ICU) patients with proven invasive Candida infection who received systemic antifungal therapy (France, 2005-2006). Of these ICU patients, 93 (median age 65 years, simplified acute physiology score II 52) had Candida peritonitis, including 73 nosocomial peritonitis, 53 concomitant bacterial peritoneal infections and 26 candidaemias. Candida species were C. albicans (n = 63/108 isolates, 58%), C. glabrata (n = 22, 20%), C. krusei (n = 9), C. kefyr (n = 5), C. parapsilosis (n = 3), C. tropicalis (n = 3), C. ciferii (n = 2) and C. lusitaniae (n = 1). Of tested isolates, 28% were fluconazole- resistant or susceptible dose-dependent (C. albicans 3/32, C. glabrata 9/14, C. krusei 4/4). Empiric antifungal treatment was started 1 day (median) after peritonitis diagnosis, with fluconazole (n = 72 patients), caspofungin (n = 12), voriconazole (n = 3), amphotericin B (n = 2), or a combination (n = 4). Following susceptibility testing, empiric antifungal treatment was judged inadequate in 9/45 (20%) patients and modified in 30 patients (fluconazole was replaced by caspofungin (n = 14) or voriconazole (n = 4)). Mortality in ICU was 38% (35/93) and was not influenced by type of Candida species, fluconazole susceptibility, time to treatment, candidaemia, nosocomial acquisition, or concomitant bacterial infection. No specific factors for death were identified. In summary, a high proportion of fluconazole-resistant or susceptible dose-dependent strains was cultured. These results confirm the high mortality rates of Candida peritonitis and plead for additional investigation in this population. Antifungal treatment for severe cases of Candida peritonitis in ICU patients remains the standard care. [ABSTRACT FROM AUTHOR]

The risk factors for complications in patients with influenza A (H1N1)v virus infection have not been fully elucidated. We performed an observational analysis of a prospective cohort of hospitalized adults with confirmed pandemic influenza A (H1N1)v virus infection at 13 hospitals in Spain, between June 12 and November 10, 2009, to identify factors associated with severe disease. Severe disease was defined as the composite outcome of intensive-care unit (ICU) admission or in-hospital mortality. During the study period, 585 adult patients (median age 40 years) required hospitalization because of pandemic (H1N1) 2009. At least one comorbid condition was present in 318 (54.4%) patients. Pneumonia was diagnosed in 234 (43.2%) patients and bacterial co-infection in 45 (7.6%). Severe disease occurred in 75 (12.8%) patients, of whom 71 required ICU admission and 13 (2.2%) died. Independent factors for severe disease were age <50 years (OR, 2.39; 95% CI, 1.05-5.47), chronic comorbid conditions (OR, 2.93; 95% CI, 1.41-6.09), morbid obesity (OR, 6.7; 95% CI, 2.25-20.19), concomitant and secondary bacterial co-infection (OR, 2.78; 95% CI, 1.11-7) and early oseltamivir therapy (OR, 0.32; 95% CI 0.16-0.63). In conclusion, although adults hospitalized for pandemic (H1N1) 2009 suffer from significant morbidity, mortality is lower than that reported in the earliest studies. Younger age, chronic comorbid conditions, morbid obesity and bacterial co-infection are independent risk factors for severe disease, whereas early oseltamivir therapy is a protective factor. [ABSTRACT FROM AUTHOR]

A matched case–control study was conducted to determine the risk factors for development of candidaemia in patients requiring intensive-care unit (ICU) treatment for more than 48 h. Patients were matched according to length of ICU stay, age, department of admission, year of admission and sex. Forty-five patients with candidaemia were identified (0.6 cases/1000 patient-days). Candidaemia developed mainly in critically ill patients with multiple organ failure and end-stage disease. Candida colonization and gastrointestinal surgery were independently associated with candidaemia. ICU and total in-hospital mortality were 40% and 66.7%, respectively. Candidaemia-related mortality was 20%. Candidaemia treatment failure was the only variable associated with in-hospital mortality (p 0.008). [ABSTRACT FROM AUTHOR]

Severe community-acquired pneumonia (CAP) is the most common infectious cause of admission to the intensive care unit and is associated with significant adverse outcomes. Antimicrobial therapy is a major aspect in the management of patients with severe CAP. This review focuses on antimicrobial therapies for severe CAP, including selection of empiric antibiotic therapy, the use of specific agents in mono or combination therapy and the duration of therapy. Early appropriate antimicrobial therapy with revision following culture confirmation, is a mainstay of therapy. There is limited evidence to guide the use of specific drugs, multidrug effective regimens and the duration of therapy, and an individualized approach is needed. [ABSTRACT FROM AUTHOR]

Background: Administering oxygen therapy plays an essential role in preventing and managing acute and chronic hypoxemia. This study assesses the level of practice of nurses on oxygen therapy in critically ill patients and associated factors., Methods: An institutional-based cross-sectional study was conducted from May 23 to June 07, 2021, at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. A self-administered structured and validated questionnaire was used. It has a socio-demographic characteristics, multiple choice questions, items that measure the possible associated factors and items were used to assess level of knowledge. Data were entered using Epi-data version 4.6 and analyzed using SPSS version 20. Descriptive and inferential statistics were analyzed and presented. The Chi-Square test was used to measure the strength of associations between variables. Binary and multiple logistic regression were used, a p-value of< 0.2 and < 0.05 were considered statistically significant, respectively., Results: A total of 400 nurses participated in the study, with a response rate of 94.8%. The overall proportion of good practice on oxygen therapy for critically ill patients was 47% (95% CI: 43-51.8). Age >39 years (AOR; 3.17, 95% CI: 1.42-7.08), nurses have good knowledge on oxygen therapy (AOR; 1.74, 95% CI: 1.11-2.74), labeling of the volume of the cylinder after use (AOR; 2.51, 95% CI: 1.36-4.63), were significantly associated with good practice on oxygen therapy in critically ill patients., Conclusions and Recommendations: We concluded that there was a gap in the practice of oxygen therapy among nurses. Therefore, regular educational and training programs about oxygen therapy are needed to increase the level of practice among nurses. In addition practical training sessions should be organized for nurses to update their practice on the latest guidelines on oxygen therapy for critical ill patients., Competing Interests: There is no conflicts of interest., (© 2022 The Authors.)

Abstract Background Globally ICUs are encountering emergence and spread of antibiotic-resistant pathogens and for some pathogens there are few therapeutic options available. Methods Antibiotic in vitro susceptibility data of predominant ICU pathogens during 2000–2 were analyzed using data from The Surveillance Network (TSN) Databases in Europe (France, Germany and Italy), Canada, and the United States (US). Results Oxacillin resistance rates among Staphylococcus aureus isolates ranged from 19.7% to 59.4%. Penicillin resistance rates among Streptococcus pneumoniae varied from 2.0% in Germany to as high as 20.2% in the US; however, ceftriaxone resistance rates were comparably lower, ranging from 0% in Germany to 3.4% in Italy. Vancomycin resistance rates among Enterococcus faecalis were ≤ 4.5%; however, among Enterococcus faecium vancomycin resistance rates were more frequent ranging from 0.8% in France to 76.3% in the United States. Putative rates of extended-spectrum β-lactamase (ESBL) production among Enterobacteriaceae were low, Escherichia coli in the five countries studied. Ceftriaxone resistance rates were generally lower than or similar to piperacillin-tazobactam for most of the Enterobacteriaceae species examined. Fluoroquinolone resistance rates were generally higher for E. coli (6.5% – 13.9%), Proteus mirabilis (0–34.7%), and Morganella morganii (1.6–20.7%) than other Enterobacteriaceae spp (1.5–21.3%). P. aeruginosa demonstrated marked variation in β-lactam resistance rates among countries. Imipenem was the most active compound tested against Acinetobacter spp., based on resistance rates. Conclusion There was a wide distribution in resistance patterns among the five countries. Compared with other countries, Italy showed the highest resistance rates to all the organisms with the exception of Enterococcus spp., which were highest in the US. This data highlights the differences in resistance encountered in intensive care units in Europe and North America and the need to determine current local resistance patterns by which to guide empiric antimicrobial therapy for intensive care infections.