Conectar
To explore surrogate decision-making practices regarding end-of-life care for people with dementia in Korean long-term care hospitals from the perspective of healthcare providers.
A qualitative descriptive study.
The data were collected through individual semi-structured interviews with 24 healthcare providers (physicians, oriental medicine doctors, registered nurses and social workers) involved in dementia end-of-life care in their current long-term care hospitals in South Korea. The data were analysed using a conventional content analytic technique.
The analysis yielded three categories and nine subcategories describing surrogate decision-making practices regarding end-of-life care for people with dementia: (a) typical circumstances of end-of-life care planning, (b) expected roles of key personnel and related challenges and (c) important considerations. Participants discussed available treatment options within long-term care hospitals and the potential transfers to acute care hospitals during admission and periods of health decline. Physicians typically led such end-of-life care planning, with nurses playing a supportive role and family members making the final decisions. However, they faced challenges in performing their roles. In end-of-life care discussions, participants weighed the patients' autonomy and best interests alongside family members' interests and other external concerns such as potential lawsuits and insufficient medical resources.
Surrogate decision-making regarding end-of-life care in the context of dementia within long-term care hospitals is considerably complex and challenging for healthcare providers, requiring multifaceted institution-sensitive support.
The study findings suggest the need for targeted education and training to enhance healthcare providers' competencies in end-of-life care discussions, advance care planning and the development of policies and regulations supporting end-of-life care-related practices within long-term care hospitals.
This study was reported in accordance with the COREQ checklist.
No patient or public contribution.
To identify and evaluate conceptual frameworks for studying neighbourhood deprivation and access to cancer services in nursing research.
Discussion paper.
We searched the literature to identify conceptual models used in peer-reviewed articles that examined neighbourhood-level factors influencing access to cancer services. As a first step in the evaluation, the Theories, Models and Frameworks Comparison and Selection Tool (TCaST) was used to assess the rigour and applicability of eligible models. The two models with the highest TCaST scores were then further evaluated using Fawcett and DeSanto-Madeya's 2013 criteria.
A total of 546 articles were screened after searching PubMed, EBSCO Cumulated Index to Nursing and Allied Health Literature and Elsevier Co. Scopus from 2014 to 2025.
Of eight eligible models, two met the criteria for further analysis. Revision 6 of Andersen's Behavioral Model (ABM) includes the full nursing metaparadigm and has been widely applied. It is logically and socially congruent, offers testable hypotheses and holds global significance. However, full utility requires familiarity with its unique vocabulary. The Concept of Access Model also demonstrates congruence, testable hypotheses and has greater parsimony than ABM, but its omission of the health metaparadigm limits its application in nursing research.
ABM most comprehensively provides clear and measurable concepts for neighbourhoods as well as realised, effective and equitable access for nursing research. It also supports the identification of highly mutable factors for clinical and policy intervention.
Nurses can play a central role in applying frameworks to ensure research aligns with the holistic nature of profession values, captures contextual realities of patients and informs equitable care delivery.
Neighbourhood deprivation continues to drive disparities in cancer care, making it a pressing research priority. This evaluation equips nurses with a clear conceptual foundation to study access inequities and support actionable cancer care solutions.
There are no relevant EQUATOR guidelines for this discursive paper.
This study did not include patient or public involvement in its design, conduct or reporting.
To co-design an information booklet to support adults living with a peripherally inserted central catheter (PICC) at home.
A sequential, mixed-method approach using Boyd's co-design framework.
A diverse project team led co-design of a PICC booklet based on preferences and PICC management strategies identified through content analysis of interviews with 15 Australian health consumers (January 2022–March 2023) using a qualitative descriptive approach. A draft booklet was developed, reviewed by the team and prototyped, which was evaluated by consumer participants and an external nurse panel, with readability assessed using Flesch Reading Ease and Flesch–Kincaid scores. The project team reviewed feedback, reached consensus on changes and collaborated with designers to produce the final booklet.
Consumer participant strategies were classified into four categories: enhancing coping, taking responsibility and understanding information, modifying life and accessing supports. Two pre-determined categories were included (participant recommendations for PICC education resource content and top tips for living with a PICC). The prototype was evaluated as highly relevant (3.9/4), comprehensive (3.8/4) with an appropriate writing style and visual appeal. Readability scores were 76.1/100 (Flesch Reading Ease) and 6.9 (Flesch–Kincaid grade level). The final booklet contained 13 sections.
A co-design approach successfully created a novel PICC information booklet with positive evaluations.
Provides understanding of consumer information preferences to inform PICC education and offers insight into consumer-developed strategies and knowledge for living with a PICC.
A co-designed PICC information booklet based on consumer knowledge may augment nursing education for people living with a PICC to improve outcomes.
The qualitative component follows the EQUATOR network COREQ guideline. A co-design research reporting standard is not available.
A consumer representative was a member of the project team and contributed to study design, interpretation of findings and development of the booklet and manuscript.
To synthesise evidence from qualitative studies on community-dwelling older adults' experiences of social interactions in group interaction programmes.
A systematic review and meta-synthesis based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines.
Two independent researchers screened the titles and abstracts of all retrieved studies based on eligibility criteria. Quality appraisal was conducted based on the comprehensive Critical Appraisal Skills Programme checklist. Data were extracted through an adapted Data Extraction Tool from the Joanna Briggs Institute Qualitative Assessment and Instrument. Findings were synthesised through the JBI meta-aggregation approach.
A literature search for peer-reviewed studies was conducted across seven databases from inception to September 2023.
Our review included the experiences of 395 community-dwelling older adults across 25 studies, yielding the overarching theme of ‘Navigating relationships and facilitating growth in a supportive community’. Five themes were identified: feeling safe in a familiar environment, bringing people together, establishing meaningful relationships, improving personal well-being and facing socialising challenges.
Our findings provided not just theoretical insights but also practical implications. They can serve as a solid foundation for formulating or enhancing similar programmes, directly addressing the pervasive issues of loneliness and social isolation among the ageing population worldwide.
This review improves our understanding of the social, emotional and personal benefits for older adults upon engaging in group interaction programmes. The insights into the elements of successful group interaction programmes for older adults, include providing a safe and familiar setting and bringing people together for socialisation. Future interventions should incorporate these elements to promote social interactions and community engagement more effectively to mitigate loneliness among older adults. Finally, the diverse range of programmes explored in this review demonstrates that future programmes can be flexibly formulated to suit different interests.
The authors have nothing to report.
The review protocol has been registered on PROSPERO.
Turnover intention among nurses is a well-established predictor of actual turnover. Despite the critical nursing shortages during COVID-19, the relative contributions of individual and organisational factors to increased turnover intention remain insufficiently understood.
This study aimed to identify the determinants of turnover intention among clinical nurses at both individual and organisational levels and to evaluate the independent effects of these factors in infectious situations.
This study conducted a secondary analysis of cross-sectional data collected in Hong Kong between April 2020 and September 2021.
A convenience sample of 188 Chinese registered nurses in Hong Kong was recruited. The survey assessed questions on demographic, organisational and workplace violence-related characteristics, the Post-Traumatic Stress Disorder Checklist-Civilian Version, the Brief Coping Orientation to Problems Experienced Inventory and the Anticipated Turnover Scale. Univariable and structured multi-phase linear regression analyses were performed to identify associated factors and to evaluate the influence of individual- and organisational-level factors. The study followed the STROBE checklist for reporting cross-sectional studies.
The regression model, incorporating individual- and organisational-level factors, explained 22.68% of the variance in turnover intention. Individual-level factors associated with increased turnover intention included younger age, high levels of post-traumatic stress symptoms and low use of accommodation coping strategies. Organisational-level factors included exposure to workplace violence and insufficient support for reporting such incidents.
This study underscores the significance of minimising workplace violence and enhancing workplace safety, in addition to addressing individual-level factors, to reduce nurses' turnover intention—particularly in the context of future pandemics and epidemics.
These findings provide insights into the factors influencing clinical nurses' turnover intention, supporting the development and implementation of targeted clinical protocols and regulations to address modifiable factors and promote a sustainable nursing workforce.
No patient or public contribution.
To classify the unmet integrated care needs of older adults with multimorbidity and to explore the factors associated with different categories of unmet integrated care needs among the target population.
A cross-sectional survey using the statistical method of latent profile analysis.
From July 2022 to March 2023, 397 older adults with multimorbidity, aged 60 years or older, were recruited from one primary healthcare setting and from four secondary and tertiary hospitals to participate in face-to-face questionnaire surveys. The questionnaire used in this study to assess unmet integrated care needs among older adults with multimorbidity was self-designed through a series of steps, including a scoping review, expert consultation and cognitive interviews. Latent profile analysis was applied to uncover distinct profiles of unmet integrated care needs, and multinomial logistic regression was employed to explore whether the profiles were further distinguished by participants' sociodemographic and health-related covariates. The data were analysed using IBM SPSS v.29.0 and Mplus v.8.0.
The optimal solution was a four-profile model, characterised by high unmet integration needs, high unmet system integration needs, low unmet system integration needs and low unmet integration needs, respectively. Multinomial logistic regression results indicated that profile differences were associated with place of residence, number of coresidents and the presence or absence of complex multimorbidity.
The integrated care needs of older adults with multimorbidity have not yet been fully met. Classifying and characterising unmet integrated care needs profiles is a crucial step in the rational allocation of integrated care resources.
This study was reported based on the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) for cross-sectional studies.
All participants were older adults with multimorbidity, and they were informed that they could withdraw from the study at any time.
Digital Creative Art Interventions (DCAIs) are innovative approaches to art interventions using digital technology, which can improve older adults' health. However, a comprehensive summary of the implementation of this intervention among older adults is lacking.
To summarise the deliveries and categories of DCAIs, review their feasibility and roles in older adults' healthcare, and explore the barriers and facilitators to implementing DCAIs in older adults.
Scoping review.
This scoping review followed Arksey and O'Malley's framework, and PRISMA-ScR was used to guide the report.
PubMed, Embase, EBSCOhost, Web of Science and Cochrane Library on 26 February 2024.
Thirty-one studies were selected in this review. We summarised the deliveries and categories of DCAIs in older adults. Besides, we cleared DCAIs to offer music, dance, museum, photo collage, drama, visual art interaction and mixed art intervention to older adults, primarily through videoconferencing or mobile applications. The five health promotion roles were physiological health enhancer, psychological caregiver, socialisation supporter, cognitive promoter and life optimiser. Most older adults believed DCAIs were not only feasible and acceptable, but they also met some barriers such as technological problems, problems brought about by older adults' decline in functioning, experience and privacy.
Despite the unique advantages of DCAIs, continuous improvements are needed. In the future, researchers and healthcare workers should focus on platform improvements, increasing interactivity, diversifying formats and ensuring security and privacy.
This review found that DCAIs offered new approaches to treatment options for older adults' physical and mental health. Therefore, it is recommended that they be continuously optimised and put into clinical practice.
No patient or public contribution.
This study summarised the DCAIs and provides the new approach for health promotion in older adults.
OSF (https://osf.io/m62x9/, registration DOI: https://doi.org/10.17605/OSF.IO/4ZGE6)
To explore the perspectives of community-dwelling older adults with sarcopenia on exercise engagement and adherence.
Sarcopenia is prevalent among community-dwelling older adults and is associated with a wide range of adverse health outcomes. Encouragingly, it is a treatable and potentially reversible condition through exercise interventions. However, studies on this population's views on exercise are scant, thus limiting the design and delivery of tailored, sustainable exercise interventions in primary care.
A descriptive qualitative study.
Data were collected through semistructured interviews with 27 community-dwelling older adults with sarcopenia from four community care centres in China between October 2023 and February 2024. The data were analysed using thematic analysis.
Four main themes with their respective subthemes were identified from the data analysis and described as: (1) limited capability to identify and engage in appropriate exercise; (2) various motivations influenced by personal values, resilience and habits; (3) exercise behaviour shaped by environmental and social factors; (4) expectations for community-based exercise programmes.
Older adults with sarcopenia often misbelieve muscle issues to be normal ageing, leaving their condition undiagnosed and unmanaged. Limited information about appropriate exercises leads them to engage in simple, unstructured activities. Motivation levels and contextual factors influence their exercise engagement and adherence. Nurse-led tailored, evidence-based and group-based programmes, complemented by home-based exercise resources, are needed to address challenges and support long-term adherence.
This study provides new insights into the perspectives, challenges and expectations of exercise in this specific population. Findings inform nurse-led exercise programmes in primary care that meet the needs and preferences of this population.
This study follows the Consolidated Criteria for Reporting Qualitative Studies.
Participant interviews offered valuable perspectives on exercise engagement and adherence.
by Deye Ge, Liyan Wu, Jingrong Yang, Jingxian Sun, Jinying Wang, Jingxin Wang, Huihui Song, Ran Wei, Zecheng Xu, Binbin Zhao, Rongfei Sun, Yifei Wang
The U.S. Food and Drug Administration (FDA) approved intravenous edaravone for the treatment of amyotrophic lateral sclerosis (ALS) in 2017, followed by the approval of the oral formulation in 2022. This study aims to utilize the FDA#39;s Adverse Event Reporting System (FAERS) to investigate the spectrum and timing of adverse events (AEs) associated with edaravone administration, employing repeatability analysis, the Reporting Odds Ratio (ROR) approach, Weibull distribution, and stratification methods. The investigation focuses on data collected from the first quarter of 2017 through the fourth quarter of 2024, aiming to identify adverse event signals and their temporal patterns related to both intravenous and oral edaravone administration. In total, 3,262 records of edaravone-related adverse reactions were identified; among these, 1,534 incidents were associated with intravenous administration, while 453 incidents pertained to oral administration. The analysis revealed distinct adverse reaction profiles for the two routes of administration. Notably, the spectrum of adverse reactions resulting from oral administration predominantly involved the respiratory system, digestive system, and skin damage. In contrast, intravenous administration was more frequently linked to complications associated with invasive procedures and local tissue damage. Furthermore, the timing of adverse reactions exhibited significant variability between the two routes. Weibull distribution analysis indicated that the median onset time for adverse reactions following intravenous administration was 35 days, whereas for oral administration, it was 27 days. Both analytical approaches identified early failure signals, suggesting that the risk of adverse events diminishes over time.
This study aimed to evaluate the efficacy of advanced optimal pulse technology (AOPT) combined with collagen dressings on facial flushing and skin barrier function in patients with rosacea. A total of 150 patients with rosacea were prospectively enrolled and randomised into the control group (n = 75, received AOPT treatment alone) and observation group (n = 75, additionally used recombinant human type III collagen dressing). Clinical improvement, erythema and lesion features were recorded before and 12 weeks after therapy. Patient quality of life was measured using the Acne-QOL scale. Skin barrier function was evaluated by transepidermal water loss (TEWL), sebum output and epidermal hydration. Serum inflammatory markers were analysed, and adverse reactions and recurrence were also tracked. Following 12 weeks of treatment, compared to the control group, the observation group showed higher overall effectiveness, greater reduction in erythema, lesion severity and pain scores, higher Acne-QOL scores across all dimensions (self-perception, emotional well-being, symptom burden and social function), lower TEWL and sebum secretion, higher hydration and lower levels of TNF-α, hs-CRP and PCT (all p < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups (2.67% vs. 6.67%, p = 0.246), but the observation group had a lower recurrence rate (2.67% vs. 14.67%, p = 0.009). The combination of AOPT with collagen dressing offers superior benefits over AOPT alone, alleviating facial flushing, strengthening the skin barrier, decreasing systemic inflammation and reducing relapse, highlighting its clinical value in rosacea management.
Chronic wounds, including Diabetic Foot Ulcers (DFUs), Venous Leg Ulcers (VLUs) and Pressure Ulcers (PUs), present significant challenges for the patients, clinicians and healthcare systems. There remains a strong need for novel and effective technologies to accelerate the healing of these wounds. The objective of this prospective, single-arm pilot study was to evaluate the clinical performance of a novel nanofiber wound matrix for the treatment of chronic lower extremity wounds refractory to standard-of-care treatment at a single centre. A total of 15 patients with 15 chronic wounds (5 DFUs, 8 VLUs and 2 PUs) were included in this study. These wounds were non-healing to previous standard-of-care treatments for an average of 4 weeks. They were all treated with the novel nanofiber wound matrix with weekly clinical evaluation and re-application for a total duration of four (4) weeks, per the study protocol. The average wound area reduction (WAR) was 83.6% upon 4 weeks of treatment with the application of the subject wound matrix, as an adjunctive measure to the standard of care. Additionally, seven (7) of the 15 wounds (46.7%) completely healed starting from Week 3, and the average complete healing time was 13.9 days. These results demonstrated accelerated healing effects of the subject wound matrix, when compared to the standard of care reported in literature, where the average WAR was at 62.9% at Week 12, six (6) of the 18 wounds (33.3%) were completely healed within 12 weeks, and the average complete healing time was 49.0 days. These results demonstrated that the subject wound matrix is a safe and effective novel technology in treating chronic wounds, providing significant clinical and economic benefits for patients with various chronic wounds.
by Meirong Shan, Qian Guo, Ruofei Li, Ni Li, Yanhua Fu, Huanyu Qi, Ge Zhang, Qian Wang, Xingli Xu, Jinchuan Lai
Hypertension is one of the main causes of cardiovascular diseases worldwide, affecting over one billion people. Although aliskiren offers a valuable option for inhibiting the renin-angiotensin system, its safety profile in the real world remains insufficiently explored, especially for rare or under-recognized adverse events (AEs), which have not been fully clarified. Therefore, leveraging large-scale post-marketing surveillance data is crucial for identifying rare AEs and guiding safer clinical practice. This study aims to elucidate pharmacovigilance signals associated with aliskiren (an antihypertensive drug) by systematically analyzing the characteristics of adverse events (AEs) from the U.S. Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) database and WHO-VigiAccess database, which provides a reliable scientific basis for clinical practice and regulatory decision-making. We conducted a retrospective quantitative analysis of aliskiren-related AE reports from the aforementioned two databases, employing the Proportional Reporting Ratio (PRR), Reporting Odds Ratio (ROR), Bayesian Confidence Propagation Neural Network (BCPNN), and Multi-item Gamma Poisson Shrinker (MGPS) algorithms for signal detection. The results indicate that there were 5,596 and 5,549 aliskiren-related reports in the FAERS and WHO-VigiAccess databases, respectively. The median duration of these AEs during the observation period was 62 days, with an interquartile range (IQR) of 7–282 days. In both databases, signals for aliskiren were distributed across 28 System Organ Classes (SOCs), among which investigations, cardiac disorders, renal and urinary disorders, vascular disorders, and metabolism and nutrition disorders exhibited significant signals based on specific criteria applied across the four algorithms. A total of 607 preferred terms (PTs) with significant disproportionality signals were detected using the four algorithms, including potential AEs not previously well-documented, such as palpitations, myalgia, proteinuria, muscular weakness, pulmonary edema, and pollakiuria. This study not only confirms the known adverse reactions of aliskiren but also uncovers new potential risks, highlighting the importance of strengthening drug safety monitoring to enhance therapeutic efficacy and reduce the risk of adverse reactions. It provides valuable safety insights for physicians considering the use of aliskiren in the management of primary hypertension.
Pressure injury (PI) is common in the ICU and not well captured by single-risk tools such as the Braden scale. We aimed to develop and internally validate a machine-learning model to predict new-onset PI using routinely collected ICU data. This retrospective single-centre cohort included adult ICU patients with length of stay ≥ 48 h (2018–2023). The primary outcome was new-onset PI during ICU stay. Candidate predictors were pre-specified: minimum albumin, maximum lactate, SOFA, APACHE II, first recorded Braden score, age, BMI, a nutrition score and treatment indicators. Missing values were imputed (median/mode). A gradient boosting model (GBM) was evaluated with stratified 3-fold cross-validation; a random forest (RF) served as a benchmark (stratified 70/30 train–test split). Discrimination (AUC) was primary; calibration, Brier score, decision-curve analysis (DCA) and feature importance were secondary. Logistic regression quantified independent associations. Among included ICU stays, 14.6% developed PI. On multivariable analysis, higher lactate, lower albumin, lower Braden scores, older age, CRRT, prone positioning, enteral nutrition and analgesic exposure were associated with increased PI risk, whereas sedatives showed an inverse association. The GBM achieved AUC≈0.69 with acceptable calibration and net clinical benefit across thresholds commonly used in preventive workflows (≈0.10–0.50). Single markers or simple combinations displayed only modest discrimination. A GBM built from routine ICU data provided moderate, well-calibrated discrimination for predicting new-onset PI and demonstrated decision-relevant net benefit. The model can complement Braden-based screening by refining risk stratification and prioritising intensified prevention for patients most likely to benefit. External validation and prospective evaluation are warranted.
Oncology nurses are frequently subjected to significant psychological stress due to the demanding nature of cancer care, which negatively impacts their mental and physical health as well as the quality of patient care. Although Mindfulness-Based Stress Reduction has been demonstrated to be effective in alleviating stress, practitioners often encounter barriers such as limited engagement and difficulty maintaining regular practice.
To enhance engagement and adherence, we integrated art elements into the Mindfulness-Based Stress Reduction framework, creating the Mindfulness-Based art therapy program, and evaluated its effectiveness among oncology nurses.
A three-arm randomized controlled trial.
90 oncology nurses participated (Mindfulness-Based Art Therapy group = 30, Mindfulness-Based Stress Reduction group = 30, waitlist controls group = 30) in an 8-week program. Stress, anxiety, depression, fatigue, and mindfulness levels were assessed at baseline, immediately after the fourth week of intervention, and immediately after the intervention concluded. Compliance and satisfaction were evaluated using attendance rates and satisfaction questionnaires. Descriptive statistics were used to analyze general data; intervention effects were compared using one-way ANOVA and generalized estimating equations, and compliance and satisfaction were compared using independent samples t-test.
Both Mindfulness-Based Art Therapy and Mindfulness-Based Stress Reduction significantly improved stress, physiological markers, and mindfulness vs. controls. Mindfulness-Based Stress Reduction better reduced depression (β = −2.980, 95% CI: −5.427, −0.533, p = 0.017), while Mindfulness-Based Art Therapy was superior for fatigue (β = −11.582, 95% CI: −20.615, −2.550, p = 0.012). Mindfulness-Based Art Therapy had higher adherence (93.3% vs. 73.3%, p < 0.05) and satisfaction (3.27 ± 0.45 vs. 2.40 ± 0.52, p = 0.01).
For oncology nurses, Mindfulness-Based Art Therapy is as effective as Mindfulness-Based Stress Reduction for improving stress and mindfulness, while providing greater adherence, satisfaction, and more consistent fatigue reduction.
Chinese Clinical Trial Registry, ChiCTR2300078124 (http://www.chictr.org.cn), 30/11/2023
by Hang Sun, Haozhi Xu, Junying Li, Xiaoman Xie, Junmei Zhang, Hongjie Dong, Huanhuan Xie, Qi Wang, Guihua Zhao, Kun Yin, Jingyu Yang, Jianwei Zhou, Ruili Wu, Chao Xu
Gastric cancer (GC) is one of the most common and lethal cancers globally. methyltransferase-like 3 (METTL3)-mediated N6-methyladenosine (m6A) RNA methylation plays a crucial role in tumor initiation and progression by regulating RNA function. STM2457, a highly efficient METTL3 inhibitor, can inhibit METTL3 activity and may serve as a potential therapeutic strategy in cancers. However, the role of STM2457 for GC cells is still unknown. In this study, we analyzed the expression profile data of GC in TCGA and GEO databases, and further explored the expression involvement of METTL3 in GC cell line, investigated the therapeutic effect of STM2457 targeted inhibition of METTL3 in GC both in vitro and in vivo experiments. The results indicated that STM2457 could suppress GC cell proliferation and migration by inhibiting METTL3, and also promoted cell apoptosis and arrest the cell cycle in S phase. In addition, STM2457 could inhibit tumor growth in subcutaneous xenotransplantation mouse model. Our findings suggested that STM2457 had great potential for the treatment of GC and could serve as a foundation for future clinical applications.
by Siyu Xie, Qiang Gu, Guiyin Zhuang, Xiaojing Guo, Bo Sun
ObjectivesTo explore the pharmacotherapeutic efficacy of heparin in the management of meconium-induced acute lung injury (ALI) in near-term newborn rabbits subjected to mechanical ventilation (MV) and ancillary respiratory medications.
MethodsNewborn rabbits at 30-day gestation (term 31 days) were anesthetized, intratracheally intubated and received human meconium-saline suspension, followed by parallel MV with individually adjusted tidal volume in a multi-plethysmograph-ventilator system. When ALI was induced after initial 3-h MV, therapeutic effects of single or combined subcutaneous heparin (100 U/kg), surfactant (200 mg/kg), and inhaled nitric oxide (iNO, 10 ppm), were compared for lung protective ventilation and survival as outcome, analyzed with linear regression models.
ResultsSignificantly reduced respiratory compliance by meconium was reinstalled during ensuing 7-h MV, with improved survival, among the treatment groups. The impact was verified by lung injury severity, surfactant phospholipid pools, and multiple mRNA expressions of surfactant proteins, lung fluid clearance-related factors, inflammatory mediators, growth factors, endothelial cell injury and coagulation-related factors as subphenotyping biomarkers. The overall benefits of heparin alone, or exerted with the dual and triple regimens, were discernible by both generalized linear model and Cox proportional hazard ratio regression for survival and other major variables as outcome. Its adverse effects were intangible.
ConclusionThe comparable efficacy of heparin, alongside the PS and NO, was corroborated in attenuating meconium-mediated, ventilator-induced ALI, which should warrant clinical investigation to validate.
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