Background. Immune dysregulation and hypoxemia are two important pathophysiological problems in patients with COVID-19 that affect peripheral blood count parameters. We hypothesized that assessment of the neutrophil–lymphocyte ratio (NLR) and red blood cell distribution width index (RDW-SD) could predict death in patients with severe and critical COVID-19. Methods. Seventy patients admitted to the intensive care unit (ICU) for COVID-19 acute respiratory failure were included in the study. RDW-SD and NLR on the day of ICU admission and peak values during the entire hospitalization were assessed. The primary endpoint was death before ICU discharge. Results. Patients who died had higher NLR on admission (20.3, IQR 15.3–30.2 vs. 11.0, IQR 6.8–16.9; p = 0.003) and higher RDW-SD (48.1 fL; IQR 43.1–50.5 vs. 43.9 fL; IQR 40.9–47.3, p = 0.01) than patients discharged from the ICU. NLR and RDW-SD values on ICU admission accurately predicted death in 76% (AUC = 0.76; 95%CI 0.65–0.86; p = 0.001; cut-off > 14.38) and 72% of cases (AUC = 0.72; 95%CI 0.60–0.82; p = 0.003; cut-off > 44.7 fL), respectively. Multivariable analysis confirmed that NLR > 14.38 on the day of ICU admission was associated with a 12-fold increased risk of death (logOR 12.43; 95%CI 1.61–96.29, p = 0.02), independent of other blood counts, clinical and demographic parameters. Conclusions. Neutrophil–lymphocyte ratio determined on the day of ICU admission may be a useful biomarker predicting death in patients with severe and critical COVID-19.

Nondiabetic hyperglycemia is a dangerous metabolic phenomenon in the intensive care unit. Inattentive treatment of glycemic disorders is a serious health hazard promoting negative outcomes. The aim of our study was to assess glycemic variability and its basic determinants, and to verify its relationship with mortality in patients hospitalized in a mixed ICU (intensive care unit). The medical records of 37 patients hospitalized 13 January–29 February 2020 were analyzed prospectively. The BG (blood glucose) variability during the stay was assessed using two definitions, i.e., the value of standard deviation (SD) from all the measurements performed and the coefficient of variation (CV). A correlation between the BG variability and insulin dose was observed (SD: R = 0.559; p < 0.01; CV: R = 0.621; p < 0.01). There was also a correlation between the BG variability and the total energy daily dose (SD: R = 0.373; p = 0.02; CV: R = 0.364; p = 0.03). Glycemic variability was higher among patients to whom treatment with adrenalin (p = 0.0218) or steroid (p = 0.0292) was applied. The BG variability, expressed using SD, was associated with ICU mortality (ROC = 0.806; 95% CI: 0.643–0.917; p = 0.0014). The BG variability in the ICU setting arises from the loss of balance between the supplied energy and the applied insulin dose and may be associated with a worse prognosis.

Remimazolam is a novel, ultra-short-acting benzodiazepine that has emerged as a promising agent in modern anesthetic and intensive care practice. This review pre­sents a detailed analysis of its pharmacokinetic and pharmacodynamic properties, clinical efficacy, and safety profile across various patient populations and procedural contexts. The drug’s rapid metabolism by plasma esterases, minimal reliance on hepatic or renal function, and availability of a reversal agent (flumazenil) distinguish it from traditional sedatives such as propofol and midazolam. Clinical data support its utility in procedural sedation, general anesthesia, and ICU sedation, particularly in elderly and hemodynamically unstable patients. Pediatric applications are discussed, highlighting the early evidence and dosing considerations. The review also compares remimazolam with other agents such as propofol and dexmedetomidine, underlining its advantages in cardiovascular stability and recovery profiles. While current results are encouraging, the article emphasizes the need for further research to establish standardized protocols and explore its long-term safety, especially in vulnerable populations.

Background: The ability to manage airways in emergencies is paramount, especially for less experienced medical students. Although the Vortex Approach, a useful scheme to support decision-making during airway management, promises structured guidance, there's limited research on its benefits among students. Our study aimed to evaluate student proficiency in a simulated difficult airway scenario and assess the advantages of the Vortex Approach. Material/Methods: Medical students initially practiced on low-fidelity mannequins. Subsequently, they were divided into Vortex (n=48) and control groups (n=48). The Vortex group received specialized training. Both groups encountered a simulated scenario focusing on proper ventilation and supraglottic device insertion when traditional intubation failed. Performance was assessed using the airway management outcome score (AMOS).Results: The Vortex-trained group demonstrated superior capabilities. Fewer participants exceeded 3 lifeline interventions (4.2% vs 16.7%, P=0.046). The Vortex group consistently optimized subsequent attempts (31.3% vs 10.4%, P=0.01) and reduced prolonged apnea episodes (47.9% vs 81.3%, P=0.0009). Their AMOS scores were notably higher (56.3% vs 27.1%, AMOS=2, P=0.002), reflecting better patient outcomes (41.7% vs 10.4%, P=0.0005).Conclusions: There is a marked need to enhance airway management skills among senior medical students. The Vortex Approach, even after brief exposure, yields significant skill improvements, underscoring its potential as a pivotal component in medical training. Integrating it into the curriculum could bridge the evident skill gap, optimizing future patient care.

Introduction: In a pre-hospital setting, uncontrolled hemorrhages in patients are undoubtedly a highly stressful situation for the rescuing medic, demanding prompt intervention. The effective stopping of a hemorrhage significantly reduces the risk of death for victims. The purpose of this study is to evaluate the students’ chosen methods and the effectiveness of their actions during a simulated hemorrhage situation. In addition, the students’ behavior and their cognitive overload classified using the NASA scale were also analyzed. Methods: The study enrolled 101 medical students, who were randomized and assigned sequentially to a study group (n = 49) and a control group (n = 52). The research group participated in a training course. Both groups then proceeded to a simulated hemorrhage scenario in a patient in a pre-hospital setting. Finally, the students assessed their cognitive overload using the NASA scale. Results: After the training, more students have achieved effective bleeding control (36/49, 73.5% vs. 22/52, 42.3%, p = 0.002). The prevalent method of bleeding control in both groups was using a tourniquet (97/101, 96%) with or without additional gauze and bandages. A significant improvement in the technique of the tourniquet application was observed—in the control group, 23/52 students (47.9%) applied it properly, while in the study group, it was 36/49 (73.5%). This resulted in a shorter time to achieve effective bleeding control and lower blood loss in the study group (p = 0.013 and p = 0.034, respectively). The median blood loss was 32 mL (IQR = 24, range 11–65 mL) in the study group compared to 53 mL (IQR = 26, range 10–117 mL) in the control group. Conclusions: The education program for young medics needs changes, including an increased emphasis on learning procedures and improving practical skills.