Background and Objectives: Traditional assessment of the readiness for the weaning from the mechanical ventilator (MV) needs respiratory parameters in a spontaneous breath. Exempted from the MV disconnecting and manual measurements of weaning parameters, a prediction model based on parameters from MV and electronic medical records (EMRs) may help the assessment before spontaneous breath trials. The study aimed to develop prediction models using machine learning techniques with parameters from the ventilator and EMRs for predicting successful ventilator mode shifting in the medical intensive care unit. Materials and Methods: A retrospective analysis of 1483 adult patients with mechanical ventilators for acute respiratory failure in three medical intensive care units between April 2015 and October 2017 was conducted by machine learning techniques to establish the predicting models. The input candidate parameters included ventilator setting and measurements, patients’ demographics, arterial blood gas, laboratory results, and vital signs. Several classification algorithms were evaluated to fit the models, including Lasso Regression, Ridge Regression, Elastic Net, Random Forest, Extreme Gradient Boosting (XGBoost), Support Vector Machine, and Artificial Neural Network according to the area under the Receiver Operating Characteristic curves (AUROC). Results: Two models were built to predict the success shifting from full to partial support ventilation (WPMV model) or from partial support to the T-piece trial (sSBT model). In total, 3 MV and 13 nonpulmonary features were selected for the WPMV model with the XGBoost algorithm. The sSBT model was built with 8 MV and 4 nonpulmonary features with the Random Forest algorithm. The AUROC of the WPMV model and sSBT model were 0.76 and 0.79, respectively. Conclusions: The weaning predictions using machine learning and parameters from MV and EMRs have acceptable performance. Without manual measurements, a decision-making system would be feasible for the continuous prediction of mode shifting when the novel models process real-time data from MV and EMRs.

Studies have shown that elevated plasma levels of platelet-derived soluble TREM-like transcript-1 (sTLT-1) are associated with an unfavorable outcome in patients with septic shock. However, the underlying molecular mechanisms are not well defined. This research aimed to study the role of sTLT-1 in mediating immune dysfunction during the development of sepsis. Our study demonstrated that patients with septic shock have significantly higher plasma concentrations of sTLT-1, whereas sTLT-1 is not detectable in healthy subjects. Plasma concentrations of sTLT-1 were correlated with the degree of immunosuppressive parameters in monocytes from patients with septic shock. sTLT-1 can first activate monocytes by binding to the TLR4/MD2 complex but subsequently induce immunosuppressive phenotypes in monocytes. Blocking Abs against TLR4 and MD2 led to a significant decrease in sTLT-1–induced activation. Treatment with an anti–TLT-1 Ab also significantly reduces sTLT-1 binding to monocytes and proinflammatory cytokine secretion in a mouse model of endotoxemia. sTLT-1 acts as an endogenous damage-associated molecular pattern molecule, triggering the activation of monocytes through the TLR4/MD2 complex followed by sustained immune suppression. This process plays a crucial role in the development of sepsis-associated pathophysiology. Our findings outline, to our knowledge, a novel pathway whereby platelets counteract immune dynamics against infection through sTLT-1.

Vitamin D deficiency is associated with mortality and morbidity in critically ill patients. This study investigated the safety and effectiveness of enteral high-dose vitamin D supplementation in intensive care unit (ICU) patients in Asia. This was a multicenter, prospective, randomized-controlled study. Eligible participants with vitamin D deficiency were randomly assigned to the control or vitamin D supplementation group. In the vitamin D supplementation group, the patients received 569,600 IU vitamin D. The primary outcome was the serum 25(OH)D level on day 7. 41 and 20 patients were included in the vitamin D supplementation and control groups, respectively. On day 7, the serum 25(OH)D level was significantly higher in the vitamin D supplementation group compared to the control group (28.5 [IQR: 20.2-52.6] ng/mL and 13.9 [IQR: 11.6-18.8] ng/mL, p < 0.001). Only 41.5% of the patients achieved serum 25(OH)D levels higher than 30 ng/mL in the supplementation group. This increased level was sustained in the supplementation group on both day 14 and day 28. There were no significant adverse effects noted in the supplementation group. Patients who reached a serum 25(OH)D level of >30 ng/mL on day 7 had a significantly lower 30-day mortality rate than did those who did not (5.9% vs 37.5%, p < 0.05). In our study, less than half of the patients reached adequate vitamin D levels after the enteral administration of high-dose vitamin D. A reduction in 30-day mortality was noted in the patients who achieved adequate vitamin D levels. TRIAL REGISTRATION CLINICALTRIALS. NCT04292873, Registered, March 1, 2020.

Background: Mechanical complications remain common with the placement of peripherally inserted central catheters (PICCs), particularly in critically ill patients. Given the need to minimise procedural complications, strategies for reducing bleeding during PICC placement are essential. This study evaluated the efficacy of a previously introduced two-stage technique in minimising insertion-related bleeding compared with the traditional modified Seldinger technique in ICU patients. Methods: This study included 86 patients who underwent 92 PICC placements in the ICU of a tertiary university medical centre, between August 2022 and January 2025. Bleeding outcomes were assessed at three time points: 5 min, 30 min and within 24 h after insertion. Blood loss was evaluated semi-quantitatively based on the extent of gauze pad contamination. Results: In total, 56 were performed using the two-stage technique and 36 using the traditional method. Baseline characteristics were comparable between the two groups. Bleeding incidence was significantly lower in the two-stage group at all time points. At 5 min post-insertion, 93% of the patients in the two-stage group had no visible or only minimal bleeding compared to 28% in the traditional group. At 30 min, 84% had no visible or only minimal bleeding compared with 14% ( p < 0.001). In multivariate analysis, the two-stage technique was independently associated with a reduced bleeding risk (OR, 0.019; 95% CI, 0.005–0.074; p < 0.001). An interaction analysis showed that aPTT significantly modified the association between technique and bleeding (OR, 20.519; 95% CI, 1.643–255.851; p < 0.001). Conclusions: The modified two-stage technique appears to be a feasible alternative to conventional PICC placement and was associated with reduced insertion-related bleeding in ICU patients. The technique also resulted in fewer dressing changes within 24 h, suggesting more stable haemostasis and potential improvements in ICU care quality.

Lower-extremity peripherally inserted central catheters (PICCs) are used in critically ill adults when upper-extremity access is limited, yet real-world data on indications, dwell time, and device-related outcomes remain scarce. We retrospectively reviewed consecutive ultrasound-guided mid-thigh lower-extremity PICC placements performed under a standardized protocol (15 cm below the inguinal ligament; fixed 55-cm insertion depth) in an adult ICU and extracted indication patterns, catheter dwell time, removal reasons, and microbiological findings. Among 38 placements in 37 patients, difficult peripheral access was present in all cases; prolonged intravenous antibiotics were the predominant indication (34/38, 89.5%), followed by total parenteral nutrition (13/38, 34.2%) and vasopressor therapy (2/38, 5.3%). Median dwell time was 19.5 days (IQR 12–25; range 3–48). Catheters were most commonly removed due to death (15/38, 39.5%), discharge (13/38, 34.2%), or no longer being clinically indicated (8/38, 21.1%), while removal for suspected catheter infection/fever occurred in 2/38 (5.3%). A catheter-drawn culture was positive in 1/38 (2.6%; Candida albicans), whereas peripheral blood cultures were positive in 4/38 (10.5%). In this single-center retrospective descriptive cohort, standardized mid-thigh lower-extremity PICCs were used for prolonged venous access. Removals for suspected infection/fever evaluation were uncommon; however, CRBSI was not adjudicated and thrombosis surveillance was not performed. These findings describe local utilization patterns and support future comparative studies and stewardship-focused quality improvement.