John Gerard Laffey

Objectives: To critically evaluate the comparative effects of open or flexible family presence policies vs. restricted or traditional family presence policies on the occurrence of delirium and other major outcomes among adult patients admitted to ICUs. Data Sources: We conducted a comprehensive electronic search of MEDLINE, Embase, Scopus, Web of Science, CINAHL, and the Cochrane Central Register of Controlled Trials from inception to November 21, 2025. Study Selection: We included randomized controlled trials (RCTs) comparing open or flexible vs. restricted ICU visiting policies in adult patients. Data Extraction: The primary outcome extracted was delirium occurrence. Secondary outcomes included the duration of invasive mechanical ventilation (IMV), ICU length of stay, hospital-acquired infections, and ICU mortality. Data Synthesis: Thirteen RCTs comprising 3861 patients were included. Random-effects models showed that compared with restricted policies, open/flexible family presence reduced delirium occurrence (risk ratio [RR], 0.48; 95% CI, 0.29–0.81; low certainty) and IMV duration (mean difference [MD], –0.36 d; 95% CI, –0.46 to –0.26 d; low certainty). The intervention did not affect the ICU length of stay (MD, 4.21 d; 95% CI, –4.65 to 13.07 d; very low certainty), the rates of hospital-acquired infections (RR, 1.00; 95% CI, 0.81–1.23; low certainty), or ICU mortality (RR, 0.88; 95% CI, 0.72–1.08; very low certainty). Conclusions: Open/flexible ICU family presence may reduce delirium and shorten the duration of IMV slightly, without increasing infections or ICU mortality, although the certainty of evidence is low and heterogeneity remains substantial.

This observational study of a combined cohort of patients with acute respiratory distress syndrome assessed the association of the novel concept of chemical power, a surrogate marker of oxygen exposure intensity, with mortality and its relative weight in this association when compared with mechanical power. Chemical power and mechanical power were independently associated with mortality. An interaction between these powers was not observed. Future experimental studies should aim to validate and optimize this novel concept.

Mesenchymal stromal cells (MSCs) have shown immunomodulatory effects and great promise in many inflammatory diseases such as acute respiratory distress syndrome (ARDS). However, several barriers to translation remain such as cell availability and potency. This study evaluates the therapeutic potentials of three types of MSCs, bone marrow-derived MSCs (BM-MSC), the human induced pluripotent stem cell-derived MSC wild type (iMSC WT) and β2 microglobulin-knockout iMSCs (iMSC B2M KO) with or without proinflammatory cytokine preconditioning. BM-MSC, iMSC WT and iMSC B2M KO were preconditioned with a proinflammatory cytokine cocktail (Cytomix: IL-1β, IFN-γ and TNF-α). Immunoregulatory biomarkers were analysed by flow cytometry and cytokines released by ELISA. MSC antimicrobial properties were analysed via CFU assays while the MSCs’ immunomodulatory effects were evaluated using macrophage activation and T cell proliferation assays. Proinflammatory cytokine preconditioning enhanced the therapeutic potency of all three types of MSCs by increasing immunomodulatory marker expression, enhancing the antimicrobial effects and improving MSC-mediated inhibition of T cell proliferation. These findings provided new insights into the therapeutic potencies of MSCs in inflammation. Further studies are required for in vitro characterisation of the MSCs and in vivo efficacy verification of these MSCs prior to their clinical application.

Acute respiratory distress syndrome (ARDS) is a heterogeneous clinical syndrome rather than a single disease. Patients who meet the same diagnostic criteria may differ in lung morphology, mechanical properties, biological injury, and clinical course. Current classifications rely largely on the severity of hypoxemia and do not capture this variability, limiting prognostic stratification and individualized treatment. This heterogeneity has clinical consequences. Supportive interventions such as positive end-expiratory pressure (PEEP), prone positioning, and recruitment maneuvers are broadly applied, yet their effects vary substantially among patients. Increasing evidence indicates that these differences are partly explained by variation in lung structure, regional aeration, recruitability, and perfusion. Recent international guidelines have identified phenotyping as a priority in ARDS and have highlighted lung morphology as a relevant source of prognostic enrichment and treatment effect heterogeneity. Computed tomography (CT) provides regional, three-dimensional information on lung injury that is not accessible through bedside physiological measurements. It allows evaluation of aeration loss, lung density, lung weight, and perfusion abnormalities. CT has been used to describe key aspects of lung injury in ARDS and to identify imaging patterns associated with lung mechanics, gas exchange, and response to ventilatory settings. Quantitative and dual-energy CT, together with computational methods, allow a more detailed description of these patterns. This review examines the role of CT in characterizing heterogeneity in ARDS, summarizes qualitative, semi-quantitative, and quantitative approaches, and discusses their clinical relevance and limitations, as well as future directions.

Introduction: More than 300 million major surgical procedures are carried out under general anaesthesia each year worldwide, and advanced airway management remains one of the leading daily challenges for clinicians. Data from large international prospective cohort studies on adverse events such as cardiovascular collapse, cardiac arrest and severe hypoxaemia during advanced airway management to facilitate anaesthesia are lacking. Methods and analysis: The International ob S ervational s T udy on A i R way mana G ement in oper A ting room and non-opera T ing room ana E sthesia (STARGATE) study will be an international prospective observational cohort study describing the incidence of major adverse events associated with advanced airway management (tracheal intubation or supraglottic airway device placement) for general anaesthesia in the operating and non-operating room for surgery and medical procedures. The secondary aim will be to describe the practice of airway management in a large international cohort. Critically ill patients will be excluded from this study. Data on patients’ characteristics, type of procedure and the adopted airway management strategy, post-procedure adverse events, operator characteristics and in-hospital mortality will be prospectively collected. The study aims to enrol 10 500 patients. Ethics and dissemination: The study has been approved by the Ethics Committee of the coordinating centre (Comitato Etico Interaziendale AOU San Luigi Gonzaga, N° 25/2023). Each of the participating centres will then seek approval of their local Ethics Committee before enrolment. Data will be disseminated to the scientific community by original articles submitted to international peer-reviewed journals. Trial registration number: NCT05759299 .

Background: Modern pacemakers incorporate a magnet‐responsive switch that, on exposure to a sufficient static magnetic field, converts the device to fixed‐rate asynchronous (magnet‐mode) pacing. This is designed behaviour rather than malfunction. Interactions between this feature and magnet‐containing medical equipment are underrecognised. The PICO 7 negative pressure wound therapy (NPWT) system contains a magnet in its pump unit, which the manufacturer states can interfere with nearby pacemakers. Case Presentation: An 81‐year‐old man was admitted to the High Dependency Unit after right hemicolectomy. He had atrial fibrillation with a slow ventricular response and a permanent pacemaker programmed VVI at 60 beats per minute. Overnight, telemetry showed a sustained paced rate of 100 beats per minute; he was asymptomatic. The PICO 7 pump unit was found resting on his chest, over the pacemaker generator. Repositioning the pump to the foot of the bed returned the paced rate to 60 beats per minute immediately, and device interrogation the following day confirmed normal pacemaker function. Discussion: The fixed rate of 100 beats per minute, its dependence on pump position and immediate resolution on removal are characteristic of magnet‐mode activation rather than generic electromagnetic interference. Although the patient was asymptomatic, a sustained rate of 100 beats per minute carried a risk of myocardial ischaemia and heart failure decompensation given his cardiac history. Recognition and a simple bedside intervention resolved the episode. Conclusion: Magnet‐containing medical equipment placed near a cardiac implantable electronic device can trigger magnet‐mode pacing. The risk depends on the position of the magnet‐bearing component, not on the wound site. An unexplained change in a paced rate should prompt early consideration of a nearby magnetic source, because the remedy may be immediate and at the bedside.