Effects of a multilevel intervention of resistance training with or without beta-hydroxy-beta-methylbutyrate in medical ICU patients during entire hospitalisation: a four-arm multicentre randomised controlled trial.

BACKGROUND: Intensive care unit-acquired weakness (ICU-AW) is a prevalent and severe issue among ICU patients. Resistance training and beta-hydroxy-beta-methylbutyrate (HMB) intervention have demonstrated the potential to enhance muscle function in patients with sarcopenia and in older adults. The purpose of this study was to determine whether resistance training and/or HMB administration would improve physical function, muscle strength, and quality of life in medical ICU patients. METHODS: In this multicentre, four-arm, single-blind randomised control trial, a total of 112 adult patients with internal medical diagnoses admitted to the ICU were enrolled. These participants were then randomly assigned to one of four treatment groups: the resistance training group received protocol-based multilevel resistance exercise, the HMB group received 3 g/day of HMBCa, combination group and control groups received standard care, from the ICU to the general ward until discharge. The primary outcomes assessed at discharge included six-minute walking distance (6MWD) and short physical performance battery (SPPB). Secondary outcomes measured included muscle mass, MRC score, grip strength, and health reports quality of life at different time points. Data analysis was performed using a generalised linear mixed model, adhering to the principles of intention-to-treat analysis. RESULTS: Resistance training and combination treatment groups exhibited significant increases in SPPB scores (3.848 and 2.832 points, respectively) compared to the control group and substantial improvements in 6WMD (99.768 and 88.577 m, respectively) (all with P < 0.01). However, no significant changes were observed in the HMB group. Muscle strength, as indicated by MRC and grip strength tests conducted at both ICU and hospital discharge, showed statistically significant improvements in the resistance training and combination groups (P < 0.05). Nevertheless, no significant differences were found between the treatment groups and usual care in terms of 60-day mortality, prevalence of ICU-AW, muscle mass, quality of life, or other functional aspects. CONCLUSIONS: Resistance training with or without beta-hydroxy-beta-methylbutyrate during the entire hospitalisation intervention improves physical function and muscle strength in medical ICU patients, but muscle mass, quality of life, and 60-day mortality were unaffected. TRIAL REGISTRATION: ChiCTR2200057685 was registered on March 15th, 2022.

Risk factors for delirium in advanced cancer patients: A systematic review and meta-analysis.

PURPOSE: To systematically collect published research in order to identify and quantify risk factors for delirium in advanced cancer patients. METHODS: The Cochrane Library, PubMed, Proquest, CINAHL, Web of Science, Ovid MEDLINE, Embase, Scopus, Chinese Wanfang Data, Chinese Periodical Full-text Database (VIP), Chinese Biomedical Literature Database (CBM), and Chinese National Knowledge Infrastructure (CNKI) were systematically searched for cohort or case-control studies reporting individual risk factors for delirium among advanced-stage cancer patients published prior to March 2022. The Newcastle-Ottawa Scale was used to assess the methodological quality of included studies. The pooled adjusted odds ratio (aOR) and its 95% confidence interval were calculated using the RevMan 5.4 software package. RESULTS: A total of 15 studies with data from 3106 advanced cancer patients were included in our analysis. Nine studies were high-quality and six were of moderate quality. Pooled analyses revealed that 11 risk factors were statistically significant. High-intensity risk factors included sleep disturbance, infection, cachexia and the Palliative Prognostic Index; medium-intensity risk factors included male sex, renal failure, dehydration and drowsiness; low-intensity risk factors included age, total bilirubin and opioid use. Antibiotic use was found to have been a protective factor. CONCLUSIONS: We identified 12 independent risk factors that were significantly associated with delirium in advanced cancer patients and provide an evidence-based foundation to implement appropriate preventive strategies.

Effects of a spray-based oropharyngeal moisturising programme for patients following endotracheal extubation after cardiac surgery: A randomised, controlled three-arm trial.

BACKGROUND: When a patient emerges from cardiac surgery, they may experience intense thirst and discomfort or even impaired swallowing after endotracheal extubation. This may lead to feelings of suffocation, desperation, fear, and anxiety. Although thirst relief and dysphagia prevention share similar mechanisms, there is limited evidence for a combined intervention to alleviate thirst and prevent dysphagia. Furthermore, no studies to date have targeted postoperative cardiac patients. OBJECTIVE: To evaluate the safety, feasibility, and effects of a spray-based oropharyngeal moisturising programme for cardiac surgery patients following endotracheal extubation. DESIGN: A randomised, controlled three-arm trial was conducted from October 2017 to December 2019. SETTING: Tertiary medical centre cardiac care unit. PARTICIPANTS: Participants (N = 145) were patients who underwent cardiac surgery and received mechanical ventilation. METHODS: Participants were randomly assigned to one of three groups: a four-part programme offering spray-based therapy with either a constant low-temperature cold spray (programme A; n = 47) or low-to-normal temperature spray (programme B; n = 49), or those that received usual care (control group; n = 49). Control group patients who complained of thirst were given wet cotton swabs to moisten their mouths. The primary outcomes included discomfort and various levels of thirst intensity; secondary outcomes included dysphagia and adverse events. Outcomes were evaluated at Time 0 (baseline), Time 1 (3 h), Time 2 (6 h) and Time 3 (96 h) post intervention. Repeated-measures analyses was performed using generalised estimating equations. RESULTS: The baseline evaluation indicated no significant differences between the groups. Participants (average age: 55 years; 53.8% men) underwent cardiac surgery for; valvular heart disease (64.8%), coronary atherosclerotic heart disease (25.5%), or aortic dissection (9.7%). Baseline scores indicated moderately severe thirst (6.24±1.57) and discomfort (9.88±2.23). Post intervention, the thirst intensity in the intervention groups was significantly lower than that of the control group (p<0.001). The generalised estimating equation analysis showed no significant difference in reduced thirst intensity between programmes A and B (adjusted ß=0.08, 95% CI: -0.59-0.76, p = 0.810) when controlling for intervention condition and time. Comparable results were found for reduced thirst discomfort (adjusted ß=0.36, 95% CI: -0.66-1.38, p = 0.493). The three groups showed no significant differences for dysphagia frequency. No observable adverse events were reported during the intervention period. CONCLUSIONS: A spray-based oropharyngeal moisturising programme is a practical and effective intervention to alleviate patient thirst after cardiac surgery and tracheal intubation that could be integrated into comfort care for post-surgical patients' critical care management. TWEETABLE ABSTRACT: A spray-based oropharyngeal moisturising programme for cardiac surgery recipients following endotracheal extubation may alleviate thirst.