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Candida spp . infections are a major cause of morbidity and mortality in critically ill patients. Candida auris is an emerging multi-drug-resistant fungus that is rapidly spreading worldwide. Since the first reports in 2009, many isolates across five continents have been identified as agents of hospital-associated infections. Independent and simultaneous outbreaks of C. auris are becoming a major concern for healthcare and scientific community. Moreover, laboratory misidentification and multi-drug-resistant profiles, rarely observed for other non-albicans Candida species, result in difficult eradication and frequent therapeutic failures of C. auris infections. The aim of this review was to provide an updated and comprehensive report of the global spread of C. auris , focusing on clinical and microbiological characteristics, mechanisms of virulence and antifungal resistance, and efficacy of available control, preventive, and therapeutic strategies.

The aim of this systematic review and meta-analysis was to estimate the pooled occurrence of ventilator-associated pneumonia (VAP) among patients admitted to an intensive care unit with COVID-19 and mortality of those who developed VAP. We performed a systematic search on PubMed, EMBASE and Web of Science from inception to 2nd March 2021 for nonrandomized studies specifically addressing VAP in adult patients with COVID-19 and reporting data on at least one primary outcome of interest. Random effect single-arm meta-analysis was performed for the occurrence of VAP and mortality (at the longest follow up) and ICU length of stay. Twenty studies were included in the systematic review and meta-analysis, for a total of 2611 patients with at least one episode of VAP. The pooled estimated occurrence of VAP was of 45.4% (95% C.I. 37.8–53.2%; 2611/5593 patients; I2 = 96%). The pooled estimated occurrence of mortality was 42.7% (95% C.I. 34–51.7%; 371/946 patients; I2 = 82%). The estimated summary estimated metric mean ICU LOS was 28.58 days (95% C.I. 21.4–35.8; I2 = 98%). Sensitivity analysis showed that patients with COVID-19 may have a higher risk of developing VAP than patients without COVID-19 (OR 3.24; 95% C.I. 2.2–4.7; P = 0.015; I2 = 67.7%; five studies with a comparison group).

Background Procalcitonin (PCT) is a biomarker used to assess systemic inflammation, infection, and sepsis and to optimize antimicrobial therapies. Its role in the in the differential diagnosis between candidemia and bacteremia is unclear. The aim of this systematic review was to summarize the current evidence about PCT values for differentiating candidemia from bacteremia. Methods PubMed and EMBASE were searched for studies reporting data on the diagnostic performance of serum PCT levels in intensive care unit (ICU) or non-ICU adult patients with candidemia, in comparison to patients with bacteremia. Results We included 16 studies for a total of 45.079 patients and 785 cases of candidemia. Most studies claimed to report data relating to the use of PCT values for differentiating between candidemia and bacteremia in septic patients in the intensive care unit. However, the studies identified were all retrospective, except for one secondary analysis of a prospective dataset, and clinically very heterogeneous and involved different assessment methods. Most studies did show lower PCT values in patients with candidemia compared to bacteremia. However, the evidence supporting this observation is of low quality and the difference seems insufficiently discriminative to guide therapeutic decisions. None of the studies retrieved actually studied guidance of antifungal treatment by PCT. PCT may improve diagnostic performance regarding candidemia when combined with other biomarkers of infection (e.g., beta- d -glucan) but more data is needed. Conclusions PCT should not be used as a standalone tool for the differential diagnosis between candidemia and bacteremia due to limited supporting evidence.

Non-invasive respiratory support (NRS) has become a cornerstone in the management of acute respiratory failure (ARF), offering an alternative or a bridge between conventional oxygen therapy (COT) and invasive mechanical ventilation (iMV). While NRS techniques—including non-invasive ventilation (NIV), continuous positive airway pressure (CPAP), and high-flow nasal oxygen (HFNO)—have demonstrated efficacy in reducing intubation rates and improving outcomes, patient tolerance and synchrony remain critical determinants of success. Analgosedation, the strategic use of analgesics and sedatives, has emerged as an important adjunctive therapy to optimise NRS delivery, reduce patient–ventilator asynchrony, and improve comfort. However, the delicate balance between adequate sedation and the preservation of spontaneous breathing, airway protection, and hemodynamic stability presents unique challenges. This comprehensive narrative review synthesises current evidence on analgosedation strategies during NRS use, examining pharmacological agents, their pharmacokinetic and pharmacodynamic properties, comparative studies, indications, monitoring parameters, clinical settings, and safety considerations. We also review existing guidelines, discuss special considerations in paediatric populations, and propose practical clinical approaches. Understanding the nuanced application of analgosedation is essential for clinicians to maximise therapeutic benefit while minimising risks of NRS treatment failure and adverse outcomes.

Long-term noninvasive ventilation modalities for the pediatric population have undergone a continuous evolution. Hybrid noninvasive ventilation modalities have been recently introduced in clinical practice. Combining the advantages of conventiol ventilation, hybrid modes use algorithms that automatically adjust the ventilator’s settings to achieve a predefined ventilation target. Most of the recommendations on the use and settings of hybrid noninvasive ventilation modalities in children are derived from adult experience. Therefore, there is a lack of evidence on its implementation in pediatric chronic respiratory diseases. This scoping review aims to map the existing information regarding the use of hybrid ventilation modalities in the pediatric population and identify knowledge or research gaps. We performed a literature search using MEDLINE and PubMed following the Preferred Reporting Items for Systematic Reviews and Meta-Alyses extension for Scoping Reviews. We included 13 studies (10 studies on average volume-assured pressure-support ventilation, 2 studies on intelligent volume-assured pressure-support ventilation, and 1 study on adaptive servoventilation). The use of new noninvasive ventilation modes in the pediatric population has been applied for the treatment of neuromuscular and hypoventilation syndromes as an altertive therapeutic option in the case of the failure of conventiol noninvasive ventilation. Their widespread use has been hampered by the limited evidence available. Longitudil studies on a larger number of patients are needed to confirm their effectiveness and evaluate their long-term clinical and functiol outcomes.

With the large volume of data coming from implemented technologies and monitoring systems, intensive care units (ICUs) represent a key area for artificial intelligence (AI) application. Despite the last decade has been marked by studies focused on the use of AI in medicine, its application in mechanical ventilation management is still limited. Optimizing mechanical ventilation is a complex and high-stake intervention, which requires a deep understanding of respiratory pathophysiology. Therefore, this complex task might be supported by AI and machine learning. Most of the studies already published involve the use of AI to predict outcomes for mechanically ventilated patients, including the need for intubation, the respiratory complications, and the weaning readiness and success. In conclusion, the application of AI for the management of mechanical ventilation is still at an early stage and requires a cautious and much less enthusiastic approach. Future research should be focused on AI progressive introduction in the everyday management of mechanically ventilated patients, with the aim to explore the great potentiality of this tool.

Background: Little is known about the occurrence of bloodstream infections in hospitalized patients with COVID-19 and the related clinical consequences. The aim of this systematic review and meta-analysis was to estimate the pooled occurrence of BSIs among hospitalized patients with COVID-19 and mortality of this patient population. Methods: A systematic search was performed on PubMed, EMBASE, and Web of Science from inception to 19 April 2021. The primary outcome was the occurrence of BSIs among hospitalized patients with COVID-19. The secondary outcome was mortality at the longest available follow-up. Results: Forty-six studies met the inclusion criteria, with a total of 42,694 patients evaluated. The estimated occurrence of BSIs was 7.3% (95% CI 4.7–1.1%) among hospitalized patients with COVID-19, with a mortality rate of 41% (95% CI 30%–52.8%). The subgroup analysis conducted on patients admitted to ICU provided an estimated occurrence of 29.6% (95% CI 21.7%–38.8%). A higher occurrence of BSI was observed in patients with COVID-19, in comparison with patients without COVID-19 (OR 2.77; 95% CI 1.53–5.02; p < 0.001). Conclusions: Our analysis estimated the occurrence of BSIs among hospitalized patients with COVID-19 at around 7%. A four-times higher occurrence was estimated among patients admitted to ICU.

Asthma is a reversible clinical condition characterized by airway obstruction due to bronchial smooth muscle contraction, inflammation and a hypersecretive state. Severe asthma exacerbations (SAE) may be a part of the natural history of this condition. Patients presenting with SAE are at higher risk of recurrent attacks, often nonresponsive to medical therapy and eventually requiring invasive mechanical ventilation (MV). The use of noninvasive respiratory supports (NRSs) may be beneficial in patients with SAE who are at risk of developing acute respiratory failure (ARF). However, their application is insufficiently supported by the evidence, as reports on their application in asthmatic patients are scarce and only a few retrospective studies with a limited number of participants have been published to date. This review discusses the potentialities of NRS in the treatment of SAE, with reference to the pathophysiological background and future perspectives on their use in asthma management.