Explore the vast range of titles available.

An increasing number of critically ill patients are immunocompromised. Acute hypoxemic respiratory failure (ARF), chiefly due to pulmonary infection, is the leading reason for ICU admission. Identifying the cause of ARF increases the chances of survival, but may be extremely challenging, as the underlying disease, treatments, and infection combine to create complex clinical pictures. In addition, there may be more than one infectious agent, and the pulmonary manifestations may be related to both infectious and non-infectious insults. Clinically or microbiologically documented bacterial pneumonia accounts for one-third of cases of ARF in immunocompromised patients. Early antibiotic therapy is recommended but decreases the chances of identifying the causative organism(s) to about 50%. Viruses are the second most common cause of severe respiratory infections. Positive tests for a virus in respiratory samples do not necessarily indicate a role for the virus in the current acute illness. Invasive fungal infections (Aspergillus, Mucorales, and Pneumocystis jirovecii) account for about 15% of severe respiratory infections, whereas parasites rarely cause severe acute infections in immunocompromised patients. This review focuses on the diagnosis of severe respiratory infections in immunocompromised patients. Special attention is given to newly validated diagnostic tests designed to be used on non-invasive samples or bronchoalveolar lavage fluid and capable of increasing the likelihood of an early etiological diagnosis.

BackgroundIt is necessary to train a large number of healthcare workers (HCW) within a limited time to ensure adequate human resources during an epidemic. There remains an urgent need for best practices on development and implementation of training programmes.ObjectiveTo explore published literature in relation to training and education for viral epidemics as well as the effect of these interventions to inform training of HCW.Data sourcesSystematic searches in five databases performed between 1 January 2000 and 24 April 2020 for studies reporting on educational interventions in response to major viral epidemics.Study eligibility criteriaAll studies on educational interventions developed, implemented and evaluated in response to major global viral outbreaks from 2000 to 2020.ParticipantsHealthcare workers.InterventionsEducational or training interventions.Study appraisal and synthesis methodsDescriptive information were extracted and synthesised according to content, competency category, educational methodology, educational effects and level of educational outcome. Quality appraisal was performed using a criterion-based checklist.ResultsA total of 15 676 records were identified and 46 studies were included. Most studies were motivated by the Ebola virus outbreak with doctors and nurses as primary learners. Traditional didactic methods were commonly used to teach theoretical knowledge. Simulation-based training was used mainly for training of technical skills, such as donning and doffing of personal protective equipment. Evaluation of the interventions consisted mostly of surveys on learner satisfaction and confidence or tests of knowledge and skills. Only three studies investigated transfer to the clinical setting or effect on patient outcomes.Conclusions and implications of findingsThe included studies describe important educational experiences from past epidemics with a variety of educational content, design and modes of delivery. High-level educational evidence is limited. Evidence-based and standardised training programmes that are easily adapted locally are recommended in preparation for future outbreaks.

ObjectiveTo identify theoretical and technical aspects regarding treatment, prevention of spread and protection of staff to inform the development of a comprehensive training curriculum on COVID-19 management.DesignCross-sectional study.SettingNine hospitals caring for patients with COVID-19 in Wuhan, China.Participants134 Chinese healthcare professionals (74 doctors and 60 nurses) who were deployed to Wuhan, China during the COVID-19 epidemic were included. A two-round Delphi process was initiated between March and May 2020. In the first round, the participants identified knowledge, technical and behavioural (ie, non-technical) skills that are needed to treat patients, prevent spread of the virus and protect healthcare workers. In round 2, the participants rated each item according to its importance to be included in a training curriculum on COVID-19. Consensus for inclusion in the final list was set at 80%.Primary outcome measuresKnowledge, technical and behavioural (ie, non-technical) skills that could form the basis of a training curriculum for COVID-19 management.ResultsIn the first round 1398 items were suggested by the doctors and reduced to 67 items after content analysis (treatment of patients: n=47; infection prevention and control: n=20). The nurses suggested 1193 items that were reduced to 70 items (treatment of patients: n=49; infection prevention and control: n=21). In round 2, the response rates were 82% in doctors and 93% in nurses. Fifty-eight items of knowledge, technical and behavioural skills were agreed on by the doctors to include in the final list. For the nurses, 58 items were agreed on.ConclusionsThis needs assessment process resulted in a comprehensive list of knowledge, technical and behavioural skills for COVID-19 management. Educators can use these to guide decisions regarding content of training curricula not only for COVID-19 management but also in preparation for future viral pandemic outbreaks.

Sepsis is a significant global health issue, with high morbidity, mortality, and economic burden. Its definition has evolved, with the latest Sepsis-3 criteria emphasizing life-threatening organ dysfunction due to a dysregulated host response. Endothelial dysfunction plays a critical role in sepsis pathogenesis, characterized by increased permeability and inflammatory responses. Human serum albumin, the most abundant protein in the bloodstream, is essential for maintaining oncotic pressure and endothelial integrity. This narrative review provides an overview of endothelial changes during sepsis and their impact on organ damage. We also explore the role of albumin administration in managing endothelial dysfunction in sepsis and discuss the available preclinical and clinical evidence.

Background Sepsis and septic shock remain major causes of morbidity and mortality worldwide, and management is largely based on source control, antimicrobial therapy, and supportive care. Despite limited high-quality evidence, adjunctive therapies targeting the dysregulated host response involving immune dysfunction, coagulopathy, and endothelial injury, steroids, vasopressors, and adjunctive therapies are frequently used in clinical practice. This survey aimed to describe real-world patterns of sepsis therapy across Europe. Methods We conducted an open, web-based, multinational survey endorsed by the European Society of Intensive Care Medicine (ESICM) and the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI). The survey was distributed through professional mailing lists, newsletters, and national society networks. A structured 30-item questionnaire collected information on respondent demographics, ICU characteristics, availability of adjunctive therapies, clinical indications, triggers for initiation, and duration of treatment. Participation was voluntary and anonymous. A total of 442 physicians completed the survey. Data were analyzed descriptively and are presented as proportions and frequencies. Results More than 80% of respondents reported use of at least one adjunctive therapy for septic shock within the previous year. Corticosteroids were used by over 90% of clinicians, predominantly hydrocortisone for septic shock. Considerable variability was observed regarding indications, timing of initiation, and duration of therapy. Extracorporeal blood purification techniques were used by approximately 75% of respondents, most frequently hemoadsorption in patients with refractory shock; high cost and limited availability were the main barriers to broader implementation. Intravenous immunoglobulins were used by approximately one-third of clinicians, often guided by measured immunoglobulin levels or perceived immune dysfunction. Additional vasoactive and inotropic agents, including levosimendan, methylene blue, and beta-blockers, were employed in selected cases. In contrast, specific immunomodulatory therapies such as interleukin (IL)-1receptor antibodies were rarely used. Across all adjunctive strategies, marked heterogeneity in practice patterns was evident. Conclusion Adjunctive therapies are widely used in European ICUs, particularly in patients with severe or refractory sepsis, despite limited supporting evidence. The substantial variability in practice highlights ongoing clinical uncertainty and underscores the need for well-designed randomized trials to inform evidence-based and individualized treatment strategies.

Therapeutic plasma exchange (TPE) is a therapeutic intervention that separates plasma from blood cells to remove pathological factors or to replenish deficient factors. The use of TPE is increasing over the last decades. However, despite a good theoretical rationale and biological plausibility for TPE as a therapy for numerous diseases or syndromes associated with critical illness, TPE in the intensive care unit (ICU) setting has not been studied extensively. A group of eighteen experts around the globe from different clinical backgrounds used a modified Delphi method to phrase key research questions related to “TPE in the critically ill patient”. These questions focused on: (1) the pathophysiological role of the removal and replacement process, (2) optimal timing of treatment, (3) dosing and treatment regimes, (4) risk–benefit assumptions and (5) novel indications in need of exploration. For all five topics, the current understanding as well as gaps in knowledge and future directions were assessed. The content should stimulate future research in the field and novel clinical applications.

The interplay between the immune system, coagulation, and endothelium is critical in regulating the host response to infection. However, in sepsis and other critical illnesses, a dysregulated immune response can lead to excessive alterations in these mechanisms, resulting in coagulopathy, endothelial dysfunction, and multi-organ dysfunction. This review aims to provide a comprehensive analysis of the pathophysiological mechanisms that govern the complex interplay between immune dysfunction, endothelial dysfunction, and coagulation in sepsis. It emphasises clinical significance, evaluation methods, and potential therapeutic interventions. Understanding these mechanisms is essential for developing effective treatments that can modulate the immune response, mitigate thrombosis, restore endothelial function, and ultimately improve patient survival.