Critical Care Research and Practice

Objective. Grip strength testing offers a mechanism to identify patients in whom frailty might be present, discriminate between robust elderly and vulnerable younger patients, and can be used as a tool to track changes in muscle bulk over the course of an inpatient stay. We compared gold-standard quantitative grip strength measurement to a low-tech alternative, a manual bedside sphygmomanometer. Design. Under supervision, subjects performed hand-grip strength testing with each instrument. A mean score is calculated from three measurements on the dominant and nondominant hand. Setting. Testing was performed in a tertiary centre in Perth, Western Australia, in both outpatient clinics and intensive care units. Participants. 51 adult pre-operative surgical outpatients were assessed, alongside 20 intensive care inpatients identified as being weak. Main outcome measures. A statistical correlation between the two measures was evaluated. Feasibility, safety, and convenience were also assessed in outpatient and bedside settings. Results. Highly correlated results in both tertiary surgical outpatients (r_s = 0.895, , N = 102; r (100) = 0.899, ) and weak intensive care patients (r_s = 0.933, , N = 39 r (37) = 0.935, ) Conclusions. Modifying a manual bedside sphygmomanometer to measure grip strength is feasible and correlates well with a formal dynamometer in preadmission surgical patients and weak patients in the intensive care unit. The use of an existing, safe, and available device removes barriers to the measurement of weakness in patients and may encourage uptake of objective measurement in multiple settings.

Background. The modified Nutrition Risk in the Critically Ill (mNUTRIC) score is a helpful tool to evaluate nutritional risk in critically ill patients. However, there is a lack of data on the relationship between mNUTRIC score and septic patients' outcomes. So, this study aims to validate the prognostic role of the mNUTRIC score and to compare the performances of mNUTRIC, APACHE II, SOFA, and SAPS 2 scores for mortality prediction in patients with sepsis. Methods. This prospective observational study was performed on 194 septic patients admitted to the Intensive Care Unit (ICU) of 108 Military Central Hospital. Sepsis was defined based on the sepsis-3 definition. The mNUTRIC score was used to evaluate the nutritional status within 24 h of ICU admission. Baseline characteristics and clinical information were collected to calculate the mNUTRIC, APACHE II, SOFA, and SAPS 2 scores. The outcome was in-hospital mortality from all causes. Results. Nonsurvivors patients had a significantly higher median mNUTRIC score (6 vs. 4, ). The mortality rate in the group with a NUTRIC score ≥5 was significantly higher than in the group with a NUTRIC score <5 (56.0% vs 10.2%; ). The area under the ROC curves (AUC) for predicting the mortality of mNUTRIC was 0.79 (sensitivity 67.1% and specificity 81.0% ()). Compared with other severity scores in mortality prediction, AUC was 0.78 for APACHE II (sensitivity 84.9% and specificity 67.7%), 0.77 for SOFA score (sensitivity 76.7% and specificity 65.3%), and 0.73 for SAPS 2 (sensitivity 66.1%, specificity 77.7%). In the multivariate analysis, mNUTRIC score was associated with in-hospital mortality (HR, 2.00; 95% CI, 1.54 to 2.58; ). Conclusions. Our study showed that the mNUTRIC score was similar to severity scores (APACHE II, SOFA, SAPS 2) in mortality prediction and was the independent mortality predictor in patients with sepsis.

Background. The incidence of delirium is high up to 46.3% among patients admitted to ICU. Delirium is linked to negative patient outcomes like increased duration of mechanical ventilation use, prolonged ICU stay, increased mortality rate, and healthcare costs. Despite the importance of delirium and its consequences that are significant, there is a scarcity of studies which explored delirium in Oman. Objectives. This study was conducted to assess the incidence of delirium, the association between the selected predisposing factors and precipitating factors with delirium, determine the predicators of delirium, and evaluate its impacts on ICU mortality and ICU length of stay among ICU patients in Oman. Methods. A multicenter prospective observational design was used. A total of 153 patients were assessed two-times a day by bedside ICU nurses through the Intensive Care Delirium Screening Checklist (ICDSC). Results. The results revealed that the delirium incidence was 26.1%. Regression analysis showed that sepsis, metabolic acidosis, nasogastric tube use, and APACHE II score were independent predictors for delirium among ICU patients in Oman and delirium had significant impacts on ICU length of stay and mortality rate. Conclusion. Delirium is common among ICU patients and it is associated with negative consequences. Multidisciplinary prevention strategies should be implemented to identify and treat the modifiable risk factors.

Background. Lung fibrosis is a sequela of COVID-19 among patients with severe pneumonia. Idiopathic pulmonary fibrosis and lung fibrosis due to COVID-19 may share many similar features. There are limited data on effects of antifibrotic treatment of infection-related lung fibrosis. This study aimed to evaluate the effect of nintedanib on patients’ post-COVID-19 lung fibrosis. Methods. A retrospective, matched case-control study was performed on hospitalized patients with COVID-19 pneumonia. Patients who received nintedanib treatment for COVID-19 pulmonary fibrosis (nintedanib group) were compared to patients with standard treatment (control group). The primary outcome was oxygen improvement. The secondary outcomes were chest X-ray improvement, SpO₂/FiO₂ ratio improvement, mortality rates at 60 days, and adverse events. Results. A total of 42 patients with COVID-19 pneumonia were included (21 in each group). Mean age was 64.43 ± 14.59 years, and 54.8% were men. At baseline, SpO₂/FiO₂ ratio before treatment was 200.57 ± 105.77 in the nintedanib group and 326.90 ± 137.10 in the control group (). Oxygen improvement and chest X-ray improvement were found in 71.4% and 71.4% in the nintedanib group and in 66.7% and 66.7% in the control group (). The nintedanib group had more improvement in SpO₂/FiO₂ ratio than in the control group (144.38 ± 118.05 vs 55.67 ± 75.09, ). The 60-day mortality rates of the nintedanib and the control groups were 38.1% vs 23.8%, . Hepatitis and loss of appetite were common adverse events (9.5% and 9.5%), while the incidence of diarrhea was 4.8%. Conclusions. Nintedanib as add-on treatment in post-COVID-19 lung fibrosis did not improve oxygenation, chest X-ray findings, or the 60-day mortality. However, this antifibrotic drug improved SpO₂/FiO₂ ratio in our patients. Further randomized controlled trials are needed to determine the efficacy of nintedanib for treatment of patients with post-COVID-19 lung fibrosis. Trial Registration. This study was registered in TCTR20220426001.

Background. Ultrasound-guided percutaneous dilatational tracheostomy (US-PDT) has been adapted for use in intensive care units (ICU). US-PDT is comparable to bronchoscopy-assisted tracheostomy. However, compared to surgical tracheostomy (ST), its safety and effectiveness have not been well studied. Objectives. To determine the efficacy and safety of US-PDT compared to ST. Materials and Methods. A total of 90 patients who underwent US-PDT (n = 36) or ST (n = 54) between July 2019 and September 2020 were enrolled. US-PDT was performed in the ICU without a surgical assistant or bronchoscope. Data were collected retrospectively and analyzed regarding clinical characteristics, procedure times and details, complications, and mortality rate. Results. The success rate of US-PDT was 97.4% and the procedure time was shorter than ST (5.2 ± 3.1 vs. 10.5 ± 5.0 min). There were no significant differences in clinical characteristics and procedure details. There was no procedure-related mortality in either of the groups. Conclusions. US-PDT is time-efficient and as safe as ST. Based on our results, US-PDT may be considered a potential alternative to ST in high-risk patients and in those who cannot be transported.

Levonadifloxacin (intravenous) and its oral prodrug alalevonadifloxacin are broad-spectrum antibacterial agents developed for the treatment of difficult-to-treat infections caused by multidrug-resistant Gram-positive bacteria, especially methicillin-resistant Staphylococcus aureus, atypical bacteria, anaerobic bacteria, and biodefence pathogens as well as Gram-negative bacteria. Levonadifloxacin has a well-defined mechanism of action involving a strong affinity for DNA gyrase as well as topoisomerase IV. Alalevonadifloxacin with widely differing solubility and oral bioavailability has pharmacokinetic profile identical to levonadifloxacin. Unlike existing MRSA drugs such as vancomycin and linezolid, which cause unfavorable side effects like nephrotoxicity, bone-marrow toxicity, and muscle toxicity, levonadifloxacin/alalevonadifloxacin has demonstrated superior safety and tolerability features with no serious adverse events. Levonadifloxacin/alalevonadifloxacin could be a useful weapon in the battle against infections caused by resistant microorganisms and could be a preferred antibiotic of choice for empirical therapy in the future.