Pleural effusion is common in critically ill adults, and bedside pigtail catheter drainage is often required; insertion without continuous imaging may lead to pneumothorax or catheter malposition. We conducted a single-center retrospective cohort study of adult intensive care unit pigtail pleural drainage procedures (28 December 2020-2018 March 2025) comparing real-time ultrasound-guided insertion with ultrasound-assisted insertion using preprocedure localization/skin marking only (no real-time needle tracking). The primary outcome was procedure-related mechanical complications (pneumothorax or catheter malposition); between-group comparisons used exact tests, and relative risks (RRs) with 95% confidence intervals (CIs) were reported. Among 175 procedures in 145 patients, 89 were real-time ultrasound-guided and 86 were ultrasound-assisted without real-time guidance. Mechanical complications occurred in 0/89 (0.0%) versus 10/86 (11.6%) procedures, respectively (RR 0.05, 95% CI 0.00-0.77; p < 0.001), driven by catheter malposition (0/89 vs 7/86 (8.1%); RR 0.06, 95% CI 0.00–1.11; p = 0.006) and pneumothorax (0/89 vs 3/86 (3.5%); RR 0.14, 95% CI 0.01–2.63; p = 0.117). Median catheter dwell time was 11.0 (8.0-20.0) versus 9.0 (6.0-15.0) days (p = 0.031). Real-time ultrasound guidance was associated with fewer observed mechanical complications in this cohort; given the retrospective design and baseline differences between groups, prospective risk-adjusted validation is warranted.

Background: Drug-induced sleep endoscopy (DISE) with a jaw-thrust maneuver is used to simulate mandibular advancement in obstructive sleep apnea (OSA), yet determinants of functional airway improvement remain incompletely defined. Objective: To identify clinical, polysomnographic, and baseline DISE anatomic factors associated with jaw-thrust responsiveness. Methods: We conducted a single-center retrospective observational study of adults with polysomnography-confirmed OSA who underwent DISE with paired baseline and jaw-thrust VOTE assessments between 1 January 2015 and 31 December 2025 (n = 355). Jaw-thrust responsiveness was defined a priori as a within-subject reduction in the number of obstructed VOTE sites (grade ≥ 1). Multivariable logistic regression was used to identify independent correlates within a prespecified explanatory modeling framework. The study was approved by the Institutional Review Board of Taipei Tzu Chi Hospital (protocol 14-IRB079), with the need for informed consent being waived. Results: Jaw thrust reduced overall obstruction burden from two (two to three) to one (one to two) sites (Wilcoxon p < 0.001). Hypopharyngeal levels demonstrated the greatest improvement, particularly at the tongue base (39.2% to 7.6%) and epiglottis (23.9% to 5.4%) (both p < 0.001). Overall, 62.8% met responder criteria and 18.9% achieved complete normalization. In multivariable analysis (n = 272), baseline tongue-base collapse (adjusted odds ratio [aOR] 2.46, 95% CI 1.20–5.04) and greater baseline multilevel obstruction burden (aOR 1.85 per SD, 95% CI 1.19–2.85) were independently associated with responsiveness, whereas conventional PSG severity metrics were not. Conclusions: In adults with OSA, jaw-thrust responsiveness during DISE is more strongly associated with baseline anatomic phenotype than with global PSG severity. Standardized DISE functional assessment may provide complementary information to support phenotype-informed selection of non-CPAP therapies, pending prospective validation.

First-24-hour hypernatremia–hyperkalemia co-occurrence may mark severe illness, but its incremental prognostic value is uncertain. We analyzed 13,383 adult ICU admissions (11,942 patients) in Taiwan during 2018–2020. Peak sodium > 145 and potassium > 5.5 mmol/L defined four phenotypes; peaks need not be simultaneous. This prognostic association analysis used information accumulated during the first ICU day. Patient-clustered logistic regression compared total APACHE II adjustment with complementary adjustment excluding its sodium/potassium points. Twenty repeated patient-grouped five-fold cross-validations assessed discrimination. Thirty-day mortality was 12.2%, 33.7%, 32.7%, and 74.4% in the neither (n = 12,097), hypernatremia-only (n = 841), hyperkalemia-only (n = 367), and co-occurrence (n = 78) groups. With total APACHE II, the co-occurrence odds ratio was 1.90 (95% CI 1.07–3.39), global phenotype P = 0.094, and mean AUC change 0.00007. With component-excluded adjustment, the corresponding odds ratio was 2.70 (1.53–4.75), global P = 0.002, and mean AUC change 0.00037. Additional sensitivity analyses examined outcome availability, in-hospital mortality, sparse data, and alternative thresholds. Outcome missingness and unavailable measurement/death timing limit interpretation. Co-occurrence characterized a small high-risk subgroup, but incremental discrimination was negligible; causality and clinical predictive utility were not established.

Background: Pleural pigtail catheters are widely used in intensive care units (ICUs), but factors associated with unplanned removal remain incompletely characterized. Methods: We conducted a single-center retrospective cohort study of adult ICU catheter-placement episodes from December 2020 to March 2025. Effusions were grouped as complex (exudative, empyema, malignant, or malignancy-related) or simple (transudative or hemothorax). The primary outcome was unplanned removal for a catheter-related complication or escalation to surgery. Associations were evaluated using Firth penalized logistic regression. Results: Among 175 screened episodes, 140 were analyzed; unplanned removal occurred in 12 (8.6%). Complex effusions (adjusted odds ratio [aOR] 6.50, 95% confidence interval [CI] 1.59–26.55) and ultrasound-assisted insertion (aOR 10.72, 95% CI 1.92–59.94) were associated with higher odds of unplanned removal. Reclassifying hemothorax as complex attenuated but did not reverse the phenotype association (aOR 4.84, 95% CI 1.17–19.93). The ultrasound association may reflect case selection, operator workflow, or procedural complexity rather than causality. Because 33 death-related episodes were excluded, the 8.6% rate applies to episodes with classifiable non-death endpoints, not all screened episodes. Conclusions: These findings are hypothesis-generating and insufficient to change clinical practice without prospective multicenter validation.