Category Archives: Original Research

Influence of different short peripheral cannula materials on the incidence of phlebitis in intensive care units: A post-hoc analysis of the AMOR-VENUS study

Yutaro Shinzato1, Hideto Yasuda1-3, Haruka Taira1, Yuki Kishihara1, Masahiro Kashiura1, Takashi Moriya1, Yuki Kotani4, Natsuki Kondo5, Kosuke Sekine6, Nobuaki Shime6, Keita Morikane7

1 Jichi Medical University Saitama Medical Center, Saitama, Japan
2 Alliance for Vascular Access Teaching and Research, Griffith University, Nathan, Queensland, Australia.
3 Department of Clinical Research Education and Training Unit, Keio University Hospital Clinical and Translational Research Centre (CTR), Tokyo, Japan.
4 Kameda Medical Center, Kamogawa, Japan
5 Chiba Emergency and Psychiatric Medical Center, Chiba, Japan
6 Division of Clinical Laboratory and Infectious Diseases, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
7 Yamagata University Hospital, Yamagata, Japan

DOI: 10.2478/jccm-2026-0014

Aim of the study: Short peripheral cannula (SPC)-related phlebitis occurs in 7.5% of critically ill patients, and mechanical irritation from cannula materials is a risk factor. Softer polyurethane cannulas reportedly reduce phlebitis, but the incidence of phlebitis may vary depending on the type of polyurethane. Differences in cannula stiffness may also affect the incidence of phlebitis; however, this relationship is not well understood. This study analyzed intensive care unit (ICU) patient data to compare the incidence of phlebitis across different cannula products, focusing on polyurethane.
Material and Methods: This is a post-hoc analysis of the AMOR-VENUS study that involved 23 ICUs in Japan. We included patients aged ≥ 18 years, who were admitted to the ICU with SPCs. The primary outcome was phlebitis, evaluated using hazard ratios (HRs) and 95% confidence intervals (CIs). Based on the market share and differences in synthesis, polyurethanes were categorized into PEU-Vialon® (BD, USA), SuperCath® (Medikit, Japan), and other polyurethanes; non-polyurethane materials were also analyzed. Multivariable marginal Cox regression analysis was performed using other polyurethanes as a reference.
Results: In total, 1,355 patients and 3,429 SPCs were evaluated. Among polyurethane cannulas, 1,087 (33.5%) were PEU-Vialon®, 702 (21.6%) were SuperCath®, and 276 (8.5%) were other polyurethanes. Among non-polyurethane cannulas, 1,292 (39.8%) were ethylene tetrafluoroethylene (ETFE) cannulas, and 72 (2.2%) used other materials. The highest incidence of phlebitis was observed with SuperCath® (13.1%). Multivariate analysis revealed an HR of 1.45 (95% CI 0.75-2.8, p = 0.21) for PEU-Vialon®, 2.60 (95% CI 1.35-5.00, p < 0.01) for SuperCath®, 2.29 (95% CI 1.19-4.42, p = 0.01) for ETFE, and 2.2 (95% CI 0.46-10.59, p = 0.32) for others.
Conclusions: The incidence of phlebitis varied among polyurethane cannulas. Further research is warranted to determine the causes of these differences.

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Prediction of acute kidney injury in mechanically ventilated patients with COVID-19-related septic shock: An exploratory analysis of non-renal organ dysfunction markers

Jose J. Zaragoza1, Jonathan S. Chávez-Iñiguez2,3, Armando Vazquez-Rangel4

1 Critical Care Department, Hospital H+ Queretaro, Mexico
2 Nephrology Department, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico
3 Centro Uniersitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
4 Nephrology Department, Instituto Nacional de Cardiologia, Mexico City, Mexico

DOI: 10.2478/jccm-2026-0013

Background: Acute kidney injury (AKI) is a common and serious complication in critically ill patients with non-kidney organ dysfunction. Early prediction of AKI is crucial for timely intervention and improved outcomes. This study aimed to identify readily available non-renal predictors of AKI and to develop an exploratory prediction model in a specific cohort of critically ill patients with COVID-19-related septic shock requiring mechanical ventilation.
Materials and methods: This was a single-center, observational, retrospective cohort study conducted in the respiratory ICU of Hospital H+ Querétaro between April and December 2020. The study included 42 mechanically ventilated patients with septic shock secondary to SARS-CoV-2 infection and non-kidney organ dysfunction. AKI was defined using the KDIGO criteria. Trend analysis, bivariate and multivariate linear regression, were used to identify predictors of AKI and severe AKI.
Results: AKI occurred in 23 (54.8%) patients, with 6 (14.3%) developing severe AKI. Trend analysis revealed differences in norepinephrine dose, hemoglobin, and lactate trends between groups. A simplified logistic regression model, validated internally with bootstrapping to prevent overfitting, identified a protective trend associated with higher hemoglobin levels on admission. Quantitative analysis of a forecasting model for daily renal function showed moderate predictive accuracy.
Conclusions: This study identified several readily available non-kidney organ dysfunction variables that can predict AKI and its severity in critically ill patients with COVID-19-related septic shock. These findings may help in the early identification of at-risk patients and facilitate timely interventions to potentially improve outcomes. Further validation in larger and more diverse populations is warranted.

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Efficacy of gabapentin versus trospium chloride for prevention of catheter-related bladder discomfort inside the surgical intensive care unit: A prospective, randomised, controlled clinical study

Ahmed Moustafa Mohamed, Wessam Zaher Selima

Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt

DOI: 10.2478/jccm-2026-0015

Introduction: Catheter-related bladder discomfort (CRBD) after perioperative catheterisation of the urinary bladder (COUB) is not uncommon.
Aim of the study: We evaluated the efficacy of both oral gabapentin and trospium in preventing CRBD during the early postoperative period in patients admitted to the surgical intensive care unit (S-ICU).
Material and Methods: 120 patients aged 20–65 years, ASA I, II or III who were admitted to S-ICU after undergoing elective spinal surgery (ESS) with COUB were included. They were randomly assigned to be administered either an oral 400 mg gabapentin capsule (Group G) or an oral 60 mg slow-release trospium chloride capsule (Group T) or nothing (Group C). The primary goal was the occurrence of CRBD and its severity at 1, 2, 6, 12, and 24 hours after the study drug administration (SDA).
Results: Group G and group T had a statistically significant lower incidence of CRBD than group C at 1, 2, 6, 12, and 24 hours after SDA, respectively. Both had considerably lower severity than group C in the first two hours only (P= 0.001 and 0.001, respectively). Group T had non-significantly lower incidence and severity of CRBD than group G. Group G had significantly lower mean total fentanyl requirements for up to 24 hours after SDA than group T and group C (P < 0.001).
Conclusion: Both oral gabapentin capsules and slow release trospium chloride capsules administered postoperatively, significantly decreased both the incidence of CRBD and its severity in the early postoperative period amongst S-ICU patients, without significant differences between the two drugs.

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Positive fluid balance is associated with earlier acute kidney injury in COVID-19 patients

Rezwan Munshi1, Sandra Gomez-Paz2, Salman Bhutta3, Joshua Fogel4, James Pellegrini1, Narois Nehru1, Eric Lam5, Sofia Rubinstein1

1 Nassau University Medical Center, East Meadow, NY, USA
2 Brody School of Medicine, East Carolina University, Greenville, NC, USA
3 Northwell Health, New Hyde Park, NY, USA
4 Brooklyn College, Brooklyn, NY, USA
5 Rutgers New Jersey Medical School, Newark, NJ, USA

DOI: 10.2478/jccm-2026-0016

Introduction: Managing fluid balance in COVID-19 patients can be challenging, particularly if acute kidney injury (AKI) develops.
Aim of the study: We study the relationship between fluid net input and output (FNIO) in COVID-19 patients with development of AKI, time to development of AKI, in-hospital length of stay (LOS), and in-hospital mortality.
Material and Methods: Retrospective study of 403 patients with COVID-19. Data for FNIO were from day 1 through day 10 or earlier if AKI occurred.
Results: AKI occurred in 22.8%, in-hospital mortality occurred in 26.3%, mean days to AKI were 7.7 (SD=6.3), and mean LOS was 11.5 (SD=13.2) days. In the multivariate logistic regression analyses, increased FNIO mean was significantly associated with slightly increased odds for mortality (OR=1.001, 95% CI:1.0001, 1.0011, p=0.02) but was not significantly associated with AKI. In the multivariate linear regression analyses, increased FNIO mean was significantly associated with lesser days to AKI (B=-6.63*10-5, SE=<0.001, p=0.003) in the whole sample, greater days to AKI in the subset of those with ICU treatment (B=<0.001, SE=<0.001, p<0.001), while FNIO mean was not significantly associated with LOS.
Conclusions: Positive fluid balance was associated with faster onset of AKI and increased mortality. Fluid administration in patients with COVID-19 should be guided by routinely measuring FNIO. A restrictive fluid management regimen rather than usual care should be practiced.

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Inhaled sevoflurane in critically ill COVID-19 patients: A retrospective cohort study

Jose J. Zaragoza1, Marco A. Baez-Garcia2,3, Jose M. Lomeli-Teran2,4, Daniela Anzures-Diaz2, Paola Zamudio-Cantellano2,4, Job H. Rodriguez-Guillen2,4

1 Hospital H+ Queretaro, Santiago de Querétaro, Mexico
2 Critical Care Department, Hospital H+ Queretaro, Queretaro, Mexico
3 Universidad Anahuac Queretaro, Queretaro, Mexico
4 Colegio Mexicano de Medicina Crítica, Benito Juárez, Mexico

DOI: 10.2478/jccm-2026-0011

Background: Managing sedation in critically ill COVID-19 patients is challenging due to high sedative requirements and organ dysfunction that alters drug metabolism. Inhaled sevoflurane offers a lung-eliminated alternative that may mitigate drug accumulation.
Methods: This single-center, retrospective cohort study analyzed 43 mechanically ventilated COVID-19 patients (March–November 2020). Patients received inhaled sevoflurane adjunctive to IV sedation (n=30) or IV sedation alone (n=13). The primary outcome was the cumulative dose of IV sedatives over 7 days. Secondary outcomes included time to extubation and antipsychotic use.
Results: There was no significant difference in the cumulative dose of IV sedatives between groups. However, the sevoflurane group had a significantly longer median duration of mechanical ventilation (206 [IQR 144-356] vs 144 [IQR 115-156] hours, p=0.005) and a higher requirement for antipsychotic medication (66.6% vs 15.3%, OR 18.6, p=0.011). Daily doses of propofol were lower in the sevoflurane group on specific days, but overall burden was unchanged.
Conclusions: In this cohort, adjunctive inhaled sevoflurane did not significantly reduce the cumulative burden of IV sedatives and was associated with delayed extubation and increased antipsychotic use. While sevoflurane is a feasible alternative, these findings suggest caution regarding weaning and delirium management in COVID-19 patients.

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Admission biomarkers and COVID-19 mortality: A retrospective study during Vietnam’s pandemic peak

Uyen Thi Bich Nguyen1, Hau Phuc Le2,3, Vu Hoang Anh Nguyen4, Ai-Thanh Tran-Nguyen4,5

1 Department of Nephrology and Hemodialysis, Le Van Viet Hospital, Ho Chi Minh City, Vietnam
2 Outpatient Clinic for HIV-AIDS Patients, Chau Thanh District Medical Center, Tra Vinh Province, Vietnam
3 Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
4 Department of Psychosomatic Medicine, Thu Duc City Hospital, Ho Chi Minh City, Vietnam
5 Thu Duc City Hospital, Ho Chi Minh City, Vietnam

DOI: 10.2478/jccm-2026-0012

Background: This study aimed to evaluate the prognostic value of key admission biomarkers in predicting mortality among hospitalized COVID-19 patients and to establish optimal cut-off thresholds for clinical decision-making.
Methods: Retrospective cohort study included 269 COVID-19 patients treated at Thu Duc City Hospital, Vietnam, during the peak of the fourth pandemic wave in 2021. Logistic regression identified independent predictors of mortality, and receiver operating characteristic (ROC) curve analysis assessed the diagnostic performance of biomarkers. The area under the ROC curve (AUROC), Sensitivity, Specificity and Accuracy Index were used to determine optimal cut-off values.
Results: Among the 269 patients, 53 (19.7%) died and 216 (80.3%) survived. Non-survivors exhibited elevated D-dimer (4.48 μg/mL vs 0.93 μg/mL, p < 0.0001), neutrophil counts (6.8 × 10⁹/L vs 3.5 × 10⁹/L, p < 0.0001) and white blood cell counts (11.68 × 10⁹/L vs. 7.87 × 10⁹/L, p < 0.0001). Lymphocyte counts and fibrinogen levels were significantly lower in non-survivors (p < 0.05). Logistic regression identified D-dimer (OR = 1.05, 95% CI: 1.02–1.09, p = 0.001), neutrophil counts (OR = 1.32, 95% CI: 1.10–1.63, p = 0.005) and lymphocyte counts (OR = 0.51, 95% CI: 0.26–0.92, p = 0.033) as significant predictors of mortality. ROC analysis revealed that D-dimer (AUROC = 0.809) and neutrophil counts (AUROC = 0.726) demonstrated strong discriminatory power, with cut-off values of ≥1.126 μg/mL (sensitivity = 90.57%, specificity = 60.19%) and ≥6.715 × 10⁹/L (sensitivity = 52.83%, specificity = 82.87%), respectively.
Conclusion: These findings support the use of admission biomarkers to guide early interventions and improve patient outcomes in severe COVID-19 cases. Further studies are warranted to validate these results and explore their applicability in other settings.

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Impaired peripheral mononuclear cell metabolism in patients at risk of developing sepsis: A cohort study

Velma Herwanto1,2, Ya Wang2, Maryam Shojaei2, Alamgir Khan3, Kevin Lai4, Amith Shetty4, Stephen Huang2, Tracy Chew5, Sally Teoh2, Marek Nalos2, Mandira Chakraborty2, Anthony S McLean2, Benjamin M P Tang2

1 Universitas Tarumanagara, Faculty of Medicine, Jakarta, Indonesia
2 Department of Intensive Care Medicine, Nepean Hospital, Kingswood, NSW, Australia
3 Australian Proteome Analysis Facility, Macquarie University, NSW, Australia
4 Department of Emergency Medicine, Westmead Hospital, NSW, Australia
5 Sydney Informatics Hub, The University of Sydney, NSW, Australia

DOI: 10.2478/jccm-2026-0010

Introduction: Dysregulated immune responses are central to progression of sepsis and closely associated with impaired cellular metabolism. However, most existing studies have focused on late-stage sepsis, leaving metabolic alterations during earlier stages of infection poorly characterised. This study aimed to determine whether immune cell metabolic impairment is already present during uncomplicated infection, prior to the development of sepsis, and to evaluate its potential as an early indicator of immune dysfunction and risk of progression.
Materials and methods: Forty patients with sepsis (fulfilling Sepsis-3 criteria) and 27 patients with uncomplicated infection were recruited from the emergency department along with 20 healthy volunteers. Whole blood samples were collected to assess gene expression, cytokine levels, and cellular metabolic functions, including mitochondrial respiration, oxidative stress, and apoptosis in immune cells.
Results: Mitochondrial respiration was significantly impaired in immune cells from both uncomplicated infection and sepsis patients compared with healthy controls (p < 0.05), with more pronounced impairment in established sepsis. Downregulation of BCL2 and BBC3 gene expression was observed in sepsis patients (p < 0.05), but not in uncomplicated infection, potentially contributing to differences in the severity of metabolic impairment. Impaired mitochondrial respiration was significantly associated with increased mitochondrial oxidative stress (p < 0.05), which was elevated in uncomplicated infection and further increased in sepsis. Oxidative stress levels also correlated with tumour necrosis factor-α (r = 0.330) and the expression of CYCS, TP53, SLC25A24, and TSPO (rs = −0.4926, −0.4422, 0.4382, and 0.4835, respectively). Despite these metabolic alterations, no significant differences in immune cell apoptosis were observed between uncomplicated infection and sepsis patients.
Conclusions: Immune cell metabolic dysfunction is present in patients with uncomplicated infection before the clinical onset of sepsis. Early mitochondrial dysfunction and oxidative stress may represent promising targets for further investigation as early biomarkers of immune dysfunction and sepsis risk.

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Real-world clinical decision of andexanet alfa administration for intracranial hemorrhage during anticoagulant therapy using factor Xa inhibitor

Shigeo Yamashiro1, Keisuke Harada1, Shunsuke Izumi1, Yusuke Morikawa1, Tomoko Ikemoto1, Koki Kameno1, Tomoaki Goto1, Yuki Ohmori1, Masatomo Kaji1, Akitake Mukasa2

1 Division of Neurosurgery, Department of Cerebrovascular Medicine and Surgery, Saiseikai Kumamoto Hospital, Kumamoto, Japan
2 Department of Neurosurgery, Faculty of Life Sciences, Kumamoto University, Kumamoto Japan

DOI: 10.2478/jccm-2025-0046

Introduction: Andexanet alfa shows excellent hemostatic efficacy in treating intracranial hemorrhage (ICH) during Xa inhibitor therapy. However, its optimal use remains uncertain.
Aim of the study: This study aims to evaluate our clinical experience in managing Xa inhibitor-related ICH to clarify its appropriate application.
Material and methods: This study was conducted as an observational, non-interventional study. We observed 63 cases of ICH in patients receiving anticoagulation therapy with apixaban, rivaroxaban, or edoxaban. After excluding 14 patients due to fatal outcomes or complete hemostasis, 49 patients were eligible for andexanet alfa administration.
Results: The mean age and hematoma volume was 78 years and the 35ml, respectively. Based on patient characteristics and severity, andexanet alfa was administered to 23 patients, while 26 patients received usual care. Hemorrhage enlargement was absent in 22 cases (92.8%) in the andexanet group and in 22 cases (84.6%) in the usual care group. Hemorrhage expansion occurred in three cases from the usual care group, one patient undergoing emergency surgery and another died from uncontrollable intraoperative bleeding. Two patients (8.7%) in the andexanet group experienced thromboembolic events as adverse reactions. At 3 months, the modified Rankin Scale (mRS) was 3 or lower in 39% of the andexanet group and 50% of the standard care group.
Conclusions: Although patient selection bias make it difficult to draw definitive conclusions, we recommend considering andexanet alfa administration for cases within several hours of the last Xa inhibitor dose to prevent neurological deterioration. Emergency surgical cases should also be eligible for andexanet alfa to ensure intraoperative safety. Further research is required to determine clinically appropriate indications for its use.

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Pharmacokinetic-guided magnesium prophylaxis in cardiac surgery: A randomized trial demonstrating guideline-level reductions in atrial fibrillation, accelerated recovery, and systemic cost savings

Sarah Hamdy Elghareeb, Islam Taher, Ahmed Abd Al Ghany, Noha Mohamed Abdelaziz

Ain Shams University Faculty of Medicine, Cairo, Egypt

DOI: 10.2478/jccm-2026-0001

Objective: To evaluate the efficacy, safety, and cost-effectiveness of a perioperative magnesium (Mg) sulfate protocol in reducing postoperative atrial fibrillation (AF) incidence and ICU resource strain following cardiac surgery.
Methods: Design: Double-blind, single-center randomized controlled trial (RCT). Setting: Tertiary-care academic hospital. Participants: 130 adults undergoing elective cardiac surgery, randomized to Mg sulfate (n=65) or placebo (n=65). Interventions: The Mg group received a pharmacokinetic-guided regimen: 2 g intravenous bolus post-cardiopulmonary bypass, followed by 1 g/h infusion for 5 hours, then 200 mg/h for 19 hours, and oral supplementation (I g every 8 hours) for one week post-discharge. The placebo group received equivalent saline infusions and oral placebo.
Results: Primary outcome: AF incidence was 18.5% in the Mg group vs. 41.5% in placebo (unadjusted RR=0.45, 95% CI: 0.25–0.81; p=0.007). Secondary outcomes: Mg shortened ICU stay by 1.4 days (p<0.001), reduced mechanical ventilation duration by 3.2 hours (p<0.001), and demonstrated comparable safety profiles for hypotension and renal impairment. Subgroup analysis: CABG patients showed 65% risk reduction (OR=0.35, p=0.01). Cost-effectiveness: ICU stay reduction projected $3,500 savings per patient.
Conclusions: Perioperative Mg sulfate significantly reduces AF incidence, accelerates recovery, and lowers healthcare costs, supporting its integration into standardized postoperative protocols. This trial provides Level I evidence for Mg as a guideline-recommended intervention. These findings are promising and support the integration of Mg into standardized postoperative protocols; however, they require confirmation in larger, multicenter studies.

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Epidemiological insights into carbapenem resistant infections in critical care settings: A molecular and clinical investigation

Camelia Vintila1, Razvan Lucian Coseriu1, Alexandru Andrei Ujlaki Nagi2, Adrian Man1

1 George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2 Mures County Clinical Hospital, Targu Mures, Romania

DOI: 10.2478/jccm-2025-0048

Objective: This study aimed to investigate the prevalence and genetic relatedness of multidrug-resistant Gram-negative bacilli, particularly those resistant to carbapenems, in patients admitted to intensive care units. It also sought to explore associations between bacterial colonization or infection and clinical outcomes, including comorbidities, treatment regimens, and mortality.
Methods: Between November 2022 and December 2023, screening and pathological samples were collected from patients at a tertiary hospital. Screening samples included rectal and pharyngeal swabs, while pathological samples comprised respiratory tract secretions. Bacterial identification and antibiotic susceptibility testing were performed using standard microbiological methods. Genetic similarity among isolates was assessed using a molecular fingerprinting technique to detect potential clonal spread.
Results: A total of 62 carbapenem-resistant strains were identified, with Acinetobacter baumannii and Klebsiella pneumoniae being the most prevalent. Pathological isolates exhibited higher resistance levels than screening isolates. Most patients had multiple comorbidities, with cardiac, renal, and pulmonary conditions being the most common. A significant association was found between prolonged intensive care unit stay and increased mortality. However, no significant correlation was observed between the number of comorbidities or antibiotic classes used and mortality. Molecular analysis revealed clonal clusters of Acinetobacter and Klebsiella strains, suggesting nosocomial transmission.
Conclusions: The findings underscore the importance of early screening, molecular surveillance, and stringent infection control measures in intensive care settings.

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