BackgroundPatients with malignant neoplasms exhibit an elevated risk of sepsis and associated mortality. For septic patients with hemodynamic instability, early albumin administration is recommended, yet its specific impact in cancer-related sepsis remains unclear. This study aims to explore the relationship between early albumin administration and prognostic outcomes in patients with solid malignant neoplasms complicated by sepsis.MethodsThis study employed a retrospective cohort analysis, utilizing data obtained from the Medical Information Mart for Intensive Care IV (MIMIC-IV v3.1) database. Patients were categorized into two groups: no-albumin and albumin. Within the albumin group, patients were further subclassified into early-albumin (infusion within 24 h of ICU admission) and late-albumin (infusion more than 24 h after ICU admission but before discharge). The primary endpoint was 28-day in-hospital mortality, while secondary endpoints including in-hospital mortality, length of hospital stay (Los_hospital), and length of ICU stay (Los_ICU).ResultsAmong 3700 eligible patients (2596 no-albumin; 1104 albumin), further subclassification within the albumin group revealed 736 early-albumin and 368 late-albumin patients. After propensity score matching (PSM), 312 pairs (early vs late) were analyzed. Cox regression models showed that early albumin administration significantly improved 28-day survival prospects. Compared to both no-albumin and late-albumin groups, the early-albumin group exhibited a pronounced survival advantage. Additionally, early albumin administration was associated with a shorter ICU stay. Subgroup analyses confirmed benefits across various demographics and clinical characteristics in the early-albumin group.ConclusionsEarly albumin administration within 24 h of ICU admission significantly decreases 28-day and in-hospital mortality and shortens ICU stay in septic patients with solid malignant neoplasms. Our findings suggest that early albumin administration should be integrated into personalized resuscitation strategies for this high-risk population and merit further prospective validation.

Acute kidney injury (AKI) is a frequent complication in critically ill patients and is associated with high mortality. While renal replacement therapy (RRT) remains a cornerstone of supportive care for severe AKI, the optimal circumstances for RRT initiation in critically ill patients is a longstanding subject of debate. This narrative review aims to provide an up to date summary of the evidence regarding timing of RRT initiation in the intensive care unit (ICU) and its impact on clinical outcomes. Additionally, management strategies for patients while RRT is delayed are suggested and means to identify patients who have a high probability of receiving RRT are explored.

BackgroundPregnancy-associated sepsis poses significant maternal, fetal and neonatal risks, with acute kidney injury (AKI) being a critical complication. The dynamic relationship between serum sodium trajectories and AKI in this population remains unclear.MethodsIn this retrospective cohort study, 138 pregnant patients with sepsis were analyzed using the MIMIC-IV 3.1 database. Three serum sodium trajectory groups were identified via group-based trajectory modeling (GBTM). AKI was defined per KDIGO criteria. Analyses employed logistic regression, inverse probability weighting, multivariable adjustments and cubic spline models.ResultsThree distinct trajectories emerged: Group 1 (low initial sodium that subsequently increased, n = 34), Group 2 (stable sodium levels, n = 83), and Group 3 (high sodium levels throughout, n = 21). Groups 1 and 3 exhibited higher AKI incidence (ORs: 4.04 [95%CI: 1.63-9.96] and 3.97 [95%CI: 1.33-11.87], respectively; both  < 0.05), prolonged ICU stay hours(72, 118 vs 47,  < 0.001), and elevated SOFA scores ( = 0.01) compared to Group 2. Cubic spline analysis revealed a U-shaped risk relationship, with AKI incidence rising at sodium levels >145 mmol/L (-value for overall was 0.037 and for nonlinear was 0.021).ConclusionsDynamic sodium trajectories, particularly low initial sodium that subsequently increased, independently predict AKI and adverse outcomes in pregnancy-associated sepsis.

BackgroundThere is limited evidence on the epidemiology and prognostic significance of acid-base disorders in the cardiovascular intensive care unit (CICU). This study examines the association of acid-base status at admission with in-hospital mortality among CICU patients.MethodsWe conducted a retrospective analysis of adults admitted to the Mayo Clinic CICU from 2007-2018 with available blood gas data, utilizing values obtained closest to CICU admission. Arterial pH, serum bicarbonate, base excess, and partial pressure of carbon dioxide (PaCO) were examined as predictors of in-hospital mortality. Multivariable logistic regression was used to assess associations, with adjustment for demographics, comorbidities, illness severity, and interventions.ResultsAmong 3229 patients included for analysis, acidemia (pH < 7.35) emerged as the strongest predictor of in-hospital mortality (adjusted odds ratio [aOR] 1.60, 95% confidence interval [CI] 1.29-1.98,  < .003). Metabolic acidosis (HCO3 < 20 mEq/L, aOR 1.55, 95% CI 1.24-1.95,  < .001) and respiratory acidosis (PaCO2 > 45 mm Hg, aOR 1.44, 95% CI 1.14-1.81,  = .002) were associated with higher in-hospital mortality, whereas metabolic and respiratory alkalosis were not. After adjustment, lower pH and more negative base excess were associated with higher in-hospital mortality (both  < .001), whereas HCO3 and PaCO2 were not ( = .053 and  = .051, respectively). Patients with combined metabolic and respiratory acidosis had the highest in-hospital mortality (56.3%).ConclusionsShort-term survival in CICU patients decreases progressively with worse acidemia, especially in the context of combined metabolic and respiratory acidosis. Incorporating metabolic acid-base disorders as key therapeutic targets in randomized cardiogenic shock trials may improve outcomes in this complex population by addressing hemometabolic shock.

Necrotizing soft tissue infections (NSTIs) present a rare but devasting disease process for affected patients. Timely diagnosis and management of this condition is essential for critical care providers to obtain optimal patient outcomes. Given their rarity, NSTIs are often diagnosed late in the disease process, contributing to an increase in morbidity and mortality among these patients. In this review, we discuss how to classify these infections, their risk factors, pathophysiology, clinical presentation, diagnosis, scoring systems and treatment, with an emphasis on surgical management.

ObjectiveThis study aimed to investigate associations between early diuretic administration following neonatal cardiac surgery and clinical outcomes.MethodsThis was a retrospective cohort study including neonates who underwent cardiac surgery within the first 30 postnatal days between September 2015 and January 2018 at 22 centers participating in the Pediatric Cardiac Critical Care Consortium (PC) and Neonatal and Pediatric Heart and Renal Outcomes Network (NEPHRON) registries. Multivariable logistic and ordinal regression models were used to assess associations between early diuretic administration [defined as receipt of furosemide in the operating room and/or any diuretic on postoperative day 0 (POD0)] and outcomes. Outcomes: peak cumulative fluid balance, delay in achieving first negative daily fluid balance, duration of mechanical ventilation, hospital length of stay (LOS), and severe persistent acute kidney injury (AKI). An additional exploratory analysis was performed to assess for association between receiving enteral diuretic within the study period (POD0-6) and hospital LOS.ResultsOf 2240 neonates, 63% (n = 1405) had early diuretic administration and 15% (n = 344) received enteral diuretics. After adjusting for covariates and center effect, early diuretic administration was associated with shorter duration of mechanical ventilation [Odds Ratio (OR) = 0.59, 95% confidence interval (95%CI) 0.42-0.82] and a lower odds of delay in negative daily fluid balance (OR = 0.44, 95%CI 0.26-0.75), but not severe persistent AKI. Receiving enteral diuretic by POD6 was associated with decreased hospital LOS (OR = 0.3, 95%CI 0.23-0.41).ConclusionsEarly diuretic administration is associated with earlier time to negative daily fluid balance and shorter duration of mechanical ventilation. Efforts to standardize early diuretic administration have the potential to decrease resource utilization and warrants further study.

Intravenous crystalloid solutions are among the most common medical interventions applied and have supplanted colloid-based solutions as the standard of care for volume resuscitation in most settings. Despite their widespread use, debate has existed over the optimal composition of these solutions and their differential effects on patient outcomes. In this review, we will describe the pre-clinical studies that identified physiological differences when 'balanced crystalloids' and 'normal saline' are administered, the experimental studies that confirmed these differences in humans, the observational studies that indicated the level of concern, and the subsequent clinical trials that provide evidence to guide therapy in current practice.

BackgroundPost-critical illness cognitive dysfunction (PCICD) is a frequent and debilitating outcome among survivors of critical illness. Although sepsis has been associated with poor cognitive outcomes, its independent contribution remains unclear due to overlapping clinical factors. This study sought to characterize cognitive recovery trajectories over 12 months after intensive care.MethodsIn this single-center prospective cohort study, adult ICU survivors were assessed at 1, 3, 6 and 12 months post-discharge using telephone-administered Mini-Mental State Examination (MMSE) or Montreal Cognitive Assessment (MoCA-Blind). Total scores were standardized within instrument (scores). Linear mixed-effects models evaluated change in -scores over time. Domain-specific analyses examined whether any cognitive domain was disproportionately impaired. Logistic regression estimated odds of cognitive impairment adjusting for time, sepsis status, test type, age, Charlson index, peak SOFA, and benzodiazepine exposure; complete-case analyses were used.ResultsOf 185 eligible patients, 84 (45%) completed at least one cognitive assessment. Standardized scores improved from 1 to 3 months (+0.40 SD; 95% CI 0.02-0.78;  = 0.04) and 6 months (+0.54 SD; 95% CI 0.10-0.98;  = 0.02), with a similar but non-significant rise by 12 months (+0.49 SD; 95% CI -0.05 to 0.95;  = 0.10). Adjusted odds of impairment declined at 6 (OR 0.25, 95% CI 0.12-0.55) and 12 months (OR 0.34, 95% CI 0.14-0.85) versus 1 month; the 3-month reduction did not reach significance (OR 0.48, 95% CI 0.23-1.04). Sepsis was not associated with impairment (OR 1.49, 95% CI 0.63-3.56). No single cognitive domain showed a significant longitudinal slope.ConclusionsICU survivors show measurable cognitive recovery over the first year-most prominently by 3-6 months-with reduced odds of impairment by 6 and 12 months. Sepsis did not independently alter recovery. These findings support early post-ICU cognitive follow-up and rehabilitation within the first six months after discharge.

BackgroundSeptic patients with coronary artery disease (CAD) face elevated mortality risks, potentially exacerbated by glycemic variability (GV). This study aimed to investigate the association between GV and in-hospital and 1-year mortality in septic patients with CAD.MethodsWe conducted a retrospective analysis using data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database as the discovery cohort and the Tianjin Health and Medical Database Platform (THMDP) as the validation cohort. Patients with sepsis and CAD who had at least three blood glucose measurements during their ICU stay were included. Glycemic variability was defined as the coefficient of variation of blood glucose levels, categorized into quartiles (Q1-Q4). The primary outcome was in-hospital mortality, with 1-year mortality as a secondary outcome. Cox proportional hazards models were used to assess the association between GV and mortality.ResultsHigher GV was significantly associated with increased in-hospital mortality in both cohorts (MIMIC-IV: n = 2599) adjusted Hazard Ratio (HR) 4.06, 95% CI 1.72-9.58,  = 0.001; THMDP: n = 2,797, adjusted HR 1.56, 95% CI 1.25-1.93,  = 0.001). A pooled two-cohort analysis confirmed a significant association with in-hospital mortality (adjusted HR for Q4 vs Q1: 1.65, 95% CI 1.34-2.03,  = 0.001), while the association with 1-year mortality was weaker (adjusted HR 1.24, 95% CI 0.89-1.73,  = 0.204). Restricted cubic spline (RCS) analyses revealed a nonlinear relationship between GV and in-hospital mortality ( for nonlinearity < 0.001). Kaplan-Meier (KM) survival curves showed reduced survival probability in the highest GV group.ConclusionsHigher GV is independently associated with increased in-hospital mortality among septic patients with CAD, but no significant association was found with 1-year mortality. These findings suggest that stabilizing GV may be a critical area for clinical management and warrants further investigation. Monitoring and managing GV may improve outcomes in this patient population.

BackgroundAdherence to evidence-based care processes and patient outcomes in intensive care units (ICUs) can be influenced by staffing and resource availability. We aimed to evaluate if there is a weekend effect on adherence to evidence-based care processes, and hospitalization outcomes and whether a checklist implementation could mitigate potential differences.MethodsPost hoc analysis of the Checklist for Early Recognition and Treatment of Acute Illness and Injury (CERTAIN) study dataset collected before and after checklist implementation in 34 ICUs across 15 countries (2013-2017). Admission days were classified as 'weekend/holidays' or 'weekdays' according to local work schedules and public holidays. The primary outcome was the omission of 10 evidence-based care processes addressed in the checklist. Mortality and length of stay differences between weekend/holiday and weekday admissions were evaluated as secondary outcomes.Results4256 patients contributed 1141 weekend versus 3501 weekday observation days pre-intervention, and 2014 versus 6507 post-intervention. Pre-intervention, peptic ulcer prophylaxis was omitted more frequently on weekends/holidays than weekdays (adjusted rate ratio [aRR], 0.58 [95%-confidence interval [CI] 0.38-0.88), whereas head-of-bed elevation was omitted more often on weekdays than on weekends/holidays (aRR, 3.17 [1.14-8.86]). Post-intervention, peptic ulcer prophylaxis omission rates became similar (aRR, 1.03 [0.68-1.56], but head-of-bed elevation became omitted more often on weekends than on weekdays (aRR, 0.63 [0.45-0.88]). Post-intervention, oral care was omitted more frequently on weekends/holidays than in weekdays (aRR, 0.63 [0.45-0.9]), and central catheter removal was more frequent on weekdays than in weekends/holidays (aRR, 1.11 [1.02-1.21]). No significant differences in mortality or length of stay were found.ConclusionA weekend effect influenced adherence to some care processes. While checklist implementation improved overall adherence, some disparities diminished, while new ones emerged. Organizational, cultural, and temporal factors should be further studied to optimize care delivery across all times and settings.Clinical Trial Registration NumberNCT01973829.

Although the brain itself lacks nociceptors and cannot directly perceive pain, it can generate chronic pain following injuries such as traumatic brain injury (TBI) or ischemic stroke. This phenomenon arises from disruptions in neural connectivity that distort the interpretation of sensory input. According to Bayes' Rule, the brain combines current sensory input with prior experiences to formulate response predictions. When this process is disrupted by TBI, chronic pain may emerge. This review identified 60 relevant studies through systematic keyword searches, with inclusion based on content relevance following abstract screening. The literature underscores the brain's adaptive processes in interpreting sensory stimuli. Disruptions to this adaptability-such as those caused by neuroinflammation, cytokine activation, or cellular injury-may contribute to persistent pain states. TBI-associated chronic pain is often classified as neuropathic and may arise from peripheral or central nerve damage, inflammation-induced injury, or impaired central processing. Pain resulting from central misinterpretation, as described by Bayesian models, frequently falls outside traditional inflammatory or neuropathic patterns and may not correspond with known dermatomal distributions, complicating diagnosis and treatment.

BackgroundRacial and ethnic disparities in healthcare outcomes are well-documented, but less is known about how these disparities manifest among survivors of critical illness. We examined whether Black and Hispanic ICU survivors experience different rates of 90-day and 1-year mortality and hospital readmission compared to White survivors, and whether these associations vary by age or Medicaid insurance status.MethodsWe conducted a retrospective cohort study using the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. Primary outcomes were 90-day and 1-year mortality; secondary outcomes included 90-day and 1-year hospital readmissions. We used Cox proportional hazards, Accelerated Failure Time (AFT), and Fine-Gray competing risk models, adjusting for age, sex, and Medicaid status. Prespecified subgroup analyses were performed among patients aged ≥60 and those admitted to surgical ICUs.ResultsAmong 46 640 ICU survivors (mean age 63.2 years; 55.6% male; 11.8% Black; 4.6% Hispanic), Black patients had lower survival at 90 days (absolute difference (AD): -0.85% (95% CI: -1.47%, -0.23%) and 1 year (AD: -1.42% (-2.46%, -0.40%) compared to White patients. Hispanic patients had higher survival (90-day AD: 1.33% (0.39%, 2.31%); 1-year AD: 2.31% (0.67%, 4.03%). Differences were more pronounced among patients ≥60 years. Black (1-year SDHR: 1.29 (1.23, 1.34)) and Hispanic patients (SDHR: 1.22 (1.14, 1.30)) had higher readmission rates. Medicaid coverage was more common among Black (aOR: 2.26 (2.10, 2.43)) and Hispanic patients (aOR: 4.23 (3.82, 4.68)). Adjustment for Medicaid was associated with smaller survival differences between Black and White patients, with limited effect on other estimates.ConclusionsIn this cohort, Black ICU survivors had lower long-term survival, and both Black and Hispanic patients had higher readmission rates compared to White patients. Differences were more pronounced among older adults. Variation in Medicaid coverage may contribute to observed disparities and warrants further investigation.

BackgroundIdentifying aspiration is an under-recognized component to reducing a patient's hospital length of stay, reducing hospital costs and lessening mortality risk. Given increased utilization of High Flow Nasal Oxygen (HFNO) and limited evidence identifying impacts of HFNO on swallowing and aspiration, our study contributes to determining the correlation between aspiration and HFNO.Research QuestionsDoes HFNO increase the odds of aspiration or silent aspiration? Do proportions of patients who exhibit aspiration or silent aspiration differ at different levels of oxygen support?Study Design and MethodsAn observational retrospective cohort study of a prospectively collected database of 910 adult patients from December 2020 - October 2022 treated with HFNO.ResultsMultivariable logistic regression modeling showed HFNO was not significantly associated with PAS 5-8, thin liquids (adjusted OR: 1.09, p = .702) nor significantly associated with PAS 8, thin liquids (adjusted OR: 1.04, p = .880). However, deep unsensed penetration and aspiration ranged from 48%-86% across all oxygen flow rate levels with a higher proportion of patients silently aspirating while on the 10-20L/min flow rate of oxygen.InterpretationWhile our findings did not find HFNO to be an independent risk factor, there were high rates of deep unsensed penetration and aspiration events across all oxygen flow levels. This indicates a high level of vigilance is necessary and prioritizing patient safety is recommended for critically ill patients receiving HFNO.

BackgroundLong-term physical dysfunction common among intensive care unit (ICU) survivors and mortality remains a concern even after hospital discharge. Although early identification of patients at risk for these outcomes is essential, few studies have investigated whether physical assessments at ICU discharge can predict physical dysfunction or death at 3, 6, and 12 months after discharge. The purpose of this study was to examine the association between physical assessment at ICU discharge and the incidence of physical functional disability or death within 12 months after discharge.MethodsThis was a multicenter prospective cohort study of 21 ICUs in Japan. Patients with sepsis admitted to the ICU for >48 h were enrolled. The primary outcome was physical dysfunction (Barthel index ≤90) or death at 3, 6, and 12 months after discharge. Physical assessments at the time of ICU discharge included the Medical Research Council (MRC) score, handgrip strength, and the Barthel index. A multiple logistic regression model and area under the curve (AUC) were used.ResultsIn total, 300 ICU patients (median age, 74 years) were included. MRC score (odds ratio [OR]: 0.98, 95% confidence interval [CI]: 0.96-0.99, cut-off: 46), hand grip strength (OR: 0.95, 95%CI: 0.92-0.98, cut-off: 12.0 kg), and Barthel index (OR: 0.96, 95%CI 0.95-0.98, cut-off: 15) were independent predictors of physical dysfunction or death at 12 months after hospital discharge and at 3 and 6 months. The Barthel index at ICU discharge showed the highest AUC for physical function or death at 12 months (0.718). The Barthel index and hand grip strength were also associated with cognitive dysfunction or mental disorders.ConclusionsIn ICU patients with sepsis, clinically available physical and muscle strength assessments at ICU discharge were significantly associated with physical dysfunction incidence or death over the first year of hospital discharge.: UMIN000041433.

BackgroundArterial catheterization serves as a cornerstone monitoring modality in septic shock management, enabling continuous hemodynamic assessment and serial blood gas analysis. Despite its widespread use, mortality benefits and optimal timing for catheter insertion remains undefined.MethodsAn analysis of clinical data from 6,485 critically ill adult patients, identified as meeting the Sepsis-3 criteria for septic shock, was conducted utilizing the MIMIC-IV database. Through entropy-balanced propensity score matching (PSM, 1:1 ratio) and doubly robust estimation with inverse probability weighting, we compared outcomes between catheterized (≤24 h post-admission) and non-catheterized groups. Restricted cubic spline (RCS) modeling characterized nonlinear temporal associations. The evaluation encompassed both primary and secondary endpoints, including 28-day mortality, mortality within the ICU and hospital settings, length of stay, CRRT requirements, and physiological resuscitation metrics.ResultsAfter PSM (1,416 patients from initial 6,485) with 1:1 ratio, arterial catheterization exhibited significantly reduced mortality across all measured outcomes compared to non-catheterized controls: 28-day mortality (26.1% vs 43.9%; aHR 0.62, 95%CI 0.51-0.75), ICU mortality (aHR 0.76, 0.61-0.94), and in-hospital mortality (HR 0.70, 0.58-0.86), all P < .05. Arterial catheterization was associated with a shorten ICU stay by 0.52 days (95%CI 0.18-0.82, P = .002) and improved physiological parameters. Restricted cubic splines identified optimal intervention timing at 204-290 min post-admission through U-shaped mortality risk association.ConclusionIn a cohort of critically ill patients with septic shock, early peripheral arterial catheterization is significantly associated with improved 28-day mortality outcomes.

Sepsis associated encephalopathy (SAE) is common in patients with sepsis, and the occurrence of SAE often indicated adverse outcomes. In recent years, the imbalance of the intestinal microbiota and metabolites have been found to be related to the occurrence of SAE, and this regulation is often accompanied by the activation of the immune system. Possible mechanism still needs to be clarified. Intestinal flora disturbances and altered metabolic profiles are often accompanied by changes in the levels of small molecule metabolites, some of which are critical for the maintenance of brain functional homeostasis, such as short-chain fatty acids (SCFAs). These changes further affect the permeability of the blood-brain barrier and the activation of the central and peripheral immune system, and finally promote the release of inflammatory cytokines and the activation of immune cells. Targeting intestinal microbiota profile, small molecule metabolite, or neurostimulation regulation may be potential therapeutic methods for SAE, such as amino acid supplements, microbiota transplantation, or other metabolite level regulation drugs. Our review will summarize the intestinal flora disturbances, metabolic profiles, neuro-immunoinflammatory changes and related possible drug intervention. These findings may provide the possibility for further exploration of the mechanisms and treatment methods of SAE.

We appreciate the insightful remarks by Sin et al regarding our systematic review and meta-analysis on extracorporeal membrane oxygenation (ECMO) cannulation by intensivists. Their comments highlight important considerations for contextualizing our findings. Our analysis confirmed that intensivist-performed cannulation is generally safe and feasible when supported by structured training, credentialing, and immediate surgical backup for complications such as vascular injury. Venovenous cannulation was associated with relatively low complication rates, whereas venoarterial cannulation carried higher risks, underscoring the need for additional caution. Importantly, extracorporeal cardiopulmonary resuscitation (ECPR) is characterized by substantially higher complication rates, likely driven by technical and environmental challenges rather than operator specialty. Equipment selection, including the use of smaller arterial cannulas in venoarterial ECMO, may further reduce vascular complications, though survival remains adversely affected when such complications occur. Beyond operator expertise, institutional infrastructure, standardized training, adherence to protocols, and availability of surgical support are pivotal to ensuring safe practice. We concur that future development of standardized guidelines addressing intensivist-led cannulation, including preparation for high-risk scenarios such as ECPR, will be essential to optimize outcomes.

Sepsis management in elderly populations presents unique challenges due to age-related physiological changes and comorbidities. Current guidelines remain conflicted regarding optimal antibiotic timing. We conducted a retrospective, multicenter study to evaluate the association between antibiotic administration timing and short-term and long-term outcomes in elderly sepsis patients.

AimTo evaluate the efficiency of combined diaphragm and intercostal muscle ultrasound assessment in predicting the extubation outcome in mechanically ventilated patients with sepsis.MethodsThis study was a prospective observational study of septic patients consecutively admitted to the hospital from October 2022 to October 2023 for mechanical ventilation. During the period when the patients passed the ventilator weaning screening and spontaneous breathing trial (SBT), ultrasound evaluation of the diaphragm and intercostal muscles was performed to measure diaphragm excursion (DE), diaphragm thickening fraction (TFD) and intercostal muscle thickening fraction (TFic). The patients were divided into the successful extubation group (89 cases) and the failed extubation group (15 cases) according to the extubation results. ROC curves were used to analyze the effects of diaphragm ultrasound and intercostal muscle ultrasound alone and in combination to predict extubation outcomes.ResultsTFic and TFic/TFD values were significantly higher in the failed extubation group than in the successful extubation group during extubation ( < 0.05). The area under the ROC curve (AUROC) of DE, TFD, and TFic to predict extubation failure in mechanically ventilated patients with sepsis before extubation were 0.689, 0.657, and 0.769, respectively, whereas the combined indexes, such as TFic/TFD and TFic &TFD_mix had AUROCs of 0.867 and 0.860, respectively. TFic/TFD with a cutoff value of >0.95, had a sensitivity of 86.7% and specificity of 75.3% in predicting extubation failure, and TFic &TFD_mix with a cutoff value of >0.13, had a sensitivity of 86.6% and specificity of 80.9% in predicting extubation failure. The combination of diaphragm and intercostal muscle ultrasound assessment might effectively predict the extubation outcome in mechanically ventilated patients with sepsis.

Pulmonary hypertension, characterized by elevated pressures in the pulmonary arteries leading to abnormalities in right ventricular function, may lead to competing demands between the pulmonary and systemic circulation during sepsis and septic shock. As a result, management of pulmonary hypertension in sepsis, including identifying the source of infection, maintaining hemodynamic stability and continuing or transitioning pulmonary hypertension-specific therapies can often be challenging. The goal of this review is to highlight factors to consider in the evaluation and management of patients with pulmonary hypertension and sepsis.

Acute Kidney Injury (AKI), a leading organ failure cause in critical patients, demands early high-risk identification to enhance outcomes. Yet comparative analyses of diagnostic and prognostic machine learning (ML) models across multiple post-admission timeframes are lacking.