Search Results (3,252)

Background/Objectives: No current guideline specifies the timing of catheter removal after percutaneous transhepatic biliary drainage (PTBD). This study aimed to evaluate the clinical outcomes of early PTBD catheter removal after resolution of biliary obstruction in patients with acute cholangitis. Methods: This retrospective, single-center cohort study included 357 patients with acute cholangitis who underwent PTBD. Patients were divided into an early removal group (7–10 days, n = 199) and a late removal group (>10 days, n = 158) according to the timing of PTBD catheter removal. Clinical outcomes after catheter removal were compared between the two groups. Results: There was no significant difference between the two groups in the complication rate after PTBD catheter removal (2.5%; 95% CI, 1.1–5.7% in the early group vs. 1.9%; 95% CI, 0.6–5.4% in the late group; p > 0.999). In the early group, the most common complication was biloma (n = 3, 1.5%), followed by bile peritonitis (n = 1, 0.5%) and hemobilia (n = 1, 0.5%). In the late removal group, biloma, bile peritonitis, and hemobilia each occurred in one patient (0.6%). The total length of hospital stay was significantly shorter in the early group than in the late group (12 days [IQR, 10–15] vs. 17 days [IQR, 14–24]; p < 0.001). In exploratory multivariable analysis, early removal was associated with a 5.36-day shorter adjusted conditional median hospital stay than late removal (95% CI, 3.63–7.08; p < 0.001). Conclusions: Early PTBD catheter removal 7–10 days after placement appears to be feasible and was associated with a low rate of post-removal complications in appropriately selected patients with acute cholangitis, provided that predefined removal criteria are met. Full article

Background: Patients undergoing urgent transcatheter aortic valve implantation (TAVI) represent a clinically high-risk population with increased peri-procedural morbidity. Whether an early discharge strategy is feasible and safe remains unclear. We evaluated the feasibility of early discharge in patients undergoing urgent transcatheter aortic valve implantation. Methods: This single-centre observational cohort study included 279 consecutive patients undergoing urgent TAVI (mean age 81 ± 7 years; 155 [56%] male). Patients were stratified according to post-TAVI length of stay into next-day discharge or prolonged hospitalisation (>1 day). Data were prospectively collected and the primary end point was 30-day all-cause mortality. Results: Among 279 urgent TAVI patients, 62 (22%) were discharged the next day and 217 (78%) had prolonged hospitalisation. Baseline clinical and echocardiographic characteristics were similar between the two groups. Among the 279 patients surviving to discharge assessment, 30-day mortality was 0.4%, with no significant difference between the next-day and longer-stay groups. Patients in the short hospital stay group had an 11% complication rate compared to 30% in the long stay one. Unlike stroke or pacemaker implantation, vascular complication was an independent predictor of extended in-hospital length of stay [Beta coefficient 3.41, 95% CI (0.98 to 5.85), p = 0.006]. Conclusions: Next-day discharge appears feasible in carefully selected patients undergoing urgent TAVI and was not associated with excess 30-day mortality in this observational cohort. Prospective multi-centre studies are required to validate these findings and establish standardised discharge criteria. Full article

Background: Hospitalizations among patients with Alzheimer’s disease (AD) carry substantial mortality risk, but length of stay (LOS) is time-dependent and may reflect heterogeneous inpatient trajectories. We examined unadjusted and adjusted LOS–mortality patterns and compared admission-only versus inpatient-course prediction using explainable machine learning. Methods: Using the full 2017 Nationwide Readmissions Database (NRD), we identified hospitalizations among adults aged ≥60 years with an ICD-10-CM G30.x AD code in any diagnosis position. Records with missing in-hospital mortality status were excluded. LOS was summarized in clinically interpretable bins and modeled using restricted cubic splines. Model A excluded explicit inpatient-course measures, whereas Model B added LOS, procedure count, and total charges. Performance was evaluated using patient-grouped 5-fold out-of-fold validation and summarized by AUROC and AUPRC; SHAP was used for interpretation. Results: Among 249,507 AD hospitalizations, 12,666 in-hospital deaths occurred (5.08%; weighted mortality 4.97%). Unadjusted mortality was highest at LOS 0–1 day (13.00%), lowest at 4–6 days (3.47%), and increased to 7.77% at ≥22 days. After multivariable adjustment, LOS remained strongly nonlinear, but adjusted predicted mortality declined across the modeled LOS range. Model A achieved AUROC/AUPRC of 0.780/0.180, whereas Model B improved to 0.828/0.329. Sepsis, diagnostic burden, acute kidney injury, age, stroke, and pneumonia were stable predictors; LOS and procedure burden added prognostic information in Model B. Conclusions: The crude LOS–mortality pattern was U-shaped, whereas the adjusted pattern suggests that the late-stay increase in unadjusted mortality is partly explained by patient complexity and evolving inpatient-course factors. Admission-only prediction provides meaningful early risk stratification, while inpatient-course information improves prognostic assessment as hospitalization evolves. Full article

Background and Objectives: Hemangiomas are the most common benign tumors of the liver. Surgical options such as enucleation, segmentectomy, and hepatectomy are the primary treatment choices, though the morbidity and complication rates remain high. Transcatheter arterial embolization (TAE) has emerged as a safe and effective alternative treatment option that has gained popularity in recent years. Materials and Methods: We retrospectively evaluated data from patients who underwent either surgical intervention (n = 19) or transarterial embolization (62 lesions in 61 patients; analyses performed per treated lesion) for liver hemangioma between 2003 and 2021. Outcomes were assessed separately for each modality without a composite efficacy endpoint: clinical success (relief of the presenting symptoms, assessed in patients symptomatic at baseline), technical success and radiological response for embolization, treatment-related complications, length of hospital stay, and the need for reintervention. Results: There was no significant difference in the pretreatment size of the lesions between the TAE and surgery groups (median of 10.0 [IQR 7.8–13.9] versus 10.0 [IQR 9.0–17.0] cm; p = 0.100). The length of hospital stay was shorter in the TAE group (median of 1 versus 6 days; p < 0.001), although era-related differences in perioperative care may contribute to this difference, and follow-up was longer in surgically treated patients, reflecting the later adoption of embolization at our institution. Postoperative mortality did not occur in either group. In the embolization group, there were significant reductions in lesion size and volume and the complication rate was low, with no serious complications, supporting the safety profile of TAE. Conclusions: In this retrospective, non-randomized, single-center series, transarterial embolization was found to be a safe and effective minimally invasive treatment for liver hemangiomas and was associated with a shorter hospital stay. Because treatment allocation was not randomized, we cannot establish therapeutic equivalence between the two modalities, and the comparison should be regarded as descriptive; TAE represents an effective minimally invasive treatment option in appropriately selected patients and may be considered within a multidisciplinary treatment strategy, while surgery remains necessary in selected cases such as embolization failure, complicated lesion vascularization, or localization. Full article

Background: Reliable predictors of perioperative risk beyond symptomatology in bronchogenic cyst (BC) resection are lacking. We aimed to compare perioperative outcomes across different imaging features to identify perioperative risk factors. Methods: We conducted a retrospective cohort study of 57 patients who underwent pathologically confirmed BC resection at a single tertiary center from 2004 to 2023. Preoperative unenhanced CT images were retrospectively reviewed for four prespecified imaging features. Only unenhanced images were used for imaging-feature classification and Hounsfield-unit measurement. Patients were stratified into two groups based on the presence (n = 19) or absence (n = 38) of abnormal features. The prespecified primary perioperative outcomes were peri-cystic adhesion, operative time, estimated intraoperative blood loss, and intensive care unit (ICU) length of stay. Secondary outcomes included chest-tube duration, postoperative hospital length of stay, major intraoperative complications, 30-day postoperative complications, and recurrence. Results: The abnormal image-feature group had a higher prevalence of male patients, symptomatic presentation, and larger cysts. Nineteen patients (33%) had at least one abnormal CT feature. Patients with abnormal CT features had significantly higher peri-cystic adhesion rates (68% vs. 34%; p = 0.015), longer mean operative times (128 ± 60 vs. 87 ± 35 min; p = 0.011), greater blood loss (100 ± 150 vs. 4 ± 24 mL; p = 0.012), and prolonged intensive care unit stays (0.84 ± 1.21 vs. 0.05 ± 0.23 days; p = 0.011) than those with normal imaging. No significant differences were observed in outcomes of chest-tube duration, postoperative hospital length of stay, or recurrence. The presence of abnormal features and cyst size remained significant in multivariate models. Conclusions: Abnormal imaging features on non-contrast CT and cyst size are associated with more challenging perioperative courses in BC resection. Incorporating these imaging features into preoperative assessment may enhance risk stratification and guide surgical approach decisions in the CT screening era. Full article

Background/Objective: Diagnostic safety is a major challenge in emergency departments (ED), where clinicians frequently make decisions under time pressure and with incomplete information. Prospective data on diagnostic discrepancies in Swiss EDs remain limited. To determine the frequency of diagnostic discrepancies between the initial ED diagnosis and the final Internal Medicine (IM) discharge diagnosis, identify associated patient-, physician-, and context-related factors, and evaluate clinical outcomes associated with diagnostic discrepancy. Methods: We conducted a prospective observational study including 515 patients admitted from the ED to an IM ward and managed by 44 physicians at a Swiss tertiary non-university hospital. The initial ED diagnosis was compared with the IM discharge diagnosis (or diagnosis on day 28 if the patient remained hospitalized). Diagnostic discrepancies were classified using a predefined algorithm with independent expert opinion where required. Generalized linear mixed-effects models were used to assess associations between diagnostic discrepancy and mortality, in-hospital transfers and length of stay; a multivariable logistic regression model was used to identify factors associated with diagnostic discrepancy. Results: Diagnostic discrepancies were identified in 10.1% of patients (n = 52). These patients had longer hospital stays (9.3 ± 9.2 vs. 6.9 ± 5.8 days; p = 0.069) and were more frequently transferred within the hospital (17% vs. 5.8%; p = 0.006). After adjustment, diagnostic discrepancies were associated with higher odds of in-hospital transfer (OR 3.35; 95% CI 1.47–7.66; p = 0.004) and a 20% longer stay (exp β = 1.20; 95% CI 1.00–1.45; p = 0.049), although the latter was attenuated after adjustment for comorbidity. Specialist involvement in the ED was independently associated with lower odds of diagnostic discrepancy (OR 0.30; 95% CI 0.10–0.72; p = 0.015), whereas each one-point increase in physician-perceived diagnostic difficulty was associated with higher odds (OR 1.42; 95% CI 1.07–1.90; p = 0.016). Conclusions: Diagnostic discrepancies occurred in approximately one in ten patients admitted from the ED to IM and were associated with increased in-hospital transfer and, less robustly, with prolonged hospitalization. Prospective multicenter studies should evaluate strategies to reduce diagnostic discrepancies and improve diagnostic safety. Full article

Background: Diabetes mellitus (DM) is associated with an increased susceptibility to lower respiratory tract infections (LRTIs) and more severe clinical courses, including prolonged hospitalization and increased mortality. During LRTI-related hospitalizations, clinical management often prioritizes the acute respiratory condition, potentially under-recognizing DM-related multimorbidity. We evaluated whether inpatient diabetes specialist consultation is associated with improved outcomes in this high-risk population. Methods: We conducted a retrospective cohort study of 677 adults with DM admitted for LRTI. Specialist consultation was defined as involvement of an endocrinology and/or diabetes nurse specialist during index hospitalization. Outcomes included length of hospital stay (LOHS) and 90-day mortality. Multivariable zero-truncated negative binomial regression (LOHS) and logistic regression (mortality) were adjusted for age, sex, Charlson Comorbidity Index (CCI), National Early Warning Score (NEWS), and pre-admission insulin use, hypoglycemic events, and admission laboratory parameters. Inverse probability of treatment weighting (IPTW) based on propensity scores was performed as a sensitivity analysis. Results: Among 677 patients, 84 (12.4%) received diabetes specialist consultation. Patients receiving consultation had lower unadjusted 90-day mortality (4.8% vs. 17.5%, p = 0.001) but longer median LOHS (9 vs. 7 days, p < 0.001). After multivariable adjustment, diabetes specialist consultation was associated with lower 90-day mortality (OR 0.23, 95% CI 0.08–0.68, p = 0.008) and longer LOHS (IRR 1.27, 95% CI 1.12–1.44, p < 0.001). The results were consistent in IPTW sensitivity analyses. Conclusions: In this retrospective cohort of patients with DM hospitalized for LRTIs, inpatient diabetes specialist consultation was associated with lower 90-day mortality, but longer hospital stay. These findings suggest that structured inpatient diabetes specialist involvement may contribute to improved medium-term outcomes in high-risk multimorbid patients. Prospective studies are required to determine causality and evaluate the impact of consultation timing and referral strategies. Full article

Background: Inappropriate antibiotic use contributes to antimicrobial resistance. Evidence regarding the impact of antimicrobial stewardship programs (ASPs) in pediatric intensive care units (PICUs) remains limited. The study aims to evaluate the impact of a multidisciplinary prospective post-prescription review and feedback (PPRF) ASP in a European PICU on antimicrobial use and prescription quality (PQ). Methods: A prospective quasi-experimental study was conducted using interrupted time-series analysis to evaluate antimicrobial use trends before (July 2018–December 2020) and after (January 2021–March 2025) the implementation of a multifaceted ASP, integrated within a hospital-wide ASP, in a tertiary 24-bed medical–surgical PICU in Barcelona, Spain. Antimicrobial use was measured as days of therapy per 100 patient-days (DOT/100 PD) and per 100 discharges (DOT/100 D) and was analyzed by WHO AWaRe group and by individual drug. PQ was evaluated by means of cross-sectional point-prevalence surveys (PPSs). Results: During the study-period, median monthly activity in the PICU remained stable: 475 patient-days (IQR: 396–534) and 113 patients discharged (IQR: 102–124). Following ASP implementation, total antibiotic consumption significantly decreased, with an immediate reduction of 18.2 DOT/100 patient-days (p = 0.006) and a sustained monthly decline of 0.73 DOT/100 patient-days (p = 0.028). The COVID-19 pandemic did not significantly affect overall antibiotic consumption. Access and Reserve antibiotic use decreased significantly after ASP implementation, whereas Watch antibiotic use remained unchanged. Overall antifungal consumption was not significantly modified, although a transient increase was observed during the pandemic. At the individual drug level, several antibiotics demonstrated significant immediate decreases after ASP implementation. Prescription quality remained high (>88% optimal prescriptions), and PICU length of stay and mortality were unchanged. Conclusions: Implementation of a multidisciplinary PPRF-based ASP in a tertiary PICU was associated with a sustained reduction in antibiotic exposure without compromising prescription quality or clinical safety. These data support the effectiveness of collaborative stewardship in one of the most complex pediatric healthcare settings. Full article

Introduction: The routine insertion of a postoperative intracranial drain following surgical evacuation of brain abscesses or subdural empyemas is practiced by some surgeons to facilitate pus evacuation and to enable cavity lavage, but robust evidence for clinical benefit is lacking. This study evaluates whether postoperative drain placement affects reoperation rates, length of hospital stay, and duration of antibiotic therapy. Methods: We performed a retrospective review of consecutive adult patients who underwent surgical drainage or excision of a primary intracranial abscess or empyema at our tertiary center between January 2020 and January 2026. Patients were grouped by whether a postoperative intracranial drain was placed. The primary endpoint was recurrence requiring reoperation. Secondary endpoints included hospital length of stay, total duration of antibiotic therapy, and operative time. Continuous variables were compared with t-tests and categorical variables with Fisher’s exact test; p < 0.05 was considered statistically significant. Results: Eighty procedures were identified, and 36 patients met inclusion criteria for final analysis; eight (22.2%) received a postoperative intracranial drain, and 28 (77.8%) did not. Overall, 13 patients (36.1%) required reoperation for radiological or clinical progression. Reoperation occurred in 50% of patients with a drain and 32.1% without a drain (p = 0.422). Median hospital stay and duration of antibiotic therapy did not differ significantly between groups (median hospital stay 27.1 vs. 23.0 days, p = 0.50; median antibiotic duration 67.3 vs. 51.7 days, p = 0.445). Operative time and infection volume rates were also similar between cohorts. Conclusions: In this single-center retrospective cohort, placement of a postoperative intracranial drain after surgical management of brain abscesses or empyemas was not associated with reduced reoperation rates, shorter hospitalization, or shorter antibiotic treatment. Given the absence of demonstrable clinical benefit and the potential risks related to drain placement, routine insertion of postoperative drains cannot be recommended. Full article

Background/Objectives: Preoperative anemia and iron deficiency increase transfusion risk in cardiac surgery. We evaluated outcomes associated with a Patient Blood Management (PBM) pathway and assessed the robustness of these associations to baseline imbalance and secular trends. Methods: This single-center retrospective cohort study compared PBM patients treated in 2019, 2022, and 2023 with historical controls from 2017–2018. Outcomes included red blood cell (RBC) transfusion, length of stay, readmission, mortality, safety events, and costs. Analyses included multivariable regression, propensity-score matching (PSM), inverse probability of treatment weighting (IPTW), and adjacent-period matching. The hospital-perspective cost-consequence analysis used 2024-unit costs, bootstrap confidence intervals (CI), and log-link models. Results: Among 1374 patients (764 PBM; 610 No-PBM controls), any RBC transfusion occurred in 17.3% versus 39.2%, and transfusion of >2 units occurred in 2.6% versus 15.1%. The adjusted odds ratios were 0.30 (95% CI, 0.23–0.39) and 0.14 (95% CI, 0.08–0.24), respectively. PSM yielded 519 pairs, and sensitivity analyses were concordant. The adjusted overall direct-cost ratio was 0.75 (95% CI, 0.68–0.82), with an adjusted marginal mean difference of −EUR 5196 (bootstrap 95% CI, −EUR 6965 to −EUR 3485). Recorded incidences of myocardial infarction, stroke, thromboembolism, and cumulative infection were low and did not differ significantly between cohorts; hypophosphatemia and treatment-specific adverse reactions were not systematically assessed. Adjacent-period matching did not confirm a reduction in 12-month readmission, and mortality was similar between cohorts. Conclusions: PBM was associated with lower transfusion rates, shorter hospitalization, and lower direct costs. Residual temporal confounding limits causal interpretation, and the economic findings do not constitute formal cost-effectiveness results. Full article

Background: Perioperative blood loss represents a major challenge in elderly patients undergoing hip fracture surgery. Although tranexamic acid (TXA) has been shown to reduce bleeding complications, evidence from large registry-based cohorts remains limited. This study assessed the efficacy and safety of perioperative TXA administration in geriatric proximal femoral fracture surgery and evaluated in a subgroup analysis whether repeated TXA administration provides additional benefit compared with a single intraoperative dose. Methods: Data were derived from the Registry for Geriatric Trauma of the German Trauma Society (ATR-DGU), a prospective multicenter registry of patients aged ≥70 years undergoing surgery for proximal femoral fractures. From a total cohort of 23,830 patients, 1:1 nearest-neighbor matching based on age, sex, America Society of Anesthesiologists (ASA) classification, fracture type, and pre-fracture mobility yielded 3697 patients receiving intraoperative TXA and 3697 controls without TXA. Outcomes included transfusion requirements, thromboembolic events, mortality, reoperation rate, and length of stay. A subgroup analysis compared single-dose intraoperative TXA with combined pre- and intraoperative administration. Results: Intraoperative TXA significantly reduced packed red blood cell transfusion rates compared with controls (44.6% vs. 52.2%; p < 0.001). No significant differences were observed in thromboembolic events, mortality, overall complication rates, or length of hospital stay. Subgroup analysis showed no additional benefit of repeated pre- and intraoperative TXA administration compared with a single intraoperative dose but was associated with a significantly higher incidence of thromboembolic risks in the multiple-dose cohort (3.56% vs. 1.1%; p = 0.038). Conclusions: Intraoperative TXA administration significantly reduces transfusion requirements in geriatric patients undergoing surgery for proximal femoral fractures without increasing thromboembolic complications or mortality. TXA should therefore be considered a safe and effective adjunct in the perioperative management of geriatric hip fracture patients. Full article

Background/Objectives: Patients with ST-segment elevation myocardial infarction (STEMI) may develop gastrointestinal (GI) bleeding. We aimed to assess the impact of GI bleeding on in-hospital outcomes in patients with STEMI. Methods: This retrospective study was performed using the National Inpatient Sample from the United States of America from the years 2016–2021 to identify STEMI hospitalizations. Index admissions were stratified according to concomitant GI bleeding. The primary outcome was in-hospital mortality; secondary outcomes were inflation-adjusted total charges, total costs, length of stay ≥7 days, acute kidney injury, and cardiogenic shock. Multivariable analysis with a logistic regression model was used to identify associations with in-hospital mortality and several secondary outcomes. Results: Of 1,013,800 index admissions with STEMI, 22,260 (2.2%) had concomitant GI bleeding. Patients with GI bleeding were older and more frequently had comorbidities such as chronic heart failure, liver disease, and chronic kidney disease. In-hospital mortality was higher in patients with GI bleeding (27.8% versus 7.6%, p < 0.001). GI bleeding was associated with 2.30 times (2.11–2.51, p < 0.001), 3.78 times (3.50–4.07, p < 0.001), 2.99 times (2.76–3.24, p < 0.001), and 2.62 times (2.42–2.83, p < 0.001) increased odds of in-hospital mortality, length of stay ≥7 days, acute kidney injury, and cardiogenic shock, respectively. However, liver disease was most strongly positively associated with in-hospital mortality (odds ratio [OR]: 5.50 [5.21–5.80], p < 0.001), acute kidney injury (OR: 6.50 [6.18–6.84], p < 0.001), and cardiogenic shock (OR: 5.47 [5.22–5.74], p < 0.001). Conclusions: GI bleeding was associated with in-hospital mortality, adverse outcomes, and increased resource utilization in patients with STEMI, highlighting the need for risk stratification, implementation of preventative strategies, and timely treatment of GI bleeding. Full article

Background: Influenza vaccination is widely recommended to prevent influenza and its complications; however, its association with clinical outcomes among high-risk populations remains uncertain. This study aimed to investigate the association between influenza vaccination status and clinical outcomes among adults hospitalized with community-acquired pneumonia (CAP) in Saudi Arabia. Methods: This retrospective cohort study included adults hospitalized with CAP in Saudi public hospitals between October 2023 and March 2024. Data on demographic characteristics, comorbidities, influenza vaccination status, laboratory-confirmed influenza infection, intensive care unit (ICU) admission, in-hospital mortality, and length of hospital stay were obtained from electronic health records. Logistic regression analyses were performed to evaluate the associations between influenza vaccination and clinical outcomes. Results: Among 485 patients, 114 (23.5%) had received the seasonal influenza vaccine. The prevalence of laboratory-confirmed influenza infection was similar among vaccinated and unvaccinated patients (57.9% vs. 58.5%, p-value = 0.910). Vaccinated patients were less likely to require ICU admission (1.8% vs. 7.5%, p-value = 0.025), while no significant differences were observed in length of hospital stay or in-hospital mortality. After adjustment for age, sex, and comorbidities, influenza vaccination was associated with lower odds of ICU admission (OR = 0.200, 95% CI: 0.045, 0.894). No significant associations were observed between influenza vaccination and laboratory-confirmed influenza infection, length of hospital stay, or in-hospital mortality. Conclusions: Among adults hospitalized with CAP in Saudi Arabia, influenza vaccination was associated with a lower likelihood of ICU admission, supporting its potential role in reducing disease severity among high-risk populations. Full article

Background: Low regional cerebral oxygen saturation (rScO₂) in children is linked to neurological sequelae. Lung-protective ventilation (LPV) mitigates lung injury but its effect on intraoperative rScO₂ is uncertain. Methods: One hundred and four children (<6 years) undergoing thoracoscopic mediastinal mass resection or lobectomy were randomized to LPV (n = 52; tidal volume: 6 mL/kg double-lung ventilation [DLV], 4 mL/kg one-lung ventilation [OLV] + 5 cm H₂O PEEP) or Control (n = 52; 10 mL/kg DLV, 8 mL/kg OLV + zero PEEP). rScO₂ was monitored continuously. Primary outcome was incidence of low rScO₂ during OLV (≥20% decrease from baseline ≥1 min). Secondary outcomes included lowest rScO₂, postoperative pulmonary complications (PPCs), and hospital length of stay (LOS). Results: Ninety-six children were analyzed (n = 48/group). Overall low rScO₂ incidence during OLV was 25/96 (26%). Significantly low rScO₂ incidence occurred with LPV (7/48, 14.6%) versus control (18/48, 37.5%; p = 0.011). The lowest intraoperative rScO₂ was significantly higher in the LPV group 76.5 (70.3, 80.0) compared to control 70.5 (60.3, 76.0); p < 0.001. PPC incidence was lower with LPV (7/48, 14.6%) than control (16/48, 33.3%; p = 0.031). Postoperative LOS was shorter in the LPV group 4.0 [4.0–5.0] days versus control group 5.0 [4.3–6.0] days, p < 0.001. Conclusions: Compared to conventional ventilation, an LPV strategy significantly reduces the incidence of low rScO₂ during OLV in young children undergoing thoracoscopic surgery. LPV also decreases PPCs and shortens hospital stay. Clinical trial registration: ChiCTR2400092732. Full article

Background/Objectives: Severe community-acquired pneumonia (CAP) can be fatal and requires the rapid and appropriate administration of antibiotics. Rapid multiplex PCR pneumonia panels are widely used tools for antimicrobial de-escalation and stewardship; however, their role in driving antibiotic escalation in severe pneumonia requiring intensive care is less well characterized. Methods: We retrospectively analyzed 288 adults with severe CAP who were admitted to the intensive care unit (ICU) of a tertiary hospital and underwent lower-respiratory BioFire FilmArray Pneumonia Panel (BFPP) testing between April 2023 and September 2024. The primary outcome was antibiotic escalation, defined as addition of an agent or a change to broader-spectrum therapy after the BFPP result, and its associated factors. Secondary outcomes were in-hospital mortality, hospital and ICU length of stay (LOS), and ventilator duration according to the antibiotic escalation. Results: Patients were elderly (median 72 years old; 60.8% male) and critically ill (median SOFA 8; median APACHE-II 19; shock 49.0%; mechanical ventilation 56.9%). The panel was positive in 66.3% of cases, and results were obtained with a median turnaround time of 2 h versus 67 h for sputum culture. After the panel, antibiotics were escalated in 34.0% of cases, de-escalated in 2.8%, discontinued in 0.7%, and unchanged in 62.5%. Escalation was independently associated with resistance gene detection (adjusted odds ratio [aOR] 3.15, 95% CI 1.71–5.82), panel positivity (aOR 1.97, 95% CI 1.02–3.80), and SOFA score (aOR 1.10 per point, 95% CI 1.01–1.19). Thirty-day mortality, in-hospital mortality, hospital LOS, ICU LOS, and ventilator duration did not differ between escalation and non-escalation groups. Conclusions: In severe CAP requiring intensive care and managed with a comparatively narrow initial empirical regimen, panel testing was predominantly followed by antibiotic escalation rather than de-escalation, particularly when resistance genes were detected. No statistically measurable difference in clinical outcomes was observed, but the study was not powered to exclude any clinically meaningful benefit or harm of escalation. Full article