Invasive fungal infections (IFI) contribute significantly to morbidity and mortality among critically ill patients, particularly in intensive care units (ICUs). Accurate prevalence estimates are essential to inform clinical strategies. This study aimed to determine the prevalence of IFI, and assess regional and methodological variations. A systematic review and meta-analysis were conducted following PRISMA guidelines. Literature from PubMed, Scopus, Web of Science, and Cochrane Library were searched for observational studies published between 1999 and 2024. Inclusion criteria targeted studies reporting IFI prevalence in ICU populations. Data extraction and bias assessment were performed independently by two reviewers. A random-effects meta-analysis assessed pooled prevalence and heterogeneity (Cochran’s Q and I2 statistics). Out of 2838 screened articles, 34 studies comprising 655,169 critically ill patients met inclusion criteria. The pooled prevalence of IFI was 5% (95% CI: 3–7%). Aspergillus spp. accounted for 10% and Candida spp. for 3%. Regional prevalence ranged from 3% in high-income countries to 21% in lower-middle-income countries. Diagnostic and methodological heterogeneity were notable contributors to variability. IFIs represent a significant burden in ICUs, particularly in resource-limited settings. Standardized diagnostic criteria and region-specific strategies are crucial to improving patient outcomes. PROSPERO ID CRD42023472191.

The spontaneous breathing trial (SBT) assesses the risk of weaning failure by evaluating some physiological responses to the massive venous return increase imposed by discontinuing positive pressure ventilation. This trial can be very demanding for some critically ill patients, inducing excessive physical and cardiovascular stress, including muscle fatigue, heart ischemia and eventually cardiac dysfunction. Extubation failure with emergency reintubation is a serious adverse consequence of a failed weaning process. Some data suggest that as many as 50% of patients that fail weaning do so because of cardiac dysfunction. Unfortunately, monitoring cardiovascular function at the time of the SBT is complex. The aim of our study was to explore if central venous pressure (CVP) changes were related to weaning failure after starting an SBT. We hypothesized that an early rise on CVP could signal a cardiac failure when handling a massive increase on venous return following a discontinuation of positive pressure ventilation. This CVP rise could identify a subset of patients at high risk for extubation failure. Two-hundred and four mechanically ventilated patients in whom an SBT was decided were subjected to a monitoring protocol that included blinded assessment of CVP at baseline, and at 2 minutes after starting the trial (CVP-test). Weaning failure was defined as reintubation within 48-hours following extubation. Comparisons between two parametric or non-parametric variables were performed with student T test or Mann Whitney U test, respectively. A logistic multivariate regression was performed to determine the predictive value on extubation failure of usual clinical variables and CVP at 2-min after starting the SBT. One-hundred and sixty-five patients were extubated after the SBT, 11 of whom were reintubated within 48h. Absolute CVP values at 2-minutes, and the change from baseline (dCVP) were significantly higher in patients with extubation failure as compared to those successfully weaned. dCVP was an early predictor for reintubation (OR: 1.70 [1.31,2.19], p<0.001). An early rise in CVP after starting an SBT was associated with an increased risk of extubation failure. This might represent a warning signal not captured by usual SBT monitoring and could have relevant clinical implications.

Background: The state of prior immunosuppression in cancer enhances harmful effects (eg, sepsis). Despite advances in cancer treatment and sepsis management, the number of critically ill patients with cancer is increasing. Although the overall survival of patients with cancer experiencing septic shock has improved, the mortality observed in studies remains high. Purpose: To determine the rate mortality from septic shock in patients with cancer by analyzing variations. Design: Systematic review and meta-analysis. Data Sources and Methods: A systematic search was performed in Medline, EMBASE, SCOPUS, Web of Science, and BIREME-BVS. Articles assessing mortality in patients with cancer experiencing septic shock (aged >18 years) were included. Review articles, letters to the editor, case reports, and conference proceedings were excluded. Methodological quality was assessed with the MInCir-Prognosis Scale and the Joanna Briggs Institute checklist to assess the risk of bias in prevalence studies. Results: Overall mortality rate from septic shock was 58% (95% confidence interval [95%CI]: 54-63). Mortality rate during 2000–2010 and 2010–2024 was 61% (95%CI: 53-68) and 58% (95%CI: 52-63), respectively. Mortality rate by continent was 50% (95%CI: 24-76) in Africa, 61% (95%CI: 53-69) in Asia, 53% (95%CI: 48-59) in Europe, 64% (95%CI: 48-78) in North America, and 61% (95%CI: 37-82) in South America. Mortality rate in the intensive care unit was 53% (95%CI: 50-57). In-hospital mortality rate was 59% (95%CI: 49-68), and 50% (95%CI: 43-57), 61% (95%CI: 40-81), 69% (95%CI: 58-80) at 28–30, 90 and 180 days, respectively. Conclusions: Despite advances in oncology and hematology, mortality among patients with cancer experiencing septic shock remains high and increases over time after discharge from the intensive care unit. Registration: PROSPERO [ID: CRD42023472191].

The integration of new technologies has shown potential to enhance self-care practices among patients with diabetic foot ulcers (DFUs). Understanding the effectiveness of these interventions can inform clinical and public health strategies to prevent complications and improve patient outcomes. This scoping review aims to assess the impact of digital and educational technologies on self-care practices and health outcomes in individuals with diabetic foot ulcers. Databases searched encompassed EMBASE, MEDLINE, SciELO, WoS, Scopus, and PubMed, covering publications up to September 2024. The search strategy incorporated MeSH terms and keywords related to “self-care,” “diabetic foot ulcers,” and “educational technology.” After duplicate removal, titles and abstracts were screened independently by three reviewers. Full texts of selected articles were analyzed, and data regarding study design, interventions, outcomes, and populations were extracted using standardized forms. Discrepancies were resolved by consensus. From 442 identified records, 12 studies met inclusion criteria, primarily highlighting the role of mobile applications and digital educational tools in enhancing self-care behaviors, adherence, and complication prevention. Positive effects on patient knowledge and routine adherence were frequently reported. Technological interventions show promise in improving self-care among DFU patients; however, further high-quality, longitudinal studies are needed to establish best practices and long-term benefits.

Several risk factors were associated with mortality in patients with coronavirus disease 2019 (COVID-19) infection in intensive care units (ICU). We assessed the effect of risk factors related to the characteristics and clinical history of the population, laboratory test results, drug management, and type of ventilation on the probability of survival/discharge from the ICU. A retrospective cohort multicentric study of adults with COVID-19 admitted to the ICU between March 2020 and December 2021. Data were collected from 6 hospitals in 5 cities in Ecuador. The primary outcome was ICU survival/discharge. Survival analysis was conducted using semi-parametric Cox proportional hazards models. Of those admitted to the ICU with COVID-19, (n = 991), mean age was 56.76 ± 13.14, and 65.9% were male. Regarding the primary outcome, 51.1% (n = 506) died and 48.9% (n = 485) survived. Of the group that died, their mean age was higher than the survivors (60.7 vs 52.60 years, respectively), and they had a higher prevalence of comorbidities such as arterial hypertension (37.2% vs 20.4%, respectively) and diabetes mellitus (26.9% vs 15.7%, respectively), with P < .001. In ventilatory management, 32.7% of patients used noninvasive ventilation and high-flow nasal cannula, and 67.3% required invasive ventilatory support. After adjusting for confounders, Cox regression analysis showed that patients were less likely to be discharged alive from the ICU if they met the following conditions: arterial hypertension (hazard ratio [HR] = 0.83 95% CI 0.723–0.964), diabetes mellitus (HR = 0.80 95% CI 0.696–0.938), older than 62 years (HR = 0.86 95% CI 0.790–0.956), obese (body mass index ≥ 30) (HR = 0.78 95% CI 0.697–0.887), 1 unit increase in SOFA score (HR = 0.94 95% CI 0.937–0.961), PaO₂/FiO₂ ratio <100 mm Hg (HR = 0.84 95% CI 0.786–0.914), and the use of invasive mechanical ventilation (HR = 0.68 95% CI 0.614–0.769). Risk factors associated with increased mortality were older age, obesity, arterial hypertension, and diabetes. Factors such as male gender, chronic obstructive pulmonary disease, acute kidney injury, and cancer reported in other investigations did not have the same effect on mortality in our study.

Background: Febrile neutropenia (FN) is the most common and serious adverse event of chemotherapy for solid and hematological neoplasms, with infection as a major complication. FN occurs in 10%–50% of patients with solid tumors and over 80% with hematological malignancies, with mortality rates up to 11%. Objective: To characterize bloodstream pathogens in post-chemotherapy FN through a systematic review and meta-analysis of studies published from 2013 to February 13, 2024. Design: Systematic review and meta-analysis. Data sources and methods: PubMed, Web of Science, Scopus, and Embase were searched using MeSH, Emtree, and keywords. Risk of bias was assessed using the JBI checklist. Random-effects proportions meta-analysis was performed. Results: Twenty-two studies ( n = 23,319) reported 8665 positive blood cultures: 59% Gram-negative (95% CI: 46.8–67.5), 39.7% Gram-positive (95% CI: 31.3–48.2), and 2.5% fungi (95% CI: 0.9–4.1). Random-effects meta-analysis showed high heterogeneity ( I ² = 98.92%, p < 0.01). Meta-regression by sample size, economic development, and risk of bias did not explain this variability. Conclusion: Gram-negative pathogens slightly predominate over Gram-positives in bloodstream infections among post-chemotherapy FN patients. Trial registration: PROSPERO (CRD42023472191).