The accurate identification of infections is critical for effective treatment in intensive care units (ICUs), yet current diagnostic methods face limitations in sensitivity and specificity, alongside cost and accessibility issues. Consequently, there is a pressing need for a marker that is economically feasible, rapid, and reliable. Presepsin (PSP), also known as soluble CD14 subtype (sCD14-ST), has emerged as a promising biomarker for early sepsis diagnosis. PSP, derived from soluble CD14, reflects the activation of monocytes/macrophages in response to bacterial infections. It has shown potential as a marker of cellular immune response activation against pathogens, with plasma concentrations increasing during bacterial infections and decreasing post-antibiotic treatment. Unlike traditional markers such as procalcitonin (PCT) and C-reactive protein (CRP), PSP specifically indicates monocyte/macrophage activation. Limited studies in critical illness have explored PSP’s role in sepsis, and its diagnostic accuracy varies with threshold values, impacting sensitivity and specificity. Recent meta-analyses suggest PSP’s diagnostic potential for sepsis, yet its standalone effectiveness in ICU infection management remains uncertain. This review provides a comprehensive overview of PSP’s utility in ICU settings, including its diagnostic accuracy, prognostic value, therapeutic implications, challenges, and future directions.

Intensive Care Unit-Acquired Weakness (ICUAW) is a very common condition in patients admitted to intensive care units (ICUs), even after relatively short stays. This weakness can develop with a pre-existing background of sarcopenia or cachexia, although these conditions are not always the direct cause. Over the years, much of the literature has focused on the nutritional aspect of the issue, leading to the development of widely accepted guidelines recommending the initiation of early nutrition, with the goal of achieving caloric and protein targets within the first five days of ICU admission. Despite adherence to these guidelines, several studies have shown a significant loss of muscle mass in critically ill patients, which directly impacts their ability to generate strength. However, it has become increasingly evident that nutrition alone is not sufficient to counteract this muscle loss, which is often closely linked to the prolonged immobility experienced by ICU patients due to a variety of clinical and logistical factors. In particular, there is growing evidence suggesting that even the introduction of early and minimal rehabilitation—including passive mobilization—when combined with appropriate nutritional support, can be a valuable strategy to help reduce the incidence of ICUAW. In this narrative review, we aim to summarize the current scientific knowledge on this topic, emphasizing the importance of an integrated approach that combines nutrition and early mobilization. Such a combined strategy not only holds the potential to reduce the acute incidence of ICUAW but also contributes to better recovery outcomes and, eventually, improved quality of life for these patients.

The diagnosis of sepsis is often difficult and belated, substantially increasing mortality in affected patients. Its early identification allows for us to choose the most appropriate therapies in the shortest time, improving patients’ outcomes and eventually their survival. Since neutrophil activation is an indicator of an early innate immune response, the aim of the study was to evaluate the role of Neutrophil-Reactive Intensity (NEUT-RI), which is an indicator of their metabolic activity, in the diagnosis of sepsis. Data from 96 patients consecutively admitted to the Intensive Care Unit (ICU) were retrospectively analyzed (46 patients with and 50 without sepsis). Patients with sepsis were further divided between sepsis and septic shock according to the severity of the illness. Patients were subsequently classified according to renal function. For the diagnosis of sepsis, NEUT-RI showed an AUC of >0.80 and a better negative predictive value than Procalcitonin (PCT) and C-reactive protein (CRP) (87.4% vs. 83.9% and 86.6%, p = 0.038). Unlike PCT and CRP, NEUT-RI did not show a significant difference within the “septic” group between patients with normal renal function and those with renal failure (p = 0.739). Similar results were observed among the “non-septic” group (p = 0.182). The increase in NEUT-RI values could be useful in the early ruling-out of sepsis, and it does not appear to be influenced by renal failure. However, NEUT-RI has not proved to be efficient in discriminating the severity of sepsis at the time of admission. Larger, prospective studies are needed to confirm these results.

Background: Optimal pain control with limited muscle weakness after total hip arthroplasty (THA) is paramount for a swift initiation of physical therapy and ambulation, thus expediting hospital discharge. FICB (Fascia Iliaca Compartment Block) has been recommended because it offers pain control with a low risk of motor block. PENG (Pericapsular Nerve Group) block with LFCN (Lateral Femoral Cutaneous Nerve) has been proposed as an alternative that offers comparable pain control with a lower risk of motor block; however, evidence is limited. We aimed to investigate the degree of muscle weakness and pain control with PENG + LFCN. Methods: Patients undergoing elective THA from November 2022 to October 2023 have been retrospectively analyzed. The degree of quadriceps femoris muscle paresis was assessed with the MRC scale at 6 h postoperatively. Secondary outcomes: NRS score at 6, 12, and 24 h, total opioid consumption, and time to first rescue opioid. Results: In total, 80 patients were included in the study, 57 received PENG + LFCN, and the remaining 23 received FICB. PENG + LCFN resulted in a higher MRC at 6 h (4 [4; 5] vs. 3 [2; 4] p = 0.0001) and better pain control (mean difference [95% CI] at 6 h, 0.93 [0.14; 1.72], at 12 h, 0.47 [−0.49; 1.43], and at 24 h, 0.39 [0.25; 1.2], p = 0.0006). Less PRN opioids were requested in the PENG + LFCN vs. FICB groups (7.5 [0; 15] MME vs. 60 [40; 80], p = 0.001). Conclusions: PENG + LFCN was associated with less muscle weakness, better pain control, and less rescue opioids in patients undergoing elective THA. A larger prospective study is needed to confirm this finding.

Background: Total hip arthroplasty (THA) improves the quality of life by alleviating pain and restoring function. The optimal pain control with minimal muscle weakness is paramount for early rehabilitation and for reducing complications. Although PROSPECT and ICAROS guidelines recommend the Fascia Iliaca Compartment Block (FICB), it is associated with insufficient pain relief and a prolonged quadriceps motor block. The association of the PENG (Pericapsular Nerve Group) with LFCN (lateral femoral cutaneous nerve) blocks may address these limitations, provide improved motor-sparing pain control, and offer a more tailored approach that enhances both an early postoperative recovery and patient satisfaction. Methods: A randomized controlled trial (November 2023–July 2024) compared the PENG + LFCN to the FICB in patients undergoing elective THAs under spinal anesthesia. The primary outcome was quadriceps weakness at 6 h post-block. Secondary outcomes included the degree of hip flexion and pain scores at 6, 24, and 48 h post-block, opioid consumption, and time to ambulation. Results: Fifty-eight patients were randomized (twenty-nine per group). The PENG + LFCN group achieved a significantly greater muscle strength (MRC: 4 [4; 4] vs. 3 [3; 4], p < 0.0001) and better hip flexion at all measured moments (6 h: 45° [37; 60] vs. 30° [25; 43], 24h: 59° [49; 66] vs. 47° [36; 50], 48 h: 62° [55; 70] vs. 50° [40; 55], all p < 0.0001). Resting pain was lower in the PENG + LFCN group (0 [0; 1], 0 [0; 2], and 0 [0; 1] vs. 2 [0; 3], 1 [0; 3], 1 [0; 3]), as was the dynamic pain during movement (1 [0; 2], 2 [2; 4], and 2 [1; 2] vs. 3 [2; 5], 3 [2; 4], and 3 [1; 3]; all p < 0.001), along with a lower total opioid consumption (0 [0; 0] vs. 7.5 [7.5; 22.5] MME, p < 0.001). Conclusions: The PENG + LFCN block outperformed the FICB in muscle strength, hip flexion, pain control, and opioid use, suggesting it may be a more effective option for THAs.

The accurate identification of bacterial infections is critical for effective treatment in intensive care units (ICUs), yet current diagnostic methods face limitations in sensitivity and specificity, along-side cost and accessibility issues. Consequently, there's a pressing need for a marker that is economically feasible, rapid, and reliable. Presepsin (PSP), also known as soluble CD14 subtype (sCD14-ST), has emerged as a promising biomarker for early sepsis diagnosis. PSP, derived from soluble CD14, reflects the activation of monocytes/macrophages in response to bacterial infec-tions. It has shown potential as a marker of cellular immune response activation against patho-gens, with plasma concentrations increasing during bacterial infections and decreasing post-antibiotic treatment. Unlike traditional markers such as procalcitonin (PCT) and C-reactive protein (CRP), PSP specifically indicates monocyte/macrophage activation in bacterial infections. While limited studies in critical illness have explored PSP's role in sepsis, its diagnostic accuracy varies with threshold values, impacting sensitivity and specificity. Recent meta-analyses suggest PSP's diagnostic potential for sepsis, yet its standalone effectiveness in ICU infection management remains uncertain. This review provides a comprehensive overview of PSP's utility in ICU set-tings, including its diagnostic accuracy, prognostic value, therapeutic implications, challenges, and future directions.