Water retention and intercompartmental redistribution occur frequently in association with adverse postoperative outcomes, yet the available strategies for non-invasive assessment are limited. One such approach for evaluating body water composition in various circumstances is bio-electrical impedance analysis (BIA). This study aims to appraise the usefulness of the Body Composition Monitor (BCM, Fresenius Medical Care, Germany) in assessing body fluid composition and intercompartmental shifts before and after open major abdominal surgery. This prospective, clinician blinded observational study enrolled all the patients scheduled consecutively for elective major open abdominal surgery during a 1-year period starting from January 1st, 2016. BIA parameters—total body water (TBW), extracellular water (ECW), intracellular water (ICW), absolute fluid overload (AFO), and relative fluid overload (RFO) were measured before and after surgery. The results were compared with fluid balance and outcome parameters such as organ dysfunction, ICU-and hospital length of stay (-LOS). The study population included 71 patients aged 60.2 ± 12 of whom 60.6% men and with a BMI of 26.3 ± 5.1 kg/m². Postoperative acute kidney injury, respiratory dysfunction, and infections occurred in 14.0%, 19.7% and 28.1% of cases, respectively. The median LOS in ICU was 20 h and the hospital-LOS was 10 days. Positive intraoperative fluid balance (2.4 ± 1.0 L) resulted in a significant increase of TBW (1.4 ± 2.4 L) and of ECW (1.4 ± 1.2 L). Intraoperative fluid balance significantly correlated with TBW change (r = 0.23, p = 0.04) and with AFO change (r = 0.31, p < 0.01). A significant correlation was found between pre- and postoperative AFO and RFO on one hand, and ICU-LOS on the other. BIA may be a useful tool for the perioperative assessment of volume status.

In routine intensive care unit (ICU) practice, fluids are often administered without a safety limit, which may lead to fluid overload and decreased survival. Recently, B-lines score (BLS) has been validated as a lung ultrasound (LUS) quantification of pulmonary congestion. This suggests that LUS may provide a safety threshold to conduct fluid therapy and to avoid overhydration. However, there is no randomized study to test the utility of LUS in guiding fluid management in ICU patients by using a pre-specified BLS cut-off value as a threshold for fluid removal. LUS Guided Fluid Management Protocol for the Critically Ill Patient is a prospective, multi-centre, randomized controlled trial. Five hundred ICU patients will be randomly assigned in a 1:1 ratio, to protocolized LUS-based fluid management or usual care. The trial intervention will start on ICU admission and will consist in daily assessment of BLS and triggered evacuation of excessive fluids with loop diuretics (Furosemide) when BLS ≥ 15. If rebalancing volume status with diuretics fails, forced evacuation by ultrafiltration will be used. The main endpoint is death from all causes at 28 days from randomization. The secondary outcomes are presence and time-course evolution of organ dysfunctions, ICU- and hospital length of stay, all-cause mortality at 90 days, and health economics data. If study results will show that LUS guided fluid management protocol improves outcome in ICU patients, it will be the base for other studies to refine this protocol or track those categories of critically ill patients to whom it may bring maximum benefits. ClinicalTrials.gov, NCT03393065 . Registered on 8 January 2018.

The value of lung ultrasound (LU) in assessing extravascular lung water (EVLW) was demonstrated by comparing LU with gold-standard methods for EVLW assessment. However, few studies have analysed the value of B-Line score (BLS) in guiding fluid management during critical illness. The purpose of this trial was to evaluate if a BLS-guided fluid management strategy could improve fluid balance and short-term mortality in surgical intensive care unit (ICU) patients. We conducted a randomised, controlled trial within the ICUs of two university hospitals. Critically ill patients were randomised upon ICU admission in a 1:1 ratio to BLS-guided fluid management (active group) or standard care (control group). In the active group, BLS was monitored daily until ICU discharge or day 28 (whichever came first). On the basis of BLS, different targets for daily fluid balance were set with the aim of avoiding or correcting moderate/severe EVLW increase. The primary outcome was 28-day mortality. Over 24 months, 166 ICU patients were enrolled in the trial and included in the final analysis. Trial results showed that daily BLS monitoring did not lead to a different cumulative fluid balance in surgical ICU patients as compared to standard care. Consecutively, no difference in 28-day mortality between groups was found (10.5% vs. 15.6%, p = 0.34). However, at least 400 patients would have been necessary for conclusive results.

According to the latest international resuscitation guidelines, extracorporeal cardiopulmonary resuscitation (ECPR) involves the utilization of extracorporeal membrane oxygenation (ECMO) in specific patients experiencing cardiac arrest, and it can be considered in situations where standard cardiopulmonary resuscitation efforts fail if they have a potentially reversible underlying cause, among which we can also find hypothermia. In cases of cardiac arrest, both witnessed and unwitnessed, hypothermic patients have higher chances of survival and favorable neurological outcomes compared to normothermic patients. ECPR is a multifaceted procedure that requires a proficient team, specialized equipment, and comprehensive multidisciplinary support within a healthcare system. However, it also carries the risk of severe, life-threatening complications. With the increasing use of ECPR in recent years and the growing number of centers implementing this technique outside the intensive care units, significant uncertainties persist in both prehospital and emergency department (ED) settings. Proper organization is crucial for an ECPR program in emergency settings, especially given the challenges and complexities of these treatments, which were previously not commonly used in ED. Therefore, within a narrative review, we have incorporated the initial case of ECPR in an ED in Romania, featuring a successful resuscitation in the context of severe hypothermia (20 °C) and a favorable neurological outcome (CPC score of 1).

Purpose: Acute dyspnea is a common presenting symptom in the Emergency Department (ED). The study aims to assess the concordance between emergency physician diagnosis (i.e., initial rapid assessment at ED admission including point-of-care lung ultrasound - PoC-LUS) and attending physician diagnosis (i.e., hospital admission diagnosis which also includes CT scans) in patients presenting with dyspnea. Method: We performed a prospective pilot observational study in the ED of tertiary care university hospital between 31.01.2022 and 03.09.2024. We included dyspneic patients presented when the physician involved in the study was on call. Results: A total of 103 patients were included (mean age, 70±16.1 years). An excellent agreement was found between emergency physician and attending physician diagnosis for all etiologies of dyspnea: pleural effusion (Cohen’s kappa coefficient 1 for bilateral, 0.844 for right, 0.790 for left pleural effusion), pneumonia (κ = 0.979 for right, κ = 0.930 for left pneumonia), bronchopneumonia (κ = 0.912), acute pulmonary edema (κ = 1), chronic obstructive pulmonary disease exacerbation (κ = 0.904), pleuropulmonary tumors (k = 0.884), acute respiratory distress syndrome – ARDS (κ = 1), (p < 0.001 for all). The median(±SD) time needed to complete the emergency physician diagnosis was 16(±4) minutes and the median(±SD) time needed to complete the attending physician diagnosis was 480(±112) minutes. Conclusion: In patients presenting in the ED with dyspnea, PoC-LUS guided emergency physician diagnosis has a very good diagnosis performance. The time needed to complete the emergency physician diagnosis is much lower than the time needed to complete the attending physician diagnosis. Given its availability, PoC-LUS is a useful tool for the assessment of patients presenting with dyspnea. Graphical

Background: Neuroendocrine tumors are tumors that can develop in any organ but show a predilection for the pancreas. These can be secreting or non-secreting tumors, or they can be well differentiated or poorly differentiated, or neuroendocrine carcinomas. Surgical treatment is the only treatment with curative intent, but postoperatively, it shows an increased incidence of postoperative pancreatic fistulas. Methods: We carried out a retrospective study which included 26 patients with neuroendocrine tumors and neuroendocrine carcinomas, for whom we performed cephalic duodenopancreatectomies, distal pancreatic resections or enucleation. Results: In our study group, the incidence of pancreatic fistulas was 28%, and a series of risk factors such as the type of surgery (duodenopancreatectomy and enucleation were associated with the highest incidence of POPF), histological type (pancreatic neuroendocrine carcinomas were associated with lowest incidence of POPF), obesity (the incidence of POPF was double in the obese group), functioning tumors (with p = 0.032 and AUC = 746) and dynamic hemoglobin value (AUC = 705 shows a good predicting power, with a cutoff value = 1.8 drop hemoglobin) were indicated. Conclusions: Neuroendocrine tumors show a predisposition for the occurrence of postoperative complications, especially postoperative pancreatic fistulas. There are multiple risk factors that interact in the production of postoperative complications.