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.

This was a single-centre retrospective diagnostic study.

The study was conducted in three intensive care units (70 beds) of a teaching hospital.

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.

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.

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.

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.

NCT06762184.

To evaluate the effectiveness of levosimendan in promoting weaning from veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in patients with refractory cardiogenic shock through a meta-analysis of clinical trials.

Systematic review and meta-analysis.

PubMed, Embase, the Cochrane Library and Web of Science were systematically searched from inception to January 2025.

Studies were included if they were clinical trials comparing outcomes between patients receiving levosimendan and those not receiving it during VA-ECMO support. Eligible studies reported on at least one of the predefined outcomes.

Two independent reviewers extracted data and assessed study quality. The primary outcome was successful VA-ECMO weaning. Secondary outcomes included 30-day mortality, in-hospital mortality, duration of ECMO support and length of stay in the intensive care unit (ICU). A random-effects model was used to synthesise data and estimate pooled effect sizes, with heterogeneity assessed using the I² statistic.

Involving 2083 patients across 16 studies, levosimendan significantly improved VA-ECMO weaning success (OR=2.44, 95% CI: 1.72 to 3.48; p2=57%) compared with the control group. Additionally, it notably reduced 30-day mortality (OR=0.48, 95% CI: 0.29 to 0.81; p=0.006; I²=56%) and in-hospital mortality (OR=0.47, 95% CI: 0.26 to 0.88; p=0.02; I²=70%). Noteworthy, however, is the association of levosimendan with prolonged VA-ECMO support (days; n=1314; weighted mean difference (WMD): 2.86, 95% CI: 1.73 to 4.00; p2=60%) and extended ICU stay (days; n=629; WMD: 5.69, 95% CI: 2.19 to 9.20; p=0.001; I²=61%).

Levosimendan improves VA-ECMO weaning success and reduces mortality. Further high-quality randomised controlled trials (RCTs) are required to confirm its clinical benefits in VA-ECMO patients. While the findings consolidate existing evidence favouring levosimendan, they also highlight residual heterogeneity and moderate-to-high risk of bias in several included studies. Therefore, future investigations, particularly well-powered RCTs with robust methodology, may help further delineate its role in specific patient populations.

The optimal method for conducting spontaneous breathing trials (SBTs) remains a subject of ongoing debate. High-flow oxygen via endotracheal tube (HFOT) has emerged as a novel alternative for SBTs. However, studies investigating the associated physiological changes are lacking. Compared to high-flow nasal cannula (HFNC), HFOT has demonstrated diminished physiological effects, likely due to the bypassing of the upper airway, which may limit its widespread adoption as an SBT strategy. Two HFOT interfaces with different expiratory port diameters will be evaluated. It is hypothesised that the narrower interface would generate higher airway pressure and mitigate weakening physiological effects compared to the HFNC. This study aims to compare the physiological effects of two HFOTs compared to T-piece during SBTs.

This is a single-centre, prospective, physiological randomised crossover study in adult patients receiving mechanical ventilation for more than 24 hours who are deemed ready for SBT. After enrolment, each patient will be disconnected from the ventilator and undergo five SBT phases in random order: T-piece at 6 L/min, HFOT via interface with an expiratory port diameter of 9.8 mm at 40 L/min and 60 L/min and HFOT via interface with an expiratory port diameter of 6.9 mm at 40 L/min and 60 L/min. To reduce carryover effects, each phase will be separated by a 10-min washout period during which baseline mechanical ventilation is resumed. Key physiological parameters will be assessed in each study phase, including airway pressure, changes in end-expiratory lung volume, vital signs, oxygenation levels and inspiratory effort. Postextubation inspiratory effort will also be measured. Finally, 20 patients with the complete five SBT phases and postextubation datasets will be analysed

The study protocol has been approved by the Institutional Ethics Committee and Review Board of Beijing Shijitan Hospital, Capital Medical University (IIT2024-157-002). The data generated in the present study will be available from the corresponding author on reasonable request. The results of the trial will be submitted to international peer-reviewed journals.

NCT06816706.

We aimed to understand the factors affecting psychological well-being of patients undergoing haemodialysis (HD). First, we explored how physical symptom severity, emotional distress and social support influence psychological well-being. Second, we examined the impact of different types of social support. Third, we investigated whether any variables mediate the relationship with psychological well-being.

A cross-sectional study, a type of observational design, was conducted on patients at a medical centre in Taiwan in 2020.

A total of 117 outpatients who had undergone regular HD for at least 3 months were enrolled.

The psychological well-being was assessed through self-report questionnaires.

We found that emotional distress (β=–0.25, p=0.033) had a significant negative impact on psychological well-being. However, the presence of appraisal support mitigated this effect. Specifically, appraisal support fully mediated the adverse impact of emotional distress on psychological well-being. In addition, the severity of physical symptoms was generally mild and did not influence psychological well-being.

Receiving appraisal support from family, friends and healthcare professionals not only alleviates emotional distress but also enhances psychological well-being both directly and indirectly among patients undergoing HD. Healthcare professionals should address issues of personal importance while serving as consultants, educators and evaluators to support patients in managing their chronic condition.