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New-onset atrial fibrillation (NOAF) frequently occurs in critically ill patients admitted to intensive care units (ICUs), yet definitions and outcome reporting remain inconsistent across clinical studies. This heterogeneity impedes evidence synthesis and limits the development of standardized management strategies. A scoping review was conducted following the Arksey and O'Malley framework and reported using PRISMA-ScR guidelines. Electronic databases were searched from 1990 to 2024 for randomized controlled trials and observational studies reporting on NOAF in acutely unwell ICU patients. Data on arrhythmia definitions and reported outcomes were extracted and categorized using the ISPOR framework. This is the first study to systematically examine and compare diagnostic criteria for NOAF in ICU-based research. Out of 8477 records, 44 studies (4 RCTs, 12 prospective, and 28 retrospective observational studies) met inclusion criteria. Significant heterogeneity was found in how NOAF was defined, including arrhythmia duration thresholds, diagnostic criteria, and heart rate cut-offs. Outcomes were primarily clinician-reported (n = 101), followed by observer-reported (n = 74), biomarker (n = 25), and patient-reported outcomes (n = 4), with no performance outcomes identified. Common outcomes included rhythm and heart rate control, arrhythmia recurrence, mortality, and length of stay, though definitions and timeframes varied considerably across studies. This review identifies substantial methodological variation in both the definition and measurement of NOAF in ICU research. The findings are immediately applicable to clinical practice, enabling ICU teams to benchmark diagnostic and monitoring approaches, align practice with guideline-based definitions, and identify patients who may benefit from structured post-discharge follow-up. They also provide evidence for the importance of the development a Core Outcome Set for NOAF.

To explore the interventional effects of a targeted diaphragmatic function exercise bundle strategy, guided by ultrasound assessment, on nutritional status, diaphragmatic function, muscle strength, and hospital stay of mechanically ventilated patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated by type II respiratory failure. A randomized controlled study was conducted. Patients with AECOPD complicated by type II respiratory failure who received mechanical ventilation in the Department of Critical Care Medicine, the Second Hospital of Tianjin Medical University from January to December 2024 were enrolled. Using a random number table, patients were divided into an experimental group and a control group. The control group received routine intensive care unit (ICU) treatment and nursing care. On the basis of routine care, the experimental group received a targeted diaphragmatic function exercise bundle strategy based on ultrasound assessment, including limb function exercises and respiratory function training. The duration and intensity of the exercises were adjusted according to the patient's vital signs, clinical condition, tolerance, and daily improvement in diaphragmatic function. The following indicators were compared between the two groups before the intervention and on the 7th day of intervention: nutritional indicators [albumin, total protein, hemoglobin, body mass index (BMI), Nutritional Risk Screening 2002 (NRS2002) score]; diaphragmatic function (diaphragmatic excursion, diaphragmatic thickness); blood gas analysis indicators (pH value, arterial partial pressure of oxygen, arterial partial pressure of carbon dioxide, base excess, lactate, alveolar-arterial oxygen gradient); and muscle strength. The duration of mechanical ventilation, length of ICU stay, and total hospital stay were also compared between the two groups. A total of 134 patients were finally enrolled, including 66 in the experimental group and 68 in the control group. There were no statistically significant differences in baseline data including gender, age, Acute Physiology and Chronic Health Evaluation II, nutritional indicators, blood gas analysis parameters, diaphragmatic excursion, diaphragmatic thickness, and muscle strength between the two groups (all P>0.05). Compared with before intervention, both groups showed varying degrees of improvement in diaphragmatic function indicators, blood gas analysis indicators, and muscle strength on the 7th day of intervention, but nutritional indicators decreased. On the 7th day of intervention, the experimental group had better nutritional indicators (albumin, total protein, hemoglobin, and BMI) than the control group [albumin (g/L): 27.49&#xb1;3.78 vs. 26.03&#xb1;3.76, total protein (g/L): 55.84&#xb1;6.17 vs. 53.42&#xb1;6.22, hemoglobin (g/L): 105.10&#xb1;24.74 vs. 96.80&#xb1;21.17, BMI (kg/m2): 24.84&#xb1;2.55 vs. 24.12&#xb1;1.13, all P<0.05]. The improvements in diaphragmatic excursion and diaphragmatic thickness were greater in the experimental group than in the control group [difference in diaphragmatic excursion before and after intervention (cm): 0.182&#xb1;0.030 vs. 0.104&#xb1;0.020; difference in diaphragmatic thickness before intervention and after intervention (cm): 0.023&#xb1;0.004 vs. 0.014&#xb1;0.002, both P<0.05], and muscle strength was enhanced in the experimental group compared with the control group (&#x3c7; 2=21.860, P=0.001), whereas there were still no statistically significant differences in blood gas analysis indicators between the two groups (all P>0.05). Compared with the control group, the experimental group had a significantly shorter duration of mechanical ventilation [hours: 137.5 (90.8, 202.2) vs. 162.5 (92.5, 263.8)], shorter length of ICU stay [days: 9.0 (5.8, 14.5) vs. 11.0 (7.0, 18.0)], shorter total hospital stay [days: 12.0 (7.0, 20.0) vs. 17.0 (10.0, 23.5)], and a higher weaning success rate (89% vs. 76%), with all differences being statistically significant (all P<0.05). Implementation of the targeted diaphragmatic function exercise bundle strategy based on ultrasound assessment can effectively improve nutritional status and diaphragmatic function, enhance muscle strength, and shorten the duration of mechanical ventilation and hospital stay in mechanically ventilated patients with AECOPD complicated by type II respiratory failure. It can serve as an effective adjunctive treatment for these patients.

Every year, millions of patients pass through emergency departments and intensive care units where clinicians must make life-altering decisions under time pressure and uncertainty. Advances in machine learning is poised to offer support for clinical decision-making, including prediction of patient deterioration, triage guidance, and identification of rare but clinically critical outcomes. Yet a persistent impediment limits its utilization in these settings: clinical data are often severely imbalanced, with critical outcomes occurring far less frequently than routine ones. This skewness can bias models toward majority classes, degrading performance. Developing models that are both robust to such imbalance and computationally efficient enough for deployment in time-sensitive environments remains an open and practically important challenge. In this paper, we empirically studied the robustness and scalability of six model families spanning classical machine learning, deep learning, and tabular foundation models on imbalanced tabular data from two large-scale clinical datasets (MIMIC-IV-ED and eICU). Class imbalance was quantified using three complementary metrics, and we compared tree-based methods (Decision Tree, Random Forest, XGBoost), the TabNet deep learning model, and two tabular foundation models (TabICL and TabPFN v2.6). All trainable models were evaluated under a unified experimental protocol using Bayesian hyperparameter optimization for trainable models, while foundation models were assessed in their pretrained inference regime without task-specific optimization or reweighting. All models were assessed on predictive performance (Macro F1-score), robustness to increasing imbalance, and computational scalability across seven clinically relevant prediction tasks. Results differed across databases. On MIMIC-IV-ED, foundation-based models (TabPFN v2.6 and TabICL) attained the strongest average Macro F1-score ranks, with XGBoost and other tree-based ensembles remaining competitive. On eICU, XGBoost consistently led, followed by other tree-based methods, while foundation models occupied intermediate positions. Across both datasets, TabNet exhibited the sharpest performance degradation under increasing imbalance and the highest computational costs. Training time analyses showed that classical and tree-based methods scale most favorably with dataset size, while foundation models achieved low per-task cost through their inference-based paradigm. These findings indicate that model selection for imbalanced clinical tabular data is context-dependent: no single family dominated across both datasets and all tasks. Nonetheless, recent advances in tabular foundation models suggest a rapidly narrowing performance gap with strong classical baselines such as XGBoost, while offering a distinct computational profile characterized by low per-task adaptation cost. This efficiency-performance trade-off may become increasingly relevant for deployment in resource-constrained clinical environments. Rather than prescribing a universal solution, this work provides clinical stakeholders with an empirically grounded framework for navigating the trade-offs between predictive robustness, computational scalability, and clinical feasibility in high-stakes, time-sensitive care environments.

The levels of alpha-1-antitrypsin (AAT) peptides could be used as prognostic biomarkers in critically ill patients, and peptide treatment has therapeutic efficiency in experimental sepsis. However, the regulation of AAT peptides in M. musculus is unknown, although they may be prerequisites for peptide-based therapies. This study aims to quantify murine AAT peptides and investigate their regulation during experimental sepsis.LC-MS/MS was used to quantify six AAT peptides from two murine AAT isoforms in plasma of septic mice.Peptide mC36-2 is the most abundant and significantly regulated murine AAT peptide, with approximately 20-fold higher level than in critically ill patients. In contrast, the upregulation of peptide C42 in septic patients is absent in mice; thus, it may represent a specific marker of human disease. Nevertheless, the increase and kinetics of mC36 during experimental sepsis reflect our observations in patients.In summary, the conserved upregulation of AAT peptides reflects important pathophysiological mechanisms of severe infections; thus, peptide levels can be used as predictive biomarkers in experimental and clinical sepsis. Although species-specific differences exist and need to be considered, quantification of AAT peptides might help to characterize individual immune responses and build the foundation for novel therapeutic approaches in pre-clinical and clinical research.

Perioperative antithrombotic management in neurosurgery carries significant bleeding and thrombosis risks. This survey aimed to provide the first structured analysis of current practices, resource availability, and decision-making heterogeneity across the coordinated neurocritical care network in Lombardia (Lombardy) an administrative region in Northern Italy. This cross-sectional, region-wide survey involved all 19 hospitals performing neurosurgery in Lombardy. It analyzed multiple domains of perioperative anticoagulant management, including preoperative risk assessment, laboratory monitoring, use of bridging therapy, reversal strategies, and timing of pharmacologic thromboprophylaxis. The head of service collected responses from two to four experienced colleagues at each center. Participation was voluntary and anonymous, and no patient-level data were collected. Data were analyzed descriptively using R software; categorical variables are expressed as number (percentage) and continuous variables as mean&#xb1; (SD)[median (IQR)]. The survey revealed marked variability across all domains, with clinical approaches remaining fragmented and largely driven by institutional culture rather than standardized protocols. A systemic lack of data collection on institutional postoperative hemorrhage and deep vein thrombosis epidemiology was found, with available data often based on subjective estimates. There is underutilization of formal thrombotic risk scores (e.g., Padua, IMPROVE) and predominantly reactive use of viscoelastic testing (ROTEM/TEG). Only 20.7% of respondents routinely involve both a Cardiologist and a Hematologist for multidisciplinary assessment. Furthermore, the timing of low-molecular-weight heparin administration varies widely: most responders delay initiation until postoperative day two to four after intracranial procedures, often deviating from guidelines recommending initiation within 24 hours when safe. The findings highlight the urgent need for structured, consensus-based perioperative anticoagulation pathways tailored to neurosurgical populations. Priority areas include standardizing venous thromboembolism prophylaxis timing and modality, promoting the systematic use of viscoelastic testing, and creating regional registries to track hemorrhagic and thrombotic events and improve evidence-based decision-making.

Sepsis is a life-threatening condition associated with significant morbidity and mortality worldwide. The emergency department (ED) plays a crucial role in the early recognition and management of sepsis, as delays in treatment are strongly associated with worse outcomes. Although sepsis management guidelines and care bundles have been widely implemented to standardize and accelerate care, their impact on patient outcomes remains variably reported. This systematic review evaluated the effect of implementing sepsis management guidelines in EDs on both process indicators and clinical outcomes. A systematic search was conducted across PubMed, Scopus, Web of Science, and the Cochrane Library using a combination of controlled vocabulary and free-text terms related to sepsis, emergency care, and guideline implementation, yielding 4,309 records; after removal of duplicates and screening, eight studies met the inclusion criteria. Data extraction was performed using a standardized form capturing study characteristics, interventions, and outcomes, and risk of bias was assessed using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. The included studies comprised diverse designs, including before-and-after studies, retrospective cohort studies, observational studies, and one quasi-experimental trial. Overall, implementation of sepsis guidelines consistently improved process measures, including reduced time to antibiotic administration, increased lactate testing, improved blood culture collection, and higher compliance with sepsis bundles. However, effects on clinical outcomes were heterogeneous: some studies reported reductions in mortality, intensive care unit (ICU) admissions, and resource utilization, while others showed no significant mortality benefit despite improved process indicators. Additionally, some studies reported unintended consequences such as increased antimicrobial use and potential overtreatment. Most studies were judged to have a moderate to serious risk of bias, largely due to confounding and non-randomized designs. In conclusion, implementation of sepsis management guidelines in EDs is associated with consistent improvements in care processes and timeliness of treatment, but evidence for improved clinical outcomes, particularly mortality, remains inconsistent and is limited by study design and risk of bias; further high-quality studies are needed to establish causality, optimize implementation strategies, and balance timely treatment with antimicrobial stewardship.

Disrupted cerebral blood flow is suggested to contribute to secondary brain injury after cardiac arrest (CA). This study aimed to investigate cerebral microcirculation after return of spontaneous circulation (ROSC) following asphyxial CA. We hypothesized that contraction of pericytes after ROSC compromises cerebral capillary blood flow. Transgenic C57BL/6NRj mice (n=19) of both sexes were studied. Mice were expressing tdTomato as a fluorescent reporter under the control of the platelet-derived growth factor receptor &#x3b2; promoter to label pericytes. Chronic cranial windows were implanted 3&#x2009;weeks before the experiment. Four minutes of asphyxial CA was followed by cardiopulmonary resuscitation. Two-photon microscopy assessed cerebral hemodynamics in the same cohort of mice at both 3 and 24&#x2009;hours after ROSC. Of 13 mice in the CA group, 9 achieved ROSC; 6 and 5 mice survived to 3 and 24&#x2009;hours after ROSC, respectively. Arterial blood pressure was similar between groups 3 and 24&#x2009;hours after ROSC. At 3&#x2009;hours after ROSC, pial arteries and penetrating arterioles were constricted in the CA group compared with sham (arteriole diameter, 12.2&#x2009;&#x3bc;m [95% CI, 10.9-13.4] versus 15.6&#x2009;&#x3bc;m [95% CI, 13.8-17.5] in CA and sham; P=0.003). Similarly, first- and second- to third-order capillaries showed reduced diameters 3&#x2009;hours after ROSC (first-order diameter, 3.9&#x2009;&#x3bc;m [95% CI, 3.5-4.2] versus 5.3&#x2009;&#x3bc;m [95% CI, 4.8-5.9] in CA and sham; P=0.002). The vasoconstriction was associated with slower red blood cell velocities throughout the capillary network (for second- to third-order capillaries upstream from venule; 0.78&#x2009;mm/s [95% CI, 0.46-1.09] versus 2.14&#x2009;mm/s [95% CI, 1.73-2.55]; P<0.001) and increased capillary flow stalling. Artery-to-vein mean transit time was increased and relative transit-time heterogeneity was decreased 3&#x2009;hours after ROSC. By 24&#x2009;hours after ROSC, vessel diameters, blood flow velocity, transit time, and capillary stalling were not different compared with sham. Cerebrovascular vasospasm 3&#x2009;hours after ROSC was associated with impaired cerebral microcirculation and increased capillary flow stalling.

Background/Objectives: In-hospital cardiac arrest (IHCA) remains a devastating event associated with high morbidity and mortality among general ward patients. While Rapid Response Systems (RRS) can help identify deteriorating patients, maintaining these systems in secondary hospitals is frequently hindered by severe fiscal and personnel constraints. Consequently, evidence regarding the real-world clinical effectiveness of artificial intelligence software as a medical device (AI-SaMD) for predicting deterioration in such resource-constrained settings remains limited. Methods: We conducted a retrospective analysis on a multicenter, staggered-implementation study evaluating 164,761 eligible adult general ward admissions across three secondary hospitals in South Korea. The intervention involved deploying an AI-SaMD (DeepCARS), which utilizes four routine vital signs to predict ward IHCA within 24 h. The primary outcome was ward IHCA. Secondary outcomes included in-hospital mortality and length of stay (LOS). Exploratory analyses investigated the mechanisms of clinical outcomes by evaluating lead-times to interventions, outcomes in sepsis subgroups, changes in care directives, and post-arrest neurological outcomes. Results: AI-SaMD implementation was associated with a 21% reduction in ward IHCA incidence (adjusted rate ratio 0.79; 95% CI, 0.65-0.96; p = 0.016) and a 15% reduction in in-hospital mortality (aRR 0.85; 95% CI, 0.79-0.90; p < 0.001), alongside significantly shorter hospital and intensive care unit LOS. These associations were also observed in patients with sepsis (IHCA aRR 0.71; 95% CI, 0.54-0.93; p = 0.013). Lead-times to critical care intervention and to antibiotic escalation were numerically shorter in the AI-SaMD group by 16.3 h (p = 0.066) and 2.6 h (p = 0.523); poor neurological outcome at discharge among ward IHCA cases was 85/108 (78.7%) in the AI-SaMD group versus 63/102 (61.8%) in the standard-care group (aRR 1.13; 95% CI, 0.99-1.33; p = 0.058); and the full-code death rate did not differ between groups (aRR 0.94; 95% CI, 0.76-1.15)-none of these additional analyses reached statistical significance. Conclusions: In secondary hospitals unable to operate an RRS due to fiscal limitations, implementation of an AI-SaMD as an additional informational layer was associated with lower ward IHCA and in-hospital mortality. The AI-SaMD may serve as an actionable and scalable additional safety layer for general-ward patients in resource-constrained environments where RRS infrastructure is not feasible. Although this was a multicenter, large-scale study, the present analysis was retrospective and quasi-experimental in design; rigorous randomized studies are needed to confirm these associations.

Interstitial lung diseases (ILDs) represent a heterogeneous group of disorders, which have in common persistent inflammation and/or pulmonary fibrosis, involving mainly but not exclusively the interstitium. This results in restrictive ventilatory physiology and limited respiratory reserve. Patients with ILD can have frequent exacerbations of their disease, with subsequent acute respiratory failure that may require admission to the intensive care unit (ICU). The diagnosis and management of ILD in the ICU presents unique challenges due to the paucity of evidence supporting survival benefits of organ support in this cohort of patients. This systematic review will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, and the protocol will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guideline. MEDLINE, Embase, Emcare and CENTRAL will be searched for studies published from inception to 2026, involving adult patients with ILD requiring invasive mechanical ventilation (IMV), with or without comparison to non-invasive respiratory support such as high-flow oxygen, non-invasive ventilation (NIV), continuous positive airway pressure or bilevel positive airway pressure. Eligible studies will include randomised controlled trials and observational studies (cohort and case-control) in adults with ILD and acute respiratory failure requiring IMV in the intensive care setting. Case series with fewer than 10 patients, non-human or in vitro studies and studies involving perioperative lung transplant or lung cancer as the primary diagnosis will be excluded. The primary outcomes assessed will be in-hospital and 1-year mortality, and secondary outcomes will include ventilator-free days, ICU and hospital length of stay, NIV failure, reintubation and postdischarge respiratory outcomes where available. Where feasible, meta-analysis will be conducted using a random-effects model. Heterogeneity will be assessed using the I&#xb2; statistic. Prespecified subgroup analyses will be performed, including ILD subtype (eg, idiopathic pulmonary fibrosis (IPF) vs non-IPF), presence of pulmonary hypertension, timing of IMV initiation (early vs late), baseline lung function (forced vital capacity &#x2265;50% vs <50%), ventilation strategy (lung protective vs non-specified) and geographical region (eg, Europe, North America, Asia). Sensitivity analyses will be conducted to evaluate robustness of results. Risk of bias will be assessed using the Cochrane Risk of Bias 2 tool (RoB 2) for randomised studies and the Newcastle-Ottawa Scale for non-randomised studies. The quality of evidence will be assessed by using the Grading of Recommendations Assessment, Development and Evaluation approach. This systematic review will be based on published data, and as such, no ethical approval is required. Findings from this study will be disseminated through peer-reviewed publications as well as presentations in healthcare-based settings. CRD420251265836.

Mucoactive agents are widely used in patients with acute respiratory failure despite limited evidence of their effectiveness or safety. We conducted a multicenter, open-label, randomized trial with a 2-by-2 factorial design that involved critically ill, mechanically ventilated participants 16 years of age or older with acute respiratory failure and difficult-to-clear secretions. All participants received usual care along with carbocisteine (750 mg three times daily enterally), 6% or 7% nebulized hypertonic saline (HTS) (4 ml four times daily), both interventions, or usual care alone for up to 28 days. The primary outcome was duration of mechanical ventilation (from randomization to first successful unassisted breathing). The primary comparisons were between any carbocisteine and no carbocisteine and between any HTS and no HTS, with each comparison comprising two treatment groups. A total of 1956 participants underwent randomization: 486 were assigned to carbocisteine, 485 to HTS, 492 to both treatments, and 493 to usual care alone (472, 474, 479, and 478, respectively, were included in the primary analysis). No evidence of treatment interaction was found (hazard ratio, 1.01, 95% confidence interval [CI], 0.83 to 1.22; P&#x2009;=&#x2009;0.91). The median duration of mechanical ventilation was 186.1 hours (95% CI, 168.3 to 196.6) with carbocisteine and 172.7 hours (95% CI, 165.2 to 190.4) with no carbocisteine (adjusted hazard ratio, 0.96; 95% CI, 0.87 to 1.05; P&#x2009;=&#x2009;0.34) and 184.5 hours (95% CI, 165.6 to 194.1) with HTS and 174.3 hours (95% CI, 166.9 to 192.7) with no HTS (adjusted hazard ratio, 1.00; 95% CI, 0.91 to 1.10; P&#x2009;=&#x2009;0.98). Clinically important upper gastrointestinal bleeding occurred significantly more often with carbocisteine than with no carbocisteine (13 of 965 [1.4%] vs. 2 of 966 [0.2%]; risk ratio, 6.51; 95% CI, 1.47 to 28.76; P&#x2009;=&#x2009;0.01). Bronchoconstriction leading to bronchodilator use occurred significantly more often with HTS than with no HTS (23 of 967 [2.4%] vs. 4 of 964 [0.4%]; risk ratio, 5.73; 95% CI, 1.99 to 16.52; P&#x2009;=&#x2009;0.001), as did hypoxemia during nebulization (40 of 967 [4.1%] vs. 3 of 964 [0.3%]; risk ratio, 13.29; 95% CI, 4.12 to 42.83; P<0.001). One serious adverse reaction was reported in the combination group. Among critically ill patients with acute respiratory failure, neither carbocisteine nor HTS significantly reduced the duration of mechanical ventilation, and each was associated with harm. (Funded by the NIHR Health Technology Assessment Programme and the Belfast Health and Social Care Trust Charitable Trust Fund; MARCH ISRCTN Registry number, ISRCTN17683568.).

During deep anesthesia, the EEG becomes discontinuous. Burst-suppression is often an intended target during deep sedation or medically induced coma. Within this state, anesthetic depth is commonly monitored by the suppression ratio (SR), which expresses the fraction of time spent in suppression. However, accumulating evidence suggests that SR remains reactive to external stimulation. We tested whether ambient music commonly played in operating theaters alters the SR in male Wistar rats under sevoflurane, chloral hydrate, or isoflurane anesthesia. To this end, the first 60 s of the Stayin' Alive audio track by the Bee Gees were played to examine auditory-induced burst-suppression reactivity in an experimental model previously established for intermittent photic stimulation. SR and the burst-suppression reactivity index (BSRi, derived as the decrease in SR during stimulation normalized to pre-stimulation SR) were measured in repeated trials. Auditory stimulation transiently decreased SR under all three anesthetics. This was associated with an increase in the rate of burst occurrence without increased burst duration. The BSRi changes depended on the anesthetic type, comparable to photic stimulation. Our experimental data suggest that the suppression ratio used to monitor targeted burst-suppression reflects both anesthetic depth and the level of ambient stimulation. Ambient sound in the operating theater or intensive care settings could influence EEG-based measures used for anesthesia monitoring.

The shift from reusable to single-use anaesthesia devices, such as laryngoscope blades, is increasingly questioned because of the financial and environmental costs of disposables. Validated disinfection methods enabling safe reuse could provide clinical, economic, and sustainability benefits. In this laboratory-based experimental study, disposable McGRATH&#x2122; X-blade video laryngoscope blades were artificially contaminated with Staphylococcus aureus and subjected to automated ultraviolet-C (UV-C) light-emitting diode (LED) disinfection under different reprocessing conditions. An integrated assessment was performed, including microbiological efficacy, material integrity after repeated UV-C exposure, estimated economic and environmental impact, and regulatory considerations. Results were compared with single-use, steam autoclaving, and chlorine dioxide wipe-based disinfection. UV-C disinfection reduced Staphylococcus aureus contamination to undetectable levels across all experimental conditions; unpackaged cleaned, uncleaned blades, and packaged uncleaned blades (n=6, n=5, and n=5, respectively). No visible degradation, functional impairment, or deterioration in image quality was observed after repeated UV-C exposure. Per-cycle cost was less than &#x20ac;0.20, and greenhouse-gas emissions were reduced by 92-94% compared with single-use. In contrast, autoclaving or chemical disinfection compromised blade usability. Automated UV-C LED treatment effectively disinfected McGRATH X-blades under controlled laboratory conditions, preserving material integrity and offering substantial environmental and economic advantages. This approach may support more sustainable anaesthetic practice where validated point-of-care reprocessing is implemented.

Severe community-acquired pneumonia (CAP) is one of the most common di-agnoses in the medical intensive care unit. The objective of this study is to seek an effective and clinically tolerable dosage of &#x3c9;-3 (EPA+DHA) fatty acids (FA) in enterally fed patients with severe pneumonia. A total of 84 patients were randomly assigned to a control group or two experimental groups from January 2022 to June 2024, each receiving 3.50g and 8.75g of &#x3c9;-3 FA daily for 7 days, and clinical outcomes and tolerance parameters were collected. &#x3c9;-3 FA supplementation significantly reduced mechanical ventilation (MV) duration, hospital expenses, and daily hospital costs. Mechanistically, the anticipated anti-inflammatory effect was not observed but a trend of immune enhancement was noted. The addition of 3.50g and 8.75g of &#x3c9;-3 FA daily was relatively well-tolerated in patients with severe pneumonia. In this pilot study, &#x3c9;-3 FA supplementation at 3.50-8.75 g/day to enterally fed patients with severe pneumonia for 7 days was relatively well-tolerated, shortened days of MV, and decreased hospital cost. Further investigation with adequate statistical power and larger sample size is warranted to confirm these clin-ical benefits and establish the optimal dosage for this supplementation strategy.

Irrational use of intravenous (IV) proton pump inhibitors (PPIs) for stress ulcer prophylaxis (SUP) in critically ill patients increases the risk of adverse drug reactions (ADRs), and may lead to longer stays in the intensive care unit (ICU). A single-center, retrospective, observational study was conducted to assess the practices with prescribing IV SUP in critically ill adult patients treated at ICUs between January 2020-December 2022. Data was collected from electronic medical records, using a pre-designed checklist. Appropriateness of SUP administration was determined using the American Society of Health-System Pharmacists (ASHP) recommendations. Medical records of 1076 patients were analyzed; majority of patients (80.9%; n = 873) received IV SUP during their ICU stay, with the most commonly prescribed drug being omeprazole (99.2%). 75.5% of patients had no major or minor risk factors based on ASHP guidelines. The rationale of SUP was deemed appropriate in 51.7% of cases. Among patients treated at specific ICU wards, male patients were less likely (OR: 0.587 [95% CI: 0.345-0.998]; p = 0.048), while ventilated patients were more likely (OR: 2.525 [95% CI: 1.219-5.233]; p = 0.013) to receive SUP. Furthermore, &#x2265;10 days of hospital stay corresponded to notable increase (OR: 4.076 [95% CI: 0.870-19.098]; p = 0.086) in the probability of receiving SUP. The results may provide a basis for developing protocols related to acid-suppressive therapy in critically ill adults, calling for heightened awareness and tailored interventions to optimize pharmacological care in ICU settings.

Human metapneumovirus (hMPV) is an important cause of pediatric lower respiratory tract infection. We describe the epidemiology and clinical severity of hMPV-associated pediatric hospitalizations in Italy in the post-coronavirus disease 2019 period and identify predictors of pediatric intensive care unit (PICU) admission and prolonged hospitalization. We conducted a multicenter observational study across 11 tertiary care centers in Italy. Children hospitalized for &#x2265;48 hours with laboratory-confirmed hMPV infection between January 2023 and June 2025 were included. Clinical features were analyzed overall and compared across co-infection categories and age groups. Associations with prolonged hospitalization (>7 days) and PICU admission were evaluated using logistic regression models. A total of 312 children were hospitalized with hMPV infection (median age 14 months, interquartile range 5-36); 86.2% were <5 years, and 44.6% were infants <1 year. Oxygen supplementation was required in 67.5% of cases, and 10.6% were admitted to the PICU. Co-detected pathogens were identified in 47.1% of cases, without significant differences in severity or outcomes. Infants experienced more severe respiratory involvement, whereas older children more frequently had underlying comorbidities, radiologic consolidation and received antibiotics. In adjusted models, comorbidities, moderate-to-severe respiratory distress, dehydration and higher base excess were independently associated with prolonged hospitalization and PICU admission. In the post-coronavirus disease 2019 period, hMPV remains a clinically relevant cause of pediatric hospitalization, particularly among infants and children with underlying medical conditions. Simple bedside assessment of respiratory distress and hydration status may support early risk stratification and inform diagnostic-driven clinical management, including antimicrobial stewardship.

Relatives of patients with delirium are often confronted with patients' challenging behaviours such as hyperactivity, aggression, or hallucinations. As a result, feelings of anxiety and depression episodes have been described. The aim is to identify psychosocial support intervention for relatives of patients with delirium in hospitals, describe components and effects, and identify research gaps. Systematic review based on PRISMA, including psychosocial support intervention studies addressing burden and support needs of adult relatives of hospital patients with delirium. We searched the databases Medline, Web of Sience, CINAHL, Livivo, PsycINFO, and Cochrane Library in 07/2024 and reference lists. We assessed reporting using TIDieR and CReDECI2 and methodological quality using ROB-1 and the JBI tool for quasi-experimental studies. We performed narrative syntheses. We identified eight intervention studies addressing relatives of patients with delirium in different settings. Intervention components included provision of information using flyers, videos, web-sites, or telephone calls, and mentoring in the intensive care unit. Reporting of interventions was mostly poor. No study reported a process evaluation. Four of six studies showed a significant difference in relatives' delirium knowledge. For relatives' psychological outcomes, no clear effects were shown. Overall, study quality was limited. More effectiveness studies are needed with better reporting of intervention components, ideally addressing psychological aspects. Feasibility and acceptance of new interventions should be described within accompanying process evaluations. https://osf.io/7jbsk .

Prolonged mechanical ventilation is closely associated with ventilator-induced lung injury (VILI) and ventilator-induced diaphragm dysfunction (VIDD). These two conditions occur in parallel and contribute to delayed weaning, prolonged intensive care unit (ICU) stay, and poor clinical outcomes. This study evaluated whether human BM-MSC-derived extracellular vesicles (EVs) can simultaneously alleviate lung and diaphragm abnormalities in a unique rat experimental ICU (ExICU) model. Rats were subjected to 5 days of controlled mechanical ventilation with or without a single intravenous EV dose. Outcomes included lung histopathology, diaphragm single-fiber contractile function, transcriptomics and metabolomics of diaphragm muscle, proteomics and metabolomics of lung tissue, and serial proteomics of bronchoalveolar lavage fluid (BALF). Five days of mechanical ventilation in the ExICU model were accompanied by severe lung morphological damage and approximately 50% reductions in diaphragm fiber size and specific force. EV treatment was associated with parallel improvements in lung pathology and diaphragm function. Multi-omics revealed coordinated molecular disturbances across lung, BALF, and diaphragm after mechanical ventilation, the majority of which were reversed by EVs. Our findings demonstrate an association between lung injury and diaphragm dysfunction during prolonged mechanical ventilation. BM-MSC-derived EVs exert parallel protective effects on both organs and represent a promising intervention to reduce complications of mechanical ventilation in critically ill patients.

The calcitonin gene-related peptide (CGRP) is a 37-amino acid neuropeptide belonging to the calcitonin family, discovered as a product of alternative splicing of the calcitonin gene. CGRP has emerged as a pleiotropic signaling molecule with widespread distribution in the central and peripheral nervous systems, particularly within primary sensory neurons. This narrative review synthesizes current knowledge on the CGRP system, integrating recent advances in its molecular structure, gene organization, and post-translational processing with high-resolution structural insights into its heterodimeric receptor complex (CLR-RAMP1) obtained through cryo-electron microscopy. We also include long-term safety data on anti-CGRP monoclonal antibodies, emerging cardiovascular risk signals, and novel therapeutic applications in vestibular migraine and pediatric populations. The intracellular signaling cascades activated by CGRP, including the canonical cAMP-PKA pathway, MAP kinase activation, and context-dependent calcium signaling, are discussed in relation to its diverse physiological functions. These encompass vasodilation, nociception modulation, neurogenic inflammation, gastrointestinal motility, bone metabolism, tissue regeneration, and energy homeostasis. The central role of CGRP in migraine pathophysiology is examined to understand the development of targeted therapies. The current pharmacological landscape is reviewed, including the evolution of small-molecule CGRP receptor antagonists (gepants) through three generations and the four approved monoclonal antibodies targeting CGRP or its receptor, with comparative analysis of their efficacy, safety profiles, and clinical positioning. Beyond migraine, emerging and predominantly preclinical roles of the CGRP system are discussed in chronic pain, osteoarthritis, cardiovascular diseases, sepsis, cancer (particularly bone metastases and tumor microenvironment immunomodulation), and neurodegenerative disorders such as Alzheimer's disease. In these areas, the available evidence remains heterogeneous and, in most cases, is not yet sufficient to support clinical translation. Finally, future directions are discussed, including the development of stable CGRP analogs, allosteric modulators, and the potential expansion of therapeutic applications into oncology, intensive care medicine, and neuroprotection.

Situational awareness (SA) is a critical nontechnical skill for intensive care unit (ICU) physicians, underpinning safe decision-making and patient safety. Despite its importance, evidence regarding how SA is assessed and improved in ICU practice remains fragmented. To map the existing evidence on interventions and assessment methods for SA among physicians in adult ICUs, and to evaluate their reported effectiveness. Scoping review of randomised controlled trials, quasi-experimental studies, cross-sectional studies, and qualitative studies, conducted in accordance with PRISMA-Scr guidelines. MEDLINE, Web of Science, Scopus, and PsycINFO were searched from inception to July 2024. Reference lists and supplementary searches were performed. We included studies involving ICU physicians, residents and medical students working in adult ICUs that assessed or intervened on SA. Exclusions included studies limited to paediatric/neonatal ICUs, non-ICU staff, inter-unit handovers, reviews, opinion pieces and nonpeer-reviewed literature. From 991 records, 11 studies were included. Simulation-based training consistently improved SA and team co-ordination, while lecture-based training alone was largely ineffective. Crew resource management (CRM) courses increased self-reported awareness but had mixed effects on outcomes. Technological tools (e.g. dashboards, 3D visualisations) showed promise in enhancing early recognition of clinical deterioration and supporting decision-making. SA assessment was most frequently performed using the Situation Awareness Global Assessment Technique (SAGAT), though this remains impractical for real-time ICU use. Methodological quality was generally moderate, with small sample sizes and heterogeneity limiting quantitative synthesis. Simulation-based interventions and novel technological tools appear most effective in enhancing SA among ICU physicians, whereas CRM and didactic methods yield mixed results. The lack of validated, ICU-specific SA assessment tools represents a critical gap. Future research should focus on scalable, team-based training models, context-appropriate assessment instruments, and integration of technological decision-support to strengthen SA and improve patient safety.