世界危重病急救学杂志(英文版)最新文献

{"title":"Efficacy and safety of exosomes from Wharton's Jelly-derived mesenchymal stem cells in traumatic brain injury.","authors":"Serdar Kabatas, Erdinç Civelek, Eyüp Can Savrunlu, Necati Kaplan, Tunç Akkoc, Nurten Küçükçakır, Mehmet Bozkurt, Erdal Karaöz","doi":"10.5492/wjccm.v14.i4.103782","DOIUrl":"10.5492/wjccm.v14.i4.103782","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury (TBI) is a significant public health issue, leading to long-term neurological impairments. Current treatments offer limited recovery, particularly in restoring lost functions. Mesenchymal stem cell-derived exosomes (MSCdE) have shown potential for promoting neuroprotection and regeneration. This study evaluates the safety and efficacy of MSCdE therapy in TBI patients.</p><p><strong>Aim: </strong>To evaluate the safety and efficacy of MSCdE therapy in TBI patients.</p><p><strong>Methods: </strong>Five patients (mean age 27.00 ± 4.06 years) with TBI from combat injuries were treated with six rounds of MSCdE therapy (3 mL intrathecally and 3 mL intramuscularly per round). The patients were followed for one year. Adverse events were assessed using the Common Terminology Criteria for Adverse Events version 5.0 (CTCAE v5.0), and functional outcomes were evaluated with the functional independence measure (FIM), Modified Ashworth Scale (MAS), and Karnofsky Performance Scale (KPS).</p><p><strong>Results: </strong>No serious adverse events occurred, and only mild side effects [subfebrile fever (37.5 °C-37.9 °C), pain] were reported (CTCAE Grade 1). FIM motor scores improved significantly (46.20 ± 16.39 to 64.20 ± 18.20, <i>P</i> < 0.01), and FIM cognitive scores also showed significant improvement (30.60 ± 4.56 to 34.00 ± 1.41, <i>P</i> < 0.001). While MAS scores improved (right/left: 4.60/3.60 to 2.20/1.60), these changes were not statistically significant (<i>P</i> > 0.05), possibly due to low baseline spasticity. KPS scores significantly improved (46.00 ± 11.40 to 72.00 ± 8.37, <i>P</i> < 0.001), indicating enhanced overall functional status and quality of life.</p><p><strong>Conclusion: </strong>MSCdE therapy is safe and effective in improving motor function, cognition, and quality of life in TBI patients. Larger, controlled trials are needed to further validate these findings and optimize MSCdE therapy for TBI treatment.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"14 4","pages":"103782"},"PeriodicalIF":0.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12687041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145727674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathophysiology and management of right ventricular failure in critically ill patients: A narrative review.","authors":"Riley Kermanian, Harpreet Dosanjh, Michael I Lewis, Yuri Matusov","doi":"10.5492/wjccm.v14.i4.111434","DOIUrl":"10.5492/wjccm.v14.i4.111434","url":null,"abstract":"<p><p>Right ventricular (RV) failure accounts for significant morbidity and mortality in critically ill patients. The RV is particularly vulnerable in conditions characterized by elevated pulmonary vascular afterload, which are commonly encountered in the intensive care unit (ICU). Conditions such as acute respiratory distress syndrome, pulmonary embolism, and decompensated pulmonary arterial hypertension are associated with acute and acute-on-chronic RV failure. In the ICU, RV failure may develop or worsen in patients with parenchymal pulmonary disease who acutely experience fluctuations in preload, excessive afterload, and/or insufficient myocardial contractility, often in addition to mechanical ventilation and circulatory compromise. This dynamic clinical scenario demands early recognition and intervention tailored to an individual patient's physiology. Distinguishing between acute and chronic RV failure in critical illness informs diagnostic workup, hemodynamic monitoring, and resuscitative efforts. This narrative review will provide an overview of common conditions associated with RV failure in critical illness, highlighting a practical, physiology-oriented approach to diagnosis and optimization of ventilator support, fluid resuscitation, vasopressor and inotrope use, and mechanical circulatory support. RV failure due to RV infarction or severe LV failure and decompensated congenital heart disease are distinct pathophysiologic entities. These conditions require distinct treatment approaches and are beyond the scope of this review.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"14 4","pages":"111434"},"PeriodicalIF":0.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12687080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145727244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reactive oxygen species elevations in human immune cell subsets during sepsis are mitigated by norepinephrine and N-acetylcysteine.","authors":"Joby Thoppil, J David Farrar, Drashya Sharma, Shaun Kirby, Angela Mobley, Daniel Mark Courtney","doi":"10.5492/wjccm.v14.i4.108638","DOIUrl":"10.5492/wjccm.v14.i4.108638","url":null,"abstract":"<p><strong>Background: </strong>Sepsis is a life-threatening condition caused by a dysregulated host response to infection. Peripheral blood mononuclear cells (PBMCs) are critical mediators of the immune response and may exhibit redox imbalance during sepsis. Reactive oxygen species (ROS) are known to influence immune cell signaling, and excessive ROS accumulation may contribute to sepsis-associated immune alterations.</p><p><strong>Aim: </strong>To assess intracellular ROS levels in PBMC subsets from septic patients and determine whether norepinephrine (NE) or N-acetylcysteine (NAC) modulate ROS levels following inflammatory stimulation <i>in vitro</i>.</p><p><strong>Methods: </strong>PBMCs were isolated from Department of Emergency patients meeting SEP-1/SEP-2 sepsis criteria and from healthy controls without signs of infection. Intracellular ROS levels were measured using a total ROS detection assay and analyzed by flow cytometry. PBMCs were also stimulated <i>in vitro</i> with lipopolysaccharide (LPS) or hydrogen peroxide (H₂O₂), with or without co-treatment with NE or NAC.</p><p><strong>Results: </strong>ROS levels were significantly elevated in CD3+ and CD14+ cells from septic patients compared to controls. <i>In vitro</i> stimulation of control PBMCs with LPS or H₂O₂ increased ROS in CD3+ and CD14+ cells, which was attenuated by co-treatment with NE or NAC.</p><p><strong>Conclusion: </strong>ROS levels are elevated in specific PBMC subsets in sepsis, particularly CD3+ T cells and CD14+ monocytes. NE and NAC reduced ROS accumulation <i>in vitro</i>, supporting their potential role as redox modulators. These findings warrant further mechanistic investigation into immune redox regulation in sepsis.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"14 4","pages":"108638"},"PeriodicalIF":0.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12687033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145727402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preventing diagnostic errors in critical care using millimeter-wave technology: A transformative approach to patient safety.","authors":"Andreas G Siamarou","doi":"10.5492/wjccm.v14.i4.104703","DOIUrl":"10.5492/wjccm.v14.i4.104703","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Diagnostic errors in critical care settings are a significant challenge, often leading to adverse patient outcomes and increased healthcare costs. Millimeter-wave (mmWave) technology, with its ability to provide high-resolution, real-time data, offers a transformative solution to enhance diagnostic accuracy and patient safety. This paper explores the integration of mmWave technology in intensive care units (ICUs) to enable non-invasive monitoring, minimize diagnostic errors, and improve clinical decision-making. By addressing key challenges, including data latency, signal interference, and implementation feasibility, this approach has the potential to revolutionize patient monitoring systems and set a new standard for critical care delivery. The paper discusses the high prevalence of diagnostic errors in medical care, particularly in primary care and ICUs, and emphasizes the need for improvement in diagnostic accuracy. Diagnostic errors are responsible for a significant number of deaths, disabilities, prolonged hospitalizations and delays in diagnosis worldwide.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To address this issue, the paper proposes the use of ultrafast wireless medical big data transmission in primary care, specifically in remote smart sensors monitoring devices. It suggests that wireless transmission with a speed up to 100 Gb/s (12.5 Gbytes/s) within a short distance (1-10 meters) is necessary to reduce diagnostic errors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The method used in the study, includes system design and testing a channel sounder operating at 63.4-64.4 GHz frequency range. The system demonstrated dynamic range of 70 dB, noise level of -110 dBm, and a time resolution of 1 ns. The experiment measured the impulse response of the channel in 36 locations within the primary care/ICU scenario.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The system was tested in a simulated ICU environment to evaluate the Latency: Assessing the time delay in data transmission and processing. The results of the study showed that the system met the requirements of ICUs, providing excellent latency values. The delay spread and excess delay values were within acceptable limits, indicating successful resolution of ICU requirements. The paper suggests timely deployment of such a system. Impact on data transmission: A 100 MB magnetic resonance imaging scan can be transmitted in approximately 0.008 seconds; A 1 GB scan would take approximately 0.08 seconds; This capability could revolutionize healthcare, enabling real-time remote diagnostics and comparisons with artificial Intelligence models, even in large-scale systems.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The experiment demonstrated the feasibility of using high-speed wireless transmission for improved diagnostics in ICUs, offering potential benefits in terms of reduced errors and improved patient outcomes. The findings are deemed valuable to the medical community and public healthcare systems, and it i","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"14 4","pages":"104703"},"PeriodicalIF":0.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12687066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145727475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of a noise reduction intervention in the intensive care unit: A prospective bicenter study.","authors":"Bernard Ong, Kay Choong See, Sunny Sunwoo Kim, Yie Hui Lau","doi":"10.5492/wjccm.v14.i4.106359","DOIUrl":"10.5492/wjccm.v14.i4.106359","url":null,"abstract":"<p><strong>Background: </strong>Excessive noise in healthcare environments-commonly described as \"unwanted sound\"-has been linked to a range of negative impacts on both patients and staff. In clinical settings, elevated noise levels have been associated with sleep disruption, heightened cardiovascular stress, and an increased risk of delirium in patients. Among healthcare workers, noise can impair focus and cognitive performance, potentially compromising care quality.</p><p><strong>Aim: </strong>To evaluate the effectiveness of educational and behavioural interventions in reducing noise levels within intensive care units (ICUs), recognizing their potential impact on patient outcomes and healthcare effectiveness.</p><p><strong>Methods: </strong>A prospective interventional study in two Singaporean teaching hospitals compared peak and average sound levels between control and intervention groups. An educational and behavioural intervention comprising talks, posters, and self-audits by nurse champions was initiated in two ICUs in one hospital on November 18, 2023. Sound measurements were collected at 4 Locations within each ICU before and after intervention. Baseline measurements were taken from October 22, 2023 to October 29, 2023, and post-intervention measurements from December 21, 2023 to December 22, 2023. The hospitals served as the primary exposure variable, controlled for ICU type (medical <i>vs</i> surgical) and hour of the day.</p><p><strong>Results: </strong>Our analysis generated 48 pairs of peak and average sound level readings for each unit (control <i>n</i> = 48 readings; intervention <i>n</i> = 48 readings). The effect of the intervention was associated with a significant 4.8 dB decrease in average sound level (<i>P</i> = 0.009) and a nonsignificant 4.3 dB decrease in peak sound level (<i>P</i> = 0.104), adjusted for hour of day and type of ICU.</p><p><strong>Conclusion: </strong>Educational and behavioural interventions successfully reduced average sound levels, emphasizing their positive impact on noise control. These findings contribute valuable insights for optimizing noise reduction efforts in critical care settings. Future studies may explore additional systemic and environmental interventions to enhance noise management strategies.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"14 4","pages":"106359"},"PeriodicalIF":0.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12687084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145727584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In-hospital <i>vs</i> out-of-hospital cardiac arrest in the Arab Asian countries: A contemporary review of the literature.","authors":"Haya Alkuwari, Noora Al-Sulaiti, Wafaa Al-Mannai, Mohammad Asim, Hassan Al-Thani, Ayman El-Menyar","doi":"10.5492/wjccm.v14.i4.112368","DOIUrl":"10.5492/wjccm.v14.i4.112368","url":null,"abstract":"<p><strong>Background: </strong>Cardiac arrest is a critical condition characterized by abrupt cessation of cardiac function, resulting in reduced oxygen delivery to vital organs and rapid progression to death if not timely treated. Despite advances in medical science and resuscitation techniques, cardiac arrest remains a significant burden globally, with survival rates remaining low. Comprehensive research on cardiac arrest, particularly comparisons between in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA), is limited.</p><p><strong>Aim: </strong>To compare the survival rates, return of spontaneous circulation (ROSC), survival to discharge, and neurological outcomes after IHCA and OHCA in Arab Asian countries.</p><p><strong>Methods: </strong>We systematically searched PubMed, Medline, EMBASE and Google Scholar (2000-2024) using keywords (\"IHCA\", \"OHCA\", \"cardiac arrest\", \"Middle East\", \"Arab\", \"Asian\") in titles/abstracts. The inclusion criterion was observational studies on adults (≥ 18 years) in Arab Asian countries reporting relevant outcomes. The exclusion criteria were narrative reviews, non-Arab Asian studies, non-English publications, inaccessible full texts, pediatric-only populations, and studies lacking outcome data.</p><p><strong>Results: </strong>In total, 44 observational studies from nine Arab Asian countries comprising 32535 participants were included. This review highlights the substantial variability in cardiac arrest outcomes in Asian countries. OHCA mortality rates were alarmingly high in several nations, with Kuwait (99%), Bahrain (98.8%), and Qatar (97.6%) reporting the highest figures. In contrast, the Kingdom of Saudi Arabia (KSA) had a markedly lower OHCA mortality rate (8.2%). The rates of ROSC also varied, with Qatar achieving the highest (34.4%) and Kuwait the lowest (3.3%). Survival to hospital discharge ranged from 1.2% in Bahrain to 18.7% in Kuwait, with Qatar also reporting favorable rates (17.5%). For IHCA, mortality was 73.6% in the United Arab Emirates (UAE) and 72.8% in KSA, whereas Lebanon and Iraq reported higher rates of 94.6% and 88%, respectively. ROSC rates were the highest in Lebanon (55.9%) and the UAE (51.3%). Neurological outcome reporting has been inconsistent, although Qatar reported a high rate (68.6%) for OHCA survivors. Comparative data showed generally better survival and neurological outcomes with IHCA than with OHCA.</p><p><strong>Conclusion: </strong>This systematic review underscores the clear disparity in survival outcomes between IHCA and OHCA in Arab Asian countries, with IHCA demonstrating superior outcomes. Despite progress in some countries, outcomes remain suboptimal compared with international standards. Future multicenter studies with standardized methodologies are required to generate high-quality evidence and provide region-specific interventions for cardiac arrest management.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"14 4","pages":"112368"},"PeriodicalIF":0.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12687053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145727634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and cost-effectiveness of noninvasive ventilation over invasive ventilation in acute respiratory failure: A single-center study from India.","authors":"Kanwalpreet Sodhi, Harmanpreet Kaur, Tanupriya Sood, Ditya Ditya, Manender Kumar, Sartaaj Tuli, Anshul Singla, Ishrat Singla","doi":"10.5492/wjccm.v14.i4.108652","DOIUrl":"10.5492/wjccm.v14.i4.108652","url":null,"abstract":"<p><strong>Background: </strong>There has been a growing interest in noninvasive ventilation (NIV) in comparison to invasive mechanical ventilation (IMV) as a standard of care for acute respiratory failure (ARF), especially in the post-covid era, but direct head-to-head cost comparisons between the two modalities are not available in literature.</p><p><strong>Aim: </strong>To compare the cost along with the clinical effectiveness of NIV in comparison to IMV in ARF.</p><p><strong>Methods: </strong>A prospective observational single-center case control study including adult patients with ARF (PaO₂/FiO₂ ratio < 300) admitted from January 1, 2024 to December 31, 2024 in medical intensive care unit (ICU) of a tertiary care hospital requiring either NIV or invasive ventilation. NIV and IMV groups were compared based on average length of ICU and hospital stay, mortality, net cost of ICU treatment, need for intubation and tracheostomy.</p><p><strong>Results: </strong>A total of 319 patients were included in the study (197 in NIV, 122 in IMV group). Statistically significant difference in length of ICU stay (NIV group: 5 ± 3.25 days, IMV group: 9 ± 2.6 days; <i>P</i> < 0.05) and mortality rate was seen (11% NIV <i>vs</i> 34% IMV; <i>P</i> < 0.01). On multivariate analyses, mortality showed a stronger association with IMV [odds ratio (OR) = 7.73; 95%CI: 3.12-19.18] as compared to ICU stay (OR = 2.73; 95%CI: 2.15-3.48). A total of 33 patients (17%) in NIV group required intubation of which 3 were tracheostomized, while 14 patients (11%) in IMV group needed tracheostomy. The net average cost of ICU stay was INR 83902 in NIV group while in IMV group, the net ICU cost was INR 476216. The average cost of ICU stay was five times higher with IMV.</p><p><strong>Conclusion: </strong>NIV has potential economic and clinical benefits as compared to invasive ventilation in ARF.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"14 4","pages":"108652"},"PeriodicalIF":0.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12687038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145727679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Giving urine biochemistry a second chance in acute kidney injury monitoring.","authors":"Alexandre Toledo Maciel","doi":"10.5492/wjccm.v14.i4.109194","DOIUrl":"10.5492/wjccm.v14.i4.109194","url":null,"abstract":"<p><p>Most studies assessing urine biochemistry for acute kidney injury (AKI) monitoring rely on paradigms from the 1970s. It was proposed that a single measurement of urinary parameters in the presence of increased serum creatinine (sCr) could help understand AKI pathophysiology and predict its duration. However, those studies produced variable and controversial results. Recently, an alternative \"urine biochemical approach\" has been proposed. In contrast with the traditional approach, it includes sequential urine electrolyte assessment, evaluation before AKI diagnosis, and interpretation of avid sodium retention as a marker of renal microcirculatory stress instead of low renal perfusion. This review highlights the rationale of this alternative approach, which is focused on early urinary biochemical changes that precede increases in sCr as well as signs of renal recovery before decreases in sCr. The relevance of urine composition in conjunction with urine volume for a proper evaluation of renal function is emphasized. This new approach aims to enhance the utility of urinary biochemical parameters in AKI monitoring, particularly in patients who are critically ill.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"14 4","pages":"109194"},"PeriodicalIF":0.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12687057/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145727625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Critical care primary services are associated with reduced midazolam use in the intensive care unit.","authors":"Konstantin G Nestoiter, Kristin Feick, Kristen Looney, Matthew Zaccheo, Yijin Wert, Christopher Franz","doi":"10.5492/wjccm.v14.i4.111260","DOIUrl":"10.5492/wjccm.v14.i4.111260","url":null,"abstract":"<p><strong>Background: </strong>Analgesia and sedation are commonly prescribed therapies within the intensive care unit (ICU) for patients receiving mechanical ventilation. Current guidelines recommend utilizing an analgesia-first approach to initially reach appropriate pain control, while potentially achieving sedation goals concurrently. Our system employs a guideline-based ICU sedation order-set that features an electronic medical record (EMR) integrated ICU checklist that combines analgesia and sedation.</p><p><strong>Aim: </strong>To identify systems-based factors that are associated with the use of continuous midazolam infusion administration in mechanically ventilated patients.</p><p><strong>Methods: </strong>We extracted EMR data from patients who received mechanical ventilation between January 1, 2021, and December 31, 2023. Subjects included were 18 years or older who received mechanical ventilation. \"R\" version 4.3.2 was used for data processing and statistical analysis. We performed a multivariable regression analysis to predict the administration of a continuous midazolam infusion with modified Sequential Organ Failure Assessment score, Charlson comorbidity index, and critical care medicine (CCM) primary service.</p><p><strong>Results: </strong>Of 3805 patients that underwent mechanical ventilation, 62% were male, with a mean age of 66.9 years. 3429 patients were treated by a provider team with a CCM attending, and 376 patients were managed by a non-CCM primary team with CCM consultative services. A midazolam infusion was used in 187 of 3429 (5%) patients with CCM as primary and in 166 of 376 (56%) patients with non-CCM primary (<i>χ</i> ² 598.23, <i>P</i> < 0.001). Of the patients who received continuous midazolam, 117 (21%) died <i>vs</i> 236 (7%) survived hospitalization. Continuous midazolam was associated with more days with coma and more days with delirium (<i>P</i> < 0.0001).</p><p><strong>Conclusion: </strong>Continuous midazolam infusion was more likely in patients admitted to the ICU under an open unit with a non-CCM physician with an intensivist consult available, despite guided order-sets and checklists integrated into the EMR.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"14 4","pages":"111260"},"PeriodicalIF":0.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12687074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145727653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive accuracy of 4C Mortality Score and Acute Physiology and Chronic Health Evaluation scores for mortality in COVID-19 patients admitted to intensive care unit.","authors":"Kush Deshpande, Dushyant Tripathi","doi":"10.5492/wjccm.v14.i4.108907","DOIUrl":"10.5492/wjccm.v14.i4.108907","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have reported the high predictive accuracy of 4C Mortality Score derived at hospital admission in coronavirus disease 2019 (COVID-19) patients. Very few studies have assessed it at intensive care unit (ICU) admission and compared it with the Acute Physiology and Chronic Health Evaluation (APACHE) II score. There are no studies comparing its accuracy with APACHE III score.</p><p><strong>Aim: </strong>To describe the characteristics and outcomes of patients admitted to ICU with COVID-19 infection and to compare the accuracy of 4C score and APACHE score in predicting mortality in these patients.</p><p><strong>Methods: </strong>We conducted this retrospective cohort study using an electronic database in a tertiary ICU in Sydney. We included all adult patients (age > 16 years) admitted to ICU with COVID-19 infection over a 5-month period (July 1, 2021 to November 30, 2021). We collected the data on demographics, clinical characteristics, interventions and outcomes for all patients. We calculated the 4C Mortality Score for each patient using eight variables as described previously. We compared the predictive accuracy of 4C Mortality Score at hospital and ICU admission and APACHE II and III scores by area under the receiver operating characteristic curve (AUROC). We determined the optimal cut-off value for each of these scores using the 'nearest' method and its 95% confidence interval by bootstrapping.</p><p><strong>Results: </strong>A total of 140 patients (62% males, mean age 56 ± 17 years, mean APACHE II score 13 ± 57) were included in the study. Nineteen (13.6%) of 140 patients died in the hospital. Compared to survivors, the non-survivors were older, males, had more comorbidities, higher rate of mechanical ventilation and vasopressor use. The AUROC for the 4C Mortality Score at hospital and ICU admission and APACHE II and II score was 0.75, 0.80. 0.75 and 0.79 respectively. The optimal cut-off value for these four scores was 9, 10, 14 and 56 respectively. The cut-point for all the scores had higher sensitivity than specificity.</p><p><strong>Conclusion: </strong>The 4C score at ICU admission had a higher accuracy in predicting mortality than the 4C score at hospital admission. The predictive accuracy was similar to that for APACHE III score. The 4C score at ICU admission needs to be validated in future studies.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"14 4","pages":"108907"},"PeriodicalIF":0.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12687081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145727429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}