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We hypothesized that impairment of peripheral perfusion index (PPI) during spontaneous breathing trial (SBT) might be predictive of weaning failure. We included 44 consecutive, adult, patients, who were scheduled for weaning after at least 48 h of invasive mechanical ventilation in this prospective observational study. Weaning failure was defined as failed SBT or reintubation within 48 h of extubation. PPI readings were obtained before initiation of the SBT, and every 5 min till the end of the SBT. PPI ratio was calculated at every time point as: PPI value/ baseline PPI. The primary outcome was the accuracy of PPI ratio at the end of the SBT in detecting failed weaning. Forty-three patients were available for the final analysis. Eighteen patients (42%) were considered failed weaning. PPI ratio was higher in patients with successful weaning compared to patients with failed weaning during the last 15 min of the SBT. PPI ratio at the end of SBT was higher in patients with successful weaning compared to patients with failed weaning. PPI ratio at the end of SBT had good predictive ability for weaning failure {area under receiver operating characteristic curve (95% confidence interval): 0.833(0.688-0.929), cutoff value ≤ 1.41}. The change in PPI during SBT is an independent predictor for re-intubation. PPI could be a useful tool for monitoring the patient response to SBT. Patients with successful weaning showed higher augmentation of PPI during the SBT compared to re-intubated patients. Failure of augmenting the PPI by 41% at the end of SBT could predict re-intubation with negative predictive value of 95%. Clinical trial identifier: NCT03974568. https ://clini caltr ials.gov/ct2/show/NCT03 97456 8?term=ahmed +hasan in&draw=3&rank=17

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Background: Hyperglycemia is common among critically ill patients and is associated with increased morbidity and mortality and there is no clear answer to the question: which to apply tight or conventional glycemic control? Objective: Evaluation and comparison of the effects of tight versus conventional glycemic control on critically ill patients in our surgical intensive care unit (ICU). Design: Prospective randomized controlled trial. Methods: 120 Patients were divided into two groups: group (I) received intensive insulin therapy targeting blood glucose level between 80 and 110 mg/dl, who referred to as intensive treatment group, and group (II) received conventional insulin therapy targeting blood glucose level between 150 and 200 mg/dl, and referred to as conventional treatment group. Results: 120 Patients were enrolled in the study, the incidence of hypoglycemia (blood glucose <70 mg/dl) was 29.09% in group I who received intensive insulin therapy versus 6.15% in group II who received conventional insulin therapy (p value 0.000) with no demonstrable complications, regarding mortality rate, impairment of Liver function tests, change in total leukocytic count, the need for red blood cell transfusion, ICU stay and Total hospital stay and we reported no statistical significant difference between the two groups. Conclusion: Tight glycemic control for critically ill patients in ICU in poor resources countries showed increased incidence of hypoglycemia with no significant benefits when compared with conventional glycemic control.