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Rehabilitation is recognised as a cornerstone of intensive care, essential for optimising functional recovery and reducing long-term disability. Contemporary ICU populations, characterised by advanced age, multimorbidity, and prolonged stays, are at heightened risk of muscle wasting, immobility, frailty, cognitive decline, and functional dependence. Mitigation of these sequelae requires careful interprofessional collaboration for person-centred rehabilitation across the care continuum. This review synthesises evidence from randomised controlled trials, meta-analyses, and clinical practice guidelines on rehabilitation during and after intensive care. Best practice within the ICU begins with early awakening and mobilisation with evidence demonstrating that physical rehabilitation is safe, with low adverse-event rates. Furthermore, multiprofessional strategies that span across ICU, ward, and community are required to address complex problems including physical, cognitive, and psychological sequelae of critical illness. Research priorities include detailed reporting of intervention dose (timing, intensity, duration) for both usual care and rehabilitation provided within clinical trials, and development of intervention implementation strategies that enhance uptake and fidelity in routine practice. Rehabilitation is integral to contemporary ICU care, spanning the trajectory of recovery into the community. Within the ICU, it requires interprofessional, experienced healthcare personnel to assess clinical status for safe rehabilitation and to identify an individual's anticipated recovery trajectory. Standardised intervention reporting and implementation-focussed research are essential to advance evidence and improve outcomes for critically ill patients.
Intensive care unit (ICU) demand is increasing, while healthcare professional shortages and turnover threaten capacity, care quality, and patient safety. This nationwide survey quantified intention to stay (ITS), leave (ITL), or being undecided among ICU professionals in Germany and assessed associated determinants. An anonymous, nationwide, cross-sectional online survey of ICU physicians, registered nurses, and allied health professionals was conducted by the Young German Interdisciplinary Association of Critical Care and Emergency Medicine between December 2024 and February 2025. Primary outcome was ITS in the ICU for at least three years. Determinants were examined using multinomial logistic regression. Of 1524 questionnaires, 1243 were eligible; median ICU experience was 7 years. 51.1% of respondents were physicians, 39.1% registered nurses and 9.8% allied health professionals. Overall, 45.4% reported ITS, 23.2% ITL, and 31.2% were undecided. A 10-point higher job satisfaction was associated with greater ITS versus being undecided (OR 1.34, 95%-CI[1.24-1.45], p < 0.001) and ITL (OR 1.49, 95%-CI[1.37-1.62], p < 0.001). Similarly, higher perceived family-friendliness was associated with greater ITS versus ITL (OR 1.11, 95%-CI[1.02-1.20], p = 0.013). Rotating day-night shift work was associated with higher ITL (OR 0.56, 95%-CI[0.34-0.92], p = 0.021). Association of annual career development dialogues were attenuated after adjustment, consistent with indirect effects via job satisfaction. More than half of ICU professionals were at risk of leaving intensive care within three years. Job satisfaction and family-friendliness emerged as key correlates of retention. Prospective studies are needed to determine whether these aspects are potentially modifiable factors to improve retention.
The complexity and rapidly evolving nature of critical patient care in Intensive Care Units underscore the importance of the accuracy and timeliness of nursing decisions, further highlighting the significance of nursing education. This study aims to examine the accuracy of four generative artificial intelligence tools (ChatGPT 5.0 Plus, ChatGPT 5.0, DeepSeek, and Google Gemini) in answering multiple-choice questions related to the intensive care nursing exam, a fundamental area in nursing education. In the study, the ChatGPT 5.0 Plus, ChatGPT 5.0, DeepSeek, and Google Gemini models were evaluated using a test data set consisting of 55 questions. The questions were classified according to their difficulty levels as easy (n = 16), medium (n = 17), and difficult (n = 22). The models' correct response rates and standard or unique correct/incorrect response distributions were examined. Computer-assisted statistical analysis used the Chi-square, one-way ANOVA, and Post-hoc Tukey tests. The study was reported according to STROBE. According to the study results, the success rates of all models were similar for easy and medium-level questions (70-82%), and the difference between them was not statistically significant (p > 0.05). Under difficult questions, however, the performance of the models diverged significantly, with Google Gemini achieving the highest success rate at 77.27% and DeepSeek showing the lowest performance at 45.45%. The chi-square analysis revealed no statistically significant difference in the correct/incorrect distribution among the models (χ²=3.69; p = 0.296), but at the observational level, Google Gemini had a higher number of unique correct answers (n = 6) compared to the other models. ChatGPT 5.0 was found to have no unique errors. In conclusion, while AI models generally showed similar levels of success in intensive care nursing exam questions, Google Gemini demonstrated superior performance in difficult questions, and DeepSeek showed the lowest level of success among the models. The study provides an essential comparative framework regarding the usability of AI-based learning and assessment tools in nursing education. It offers guidance for the future development of AI-based educational technologies. Not applicable.
The global shortage of healthcare professionals is a critical challenge driven by demographic changes, workforce attrition, and increasing healthcare demands. Older professionals contribute valuable experience and interpersonal skills but are often underutilized due to stereotypes, health concerns, and challenges in adapting to new technologies. This systematic review, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 reporting guideline, examined strategies to recruit and retain older healthcare professionals and to promote intergenerational collaboration. A comprehensive literature search was performed in PubMed, Medline, and Google Scholar for studies published before March 2025 that addressed recruitment and retention strategies, workplace diversity, and collaboration across generations. Of 224 records initially identified, 84 met the inclusion criteria and were synthesized narratively. Effective recruitment strategies included community-based outreach and flexible work arrangements, while retention measures such as phased retirement, mentoring programs, and workplace health initiatives supported knowledge transfer, job satisfaction, and workforce stability. Digital knowledge management and structured mentoring programs further facilitated intergenerational collaboration. A structured approach to workforce planning that integrates diversity and inclusivity can help mitigate healthcare workforce shortages by leveraging the strengths of different generations. Ensuring adaptable working conditions, intergenerational collaboration, and continuous knowledge exchange can strengthen workforce resilience and support the sustainability of healthcare systems. Future research should evaluate the long-term effects of these strategies on workforce stability and patient outcomes.
Recruiting patients/family for research related to intensive care unit (ICU) care can be challenging. To engage diverse stakeholders (patients with recent ICU discharge, their families/caregivers, ICU clinicians, and health services researchers) to identify barriers to research engagement among recently discharged patients and their family members/caregivers and to highlight strategies to address the barriers. Four sessions of group concept mapping, a participatory research and engagement approach, were used with 16 former patients and their family members/caregivers and 23 professionals (clinicians and researchers) to elicit barriers to ICU research participation. Strategies to address the barriers were outlined and categorized according to themes identified in the literature, with input from a patient and family advisory board. Ninety-eight unique barriers were identified and organized into 7 clusters: negative experiences surrounding ICU stay, difficult research logistics, patient and family characteristics, ICU setting limitations, post-critical illness issues, research fears, and (mis)perceptions about research. Strategies to overcome those barriers were identified and outlined in an open access, web-based toolkit to help ICU clinicians and researchers engage people in research. Ensuring that patients and families have sufficient information about research participation, promoting a research-supportive culture, addressing uncertainty about research participation, and providing clinical staff with access to research training can help engage ICU patients and family members in critical care research.
Children who survive critical illness commonly experience long-term morbidities. Little is known about the association of critical illness with cognitive health due to lack of preillness and postillness assessments and an adequate comparison population. To use school-based testing to evaluate cognitive health outcomes among children treated in the pediatric intensive care unit (PICU) compared with non-PICU-exposed control students. This retrospective case-control study used statewide academic data and propensity score matching of 1088 patients admitted to the only PICU in Arkansas from January 1, 2008, to December 31, 2018, as well as controls matched on sociodemographic and pre-PICU admission academic factors. Statistical analysis was performed from March 2024 to September 2025. PICU admission. Primary outcomes were (1) return to standardized testing, assessed using multivariable logistic regression to assess the odds of having a standardized test within 2 years after PICU admission compared with controls, and (2) change in pre-PICU to post-PICU test scores for PICU patients compared with propensity-matched control students, assessed using multivariable linear regression. In this case-control study of 1088 school-aged patients (mean [SD] age, 12.1 [1.6] years; 566 girls [52.0%]), fewer PICU patients than controls had test scores after admission for math (80.6% [874 of 1085] vs 86.5% [938 of 1085]; adjusted odds ratio [AOR], 0.64 [95% CI, 0.51-0.81]) and reading (81.1% [877 of 1081] vs 87.1% [941 of 1081]; AOR, 0.64 [95% CI, 0.51-0.82]). PICU patients' preadmission z scores were below average in math (z = -0.23 [95% CI, -0.29 to -0.16]) and reading (z = -0.22 [95% CI, -0.29 to -0.15]) compared with Arkansas students in the same grade and year. In adjusted pre-post analyses, PICU patients had a small but significant decrease in reading relative to controls (-0.07 [95% CI, -0.14 to -0.01]). The change in math score was not statistically significant (-0.06 [95% CI, -0.13 to 0.003]). This study suggests that PICU patients were less likely to take standardized tests after discharge and that those who did had greater decreases in reading scores relative to matched controls. Future studies should identify risk factors for nonreturn to testing and score decrease.
Post-extubation dysphagia (PED) is a prevalent and debilitating complication in intensive care unit (ICU) patients, yet the longitudinal heterogeneity of swallowing recovery remains poorly understood. This study was aimed to characterize distinct recovery trajectories of swallowing function in ICU patients with PED and to identify the clinical predictors associated with each pattern. This longitudinal observational study utilized convenience sampling to enroll ICU patients from a tertiary hospital. Swallowing function was evaluated using the Standard Swallowing Assessment (SSA) at seven time points post-extubation, at 4-6, 24, 48, and 72 h and 7, 14, and 28 days. Latent recovery trajectories were identified using growth mixture modeling (GMM), and independent predictors of group membership were determined by multivariate logistic regression. Of 495 intubated patients, 248 (54.98%) developed PED and were included; 209 completed all follow-up assessments. Three distinct trajectories emerged: Group HS (high level, slow improvement; 10.0%), Group HR (high level, rapid improvement; 22.5%), and Group LE (low level, early recovery; 67.5%). For both Group HR and Group HS, membership was predicted by older age, neurological diagnosis, higher peak inspiratory pressure, longer intubation duration, and early pharyngeal pain. In addition, membership in Group HR was uniquely associated with an APACHE II score of 10-14 and exposure to fiberoptic bronchoscopy. Post-extubation swallowing recovery follows distinct trajectories shaped by physiological, procedural, and disease-related factors. Early trajectory identification allows for personalized, stage-specific interventions to optimize functional outcomes and mitigate long-term morbidity.
To compare the safety of conventional physiotherapy alone versus its combination with cycloergometry by analysing session interruptions and physiological tolerance in critically ill patients. Secondarily, efficacy was assessed through strength and functional related outcomes. Single-centre, parallel, two-arm, randomized clinical trial. Intensive Care Department. Mechanically ventilated patients. Control group received 30-min of conventional physiotherapy; intervention group received 15-min of cycloergometry and 15-min of conventional physiotherapy. Safety was evaluated by recording session interruptions and changes in blood pressure, heart rate, respiratory rate, SpO2, FiO2 and tidal volume before and after sessions. Muscle strength (modified Medical Research Council score, quadriceps and handgrip strength) was evaluated at first cooperation of participants, ICU discharge, 28-day and 6-month follow-up; Activities of Daily Living score and mobility scale at ICU discharge, 28 days and 6 months; and six-minute walking test and Short Form-36 at 28 days and 6 months. 46 participants completed 732 sessions. Both interventions produced significant but comparable physiological changes. Cycloergometry sessions were longer (30 vs. 25 min, p < 0.001) and had more interruptions (13% vs. 7%, p = 0.008), mainly due to fatigue and lack of cooperation. With the applied methodology no significant differences were observed in muscle strength or functional outcomes at any time point. Partially replacing conventional physiotherapy with cycloergometry was safe and well tolerated in critically ill patients. However, due to methodological limitations and the small sample size, no firm conclusions regarding efficacy can be drawn.
To evaluate 25-year national trends in paediatric intensive care utilisation, patient outcomes, rehospitalisations and regional resource distribution in Israel. Retrospective, population-based cohort study of all paediatric (0-17 years) ICU hospitalisations in Israel between 1999 and 2023. We linked the National Hospital Discharge Register with paediatric ICU bed capacity data and Central Bureau of Statistics population estimates. Outcomes included age-adjusted ICU admission rates, in-hospital and 1-year post-discharge mortality, rehospitalisation at 7, 30 and 365 days, and paediatric ICU beds per 100 000 children. The proportion of hospitalisations involving ICU care increased from 3.53% to 6.1%. In-hospital ICU mortality declined from 4.3% to 2.3%, and 1-year post-discharge mortality decreased from 3.2% to 2.6%. One-year rehospitalisation occurred in 46% of ICU survivors versus 29% of non-ICU patients. Between 2018 and 2023, national paediatric ICU bed capacity rose by 23%, yet regional bed-to-population ratios varied up to 2.6-fold. Over 25 years, paediatric ICU utilisation and capacity nearly doubled, accompanied by reductions in mortality. However, persistently high rehospitalisation rates and regional disparities underscore the need for structured post-ICU follow-up, standardised admission criteria, equitable resource allocation and further research to clarify drivers of ICU utilisation and long-term outcomes.
Predicting enterocutaneous fistula (ECF)-associated sepsis and mortality poses significant challenges in digital health care due to the disease's complexity and heterogeneous clinical manifestations. Current approaches that rely on single-modal data or traditional scoring systems often fail to capture the intricate immune-inflammatory dynamics and multisystem involvement in patients with ECF. This study aims to develop an artificial intelligence (AI)-driven multimodal fusion model integrating clinical, imaging, and transcriptomic data for early prediction of ECF-associated sepsis and 28-day mortality, addressing the limitations of conventional single-dimensional models. This study leveraged publicly available datasets (Medical Information Mart for Intensive Care III [MIMIC-III], electronic Intensive Care Unit [eICU], and The Cancer Genome Atlas) to construct a multimodal framework. Clinical parameters were processed using Extreme Gradient Boosting, abdominal imaging features were extracted via convolutional neural networks, and transcriptomic profiles were analyzed with variational autoencoders. A Transformer-based fusion network was employed for joint prediction and validated through cross-validation and external testing. Key features were identified using Shapley Additive Explanations and Local Interpretable Model-Agnostic Explanations interpretability algorithms, while immune regulatory mechanisms were explored via weighted gene co-expression network analysis. The multimodal model achieved an area under the curve (AUC) of 0.89 for predicting sepsis and 28-day mortality, outperforming unimodal models (clinical-only model, AUC 0.72, and imaging-only model, AUC 0.78). Critical predictors included Sequential Organ Failure Assessment score, lactate levels, intra-abdominal free fluid on imaging, and immunoregulatory genes (programmed death-ligand 1 [PD-L1] and indoleamine 2,3-dioxygenase 1 [IDO1]). Mechanistic analysis revealed distinct immune reprogramming in patients with sepsis, characterized by increased regulatory T cells and M2 macrophages, along with downregulated cluster of differentiation 8+ (CD8+) T cells. This multimodal AI model offers an innovative digital solution in medical informatics, enabling precise early risk stratification for ECF-associated sepsis. By integrating multisource data and providing interpretable insights into immune-inflammatory pathways, the model enhances health care quality for patients with ECF and paves the way for personalized intervention strategies.
Previously, young children had limited respiratory support options during interfacility transport. Recently, high-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) have become available for pediatric transport. We hypothesized that the implementation of HFNC and NIV on interfacility transport decreases the rate of intubation in infants and toddlers before and after transport to a tertiary-care pediatric intensive care unit (PICU). We conducted a retrospective chart review of children aged 30 days to < 36 months transported to a tertiary-care PICU from a referring hospital with respiratory distress from 2014 to 2019. Groups were analyzed before (2014-2017) and after the implementation (2017-2019) of HFNC and NIV during transport. NIV was defined as positive pressure ventilation delivered through nasal cannula. The primary outcome was to compare the pre- and postimplementation groups with regard to the rate of intubation before transport and within 48 hours of PICU admission. Secondary outcomes were the association between intubation rate and comorbidities and the comparison of length of respiratory support and hospital length of stay between the pre- and postimplementation groups. A total of 262 patients met criteria, 133 before and 129 after the intervention. The rate of intubation before PICU admission was 44% in the preintervention group versus 36% in patients transported after the implementation of HFNC and NIV, a trend that was not statistically significant (P = .19). The rate of intubation within 48 hours of PICU admission was 8% (before) and 11% (after) with no statistical significance (P = .48). Comorbidities were not associated with an increased rate of intubation before transport (P = .09) or within 48 hours of admission (P = .45). Hospital length of stay and length of respiratory support were not different between pre- and postintervention groups (P = .18 and P = .3, respectively). The availability of HFNC/NIV was associated with a significant decrease in the proportion of patients who received oxygen via nasal cannula or face mask during transport (46% before vs. 13% after the intervention; P < .01). After the introduction of HFNC/NIV during transport to a large tertiary-care hospital in a major metropolitan area, fewer nasal cannula/face masks were used during transport in favor of HFNC/NIV but no significant change in intubation rates was found.
Respiratory syncytial virus has traditionally been associated with childhood illness, but it is increasingly recognised as a cause of severe disease in adults, particularly older people and those with chronic comorbidities. Despite its growing clinical relevance, evidence describing outcomes and predictors of disease severity in adults remains relatively limited. To identify factors associated with hospital admission, clinical severity and 90-day mortality in adults with respiratory syncytial virus infection. A single-centre observational cohort study was conducted including 340 adults with polymerase chain reaction-confirmed respiratory syncytial virus infection between October 2023 and September 2024. Clinical, demographic and care-related variables were analysed using multivariable logistic regression and ordinal regression models. Clinical severity was assessed using an ordinal composite outcome including non-hospitalisation, hospital admission, intensive care unit admission and death. Of the 340 patients, 172 (50.6%) required hospital admission and 39 (11.5%) died within 90 days. Age 65 years or older, diabetes mellitus, immunosuppression, institutionalisation and chronic heart disease were independently associated with hospital admission. Age 65 years or older and chronic kidney disease were the strongest predictors of 90-day mortality. Ordinal regression analysis showed that these factors were consistently associated with increasing clinical severity. Adults with respiratory syncytial virus infection experience substantial morbidity and mortality, particularly those who are older, have chronic comorbidities or are socially vulnerable. These findings support early risk stratification and may assist critical care and interprofessional teams in identifying patients who require closer monitoring and timely escalation of care.
Acute ischemic stroke (AIS) is a major cause of functional disability and mortality in the geriatric population. This study aimed to evaluate the predictive performance of the prognostic nutritional index (PNI), geriatric nutritional risk index (GNRI), and the controlling nutritional status (CONUT) score for in-hospital mortality among critically ill geriatric patients. Critically ill AIS patients admitted to a tertiary hospital intensive care unit from January 2021 to January 2023 were retrospectively analyzed. Patients were classified into survivor and mortality groups. Nutritional scores were calculated: PNI = (10 × serum albumin [g/dL]) + (0.005 × total lymphocyte count); GNRI = (1.489 × albumin [g/dL]) + (41.7 × [body weight/ideal body weight]); CONUT (scored 0-12 based on serum lymphocyte count, cholesterol, and albumin). The predictive performances of the scores for in-hospital mortality were compared. A total of 142 patients were included, with 25 in the mortality group and 117 in the survivor group. The median age was 77 (range: 68-84) years, and 55.6% (n = 79) were female. Demographic characteristics (age, sex, body mass index) were similar between groups. Median PNI (36.3 vs 39.5, P = .017), GNRI (53.4 vs 56.6, P = .007), and CONUT (2 vs 2, P = .012) scores were significantly lower in the mortality group. Multivariate regression analysis showed that GNRI was an independent predictor of mortality (odds ratio = 0.935, 95% confidence interval = 0.877-0.998, P = .042). Receiver operating characteristic analyses showed a PNI cutoff value of ≤34.2 (area under curve [AUC] 0.653, 0.535-0.770), GNRI ≤56.2 (AUC 0.672, 0.577-0.767), and CONUT ≥1.5 (AUC 0.659, 0.545-0.773). Nutritional scores such as PNI, GNRI, and CONUT can predict mortality in critically ill geriatric AIS patients in the intensive care unit. Their prognostic performances were found to be similar.
Clinical debriefing is a key strategy to promote iterative team adaptation and Safety-II learning (from successes, failures, and performance variation). To explore changes in communication behaviors after implementation of the TALK framework for voluntary team self-debriefing. A 12-month, single-center interventional study in critical care at a university hospital. Data were collected on debriefing frequency, use of structured debriefing, perceived barriers, and the nature of improvement actions resulting from debriefing episodes. At baseline, 45.4% of the 653 shift teams reported considering debriefing; after the intervention, 65.4% to 95.0% of teams did so. A mean of 7.2 debriefings per week were completed. The gap between consideration and completion widened significantly, primarily due to the perception of having "no issues to discuss." Use of structured debriefing and the TALK framework increased from 0% to 100%. Concurrently, reporting of barriers to debriefing declined from 25% at baseline to 0% at 12 months. Voluntary, spontaneous team self-debriefing occurred more often than previously reported. Introduction of the TALK framework led to substantial reductions in barriers to reflective conversations, a 3-fold increase in structured debriefings, and greater team-driven engagement in improvement. As consideration of debriefing increased, so did the "intention-behavior gap," largely due to a lack of identified issues to discuss, highlighting the need for targeted strategies to promote Safety-II learning.
Carbon dioxide is a key determinant of cerebral blood flow and is needed to prevent secondary damage in neurocritical care; however, optimal targets across the heterogeneous spectrum of acute brain injury (ABI) remain to be elucidated. The aim of this study was to evaluate the association between arterial hypocapnia and mortality and neurological outcomes in adult patients with ABI. Six electronic databases were systematically searched from inception to January 2025. Observational and randomized controlled trials comparing exposure to hypocapnia, defined as an arterial partial pressure of carbon dioxide (PaCO2) lower than 35 mmHg, and no-hypocapnia in adult patients with ABI-related conditions (including traumatic brain injury, subarachnoid hemorrhage, intracerebral hemorrhage, ischemic stroke, central nervous system infections, brain tumors, and post-cardiac arrest encephalopathy) were included. Random-effects meta-analyses were conducted using the restricted maximum likelihood (REML) method to pool unadjusted odds ratios (ORs). The primary outcome was all-cause mortality, and the secondary outcome was the occurrence of poor neurological outcomes defined using validated scales. Prespecified subgroup analyses and meta-regression were conducted to explore sources of heterogeneity. A total of 8,637 records were identified after duplicate removal, of which 37 studies met inclusion criteria for the systematic review. Twenty-seven studies (51,373 patients) were included for mortality outcomes, and thirteen studies (3,814 patients) were included for neurological outcomes. Hypocapnia was associated with higher odds of mortality in adult patients with ABI (OR 1.29, 95% CI 1.05-1.59). Subgroup analyses demonstrated variability across ABI types, with stronger associations observed in subarachnoid hemorrhage and ischemic stroke populations. Hypocapnia was also associated with increased odds of poor neurological outcomes (OR 2.09, 95% CI 1.24-3.54), particularly in the traumatic brain injury population. Subgroup analyses suggested that the association with neurological outcomes was more consistent in studies defining exposure as severe hypocapnia (PaCO2<32 mmHg). Arterial hypocapnia was associated with increased mortality and poor neurological outcomes in adults with acute brain injury, although the evidence is predominantly observational and limited randomized data are available. These findings underscore the need for cautious, individualized PaCO2 management and further high-quality prospective research.
ObjectiveThe ROX index, combining oxygenation and respiratory rate, is widely used to assess respiratory failure. However, its prognostic value in critically ill patients with chronic obstructive pulmonary disease (COPD) remains unclear. This study aimed to explore the association between the ROX index and mortality in ICU patients with COPD.MethodsThis retrospective cohort study included patients with COPD from two large databases: MIMIC-IV (v3.1) and eICU-CRD (v2.0). The ROX index was calculated within the first 24 hours of ICU admission. The primary outcome was in-hospital mortality, with ICU mortality and 28-day mortality as secondary outcomes. Cox regression models, Kaplan-Meier survival curves, restricted cubic spline (RCS) analysis, and subgroup analyses were used to evaluate the association between ROX and mortality.ResultsA total of 1,639 patients from the MIMIC-IV cohort and 2,170 from the eICU-CRD cohort were included. In multivariable Cox regression, a higher ROX index was independently associated with a lower risk of in-hospital mortality (MIMIC-IV: HR = 0.96, 95% CI: 0.93-0.98; eICU-CRD: HR = 0.95, 95% CI: 0.92-0.98). Similar associations were observed for ICU and 28-day mortality. RCS analysis demonstrated a linear negative correlation between ROX and the risk of death. Subgroup analyses showed consistent results across various clinical strata. The E-value analysis suggested that a considerable amount of unaccounted confounding would be necessary to invalidate the observed associations.ConclusionsThe ROX index is inversely associated with mortality in critically ill patients with COPD, with higher values indicating better prognosis. It may serve as a simple, non-invasive, and valuable tool for early risk stratification in the ICU setting.
Data collection in randomized trials is expensive and labor intensive. With the rise in ongoing pragmatic trials, the use of electronic medical records (EMR) as a source of data has increased. Although potentially faster and cheaper, EMR use can lead to errors. Therefore, to ensure accurate data collection and to avoid systematic errors we performed a study comparing automated data extraction (ADE) with manual data extraction (MDE). We performed a retrospective cohort study to compare the accuracy of ADE using Structured Query Language with MDE by blinded physicians from our EMR. We tested the interrater agreement and intraclass correlation coefficient of clinical baseline data and outcomes of a random sample of 30 patients admitted to the ICU, on mechanical ventilation, requiring opioids for analgosedation for an upcoming pragmatic clinical trial. Key data compared included, but not limited to, patient's demographics, laboratory and vital signs, daily morphine milligram equivalent (MME), days alive and free of mechanical ventilation, days alive and free of hospitalization, days alive and free of ICU, days alive and free of vasopressors, and death. Among 238 patients screened over 1-month period, 72 fulfilled inclusion criteria and 30 were randomly selected to be included in the evaluation. We blindly collected 1320 baseline data, 2160 categorical outcomes and 705 continuous outcomes for a total of 4185 data points. The intraclass correlation coefficient and the Cohen's Kappa were perfect or almost perfect for all data, including outcomes such as daily MME, days alive and free of mechanical ventilation, days alive and free of ICU and days alive and free of hospital with p < 0.001. Among all rechecked data, the ADE was correct in 53 (77.9%) of cases, while MDE in 15 (22.1%). The inaccurate data collected by ADE accounted for 0.36% of the total data-points. The performance of ADE had almost perfect agreement for all outcomes and when rechecking for disagreements, it was more accurate than MDE.
The serial performance of C-reactive protein (CRP), procalcitonin, and emerging biomarker pancreatic stone protein (PSP) was evaluated for the diagnosis of infection and sepsis in patients admitted to the intensive care unit (ICU). All consecutive adult patients with suspected infection or sepsis upon their admission to the ICUs of three multi-speciality hospitals in the UAE were enrolled. CRP, procalcitonin, and PSP levels were measured at admission and repeated within 24-48 h. Patients were categorized into infection vs. non-infection, sepsis vs. non-sepsis groups, and into culture-positive and culture-negative subgroups. A total of 272 ICU patients were analyzed. All biomarkers could be used to distinguish infection with CRP (AUROC 0.77; 95% confidence intervals [CI] 0.70-0.83) and procalcitonin (AUROC 0.75; 95% CI 0.68-0.81) showing fair performance. Moreover, serial monitoring at 24-48 h improved performance, especially for procalcitonin (p = 0.04). Among patients with infection, PSP levels were higher in culture-positive compared to culture-negative patients, but the difference did not reach statistical significance (median 229 vs. 142 ng/ml, p = 0.05). However, all three biomarkers failed to discriminate sepsis with an AUROC of 0.56 (95% CI 0.49-0.64) for CRP, 0.54 (95% CI 0.46-0.62) for procalcitonin, and 0.58 (95% CI 0.50-0.66) for PSP, respectively. Combining biomarkers improved specificity (93.85%) but with reduced accuracy. Despite a significant rise in all biomarkers, procalcitonin has overall better performance for diagnosing infections. None of the biomarkers could differentiate sepsis at admission.
This pilot study aimed to evaluate the feasibility, safety, and preliminary effects of a 12-week self-exercise program delivered via a three-dimensional (3D) animation-based mobile application for individuals with spinal cord injury (SCI). Fifteen manual wheelchair users with SCI participated in a progressive 12-week intervention. The program utilised a smartphone application featuring 3D animated exercises designed to enhance motor learning and rehabilitation adherence. Primary outcomes included adherence rates, user satisfaction, and physical function (muscle strength, arm circumference). Secondary outcomes included metabolic markers and health-related quality of life (HRQoL). The intervention demonstrated high feasibility, with an 81.0% adherence rate and a satisfaction score of 39.8/50. Significant improvements were observed in upper extremity strength, including elbow flexors, extensors, and grip strength (p < 0.001). However, no significant changes were found in cardiometabolic markers or HRQoL. This divergence likely reflects the strategic focus of the protocol on musculoskeletal strengthening rather than intensive cardiorespiratory conditioning. No serious adverse events occurred; minor events, such as transient muscle soreness (28.6%), resolved spontaneously. A 3D animation-based mobile exercise program is a feasible and well-accepted tool for SCI rehabilitation, showing significant potential for enhancing upper extremity strength. While metabolic and quality-of-life changes were limited - potentially due to the specificity and short duration of the intervention - the high adherence and safety profiles suggest this platform is a reliable tool for long-term rehabilitation. Further investigation through large-scale randomised controlled trials is warranted to optimise multi-modal protocols. The use of a 3D animation-based mobile application significantly improved adherence to self-directed exercise programs, suggesting that interactive, visual guidance can sustain long-term engagement in home-based rehabilitation for individuals with SCI.The intervention demonstrated substantial improvements in upper extremity strength, which is critical for activities of daily living, wheelchair mobility, and overall independence for individuals with SCI, underscoring the potential of this technology in functional rehabilitation.The success of this pilot study in integrating mobile health technology offers a promising pathway for scalable, individualised rehabilitation programs that can be tailored to the unique needs of patients with SCI, potentially reducing barriers to access and enhancing the continuity of care beyond clinical settings.