Search Results (18)

Background and Objectives: This study aimed to compare the effects of patient-preferred music delivered intraoperatively versus postoperatively on Emergence Delirium (ED) incidence, severity, and duration, while identifying predictors, to evaluate non-pharmacologic interventions for enhanced anesthetic management. Materials and Methods: In a prospective, single-blind, randomized controlled trial, 360 patients aged ≥ 65 years undergoing elective surgery under general anesthesia were randomized to intraoperative music, postoperative music, or control groups. Participants selected genres played via headphones. Primary outcome was ED incidence (Richmond Agitation–Sedation Scale [RASS] score ≥ +1 within 60 min after extubation); secondary outcomes included severity, duration, visual analogue scale pain scores, satisfaction, and adverse events. Results: Intraoperative music reduced ED incidence (13.8% vs. 28.7% in controls, p < 0.001) and severity (mean RASS 1.3 vs. 1.8, p < 0.01). Postoperative music shortened duration (15.2 vs. 22.5 min, p < 0.01) and pain (mean visual analogue scale 3.0 vs. 4.2, p < 0.01). Both improved satisfaction (p < 0.001). Higher preoperative State–Trait Anxiety Inventory scores predicted ED (odds ratio [OR] 1.06, p = 0.01), with music protective (OR 0.45–0.62). Conclusions: Intraoperative music effectively prevents ED, and postoperative music improves recovery. Integrating patient-preferred music and screening for anxiety may enhance peri-anesthesia care in elderly patients. Full article

The latest FAO report indicates that aquaculture accounts for 51% of the global production volume of fish and seafood. However, despite the continuous growth of this activity, there is evidence of the excessive use of groundwater in its production processes, as well as pollution caused by nutrient discharges into surface waters due to the water exchange required to maintain water quality in fishponds. Given this context, the objectives of this study were as follows: (1) to review which emergent and floating plant species are used in constructed wetlands (CWs) for the bioremediation of aquaculture wastewater; (2) to identify the aquaculture species whose wastewater has been treated with CW systems; and (3) to examine the integration of CWs with recirculating aquaculture systems (RASs) for water reuse. A systematic literature review was conducted, selecting 70 scientific articles published between 2003 and 2023. The results show that the most used plant species in CW systems were Phragmites australis, Typha latifolia, Canna indica, Eichhornia crassipes, and Arundo donax, out of a total of 43 identified species. These plants treated wastewater generated by 25 aquaculture species, including Oreochromis niloticus, Litopenaeus vannamei, Ictalurus punctatus, Clarias gariepinus, Tachysurus fulvidraco, and Cyprinus carpio, However, only 40% of the reviewed studies addressed aspects related to the incorporation of RAS elements in their designs. In conclusion, the use of plants for wastewater treatment in CW systems is feasible; however, its application remains largely at the experimental scale. Evidence indicates that there are limited real-scale applications and few studies focused on the reuse of treated water for agricultural purposes. This highlights the need for future research aimed at production systems that integrate circular economy principles in this sector, through RAS–CW systems. Additionally, there is a wide variety of plant species that remain unexplored for these purposes. Full article

Due to its good adaptability, the pneumatic conveying feeder has been widely developed and applied in recirculating aquaculture systems (RASs). Its important performances include the integrity of feed pellets and the feeding accuracy. The aim of this study was to design and evaluate a feed distribution device for a small-scale pneumatic conveying feeder. A cylindrical hopper with a feed capacity of 4 kg and a feed distribution device were designed based on theoretical calculations. The motion and force of feed pellets during the distribution process were studied using the discrete element method (DEM) simulation to evaluate the integrity of feed pellets. Additionally, to evaluate feeding accuracy, the effect of discharge disk rotational speed on single feeding quantity was studied using DEM simulations and experimental validations, as well as the effect of the proportion of feed pellets in the hopper. Results showed that the maximum force on feed pellets was 1.25 N during the distribution process. It was inferred that the feed pellets can be distributed without breaking based on their shear strength. When the rotational speed of the discharge disk was set at a maximum of 28 rpm, the relative error of single feeding quantity between simulation and actual experiments was 4.43%, and the single feeding mass was 62.74 g, suggesting an optimal speed. In addition, the average single feeding quantity ranged from 262 to 301 feed pellets at the different proportions of feed pellets in the hopper, and its coefficient of variation was 12.46%, which generally meets the distribution requirements of the small-scale feeder. This study provides a feed distribution device for a small-scale pneumatic conveying feeder and offers references for the relevant analysis of DEM simulation. Full article

During the COVID-19 pandemic, concerns grew about excessive opioid dosing in Intensive Care Unit (ICU) patients. This study aimed to evaluate opioid dosing in the ICU by comparing objective (Nociception Level Monitor (NOL)) and subjective (Behavioral Pain Score (BPS)) pain measurement tools in COVID-19 and non-COVID-19 ICU patients. This observational study included 40 sedated, mechanically ventilated ICU patients, with half confirmed as COVID-19. Measurements included NOL, BPS, Richmond Agitation Sedation Scale (RASS), Bispectral Index (BIS) and nurse questionnaires. NOL was categorized as <10 (possible excessive analgesia), 10–25 (adequate analgesia), and >25 (possible need for more analgesia). The Time Weighted Average (TWA) assessed the duration of NOL >25 (TWA_NOL>25). Primary outcomes were NOL and BIS over time. COVID-19 patients received higher sufentanil (18 ± 9 µg/h versus 9 ± 6 µg/h) and propofol (307 ± 127 mg/h versus 277 ± 137 mg/h) doses (p < 0.001). No significant differences were found in TWA_NOL>25 (p = 0.78) or BPS (p = 0.1). NOL values were <10 for 63% and 57% of the time in COVID-19 and non-COVID-19 patients. BIS (p < 0.001) and RASS (p = 0.02) were lower in COVID-19 patients. While COVID-19 patients received higher opioid doses, low NOL and BPS were seen in all patients, suggesting high analgesia in all patients. Based on our data, we cannot determine whether higher opioid doses in COVID-19 were warranted. Full article

Seahorses are increasingly regarded as a promising farming object suitable for recirculating aquaculture systems (RASs) due to their high economic value. However, reports on the large-scale farming of seahorses in RASs are rare, and some key parameters, such as stocking densities, are still unclear. In the present study, we employed the lined seahorse (Hippocampus erectus), for which large-scale farming has been achieved, to determine the suitable stocking density for three different-sized juveniles in RASs. The three different-sized juveniles had body heights of 4.0, 7.0, and 9.0 cm, and their test density gradients were 1.0, 0.8, 0.6, and 0.4 inds/L; 0.6, 0.5, 0.4, and 0.3 inds/L; and 0.4, 0.3, 0.2, and 0.1 inds/L, respectively. The juveniles were cultivated for one month, and then their survival, growth, and plasma cortisol and brain serotonin contents (two stress-related indicators) were analyzed. The results show that, regardless of the size of the juveniles, a high density can inhibit growth and trigger stress responses. In addition, for small- (4.0 cm) and medium-sized (7.0 cm) juveniles, a high density can also exacerbate size heterogeneity and cause death. Taking into account the welfare and yield of farmed seahorses, the present study suggests that the suitable stocking densities for 4.0, 7.0, and 9.0 cm juveniles in RASs are 0.6, 0.4, and 0.2 inds/L, respectively. Full article

Objective: In this study, we aimed to examine the healing trend of hepatic encephalopathy after transplantation surgery in patients with liver failure. Method: We conducted this descriptive and cross-sectional study with the participation of liver transplant recipients. A personal information form, the West Haven Criteria (WHC), the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS), and the Richmond Agitation Sedation Scale (RASS) were used for data collection. The data were analyzed using Chi-squared tests, ANOVA, and paired-samples t-tests. Results: As time progressed after liver transplantation, hepatic encephalopathy stages regressed (p < 0.01). We found that liver transplant recipients with end-stage hepatic encephalopathy were mostly within the first 6 months after transplantation, while patients with first-stage hepatic encephalopathy had received liver transplants more than 2 years ago (p < 0.01). Conclusions: The results of our study revealed that hepatic encephalopathy stages regressed after transplantation, but there was no complete recovery. This highlights the need to develop new treatment strategies other than liver transplantation for the treatment of hepatic encephalopathy. Full article

This paper presents a novel sensor for the detection and characterization of regions of air turbulence. As part of the ground truth process, it consists of a combined Schlieren imager and a Radar Acoustic Sounding System (RASS) to produce dual-modality “images” of air movement within the measurement volume. The ultrasound-modulated Schlieren imager consists of a strobed point light source, parabolic mirror, light block, and camera, which are controlled by two laptops. It provides a fine-scale projection of the acoustic pulse-modulated air turbulence through the measurement volume. The narrow beam 40 kHz/17 GHz RASS produces spectra based on Bragg-enhanced Doppler radar reflections from the acoustic pulse as it travels. Tests using artificially generated air vortices showed some disruption of the Schlieren image and of the RASS spectrogram. This should allow the higher-resolution Schlieren images to identify the turbulence mechanisms that are disrupting the RASS spectra. The objective of this combined sensor is to have the Schlieren component inform the interpretation of RASS spectra to allow the latter to be used as a stand-alone sensor on a UAV. Full article

Background: Delirium is difficult to measure in the Intensive Care Unit (ICU). It is possible that by considering the rate of screening, incidence, and rate of treatment with antipsychotic medications (APMs) for suspected delirium, a clearer picture can emerge. Methods: A retrospective, observational study was conducted at two ICUs in Australia, between April and June of 2020. All adult ICU patients were screened; those who spoke English and did not have previous neurocognitive pathology or intracranial pathology were included in the analysis. Data were collected from the hospitals’ electronic medical records. The primary outcome was incidence of delirium based on the use of the Confusion Assessment Method for ICU (CAM-ICU). Secondary outcomes included measures of screening for delirium, treatment of suspected delirium with APMs, and identifying clinical factors associated with both delirium and the use of APMs. Results: From 736 patients that were screened, 665 were included in the analysis. The incidence of delirium was 11.3% (75/665); on average, the Richmond Agitation and Sedation Scale (RASS) was performed every 2.9 h and CAM-ICU every 40 h. RASS was not performed in 8.4% (56/665) of patients and CAM-ICU was not performed in 40.6% (270/665) of patients. A total of 17% (113/665) of patients were prescribed an APM, with quetiapine being the most used. ICU length of stay (LOS), APACHE-III score, and the use of alpha-2 agonists were associated with the presence of delirium, while ICU LOS, the use of alpha-2 agonists, and the presence of delirium were associated with patients receiving APMs. Conclusions: The incidence of delirium was lower than previously reported, at 11.3%. The rate of screening for delirium was low, while the use of APMs for delirium was higher than the incidence of delirium. It is possible that the true incidence is higher than what was measured. Critical prospective assessment is required to optimize APM indications in the ICU. Full article

This retrospective observational study evaluated the safety and efficacy of the ketamine and dexmedetomidine combination (keta-dex) compared to ketamine or dexmedetomidine alone for sedation of patients with acute respiratory distress due to COVID-19 pneumonia who require non-invasive ventilation. The following factors were assessed: tolerance to the ventilation, sedation level on the Richmond Agitation-Sedation Scale (RASS), hemodynamic and saturation profile, adverse effects, and discontinuation or mortality during ventilation. The study included 66 patients who underwent sedation for non-invasive ventilation using keta-dex (KETA-DEX group, n = 22), ketamine (KET group, n = 22), or dexmedetomidine (DEX group, n = 22). The DEX group showed a slower sedation rate and a significant reduction in blood pressure compared to the KETA-DEX group (p < 0.05). An increase in blood pressure was recorded more frequently in the KET group. No reduction in oxygen saturation and no deaths were observed in any of the groups. None of the patients discontinued ventilation due to intolerance. The mean duration of sedation was 28.12 h. No cases of delirium were observed in any of the groups. Overall, keta-dex was associated with faster sedation rates and better hemodynamic profiles compared to dexmedetomidine alone. Keta-dex is effective and safe for sedation of uncooperative patients undergoing non-invasive ventilation. Full article

Emergence delirium (ED) is a postoperative complication in pediatric anesthesia characterized by perception and psychomotor disorder and has a negative impact on morbidity in the form of maladaptive behavior, which can last weeks after anesthesia. Patients with developed ED present with psychomotor anxiety, agitation, and are at higher risk of unintentional extraction of an intravenous cannula, self-harm and nausea and vomiting. The described incidence of ED varies between 25–80%, with a higher prevalence among children younger than 6 years of age. We aimed to determine the incidence of ED in pediatric patients (>1 month) after general anesthesia in the post-anesthesia care unit (PACU), using Paediatric Anaesthesia Emergence Delirium (PAED) score, Watcha score and Richmond agitation and sedation scale (RASS). The incidence of ED was the highest in the PAED score with cutoff ≥10 points (89.0%, n = 1088). When using PAED score >12 points, ED incidence was 19.3% (n = 236). The lowest incidence was described by Watcha and RASS scores, 18.8% (n = 230) vs. 18.1% (n = 221), respectively. The threshold for PAED ≥10 points seems to give false-positive results, whereas the threshold >12 points is more accurate. RASS scale, although intended primarily for estimation of the depth of sedation, seems to have a good predictive value for ED. Full article

Background: Intensive Care Unit (ICU) patients often experience pain, especially during diagnostic, nursing, and therapeutic interventions. Pain assessment using the Behavioral Pain Scale (BPS) and Critical Care Pain Observation Tool (CCPOT) are recommended, but they are difficult to do in patients undergoing deep sedation. This study analyzed the usefulness of the BPS and CCPOT scales in assessing pain among patients with varying degrees of sedation. Methods: In 81 mechanically ventilated and sedated ICU patients, 1005 measurements were performed using the BPS and CCPOT scales. The study was conducted by 3 trained observers 3 times a day (each measurement at rest, during painful nursing interventions, and after the intervention). The Richmond Agitation-Sedation Scale (RASS), the Simplified Acute Physiology Score (SAPS II), and the Acute Physiology and Chronic Health Evaluation (APACHE II) were also analyzed from medical records as well as information on the length of hospitalization and treatment. Results: It was shown that signs of pain increased significantly (p < 0.001) during interventions in patients on both scales (BPS and CCPOT), and then returned to values close to the resting period. RASS results correlated significantly (p < 0.05) and positively with the results of the BPS and CCPOT. A strong correlation was found between the results of both scales at each stage of the study (R = 0.622–0.907). Conclusions: Nursing procedures are a source of pain in analgosedated patients. The BPS and CCPOT scales are useful tools for assessing the occurrence of pain in mechanically ventilated patients, including those in deep sedation. Full article

Introduction: The incidence of delirium in the intensive care unit is high, although it may differ according to the specific characteristics of the unit. Despite the rapid development of research on delirium in recent years, the pathophysiological mechanisms leading to the clinical presentation of delirium are still subject to hypotheses. The aim of this review was to describe the incidence of delirium in cardiac arrest survivors and the clinical impact of delirium on patient outcomes. Methods: A scoping review was conducted in the second quarter of 2022. The number of articles retrieved during each search test was limited to studies conducted between 2010 and 2020. Strict inclusion and exclusion criteria were applied. The last search was conducted in May 2022. Results: A total of 537 records was initially obtained from the databases. After discarding duplicates, selecting titles and abstracts, and then analyzing full-text articles, 7 studies met the inclusion criteria. The incidence of delirium in the cardiac arrest survivor population ranged from 8% to as high as 100%. The length of stay in ICU and hospital was significantly longer in patients with delirium than those without. Ninety-eight percent of patients had cognitive or perceptual impairment and psychomotor impairment. Of the seven studies included in the analysis, the RASS, CAM, and NuDesc scales were used to diagnose delirium. Potential risk factors that may influence the duration of delirium include age and time since resuscitation; propofol use shortened the duration of delirium. Conclusion: the incidence of delirium in ICU patients who survived CA is high. Cardiac arrest is an additional predisposing factor for delirium. In cardiac arrest survivors, the occurrence of delirium prolongs the duration of ICU and hospital stay and adversely affects functional outcomes. The most common type of delirium among this population was hypoactive delirium. A large percentage of patients manifested symptoms such as cognitive or perception impairment, psychomotor impairment, and impaired concentration and attention. Full article

The sedation management of patients with severe COVID-19 is challenging. Processed electroencephalography (pEEG) has already been used for sedation management before COVID-19 in critical care, but its applicability in COVID-19 has not yet been investigated. We performed this prospective observational study to evaluate whether the patient sedation index (PSI) obtained via pEEG may adequately reflect sedation in ventilated COVID-19 patients. Statistical analysis was performed by linear regression analysis with mixed effects. We included data from 49 consecutive patients. None of the patients received neuromuscular blocking agents by the time of the measurement. The mean value of the PSI was 20 (±23). The suppression rate was determined to be 14% (±24%). A deep sedation equivalent to the Richmond Agitation and Sedation Scale of −3 to −4 (correlation expected PSI 25–50) in bedside examination was noted in 79.4% of the recordings. Linear regression analysis revealed a significant correlation between the sedative dosages of propofol, midazolam, clonidine, and sufentanil (p < 0.01) and the sedation index. Our results showed a distinct discrepancy between the RASS and the determined PSI. However, it remains unclear to what extent any discrepancy is due to the electrophysiological effects of neuroinflammation in terms of pEEG alteration, to the misinterpretation of spinal or vegetative reflexes during bedside evaluation, or to other causes. Full article

Background: Studies have shown that dexmedetomidine improves neurological function. Whether dexmedetomidine reduces mortality or improves quantitative electroencephalography (qEEG) among patients post-craniotomy remains unclear. Methods: This single-center randomized study was conducted prospectively from 1 January 2019 to 31 December 2020. Patients who were transferred to the ICU after craniotomy within 24 h were included. The analgesic was titrated to a Critical care Pain Observation Tool (CPOT) score ≤2, and the sedative was titrated to a Richmond Agitation–Sedation Scale (RASS) score ≤−3 for at least 24 h. The qEEG signals were collected by four electrodes (F3, T3, F4, and T4 according to the international 10/20 EEG electrode practice). The primary outcome was 28-day mortality and qEEG results on day 1 and day 3 after sedation. Results: One hundred and fifty-one patients were enrolled in this study, of whom 77 were in the dexmedetomidine group and 74 in the midazolam group. No significant difference was found between the two groups in mortality at 28 days (14.3% vs. 24.3%; p = 0.117) as well as in the theta/beta ratio (TBR), the delta/alpha ratio (DAR), and the (delta + theta)/(alpha + beta) ratio (DTABR) between the two groups on day 1 or day 3. However, both the TBR and the DTABR were significantly increased in the dexmedetomidine group. The DTABR in the midazolam group was significantly increased. The DAR was significantly increased on the right side in the dexmedetomidine group (20.4 (11.6–43.3) vs. 35.1 (16.7–65.0), p = 0.006) as well as on both sides in the midazolam group (Left: 19.5 (10.1–35.8) vs. 37.3 (19.3–75.7), p = 0.006; Right: 18.9 (10.1–52.3) vs. 39.8 (17.5–99.9), p = 0.002). Conclusion: Compared with midazolam, dexmedetomidine did not lead to a lower 28-day mortality or better qEEG results in brain injury patients after a craniotomy. Full article

The increase in partial pressure of CO₂ in the oceans directly affects the productivity and survival of coastal industries and ecosystems. For marine aquaculture, the decreased alkalinity of seawater results in reduced availability of carbonates for marine organisms to build their shells, leading to decreased aquaculture quality and productivity. The industry has been implementing recirculating aquaculture systems (RASs) to reduce CO₂ in feedwaters, but recent interest in ocean-based CO₂ capture has led to additional strategies that may be relevant. The new methods in addition to CO₂ removal offer capture options for enhanced aquaculture sustainability. Here, we review and compare early-stage and commercially available technologies for deacidification of seawater and their suitability for aquaculture. Most methods considered rely on a voltage-induced pH swing to shift the carbonate/bicarbonate equilibrium toward the release of CO₂, with subsequent capture of the released CO₂ as a gas or as solid mineral carbonates. The modular design and distributed deployment potential of these systems offers promise, but current demonstrations are limited to bench scale, highlighting the need for sustained research and development before they can be implemented for marine aquaculture. Full article