Pregnancy-related complications can lead to respiratory failure, which includes failure to oxygenate and/or ventilate. While there are normal physiologic changes in respiratory status in pregnant women, respiratory depression and hypoxia can still place the mother and fetus in jeopardy. In this paper, we propose an approach to managing and treating pregnant women with respiratory failure. First, we address the physiologic changes and respiratory pathology in pregnancy. Next, we examine a stepwise approach to oxygenation from noninvasive oxygenation to a mechanical ventilation strategy in pregnant patients. We then address specific respiratory pathologies common in pregnant patients and how to manage them. Finally, we discuss an approach to advanced cardiac life support in this patient population.Copyright © 2025 Baylor University Medical Center.

Cardiac arrest is a commonly managed condition in the emergency department (ED), and defibrillation of shockable rhythms is a key component of treatment, along with high-quality chest compressions.This narrative review seeks to evaluate evidence-based updates concerning defibrillation in cardiac arrest.Cardiac arrest management includes cardiopulmonary resuscitation (CPR) and defibrillation of shockable rhythms. CPR should be provided until a defibrillator is applied. In those with pulseless ventricular tachycardia or ventricular fibrillation, defibrillation should be performed as soon as possible. If the arrest is unwitnessed, or there will be a delay in rhythm analysis or applying/obtaining a defibrillator, CPR should be performed while the defibrillator is being obtained and prepared for use. Biphasic waveform defibrillators are recommended. Shorter pre- and peri-shock pauses are associated with higher survival rates. Charging the defibrillator during chest compressions, holding compressions for rhythm analysis alone, and immediately resuming compressions following defibrillation are recommended to maximize chest compression fraction. Two common defibrillator pad configurations include anterolateral (AL) and anterior-posterior (AP). Vector-change defibrillation can be attempted if the first defibrillation attempt is unsuccessful. Double defibrillation (DD) includes either double simultaneous defibrillation (DSD) or dual sequential external defibrillation (DSED), though DSED is more common. DD utilizes two biphasic defibrillators and two sets of defibrillator pads in an AL and AP configuration. If the patient is refractory to 3 or more defibrillation attempts, DD may be attempted. Defibrillator damage with DD is rare, and clinicians must consider the potential survival benefit with DD, patient and provider safety issues, cost, and system-level impact when using two defibrillators.An understanding of literature updates focused on defibrillation can improve the ED care of patients in cardiac arrest.Copyright © 2025 Elsevier Inc. All rights reserved.

Wearable devices could be used to continuously monitor vital signs in patients who are hospitalized, but they require validation.

Exercise induces changes in haemostatic parameters and core body temperature (CBT). We aimed to assess whether exercise-induced elevations in CBT induce pro-thrombotic changes in a dose-dependent manner.Observational study.CBT and haemostatic responses were measured in 62 participants of a 15-km road race at baseline and immediately after finishing. As haemostasis assays are routinely performed at 37°C, we corrected the assay temperature for the individual's actual CBT at baseline and finish in a subgroup of n=25.All subjects (44±11 years, 69% male) completed the race at a speed of 12.1±1.8km/h. CBT increased significantly from 37.6±0.4°C to 39.4±0.8°C (p<0.001). Post-exercise, haemostatic activity was increased, as expressed by accelerated thrombin generation and an attenuated plasmin response. Synchronizing assay temperature to the subjects' actual CBT resulted in additional differences and stronger acceleration of thrombin generation parameters.This study demonstrates that exercise induces a prothrombotic state, which might be partially dependent on the magnitude of the exercise-induced CBT rise. Synchronizing the assay temperature to approximate the subject's CBT is essential to obtain more accurate insight in the haemostatic balance during thermoregulatory challenging situations. Finally, this study shows that short-lasting exposure to a CBT of 41.2°C does not result in clinical symptoms of severe coagulation. We therefore hypothesize that prolonged exposure to a high CBT or an individual-specific CBT threshold needs to be exceeded before derailment of the haemostatic balance occurs.Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

According to the Swiss hypothermia clinical staging, patients with stage III are unconscious with preserved vital signs, with core temperature usually between 24° and 28°C. With stage IV, vital signs are absent with core temperature <24°C.To describe a patient presenting with HT stage III with vital signs but a core temperature of <24°C, and to search for similar patients in the medical literature.MEDLINE was used to search for cases of deep accidental hypothermia (<24°C) and preserved vital signs.We found 22 cases in addition to our case (n=23). Median age was 44 years (IQR 36; range 4-83) and median core temperature 22°C (IQR 1.7; 17-23.8). Vital signs were often minimal. Seven patients developed ventricular fibrillation (VF). Twenty patients survived with excellent neurological outcome.Vital signs can be present in hypothermic patients with core temperature <24°C. In deeply hypothermic patients, a careful check and prolonged check of vital functions should be made, as vital signs may be minimal. The clinical Swiss staging remains valuable in the prehospital evaluation of hypothermic patients; its correlation with core temperature should be better defined.

The American Diabetes Association (ADA) “Standards of Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee for Diabetes, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Severe trauma represents a major global public health burden and the management of post-traumatic bleeding continues to challenge healthcare systems around the world. Post-traumatic bleeding and associated traumatic coagulopathy remain leading causes of potentially preventable multiorgan failure and death if not diagnosed and managed in an appropriate and timely manner. This sixth edition of the European guideline on the management of major bleeding and coagulopathy following traumatic injury aims to advise clinicians who care for the bleeding trauma patient during the initial diagnostic and therapeutic phases of patient management.

A specific magnesium level is essential to be maintained to ensure appropriate neuromuscular excitability and cardiac function; an increase or decrease in its levels usually leads to critical abnormality. Hypomagnesemia in critically ill patients has many potential ramifications and is found to be an important factor in hindering their recovery. Thus, the study aimed to assess the serum magnesium levels in critically ill participants and explore its effect on their condition.A prospective observational study was conducted for 21 months, from February 2019 to October 2020, among all critically ill participants admitted to the medical intensive care unit (ICU) of a tertiary care hospital. The Acute Physiology and Chronic Health Evaluation II score questionnaire was used to determine the severity of their condition and blood samples were collected within 24 h of their ICU admission for analysis.One hundred participants were enrolled, of which 40% were between the age group of 46 and 65 years and 71% were males. Among all participants with hypomagnesemia, 52% were diabetic, 19% had a history of alcohol use disorder, and 27% had normal calcium and potassium levels. Hypomagnesemia significantly correlated with a longer duration of ICU stay among participants.A significant correlation was observed between hypomagnesemia and increased ICU length of stay and mortality but not the duration of mechanical ventilation. Monitoring and appropriate supplementation of serum magnesium is recommended to limit further comorbidity and mortality in the critical care setting.Copyright: © 2023 International Journal of Critical Illness and Injury Science.

The optimal strategy for hemodynamic resuscitation in early septic shock remains uncertain.

The 2024 revised edition of the Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock (J-SSCG 2024) is published by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine. This is the fourth revision since the first edition was published in 2012. The purpose of the guidelines is to assist healthcare providers in making appropriate decisions in the treatment of sepsis and septic shock, leading to improved patient outcomes. We aimed to create guidelines that are easy to understand and use for physicians who recognize sepsis and provide initial management, specialized physicians who take over the treatment, and multidisciplinary healthcare providers, including nurses, physical therapists, clinical engineers, and pharmacists. The J-SSCG 2024 covers the following nine areas: diagnosis of sepsis and source control, antimicrobial therapy, initial resuscitation, blood purification, disseminated intravascular coagulation, adjunctive therapy, post-intensive care syndrome, patient and family care, and pediatrics. In these areas, we extracted 78 important clinical issues. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) method was adopted for making recommendations, and the modified Delphi method was used to determine recommendations by voting from all committee members. As a result, 42 GRADE-based recommendations, 7 good practice statements, and 22 information-to-background questions were created as responses to clinical questions. We also described 12 future research questions.© 2025. The Author(s).

Sepsis is a life-threatening, dysregulated host response to infection. Immunosuppression is a risk factor for infections and sepsis. However, the specific immune derangements elevating the risk for infections and sepsis remain unclear in the individual patient, raising the question of whether a general state of immunosuppression exists. In this Review, we explore the relationship between immunosuppression and sepsis, detailing the definitions, causes, and clinical implications. We address the effect of primary immunodeficiencies, acquired conditions, and drugs on the risk of infection and the development of sepsis. Patients with sepsis who are immunocompromised often present with atypical symptoms and diagnostic test results can differ, making early recognition difficult. Future perspectives entail novel biomarkers to improve early sepsis detection and tailored treatments to modulate immune function. Including patients who are immunocompromised in clinical trials is crucial to enhance the relevance of research findings and improve treatment strategies for this vulnerable population.Copyright© 2025 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.