Search Results (3,064)

Introduction: Diabetic gastroparesis increases the risk of aspiration, pneumonia, and sepsis, yet the impact of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) on these outcomes is uncertain because of their gastric-emptying effects. Methods: We performed a retrospective cohort study using the TriNetX Global Research Network. Adults (≥18 years) with diabetes mellitus and gastroparesis were identified and divided into two cohorts based on GLP-1 RA exposure. Propensity score matching (1:1) balanced demographics, comorbidities, and antidiabetic medications, yielding 23,371 patients per cohort. Outcomes, assessed from 180 days after index, included pneumonia, pneumonitis, mechanical ventilation, ventilator-associated pneumonia, sepsis, bacteremia, empyema, lung abscess, acute respiratory distress syndrome (ARDS), and need for enteral feeding. Risk ratios (RRs) and hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated. Results: Compared with GLP-1 users, non-GLP-1 patients had higher incidences of pneumonitis (3.6% vs. 2.5%; HR 1.76, 95% CI 1.58–1.95), pneumonia (13.2% vs. 12.2%; HR 1.34, 95% CI 1.27–1.41), mechanical ventilation (4.4% vs. 3.3%; HR 1.63, 95% CI 1.49–1.79), sepsis (12.8% vs. 11.1%; HR 1.44, 95% CI 1.37–1.52), and bacteremia (5.2% vs. 4.4%; HR 1.46, 95% CI 1.35–1.59) (all p < 0.001). Empyema and ARDS were also numerically lower among GLP-1 users, while ventilator-associated pneumonia and lung abscess were rare and similar between groups. No patients required percutaneous endoscopic gastrostomy or nasal enteral feeding. Conclusions: In patients with diabetes and gastroparesis, GLP-1 RA therapy was associated with significantly fewer pulmonary and systemic infectious complications. These data suggest that the systemic benefits of GLP-1 RAs may outweigh concerns regarding delayed gastric emptying in this high-risk population. Full article

Respiratory support requirement among children hospitalized with pneumonia is a key marker of disease severity and resource needs, yet scalable risk stratification tools for routine hospital settings in Southern Vietnam remain limited. Background: This study aimed to develop and evaluate clinical and laboratory-based multivariable models to predict respiratory support requirement in children under five hospitalized with pneumonia, using a routine care dataset. Methods: We conducted a retrospective cohort study conducted at a tertiary pediatric hospital in Southern Vietnam (July 2024–November 2025), children aged 2–59 months hospitalized with pneumonia were included after predefined exclusions. The outcome was the maximum (worst) level of respiratory support required during hospitalization (oxygen therapy, CPAP, or invasive mechanical ventilation), analyzed as a binary endpoint (any support vs. none) for model development. Candidate predictors included bedside clinical variables (age < 12 months, malnutrition, recurrent pneumonia, cyanosis, tachypnea, chest indrawing) and complete blood count-derived inflammatory indices. Univariable logistic regression was used for crude associations. Two multivariable logistic regression models were built: Model 1 (clinical-only) and Model 2 (clinical + neutrophil-to-lymphocyte ratio [NLR]; primary). Discrimination was assessed using area under the ROC curve (AUC), and calibration was evaluated using the Hosmer–Lemeshow test and observed-to-expected (O:E) ratio. Results: A total of 1797 children were included; 154 (8.6%) required respiratory support. In the primary model, independent predictors were age < 12 months (aOR 2.57, 95% CI 1.69–3.92), malnutrition (aOR 4.33, 2.56–7.33), recurrent pneumonia (aOR 1.82, 1.18–2.81), cyanosis (aOR 24.02, 7.41–77.87), chest indrawing (aOR 4.19, 2.73–6.43), and higher NLR (per 1 unit: aOR 1.49, 1.38–1.60), while tachypnea was not independently associated after adjustment. Discrimination improved from Model 1 (AUC 0.754) to Model 2 (AUC 0.840; 95% CI 0.806–0.874). At the optimal probability cut-off (0.122), Model 2 achieved sensitivity 66.2%, specificity 86.2%, PPV 31.1%, NPV 96.5%, and accuracy 84.5%. Calibration was acceptable (Hosmer–Lemeshow p = 0.662; O:E = 1.00). Conclusions: A simple clinical model strengthened by NLR provided good discrimination and calibration for predicting respiratory support requirement among children under-five hospitalized with pneumonia in Southern Vietnam. This approach may support early triage, prioritization of monitoring intensity, and escalation readiness in resource-constrained settings, although external validation is warranted. Full article

Emergent tracheal intubation in critically ill patients is a common, yet high-risk, intervention. It is frequently complicated by peri-intubation hypoxemia, hemodynamic instability, and metabolic derangements that increase the risk of arrhythmias, hypotension, cardiac arrest, and death. Because the highest-risk interval often occurs in the minutes surrounding induction, when apnea, derecruitment, and abrupt cardiopulmonary shifts converge, oxygenation failure frequently reflects a mismatch between preoxygenation strategy and the underlying physiology rather than inadequate oxygen delivery alone. This review proposes a phenotype-based approach to peri-intubation oxygenation and focuses on four high-risk phenotypes in whom standard preoxygenation strategies commonly fail: obesity, neuromuscular disease, right ventricular dysfunction or pulmonary hypertension, and post-operative respiratory failure with altered respiratory mechanics or airway anatomy. We summarize the key mechanisms that shorten safe apnea time, including reduced functional residual capacity, intrapulmonary shunt, elevated oxygen consumption, rapid derecruitment after induction, and impaired oxygenation–hemodynamics coupling. We then compare preoxygenation modalities as physiologic tools, including facemask oxygen, high-flow nasal cannula (HFNC), noninvasive ventilation (NIV), and controlled bag-mask ventilation (BMV), and integrate contemporary randomized trial evidence that informs bedside selection and combination of these approaches. Finally, we synthesize these concepts into a practical, physiology-informed framework to guide clinicians in choosing and troubleshooting preoxygenation strategies in high-risk patients undergoing emergent intubation. Full article

This paper investigates the effectiveness of a coal mine methane drainage system in hard coal mining, with particular emphasis on coal seam 501 at the Staszic–Wujek coal mine (Polska Grupa Górnicza S.A., Katowice, Poland) in the Upper Silesian Coal Basin (USCB), Poland. The study evaluates methane drainage efficiency considering geo-mechanical conditions governing the optimal location of drainage boreholes. Conventional and long directional boreholes are analyzed. Opposite to conventional static analytical approaches, the proposed integrated analysis framework incorporates multi-physics processes, improving forecasting accuracy and enabling dynamic optimization of methane control in deep coal mines. The framework reproduces the geometry of the mining system and the mechanical properties of the surrounding rock mass, allowing the influence of geo-mechanical processes on methane drainage efficiency to be assessed. The methane content of coal seam 501 and methane sorption kinetics on representative coal samples are analyzed together with key characteristics of the mine ventilation system, including air and pressure distribution in workings and goafs and migration paths of methane–air mixtures within coal panel II/C. Full article

Caffeine is widely consumed and generally considered safe at customary doses. How-ever, high-dose preparations available online pose a risk of severe and potentially fatal intoxication. Although uncommon, lethal caffeine poisoning is associated with profound cardiovascular and neurological toxicity. A rare case of intentional acute caffeine intoxication with fatal outcome is presented. A 25-year-old woman ingested an estimated 60 tablets containing 200 mg of caffeine each, purchased online. She was admitted to hospital shortly after ingestion of the caffeine tablets with palpitations, agitation, dizziness, and repeated vomiting. On examination, she presented with arterial hypotension (90/60 mmHg) and marked sinus tachycardia (150 beats/min), accompanied by psychomotor agitation. Her blood caffeine concentration measured by means of high-performance liquid chromatography (HPLC) was 177 µg/mL. The patient’s condition rapidly deteriorated, with the development of convulsive syndrome progressing to coma, extreme ventricular tachycardia, exotoxic shock, and toxic cardiomyopathy. Despite intensive care management, including mechanical ventilation and advanced cardiopulmonary resuscitation, the patient died several hours after admission. In conclusion, this case underscores the life-threatening potential of acute high-dose caffeine ingestion and highlights the risk associated with unrestricted access to concentrated caffeine products. Early recognition and aggressive management are crucial, yet may be insufficient in cases of massive overdose. Full article

Background and Objectives: Diabetes mellitus (DM) is a highly prevalent comorbidity among critically ill patients and may significantly influence intensive care unit (ICU) outcomes through metabolic, immune, and cardiovascular mechanisms. This study aimed to evaluate the impact of DM on clinical profile, comorbidities, complications, need for intensive support, and mortality in adult ICU patients. Materials and Methods: A retrospective observational study was conducted between January and December 2024 in a tertiary ICU, including 1344 adult patients. Among them, 435 (32.37%) had DM. Demographic data, admission diagnoses, laboratory parameters, comorbidities, complications, therapeutic interventions, and outcomes were analyzed. Comparative statistical analysis and multivariate logistic regression were performed to identify independent predictors of ICU mortality. Results: Patients with DM were significantly older than patients without diabetes mellitus (non-DM group) (69.62 ± 10.26 vs. 67.16 ± 14.26 years, p < 0.001) and more frequently female (57%, p = 0.0002). At admission, they presented higher glycemia (204.7 vs. 134.0 mg/dL, p < 0.00001), reduced glomerular filtration rate (47.2 vs. 59.5 mL/min/1.73 m², p < 0.00001), and more pronounced lymphocytopenia (p = 0.025). Cardiovascular and renal comorbidities were significantly more prevalent in DM, including hypertension (76.3%), heart failure (32.4%), and chronic kidney disease (33.1%) (all p < 0.01). DM was associated with increased odds of sepsis (OR 1.56), acute kidney injury (OR 1.51), and obesity (OR 2.57). ICU mortality was significantly higher in patients with DM (54.9% vs. 46.3%, p = 0.004; RR 1.19). Independent predictors of death included mechanical ventilation (OR 36.48), inotropic therapy (OR 4.74), hemodialysis (OR 2.57), elevated lactate, neutrophilia, and reduced glomerular filtration rate (GFR). Conclusions: DM was associated with increased ICU mortality and a higher burden of cardio-renal comorbidities and complications; however, mortality in the multivariate model was primarily driven by markers of organ dysfunction and the need for advanced supportive therapies. Early risk stratification and individualized management strategies are essential to improve outcomes in critically ill patients with diabetes. Full article

Background: Low cardiac output syndrome (LCOS) is a significant cause of postoperative morbidity and mortality in children with congenital heart disease. Prophylactic levosimendan is increasingly used to prevent LCOS, but its superiority to other strategies remains unproven. Based on the pharmacokinetics of levosimendan, we hypothesize that preoperative administration is beneficial for preventing LCOS in a specifically at-risk population. Methods: This is a retrospective single-center cohort study in a tertiary pediatric intensive care unit. All patients under one year of age undergoing surgery for congenital heart disease using cardiopulmonary bypass and receiving levosimendan within 24 h before or after surgery were included and classified into two groups: preoperative and postoperative administration. Results: Overall, 107 patients were included. Fifty-three patients (49.5%) received levosimendan before surgery, with significantly lower mortality, fewer LCOS markers, and lower LCOS scores compared to patients receiving levosimendan after surgery. Although not significant, the use of extracorporeal membrane oxygenation, renal replacement therapy, and temperature control was also lower in the preoperative group. There was no difference in mechanical ventilation duration and length of stay. Conclusions: Preoperative administration of levosimendan seems associated with a lower incidence of LCOS and reduced mortality in high-risk children with congenital heart surgery. Full article

Background: Acute kidney injury (AKI) is a common and high-risk complication of hospitalization that frequently occurs in patients with chronic cardiometabolic disease. Although heart failure (HF) and diabetes mellitus (DM) are prevalent among hospitalized adults and may differentially modify AKI-associated outcomes, their joint impact on in-hospital risk profiles and cumulative burden remains incompletely characterized. Methods: We conducted a retrospective analysis of adult hospitalizations complicated by AKI using a nationally representative inpatient database. Hospitalizations were classified into four cardiorenal metabolic phenotypes: AKI alone, AKI with HF, AKI with DM, and AKI with both HF and DM. Primary outcomes included in-hospital mortality, dialysis initiation, and mechanical ventilation. Survey-weighted multivariable logistic regression models incorporating HF, DM, and their interaction were used to estimate adjusted associations and model-based predicted probabilities. Adjusted risks were visualized across outcomes, and a composite burden metric was constructed to summarize cumulative in-hospital adverse events. Results: AKI outcomes varied substantially across cardiorenal metabolic phenotypes. HF was consistently associated with higher adjusted mortality and mechanical ventilation risk, whereas DM alone was associated with lower adjusted mortality. A significant interaction between HF and DM was observed regarding dialysis initiation, with a disproportionately higher adjusted risk when both conditions coexisted. Integrated visualization across outcomes demonstrated distinct risk profiles by phenotype, with the combined HF and DM group exhibiting the highest cumulative burden of adverse in-hospital events. Conclusions: Among hospitalizations complicated by AKI, the underlying cardiorenal metabolic status is associated with marked heterogeneity in in-hospital outcomes. HF appears to be a dominant modifier of AKI-associated risk, while DM exerts outcome-specific effects and synergistically increases the risk of dialysis initiation when combined with HF. These findings highlight the importance of incorporating cardiometabolic context into AKI risk stratification approaches and underscore the value of multidimensional in-hospital assessments. Full article

Indoor air quality (IAQ) in educational buildings plays a critical role in the health, cognitive performance, and well-being of occupants. Aging university facilities often rely on outdated ventilation systems that are not designed to meet current demands or respond to dynamic occupancy levels. This study investigates the performance and feasibility of various advanced ventilation strategies in comparison to an existing balanced mechanical ventilation (BMV) system in a university classroom accommodating 100 students. Using a Dynamic Building Energy Simulation Program, simulations were conducted to evaluate IAQ (using CO₂ levels), energy consumption, and thermal comfort under three retrofitting scenarios: BMV, demand-controlled ventilation (DCV), and hybrid ventilation combining natural and mechanical airflow. The simulations indicate that DCV cuts annual HVAC energy use by 33% relative to the baseline, while the hybrid strategy achieves the greatest reduction of 42% and maintains CO₂ levels and thermal comfort within recommended limits. Although hybrid systems provide seasonal advantages, their complexity may limit applicability. In addition to technical analysis, this study also explores the financial and tax-related challenges associated with retrofitting ventilation systems in university buildings. Investment payback periods, operational costs, and potential tax incentives are discussed to evaluate economic viability. Overall, the endorse hybrid ventilation as the most cost-effective strategy where mixed-mode control is feasible, and DCV as a practical alternative for buildings unable to employ natural ventilation. Full article

Introduction: Congenital central hypoventilation syndrome (CCHS) is a rare disorder characterized by an impaired ventilatory response to hypercapnia and hypoxia, particularly during sleep, and frequently associated with autonomic dysfunction. It is caused by pathogenic variants in the PHOX2B gene. Although CCHS is typically diagnosed in the neonatal period, milder forms may present later in infancy or childhood, often triggered by respiratory infections. Case presentation: We report the case of 16-month-old male diagnosed with CCHS following an episode of hypoxemic–hypercapnic respiratory failure during respiratory syncytial virus (RSV) infection. His medical history included neonatal respiratory distress requiring oxygen therapy and recurrent wheezing. At 15 months, he developed acute respiratory distress with severe hypercapnia (PaCO₂ 70 mmHg), requiring admission to the Pediatric Intensive Care Unit and invasive mechanical ventilation. Persistent sleep-related hypercapnia and hypoxemia prompted evaluation for central hypoventilation, confirmed by means of transcutaneous capnography and nocturnal pulse oximetry. Genetic testing revealed a de novo nonsense mutation in exon 1 of PHOX2B (p.Tyr14Ter). Brain magnetic resonance imaging showed diffuse white matter changes suggestive of gliosis. Further investigations identified early-onset systemic hypertension, requiring antihypertensive therapy. The patient was discharged on nocturnal non-invasive ventilation and enrolled in a neurodevelopmental rehabilitation program. Conclusions: This case highlights the phenotypic variability of CCHS and the importance of considering this diagnosis in children presenting with unexplained hypercapnia and sleep-related hypoxemia. It underscores the need for comprehensive autonomic evaluation, including blood pressure monitoring. The p.Tyr14Ter variant may allow partial protein function, potentially accounting for the relatively mild phenotype. Full article

Background/Objectives: Publicly available open databases offer advantages in terms of accessibility and transparency. However, their application in intensive care research remains limited. Therefore, in this study, we examined whether simple nationwide comparisons of intensive care unit (ICU) practice patterns are feasible using an open database. Methods: A multicenter, cross-sectional study was conducted using data from the Bed Function Report. ICU wards reimbursed under ICU admission fee types were included and classified as high-acuity or standard ICUs. The ward-level procedure frequencies of procedures, including mechanical ventilation, were calculated. Comparisons were performed according to ICU admission fee type and geographic region. Quasi-Poisson regression models with offsets for annual ICU admissions were applied, accounting for overdispersion. Results: A total of 602 ICUs were included in the study. Non-metropolitan ICUs demonstrated higher procedural rates for mechanical ventilation compared with metropolitan ICUs (rate ratio [RR], 1.11; 95% confidence interval [CI], 1.02–1.21). Standard ICUs consistently had lower procedural rates for mechanical ventilation than high-acuity ICUs (RR, 0.74; 95% CI, 0.68–0.81). Group analyses indicated that regional differences in procedure frequencies were evident in standard ICUs, but not in high-acuity ICUs. Conclusions: This study demonstrated the feasibility of comparing ICU practice patterns across different regions and facility types in Japan using a nationwide open public database. This approach may serve as an initial step in a stepwise research framework that links open-database profiling to patient-level analysis using more detailed data sources. Full article

Background/Objectives: Myositis-associated interstitial lung disease (ILD) can occasionally present as acute respiratory distress syndrome (ARDS); however, clinical data on this presentation remain limited. This study aimed to describe the clinical characteristics and outcomes of patients with myositis-associated ILD presenting as ARDS. Methods: We conducted a single-center retrospective observational study of patients with myositis-associated ILD who were admitted to the intensive care unit (ICU) for acute hypoxemic respiratory failure. Results: Ten patients positive for myositis-specific antibodies met the new global ARDS definition. The median age was 62 years, and eight patients were male. Antibody profiles included anti-MDA-5 (n = 5), anti-synthetase antibodies (Jo-1 [n = 1], PL-7 [n = 2], EJ [n = 4]), and NXP-2 (n = 1). Fever and cutaneous manifestations were the most common extrapulmonary features. Chest computed tomography demonstrated diffuse alveolar damage patterns in six patients and organizing pneumonia patterns in four. At ICU admission, four patients required mechanical ventilation and six received high-flow nasal cannula, of whom four subsequently progressed to mechanical ventilation. Extracorporeal membrane oxygenation was implemented in three patients. All patients received high-dose corticosteroids, six underwent steroid pulse therapy, and four additionally received immunosuppressive agents. Six patients died during hospitalization. Conclusions: Myositis-associated ILD may present as ARDS and should be considered in patients with ARDS of unclear etiology. Careful physical examination and autoantibody testing may assist in recognizing this condition in the critical care setting. Full article

Background: Intraoperative high-volume diuresis is a common but under-recognized phenomenon during off-pump coronary artery bypass grafting (OPCABG). Its clinical correlates and implications for perioperative management remain incompletely characterized. Methods: This single-center retrospective cohort study included 1274 adults undergoing elective OPCABG between January and August 2025. High-volume diuresis was defined as urine output ≥ 5 mL·kg⁻¹·h⁻¹. Multivariable logistic regression was used to identify factors independently associated with intraoperative high-volume diuresis. Model discrimination was assessed using the area under the receiver operating characteristic curve (AUC). Results: High-volume diuresis occurred in 39.6% of patients. Older age, hypertension and greater intraoperative fluid infusion were independently associated with high-volume diuresis, whereas preoperative diuretic and greater cumulative exposure to systolic blood pressure < 100 mmHg were inversely associated with diuresis. The multivariable model demonstrated acceptable discrimination (AUC = 0.756). Postoperative outcomes, including acute kidney injury, duration of mechanical ventilation, intensive care unit stay, and hospital length of stay, did not differ between groups. Conclusions: Intraoperative high-volume diuresis during OPCABG reflects complex physiological and hemodynamic responses and can be anticipated based on preoperative and intraoperative factors. These findings support a more individualized interpretation of urine output and perioperative management strategies in OPCABG. Full article

Background/Objectives: Tidal volume is determined by height and sex in adults under mechanical ventilation, and it serves as the foundation for implementing a lung-protective ventilation strategy. In children, tidal volume is often calculated based on actual body weight, without established guidelines regarding the predictors of lung volume. The aim of this study was to identify the key predictors of lung volume in children aged 0–5 years. Methods: This retrospective study involved 51 children aged 0–5 years who underwent chest computed tomography (CT) and surgery under general anesthesia between 2014 and 2024. The total lung volume was calculated using three-dimensional segmentation of the CT images. Linear regression models were used to assess predictors, including height, weight, age, sex, and body mass index (BMI). Model performance was evaluated using the adjusted R-squared and Akaike Information Criterion (AIC). Bootstrap validation with 2000 iterations was used to validate model reliability. Results: Height was the strongest predictor of lung volume (adjusted R-squared: 0.5621), and it showed a collinearity with age. The final model included age and sex as the covariates. The Bootstrap validation confirmed the model’s reliability. Conclusions: Age and sex are key predictors of the CT-derived total lung volume in children aged 0–5 years. Further studies are required to validate these findings. In addition, research is needed to derive and validate a tidal volume equation based on these predictors and assess the influence of this equation on clinical outcomes such as atelectasis, oxygenation, and inflammatory markers in pediatric surgery. Full article

To address the rock burst safety hazards encountered during coal seam mining in coal pillar areas under complex geological conditions and ensure sustainable and stable mine production, this study investigates the coal pillar area of a ventilation shaft in a mining area. Through an integrated approach incorporating field investigation, laboratory testing, numerical simulation, and engineering analogy, systematic research was conducted on rock burst mechanisms, geological modeling, and risk assessment. The results indicate that rock bursts in this coal pillar area represent tectonic-type disasters dominated by tectonic stress and induced by multi-factor coupling, with the coal seam exhibiting weak burst proneness. Based on a refined three-dimensional geological model constructed from borehole data, combined with mesh optimization and FDEM (Finite-Discrete Element Method) numerical simulations, precise delineation of rock burst hazard zones was achieved. These findings provide theoretical foundations and technical paradigms for safe mining operations in coal pillar area as under similar complex geological conditions, contributing to the sustainable development of coal resources through enhanced safety, extended mine service life, and optimized resource utilization. Full article