The Future of Critical Care: Innovations in Patient-Centered Technology

In the landscape of modern healthcare, the evolution of critical care has been marked by the integration of innovative technologies and the emergence of patient-centered approaches. This study aimed to explore the potential of Artificial Intelligence (AI) in shaping the future of critical care, using data collected from Centricity High Acuity data warehouse from the Anesthesia and Intensive Care Clinic and the operating theater from Emergency County Clinical Hospital "Pius Brînzeu" Timişoara. The existing healthcare landscape is characterized by the complex balance between technological advances and patient-centered care. The advent of AI presents an opportunity to revolutionize critical care, offering real-time insights and personalized interventions. This research seeks to harness the capabilities of AI to enhance patient outcomes in critical care scenarios. The study was conducted at a tertiary care hospital, using a mixed-methods approach that involved retrospective analysis of patient data from Centricity. The AI algorithms were trained on historical data to predict patient deterioration patterns, enabling timely interventions and proactive management. Results demonstrated that the integration of AI-driven insights from Centricity High Acuity data warehouse significantly improves patient outcomes. AI-assisted interventions led to reduced instances of adverse events, shorter lengths of stay, and improved resource utilization. The AI algorithms demonstrated high accuracy in predicting patient deterioration, enabling early interventions and preventing complications. In conclusion, the integration of AI technology using data from Centricity High Acuity data warehouse holds immense promise for the future of patient-centered critical care. The results indicate that AI-driven interventions can enhance patient outcomes, reduce healthcare costs, and improve resource utilization. As healthcare continues to embrace AI, the potential for transformative advancements in critical care is evident, paving the way for a new era of innovative and personalized patient-centered care

Enterobacteria in the hospital environment and their antimicrobial resistance

CHU Reunion, France, Vasile Goldis Western University of Arad, Romania, Arad County Clinical Hospital, Romania, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania, The 5th International Congress of the Society of Anesthesiology and Reanimatology of the Republic of Moldova, 16th Edition of the International Course of Guidelines and Protocols in Anesthesia, Intensive Care and Emergency Medicine, 28th Meeting of the European Society for Computing and Technology in Anesthesia and Intensive Care September 27-29, 2018, Chisinau, the Republic of MoldovaBackground: Enterobacteria can produce enzymes (ESBLs) to inactivate beta-lactamins and can also be resistant to carbapenems (CRE), as superbugs. Objective: To evaluate the superbacteria frequency in the last two years in Arad County Clinical Hospital. Material and methods: The multidrug criteria described in Clinical Microbiology and Infection Volume 18, Issue 3, 2011 were used. VITEK and E-test for ESBLs and diffusometric anti-biograms methods for CRE were used, interpreted according to EUCAST and CLSI. Results: Were identified 5093 isolates, 67.85% were Gram negative (n = 3456), 2905 were enterobacteria (57.03% of total, 84.05% of Gram negatives). ESBLs represent 19.53% (n = 995), 15.2% (n = 151) in Surgical wards, 14.94% (n = 149) on ICU and 12.8% (n = 127) in Internal Medicine departments; they were present in all 24 hospital wards, colonizing even ambulatory patients (n = 32; 3.2%). Superbugs were 117 of these, most of which were present on ICUs (n = 57; 48.7%), Neurology (n = 15; 12.8%), Surgery (n=15; 12.8%) and Palliative (n = 12; 10.3%). Most multidrug resistant organisms were Klebsiella pneumoniae (n = 58; 49.6%), Proteus spp (n = 28; 23.91%) and Providencia stuartti (n = 19; 16.2%). Conclusions: Enterobacteria with extended resistance to cephalosporins and carbapenems were identified in the last two years in this hospital, especially in the ICU, Surgical and Internal Medicine departments, colonizing ambulatory patients as well. They are in the WHO alert, along with other Gram negative species, as Acinetobacter baumannii and Pseudomonas aeruginosa

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Volaemic resuscitation in critical patients with severe haemorrhagic shock. Complications due to impaired microvascular system and ischaemia/reperfusion syndrome: A Case Report

Severe trauma is one of the most common causes of death all around the world. Complications of haemorrhagic shock, such as coagulopathy, hypothermia and metabolic acidosis, form the lethal triad in trauma. In this case report we present a male patient admitted with severe haemorrhagic shock – haemoglobin (Hb) 5.6 mg/dL, arterial pressure (AP) 60/53 mmHg, heart beat (HB) 140 bpm, hypothermia (35 0C), lactic acidosis pH 7.21, lactates (Lac) 3.9 mmol/L, excess bases BE(E) – 12.8 mmol/L. Volume resuscitation was started in the emergency department (ED), and continued in the operating room (OR). Fluid resuscitation was guided taking into account a number of factors, such as maintaining fluid and electrolyte balance, protecting the microcirculation, avoidance of ischaemia / reperfusion syndrome, minimization and inhibition of free radical synthesis, responsible for oxidative stress, by administration of high doses of antioxidants. During Intensive Care Unit (ICU) admission, the patient developed severe left lower limb ischaemia. After clinical and laboratory investigations, it was decided to perform a femoral-popliteal by-pass. Failure of the by-pass resulted in amputation of the left lower limb. The patient was discharged from ICU after 27 days of intensive therapy and nursing. In conclusion, we can affirm that the adjustment of fluid management, as well as administration of substances with antioxidant properties, improved the clinical status of the patient and chance of survival

Oxidative Stress and Antioxidant Therapy in Critically Ill Polytrauma Patients with Severe Head Injury

Traumatic Brain Injury (TBI) is one of the leading causes of death among critically ill patients from the Intensive Care Units (ICU). After primary traumatic injuries, secondary complications occur, which are responsible for the progressive degradation of the clinical status in this type of patients. These include severe inflammation, biochemical and physiological imbalances and disruption of the cellular functionality. The redox cellular potential is determined by the oxidant/antioxidant ratio. Redox potential is disturbed in case of TBI leading to oxidative stress (OS). A series of agression factors that accumulate after primary traumatic injuries lead to secondary lesions represented by brain ischemia and hypoxia, inflammatory and metabolic factors, coagulopathy, microvascular damage, neurotransmitter accumulation, blood-brain barrier disruption, excitotoxic damage, blood-spinal cord barrier damage, and mitochondrial dysfunctions. A cascade of pathophysiological events lead to accelerated production of free radicals (FR) that further sustain the OS. To minimize the OS and restore normal oxidant/antioxidant ratio, a series of antioxidant substances is recommended to be administrated (vitamin C, vitamin E, resveratrol, N-acetylcysteine). In this paper we present the biochemical and pathophysiological mechanism of action of FR in patients with TBI and the antioxidant therapy available

Influence of Hypothermia on the Clinical and Molecular Status of a Freshwater Drowning Victim with Severe Trauma. A Case Report

Drowning in freshwater kills many people around the world. Complications are multiple and sometimes impossible to treat. Fluid and electrolyte resuscitation is difficult because of all the physiological, biophysical and biochemical changes that decrease the rate of survival. Extreme lung injury and cardiovascular disorders are responsible for tissue hypoxia, increased production of inflammation markers, biosynthesis of reactive oxygen species and finally, multiple organ damage. Hypothermia, frequently associated with drowning, provides multiple benefits to this type of patients. Various studies have developed the idea that hypothermia protects the brain from biochemical mediators, thereby preventing neuronal cell destruction. In this case report we present the biological parameters and evolution of a patient drowned in freshwater, and also the benefits of hypothermia to the clinical picture