Dual Blood Purification with CytoSorb and oXiris in Managing Recurrent Septic Shock: A Case Report.

BACKGROUND Extracorporeal blood purification strategies were recently developed as adjunctive treatments for sepsis. CytoSorb® is an approved medical device designed to reduce blood levels of inflammatory cytokines. The oXiris high-adsorption membrane filter is used in continuous hemofiltration adsorption.

Sex disparities in ICU care and outcomes after cardiac arrest: a Swiss nationwide analysis.

Background: Conflicting data exist regarding sex-specific outcomes after cardiac arrest. This study investigates sex disparities in the provision of critical care and outcomes of in-hospital (IHCA) and out-of-hospital cardiac arrest (OHCA) patients.

Methods: Analysis of adult cardiac arrest patients admitted to certified Swiss intensive care units (ICUs) (01/2008-12/2022) using the nationwide prospective ICU registry.

Wound irrigation and peritoneal lavage with antiseptic/antibiotic solution before wound closure during gastrointestinal surgery: a systematic review and meta-analysis.

Background: Surgical site infections (SSIs) can affect mortality, morbidity, and medical costs. Although it has recently been reported that washing with antiseptic/antibiotic solution can prevent SSI in clean surgery, the clinical impact in gastrointestinal surgery is still uncertain. Therefore, we performed a systematic review and meta-analysis to evaluate the efficacy of antiseptic/antibiotic solution during wound irrigation or peritoneal lavage in gastroenterological surgery.

The Brussels consensus for non-invasive ICP monitoring when invasive systems are not available in the care of TBI patients (the B-ICONIC consensus, recommendations, and management algorithm).

Background: Invasive systems are commonly used for monitoring intracranial pressure (ICP) in traumatic brain injury (TBI) and are considered the gold standard. The availability of invasive ICP monitoring is heterogeneous, and in low- and middle-income settings, these systems are not routinely employed due to high cost or limited accessibility. The aim of this consensus was to develop recommendations to guide monitoring and ICP-driven therapies in TBI using non-invasive ICP (nICP) systems.

Minimising harms of tight glycaemic control in older patients with type 2 diabetes.

In older adults with type 2 diabetes (T2DM), tight glycaemic control (HbA1c 7%) can result in more harm than benefit, especially when using insulin or sulfonylureas. Older adults are at higher risk for adverse drug events, especially hypoglycaemia, which may cause falls, confusion and hospitalisations. This Therapeutic Letter evaluates the risks of tight glycaemic control in older adults with T2DM, focusing on deprescribing diabetes medications in those over 65, especially those with multimorbidity and polypharmacy.

Lanthanide Metal-Organic Framework Flowers for Proteome Profiling and Biomarker Identification in Ultratrace Biofluid Samples.

Identifying effective biomarkers has long been a persistent need for early diagnosis and targeted therapy of disease. While mass spectrometry-based label-free proteomics with trace cell has been demonstrated, deep proteomics with ultratrace human biofluid remains challenging due to low protein concentration, extremely limited patient sample volume, and substantial protein contact losses during preprocessing. Herein, we proposed and validated lanthanide metal-organic framework flowers (MOF-flowers), as effective materials, to trap and enrich protein in biofluid jointly through cation-π interaction and O-Ln coordination.

Interpretation of Viscoelastic Hemostatic Assays in Cardiac Surgery Patients: Importance of Clinical Context.

Background: Rotational thromboelastometry (ROTEM) is widely used for point-of-care coagulation testing to reduce blood transfusions. Accurate interpretation of ROTEM data is crucial and requires substantial training. This study investigates the inter- and intrarater reliability of ROTEM interpretation among experts and compares their interpretations with a ROTEM-guided algorithm.

Ten Machine Learning Models for Predicting Preoperative and Postoperative Coagulopathy in Patients With Trauma: Multicenter Cohort Study.

Background: Recent research has revealed the potential value of machine learning (ML) models in improving prognostic prediction for patients with trauma. ML can enhance predictions and identify which factors contribute the most to posttraumatic mortality. However, no studies have explored the risk factors, complications, and risk prediction of preoperative and postoperative traumatic coagulopathy (PPTIC) in patients with trauma.

Mitochondrial oxygen metabolism as a potential predictor of weight loss after laparoscopic sleeve gastrectomy for class III obesity.

Unlabelled: The prevalence of obesity is increasing at an alarming rate in industrialized countries. Obesity is a systemic disease that causes not only macroscopic alterations, but also mitochondrial dysfunction. Laparoscopic sleeve gastrectomy (LSG) poses a potential therapeutic option for patients with severe obesity.

Effectiveness of non-pharmacological intervention protocol for prevention of postoperative delirium in the surgical intensive care unit.

Postoperative delirium (POD) is a common adverse event in patients admitted to the intensive care unit (ICU). We aimed to determine the effectiveness of a multicomponent non-pharmacological intervention protocol to reduce the incidence of POD in elderly patients admitted to the surgical ICU (SICU). This before-and-after cohort study included 300 patients aged ≥ 65 years who were admitted to the SICU within 7 days postoperatively with an anticipated SICU stay > 24 h.

Intermittent enteral nutrition shortens the time to achieve nutritional goals in critically ill patients.

Nutritional support is associated with improved clinical outcomes in critically ill patients; however, loss of muscle mass during critical illness leads to weakness, delayed return to work, and increased healthcare consumption. Animal data have suggested that intermittent feeding decreases protein catabolism. This study was aimed at determining whether the mode of enteral nutrition administration might lead to differences in meeting nutritional goals, tolerance, and complications.

Transitioning from the safety of the womb to the outside world for neonates with life-threatening cardiovascular conditions: The IMmediate Postpartum Access to Cardiac Therapy (IMPACT) Procedure.

The IMmediate Postpartum Access to Cardiac Therapy (IMPACT) procedure is a multidisciplinary, collaborative, highly coordinated clinical service in which a planned delivery and intensive neonatal care are offered for conditions where there is a high likelihood of postnatal instability. This process includes prenatal consultation with the parent(s), involving each service engaged with the delivery, postnatal resuscitation, and procedural care. A Cesarean section delivery is planned in an operating room with immediate access to a multifunctional procedural suite where the neonate can undergo rapid cardiac evaluation and initiation of interventional treatments which can have a positive, life-saving impact.

Does a Simple Blood Gas Analysis and the Clinical Impression Predict Trauma-Induced Coagulopathy?

Objectives:  Trauma-induced coagulopathy (TIC) is common in severely injured patients and is associated with significant morbidity and mortality.

Method:  The association of two parameters of blood gas analysis (hemoglobin [Hb], base excess [BE]) with standard coagulation tests (SCTs) and rotational thrombelastometry (ROTEM) using the database of the TraumaRegister DGU between 2015 and 2022 was studied. In a stepwise approach, the occurrence of a TIC, the correlations between Hb/BE levels and SCT, as well as ROTEM were calculated respectively.

Suspected heparin-induced thrombocytopaenia in pulmonary thromboendarterectomy: retrospective cohort.

Objectives: Heparin is given for anticoagulation during and after pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension. Our objective was to add to the limited data available on the incidence, management and outcomes of suspected heparin-induced thrombocytopaenia after pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension.

Methods: This retrospective single-centre study included consecutive patients with suspected heparin-induced thrombocytopaenia after pulmonary thromboendarterectomy done in 2005-2018.

Assessing fluid responsiveness by using functional hemodynamic tests in critically ill patients: a narrative review and a profile-based clinical guide.

Fluids are given with the purpose of increasing cardiac output (CO), but approximately only 50% of critically ill patients are fluid responders. Since the effect of a fluid bolus is time-sensitive, it diminuish within few hours, following the initial fluid resuscitation. Several functional hemodynamic tests (FHTs), consisting of maneuvers affecting heart-lung interactions, have been conceived to discriminate fluid responders from non-responders.

Key Concepts in Machine Learning and Clinical Applications in the Cardiac Intensive Care Unit.

Purpose Of Review: Artificial Intelligence (AI) technology will significantly alter critical care cardiology, from our understanding of diseases to the way in which we communicate with patients and colleagues. We summarize the potential applications of AI in the cardiac intensive care unit (CICU) by reviewing current evidence, future developments and possible challenges.

Recent Findings: Machine Learning (ML) methods have been leveraged to improve interpretation and discover novel uses for diagnostic tests such as the ECG and echocardiograms.

Coagulation and platelet function in cold-stored whole blood on missions in a helicopter emergency service.

Background: Haemorrhage is a leading cause of morbidity and mortality in trauma, and prehospital transfusion of blood products is often necessary. Whole blood has been proposed to be the best alternative, but it is unclear whether, and how, storage and transport of the blood in a helicopter affects the blood units. We investigated the coagulation capacity and platelet function in whole blood at different time points during helicopter missions.

Impact of invasive infections on clinical outcomes in acute pancreatitis: early predictive factors and implications for prophylactic anti-infective therapy.

Background: The use of antibiotic therapy in acute pancreatitis remains controversial and is currently recommended only for confirmed infections of peripancreatic necrosis. However, reliable early predictors of septic complications and unfavorable outcomes are substantially lacking.

Methods: Patients with acute pancreatitis were retrospectively reviewed and divided into two groups: one with a septic course defined by pathogen detection [GERM(+)] and one without [GERM(-)].

Novel use of ultrasound-guided high-intensity focused ultrasound (HIFU) may enable the neuroablation of the sacroiliac joint in a swine model: a feasibility study.

Background: Sacroiliac joint (SIJ) dysfunction accounts for the etiology of pain in 15%-30% of low back pain cases. Some patients with conservative treatment-refractory SIJ dysfunction undergo radiofrequency (RF) ablation of the SIJ for prolonged pain relief. This procedure involves placing up to 12 RF probes in what is an invasive, resource-intensive, and time-consuming process.

Brain acid sphingomyelinase controls addiction-related behaviours in a sex-specific way.

Addiction is a chronic and severe mental disorder with high gender- and sex-specificity. However, the pathogenesis of this disorder is not fully elucidated, and no targeted pharmacotherapy is available. A growing body of evidence points out the potential involvement of the ceramide system in the pathophysiology of addiction.

Comparison of Piperacillin-tazobactam and Vancomycin (TZP-VAN) with Piperacillin-tazobactam and Teicoplanin (TZP-TEI) for the risk of Acute Kidney Injury (CONCOMITANT): A prospective observational, multinational, multi-centre cohort study.

Objectives: Both vancomycin (VAN) and teicoplanin (TEI) augment the risk of acute kidney injury (AKI) when combined with piperacillin-tazobactam (TZP). We aimed to compare the risk of AKI among patients receiving TZP-VAN versus TZP-TEI.

Methods: This was a prospective, multinational, multicentre cohort study conducted in 12 centres from Turkiye, Italy and Spain between June 1, 2022, and December 31, 2023.

Decision support guided fluid challenges and stroke volume response during high-risk surgery: a post hoc analysis of a randomized controlled trial.

Intravenous fluid is administered during high-risk surgery to optimize stroke volume (SV). To assess ongoing need for fluids, the hemodynamic response to a fluid bolus is evaluated using a fluid challenge technique. The Acumen Assisted Fluid Management (AFM) system is a decision support tool designed to ease the application of fluid challenges and thus improve fluid administration during high-risk surgery.

Impact of hemoadsorption with CytoSorb® on meropenem and piperacillin exposure in critically ill patients in a post-CKRT setup: a single-center, retrospective data analysis.

Purpose: CytoSorb® (CS) adsorbent is a hemoadsorption filter for extracorporeal blood purification often integrated into continuous kidney replacement therapy (CKRT). It is primarily used in critically ill patients with sepsis and related conditions, including cytokine storms and systemic inflammatory responses. Up to now, there is no evidence nor recommendation for the use of CS filters in sepsis (22).

The use of noninvasive positive pressure ventilation for severe asthma: a systematic review and meta-analysis of randomized controlled trials with trial sequential analysis.

Introduction: To evaluate the effectiveness of noninvasive positive pressure ventilation (NPPV) versus standard therapy in severe asthma exacerbations through meta-analysis.

Methods: Nine randomized controlled trials (344 patients) were analyzed from inception to August 2024. Primary outcomes included respiratory rate, forced expiratory volume in first second (FEV1), and oxygen saturation (SpO2).

Granulocyte and Monocyte Adsorption Therapy in Patients With Sepsis: A Feasibility Study.

Background: The pathogenesis of sepsis is thought to be linked to a dysregulated immune response, particularly that involving neutrophils. We have developed a granulocyte adsorption column as a "decoy organ," which relocates the massive inflammation in organs in the body to a blood purification column. This study was conducted to assess the safety and experimental effectiveness of granulocyte monocyte adsorption apheresis-direct hemoperfusion (G1-DHP) in the treatment of patients with sepsis, using a prospective, multicenter design.