Background and Objectives: Mechanical ventilation, while essential, can precipitate ventilator-induced lung injury (VILI) due to excessive mechanical stress. Among respiratory mechanics, driving pressure (ΔP) has emerged as the most robust predictor of mortality, with mechanical power (MP) and tidal volume (TV), respiratory rate (RR), positive end-expiratory pressure (PEEP), and peak inspiratory pressure (P_peak) also potentially influencing clinical outcomes. This study primarily evaluated whether the implementation of a standardized Lung and Diaphragm Protective Ventilation (LDPV) protocol, designed to minimize ΔP, reduced intensive care unit (ICU) mortality. Secondary objectives included assessing the prognostic impact of MP, P_peak, TV, RR, and PEEP on mortality in the pre- and post-LDPV implementation periods. Materials and Methods: In this retrospective cohort study, a total of 3468 adult ICU patients receiving invasive mechanical ventilation between 2012 and 2024 were analyzed. Patients were categorized into two groups: pre-LDPV (2012–2018) and post-LDPV (2019–2024). Ventilatory data were automatically collected using the Metavision system and evaluated through receiver operating characteristic (ROC) derived cutoffs, survival modeling, and Cox proportional hazards regression. Results: Implementation of the LDPV protocol was associated with a significant reduction in ICU mortality (47.7% vs. 41.1%, p < 0.0001) and a shorter ICU length of stay. Patients in the post-LDPV cohort (2019–2024) exhibited lower ΔP (median 12.9 vs. 14.3 cmH₂O), lower MP (median 15.0 vs. 17.0 J/min), improved respiratory system compliance, and reduced peak inspiratory pressure (P_peak) and tidal volume (TV_e) compared to the pre-LDPV cohort (2012–2018). Analysis revealed that the reduction in ΔP was the most significant determinant of improved survival; median ΔP decreased by approximately 2 cmH₂O (from 14.3 to 12.9 cmH₂O). Elevated MP and P_peak were also predictive of mortality, while compliance below 34 mL/cmH₂O consistently indicated a poor prognosis across both study periods. Conclusions: Implementation of an LDPV protocol significantly reduced ICU mortality, primarily through the systematic reduction in ΔP, while MP and its components provided complementary prognostic information. These findings underscore ΔP as the primary modifiable determinant of survival, with MP, P_peak, TV, and PEEP serving as secondary indicators of VILI.

Background: High-chloride solutions such as 0.9% saline are widely used for medication dilution in intensive care units (ICUs) and are an underrecognized source of hyperchloremia and acid–base disturbances. Excess chloride reduces the strong ion difference (SID), contributing to hyperchloremic metabolic acidosis and worse clinical outcomes. This study evaluated the impact of replacing isotonic saline with 5% dextrose as a diluent on ICU outcomes in mechanically ventilated patients. Methods: In this retrospective cohort study, 4347 adult ICU patients requiring ≥12 h of mechanical ventilation were analyzed across two periods with different diluent strategies (2015–2018: saline-based; 2019–2025: chloride-sparing, dextrose-based). Demographics, comorbidities, illness severity (APACHE II, SOFA), fluid exposure, SID, and laboratory values over the first 48 h were compared. Predictors of mortality were identified using multivariate logistic regression. Results: Mortality decreased from 44.6% to 39.2% after adoption of chloride-sparing diluents (absolute reduction 5.4%, p = 0.003), despite similar renal function across periods. The later cohort demonstrated significantly higher SID (median 39 vs. 38 mmol/L; p < 0.001), lower chloride levels, and more favorable acid–base profiles. In 2015–2018, chloride showed a strong association with mortality (~12–13% increased odds per mmol/L), while in 2019–2025 the association persisted but was attenuated (~2% per mmol/L). SID emerged as a significant marker of improved acid–base balance after the diluent transition. pH remained the most powerful predictor of mortality in both periods. Mean glucose levels increased by ~30–40 mg/dL after switching to dextrose diluents, although insulin requirements did not change. Conclusions: Transitioning from chloride-rich to chloride-sparing diluents was associated with reduced ICU mortality and improved acid–base balance, without changes in renal function. However, modestly increased glucose levels highlight the need for strict glycemic monitoring. These findings support chloride-sparing strategies with robust glycemic monitoring in critical care.

Background and Objectives: Mechanical ventilation, though life saving for patients with Acute Respiratory Distress Syndrome (ARDS), carries the risk of Ventilator-Induced Lung Injury (VILI) through mechanisms such as alveolar volutrauma and barotrauma. These injuries can exacerbate systemic inflammation and hinder recovery, particularly in compromised lungs. Lung and Diaphragm Protective Ventilation (LDPV) has demonstrated significant survival benefits, with driving pressure (ΔP) emerging as a key predictor of outcomes. This study evaluated whether a standardized Lung and Diaphragm Protective Ventilation (LDPV) protocol, optimizing ΔP and MP, reduced ICU mortality in mechanically ventilated patients over 12 years (2012–2024). Materials and Methods: This retrospective cohort study included all adult ICU patients requiring invasive mechanical ventilation between January 2012 and December 2024. A standardized LDPV protocol was introduced in November–December 2018 for all intubated patients, incorporating low Tidal Volumes (TV) (6–8 mL/kg), individualized Positive End Expiratory Pressure (PEEP), ΔP <15 cmH₂O, and reduced MP. Patients were categorized into pre-LDPV (2012–2018) and post-LDPV (2019–2024) groups. Primary outcome was ICU mortality. Secondary outcomes included temporal trends in ΔP, MP, and other ventilatory parameters (TV, PEEP, compliance, peak inspirator pressure). Results: Implementation of the LDPV strategy was associated with a significant reduction in ICU mortality, despite increasing number of admitted patienst, age and illness severity over time. Both ΔP and MP declined progressively in 2019-2024 group, particularly after protocol adoption. Improvements were also observed in compliance, tidal volumes, and SOFA scores in the 2019-2024 period. Conclusions: Systematic optimization of ΔP and MP through an LDPV protocol is associated with markedly improved survival in mechanically ventilated patients. These findings support the incorporation of real-time ΔP/MP monitoring into routine ICU practice to guide personalized, physiology-based ventilation strategies.

Sepsis-associated Brain Dysfunction (SABD) affects over 70% of septic patients, often manifesting early and increasing the risk of neurological sequelae if undiagnosed. Transcranial Doppler (TCD) ultrasonography is a noninvasive, bedside method to assess Cerebral Blood Flow (CBF). This study evaluates temporal changes in middle cerebral artery blood flow in septic patients using Pulsatility Index (PI), Resistance Index (RI), and CBFi at 0, 6, 24, and 48 hours. Forty-seven septic patients admitted to the Bursa Uludag University Intensive Care Unit were prospectively studied. Demographic data, comorbidities, Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation (APACHE) II scores, vital signs, laboratory parameters, and TCD measurements (PI, RI, CBFi) were recorded at baseline, 6, 24, and 48 hours. No statistically significant changes were observed in PI, RI, or CBFi at 6, 24, or 48 hours compared to baseline (p>0.05), though slight increases in PI (2.13%) and CBFi (16.99%) were noted at 48 hours. A significant difference in PI was found at 48 hours in patients receiving vasoactive drugs (p<0.05), and in RI at 6 hours in those receiving sedoanalgesics (p<0.05). Stable systemic hemodynamics were maintained using advanced monitoring. In septic patients with optimized hemodynamic management, cerebrovascular resistance and perfusion indices (PI, RI, CBFi) remain largely stable within 48 hours, suggesting effective autoregulation. TCD shows potential as a tool to monitor cerebral perfusion and guide therapy in sepsis, warranting further research.