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Introduction: Dexmedetomidine (DEX) use in children receiving noninvasive ventilation such as BiPAP and CPAP has been reported to be effective for achieving patient tolerance of the interface. DEX use in HFNC has not been described though it is anecdotally used with the thought that it helps alleviate anxiety and agitation impeding effective respiratory effort. Our primary aim was to describe the use of DEX in children with bronchiolitis requiring HFNC. Our secondary objective was to compare characteristics and outcomes between patients who received DEX to those that did not. Methods: We performed a single center, retrospective cohort study using the Virtual Pediatric Systems (VPS) database from 2018-2024. All patients admitted to our pediatric intensive care unit with a diagnosis of bronchiolitis and requiring the use of HFNC were included. Univariate analyses were performed to compare characteristics and outcomes between patients who received DEX and those that did not. Significant factors identified in the univariate analyses were used in multivariate analyses to confirm the independent associations with the use of DEX. Results: Among 1,756 children admitted to the PICU with bronchiolitis, 699 (39.8%) received DEX. The DEX group had a higher proportion of male patients (63.3% vs. 55.5%, p=0.002) and more frequent diagnoses of bronchiolitis due to RSV (70.3% vs. 44.8%, p< 0.001). PRISM III risk of mortality was slightly higher in the DEX group (median 0.56 vs. 0.51, p< 0.001). Use of DEX was associated with increased rate of escalation from HFNC to NIPPV (6.3% vs. 3.5%, p=0.01) and from HFNC to IMV (7.4% vs. 4.3%, p=0.02). PICU length of stay was slightly longer in the DEX group (median 2.51 vs. 2.13 days, p< 0.001), though hospital LOS was not significantly different. Logistic regression adjusting for age, sex, and PRISM III risk of mortality showed that DEX use was associated with increased odds of escalation from HFNC to NIPPV (adjusted OR 1.77, 95% CI 1.10–2.85), and from HFNC to IMV (adjusted OR 1.77, 95% CI 1.15–2.74). Conclusions: Our findings show that DEX use was associated with increased escalation of respiratory support. Future work, including multicenter analyses, is necessary to further characterize the role of DEX in escalation of respiratory support in children with bronchiolitis.

Hospitalized patients with asthma or COPD typically receive respiratory medications via inhalers (pressurized metered dose inhalers, dry powder inhalers, or soft mist inhalers) or nebulizers. Because in-hospital use of inhalers may be complicated by required interchanges from nonformulary home inhalers to inpatient formulary inhalers, clinician or patient errors in administration, unclear dosage received, wasted drug, misplaced devices, and increased costs, switching from the use of inhalers to an all-nebulization strategy may streamline processes and improve outcomes. As respiratory therapists and hospital pharmacists, we have had experience with making this switch in different types and sizes of hospital systems. Despite the challenges we encountered, each of our approaches to implement an all-nebulization protocol was ultimately successful. In this article, we summarize our learnings during the operationalization of all-nebulization protocols, describe the benefits we observed post-implementation, and provide recommendations including detailed guidance for how to implement this type of switch successfully.

BackgroundHealthcare workers frequently experience significant levels of stress impacting wellbeing and performance. A previous single site study showed multisensory, naturalistic “Recharge Rooms” were associated with a self-reported improvement in stress across healthcare workers. Subsequently, rooms were constructed at multiple hospitals across the country to assess their effects in a multi-site study.ObjectivesTo investigate the association between the Recharge Rooms and self-reported stress levels, alertness, and mood of healthcare workers in multiple health centers.MethodsUnderutilized spaces across 18 US hospitals were converted into Recharge Rooms using video projections of nature landscapes, silk imitation plants, essential oil diffusers, low lighting, music, and nature sounds to create an immersive atmosphere. Healthcare staff had 24/7 access to the rooms. Stress, hopefulness, and alertness were assessed pre- and post-experience on a 0–100 scale with 100 representing “extreme” and 0 being “not at all.”ResultsOf 739 healthcare workers who scheduled time in the rooms, 563 (76%) completed the survey. Average self-reported stress scores decreased from 63.2 to 25.8 (59.1% reduction, p < 0.0001). In addition, the average self-reported hopefulness and alertness increased by 29.6% and 35.1% after a session, respectively (p < 0.0001).DiscussionThe Recharge Rooms were well-received and associated with immediate, self-reported reductions in perceived stress. The self-reported improvement in perceived stress, mood, and alertness were promising results of this multisite, survey-based evaluation of the technology. Controlled trials using validated instruments are necessary to confirm these findings, assess long-term outcomes, and to better understand the physiological effects of this employee wellness intervention.

Background: Patients with acute myocardial infarction (AMI) who experience in-hospital heart failure (HF) would present a higher risk for fatal events. This study aims to develop and validate a simple-to-use diagnostic nomogram to identify high-risk individuals for in-hospital HF in patients with AMI. Methods: Using data from CCC-ACS (Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome) project (2014–2019), this study included 74,697 patients with ST elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI) who admitted within 24 h after symptom onset, without HF, cardiac arrest, or cardiac shock at admission. Independent predictors were identified through univariate logistic regression analyses and least absolute shrinkage and selection operator (LASSO) regression. A nomogram was subsequently constructed based on multivariate logistic regression. The model’s performance was evaluated by its discrimination and calibration, assessed using Harrell’s C-index and calibration curves with Hosmer–Lemeshow goodness-of-fit tests, respectively. Results: Six predictors were selected for the final nomogram, including age, heart rate, history of atrial fibrillation, history of chronic obstructive pulmonary disease, history of chronic HF, and history of chronic kidney disease. The nomogram demonstrated a C-index of 0.68 (95% CI: 0.66–0.69) in the training cohort and 0.67 (95% CI: 0.66–0.69) in the validation cohort. The calibration curves of the nomogram showed a strong calibration, as Hosmer–Lemeshow goodness-of-fit tests yielded chi-squares of 11.00 (p = 0.21) and 8.48 (p = 0.39) for the training and validation cohort, respectively. Conclusions: This simple-to-use nomogram for effectively predicting the risk for in-hospital HF may be used as a helpful tool in clinical decision-making during treatment and management in patients with AMI.

BackgroundCSF and blood soluble TREM2 (sTREM2) levels have been found to increase at early stage of Alzheimer's disease (AD). The relationships between sTREM2, AD-related biomarkers, and other neuroinflammation biomarkers remain unclear. Moreover, the impact of rare variants in TREM2 gene (R47H/R62H), which are associated with increased risk of AD, on plasma sTREM2 has not been elucidated.ObjectiveInvestigate the association of plasma sTREM2 levels with brain amyloid-β (Aβ) load and AD-related blood biomarkers, i.e., phosphorylated tau (pTau)-181, pTau-231, GFAP, NFL, and other neuroinflammation and peripheral inflammation markers in cognitively normal (CN) older adults at risk of AD (CN Aβ+) compared to CN Aβ-, including the effect of AD-linked TREM2 rare variants.MethodsPlasma sTREM2 concentrations were measured by MesoScale Discovery (MSD) assay from the KARVIAH cohort. Participants underwent cognitive tests and PET amyloid imaging. Genetic data and blood biomarkers were included for correlation analysis. Associations with plasma sTREM2 were investigated upon stratification by PET-Aβ load SUVR ((CN Aβ- (n = 65) and CN Aβ+ (n = 35)) as the main analysis. A subgroup analysis based on the TREM2 R47H and R62H genotype was conducted as exploratory analysis.ResultsPlasma sTREM2 positively correlated with plasma pTau181, and pTau231 in CN Aβ+ group. Plasma sTREM2 positively correlated with serum microglial kynurenine pathway metabolites. Plasma sTREM2 and brain Aβ load were higher in R47H TREM2 carriers compared to non-carriers.ConclusionsOur findings suggest plasma sTREM2 relates to downstream tau processes in amyloid-positive individuals, providing novel insights into the roles of peripheral TREM2 signaling that reflects microglial activity in early AD neuropathological development.