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Extended Prone Positioning Is Associated With Reduced Mortality in Adults With ARDS

A systematic review and meta-analysis published in Respiratory Care compared clinical outcomes of extended (≥24 h) versus traditional prone positioning (16-24 h) of adults with moderate-to-severe ARDS receiving invasive mechanical ventilation. Ten studies comprising 2412 patients were included. Extended prone positioning was associated with reduced mortality compared with the traditional approach (RR = 0.76; 95% CI, 0.66-0.86). No differences were found in duration of mechanical ventilation (MD = 2.43 days; 95% CI, −1.06 to 5.92) or ICU stay (MD = 1.31 days; 95% CI, −1.07 to 3.68). Extended proning was associated with a higher incidence of pressure injuries (RR = 1.30; 95% CI, 1.02-1.65) but no differences in device displacement or hemodynamic instability. Future RCTs are warranted to confirm its role in routine practice.

NMBAs Reduce Incidence of Difficult Tracheal Intubation in Children and Infants

A systematic review and meta-analysis published in European Journal of Anesthesiology assessed the effects of avoidance versus use of NMBAs for facilitation of tracheal intubation in children and infants. Forty-seven RCTS comprising 2276 patients were included. The primary outcome was incidence of difficult tracheal intubation. Avoidance of NMBAs was associated with increased risk of difficult tracheal intubation (RR = 3.47; 95% CI, 2.52-4.77, P < 0.001). The trial sequential analysis resulted in an adjusted increased risk of difficult tracheal intubation (RR = 3.68; 95% CI, 2.22 to 6.11; α = 5%, β = 90%) when avoiding NMBAs. No significant increased risk of serious adverse events comparing avoidance and use of NMBAs was reported.

Phosphorus-To-Albumin Ratio Predicts Mortality and AKI in Critically Ill Pancreatitis Patients

A multicenter retrospective analysis published in European Journal of Medical Research extracted data of ICU patients with acute pancreatitis (AP) and applied 7 machining learning algorithms to identify risk factors for prediction of AKI. Collectively, the AKI prediction models demonstrated that the phosphorus-to-albumin ratio is a potential risk factor and is associated with 28-day and 1-year all-cause mortality in patients with AP. Specifically, the Light Gradient Boosting machine (LightGBM) model achieved an AUROC of 0.880 (95% CI, 0.825-0.935) and AUPRC of 0.944 in the test set and AUROC of 0.837 (95% CI. 0.785-0.889) and AUPRC of 0.784 in the external validation set. The LightGBM model is an efficient tool for early AKI identification in high-risk AP patients.

Incidence and Prevalence of PICS Is High in ICU Survivors

A systematic review and meta-analysis published in Annals of Medicine assessed the prevalence and incidence of PICS in ICU survivors. PICS manifests as a range of physical, cognitive, and psychological impairments in post-discharge ICU patients. Thirty-four studies comprising 6230 patients were included. The pooled prevalence and incidence of PICS were 60.3% (95% CI, 48.5-72.1) and 52.4% (95% CI, 47.6-57.2), respectively. These findings highlight the need for early detection of at-risk patients and development of evidence-based approaches to monitor and address impairments related to PICS.

Melatonin Supplementation Reduces Incidence of Delirium in Critically Ill Patients

A systematic review and meta-analysis published in Frontiers in Pharmacology evaluated the effects of melatonin and melatonin receptor agonists on the incidence and duration of delirium, length of ICU stay, and mortality among adult critically ill patients. Twenty-two RCTs involving 3706 patients were included. The meta-analysis found that melatonin was associated with a significant reduction in the incidence of delirium compared to the control group (RR = 0.75; 95% CI, 0.63-0.90, P = 0.001). However, melatonin did not significantly affect the duration of delirium (MD = 0.18 days; 95% CI, −0.16 to 0.52, P = 0.56), length of ICU stay (MD = −0.45 days; 95% CI, −1.10 to 0.20, P = 0.09), or overall mortality (RR = 0.92; 95% CI, 0.79-1.06, P = 0.25). These findings suggest that the benefits of melatonin supplementation may be limited to reducing occurrence rather than altering the course of established delirium or other clinical outcomes.

HALP Score Has Prognostic Value for Predicting In-Hospital Mortality in Sepsis Patients

A multicenter retrospective cohort study published in Frontiers in Public Health investigated the association between hemoglobin, albumin, lymphocyte, and platelet (HALP) score and in-hospital mortality in sepsis patients using 2 large critical care databases. The derivation and validation cohorts consisted of 12,889 and 3726 patients, respectively. Restricted cubic spline analysis demonstrated significant nonlinear associations between HALP and in-hospital mortality in both cohorts, with an inflection point near 12.45. Below this threshold, each unit increase in HALP was associated with a 3% reduction in mortality risk. Kaplan-Meier analyses showed significantly higher survival in the high HALP group (deviation cohort: HR = 0.882; 95% CI, 0.808-0.962, P = 0.005 and validation cohort: HR = 0.723; 95% CI, 0.607-0.862, P < 0.001). Multivariable Cox regression confirmed that high HALP remained independently protective after full adjustment (deviation cohort: HR = 0.90; 95% CI, 0.82-0.98, P = 0.017 and validation cohort: HR = 0.85; 95% CI, 0.74-0.98, P = 0.028). The HALP score’s simplicity and reliance on routine laboratory parameters support potential clinical application in sepsis risk stratification.

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