The Accuracy of Dynamic Parameters for Prediction of Fluid Responsiveness in Elderly Patients with Septic Shock.

Purpose: Assessed the accuracy of stroke volume variation (SVV), pulse pressure variation (PPV), and dynamic arterial elastance (Eadyn) in predicting fluid responsiveness (FR) and mean arterial pressure (MAP) response in elderly patients with septic shock.

Patients And Methods: Mechanically ventilated patients aged over 65 with septic shock were enrolled. SVV, PPV, and Eadyn were recorded before and after FR testing (≥10% increase in cardiac output following a passive leg raise test or fluid challenge).

Unsupervised machine learning clustering approach for hospitalized COVID-19 pneumonia patients.

Background: Identification of distinct clinical phenotypes of diseases can guide personalized treatment. This study aimed to classify hospitalized COVID-19 pneumonia subgroups using an unsupervised machine learning approach.

Methods: We included hospitalized COVID-19 pneumonia patients from July to September 2021.

Expiratory flow limitation during mechanical ventilation: real-time detection and physiological subtypes.

Background: Tidal expiratory flow limitation (EFL) complicates the delivery of mechanical ventilation but is only diagnosed by performing specific manoeuvres. Instantaneous analysis of expiratory resistance (Rex) can be an alternative way to detect EFL without changing ventilatory settings. This study aimed to determine the agreement of EFL detection by Rex analysis and the PEEP reduction manoeuvre using contingency table and agreement coefficient.

Effect of the Ramathibodi Rapid Response System Triggered by the Ramathibodi Early Warning Score and Clinical Warning Signs on in-Hospital Mortality and the Incidence of Cardiopulmonary Resuscitation in Adult Hospitalized Patients.

Purpose: The Ramathibodi Rapid Response System (RRRS), implemented in March 2017, aims to identify and respond to patients with deteriorating conditions outside the ICU. It employs the Ramathibodi early warning score and clinical signs to monitor all admitted patients, providing expert physician monitoring and early treatment for stabilization and appropriate care triage. This study assesses the RRRS's effectiveness in reducing in-hospital mortality and CPR events outside the ICU.

The Association between Emergency Department Length of Stay and In-Hospital Mortality in Older Patients Using Machine Learning: An Observational Cohort Study.

The association between emergency department (ED) length of stay (EDLOS) with in-hospital mortality (IHM) in older patients remains unclear. This retrospective study aims to delineate the relationship between EDLOS and IHM in elderly patients. From the ED patients (n = 383,586) who visited an urban academic tertiary care medical center from January 2010 to December 2016, 78,478 older patients (age ≥60 years) were identified and stratified into three age subgroups: 60-74 (early elderly), 75-89 (late elderly), and ≥90 years (longevous elderly).

The ratio of respiratory rate to diaphragm thickening fraction for predicting extubation success.

Background: Several parameters are used to predict successful extubation but their accuracy varies among studies. We hypothesized that combining conventional and diaphragmatic parameters would be more effective than using just one. Our primary objective was to evaluate the performance of the respiratory rate in relation to the diaphragm thickening fraction (RR/DTF) ratio to predict the success of extubation.

Length-of-Stay in the Emergency Department and In-Hospital Mortality: A Systematic Review and Meta-Analysis.

The effect of emergency department (ED) length of stay (EDLOS) on in-hospital mortality (IHM) remains unclear. The aim of this systematic review and meta-analysis was to determine the association between EDLOS and IHM. We searched the PubMed, Medline, Embase, Web of Science, Cochrane Controlled Register of Trials, CINAHL, PsycInfo, and Scopus databases from their inception until 14−15 January 2022.

The physiological underpinnings of life-saving respiratory support.

Treatment of respiratory failure has improved dramatically since the polio epidemic in the 1950s with the use of invasive techniques for respiratory support: mechanical ventilation and extracorporeal respiratory support. However, respiratory support is only a supportive therapy, designed to "buy time" while the disease causing respiratory failure abates. It ensures viable gas exchange and prevents cardiorespiratory collapse in the context of excessive loads.

Dyspnoea and respiratory muscle ultrasound to predict extubation failure.

Background: This study investigated dyspnoea intensity and respiratory muscle ultrasound early after extubation to predict extubation failure.

Methods: The study was conducted prospectively in two intensive care units in France and Canada. Patients intubated for at least 48 h were studied within 2 h after an extubation following a successful spontaneous breathing trial.

Reverse Triggering Dyssynchrony 24 h after Initiation of Mechanical Ventilation.

Background: Reverse triggering is a delayed asynchronous contraction of the diaphragm triggered by passive insufflation by the ventilator in sedated mechanically ventilated patients. The incidence of reverse triggering is unknown. This study aimed at determining the incidence of reverse triggering in critically ill patients under controlled ventilation.

Malignant pleural mesothelioma in a kidney transplant recipient.

Post-transplantation malignancy is one of the most common complication-related mortality in transplant recipients. Here, we report the case of a kidney transplant patient for 2 years with malignant pleural effusion that was subsequently diagnosed as malignant pleural mesothelioma.

Airway Occlusion Pressure As an Estimate of Respiratory Drive and Inspiratory Effort during Assisted Ventilation.

Monitoring and controlling respiratory drive and effort may help to minimize lung and diaphragm injury. Airway occlusion pressure (P0.1) is a noninvasive measure of respiratory drive.

Sleep and Pathological Wakefulness at the Time of Liberation from Mechanical Ventilation (SLEEWE). A Prospective Multicenter Physiological Study.

Abnormal patterns of sleep and wakefulness exist in mechanically ventilated patients. In this study (SLEEWE [Effect of Sleep Disruption on the Outcome of Weaning from Mechanical Ventilation]), we aimed to investigate polysomnographic indexes as well as a continuous index for evaluating sleep depth, the odds ratio product (ORP), to determine whether abnormal sleep or wakefulness is associated with the outcome of spontaneous breathing trials (SBTs). Mechanically ventilated patients from three sites were enrolled if an SBT was planned the following day.

High-flow nasal oxygen versus noninvasive ventilation in adult patients with cystic fibrosis: a randomized crossover physiological study.

Background: Noninvasive ventilation (NIV) is the first-line treatment of adult patients with exacerbations of cystic fibrosis (CF). High-flow nasal oxygen therapy (HFNT) might benefit patients with hypoxemia and can reduce physiological dead space. We hypothesized that HFNT and NIV would similarly reduce work of breathing and improving breathing pattern in CF patients.

Expiratory Flow Limitation During Mechanical Ventilation.

Expiratory flow limitation (EFL) is present when the flow cannot rise despite an increase in the expiratory driving pressure. The mechanisms of EFL are debated but are believed to be related to the collapsibility of small airways. In patients who are mechanically ventilated, EFL can exist during tidal ventilation, representing an extreme situation in which lung volume cannot decrease, regardless of the expiratory driving forces.

Cartoon versus traditional self-study handouts for medical students: CARTOON randomized controlled trial.

Objective: The objective of this study is to compare the effectiveness of a "cartoon-style" handout with a "traditional-style" handout in a self-study assignment for preclinical medical students.

Methods: Third-year medical students (n = 93) at the Faculty of Medicine Ramathibodi Hospital, Mahidol University, took a pre-learning assessment of their knowledge of intercostal chest drainage. They were then randomly allocated to receive either a "cartoon-style" or a "traditional-style" handout on the same topic.

Lactate and combined parameters for triaging sepsis patients into intensive care facilities.

Purpose: To find predictors of intensive care unit (ICU) requirement within the first 48 hours in newly diagnosed sepsis patients presenting at the emergency department.

Materials And Methods: Analysis of a prospective observational cohort was performed. We recruited new sepsis patients at the emergency department, and collected baseline characteristics and parameters.

Association between admission delay and adverse outcome of emergency medical patients.

Aim: To determine whether admission delay (lead-time) and other factors are associated with hospital mortality rates of emergency medical patients.

Methods: Patients presenting with emergency conditions during August to November 2009, and admitted to medical wards, including intensive care units, were enrolled. The time each patient spent in the ED, and other parameters were recorded.