Background: Ventilator-associated pneumonia (VAP) is the most monitored form of respiratory tract infections (RTIs). A small number of epidemiological studies have monitored community-acquired pneumonia (CAP), non-ventilator hospital-acquired pneumonia (NV-HAP) and ventilator-associated tracheobronchitis (VAT) in intensive care units (ICUs). The objective of this study was to assess the frequency, etiology, mortality, and additional costs of RTIs. Methods: One-year prospective RTI surveillance at a 30-bed ICU. The study assessed the rates and microbiological profiles of CAP, VAP, NV-HAP, VAT, and VAP prevention factors, the impact of VAP and NV-HAP on the length of ICU stays, and the additional costs of RTI treatment and mortality. Results: Among 578 patients, RTIs were found in 30%. The CAP, NV-HAP, VAP, and VAT rates/100 admissions were 5.9, 9.0, 8.65, and 6.05, respectively. The VAP incidence density/1000 MV-days was 10.8. The most common pathogen of RTI was Acinetobacter baumannii MDR. ICU stays were extended by VAP and NV-HAP for 17.8 and 3.7 days, respectively, and these RTIs increased the cost of therapy by 13,029 and 2708 EUR per patient, respectively. The mortality rate was higher by 11.55% in patients with VAP than those without device-associated and healthcare-associated infections (p = 0.0861). Conclusions: RTIs are a serious epidemiological problem in patients who are admitted and treated in ICU, as they may affect one-third of patients. Hospital-acquired RTIs extend hospitalization time, increase the cost of treatment, and worsen outcomes.

Tracheostomy can reduce mechanical ventilation (MV) duration, ICU and hospital length of stay (LOS), and ventilator-associated pneumonia (VAP) risk in critically ill patients. The timing of tracheostomy in COVID-19 patients has been studied, but its impact on VAP incidence has rarely been analyzed. This study investigated tracheostomy timing’s impact on VAP incidence, ventilation time, ICU and hospital LOS, and mortality in critically ill COVID-19 patients. It was conducted at the University Hospital in Wroclaw, Poland, from October 1, 2020, to June 30, 2021. Of 60 tracheostomized patients, 21 (35%) developed VAP. Early tracheostomy (≤ 13 days) resulted in 8/42 (19%) VAP cases, while late tracheostomy (> 13 days) had 13/18 (72%) VAP cases, showing a significantly lower VAP risk in the early group (p < 0.05). VAP incidence rates were 7.9 and 22.8 per 1000 patient-days for early and late groups, respectively. Early tracheostomy patients had shorter median MV duration (18 vs. 33 days, p < 0.05), ICU LOS (20 vs. 31 days, p < 0.05) and hospital LOS (25 vs. 47 days, p < 0.05). Early tracheostomy in critically ill COVID-19 patients significantly reduced VAP risk, MV duration, ICU, and hospital LOS.

Prolonged deterioration of microvascular flow during sepsis leads to organ dysfunction. Capillary flow restoration may prevent this complication. The main aim of this study was to investigate the microcirculatory effects of inhaled nitric oxide (iNO) combined with intravenous hydrocortisone in a porcine model of sepsis. The 2nd aim was to evaluate the influence of hemodynamic resuscitation with noradrenaline and crystalloids on capillary flow. Eleven piglets of Polish breed underwent surgical colon perforation to develop sepsis. They were randomly allocated to one of 3 treatment groups. Group 1 received iNO and hydrocortisone, whereas group 2 did not. Both groups were resuscitated with crystalloids and noradrenaline if hypotensive. Group 3 received no treatment at all. During a 30-hour observation, we assessed the microcirculation using sidestream dark field imaging (SDF). We found no effect of iNO with hydrocortisone on the microcirculation. Fluid and vasopressor treatment led to a higher microcirculatory flow index after 20 h of observation (3 and 2.75 in groups 1 and 2 compared to 1.9 in group 3), a greater proportion of perfused vessels (94% and 87% compared to 63% in groups 1, 2 and 3, respectively) and a greater perfused vessel density (15.2 mm/mm2, 15.09 mm/mm2 and 10.1 mm/mm2 in groups 1, 2 and 3, respectively). Crystalloid and vasopressor treatment postponed microvascular flow derangements, whereas iNO combined with intravenous hydrocortisone did not improve microvascular perfusion.

Objective: Multiple organ failure can occur as a result of postoperative complications. Research has indicated that the underlying mechanism of organ dysfunction is a microcirculation disorder. Because of its antioxidant and anti-inflammatory properties, lidocaine has the potential to improve microvascular blood flow. This study was performed to assess the effect of intraoperative intravenous lidocaine infusion on the microcirculation and determine the incidence of postoperative complications. Methods: In this prospective randomized double-blind pilot study, 12 patients scheduled for abdominal surgery were randomly allocated to receive an intraoperative infusion of either 1% lidocaine or the same volume of 0.9% sodium chloride solution. The microcirculation was monitored using sidestream dark-field imaging and the vascular occlusion test combined with near-infrared spectroscopy. Results: Lidocaine significantly increased the total vascular density and small vessel density after 2 hours of infusion, with preservation of 99% to 100% of the capillary perfusion in both groups. No patients developed organ failure. Conclusions: An increase in vessel density may be beneficial in major abdominal surgeries because it is associated with better tissue perfusion and oxygen delivery. However, this finding requires further investigation in patients with increased surgical risk. Overall, this study indicates that lidocaine has potential to improve microvascular perfusion. Research Registry number: 9549 ( https://www.researchregistry.com/browse-the-registry#home/registrationdetails/650ffd27b3f547002bd7635f/ )

BackgroundCapillary flow restoration in sepsis may prevent organ dysfunction caused by a prolonged impairment of microvascular flow. The main aim of the study was to investigate the microcirculatory effect of inhaled nitric oxide (iNO) combined with intravenous hydrocortisone in a porcine model of sepsis. The second aim was to evaluate the influence of hemodynamic resuscitation with noradrenaline and crystalloids on capillary flow.Materials and MethodsIn the study, 11 piglets of Polish breed were generally anaesthetized and underwent surgical colon perforation. The animals were randomly allocated to one of three treatment groups. Group 1 received iNO and hydrocortisone, whereas Group 2 was a control group. Both groups were resuscitated with crystalloids and noradrenaline if hypotensive. Group 3 received no treatment at all.In a 30-hour period of observation, we assessed microcirculation using sidestream dark field imaging (SDF) and monitored hemodynamics with a pulmonary artery catheter.Results We found no effect of iNO with hydrocortisone on microcirculation in septic piglets. Fluid and vasopressor treatment postponed microvascular flow impairment and led to a higher microcirculatory flow index, greater proportion of perfused vessels, and perfused vessel density.ConclusionCrystalloid and vasopressor treatment postpones microvascular flow derangement and organ dysfunction in septic piglets.

Background: Sepsis has heterogeneous etiologies. Although bacteria are the most common causative agents, viral and yeast forms of sepsis also occur. Procalcitonin (PCT) is widely used to monitor severe bacterial infections and may support the differential diagnosis of infection etiology. Methods: We evaluated the diagnostic value of PCT in viral sepsis using PCT levels at ICU admission and PCT kinetics during ICU treatment. Results: During the COVID-19 pandemic, 191 adult ICU patients with sepsis and a positive SARS-CoV-2 PCR test at hospital admission were included and classified into two groups according to the presence or absence of bacterial or yeast co-infection. PCT showed a distinct diagnostic pattern influenced by the presence of co-infection. PCT remained low in isolated viral sepsis, whereas elevated concentrations were associated with superimposed bacterial or yeast co-infection and worse clinical outcomes. Overall mortality was significantly lower in patients with isolated viral sepsis compared to those with co-infection (50 vs. 69%, p = 0.009). Conclusions: In viral sepsis, persistently low PCT concentrations argue against bacterial co-infection, whereas elevated or rising values should prompt increased diagnostic evaluation. Although PCT provides clinically relevant diagnostic information, it must be interpreted cautiously and in conjunction with clinical assessment and microbiological data. PCT should serve as an adjunctive, not a standalone, marker of infection etiology in sepsis.