Category Archives: Original Research

Assessing volume status in heart failure: The role of renal duplex ultrasound in evaluating cardiorenal morbidity and heart failure mortality

Mohamed Elsayed Elrokh, Waleed Shehata Hassan, Ramadan Ahmed Khalil, Ayman Nehad Moharam, Emad Eldin Omar Abdelaziz

Department of Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt

DOI: 10.2478/jccm-2025-0029

Background: Critical care physicians face challenges managing decompensated heart failure. This study aims to examine the volume status of patients with decompensated heart failure and evaluate the effectiveness of the renal resistive index (RRI) and renal venous flow pattern (VFP) in assessing volume status and predicting outcomes related to cardiorenal syndrome and mortality.
Patients and methods: This prospective study was conducted in the intensive care unit of Kasr Elainy Hospital at Cairo University with patients admitted for acute decompensated heart failure (ADHF). Patients were subjected to clinical screening, laboratory measurements, and echocardiographic examination, including cardiac index renal duplex.
Results: This study included 61 patients with a mean age of 64.8±9.1 years. Renal duplex parameters were 0.692±0.087 for the mean RRI, and the percentages of VFP were as follows: continuous 49.2%, biphasic 27.9%, and monophasic 23%. Elevated proBNP levels and IVC collapsibility index were significantly associated with RRI ≥0.75 and abnormal VFP patterns in assessing volume status. The ROC curve of the RRI, VFP, proBNP, SOFA score, ADHERE risk score, and GWTG-HF score for AKI occurrence showed that RRI has 68% sensitivity to detect AKI, but VFP has better results with 86.4% sensitivity. RRI has a prognostic role in predicting in-hospital mortality in acute heart failure, as RRI has 83.3% sensitivity, and VFP showed better results with 83.3% sensitivity. Also, VFP had a better predictive value for the incidence of 3 months mortality with 90.9% sensitivity, while RRI has 63.4% sensitivity.
Conclusion: Renal duplex measures, such as VFP and RRI, are highly effective prognostic tools for identifying worsening renal function. Beyond renal outcomes, these measures also serve as reliable predictors of mortality and survival in patients with acute decompensated heart failure, offering clinicians the opportunity to tailor therapeutic approaches early during treatment.

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Comparative analysis of outcomes between anemic and non-anemic critically ill elderly patients in a geriatric ICU in Egypt: A focused study

Manar Mamdouh Abd Al Kader, Manar Mostafa Adel Maamoun, Walaa W. Aly, Heba Youssif Youssif, Mennatallah Safwat Elaraby

Geriatrics and Gerontology Department, Faculty of Medicine, Ain Shams University

DOI: 10.2478/jccm-2025-0028

Background: Numbers of elderly patients who are being admitted to the intensive care unit (ICU) are increasing; Among ICU patients, elderly patients represent a particular subgroup, with a proportion of up to 50% for patients aged 65 years and over, and on average about 35% of admissions for patients older than 70–75 years. Also, those aged 80 years and older represent around 15% of total ICU population. In Egypt, a study conducted in seven regions found that geriatric patients represent around 48.5% of total ICU admission. Elderly individuals are more susceptible to anemia due to multiple comorbidities and age related changes. Anemia is a common problem among critically ill elderly patients with serious consequences. It is recognized as an independent risk factor for increased mortality and morbidity. In fact, anemia is the most prevalent hematologic disorder in the ICU. The prevalence of anemia among critically ill patients admitted to the ICU ranges from 60 to 66%. Approximately 60% of critically ill patients are anemic at admission, and an additional 40–50% develop anemia during their ICU stay. The condition is particularly common among older patients. Low hemoglobin (Hb) concentrations are associated with prolonged ICU and hospital stays , as well as increased mortality rates. Therefore, anemia is consequently a significant public health issue from the medical and economic perspectives. Aim: To compare outcomes between anemic and non- anemic critically ill elderly patients admitted to the Geriatric ICU at Ahmed Shawky geriatric Hospital, Ain Shams University hospitals.
Subjects and methods: A Prospective cohort study was conducted on two hundred sixteen elderly patients of both sexes aged 60 years old or older. It was carried out in the geriatric ICU at Ahmed Shawky geriatric Hospital, Ain Shams University Hospitals. Data collection included participants demographics, medical history, full labs assessment and anemia evaluation based on hemoglobin level, Severity of illness was assessed by validated scoring systems, including the Sequential organ failure assessment (SOFA score) on the first day of admission, as well as Acute physiology and chronic Health Evaluation (APACHE II, APACHE IV). Additionally, the Mortality Probability Model Score (MPM0-III) was applied at first day of admission, 48hours and 72 hours following ICU admission. Anemia management strategies were documented, including the use of blood transfusions, iron therapy and other supportive treatments. Clinical outcomes assessed included ICU length of stay, Site of discharge, in- hospital Mortality and the incidence of Hospital acquired infections.
Results: On admission 172(79.6%) of studied subjects were anemic, (90)41.7% had mild anemia, 56(25.9%) had moderate anemia and 26(12%) had severe anemia. Anemic patients showed significantly higher SOFA, MPM 24hrs, MPM 48hrs, MPM 72hrs, APACHE4, SAPSIII, extended hospital stays, and increased rates of hospital acquired infections(P<0.05). Predicators of mortality included the severity of anemia, the need for mechanical ventilation, and thrombocytopenia (P<0.001). However, anemia on admission to ICU was not a direct predictor of in- hospital mortality. Regarding management of anemia: seventy three (33.9%) of the anemic subjects received blood transfusion. Fourteen (6.5%) received either enteral or parental iron therapy, 20(9.3%) of studied subjects were given erythropoietin, 3(1.4%) of them were given vitamin B12 and folic acid.
Conclusion: On admission, 79.6% of critically ill elderly patients had anemia. The presence of anemia in this population was associated with prolonged ICU stays, increased in-hospital mortality and a higher risk of hospital acquired infections.

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Hyperglycemia, diabetes, and de novo diabetes in patients hospitalized in intensive care units for COVID-19 in Colombia: Results from a longitudinal cohort study

John Jaime Sprockel1,2, Ana Maria Perez2, Maria Camila Chamorro2, Jose Alejandro Vergel2, Ximena Espinosa1, Juan Carlos Vargas1, Carlos Angarita1, Jhon Edinson Parra1

1 El Tunal Hospital, Bogota, Cundinamarca, Colombia
2 Fundación Universitaria de Ciencias de la Salud, Bogota, Colombia

DOI: 10.2478/jccm-2025-0026

Introduction: Hyperglycemia and diabetes have been identified as risk factors for severe COVID-19 and death, with a high rate of reported de novo diabetes. We evaluated their incidence and relationship with adverse outcomes in critically ill COVID-19 patients.
Methods: Prospective single-center longitudinal cohort study in adults hospitalized in intensive care units for confirmed COVID-19. ROC curves for serum glucose and glycated hemoglobin were plotted in relation to 60-day mortality. A Cox proportional hazards model was used to assess the association of diabetes and de novo diabetes with 60-day mortality.
Results: 547 patients were included, with a mean age of 59.8 years; 133 (24.3%) had a history of diabetes, and 67 (12.2%) had de novo diabetes. At 60 days, 317 (57.9%) had died. For mortality, the AUC for glucose at admission was 0.55 (95% CI: 0.48 – 0.62) and 0.51 (95% CI: 0.41 – 0.62) for glycated hemoglobin. In the Cox model, diabetes had an HR of 0.888 (95% CI: 0.695 – 1.135, p: 0.344), history of DM had an HR of 0.881 (95% CI: 0.668 – 1.163, p: 0.371), and de novo diabetes had an HR of 0.963 (95% CI: 0.672 – 1.378, p: 0.835).
Conclusion: There was a high incidence of de novo diabetes in patients hospitalized in intensive care for COVID-19. Neither hyperglycemia, history of diabetes, nor de novo diabetes were associated with the development of complications or 60-day mortality.

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Angioedema: Is ICU admission warranted? A single institution assessment

Madeleine Brill-Edwards1, W. Chase Hamilton2, Erika J. Yoo3, Jennifer Costello4, George J. Koenig Jr.4, Murray J. Cohen4, Joshua A. Marks4

1 Eastern Virginia Medical School, Norfolk, VA, USA
2 Department of Anesthesia, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA USA; Bethlehem Campus, St. Luke’s University Health Network, Fountain Hill, PA, USA
3 Division of Pulmonary, Allergy and Critical Care Medicine, Jefferson-National Jewish Health Jane and Leonard Korman Respiratory Institute, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
4 Division of Acute Care Surgery, Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA USA

DOI: 10.2478/jccm-2025-0023

Introduction: Angioedema has potential for rapid airway decompensation requiring intervention. Patients are often admitted to an ICU for “airway watch.” There is a lack of evidence to support which patients require this.
Aim: We aimed to characterize admission patterns and outcomes of angioedema patients at our institution to assess resource utilization and necessity of ICU use. We hypothesized that patients not requiring intubation upon presentation are safe to manage outside the ICU.
Materials and Methods: Retrospective chart review of patients admitted to our urban academic quaternary referral institution with angioedema ICD-10 codes between 2017 and 2020. Charts reviewed for demographics, etiology, admission location, level of care, length of stay (LOS), intubation information, discharge destination, and specific treatment administered. Statistical analysis included a t-test for continuous variables (LOS).
Results: Of 135 encounters for angioedema, 117 patients were admitted. 50 were admitted to an ICU. Patients were evenly split based on sex, majority black, and the most common etiology was ACE-inhibitor use. 20 required airway intervention with intubations primarily outside the ICU setting and only 2 in the ICU. 1 surgical airway performed in the ED. The mean time from presentation to intubation was 2.7 hours (Min 0h; Max 7.5h). The average ICU LOS for non-intubated patients was 1.1 days, with hospital LOS 1.5 days compared to 0.25 days for those not admitted to an ICU (p<0.001). For intubated patients, average ICU LOS was 4.3 days, with hospital LOS 6.2 days. All intubated patients were successfully liberated from the ventilator. No deaths occurred.
Conclusion: Most angioedema encounters did not require airway intervention within the first hours of presentation. Airway decompensation and intervention mostly occurred prior to the ICU setting. ICU resources should be carefully allocated and may be unnecessary for patients presenting with angioedema who are not intubated on initial evaluation.

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Comparative assessment of hemodynamic changes and outcomes in ventilator weaning

Dina Zeid Roushdy, Hossam Ahmed Saad, Randa Aly Soliman, Mohammed Aly Shehata, Mohammed Amin Fakhir

Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egipt

DOI: 10.2478/jccm-2025-0022

Introduction: Mechanical ventilation is fundamental for the management of critically ill patients. The mode of mechanical ventilation may impact the patient in different ways. This study aimed to assess the hemodynamic changes occurring when transitioning between Volume-Controlled Ventilation (VCV) to Variable Pressure Support (VPS) and VCV to Pressure Support (PS) by echocardiography. Also, a comparison between the spontaneous breathing modes in terms of outcomes, specifically, weaning of mechanical ventilation, days on a ventilator, hospital days, and survival, was conducted.
Methods: This prospective observational study was conducted on 40 mechanically ventilated patients who showed readiness for weaning from Mechanical ventilation. When transitioning between VCV and VPS in arm A and from VCV to PS in arm B, an echocardiographic assessment (transesophageal echocardiography and transthoracic echocardiography) was performed. Both modes were further compared in terms of weaning and the success of liberation from mechanical ventilation.
Results: By comparing both arms, there was a significant difference in velocity time integral (VTI) and stroke volume (SV) for TEE and TTE with p-values of 0.044, 0.022, and 0.05, 0.059, respectively. Also, the cardiac output (CO) showed a statistically significant difference between both arms with a p-value of 0.04. On the other side, there was no statistically significant difference between both arms in terms of ventilator days (p-value of 0.88), length of stay (p-value of 0.651), weaning trial success (p-value of 0.525), and survival rate (p-value of 0.525).
Conclusion: The study showed that VPS is a promising modality that can be used in place of PS as a weaning mode. It provides better patient comfort and a more physiological way of breath delivery. The study also concluded that TTE and TEE will show similar results in most patients and that both can be used interchangeably.

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A brief report on the association of preoperative hematological indices and acute deep vein thrombosis following total hip arthroplasty for osteoarthritis

Razvan Marian Melinte1, Matei Florin Negrut2, Daniel Oltean-Dan3, Adrian Dumitru Ivanescu4, Tudor-Mihai Magdas5, Oana Antal6, Adela Hilda Onutu7, Marian Andrei Melinte8, Robert Bolcas6

1 1st Department of Orthopedics and Traumatology, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania; Department of Orthopedics, Regina Maria Health Network, Targu Mures, Romania
2 “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
3 Department of Orthopedics and Traumatology, County Emergency Hospital, Cluj-Napoca, Romania; MedLife Humanitas Hospital, Cluj-Napoca, Romania
4 Department of Anatomy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
5 Department of Anatomy, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
6 2nd Department of Anesthesia and Intensive Care, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
7 Department of Anesthesia and Intensive Care, Orthopaedics and Traumatology Clinic, County Emergency Hospital, Cluj-Napoca, Romania
8 George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/jccm-2025-0018

Introduction: Total hip arthroplasty (THA) is a standard orthopedic procedure. Deep vein thrombosis (DVT) and pulmonary embolism are potential life-threatening postoperative complications.
Aim of the study: This study aimed to assess the prognostic value of systemic inflammatory indices [monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), platelets-to-lymphocyte ratio (PLR), systemic inflammatory index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI)] and their potential association with acute postoperative DVT.
Materials and methods: We designed a multicentric, retrospective, observational cohort study, including adult patients undergoing elective HTA. Patients were divided into two groups, the DVT and non-DVT groups. We investigated the development of acute DVT early, and at 4 weeks after surgery and also registered length of hospital stay and mortality. All demographic data and laboratory data, hematological indices were extracted from patients files.
Results: 199 patients were included. Of those, 12 (6.03%) developed DVT and 187 (93.97%) did not. There was no statistically significant difference between patient age, gender, BMI, smoking status or comorbidities. No difference was founds between the two groups regarding median values of MLR (0.31 vs 0.27, p=0.12), NLR (3.16 vs 2.42, p=0.27), PLR (163.39 vs 123.01, p=0.27), SII (660.26 vs 568.52, p=0.33), SIRI (67.5 vs 65.26, p=0.89) and AISI (302.35 vs 290.48, p=0.85). Length of hospital stay was not significantly different (median 9 days in the DVT group vs 7 days in the non-DVT group, p=0.38), but mortality was significantly higher in the DVT group (3 deaths vs none in the non-DVT group, p<0.001).
Conclusion: MLR, NLR, PRL, SII, SIRI and AISI were not associated with the development of acute DVT following HTA in our study population.

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Ability to identify patient-ventilator asynchronies in intensive care unit professionals: A multicenter cross-sectional analytical study

Andrés Mauricio Enríquez Popayán1, Iván Ignacio Ramírez2, Juan Felipe Zúñiga3, Ruvistay Gutierrez-Arias4, Mayda Alejandra Jiménez Pérez5, Henry Mauricio Parada-Gereda6, Luis Fernando Pardo Cocuy7, Ana Lucia Rangel Colmenares8, Nubia Castro Chaparro9, Ana Pinza Ortega10, Jorge Martínez Díaz11, Johanna Hurtado Laverde12, Joismer Alejandro Henao Cruz13

1 Departamento de Fisioterapia en Cuidado Intensivo, GyO Medical, Yopal, Colombia; Departamento de Fisioterapia en Cuidado Intensivo, Clínica SIMALINK, Yopal, Colombia
2 Departamento de Apoyo en Rehabilitación Cardiopulmonar Integral, Instituto Nacional del Tórax, Santiago, Chile; INTRehab Research Group, Instituto Nacional del Tórax, Santiago, Chile; Escuela de Kinesiología, Facultad de Ciencias de la Salud, Universidad Diego Portales, Santiago, Chile
3 Departamento de Fisioterapia en Cuidado Intensivo, Clínica de Occidente, Cali, Colombia
4 Departamento de Apoyo en Rehabilitación Cardiopulmonar Integral, Instituto Nacional del Tórax, Santiago, Chile; INTRehab Research Group, Instituto Nacional del Tórax, Santiago, Chile; Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
5 Departamento de Fisioterapia en Cuidado Intensivo, Fundación Hospital San Pedro, Pasto, Colombia
6 Unidad de Cuidado Intensivo, Clínica Reina Sofia, Bogotá, Colombia; Clínica Colsanitas, Grupo de Investigación en Nutrición Clínica y Rehabilitación-Keralty, Bogotá, Colombia. ???Especialización de Fisioterapia en Paciente Adulto Critico, Universidad del Rosario, Bogotá, Colombia
7 Departamento de Fisioterapia en Cuidado Intensivo, Hospital Universitario Mayor Méderi, Bogotá, Colombia; Especialización de Fisioterapia en Paciente Adulto Critico, Universidad del Rosario, Bogotá, Colombia
8 Departamento de Fisioterapia en Cuidado Intensivo, Clínica Norte, Cúcuta, Colombia; Departamento de Fisioterapia en Cuidado Intensivo, Clínica San José, Cúcuta, Colombia
9 Departamento de Cuidado Intensivo, Lumira SAS, Cali, Colombia
10 Departamento de Fisioterapia en Cuidado Intensivo, Fundación Hospital San Pedro, Pasto, Colombia; Programa de Fisioterapia, Universidad Mariana, Pasto, Colombia; Grupo de Investigación en Medicina Critica GMC, Fundación Hospital San Pedro, Pasto, Colombia
11 Departamento de Cuidado Intensivo, Fundación Hospital San Pedro, Pasto, Colombia; Programa de Medicina, Fundación Universidad San Martin, Pasto, Colombia; Grupo de Investigación en Medicina Critica GMC, Fundación Hospital San Pedro, Pasto, Colombia
12 Programa de Terapia Respiratoria, Universidad Manuela Beltrán, Bogotá, Colombia
13 Departamento de Fisioterapia en Cuidado Intensivo, Hospital Universitario de Caldas, Manizales, Colombia

DOI: 10.2478/jccm-2025-0017

Introduction: Patient-ventilator asynchrony (PVA) is frequent in intensive care. Its presence is associated with prolonged days of mechanical ventilation and may lead to increased mortality in the intensive care unit (ICU) and hospital. Little is known about the ability of Colombian intensive care professionals to identify asynchronies, and the factors associated with their correct identification are not apparent.
Aim of the study: To describe the ability of Colombian intensive care professionals to identify patient-ventilator asynchronies (PVA) using waveform analysis. In addition, to define the characteristics associated with correctly detecting PVA.
Material and methods: We conducted a multicenter, cross-sectional, national survey-based study between January and August 2024. Colombian physiotherapists, respiratory therapists, nurses and intensive care physicians from 24 departments participated in the study. An online survey was used. They were asked to identify six different PVAs presented as videos. The videos were displayed using pressure/time and flow/time waveform of a Puritan Bennett 840 ventilator.
Results: We recruited 900 participants, 60% female, most of whom were physiotherapists (53%). Most professionals had specialty training in critical care (42%), and 32% reported having specific PVA training. Double triggering was the most frequently identified PVA (75%). However, only 3.67% of participants recognized all six PVAs. According to multiple logistic regression analysis, working in a mixed unit (OR 2.59; 95% CI 1.19 – 5.54), caring for neonates (OR 5.19; 95% CI 1.77 – 15.20), and having specific training (OR 2.38; 95% CI 1.16 – 4.76) increases the chance of correctly recognizing all PVAs.
Conclusion: In Colombia, a low percentage of professionals recognize all PVAs. Having specific training in this topic, working in mixed ICUs and neonatal intensive care was significantly associated with identifying all PVAs.

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Latent class analysis for identification of sub-phenotypes predicting prognosis in hospitalized out-of-hospital cardiac arrest

Yuki Kishihara1, Hideto Yasuda1–4, Masahiro Kashiura1, Shunsuke Amagasa5, Hiroyuki Tamura1, Yutaro Shinzato1, Takashi Moriya1

1 Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
2 Department of Clinical Research Education and Training Unit, Keio University Hospital Clinical and Translational Research Center, Tokyo, Japan
3 School of Nursing, Midwifery and Social Work, UQ Centre for Clinical Research, The University of Queensland, Australia
4 School of Nursing and Midwifery; Alliance for Vascular Access Teaching and Research, Griffith University, Australia
5 Department of Emergency and Transport Medicine, National Center for Child Health and Development, Tokyo, Japan

DOI: 10.2478/jccm-2025-0016

Aim of the study: To determine which out-of-hospital cardiac arrest (OHCA) patients should receive advanced treatment is extremely challenging. The objective was to identify sub-phenotypes predicting the prognoses of adult OHCA patients by latent class analysis (LCA) using data up to just after admission.
Material and Methods: We conducted a retrospective observational study using multicentre OHCA registry from 95 Japanese hospitals including adult non-traumatic hospitalized OHCA. The primary outcome was 30-day favourable neurological outcome. Our LCA used clinically relevant variables up to just after admission and the optimal class number was determined from clinical importance and Bayesian information criterion. The associations between sub-phenotypes and outcomes were analysed using univariate logistic regression analysis with odds ratios (ORs) and 95% confidence intervals (CIs).
Results: Our LCA included 2,162 patients and identified four sub-phenotypes. The base excess on hospital arrival had the highest discriminative power. Thirty-day favourable neurological outcomes were observed in 526 patients (24.3%), including 284 (53.8%) in Group 1, 179 (21.2%) in Group 2, 26 (11.4%) in Group 3, and 37 (6.6%) in Group 4. Prehospital return of spontaneous circulation (ROSC) was achieved in 1,009 patients (46.7%), including 379 (81.8%) in Group 1, 340 (40.3%) in Group 2, 115 (50.4%) in Group 3, and 175 (31.1%) in Group 4. Univariate logistic regression analysis for primary outcome using Group 4 as reference revealed ORs (95% CI) of 16.5 (11.4–24.1) in Group 1, 3.83 (2.64–5.56) in Group 2, and 1.83 (1.08–3.10) in Group 3.
Conclusions: Our LCA classified OHCA into four sub-phenotypes showing significant differences for prognosis. In cases who achieved prehospital ROSC, it might be meaningful to continue advanced therapeutic interventions.

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Use of prone position in spontaneous breathing in patients with COVID-19

Rodrigo Cerqueira Borges1, Isadora Salvador Rocco2, Camila Botana Alves Ferreira1, Mauricio Kenzo Tobara1, Cristiane Helena Papacidero1, Vanessa Chaves Barreto Ferreira1, Andrey Wirgues Sousa1

1 Hospital Samaritano Higienópolis, São Paulo, Brazil
2 Universidade Federal de Sao Paulo, Brazil

DOI: 10.2478/jccm-2025-0015

Objective: To investigate if awake prone position (PP) reduces the rate of endotracheal intubation and mortality in patients with COVID-19 admitted to the intensive care unit (ICU).
Methods: This was a retrospective cohort study of 726 patients who were admitted to the ICU with acute hypoxic respiratory failure secondary to COVID-19. The protocol of the institution recommended the use of awake PP in patients with nasal catheter with an oxygen flow ≥ 5 L/min and SpO2 ≤ 90% or a high-flow nasal catheter (HFNC) with FiO2 ≥ 50% and SpO2 ≤ 90%. The following data were collected: age, comorbidities, SAPS-3 score, onset of symptoms, the degree of pulmonary involvement, duration of invasive and noninvasive MV, HFNC therapy, nitric oxide therapy, hemodialysis and PP while spontaneously breathing.
Results: There was a higher mortality rate in the supine position group (27.1%) than in the awake PP group (13.9%). There was no significant difference in the time on MV or number of patients on MV (p>0.05). The variables with p < 0.05 in the bivariate analysis were entered into the Cox regression model. The model was adjusted for awake PP, sex, age, SAPS-3 score, onset of symptoms, the degree of pulmonary involvement, chronic arterial disease, and noninvasive ventilation. The only variable associated with lower mortality over time was awake PP (hazard ratio: 0.55; 95% confidence interval: 0.33-0.92).
Conclusion: Awake prone position has been shown to be a safe and effective therapy that reduced mortality but not the risk of intubation in patients with COVID-19.

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The effect of antiseizure medication on mortality in spontaneous aneurysmal subarachnoid hemorrhage

John Harold Kanter, Adam C. Glaser, Pablo Martinez-Camblor, Jakob V.E. Gerstl, Anna B. Lebouille-Veldman, Harshit Arora, Lauren Buhl, Myles D. Boone, Christopher S. Ogilvy

1 Department of Neurological Surgery, University of California, San Francisco, California; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
2 Department of Neurological Surgery, Brigham and Women’s Hospital, Harvard Medical School Department of Neurological Surgery, Boston Children’s Hospital, USA
3 Department of Anesthesiology, Dartmouth Health Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Dartmouth Hitchcock Medical Center, USA
4 Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women’s Hospital, Boston, USA
5 Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women’s Hospital, Boston, USA; Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
6 Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women’s Hospital, Boston, USA. Department of Neurosurgery, University of Kentucky, Lexington, KY, USA
7 Department of Anesthesiology, Dartmouth Health, Dartmouth Hitchcock Medical Center, USA
8 Department of Anesthesiology, Dartmouth Health Department of Neurology, Dartmouth Health, Dartmouth Hitchcock Medical Center, USA
9 Neurosurgical Service, BIDMC Brain Aneurysm Institute, Harvard Medical School, Beth Israel Deaconess Medical Center, USA

DOI: 10.2478/jccm-2025-0014

Background: Spontaneous aneurysmal subarachnoid hemorrhage (aSAH) is a major cause of morbidity and mortality in the United States. The efficacy of early antiseizure medication (ASM) is debated. Recent literature reports seizure rates ranging from 7.8% to 15.2% following spontaneous aSAH. Current guidelines recommend use of early ASM in patients with “high-risk features,” but whether early ASM use decreases the rate of death associated with aSAH remains unclear. This study assessed whether early administration of early ASM impacts mortality rates after spontaneous aSAH.
Methods: We conducted a retrospective cohort study using a publicly available dataset from the Massachusetts Institute of Technology, Medical Information Mart for Intensive Care-III (MIMIC) database of all patients over the age of 18 with spontaneous aSAH resulting in an intensive care unit (ICU) admission to a major United States trauma center from 2001 to 2012. The primary exposure was receiving early ASM and primary outcome of death within 7 days. Different regression models were created to explore the association between early ASM administration within 24 hours of admission and a composite outcome of seizure and/or death within 7 days of admission. Secondary outcomes included 30-day and one-year mortality.
Results: Of 253 patients with spontaneous aSAH, 148 received early ASM within 24 hours. Patients who did receive early ASM were less likely to die within 7 days of admission (adjusted odd ratio, [aOR]: 0.26 95% CI 0.10 to 0.68; P=0.006) but were more likely to have a seizure (aOR: 7.63 95% CI 2.07 to 28.17; P=0.002).
Conclusion: Early ASM administration was associated with lower rates of death and composite death/seizure within 7 days of admission among patients who presented to an ICU with spontaneous aSAH. These findings suggest broader use of early ASM in patients who present with spontaneous aSAH may improve early mortality.

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