BACKGROUND: Bystanders play a crucial role in improving the efficacy of Cardiopulmonary Resuscitation (CPR) for patients experiencing out-of-hospital cardiac arrest. The highest rates of bystander CPR are observed in sev...BACKGROUND: Bystanders play a crucial role in improving the efficacy of Cardiopulmonary Resuscitation (CPR) for patients experiencing out-of-hospital cardiac arrest. The highest rates of bystander CPR are observed in several Scandinavian countries, where CPR training has been mandated in schools for decades. OBJECTIVES: To assess the basic life support (BLS) knowledge and skills of early middle school students in Turkey and evaluate the effectiveness and retention of a brief CPR training program. METHODS: This study employed a non-randomized before-after design at a private school. Participants were fifth and sixth-grade students (n = 170). A two-hour CPR training program, consisting of a PowerPoint presentation and hands-on manikin practice, was administered. Data were collected via pretests, immediate posttests, and posttests administered two weeks later. BLS knowledge, self-perceived competence, and willingness to perform CPR were assessed. RESULTS: Participants demonstrated limited baseline BLS knowledge despite some understanding of cardiovascular and pulmonary physiology. The CPR training program significantly improved BLS knowledge and self-perceived competence immediately after the intervention (p < 0.05). However, knowledge and self-perceived competence decreased significantly at the two-week follow-up. Students with prior BLS training paradoxically scored lower on the BLS knowledge test than those without prior training. Having a healthcare professional relative was not significantly associated with BLS knowledge. CONCLUSION: Brief CPR training can improve BLS knowledge and skills in middle school students. However, sustained knowledge and competence require ongoing reinforcement. Integrating CPR training into the school curriculum and providing regular refresher courses are potentially effective strategies for improving bystander CPR rates.
BACKGROUND: Metaldehyde is a highly selective molluscicide with moderate water solubility. Acute metaldehyde poisoning is most commonly reported in veterinary medicine and is extremely rare in humans. Its optimal clinica...BACKGROUND: Metaldehyde is a highly selective molluscicide with moderate water solubility. Acute metaldehyde poisoning is most commonly reported in veterinary medicine and is extremely rare in humans. Its optimal clinical management remains poorly defined and warrants further investigation. CASE REPORT: An 81-year-old male presented with altered mental status and respiratory distress. A computed tomography (CT) scan revealed a hyperdense shadow within the gastric cavity. Blue granules were observed in the oral cavity during endotracheal intubation. Given the presence of metaldehyde at his residence, a diagnosis of acute metaldehyde poisoning was made. Despite initial treatment with gastric lavage, catharsis, hemoperfusion, and mechanical ventilation, the patient remained comatose with persistently elevated serum and urine metaldehyde concentrations. A repeat CT scan demonstrated retained hyperdense material in the stomach. Endoscopy subsequently identified and removed residual metaldehyde granules from the gastric fundus. Additionally, the cholinergic receptor antagonist penehyclidine hydrochloride was administered to alleviate muscarinic symptoms. The patient ultimately recovered fully, with no residual neurological deficits. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Metaldehyde toxicity is rarely encountered in the emergency department. Due to its moderate water solubility, oral metaldehyde ingestion can lead to prolonged gastrointestinal retention with delayed elimination and sustained toxicity. Emergency physicians should be aware of this risk and consider repeat imaging and early specialty consultation for endoscopic intervention in patients with persistent severe symptoms after oral metaldehyde ingestion.
BACKGROUND: Medications in emergency medical services vehicles in International Council for Harmonization zone IV regions (e.g., Qatar) are subject to environmental stress, potentially compromising stability. Real-world...BACKGROUND: Medications in emergency medical services vehicles in International Council for Harmonization zone IV regions (e.g., Qatar) are subject to environmental stress, potentially compromising stability. Real-world long-term data remains limited. OBJECTIVES: This study aims to investigate the stability of 13 essential medications stored in operational Hamad Medical Corporation Ambulance Service (HMCAS) vehicles over 1 year under uncontrolled storage conditions, regardless of expiry dates and organizational drug replacement practice. METHODS: From January to December 2021, over 1600 samples of 13 critical care medications (126 samples of each medication) were placed in six rapid response cars (RRCs) across seven intervals over a year. Medications were exposed to real-world conditions of heat, humidity, vibration, and light; controls were stored under manufacturer-recommended laboratory conditions. Drug concentration was analyzed using high-performance liquid chromatography with ultraviolet detection. RESULTS: Ten medications, including rocuronium, nitroglycerine, and ondansetron, remained within United States Pharmacopeia/British Pharmacopoeia limits, validating current HMCAS storage protocols. Rocuronium, typically replaced every 60 days, remained stable across all intervals. Epinephrine exhibited the highest instability (24/126 samples <90% labeled content), followed by furosemide (21/126 < 90%). Insulin demonstrated greater variability (7/126 > 105% and 1/126 < 95%). Most outliers clustered in three specific RRCs, suggesting vehicle-specific variation in environmental exposure. CONCLUSION: These findings highlight the fact that despite the very harsh environmental conditions to which the medications have been exposed to, deviating from our normal medication management practices, most medications remained stable. Only epinephrine, furosemide, and insulin exhibited some content variability. In real practice, this would not have occurred due to HMCAS drug monitoring and replacement cycles.
BACKGROUND: Upper gastrointestinal bleeding (UGIB) is a time-critical emergency where early identification of transfusion needs and hypovolemia is essential, yet conventional risk scores rely on often delayed laboratory...BACKGROUND: Upper gastrointestinal bleeding (UGIB) is a time-critical emergency where early identification of transfusion needs and hypovolemia is essential, yet conventional risk scores rely on often delayed laboratory and endoscopy data. OBJECTIVES: The primary objective of this study was to determine the prognostic value of the peripheral perfusion index (PPI) for predicting two critical outcomes in patients with UGIB: the requirement for blood transfusion and the development of hypovolemic shock. METHODS: This prospective observational study enrolled 134 adult patients with endoscopically confirmed UGIB at a tertiary emergency department (ED). Following rest in a temperature-controlled room (24°C), PPI was measured. The primary outcomes were transfusion requirement and hypovolemic shock (systolic blood pressure [SBP] <90 mm Hg or shock index [SI] >1). PPI's predictive performance was evaluated against the shock index, lactate, and base deficit using receiver operating characteristic (ROC) analysis and multivariate logistic regression. RESULTS: Of 134 patients (61.2% male, mean age 68.0 ± 14.7 years), 49.3% (n = 66) had a PPI <1.0. These patients demonstrated significantly higher rates of transfusion (71.2% vs. 27.9%, p < 0.001) and mortality (21.2% vs. 8.8%, p = 0.044). A PPI <1.0 was significantly associated with markers of severity, including lower blood pressure, higher shock index, and worse laboratory values (all p < 0.01). Multivariate analysis identified PPI <1.0 as a strong independent predictor of transfusion (OR: 7.68). PPI showed superior predictive accuracy for transfusion (area under the curve [AUC] = 0.771) compared to shock index (AUC = 0.750), lactate (AUC = 0.628), and base deficit (AUC = 0.682). CONCLUSION: A PPI value <1.0 was a strong independent predictor of transfusion need and demonstrated excellent discriminative power. The PPI is therefore a rapid, non-invasive bedside tool that reliably identifies patients with UGIB at risk of needing transfusions.
BACKGROUND: Peak expiratory flow rate (PEFR) is used to assess asthma severity, and guidelines recommend serial PEFR measurements to guide management. However, the evidence behind this practice is limited. OBJECTIVES: To...BACKGROUND: Peak expiratory flow rate (PEFR) is used to assess asthma severity, and guidelines recommend serial PEFR measurements to guide management. However, the evidence behind this practice is limited. OBJECTIVES: To compare outcomes between PEFR-guided and non-PEFR-guided emergency department (ED) care for acute asthma exacerbations. METHODS: This randomized, unblinded, two-arm study compared PEFR-guided therapy with symptom-guided therapy in ED patients aged 16 to 55 years presenting with acute asthma without chronic obstructive pulmonary disease (COPD). Patients were enrolled within 15 min of their first nebulizer treatment. PEFR was measured at baseline and every 30 min until symptom resolution, discharge, or admission. Clinicians in the PEFR-guided group received PEFR values with guideline-based recommendations, while clinicians in the non-PEFR-guided group were blinded to PEFR values. The primary outcome was the proportion of patients with none or mild asthma symptoms by 150 min after enrollment. The secondary outcome was hospitalization. RESULTS: A total of 210 patients were enrolled (101 PEFR-guided; 109 non-PEFR-guided). Symptom control by 150 min occurred in 73 (72%) vs. 78 (72%) patients (95% CI, -11% to 13%). Hospitalization was similar: 17 (17%) in the PEFR group vs. 13 (12%) in the non-PEFR group (95% CI, -5% to 14%). Subgroup hospitalization results by percent-predicted PEFR were comparable. There was no difference in nebulized medication use. CONCLUSION: In this randomized trial, PEFR-guided care did not improve symptom control, reduce resource utilization, or affect disposition compared with symptom-guided care. These findings suggest limited benefit of PEFR use in ED asthma management. Larger, multicenter studies are needed before informing practice changes.
Ehrman RR, Harrison NE, Malik AN
… +5 more, Khait L, Favot MJ, Welch RD, Sherwin RL, Levy PD
J Emerg Med
· 2026 Jul · PMID 42166901
·
Full text
BACKGROUND: Volume resuscitation of septic patients must balance harms and benefits. Many emergency physicians are concerned excessive intravenous fluid (IVF) may be harmful, particularly in patients with heart failure (...BACKGROUND: Volume resuscitation of septic patients must balance harms and benefits. Many emergency physicians are concerned excessive intravenous fluid (IVF) may be harmful, particularly in patients with heart failure (HF). OBJECTIVE: To compare the association between IVF and left ventricular function over the first 24 h of admission in septic patients with vs. without HF history. METHODS: Secondary analysis of a prospective, observational cohort of septic adult patients in the emergency department (ED). Patients had an echocardiogram performed at 0, 3, and 24 h after enrollment, with assessment of left ventricular ejection fraction (LVEF), e' velocity, and E/e' ratio. The primary outcome was association of 24-h IVF volume and LV function (modeled as a tensor product interaction between IVF volume and ED Sequential Organ Failure Assessment score) assessed using multilevel Bayesian location-scale models. RESULTS: Seventy-three patients were recruited. Mean (SD) age was 60.7 (15.6) years; 19% had history of HF. After adjusting for age, biologic sex, HF history, and inferior vena cava collapsibility, each 1-SD increase in IVF volume was associated with small improvements in LV function in patients with or without HF history; the average marginal effect was 2.4% (95% credible interval [CI] -2.6 to 10%) vs. 1.3% (95% CI -1.2 to 4.7%) for LVEF; 1.2 cm/s (95% CI -0.6 to 3.1 cm/s) vs. 0.8 cm/s (95% CI -0.004 to 1.2 cm/s) for e' velocity; -1.72 (95% CI -6.9 to 2.5) vs. -0.92 (95% CI -3.1 to 1.0) for E/e' ratio. CONCLUSIONS: IVF volume is not unequivocally associated with declining LV function, even in patients with HF. Volume resuscitation should be administered in accordance with clinical need for volume expansion.
BACKGROUND: Abdominal compartment syndrome (ACS) is a rare but life-threatening complication of small bowel obstruction. Early recognition and intervention in the emergency department (ED) is imperative to preventing fur...BACKGROUND: Abdominal compartment syndrome (ACS) is a rare but life-threatening complication of small bowel obstruction. Early recognition and intervention in the emergency department (ED) is imperative to preventing further complications and reducing mortality in these patients. CASE REPORT: We present a case of a 42-year-old man with recent history of Nissen fundoplication, presenting to the ED with a small bowel obstruction, who was unable to be conservatively managed due to challenges placing the nasogastric (NG) tube. As the patient was being transitioned to the operating room, he progressed to ACS and cardiac arrest, requiring a bedside laparotomy in the ED for return of spontaneous circulation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: A high level of suspicion for ACS by emergency physicians can help this patient population reach definitive treatment sooner. Early detection including obtaining a bladder pressure to measure for intra-abdominal hypertension is significant. Primary interventions for ACS that can be done in the ED include conservative management with intraluminal decompressions via NG and rectal tube placement in addition to maintaining adequate blood pressure. If challenges arise with NG tube insertion, various techniques can be exercised to increase the odds of successful tube placement.
BACKGROUND: Dental infections are common and patients with dental abscesses (DA) often require emergency department (ED) incision and drainage (I&D). Computed tomography (CT) is frequently used to diagnose DA but has dra...BACKGROUND: Dental infections are common and patients with dental abscesses (DA) often require emergency department (ED) incision and drainage (I&D). Computed tomography (CT) is frequently used to diagnose DA but has drawbacks. OBJECTIVES: We sought to measure the accuracy of point-of-care ultrasound (POCUS) in identifying ED patients with DA compared to CT. METHODS: A prospective, observational, convenience study of adults presenting to the ED with atraumatic dental pain and facial swelling. Patients were approached for enrollment if the treating physician suspected DA and ordered a CT scan of the face. Patients with airway or hemodynamic compromise were excluded. Enrolled patients had POCUS examinations of the face performed by blinded faculty while awaiting CT. These were interpreted as abscess versus no abscess and retrospectively compared with concurrent CT. The medical record was reviewed for subsequent ED visits and oral surgery follow-up within 30 days. RESULTS: A total of 29 patients were included in the final analysis. POCUS examinations were performed by 7 physicians. 66% of patients were female, 45% Caucasian. The sensitivity of POCUS for identifying DA was 1 (95% CI: 0.74-1), specificity 0.35 (95% CI: 0.13-0.64), PPV 0.63 and NPV 1. Nine patients had a DA on POCUS but only phlegmon or cellulitis on CT. One of these 9 patients had I&D yielding pus despite equivocal CT, and 2 others returned to the ED within 2 days with repeat CT showing definitive DA. CONCLUSION: Preliminary data suggests POCUS is highly sensitive, but less specific compared to CT for evaluating suspected DA in ED patients.
Primary aortoenteric fistula (AEF) is a rare but fatal cause of upper gastrointestinal bleed. A 27-year-old previously healthy man presented with massive hematemesis, melena, severe anemia and hemodynamic instability. Po...Primary aortoenteric fistula (AEF) is a rare but fatal cause of upper gastrointestinal bleed. A 27-year-old previously healthy man presented with massive hematemesis, melena, severe anemia and hemodynamic instability. Point-of-care ultrasound and chest radiography suggested thoracic aortic pathology, and CT aortography confirmed a descending thoracic aneurysm with contained rupture and fistulous communication with the esophagus. This case highlights the need to consider rare vascular causes in massive hematemesis, where early imaging can facilitate rapid diagnosis and timely intervention.
BACKGROUND: Isolated T-wave inversion (TWI) in lead aVL is commonly regarded as a benign normal variant in asymptomatic individuals during routine electrocardiogram (ECG) interpretation. In patients presenting with chest...BACKGROUND: Isolated T-wave inversion (TWI) in lead aVL is commonly regarded as a benign normal variant in asymptomatic individuals during routine electrocardiogram (ECG) interpretation. In patients presenting with chest pain, however, this subtle abnormality may represent early high lateral myocardial ischemia, often involving diagonal branch disease, and may be overlooked when the remainder of the ECG appears normal. The diagnostic challenge in such cases is not a lack of knowledge regarding lead aVL, but the ease with which isolated abnormalities can be discounted when patients appear clinically stable, and ECGs are reviewed outside the full clinical context. CASE REPORT: A man in his mid-60s presented to the ED with 3 h of ongoing retrosternal chest pain. He appeared clinically stable on arrival. The initial ECG demonstrated isolated TWI in lead aVL as the sole abnormality, without ST-segment deviation or additional ischemic changes. Given the persistence and typical nature of the symptoms, serial high-sensitivity cardiac troponin I levels were obtained and were markedly elevated, confirming non-ST-elevation myocardial infarction. Coronary angiography subsequently demonstrated an 80% stenosis of the first diagonal branch of the left anterior descending artery, which was successfully treated with percutaneous coronary intervention. Following revascularization, the T-wave abnormality in lead aVL resolved. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In busy emergency department settings, isolated T-wave inversion in lead aVL may be discounted when patients appear clinically stable, particularly when ECGs are reviewed rapidly or independently of the patient encounter. This case demonstrates that persistent ischemic symptoms, even in the presence of subtle and isolated ECG changes, may represent early myocardial ischemia. Careful correlation of ECG findings with ongoing symptoms and cardiac biomarker trends is therefore essential to avoid missed or delayed diagnosis of acute coronary syndrome.
BACKGROUND: Renal colic is a common emergency department (ED) presentation, and imaging practices vary despite increasing use of renal point-of-care ultrasound (rPOCUS). OBJECTIVES: To evaluate the association between rP...BACKGROUND: Renal colic is a common emergency department (ED) presentation, and imaging practices vary despite increasing use of renal point-of-care ultrasound (rPOCUS). OBJECTIVES: To evaluate the association between rPOCUS findings and Computed tomography (CT) utilization, ED length of stay (LOS), and downstream urologic interventions in patients with suspected renal colic. METHODS: We conducted a retrospective cohort study of adults undergoing rPOCUS for suspected renal colic from January 2020 through January 2022. Standardized chart abstraction with double review of a subset captured prespecified clinical and imaging variables. Comparative analyses and regression models assessed predictors of CT utilization, stone detection, urologic intervention timing, and ED LOS. RESULTS: Among 188 patients, 89 (47%) had hydronephrosis on rPOCUS. CT was obtained in 108 (57%) and was notably more common in patients with hydronephrosis on rPOCUS (72% vs. 44%; adjusted OR: 2.63, 95% CI: 1.29-5.46). Hydronephrosis predicted ureteral stone presence on CT (74% vs. 30%; OR: 6.71) and urologic intervention within 24 hours (26% vs. 6%; OR: 5.40). Clinically significant alternative diagnoses were uncommon (1.6%) and occurred only in patients without hydronephrosis. Mean LOS did not differ by hydronephrosis status (269 vs. 273 minutes; p = 0.81), but LOS was longer when CT was performed (p < 0.01). In multivariable analysis, CT utilization and abdominal tenderness were associated with longer LOS, whereas hydronephrosis was not. CONCLUSIONS: Hydronephrosis on rPOCUS was associated with stone disease and early urologic intervention but not shorter ED LOS. CT utilization was higher in patients with hydronephrosis and remained the primary factor associated with prolonged ED throughput. These findings reflect contemporary imaging patterns and suggest that the operational benefits of rPOCUS may be limited when CT is obtained irrespective of ultrasound findings.
BACKGROUND: Initial burn management often starts at the emergency call. Emergency medical dispatch (EMD) must identify high-risk features, initiate evidence-based first aid, and support safe referral decisions despite un...BACKGROUND: Initial burn management often starts at the emergency call. Emergency medical dispatch (EMD) must identify high-risk features, initiate evidence-based first aid, and support safe referral decisions despite uncertainty in burn size and depth. STUDY OBJECTIVE: To synthesize evidence and standards relevant to dispatcher-assisted burn telephone triage, pre-arrival instructions, and destination/referral decisions, and to propose an implementable dispatch-to-emergency department (ED) framework. METHODS: We performed a structured clinical (narrative) review informed by SANRA and complemented by standards and guideline sources. The synthesis provides a core pre-arrival instruction bundle (including cooling with hypothermia safeguards), phenotype-specific add-ons (chemical, electrical, inhalation risk), conservative escalation triggers, and a minimum prenotification dataset to support ED parallel processing. CONCLUSIONS: Standardized, safety-bounded dispatcher scripts and governance across the dispatch-ED interface may reduce harmful first-aid variation, improve timely escalation and burn-center referral, and strengthen handover quality for patients with burn injuries.
BACKGROUND: Conventional oxygen therapy is a first-line treatment for acute respiratory failure, but accurately predicting which patients will require escalated respiratory support remains a critical clinical challenge....BACKGROUND: Conventional oxygen therapy is a first-line treatment for acute respiratory failure, but accurately predicting which patients will require escalated respiratory support remains a critical clinical challenge. OBJECTIVE: To explore the clinical significance of the respiratory rate oxygenation (ROX) and ROX-heart rate (ROX-HR) indexes in forecasting outcomes of standard oxygen therapy in patients with acute respiratory failure (ARF). METHODS: This retrospective study analyzed 262 ARF patients admitted to the emergency department between June 2021 and May 2023. Patients were categorized into a Success group (n = 153) and a Failure group (n = 109) based on their response to standard oxygen therapy. ROX and ROX-HR indexes were compared between groups at baseline 0 h and 1 h, and we assessed the predictive efficacy by Receptor Operator Characteristic (ROC) curves, Area under the ROC curve (AUROC), and multivariable Logistic regression. RESULTS: The Success group had significantly higher ROX and ROX-HR indexes at both 0 h and 1 h compared to the Failure group (all p < 0.001). At 0 h, the AUROC for the ROX-HR index outperformed the ROX index at 0.76 (95% CI 0.70-0.81), and 0.75 (95% CI 0.69-0.81) respectively. The ROX-HR-0 was found to be an independent predictor of successful response to oxygen therapy in a multivariate analysis (odds ratio [OR] = 0.48, 95% CI 0.27-0.86, p = 0.013). CONCLUSIONS: The ROX and ROX-HR indexes were associated with the outcome of standard oxygen therapy in patients with ARF, with the ROX-HR index showing a good AUROC. Further validation in larger patient populations is warranted to confirm their utility as dynamic monitoring tools.
BACKGROUND: Pediatric spinal cord injury (SCI) is a rare, life-threatening condition that requires prompt recognition and management. Although such injuries usually require a high-risk mechanism, certain congenital spina...BACKGROUND: Pediatric spinal cord injury (SCI) is a rare, life-threatening condition that requires prompt recognition and management. Although such injuries usually require a high-risk mechanism, certain congenital spinal anomalies can increase the risk of experiencing SCI from even minor trauma. Type 1 Chiari malformation (CM1) is a congenital spinal anomaly that is generally asymptomatic until a precipitating event causes sudden deterioration. We present the case of a child with a previously undiagnosed CM1 and syrinx who developed central cord syndrome after minor trauma. CASE REPORT: A previously healthy 4-year-old boy developed neck and back pain and arm weakness after a low-level fall. He was found to have central cord syndrome with urinary retention. Emergent neuroimaging identified CM1, syringomyelia, and cervical cord edema. The following day he developed respiratory failure requiring intubation. Pediatric neurosurgery performed a decompression craniectomy with a favorable outcome. He was ultimately discharged to inpatient rehabilitation and has shown steady improvement in motor function. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Trivial trauma can cause SCI in pediatric patients with congenital spinal anomalies. These anomalies are not always foreknown but should be suspected when focal neurologic deficits are present after minor trauma. Patients with CM1 and neurologic symptoms require emergent neuroimaging and neurosurgical evaluation. Patients with known CM1 and head or neck trauma, but without neurologic symptoms, do not necessarily need imaging or hospitalization but should be counseled on the potential for progressive injury.
BACKGROUND: There has been limited research on the prevalence of concomitant bacterial infections in Emergency Department (ED) patients with a positive viral test. OBJECTIVE: To determine the frequency and characteristic...BACKGROUND: There has been limited research on the prevalence of concomitant bacterial infections in Emergency Department (ED) patients with a positive viral test. OBJECTIVE: To determine the frequency and characteristics of adult patients admitted to the hospital from the ED with a positive viral isolate(s) who were also determined to have a concomitant bacterial infection on admission. METHODS: A retrospective study was conducted for three EDs in a Midwestern health system for the period of July 2022 through June 2023. Included in the study were adult inpatients admitted through the ED with a positive viral isolate. Variables of interest included labora values, clinical information, and antibiotic therapy data. RESULTS: The study included 892 patients, with 682 (76%) categorized as viral only infection (ViO) and 210 (24%) as viral plus concomitant bacterial infection (ViCon). Twenty-one percent (45/210) of ViCon patients were categorized as bacteremic. Seventy-two percent (119/165) of nonbacteremic patients and 44% (20/45) of bacteremic patients had a bacterial respiratory source. In patients receiving antibiotics (n = 558), ViCon patients received a median of 3 (95% CI: 2, 4) more days of therapy than ViO patients. A standard deviation increase in bandemia and procalcitonin were associated with a 1.5 (95% CI: 1.3, 1.9) and 1.6 (95% CI: 1.2, 2.3) times higher adjusted odds ratio of being in the ViCon group, respectively. CONCLUSION: A quarter of ED admitted patients with a positive viral isolate had a concomitant bacterial infection. ViCon patients received more days of antibiotic therapy and had higher bandemia and procalcitonin values.