Fecal Microbiota Transplantation for the Treatment of ICU Delirium

The CAM-ICU is a standardized tool specifically designed for the rapid screening of delirium in ICU patients. It achieves efficient diagnosis by evaluating indicators including consciousness state, attention, and disordered thinking. and perceptual abnormalities. Delirium can be diagnosed if features 1 and 2 are met, and at least 3 or 4 are present. The assessment process is standardized, and medical staff can operate independently after training.

For patients who survived and were discharged from the ICU or hospital during the study observation period, the entire period subsequent to their discharge date shall be counted as delirium-free. For patients who died during the study observation period, the interval from their date of death to the end of the observation period shall be recorded as 0 delirium-free days.

DFDs = Total observation days - Days with delirium - Days with coma - Days from death to the end of observation.

A 7-point rating scale (0-7) was derived from the CAM-ICU and RASS assessments. The final CAM-ICU-7 score ranges from 0-7 with 7 being most severe. CAM-ICU-7 scores were further categorized as 0-2: no delirium, 3-5: mild to moderate delirium, and 6-7: severe delirium.

Metagenomic profiling of fecal samples obtained via rectal swabs to assess: Changes in alpha-diversity (Shannon index), beta-diversity (Bray-Curtis dissimilarity), and relative abundance of specific bacterial taxa.

Serum samples were collected for non-targeted metabolomics analysis to comprehensively examine the composition and changes of endogenous small molecule metabolites in the blood.

The AGI scoring system is a standardized tool in critical care for assessing gastrointestinal dysfunction severity. It divides injury into four grades based on clinical and physiological findings: Grade I involves partial gastrointestinal impairment, such as feeding intolerance or transient diarrhea; Grade II includes gastrointestinal dysfunction, like gastroparesis with aspiration risk or abdominal compartment syndrome; Grade III indicates gastrointestinal failure, marked by persistent feeding intolerance or intestinal ischemia; Grade IV features gastrointestinal failure with severe systemic consequences, including intestinal necrosis or septic shock. This system supports dynamic assessment and guides clinical intervention in critically ill patients.

The APACHE II scoring system includes three components: the Acute Physiology Score (APS), Age Score, and Chronic Health Evaluation. The total score, ranging from 0 to 71, reflects disease severity, with higher values indicating worse condition. The APS incorporates 12 physiological variables. A built-in formula calculates individual risk of death (R); averaging all R values gives the predicted mortality rate for a patient group. APACHE II is a key tool for assessing critically ill patients in ICU.

Duration of ICU stay, defined as the number of days from patient admission to the intensive care unit until either discharge from the ICU or in-ICU mortality.

The ICU mortality rate is defined as the proportion of patients admitted to the ICU who die during their ICU stay, calculated as the number of deaths occurring within the ICU divided by the total number of ICU admissions, excluding patients transferred to other facilities or discharged against medical advice.

The in-hospital mortality rate is a standardized clinical outcome measure defined as the proportion of patients admitted to the hospital who die during their stay, calculated as the number of deaths occurring from admission to death.

"Number of days alive and discharged within 28 days" is defined as the total number of days that a patient remains both alive and in a discharged state within the 28-day period starting from the date of the first FMT administration.

"Number of days survived without mechanical ventilation within 28 days" is defined as the total number of days during the 28-day period following the first administration of FMT on which the patient remains both alive and not requiring invasive or non-invasive mechanical ventilation.

The 28-day all-cause mortality rate refers to the proportion of individuals who die from any cause within 28 days following a specific event or admission, and is commonly used as a standardized outcome measure in clinical studies.