Mildly elevated lactate levels (i.e., 1–2 mmol/L) are increasingly recognized as a prognostic finding in critically ill patients. One of several possible underlying mechanisms, microcirculatory dysfunction, can be assessed at the bedside using sublingual direct in vivo microscopy. We aimed to evaluate the association between relative hyperlactatemia, microcirculatory flow, and outcome. This study was a predefined subanalysis of a multicenter international point prevalence study on microcirculatory flow abnormalities, the Microcirculatory Shock Occurrence in Acutely ill Patients (microSOAP). Microcirculatory flow abnormalities were assessed with sidestream dark-field imaging. Abnormal microcirculatory flow was defined as a microvascular flow index (MFI) < 2.6. MFI is a semiquantitative score ranging from 0 (no flow) to 3 (continuous flow). Associations between microcirculatory flow abnormalities, single-spot lactate measurements, and outcome were analyzed. In 338 of 501 patients, lactate levels were available. For this substudy, all 257 patients with lactate levels ≤ 2 mmol/L (median [IQR] 1.04 [0.80–1.40] mmol/L) were included. Crude ICU mortality increased with each lactate quartile. In a multivariable analysis, a lactate level > 1.5 mmol/L was independently associated with a MFI < 2.6 (OR 2.5, 95% CI 1.1–5.7, P = 0.027). In a heterogeneous ICU population, a single-spot mildly elevated lactate level (even within the reference range) was independently associated with increased mortality and microvascular flow abnormalities. In vivo microscopy of the microcirculation may be helpful in discriminating between flow- and non-flow-related causes of mildly elevated lactate levels. ClinicalTrials.gov, NCT01179243 . Registered on August 3, 2010.

Background/Objectives: Central line-associated bloodstream infections (CLABSIs) remain a leading healthcare-associated infection in intensive care units (ICUs), yet independent risk factors and evidence-based catheter duration thresholds have not been defined through analytical study designs in settings with endemic multidrug-resistant organisms (MDROs). Methods: A retrospective case–control study was conducted in the ICU of a tertiary teaching university hospital in western Türkiye (January 2019–December 2024). Cases (n = 74) were patients with confirmed CLABSIs per CDC/NHSN criteria; controls (n = 148) were randomly selected central venous catheter (CVC)-bearing patients without CLABSIs. A reduced multivariate logistic regression model (seven variables; events-per-variable ratio 10.6) identified independent risk factors. Results: In multivariate analysis, catheter duration (adjusted OR: 1.19 per day; 95% CI: 1.13–1.24; p < 0.001), renal replacement therapy (aOR: 3.66; 95% CI: 1.68–7.95; p = 0.001), vasopressor support (aOR: 3.04; 95% CI: 1.50–6.17; p = 0.002), APACHE-II score (aOR: 1.07 per point; 95% CI: 1.02–1.11; p = 0.002), lower Glasgow Coma Scale (aOR: 0.86 per point; 95% CI: 0.78–0.94; p = 0.002), mechanical ventilation (aOR: 2.48; 95% CI: 1.24–4.95; p = 0.010), and total parenteral nutrition (aOR: 2.33; 95% CI: 1.12–4.86; p = 0.024) were independently associated with CLABSI. The model demonstrated good discrimination (C-statistic: 0.864) and calibration (Hosmer–Lemeshow p = 0.425). Kaplan–Meier analysis showed CLABSI-free survival declining from 98.9% at day 7 to 42.9% at day 21 (log-rank p < 0.001); these within-study estimates reflect relative risk patterns given the artificial 1:2 case-to-control ratio. Receiver operating characteristic (ROC) analysis identified day 13 as an exploratory optimal cutoff (AUC: 0.818; 95% CI: 0.762–0.874; sensitivity: 77.0%; specificity: 74.3%). CLABSI-attributable ICU mortality was 20.3% (47.3% vs. 27.0%; p = 0.004). Late-onset CLABSIs (>10 days) were dominated by Gram-negative pathogens (68.3%) versus 35.7% in early-onset infections (Fisher’s exact p = 0.012), with Acinetobacter baumannii as the predominant organism (27.0%; 83.3% carbapenem-resistant). Conclusions: Each additional catheter-day is independently associated with a 19% increment in CLABSI odds, with an exploratory critical threshold at day 13 beyond which enhanced surveillance measures should be considered, pending external validation.

Şiddetli acute respiratory distress syndrome (akut solunum yetmezliği sendromu) (ARDS) artan pulmoner vasküler geçirgenliğin artması sonucunda, hipoksemi ve bilateral radyolojik opasiteler ile giden, azalmış akciğer komplians ile ilişkili akut diffüz, enflamatuvar akciğer hasarıdır. Extracorporeal membrane oxygenation (ekstrakorporeal membran oksijenasyonu) (ECMO) yenidoğan, çocuk ve yetişkinlerde görülen birincil veya ikincil solunum veya kalp hastalıklarının neden olduğu yetmezliklerde destek tedavisi olarak kullanılmaktadır. Şiddetli ARDS hastaları ECMO tedavisi için adaydırlar. Birincil geri dönüşümlü hastalıkları olan hastalarda uygulanan ECMO bir tedavi yöntemi değil, bir destek yöntemidir. ECMO tedavisi ile ilişkili olarak-mortalite, morbidite de artış, uzun süreli sakatlık ve yaşam kalitesinin düşmesi-cerrahi alan ve organ kanamaları, böbrek ve çoklu organ yetmezliği ve santral sinir sistemi problemleri görülebilir. Bu derlemede şiddetli ARDS olan hastalarda ECMO kullanımına ilişkin genel bir bakış sağlamak amaçlanmıştır.

Myasthenia gravis (MG) is a chronic autoimmune neuromuscular disorder caused by the development of antibodies to nicotinic acetylcholine receptors. The disease characterized by variable muscle weakness worsening with exercise. Although most patients have neurological signs and symptoms, respiratory symptoms occur in the late stages of the disease. However, rarely, respiratory failure may be the first symptom in some undiagnosed patients. We report the case of an elderly patient who was admitted with respiratory failure and intubated and transferred to the internal medicine intensive care unit. Two days after intubation, when she was awake and met the extubation criteria, endotracheal tube was successfully removed. At this time, her vital signs were normal. However, next day, her arterial blood gas CO2 rose and he became drowsy, requiring re-intubation. This situation repeated on the fifth and 16th days of her hospitalization and prolonged apnea was observed after intubation with rocuronium. All other causes of failed extubation, such as sepsis and pneumonia, were ruled out. During follow-up, ptosis was detected in the right eye and acetylcholine receptor antibody was positive. On the 30th day of the follow-up, methylprednisolone 1mg/kg and pyridostigmine 240 mg/day was initiated. The patient, whose spontaneous respiration was sufficient, was extubated and taken to the neurology clinic for further examination and treatment.