Machine Learning-Based Identification of Risk Factors for ICU Mortality in 8902 Critically Ill Patients with Pandemic Viral Infection.

: The SARS-CoV-2 and influenza A (H1N1)pdm09 pandemics have resulted in high numbers of ICU admissions, with high mortality. Identifying risk factors for ICU mortality at the time of admission can help optimize clinical decision making. However, the risk factors identified may differ, depending on the type of analysis used.

Efficacy and Safety of a Balanced Gelatine Solution for Fluid Resuscitation in Sepsis: A Prospective, Randomised, Controlled, Double-Blind Trial-GENIUS Trial.

: Sepsis is a leading cause of death in noncoronary intensive care units (ICUs). Fluids for intravascular resuscitation include crystalloids and colloids. There is extensive clinical evidence on colloid use, but large trials comparing gelatine with crystalloid regimens in ICU and septic patients are lacking.

Re-evaluating albumin use in traumatic brain injury.

Traumatic brain injury (TBI) affects approximately 69 million people annually, with the majority of cases being mild-to-moderate in severity. However, in severe TBI, early management is critical and includes fluid resuscitation to control intracranial pressure (ICP) and optimize cerebral perfusion pressure. The SAFE-TBI study linked hypotonic 4% albumin to higher mortality versus saline (33.

Evolution of Clinical Trials in Anticoagulation for Sepsis: Bridging Past to Future.

Demonstrating the efficacy of new treatments in any condition may be a challenging endeavor, and is particularly the case in sepsis. In the early 21st century, recombinant activated protein C showed a survival benefit in severe sepsis; however, subsequent studies could not replicate these results, leading to the discontinuation of this agent. Several potential reasons have been proposed for the unfavorable results of trials, including choosing an inappropriate outcome target.

Estimating the Value of Aztreonam-Avibactam in Treating Metallo-beta-Lactamase-Producing Enterobacterales Infections in Spain Using the STEDI AMR Value Framework.

Introduction: Treatments for serious infections caused by multidrug-resistant gram-negative bacteria, including metallo-β-lactamase-producing Enterobacterales (MBL-EB), are limited and aztreonam with avibactam (ATM-AVI) is the first β-lactam/β-lactamase inhibitor combination active against MBL-EB approved in Europe and approved for reimbursement by the Spanish National Health System (NHS). This study aims to estimate the value of adding ATM-AVI as a new first-line treatment into the current strategy (ATM-AVI → cefiderocol → colistin + meropenem) in patients with hospital-acquired/ventilator-associated pneumonia (HAP/VAP) and complicated intra-abdominal infections (cIAI), caused by MBL-EB from the Spanish NHS perspective.

Methods: A dynamic disease transmission model was developed to assess the value of ATM-AVI considering the transmission, diversity and enablement components of the value framework for antibiotics, called STEDI (spectrum, transmission, enablement, diversity, insurance).

Pharmacokinetics of Isavuconazole During Extracorporeal Membrane Oxygenation Support in Critically Ill Patients: A Case Series.

Background/objectives: Extracorporeal membrane oxygenation (ECMO) is increasingly used in critically ill patients, but may significantly alter the pharmacokinetics (PK) of antifungals. Data on plasma concentrations of Isavuconazole (IsaPlasm) in ECMO patients are limited. Our objective is to evaluate Isavuconazole exposure and variability in critically ill COVID-19 patients receiving ECMO.

Does Empirical Antibiotic Use Improve Outcomes in Ventilated Patients with Pandemic Viral Infection? A Multicentre Retrospective Study.

During the influenza A(H1N1) and COVID-19 pandemics, empirical antibiotic treatment (EAT) was widely administered to critically ill patients despite low rates of confirmed bacterial co-infection (COI). The clinical benefit of this practice remains uncertain and may contradict antimicrobial stewardship principles. To evaluate whether EAT at ICU admission reduces ventilator-associated pneumonia (VAP) incidence or ICU mortality in critically ill patients with pandemic viral pneumonia, stratified by presence of COI.

Circulating histones as clinical biomarkers in critically ill conditions.

Extracellular histones, primarily nuclear proteins involved in chromatin organization, have emerged as key mediators in pathological processes in critically ill patients. When released into circulation due to cell death mechanisms such as NETosis, histones act as damage-associated molecular patterns (DAMPs), contributing to excessive inflammation, endothelial dysfunction, immune response dysregulation, coagulation activation, cell death, and multi-organ damage. Increasing evidence supports their role in the pathophysiology of sepsis, acute lung injury, cardiac injury, pancreatitis, and other life-threatening conditions.

Outcomes and Predictors of Mortality in Patients with Severe COVID-19 and COPD admitted to ICU: A multicenter study.

Background: High mortality rates among patients with chronic obstructive pulmonary disease (COPD) admitted to intensive care units (ICUs) during the COVID-19 pandemic highlight the need for tailored clinical management strategies.

Study Design And Methods: Epidemiological, clinical, and laboratory data were collected in REDCap for 6,512 patients hospitalized with COVID-19 across 55 Spanish ICUs. Patients were stratified into three groups: those with COPD, those with other chronic respiratory diseases (CRD), and those without respiratory comorbidities (No CRD).

How to approach a patient hospitalized for pneumonia who is not responding to treatment?

Pneumonia is a frequent cause of intensive care unit (ICU) admission and is the most common infection in ICU patients across all geographic regions. It takes 48-72h for most patients to respond to appropriate antibiotic therapy. Non-response is typically defined as the persistence/worsening of clinical signs-such as fever, respiratory distress, impaired oxygenation and/or radiographic abnormalities-with rates ranging 20-30%.

Sepsis in patients who are immunocompromised: diagnostic challenges and future therapies.

Sepsis is a life-threatening, dysregulated host response to infection. Immunosuppression is a risk factor for infections and sepsis. However, the specific immune derangements elevating the risk for infections and sepsis remain unclear in the individual patient, raising the question of whether a general state of immunosuppression exists.

Endotoxin hemoadsorption in refractory septic shock with multiorgan dysfunction and extreme endotoxin activity.

Endotoxin septic shock is marked by severe organ failure and mortality rate that exceeds fifty percent, underscoring the critical need to tailor management strategies. Monitoring -endotoxin activity can guide the initiation and direction of adjunctive treatment for refractory septic shock through hemoadsorption. Thus, intervening based on the pathophysiological foundation may potentially improve outcomes.

Preferences on the Use of Prokinetic Agents in Adult Intensive Care Unit Patients-An International Survey.

Introduction: Feeding intolerance complicates enteral nutrition in intensive care unit (ICU) patients but is poorly defined. Prokinetic agents are administered to facilitate the uptake of enteral nutrition, but preferences for their use among clinicians in ICUs are unknown.

Methods: We conducted an international electronic survey targeting ICU doctors.

Environmental sustainability in intensive care: An international survey of intensive care professionals'views, practices and proposals to the European Society of Intensive Care Medicine.

Background: The intensive care unit (ICU) is a high-resource area, generating more waste and greenhouse gas (GHG) emissions than standard hospital wards. Environmental sustainability is important for healthcare professionals worldwide, prompting scientific societies to call for urgent action. To respond to this global need, the European Society of Intensive Care Medicine (ESICM) conducted an international survey assessing intensive care professionals' attitudes and practices towards environmental sustainability.

Longitudinal recovery trajectories and ventilatory modalities in COVID-19 acute respiratory distress syndrome survivors.

Background: The impact of different ventilatory support modalities and timing of intubation on longitudinal lung recovery trajectories in patients with severe coronavirus disease 2019 (COVID-19) is unknown.

Methods: This was a multicentre, prospective observational study conducted in 52 Spanish intensive care units (ICUs) involving critically ill COVID-19 patients admitted between 25 February 2020 and 8 February 2021. 1854 COVID-19 patients were followed after hospital discharge at 3, 6 and 12 months with diffusing capacity of the lung for carbon monoxide ( ) measurements and chest imaging.

Effectiveness and safety of cefiderocol treatment in patients with Gram-negative bacterial infections in Spain in the early access programme: results of the PERSEUS study.

Purpose: We assessed the effectiveness and safety of cefiderocol in patients with Gram-negative bacterial infections, excluding Acinetobacter spp., in the early access programme (EAP) in Spain.

Methods: The retrospective, multicentre PERSEUS study (2018-2022) enrolled hospitalised patients with serious Gram-negative infections, except Acinetobacter spp.

Cefiderocol treatment for patients infected by Stenotrophomonas maltophilia, Burkholderia cepacia complex and Achromobacter spp.: subgroup analysis from the PERSEUS study.

Purpose: This subgroup analysis of the PERSEUS study aimed to describe the effectiveness of cefiderocol treatment in the early access programme in Spain in patients infected by Stenotrophomonas maltophilia, Burkholderia cepacia complex (Bcc) or Achromobacter species.

Methods: In the retrospective, observational, multicentre PERSEUS study in Spain, the effectiveness and safety of cefiderocol treatment administered for at least 72 h up to 28 days in patients infected by Gram-negative bacteria, except Acinetobacter spp., in the early access programme was investigated.