Search Results (300)

Background: Fluid management is a critical aspect of care for neurocritically ill patients, yet the optimal approach remains unclear. The relationship between fluid balance and clinical outcomes in these patients requires further investigation, particularly regarding the timing and volume of fluid administration. Methods: This retrospective observational study analyzed 2186 adult patients admitted to the neurosurgical intensive care unit (ICU) from January 2013 to December 2022. We employed a generalized additive model (GAM) with cubic spline smoothing to examine non-linear relationships between fluid balance and mortality. The maximally selected rank statistics method was used to determine the optimal cutoff value for fluid balance. Associations between fluid balance patterns and 28-day mortality were analyzed using a multivariable logistic regression model. Results: Initial analysis identified fluid balance on day 1 as the most significant predictor of mortality; patients with positive fluid balance showed a higher 28-day mortality. Non-survivors showed significantly higher fluid input throughout the 7-day observation period, particularly during the first 24 h (4444 mL vs. 3978 mL, p = 0.007). Multivariable analysis confirmed that fluid balance on day 1 remained independently associated with 28-day mortality after adjusting for confounders (adjusted odd ratio 1.705, 95% confidence interval: 1.001–2.905, p = 0.049). Additionally, the relationship between fluid input day 1 and mortality demonstrated a progressively increasing probability of 28-day mortality with higher fluid volumes. Early fluid balance, particularly during the first 24 h of ICU admission, shows a significant association with mortality in neurocritically ill patients. Conclusions: These findings emphasize the crucial importance of careful fluid management in the early phase of neurocritical care and suggest that implementation of strict fluid monitoring protocols, especially during the initial period of care, may improve patient outcomes. Full article

Ceftazidime–avibactam (CAZ-AVI) is a second-generation intravenous β-lactam/β-lactamase inhibitor combination. In recent years, substantial evidence has emerged regarding the efficacy and safety of CAZ-AVI. However, data on its use in critically ill patients remain limited. Background/Objectives: This multicenter, retrospective, observational cohort study was conducted across four Intensive Care Units (ICUs) in three hospitals in the Marche region of Italy. The primary objective was to evaluate the 30-day clinical outcomes and identify risk factors associated with 30-day clinical failure—defined as death, microbiological recurrence, or persistence within 30 days after discontinuation of therapy—in critically ill patients treated with CAZ-AVI. Methods: The study included all adult critically ill patients admitted to the participating ICUs between January 2020 and September 2023 who received CAZ-AVI for at least 72 h for the treatment of a confirmed or suspected Gram-negative bacterial (GNB) infection. Results: Among the 161 patients included in the study, CAZ-AVI treatment resulted in a positive clinical outcome (i.e., clinical improvement and 30-day survival) in 58% of cases (n = 93/161), while the overall mortality rate was 24% (n = 38/161). Relapse or persistent infection occurred in a substantial proportion of patients (25%, n = 41/161). Notably, acquired resistance to CAZ-AVI was observed in 26% of these cases, likely due to suboptimal use of the drug in relation to its pharmacokinetic/pharmacodynamic (PK/PD) properties in critically ill patients. Furthermore, treatment failure was more frequent among immunosuppressed individuals, particularly liver transplant recipients. Conclusions: This study demonstrates that the mortality rate among ICU patients treated with this novel antimicrobial combination is consistent with findings from other studies involving heterogeneous populations. However, the rapid emergence of resistance underscores the need for vigilant surveillance and the implementation of robust antimicrobial stewardship strategies. Full article

Background: Right ventricular (RV) dysfunction is associated with poor clinical outcomes in critically ill sepsis patients, but its pathophysiology and predictors are incompletely characterized. We aimed to investigate the predictors of RV dysfunction and its outcomes in sepsis patients admitted to the intensive care unit (ICU). Methods: This is a single-center retrospective cohort study of adult patients admitted to the ICU for sepsis who had echocardiography within 72 h of diagnosis. Patients with acute coronary syndrome, acute decompensated heart failure, or significant valvular dysfunction were excluded. RV dysfunction was defined as the presence of RV dilation, hypokinesis, or both. Demographics and clinical outcomes were obtained from electronic medical records. Results: A total of 361 patients were included in our study—47 with and 314 without RV dysfunction. The mean age of the population was 66.8 years and 54.6% were females. Compared to those without RV dysfunction, patients with RV dysfunction were more likely to require mechanical ventilation (63.8% vs. 43.9%, p = 0.01) and vasopressor support (61.7% vs. 36.6%, p < 0.01). On multivariate logistic regression analysis, increasing age (OR 1.03, 95% C.I. 1.00–1.06), a history of HIV infection (OR 5.88, 95% C.I. 1.57–22.11) and atrial fibrillation (OR 4.34, 95% C.I. 1.83–10.29), and presence of LV systolic dysfunction (OR 14.40, 95% C.I. 5.63–36.84) were independently associated with RV dysfunction. Patients with RV dysfunction had significantly worse 30-day survival (Log-Rank p = 0.023). On multivariate Cox regression analysis, older age (HR 1.02, 95% C.I. 1.00–1.04) and peak lactate (HR 1.16, 95% C.I. 1.11–1.21) were independent predictors of 30-day mortality. Conclusions: Among other findings, our data suggests a possible association between a history of HIV infection and RV dysfunction in critically ill sepsis patients, and this should be investigated further in future studies. Patients with evidence of RV dysfunction had poorer survival in this population; however this was not an independent predictor of mortality in the multivariate analysis. A larger cohort with a longer follow-up period may provide further insights. Full article

Background: Magnesium (Mg) is an essential mineral that plays a vital role in various physiological processes, including enzyme regulation, neuromuscular function, and cardiovascular health. Dysmagnesemia has been associated with arrhythmias, neuromuscular dysfunction, and poor outcomes in intensive care unit (ICU) settings, representing diagnostic and therapeutic challenges. However, the relationship between dysmagnesemia and health outcomes in the ICU remains inadequately defined. Aim/Objective: This study aimed to assess the prevalence of dysmagnesemia and evaluate the correlation between total (tMg) and ionized magnesium (iMg) levels in a cohort of ICU and high dependency unit (HDU) patients. It also sought to evaluate patient characteristics and relevant health outcomes by comparing both concentrations of iMg and tMg. Methods: This prospective study was conducted among adult patients admitted to the ICU and the high dependency unit (HDU). Results: Among the 134 included patients, the median age was 63.5 years (IQR: 52.0–77.0). The majority, 91.0%, required mechanical ventilation. Additionally, 50.0% were diagnosed with diabetes, 28.4% had chronic kidney disease, and proton pump inhibitors (PPIs) were administered to 67.2% of the patients. The prevalence of hypomagnesemia, as measured by iMg, was 6.7%, while hypermagnesemia was at 39.6%. When measured by tMg, hypomagnesemia and hypermagnesemia were observed at rates of 14.9% and 22.4%, respectively. The iMg measurements showed an association between the incidence of atrial fibrillation and hypomagnesemia (p = 0.015), whereas tMg measurements linked hypomagnesemia with longer hospital stays. Notably, only a few patients identified with iMg-measured hypomagnesemia received magnesium replacement during their ICU stay. Conclusions: Dysmagnesemia is prevalent among critically ill patients, with discordance between iMg and tMg measurements. iMg appears more sensitive in detecting arrhythmia risk, while tMg correlates with length of stay. These findings support the need for larger studies and suggest considering iMg in magnesium monitoring and replacement strategies. Full article

Background/Objectives: Young female cancer survivors often face specific informational needs related to the physical and emotional effects of cancer and its impact on life plans, particularly fertility and parenthood. However, few tools are tailored to assess these needs during this critical life stage. This study aimed to (i) validate a multidimensional measure—the Satisfaction with Information Provided to Young Oncology Patients Scale (SIPYF-CPS)—to assess the specific informational needs of young adult female cancer survivors; and (ii) explore preferences regarding the provision of information and counseling. Methods: A total of 124 women (M[age] = 38.18; SD = 5.49; range 21–45), 76.6% diagnosed with breast cancer, participated in the study. Psychometric analyses included exploratory factor analysis and correlation coefficients to assess reliability and construct validity. Convergent validity was evaluated through standardized measures of anxiety, reproductive concerns, and quality of life. Results: A final 22-item measure demonstrated strong reliability and validity, capturing four factors: (i) Disease-Related Information, (ii) Symptoms and Functional Limitations, (iii) Implications for Fertility and Parenthood, and (iv) Support Services. Participants expressed low satisfaction with information on fertility preservation, sexual health, and support services. Lower satisfaction was moderately associated with higher anxiety and depression while positively related to quality of life. Most participants preferred phased, face-to-face communication throughout the illness trajectory. Conclusions: The SIPYF-CPS is a valid, multidimensional tool that captures the complex and evolving informational needs of young female cancer survivors. Its clinical use may promote earlier, personalized, and emotionally responsive communication—supporting psychological well-being, informed decision-making, and long-term survivorship care. Full article

Background: Necroptosis, a regulated form of inflammatory cell death, is increasingly recognized as a key driver of sepsis and critical illness. The balance between necroptosis and apoptosis may influence immune responses and outcomes in ICU patients. Objective: To evaluate necroptosis- and apoptosis-related protein expression in critically ill pediatric and adult patients with sepsis/septic shock, trauma/SIRS, or cardiac conditions, and assess their association with clinical outcomes. Methods: In this prospective, observational study, 88 patients admitted to a tertiary ICU were categorized into four groups: sepsis/septic shock, trauma/SIRS, cardiac disease, and healthy controls. Serum levels of RIPK1, RIPK3, MLKL, A20, caspase-8, IL-1β, and IL-18 were measured within 24 h of admission using ELISA. Biomarkers were analyzed by disease group, age, and severity indices. Results: Patients with sepsis—both adults and children—exhibited significantly elevated levels of RIPK1, IL-1β, and IL-18 (p < 0.001) and reduced levels of caspase-8 (p = 0.015), indicating activation of the necroptosis pathway. A20 was significantly upregulated (p < 0.001) and independently associated with lactate levels. RIPK1, IL-1β, and IL-18 were positively correlated with ICU length of stay and illness severity, whereas caspase-8 showed an inverse correlation. ROC analysis demonstrated strong predictive performance for sepsis/septic shock using RIPK1 (AUC = 0.81), IL-18 (AUC = 0.71), and A20 (AUC = 0.71); conversely, caspase-8 was inversely associated with sepsis (AUC = 0.32). Conclusions: Necroptosis appears to play a central role in the pathophysiology of sepsis across age groups. Elevated levels of RIPK1, IL-1β, IL-18, and A20 may serve as biomarkers of disease severity, while reduced caspase-8 supports a shift away from apoptosis toward necroptotic cell death. These findings highlight the potential of necroptosis-related pathways as targets for risk stratification and therapeutic intervention in critically ill patients of all ages. Full article

Background/Objectives: Pressure injuries (PIs), a recognized indicator of care quality, have a higher incidence in intensive care units (ICUs). Our objective was to assess whether critically ill patients identified as “unprotected” (COMHON ≥ 11) developed pressure injuries despite additional preventive measures. Methods: A historical cohort study of an adult ICU was carried out. Of the 811 patients admitted in 2022, 400 were selected. All of them were subjected to the ICU’s PI Prevention Protocol, and those with a moving average of the COMHON Index ≥ 11 were given two additional measures: a multilayer dressing on the sacrum, and anti-equinus and heel-pressure-relieving boots. Results: A total of 36 patients presented with PIs (cumulative incidence of 9%). Significant differences were observed in their mean length of stay and in their disease severity score (APACHE-II). Most of the PIs were located on the sacrum, followed by the heel. Prior to the appearance of the PIs, a sacral dressing was applied to 100% of the patients, while anti-equinus and heel-pressure-relieving boots were only applied to 58.3%. Of the 36 patients with PIs, 52.8% had a PI on the sacrum and 22.2% on the heel. Conclusions: Focusing only on those who presented with PIs, we observed that the considered measures were not effective for preventing PIs in all the patients. Not all PIs are preventable, and individual risk factors should be considered. In the future, we will analyze the individual characteristics of these patients and verify whether the Prevention Protocol was followed, in order to determine how they could have been prevented or whether they were so-called unavoidable PIs. Full article

Background: Brain injuries, including stroke and traumatic brain injury (TBI), pose a major healthcare challenge due to their severe consequences and complex recovery. While ischemic strokes are more common, hemorrhagic strokes have a worse prognosis. TBI often affects young adults and leads to long-term disability. A critical concern in these patients is the frequent development of chronic critical illness, compounded by metabolic disturbances and malnutrition that hinder recovery. Objective: This study aimed to compare changes in nutritional status parameters under standard enteral nutrition protocols and clinical outcomes in prolonged/chronic critically ill patients with TBI or stroke versus such a population of patients without TBI or stroke. Methods: This matched prospective–retrospective cohort study included intensive care unit (ICU) patients with TBI or stroke from the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology and patients without these conditions from the eICU-CRD database. Inclusion criteria comprised age 18–74 years, ICU stay >5 days, and enteral nutrition. Patients with re-hospitalization, diabetes, acute organ failure, or incomplete data were excluded. Laboratory values and clinical outcomes were compared between the two groups. Propensity score matching (PSM) was used to balance baseline characteristics (age, sex, and body mass index). Results: After PSM, 29 patients with TBI or stroke and 121 without were included. Univariate analysis showed significant differences in 21 laboratory parameters and three hospitalization outcomes. On day 1, the TBI/stroke group had higher hemoglobin, hematocrit, lymphocytes, total protein, and albumin, but lower blood urea nitrogen (BUN), creatinine, and glucose. By day 20, they had statistically significantly lower calcium, BUN, creatinine, and glucose. This group also showed less change in lymphocytes, calcium, and direct bilirubin. Hospitalization outcomes showed longer mechanical ventilation duration (p = 0.030) and fewer cases of acute kidney injury (p = 0.0220) in the TBI/stroke group. Conclusions: TBI and stroke patients exhibit unique metabolic patterns during prolonged/chronic critical illness, differing significantly from other ICU populations in protein/glucose metabolism and complication rates. These findings underscore the necessity for specialized nutritional strategies in neurocritical care and warrant further investigation into targeted metabolic interventions. Full article

Background: Multidrug-resistant (MDR) Gram-negative infections, particularly those caused by carbapenem-resistant Enterobacterales (CRE) and difficult-to-treat Pseudomonas aeruginosa (DTR-Pa), present a growing global healthcare challenge, especially in critically ill populations. Imipenem–relebactam (I/R), a novel β-lactam/β-lactamase inhibitor combination, has shown efficacy in clinical trials, but real-world data remain limited. Methods: We conducted a multicenter, retrospective–prospective observational study across tertiary-care hospitals in Italy between January 2020 and May 2025. Adult patients (≥18 years) treated with I/R for ≥48 h for suspected or confirmed MDR Gram-negative infections were included. Primary endpoints were clinical success at the end of therapy and 30-day all-cause mortality. Secondary endpoints included microbiological eradication, recurrence, safety, and predictors of treatment failure. Statistical analysis involved descriptive methods and correlation analysis for mortality predictors. Results: Twenty-nine patients were included (median age 66 years; 58.6% ICU admission; 71.4% mechanical ventilation). Clinical success was achieved in 22/29 patients (75.9%), while 30-day mortality was 24.1% (7/29). The most common pathogen was Klebsiella pneumoniae (62.1%), with 41.4% of infections being polymicrobial. Microbiological eradication was confirmed in all the BSIs. Parenteral nutrition (p = 0.016), sepsis at presentation (p = 0.04), candidemia (p = 0.036), and arterial catheter use (p = 0.029) were significantly more frequent in non-survivors. Survivors showed significant reductions in CRP, PCT, and bilirubin at 48 h, while non-survivors did not. Parenteral nutrition (rho = 0.427, p = 0.023), sepsis (rho = 0.378, p = 0.043), and arterial catheter use (rho = 0.384, p = 0.04) were significantly correlated with mortality. Conclusions: In this Italian multicenter cohort of critically ill patients, imipenem–relebactam demonstrated high clinical success and acceptable mortality rates in the treatment of severe MDR Gram-negative infections, particularly those caused by KPC-producing K. pneumoniae. Early biomarker dynamics may aid in monitoring treatment response. Larger prospective studies are needed to confirm these findings and define optimal treatment strategies. Full article

Background/Objectives: Severe COVID-19 pneumonia damages alveolar type II cells and disrupts surfactant homeostasis, contributing to acute respiratory distress syndrome (ARDS). Surfactant proteins (SP-A, SP-B, SP-C, SP-D) are critical for reducing alveolar surface tension and for innate immune defense. We aimed to evaluate whether surfactant protein gene expression varies with the severity of COVID-19. Methods: Peripheral blood was collected from 122 adults with confirmed COVID-19, categorized as asymptomatic (no symptoms), mild (requiring hospitalization), or severe (requiring ICU admission). We quantified mRNA expression of surfactant protein genes (SFTPA1, SFTPA2, SFTPB, SFTPC, SFTPD) in blood cells using RT-qPCR. Relative expression was normalized to GAPDH and compared among the groups using the 2^−ΔΔCt method. Outliers (Ct values > 3 SD from the mean) were excluded before analysis. Results: Distinct surfactant gene expression patterns were markedly associated with disease severity. Transcripts of SFTPB and SFTPC decreased with increasing severity of the disease. Notably, SFTPC expression was ~49-fold higher in mild cases compared to asymptomatic COVID-19-positive patients (p < 0.0001), but then decreased by ~54-fold in severe cases relative to mild (p < 0.0001), returning to near-baseline levels. In contrast, SFTPA2 and SFTPD were dramatically upregulated in severe cases. SFTPA2 was ~50-fold higher in severe versus mild cases (p < 0.0001), and SFTPD was ~4346-fold higher in severe versus asymptomatic cases (p < 0.0001; ~9.6-fold higher than in mild). SFTPA1 showed only a modest ~1.4-fold decrease in severe cases (vs. mild). All noted differences remained statistically significant after outlier exclusion. Conclusions: COVID-19 severity is correlated with profound changes in surfactant gene expression in blood. Critically ill patients exhibit loss of key surfactant components (SP-B and SP-C transcripts) alongside an excessive SP-D response. These preliminary findings suggest an imbalance that may contribute to lung injury in severe disease. However, further validation is needed to establish surfactant proteins, such as SP-D, as biomarkers of COVID-19 severity. Full article

Background/Objectives: The COVID-19 pandemic exposed critical vulnerabilities in healthcare systems, especially in ensuring continuity of care for patients with chronic diseases. Rehabilitation services, essential for recovery following SARS-CoV-2 infection, were among the most disrupted. This exploratory study aimed to assess Romanian patients’ perceptions of the accessibility and quality of post-COVID-19 rehabilitation services, focusing on individuals with chronic conditions. Methods: This exploratory cross-sectional study was conducted over a 12-month period in 2024. Data were collected from 76 adult patients diagnosed with at least one chronic condition (hypertension, diabetes mellitus, ischemic heart disease, cancer, or chronic obstructive pulmonary disease) and with confirmed prior SARS-CoV-2 infection. Most participants were recruited during outpatient specialty consultations, with a smaller number included from hospital settings, all located in Bucharest. A structured questionnaire was administered by the principal investigator after obtaining informed consent. Quantitative data were analyzed using non-parametric methods following confirmation of non-normal distribution via the Shapiro–Wilk test (p < 0.05). Satisfaction scores were reported as medians with interquartile ranges (IQR), and group comparisons were performed using the Mann–Whitney U test. A mixed-methods approach was employed, including thematic analysis of open-ended responses. Results: Patient satisfaction with rehabilitation services was consistently low. The median satisfaction scores [IQR] were accessibility 1.0 [0.0–2.0], quality of services 0.0 [0.0–4.0], staff empathy 0.0 [0.0–5.0], and perceived effectiveness 0.0 [0.0–5.0]. The median score for perceived difficulties in access was 1.0 [1.0–2.0], indicating widespread barriers. No statistically significant differences were observed between urban and rural participants or across chronic disease categories. Thematic analysis (n = 65) revealed key concerns including lack of publicly funded services, cost barriers, limited physician referral, service scarcity in rural areas, and demand for home-based rehabilitation options. Conclusions: Romanian patients with chronic illnesses and previous SARS-CoV-2 infection continue to face substantial barriers in accessing post-COVID-19 rehabilitation services. These findings highlight the need for more equitable and integrated recovery programs, especially for vulnerable populations in underserved settings. Full article

Hypoglycemia is defined by the presence of Whipple’s triad, which is (1) low plasma glucose concentration, (2) neurogenic and neuroglycopenic symptoms and/or signs, and (3) their resolution with normalization of plasma glucose concentration. Hypoglycemia in adult patients without diabetes is rare and much less common compared to patients with diabetes. Because of its rarity in the general adult population, recognition and treatment may be delayed. Our review provides a comprehensive summary of non-insulin-mediated and insulin-mediated hypoglycemia in adult patients without diabetes. It explores the pathophysiology of various causes of hypoglycemia and reviews diagnostic approaches such as clinical history, key biochemical findings, and other relevant diagnostic modalities that aid in distinguishing among the different causes, from non-insulin-mediated (e.g., critical illness) to insulin-mediated causes (e.g., post-bariatric hypoglycemia). Our aim is to present the most up-to-date information regarding the diagnosis and management of non-diabetic hypoglycemia to increase awareness and understanding of the condition and promote prompt recognition in patients to expedite diagnosis and treatment. Full article

Background: There is limited knowledge about nutritional intake and energy needs during the post-intensive care unit (ICU) period and their relationship with clinical outcomes and physical recovery. Aims and Methods: Thus, this observational multicenter study (Azienda Ospedaliero-Universitaria “Santa Maria”, Terni and “Madonna del Soccorso” General hospital, San Benedetto del Tronto, Italy) aimed, firstly, to measure energy expenditure via indirect calorimetry (IC) (Q-NRG+^® Metabolic Monitor, Cosmed, Rome, Italy), derived respiratory quotient (R/Q1) and, malnutrition risk via Mini Nutritional Assessment (MNA) test and body composition through bioimpedance vector analysis (BIVA-Akern, Pontassieve, Italy); secondly, to assess their effect on energy needs, body composition and physical rehabilitation steps in critically ill adults after ICU discharge. The provision of nutrients (PIS test) was also recorded. Oral nutritional supplementation was used to reach the optimal nutritional intake. All patients followed a standardized rehabilitation program. Results: A total of 43 patients were enrolled from January 2024 until February 2025 at the beginning of their post-ICU period. The mean age was 65.7 ± 1.0 years, the mean BMI was 20.73 ± 0.8 kg/m² at the recovery ward, and 60.4% (n = 26) were male. The mean admission period was 19.5 ± 1.7 days. The resting energy expenditure (mREE) was 1591 ± 71.2 at the admission and 1.856 ± 62.7 kcal/kg/d at the discharge (p < 0.05). The median phase angle value was 4.33 ± 0.15 at the admission and 5.05 ± 0.17° at the discharge (p < 0.05); R/Q1 at the admission was 0.7 ± 0.1 and 1.086± 0.11 at the discharge (p < 0.05). Improved energy expenditure significantly correlated with R/Q1 and phase angle (r = 0.81 and r = 0.72, respectively). Interestingly, there was no significant correlation between improved metabolism and improved PIS test scores (r = 0.18). Improved metabolism and nutritional status showed a tendency to correlate with shorter post-ICU courses and earlier physical recovery, without reaching statistical significance. Conclusions: Measurement of energy expenditure and caloric intake, along with the assessment of body composition is feasible and provides an objective tool to guide and possibly enhance the functional recovery in patients during the post-ICU period. Full article

Background: During the influenza A(H1N1) and COVID-19 pandemics, empirical antibiotic treatment (EAT) was widely administered to critically ill patients despite low rates of confirmed bacterial co-infection (COI). The clinical benefit of this practice remains uncertain and may contradict antimicrobial stewardship principles. Objective: To evaluate whether EAT at ICU admission reduces ventilator-associated pneumonia (VAP) incidence or ICU mortality in critically ill patients with pandemic viral pneumonia, stratified by presence of COI. Methods: This retrospective analysis combined two national multicentre ICU registries in Spain, including 4197 adult patients requiring invasive mechanical ventilation for influenza A(H1N1) or COVID-19 between 2009 and 2021. Primary outcomes were ICU mortality and VAP incidence. Analyses were stratified by microbiologically confirmed bacterial COI. Propensity score matching, Cox regression, General Linear (GLM), and random forest models were applied. Results: Among patients without COI (n = 3543), EAT was not associated with lower ICU mortality (OR = 1.02, 95%CI 0.81–1.28, p = 0.87) or VAP (OR = 1.02, 95%CI 0.79–1.39, p = 0.89). In patients with confirmed COI (n = 654), appropriate EAT was associated with reduced VAP (17.4% vs. 36.3%, p < 0.001) and ICU mortality (38.4% vs. 49.6%, OR = 1.89, 95%CI 1.13–3.14, p = 0.03) compared to inappropriate EAT. Conclusions: EAT was not associated with a lower incidence of VAP or higher survival rates and could be harmful if administered incorrectly. These findings support a more targeted approach to antibiotic use, guided by microbiology, biomarkers and stewardship principles. Full article

Background: This study aims to evaluate the impact of critical illness, defined as the need for preoperative intensive care unit (ICU) admission for invasive monitoring or organ support, on cardiac surgery outcomes for patients with acute infective endocarditis (IE). Methods: A retrospective analysis of prospectively collected data from patients treated between 1 January 2017 and 30 May 2024 at a single Australian tertiary cardiothoracic centre was performed. Data were collected from the Australian and New Zealand Cardiothoracic Society (ANZCTS) database and the Australian and New Zealand Intensive Care Adult Patients Database (ANZICS-APD). Results: Among 342 patients who underwent cardiac surgery for IE, 32 (9.4%) were critically ill. The critically ill patients were admitted to the ICU before surgery with a diagnosis of septic or cardiogenic shock, with 86% (n = 30) requiring mechanical ventilation. Compared to the non-critically ill cohort, critically ill patients were more likely to have a history of intravenous drug use (IVDU) (41% vs. 14%, p = 0.03) and a younger age (median age 49 years [42–56] vs. 61 years [44–70], p = 0.03), and although methicillin-sensitive Staphylococcus aureus (MSSA) was the most common causative organism in both groups, it was found significantly more often in the critically ill cohort (66% and 27%, p = 0.001). The median EuroSCORE II was comparable between the groups (2.1 [1.3–10] vs. 2.8 [1.3–5.7], p = 0.69); however, the APACHE III (57 [49–78] vs. 52 [39–67], p = 0.03) and ANZROD scores (0.04 [0.02–0.09] vs. 0.013 [0.004–0.038], p = 0.00002) were significantly higher in the critically ill patients. The overall 30-day mortality rates were similar between the groups (13% vs. 5%, p = 0.60). The median ICU length of stay (LOS) was significantly longer for the critically ill patients (5 days [IQR 2–10 days] vs. 2 days [1–4 days], p = 0.0004), with a similar hospital LOS (23 days [IQR 14–36] vs. 21 days [12–34], p = 0.46). Renal replacement therapy was three times higher in the critically ill (34% vs. 11%, p = 0.0001). Reoperations for bleeding were similar between the groups (16% vs. 11%, p = 0.74). Conclusions: Despite being associated with higher ANZROD and APACHE III scores, a longer ICU length of stay, and higher use of renal replacement therapy, critical illness did not have an impact on the EuroSCORE II, hospital length of stay, or reoperation rates for bleeding or 30-day mortality among patients with IE undergoing cardiac surgery. The lessons from this study will guide and inform the development of better infective endocarditis databases and registries. Full article