Gut microbiota differs between ICU patients admitted for cardiac arrest and other causes: a secondary, propensity-matched cohort analysis.

Background: Critical illness is known to reduce gut microbiota (GM) diversity, a change associated with adverse outcomes. Among potential mechanisms, splanchnic hypoperfusion may play a key role. Cardiac arrest (CA), characterized by transient global hypoperfusion, provides a relevant model to explore this effect.

The analgesic effect of transversalis fascia plane block after cesarean delivery: a systematic review and meta-analysis with trial sequential analysis.

Introduction: The transversalis fascia plane block (TFPB) has been utilized for pain relief following cesarean delivery (CD) but its analgesic efficacy remains controversial. This systematic review and meta-analysis with trial sequential analysis, aimed to evaluate the effectiveness of TFPB in providing postoperative analgesia for patients undergoing CD.

Evidence Acquisition: A comprehensive literature search was conducted to identify trials comparing TFPB with a control group in CD patients.

Increased Driving Pressure During Assisted Ventilation for Hypoxemic Respiratory Failure Is Associated with Lower ICU Survival: The ICEBERG Study.

Rationale: Driving pressure is marker of severity and a possible target for lung protection during controlled ventilation, but its value during assisted ventilation is unknown. Inspiratory holds provide an estimate of driving pressure (quasi-static). Expiratory holds provide an estimate of the inspiratory effort, useful to estimate the transpulmonary dynamic driving pressure.

Noninvasive ventilation failure in thoracic trauma: A retrospective study on predictive scores, ventilatory strategies and pain management'.

Background: Blunt thoracic trauma is a major cause of respiratory failure. While most patients recover, some deteriorate, requiring invasive ventilation. The HACOR score (Heart rate, Acidosis, Consciousness, Oxygenation, Respiratory rate) and ROX index (SpO₂/FiO₂ to respiratory rate) have been used to assess the risk of non-invasive ventilatory support (NIV) failure in hypoxemic respiratory failure but have not been validated in trauma patients.

Enhancing Safety in Regional Anesthesia: Guidelines from the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI).

Background: Regional anesthesia techniques have become integral to modern perioperative care, offering enhanced pain management and recovery outcomes. However, their application in patients with specific conditions, such as anticoagulation therapy or preexisting comorbidities, raises concerns regarding safety and efficacy. Current guidelines addressing these issues are fragmented, necessitating comprehensive, evidence-based recommendations.

ICU 'Magic Numbers': The Role of Biomarkers in Supporting Clinical Decision-Making.

Critical care medicine is a highly complex field where diagnosing diseases and selecting effective therapies pose daily challenges for clinicians. In critically ill patients, biomarkers can play a crucial role in identifying and addressing clinical problems. Selecting the right biomarkers and utilizing them effectively can lead to more informed decisions, ultimately impacting patient outcomes.

Prone positioning during veno-venous extracorporeal membrane oxygenation: a systematic review and meta-analysis.

Purpose: The evidence supporting the benefit on clinical outcomes of prone positioning during veno-venous extracorporeal membrane oxygenation (V-V ECMO) for acute hypoxemic respiratory failure remains inconclusive. We aimed to assess the association of prone positioning, compared to no prone positioning, with 28-day mortality and other clinical outcomes in different patient subgroups.

Methods: A systematic review and meta-analysis of randomized and non-randomized controlled trials (RCTs) using a random-effects model was conducted.

Impact of Fluid Management on Outcomes in Sequential Extracorporeal Support: A Post Hoc Analysis.

Introduction: Sepsis is a life-threatening condition characterized by dysregulated inflammatory responses, often leading to multiple organ dysfunction and high mortality rates. Continuous renal replacement therapy (CRRT) and extracorporeal blood purification therapies have emerged as vital adjuncts to manage fluid overload and modulate immune responses in septic shock. This study evaluates the impact of daily fluid balance variation on 90-day mortality and hospital length of stay in ICU patients undergoing CRRT for septic shock with endotoxin activity.

Advances in Renal Replacement Therapy: The Role of Polymethyl Methacrylate Membranes in Acute Critically Ill Patients.

Background: Polymethyl methacrylate (PMMA) membranes are increasingly recognized for their effectiveness in treating acute kidney injury (AKI) due to their strong adsorption capabilities, particularly for inflammatory mediators like β2-microglobulin and IL-6. These membranes ensure mechanical stability and chemical inertness, minimizing adverse reactions during blood filtration.

Summary: In acute conditions such as sepsis and acute respiratory distress syndrome (ARDS), PMMA membranes show promising findings.

Regional anesthesia for pediatric cardiac surgery: a review.

Background: Effective pain management in pediatric cardiac surgery is essential for optimizing postoperative outcomes and promoting faster recovery. While intravenous analgesia remains a standard approach, regional anesthesia (RA) techniques have gained attention in this population due to their analgesic efficacy, reduced dependence on systemic opioids, and enhanced hemodynamic stability.

Main Body: This article provides an overview of current evidence of RA techniques for pediatric cardiac surgery.

Association of Inflammatory Profile During Lung Perfusion With High-Grade Primary Graft Dysfunction: A Systematic Review and Meta-Analysis.

Unlabelled: PGD3 is the manifestation of ischemia-reperfusion injury which results from inflammation and cell death and is associated with poor outcome. This systematic-review and meta-analysis of non-randomized controlled trials on patients undergoing Ltx with reconditioned lungs via EVLP, aims to assess the association between the levels of proinflammatory biomarkers during EVLP and PGD3 development within the firsts 72 h post-Ltx. Biomarkers were categorized by timing (1-hour, T0 and 4-hours, Tend from EVLPstart) and by their biological function (adhesion molecules, chemokines, cytokines, damage-associated-molecular-patterns, growth-factors, metabolites).

Paravertebral block is not superior to the interpectoral and pectoserratus plane block for patients undergoing breast surgery: An updated meta-analysis of randomised controlled trials with meta-regression and trial sequential analysis.

Background: Breast surgery is frequently associated with significant acute postoperative pain, necessitating effective pain management strategies. Both thoracic paravertebral block (PVB) and interpectoral plane and pectoserratus plane (IP+PS) blocks have been used to relieve pain after breast surgery.

Objective: In this systematic review and meta-analysis with trial sequential analysis, we aimed to identify the optimal analgesic technique for achieving effective pain relief in breast surgery.

Impact of Multidrug-Resistant Bacteria in a Cohort of COVID-19 Critically Ill Patients: Data from a Prospective Observational Study Conducted in a High-Antimicrobial-Resistance-Prevalence Center.

: Bacterial superinfections are common complications during viral infections, but the impact of multidrug-resistant (MDR) pathogens in critically ill patients affected by coronavirus disease 2019 (COVID-19) is still debated. : This is an observational, monocentric, and prospective study designed to investigate the incidence, risk factors, and outcomes of MDR bacterial superinfections in COVID-19 patients admitted to the intensive care unit (ICU). : A high incidence of superinfections (66%, 159/241) was observed: ventilator-associated pneumonia (VAP) (65%, 104/159) and bloodstream infection (BSI, 32%, 51/159) were the most common.

Early reduction in gut microbiota diversity in critically ill patients is associated with mortality.

Background: Critical illness is associated with an altered gut microbiota, yet its association with poor outcomes remains unclear. This study evaluates the early gut microbiota diversity changes in intensive care unit patients and its association with mortality. Additionally, it explores fecal pH as a potential biomarker for these changes.

Respiratory Drive, Effort, and Lung-Distending Pressure during Transitioning from Controlled to Spontaneous Assisted Ventilation in Patients with ARDS: A Multicenter Prospective Cohort Study.

: To investigate the impact of patient characteristics and treatment factors on excessive respiratory drive, effort, and lung-distending pressure during transitioning from controlled to spontaneous assisted ventilation in patients with acute respiratory distress syndrome (ARDS). : Multicenter cohort observational study of patients with ARDS at four academic intensive care units. Respiratory drive (P), diaphragm electrical activity (EAdi), inspiratory effort derived from EAdi (∆Pmus) and from occlusion of airway pressure (∆Pocc) (Pmus), and dynamic transpulmonary driving pressure (ΔP) were measured at the first transition to assisted spontaneous breathing.

Analgesic benefits of pre-operative versus postoperative transversus abdominis plane block for laparoscopic cholecystectomy: a frequentist network meta-analysis of randomized controlled trials.

Background: Transversus abdominis plane (TAP) block has been utilized to alleviate pain following laparoscopic cholecystectomy (LC). However, the optimal timing of administration remains uncertain. This study aimed to compare the efficacy of pre-operative and postoperative TAP blocks as analgesic options after LC.

Critical and non-critical coronavirus disease 2019 patients: which is the most predictive biomarker for disease severity and outcome?: A multicentre prospective cohort study comparing mid-regional pro-adrenomedullin, inflammatory and immunological patterns.

Background: Severe acute respiratory syndrome-coronavirus-2 in coronavirus disease 2019 (COVID-19) patients leads to a wide range of clinical manifestations. The evaluation of mid-regional pro-adrenomedullin (MR-proADM) as a prognostic biomarker in noncritical wards (NON-ICU) and intensive care units (ICU), may have a potential in predicting disease severity and outcomes.

Objective: To assess the difference in the prognostic power of MR-proADM in NON-ICU wards and in ICUs in a prospective multicentre cohort study.

Pneumonia after Heart Transplantation: Two Case Reports and a Review of the Literature.

Post-transplant pneumonia (PcP) is an uncommon but increasingly reported disease among solid organ transplantation (SOT) recipients, associated with significant morbidity and mortality. Although the introduction of PcP prophylaxis has reduced its overall incidence, its prevalence continues to be high, especially during the second year after transplant, the period following prophylaxis discontinuation. We recently described two cases of PcP occurring more than one year after heart transplantation (HT) in patients who were no longer receiving PcP prophylaxis according to the local protocol.

The safety of thoracic paravertebral block and erector spinae plane block in patients treated with anticoagulant or antiplatelet therapy. A narrative review of the evidence.

Introduction: The management of thoracic paravertebral block (TPVB) and erector spine plane block (ESPB) in patients treated with anticoagulant or antiplatelet therapy is based on limited clinical data, mostly from single case reports. Scientific societies and organizations do not provide strong detailed indications about the limitations of these regional anesthesia techniques in patients receiving antithrombotic therapy. This review summarizes evidence regarding TPVB and ESPB in patients under antithrombotic therapy.