Unmasking the hidden aftermath: postintensive care unit sequelae, discharge preparedness, and long-term follow-up

Critical Care Science, Journal Year: 2024, Volume and Issue: 36

Published: Jan. 1, 2024

A significant portion of individuals who have experienced critical illness encounter new or exacerbated impairments in their physical, cognitive, mental health, commonly referred to as postintensive care syndrome. Moreover, those survive often face an increased risk adverse consequences, including infections, major cardiovascular events, readmissions, and elevated mortality rates, during the months following hospitalization. These findings emphasize necessity for effective prevention management long-term health deterioration environment. Although conclusive evidence from well-designed randomized clinical trials is somewhat limited, potential interventions include strategies such limiting sedation, early mobilization, maintaining family presence intensive unit stay, implementing multicomponent transition programs (from ward hospital home), offering specialized posthospital discharge follow-up. This review seeks provide a concise summary recent medical literature concerning outcomes highlight approaches preventing addressing decline survivors.

Language: Английский

---

Propofol improves sleep deprivation‐induced sleep structural and cognitive deficits via upregulating the BMAL1 expression and suppressing microglial M1 polarization

CNS Neuroscience & Therapeutics, Journal Year: 2024, Volume and Issue: 30(7)

Published: July 1, 2024

Abstract Background Sleep deprivation (SD) is a growing global health problem with many deleterious effects, such as cognitive impairment. Microglia activation‐induced neuroinflammation may be an essential factor in this. Propofol has been shown to clear sleep debt after SD rats. This study aims evaluate the effects of propofol‐induced on ameliorating quality impairment and decline 48 h SD. Methods Almost 8–12‐week‐old rats were placed system for natural or continuous Afterwards, received propofol (20 mg·kg −1 ·h , 6 h) via tail slept naturally. The Morris water maze (MWM) Y‐maze test assessed spatial learning memory abilities. Rat EEG/EMG monitored sleep. expression brain muscle Arnt‐like protein 1 (BMAL1), brain‐derived neurotrophic (BDNF) hippocampus BMAL1 hypothalamus by western blot. Enzyme‐linked immunosorbent assay detected IL‐6, IL‐1β, arginase (Arg1), IL‐10 levels hippocampus. Immunofluorescence was used determine microglia well morphological changes. Results Compared control group, sleep‐deprived showed poor performance both MWM test, accompanied disturbances structure, including increased total time, time spent delta power non‐rapid eye movement In addition, induces abnormal circadian rhythm BMAL1, activates microglia, causes nerve damage. reversed these changes saved Furthermore, treatment significantly reduced hippocampal IL‐1β IL‐6 levels, BDNF, Arg1, switched surface markers from inflammatory M1 type anti‐inflammatory M2 type. Conclusion reduces SD‐induced disruption, possibly lowering neuronal inflammation switching phenotype activated state, thus exerting neuroprotective effects.

Language: Английский

---

Feasibility Challenges in Protein Supplementation Research: Insights from the convalescence of functional outcomes after Intensive Care Unit Stay in a Randomised Controlled Trial

Clinical Nutrition, Journal Year: 2025, Volume and Issue: 46, P. 119 - 130

Published: Jan. 22, 2025

Language: Английский

---

Optimizing Sleep Disorder Management in Hospitalized Patients: Practical Approach for Healthcare Providers

Brain and Behavior, Journal Year: 2025, Volume and Issue: 15(2)

Published: Feb. 1, 2025

ABSTRACT Purpose To provide a comprehensive review of sleep disturbances in hospitalized patients, focusing on case‐based approach to illustrate the multifaceted nature this clinical challenge. Method An extensive related literature was conducted determine common causes such as environmental, medical, psychological, and physiological factors. The case Mrs. Z used how these factors interact setting. Findings study revealed high prevalence which can lead significant adverse outcomes. A multidisciplinary involving physicians, nurses, pharmacists, other healthcare professionals is essential effectively manage disorders due interplay various Nonpharmacological interventions are fundamental management plan. Pharmacotherapy may sometimes be necessary improve quality duration. Conclusion Health significantly enhance piatients by understanding value providing evidence‐based strategies for improvement. In return, improves patient outcomes, reduces costs, advances general satisfaction.

Language: Английский

---

Evaluation of postoperative delirium in cardiac surgery patients with the SDACS screening tool: a multicenter-multiphase study

Perioperative Medicine, Journal Year: 2025, Volume and Issue: 14(1)

Published: March 27, 2025

Postoperative delirium is a prevalent complication in cardiac surgery patients, highlighting the importance of early risk factor identification for optimal management. This study aimed to pinpoint factors and devise novel screening tool, Screening Tool Delirium After Cardiac Surgery (SDACS), predict postoperative patients after first day. employed multiphase design consisting three phases. In phase, through scoping review 38 finally selected published papers, 136 potential identifying were identified. These then incorporated into Delphi rounds expert panels develop tool delirium. Finally, 76 examined on 920 at academic institutions between 2020 2023 (third phase study). All predictors included instrument regression coefficient each predictor was transformed score. diagnosed 53% (n = 488) patients. Four independent identified: chronic opioid use (OR: 4.605, 95% CI: 2.163–9.804), hearing impairment 6.926, 3.630–12.215), benzodiazepine history 8.506, 5.651–11.805), poor sleep quality night 9.081, 6.225–12.248). The cross-validated area under receiver operating characteristics curve (AUC) 0.897 (95% 0.876–0.916; P < 0.001). Chronic use, impairment, history, post-surgery are linked SDACS effectively forecasts this syndrome early, offering bedside nurses valuable prompt intervention improved patient outcomes. aids assessment, enabling timely interventions better By predicting accurately, can address proactively, potentially reducing its incidence severity, leading outcomes

Language: Английский

---

Critical illness-based chronic disease: a new framework for intensive metabolic support

Current Opinion in Critical Care, Journal Year: 2025, Volume and Issue: unknown

Published: March 25, 2025

This review addresses the novel concept of critical illness as a potential chronic disease. The high clinical and economic burdens post-ICU syndromes are mainly due to refractoriness therapy consequently lead significant complications. Interventions need be preventive in nature therefore robust disease model is warranted. There three paradigms that leveraged create new illness-based (CIBCD) model: metabolic illness, intensive support (IMS; insulinization nutrition support), driver-based modeling. CIBCD consists four stages: risk, predisease, (chronic) disease, principal goal expose early opportunities prevent progression, particularly further morbidity, complications, mortality. IMS used target seminal pathophysiological events such immune-neuroendocrine axis (INA) activation failure downregulate INA because preexisting diseases recurrent pathological insults. complements our understanding provides needed structure actions can improve outcomes. Many research, knowledge, practice gaps exist, which will addressed optimize validate this model.

Language: Английский

---

Sleep, depression, anxiety and quality of life in patients with systemic lupus erythematosus

The Egyptian Rheumatologist, Journal Year: 2025, Volume and Issue: 47(3), P. 113 - 116

Published: April 12, 2025

Language: Английский

---

A multicentre point prevalence study of nocturnal hours awake and enteral pharmacological sleep aids in patients admitted to Australian and New Zealand intensive care units

Critical Care and Resuscitation, Journal Year: 2024, Volume and Issue: 26(3), P. 192 - 197

Published: July 31, 2024

Critically ill patients suffer disrupted sleep. Hypnotic medications may improve sleep; however, local epidemiological data regarding the amount of nocturnal time awake and use such is needed. Point prevalence study. Adult ICUs in Australia New Zealand. All adult admitted to participating Intensive Care Units (ICUs) on study day. Time overnight (22:00–06:00) was determined by structured nurse observation. The enterally administered sedative-hypnotic drugs prior during ICU admission recorded, as a unit policy non-pharmacological sleep promotion strategies. Data were available for 532 40 (median age 60 years, 336 (63.2%) male, 222 (41.7%) invasively ventilated). Forty-eight (9.0%) received an enteral pharmacological aid, which melatonin (28, 5.2%) most frequently used. Patients not ventilated observed be median 4.0 h (interquartile range (IQR): 2.5, 5.5), with no difference those receiving hypnotic (p = 0.9). Non-pharmacological aids reportedly offered or 52% (earplugs) 63% (eye masks). Only 7 (17.5%) had informing sleep-optimising interventions. invasive ventilation appeared spend many hours awake. Pharmacological aid administration associated greater asleep. Most did receive any have guideline promotion.

Language: Английский

---

Biomarkers and patient-related factors associated with clinical outcomes in dupilumab-treated atopic dermatitis

Journal of Allergy and Clinical Immunology Global, Journal Year: 2024, Volume and Issue: 3(4), P. 100317 - 100317

Published: Aug. 1, 2024

BackgroundAtopic dermatitis (AD) is a common chronic eczematous skin disease with severe pruritus. Several new therapeutic agents for AD such as dupilumab, an anti–IL-4Rα antibody, have been developed in recent years. We need to predict which agent the best choice each patient, but this remains difficult.ObjectiveOur aim was examine clinical background factors and baseline biomarkers that could achievement of improved outcomes patients treated dupilumab.MethodsA multicenter, prospective observational study conducted on 110 AD. The Eczema Area Severity Index used objective assessment, Patient-Oriented Measure Numerical Rating Scale Pruritus were patient-reported outcomes. In addition, some evaluated.ResultsThe absolute 7 or less negatively associated current comorbidity food allergy serum lactate dehydrogenase (LDH) levels. There negative associations between score duration itching 1 allergic conjunctivitis periostin level. Furthermore, signal detection analysis showed LDH level than 328 U/L potentially be cutoff value predicting efficacy dupilumab.ConclusionBaseline long period may useful indicators when choosing dupilumab systemic treatment AD, they can dupilumab.

Language: Английский

---

Designing Intensive Care Unit Windows in a Mediterranean Climate: Efficiency, Daylighting, and Circadian Response

Applied Sciences, Journal Year: 2024, Volume and Issue: 14(21), P. 9798 - 9798

Published: Oct. 26, 2024

Hospital intensive care units (ICUs) frequently experience inadequate lighting conditions, with low daytime and excessive nighttime illuminance, which can negatively affect patient recovery the work performance of health personnel. This study examines impact window design parameters—specifically, window-to-wall ratio (WWR) position—and interior surface reflectance on visual comfort, performance, energy consumption, human well-being in Mediterranean climates, according to orientation. Using dynamic metrics, such as daylight autonomy (DA) circadian stimulus (CSA), this research quantifies influence these factors. The results suggest that a WWR 25% is optimal for achieving sufficient DA CSA values, centered configurations preferred uniform distribution stimulus. further emphasizes significance reflectance, recommending bright coatings maximize outcomes, while advising against dark finishes, particularly north-facing rooms or smaller WWRs. Although Seville shows slightly better than Barcelona, proposed are effective across both locations, highlighting prioritization sizing, positioning, over geographical differences. These findings offer practical guidance ICU enhance natural lighting, supporting overall through improved alignment.

Language: Английский

---