Search Results (1,202)

Background: Short-term morbidities and mortality decreased significantly in the past decade at preterm born < 25 weeks of gestation. Severe lifelong morbidities affect an important part of these patients. Objective: to investigate the in-hospital morbidity, mortality, and short-term complications of preterm neonates born ≤25 weeks of gestation. Methods: A prospective longitudinal cohort study was conducted in children born 2021–2024, ≤25 weeks of gestation, admitted to a 3rd-level unit, and care till discharge. Pregnancy complications’ effect on neonatal evolution was analyzed, six main in-hospital morbidities specific for preterm birth and other aggravating circumstances, with a possible effect on the evolution were analyzed, as follows: inflammatory syndrome, early pulmonary or digestive hemorrhages, and early inotropic support. The neurological development in the first year of life was analyzed through theparticipation of premature infants in the follow-up program after discharge. Results: Forty-nine premature infants were enrolled, with a mean gestational age of 24.37 ± 0.76 weeks and an average weight of 665 ± 143 g. Most newborns required intubation at birth (42/49), and 33/49 received 2-dose surfactant therapy postnatally. NEC was present in 26.5% of the group, being more common in patients with inflammatory syndrome—increase in procalcitonin (PCT), and those who received a higher number of blood transfusions. The BPD and ROP, as well as the severity of the latter, correlated with the oxygen requirement on the 28th day of life. BPD was more common in infants associated with PDA requiring combination treatment. ROP increased with the number of transfusions required by patients. At the follow-up at the first timepoint evaluation, were 51% of the study group, and 30.6% of them had normal neurological development. At 12 months of age, however, the neurological examination was normal in only three patients (23.08%) but only 36.5% of the study group attended the follow-up. Neurodevelopmental disorders were present in 10 of the patients, one with spastic diplegia. Conclusions: In the hospital, the morbidity and survival rate of the group was like other studies. The small number of follow-up participants does not allow the generalization of the data, but as far as neurological development is concerned, it is like that of other studies. Full article

Background: One of the most debated scientific topics in recent years is the role of non-invasive respiratory support techniques in the treatment of de novo acute hypoxemic respiratory failure. Until pre-COVID-19, the most accredited guidelines did not make recommendations for or against the use of these techniques in this clinical condition, and the increased risk of adverse events for patients who failed the non-invasive approach was widely reported in the literature. The most recent guidelines recommend the use of HFNC as a first-line technique in the treatment of de novo acute hypoxemic respiratory failure to avoid the need for tracheal intubation. However, the strength of these recommendations remains weak, the quality of the underlying evidence is poor, and their usefulness in deciding which technique to apply to an individual patient is questionable. Aim: The aim of this review was to provide the reader with some critical tools to interpret the different indications regarding the choice of the best non-invasive support technique to be used in this setting. Methods: To this end, we analyzed the available literature on this topic, privileging the works that are most useful in correlating the practical indications to the pathophysiological assumptions. Results and Conclusions: The notable heterogeneity of the studies on which the current recommendations are based, as well as the affirmation of the concept of patient self-induced lung injury (P-SILI), highlights the importance of assessing each patient’s risk of developing this complication, individualizing treatment to the patient’s specific needs, and monitoring the patient during treatment. Full article

Background/Objectives: Surfactant has been delivered via less-invasive surfactant administration (LISA) in our neonatal intensive care unit (NICU) since 2020. Data have been monitored and the literature regularly reviewed to improve our LISA practice. The purpose of this project is to share the clinical practice changes made to help other NICU providers fine-tune their LISA practice. Methods: The original LISA criteria included babies with GA 27–36 6/7 w, on > 21% O₂, on continuous positive airway pressure (CPAP), pCO₂ < 70 if a blood gas was obtained, and radiographic and/or clinical evidence of respiratory distress syndrome (RDS). Current criteria include GA 25–35 6/7 w and minimum CPAP + 6. This manuscript highlights the changes made since 2023. To monitor these changes, targeted data from the entire cohort were examined before and after each change. Results: LISA was attempted on 399 babies (average (SD) GA 31.7 (2.7), birth weight 1752 (590), with a procedural success rate of 97%. Overall, 18% required intubation within 7 days after LISA. The median (IQR) for FiO₂ was 32 (28, 40) prior to LISA and 23 (21, 30) post-LISA and the hour of age of LISA was 4 (2.5, 9.9). LISA procedure success rate was increased by the use of video laryngoscopy as well as reinforcement of the use of sucrose sedation and swaddling; our first attempt success increased overall from 39% to 52%. After the introduction of a clinical RDS score (Downes), there was an expected and logical increase in the number of infants requiring intubation within 7 days of LISA indicating likely over-treatment prior to this change. After implementation of a clearly described plan for babies <28 w gestation there was a decrease in the hour of age of LISA from 3 (2.5, 4.5) to 2 (0.8, 3) h. Conclusions: It is critical to continually evaluate a new practice and identify strategic changes. We offer our changes to assist others starting or using LISA. Full article

Background: Myocarditis is an uncommon but recognized adverse event following mRNA COVID-19 vaccination, with risk varying by age, sex, dose number, and vaccine product. Clarifying the magnitude of risk, clinical course, and recovery—relative to myocarditis following SARS-CoV-2 infection—is essential for risk–benefit assessment and public health guidance. Methods: We performed a systematic PubMed and Embase search (January 2020–December 2024) and synthesized cohort, registry, and surveillance data on myocarditis incidence and outcomes following mRNA COVID-19 vaccination. Outcomes included incidence, observed-to-expected (OE) or incidence rate (IRRs) ratios, hospitalization, and short-term recovery. Study selection followed PRISMA 2020 systematic review guidelines. Results: Myocarditis following mRNA COVID-19 vaccination was identified as a rare adverse event, most commonly occurring after the second dose and in younger male individuals. Across multiple cohort and registry-based studies, cases were generally mild and self-limited, with most patients recovering without complication. In contrast, myocarditis following SARS-CoV-2 infection was consistently associated with more severe outcomes, including higher rates of hospitalization and mortality. Conclusions: Vaccine-associated myocarditis is rare, typically mild, and self-limited, with excellent short-term recovery; vaccinated individuals also exhibit lower odds of in-hospital death and intubation. In contrast, infection-associated myocarditis is more frequent and severe. Overall, the benefit–risk profile of mRNA vaccination remains strongly favorable. Full article

Background: Influenza is a common cause of hospitalization in young children, particularly infants. While most infections are self-limited, severe and life-threatening complications may occur. Diffuse alveolar hemorrhage (DAH) is a rare pulmonary manifestation of influenza, predominantly reported in adults, and is exceedingly uncommon in immunocompetent infants. Case Presentation: We report the case of an 8-month-old previously healthy female infant who presented with influenza A infection and rapidly progressed to acute respiratory failure and shock despite antiviral therapy. Bleeding was noted from the nasal cavity prior to clinical deterioration, and during emergent endotracheal intubation, blood was observed flooding the bronchial tree, consistent with massive pulmonary hemorrhage. Flexible bronchoscopy showed diffusely erythematous and friable airway mucosa without an identifiable focal bleeding source, and early bronchoalveolar lavage was nondiagnostic. Nasopharyngeal testing confirmed influenza A (H3). Laboratory findings revealed severe systemic inflammation, leukopenia with neutropenia, and anemia with normal coagulation parameters. Chest imaging demonstrated bilateral pulmonary infiltrates. After exclusion of autoimmune, coagulation, immunodeficiency, and alternative infectious causes, a diagnosis of diffuse alveolar hemorrhage secondary to influenza A infection was established. The patient was successfully managed with supportive care, antiviral therapy, tranexamic acid, and empiric antibiotics, without corticosteroid treatment, and made a full recovery. Conclusions: This case emphasizes that influenza-associated DAH in infants may occur without overt hemoptysis and may not demonstrate classical BAL findings early in the disease course. Clinicians should maintain a high index of suspicion in rapidly deteriorating infants with influenza and diffuse pulmonary infiltrates. The optimal role of corticosteroids remains uncertain and should be individualized. Full article

Background/Objectives: Primary acquired lacrimal drainage obstruction (PALDO) is a common cause of epiphora. Although dacryoendoscopic recanalization (DER) is widely performed, its long-term success is limited by restenosis related to fibro-inflammatory processes. This study aimed to evaluate the efficacy of a novel Q-needle for targeted intraductal delivery of antifibrotic and anti-inflammatory agents during DER. Methods: A retrospective review was performed on 190 eyes treated with DER, silicone tube intubation (SI), and retrograde intraductal injection via the inferior meatus using a Q-needle. A mixture of dexamethasone (1 mL), 5-fluorouracil (1 mL), and triamcinolone acetonide (1 mL) was administered directly into the obstruction site under endoscopic visualization. Obstruction type was classified intraoperatively as secretory or structural based on dacryoendoscopic findings. Results: The overall surgical success rate was 92.1%, with significantly greater success in secretory-type PALDO compared to the structural type (96.8% vs. 87.4%, p = 0.031). These outcomes contrast with previous reports in which secretory-type PALDO was associated with poorer prognosis after DER. Conclusions: The improved outcomes in the secretory group suggest a potential role of combined antiproliferative and multi-phase anti-inflammatory therapy in effectively addressing the key mechanisms of restenosis. Q-needle–assisted intraductal injection during DER may represent a simple and safe adjunctive approach to improve surgical consistency and long-term patency in patients with PALDO. Full article

Accurate and rapid detection of anatomical structures, such as the glottis, is critical during tracheal intubation (TI) to ensure patient safety and procedural success. However, it remains a challenge due to the limited field of view and computational resources of video laryngoscopy, especially for difficult airway situations. Existing deep learning (DL) models struggle to balance high accuracy and real-time clinical deployment. To address these issues, we propose TI-YOLO (TI-You Only Look Once), a lightweight and efficient object detection model built upon the YOLOv11 architecture. TI-YOLO introduces the Bidirectional Feature Pyramid Network (BiFPN) module for multi-scale feature fusion, effectively enhancing the ability to detect anatomical structures of different sizes. TI-YOLO integrates the Deformable Attention Transformer (DAT) module to enhance the perception of crucial regions, improving detection accuracy and robustness. To further reduce the consumption of computational resources while maintaining efficiency, TI-YOLO is optimized by reconstructing the backbone based on MobileNetV4. Furthermore, TI-YOLO employs the Slide Weight Function (SWF) as a loss function during model training to mitigate the class imbalance within the dataset. One self-built dataset is used to validate the effectiveness of TI-YOLO. Compared to the original YOLOv11, TI-YOLO achieves mean Average Precision at IoU 0.50 (mAP50) scores of 0.902, with improvements of 3.8%. Meanwhile, TI-YOLO balances detection accuracy and computational efficiency with a 10.5% reduction in floating-point operations (FLOPs) and a 28.9% reduction in parameters, and the model weight is only 4.6 MB. Additionally, to evaluate TI-YOLO real-time inference capability, we quantize and deploy it on a low-cost embedded OrangePi 5 platform. The inference speed reaches over 50 frames per second (FPS), meeting real-time clinical requirements. Full article

Pediatric subglottic stenosis (SGS) remains a significant cause of upper airway obstruction in infants and children, most commonly resulting from prolonged endotracheal intubation. Although open airway reconstruction procedures such as laryngotracheal reconstruction (LTR) and partial cricotracheal resection (PCTR) provide definitive treatment for severe disease, their invasiveness and the burden of postoperative management have prompted increasing interest in less invasive approaches. Endoscopic balloon dilation has emerged as an effective therapeutic option, particularly for early-stage, short-segment, and soft acquired stenosis. This review summarizes the pathophysiology, clinical presentation, and severity assessment of pediatric SGS, and discusses the evolution of surgical management with particular emphasis on the role of balloon dilation. Technical aspects—including balloon sizing, adjunctive radial incision, dilation protocols, and local pharmacologic therapies—are outlined. Endoscopic balloon dilation is most effective in carefully selected patients, particularly those with early-stage and less severe stenosis. While it can significantly reduce the need for open airway reconstruction, recurrence remains a key limitation, necessitating careful patient selection and long-term follow-up. This article represents a narrative review of the current literature combined with the authors’ clinical experience. Full article

Background/Objectives: The rise in healthcare-associated infections caused by multidrug-resistant (MDR) bacteria in hospitals, particularly in intensive care units, has resulted in increased rates of morbidity and mortality, escalating costs, and has become a significant public health concern. In our Intensive Care Unit, we address healthcare-associated infections caused by multidrug-resistant bacteria, with a specific focus on those listed in the WHO 2024 List of Critically and Highly Prioritized Pathogens. Methods: Over the course of 1 year, from 1 January to 31 December 2024, we monitored the prevalence of healthcare-associated infections in the Intensive Care Unit of the Sibiu County Emergency Clinical Hospital, Romania, and the antibiotic susceptibility of the isolated bacteria. Results: The majority of infections were caused by pathogens in the ESKAPEE group. The most frequently isolated microorganism was Klebsiella pneumoniae (36.8%), followed by Acinetobacter baumannii (24.5%), classified as a critical priority by the WHO in 2024. Most positive samples for critical priority pathogens, including Klebsiella pneumoniae and Acinetobacter baumannii, as well as all MRSA strains (high priority), were obtained from tracheal aspirates collected from intubated and mechanically ventilated patients. A significant proportion of the isolated bacteria were multidrug-resistant, including extensively drug-resistant and pan-drug-resistant strains. Conclusions: The increase in antibiotic and antimicrobial resistance among hospital strains raises serious concerns about limited treatment options. Full article

Background: Early identification of patients at risk for adverse outcomes after cardiac surgery remains a major clinical challenge. While preoperative risk scores are widely used, the prognostic value of early postoperative ICU severity scores and functional performance measures has not been fully clarified. Methods: This prospective observational study included 195 patients undergoing cardiac surgery between 2018 and 2024. Predictive performance of EuroSCORE II, the SOFA score, the APACHE II score, Karnofsky performance status, handgrip strength, and phase angle was assessed for postoperative complications and mortality. Receiver operating characteristic (ROC) curves with 95% confidence intervals were calculated, and pairwise comparisons between ROC curves were performed. Major postoperative complications were analyzed using a composite endpoint including stroke, prolonged intubation, sepsis, and reoperation, excluding systemic inflammatory response syndrome (SIRS). Results: Major postoperative complications occurred in 46 patients (23.6%). For prediction of major postoperative complications, SOFA demonstrated the highest discrimination (AUC = 0.881, 95% CI 0.819–0.928), followed by APACHE II (AUC = 0.826, 95% CI 0.753–0.888) and EuroSCORE II (AUC = 0.695, 95% CI 0.602–0.785). In-hospital mortality occurred in 19 patients (9.7%). SOFA showed the strongest predictive performance (AUC = 0.915, 95% CI 0.851–0.968), followed by APACHE II (AUC = 0.869, 95% CI 0.781–0.939) and EuroSCORE II (AUC = 0.742, 95% CI 0.595–0.870). During follow-up, 54 patients (27.7%) died. Predictive performance was comparable between SOFA (AUC = 0.710, 95% CI 0.618–0.793), APACHE II (AUC = 0.695, 95% CI 0.606–0.782), and EuroSCORE II (AUC = 0.680, 95% CI 0.599–0.757). Conclusions: Early postoperative ICU severity scores, particularly SOFA and APACHE II, demonstrated strong predictive ability for major postoperative complications and in-hospital mortality following cardiac surgery and outperformed preoperative risk scores. Full article

Background: Unanticipated difficult airways remain a leading cause of anesthesia-related morbidity and mortality, with traditional bedside predictors demonstrating limited sensitivity. Point-of-Care Ultrasound (POCUS) has emerged as a non-invasive adjunct offering real-time visualization and quantitative measurement of airway anatomy. This narrative review, structured according to the Scale for the Assessment of Narrative Review Articles (SANRA), synthesizes current evidence on POCUS as an adjunct for airway evaluation. We explore the sonoanatomy of the upper airway, the utility of ultrasound in predicting difficult laryngoscopy and intubation, its critical role in emergency front-of-neck access, and the verification of endotracheal tube placement. Furthermore, we discuss the integration of Artificial Intelligence (AI) in image interpretation and the necessity of standardized training curricula. Methods: We systematically searched PubMed/MEDLINE, Scopus, and Web of Science for English-language peer-reviewed studies addressing sonographic airway assessment, including sonoanatomy, prediction of difficult laryngoscopy/intubation, guidance for emergency FONA and endotracheal tube confirmation. Results: POCUS enhances visualization of critical anatomical structures, may improve anatomical assessment and risk stratification when combined with clinical assessment, and it may provide real-time guidance during emergency procedures. Integration of AI has shown promising diagnostic performance, primarily based on surrogate outcomes. Conclusions: Airway ultrasound may represent a shift toward personalized, safer airway management. However, standardized training protocols and validation in diverse clinical settings remain essential. Future research should focus on developing evidence-based algorithms integrating POCUS into airway management guidelines. Full article

Postoperative respiratory failure (PRF) remains a pervasive clinical challenge that substantially contributes to perioperative morbidity, mortality, and prolonged ICU stay. Although conventional oxygen therapy is often sufficient, a significant subset of high-risk patients requires escalation to advanced non-invasive support to avoid reintubation and invasive mechanical ventilation. Evidence from recent randomized trials, including the 2025 RENOVATE and Goret et al. studies, indicates that both non-invasive ventilation (NIV) and high-flow nasal oxygen (HFNO) reduce postoperative pulmonary complications and reintubation in selected high-risk populations. While NIV is preferred for hypercapnic ventilatory failure and is commonly used in selected high-risk cardiac surgery patients, HFNO offers comparable outcomes in pure hypoxemic failure with the added benefits of superior patient tolerance and a lower incidence of interface-related complications. Effective PRF management necessitates an individualized, physiology-based approach. By implementing a phenotype-driven algorithm that aligns device mechanics with the dominant pathophysiology, such as atelectasis versus pump failure, clinicians can optimize patient outcomes while minimizing the specific risks associated with delayed intubation. Full article

Introduction: The retropharyngeal carotid artery (RCA) is a rare anatomical variant where the carotid artery resides in the retropharyngeal space. The co-occurrence of RCA and significant atherosclerotic stenosis of the carotid bifurcation is even rarer. Recognizing this anatomy is crucial because of the increased risk of adverse events during procedures such as intubation or oropharyngeal surgery. Furthermore, differentiating between the fixed and dynamic forms is essential for guiding appropriate diagnostic and therapeutic strategies. A scoping review was undertaken, and two cases of RCA and significant internal carotid artery stenosis requiring a surgical approach were presented. Materials and Methods: EMBASE and OVID were systematically searched for studies reporting data on RCA and significant internal carotid artery stenosis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) was followed, and we presented two case reports of RCA and significant internal carotid artery stenosis requiring surgical treatment, treated at the Division of Vascular Surgery, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy. Results and Discussion: Among the 22 papers identified by the scoping review, 6 case reports were ultimately included in the analysis, supplemented by our two cases. The review and the added cases highlight significant heterogeneity in the clinical presentation and management of RCA with stenosis. Therapeutic options include carotid endarterectomy (CEA), transfemoral carotid artery stenting (TF-CAS), and transcarotid artery revascularization (TCAR). Also, the diagnostic with dynamic 3D-CT angiography during swallowing would be important in some symptomatic cases to document mechanical compression by the hyoid bone or thyroid cartilage (dynamic RCA), which standard static imaging failed to detect. Conclusions: Due to the rarity of the condition, no high-level evidence (RCTs) exists. Treatment decisions are based on the qualitative assessment of anatomical risk and isolated case reports. Standard interventions (CEA and TF-CAS) are generally considered high-risk. The final management choice must be individualized based on technical feasibility, neurological risk, and the determination of whether the pathology is fixed or dynamically compressive. Full article

Background: Arytenoid cartilage dislocation (ACD) is a rare but clinically significant complication of endotracheal intubation that may be misdiagnosed as transient vocal cord paralysis. The potential role of prolonged surgical positioning in ACD remains underrecognized. Methods: A 63-year-old male developed left posterior ACD following robot-assisted radical prostatectomy (RARP) performed in a steep Trendelenburg position for 3.5 h. Intubation was successfully achieved on the first attempt using a video laryngoscope with full glottic visualization and no apparent airway trauma. Postoperatively, the patient developed persistent dysphonia, dysphagia, aspiration, and tongue deviation. Initial flexible laryngoscopy suggested left vocal cord paralysis, whereas direct laryngoscopy on postoperative day 6 confirmed posterior arytenoid dislocation. Urgent closed reduction was performed, followed by structured voice therapy, which resulted in substantial functional recovery. Discussion: This case illustrates that ACD may occur despite technically optimal and atraumatic intubation and should be interpreted as reflecting a temporal association rather than a definitive causal relationship. Prolonged steep Trendelenburg positioning and extended operative duration may be considered potential contributing biomechanical factors, possibly mediated by venous congestion, mucosal edema, altered endotracheal tube dynamics, and cumulative shear stress on the cricoarytenoid joint. However, these mechanisms remain interpretive and hypothesis-generating. Conclusions: Prolonged steep Trendelenburg positioning and extended operative duration may represent possible contributing biomechanical factors in ACD, even in the setting of atraumatic intubation. Early laryngeal evaluation and timely reduction remain essential for optimal functional recovery. Full article

Background: Difficult intubation is an important clinical problem faced by anesthesiologists and is one of the most important causes of anesthesia-related morbidity. According to various sources, the frequency of encountering a difficult airway is stated as 1–4%. Aim: We thought that difficult tracheal intubation could be predicted by photographic analysis using artificial intelligence. Methods: Sixteen photographs were taken in the preoperative period in the sitting and lying positions anteriorly, laterally, with the mouth open, with the mouth closed, with the neck straight, and with the neck extended. Intubations performed without intervention for the first time were considered easy. Intubations with external tracheal intervention and with more than one attempt were evaluated as medium. Intubations requiring more than three attempts; intubation with stylets, fiberoptic bronchoscopes, or video laryngoscopes; or cases in which patients could not be intubated and provided airway with a laryngeal mask were considered difficult. Results: In our study, the CNN (convolutional neural network) model performed well overall, with the best results generally obtained using batch sizes of 32 and 128 and learning rates ranging from 0.1 to 0.001. Conclusions: The prominent aspects of our study are that it can be conducted with an easily accessible mobile phone, can be performed at the bedside, and is successful in predicting difficult intubation. The sensitivity of methods currently used to assess difficult airways is generally low, and the likelihood of clinicians successfully identifying this condition using available information varies widely; thus far, there is no gold standard for prediction. We believe that our study will bring a different perspective to estimating the difficulty of intubation, which occupies a very important place in anesthesia practice. Full article