Introduction: Left ventricular (LV) dysfunction is common in septic shock. Its association with the clinical outcome is still controversial. Tissue Doppler imaging (TDI) is a useful tool to quantify LV function; however, little knowledge is available about the prognostic value of these TDI variables in septic shock. Therefore, we performed this prospective study to determine the role of TDI variables in septic shock. Methods: Patients with septic shock in a medical intensive care unit were studied with transthoracic echocardiography with TDI within 24 hours after the onset of septic shock. Baseline clinical, laboratory, and echocardiographic variables were prospectively collected. Independent predictors of 90-day mortality were analyzed with the Cox regression model. Results: During a 20-month period, 61 patients were enrolled in the study. The 90-day mortality rate was 39%; the mean APACHE IV score was 84 (68 to 97). Compared with survivors, nonsurvivors exhibited significantly higher peak systolic velocity measured at the mitral annulus (Sa) (11.0 (9.1 to 12.5) versus 7.8 (5.5 to 9.0) cm/sec; P < 0.0001), lower PaO₂/FiO₂ (123 (83 to 187) versus 186 (142 to 269) mm Hg; P = 0.002], higher heart rate (120 (90 to 140) versus 103 (90 to 114) beats/min; P = 0.004], and ahigher dose of norepinephrine (0.6 (0.2 to 1.0) versus 0.3 (0.2 to 0.5) μg/kg/min; P = 0.007]. In the multivariate analysis, Sa > 9 cm/sec (hazard ratio (HR), 5.559; 95% confidence interval (CI), 2.160 to 14.305; P < 0.0001), dose of norepinephrine (HR, 1.964; 95% CI, 1.338 to 2.883; P = 0.001), and PaO₂/FiO₂ (HR, 0.992; 95% CI, 0.984 to 0.999; P = 0.031) remain independent predictors of 90-day mortality in septic-shock patients. Conclusions: Our study demonstrated that LV systolic function as determined by TDI, in particular, Sa, might be associated with mortality in patients with septic shock.

Objective: The purpose of this study was to evaluate the accuracy of different scoring systems, including the Acute Physiology and Chronic Health Evaluation (APACHE) II, the Simplified Acute Physiology Score (SAPS) II, the Sequential Organ Failure Assessment (SOFA) score, the Glasgow Coma Scale (GCS) and the Glasgow Coma Scale-Pupils (GCS-P), in predicting in-hospital mortality for critically ill patients after craniotomy. Design: This was a single-centre retrospective diagnostic study. Setting: The study was conducted in three intensive care units (70 beds) of a teaching hospital. Participants: Adult patients who underwent craniotomy and stayed in the ICU for more than 24 hours were included. Pregnant or lactating women and patients enrolled in other clinical studies were excluded. Outcome measures: Data on demographics, clinical characteristics and scoring systems (APACHE II, SOFA, SAPS II, GCS and GCS-P) were collected. Receiver operating characteristic (ROC) curves were used to assess the predictive accuracy of each scoring system. Results: Among 1717 patients included, the in-hospital mortality rate was 6.8%. SAPS II (AUC = 0.822) and APACHE II (AUC = 0.819) demonstrated the highest predictive accuracy, followed by GCS-P (AUC = 0.812), GCS (AUC = 0.803) and SOFA (AUC = 0.762). SAPS II and APACHE II significantly outperformed SOFA, while no significant differences were observed among SAPS II, APACHE II, GCS and GCS-P. For patients with supratentorial lesions, APACHE II, SAPS II, GCS and GCS-P showed similar predictive accuracy, all superior to SOFA. For infratentorial lesions, SOFA outperformed GCS and GCS-P. Among patients with cerebrovascular diseases, SOFA had the lowest predictive accuracy, while GCS-P outperformed GCS. Conclusions: APACHE II, SAPS II, GCS and GCS-P demonstrated comparable predictive accuracy for in-hospital mortality in critically ill post-craniotomy patients, with SOFA being less effective. Trial registration number: NCT06762184 .

Objectives The purpose of this study was to evaluate the predictive value of the cough peak flow (CPF) for successful extubation in postcraniotomy critically ill patients. Design This was a single-centre prospective diagnostic study. Setting The study was conducted in three intensive care units (ICUs) of a teaching hospital. Participants Postcraniotomy patients who were 18 years or older, stayed in ICU for more than 24 hours and underwent mechanical ventilation for more than 24 hours were eligible for the study. Patients were excluded if one of the following was present: no extubation attempt during the ICU stay; underwent tracheostomy without extubation attempt; pregnant or lactating women; enrolled in other clinical trials; declined to participate in the study. A total of 4879 patients were screened and 1037 were eligible for the study, among whom 785 were included in the study. Outcome measures CPF, including involuntary (CPF-invol) and voluntary CPF (CPF-vol), were measured before extubation. The area under the receiver operating characteristic curve (AUC) was calculated to explore the diagnostic accuracy of CPF in predicting successful extubation. Results There were 641 successful extubation cases (81.7%). The AUC of CPF-invol for predicting successful extubation was 0.810 (95% CI 0.766 to 0.854), with a cut-off value of 63.2 L/min, a sensitivity of 87.4% and a specificity of 66.7%. For conscious patients, the AUC of CPF-invol for the prediction of successful extubation was 0.849 (95% CI 0.794 to 0.904), with a cut-off value of 63.2 L/min and the AUC of CPF-vol was 0.756 (95% CI 0.696 to 0.817), with a cut-off value of 68.2 L/min. Conclusions The CPF was much higher in patients with successful extubation than that in patients with failed extubation. CPF might be valuable for the prediction of extubation outcomes in postcraniotomy critically ill patients. Multicentre studies could be carried out to further validate the results of this study. Trial registration number NCT04000997.

Objective: Extubation failure is common in critically ill post-craniotomy patients. This study aimed to assess extubation outcomes and examine demographic and surgical predictors of extubation success. Methods: In this retrospective cohort study, we analyzed adult ICU patients from January 2017 to December 2020 with ≥24 hours of both ICU stay and endotracheal intubation. We collected demographic characteristics, surgical parameters, severity scores (APACHE II, SOFA, GCS), and extubation outcomes. Independent predictors of successful extubation were determined through multivariate logistic regression. Results: Among 1,683 enrolled patients, first-attempt extubation success was achieved in 70.7% (1,190/1,683), declining to 46.6% (135/290) and 28.6% (12/42) for second and third attempts respectively. Subsequent tracheostomy was performed in 19, 3, and 1 patients following first, second, and third successful extubations. At discharge, 1,244 patients (73.9%) maintained extubation success while 348 (20.7%) required tracheostomy. Successful first extubation correlated with significantly reduced ICU stay (median 4 vs 15 days, p < 0.001) and total hospitalization duration (19 vs 30 days, p < 0.001), though mortality rates showed no significant difference (6.0% vs 8.1%, p = 0.106). Multivariable analysis demonstrated that male sex (OR 0.680, 95% CI 0.531–0.871), history of hypertension (OR 0.637, 95% CI 0.489–0.829), supratentorial lesions (OR 1.315, 95% CI 1.016–1.701), SOFA score (OR 0.844, 95% CI 0.791–0.900), and APACHE II score (OR 0.930, 95% CI 0.902–0.958) were independent factors influencing initial extubation success. Conclusion: Although first-attempt extubation success remains suboptimal in post-craniotomy critical care, nearly half of initial failures achieve success on subsequent attempts. Multivariable analysis identified female sex, absence of hypertension, infratentorial lesions, lower SOFA, and APACHE II score were independent predictors of initial extubation success.

Beta-blocker therapy has garnered attention for sepsis and septic shock because of its potential benefits in modulating hemodynamics through heart rate control and reducing the in-hospital mortality rate. This study examined the evolving trends and focal points of this domain. This study retrieved 418 articles and reviews related to beta-blocker therapy in sepsis and septic shock published from the Web of Science Core Collection Database from January 1, 1990, to November 30, 2023. CiteSpace and VOSviewer software were used for visual bibliometric analysis, including co-citation analysis of references, co-occurrence analysis of keywords, and collaborative network analysis involving countries/regions, institutions, and authors. Over time, a discernible upward trend has been observed in the annual publication of articles related to β-blockers in sepsis, particularly from 2013 to 2023. Keyword publication burst detection revealed that initial studies primarily focused on the role of excessive catecholamine release as a mechanism and potential therapeutic target in sepsis and septic shock. β-blockers have emerged as a pivotal area of investigation and are associated with improved hemodynamics and decreased in-hospital mortality. The United States is the most prolific contributor, wielding substantial influence, whereas China exhibits a recent surge in publications, ranking second in terms of publication strength. University College London published the most articles, with the University of Oxford demonstrating the highest centrality. Collaborative endeavors are frequently observed among countries and institutions. Beta-blocker therapy may hold promise in reducing in-hospital mortality among patients with sepsis and septic shock, thus becoming a central focus of research.