Eduard Valdes, Taolin Fang, Michael Boffa, Jennifer A Frontera
OBJECTIVES: Critically ill patients eliminate levetiracetam (LEV) more rapidly than healthy controls, yet low doses are commonly used for seizure prophylaxis in the ICU setting. We compared the rates of achievement of target serum levels and new onset seizure (clinical and/or electrographic) among patients who received low (500 mg bid) versus high (750-1,000 ;mg bid) dose LEV. DESIGN: Prospective, observational study. SETTING: Tertiary care, academic center...
September 20, 2023: Critical Care Medicine
Jorge I F Salluh, Amanda Quintairos, Dave A Dongelmans, Diptesh Aryal, Sean Bagshaw, Abigail Beane, Gaston Burghi, Maria Del Pilar Arias López, Stefano Finazzi, Bertrand Guidet, Satoru Hashimoto, Nao Ichihara, Edward Litton, Nazir I Lone, Vrindha Pari, Cornelius Sendagire, Bharath Kumar Tirupakuzhi Vijayaraghavan, Rashan Haniffa, Luigi Pisani, David Pilcher
OBJECTIVES: Clinical quality registries (CQRs) have been implemented worldwide by several medical specialties aiming to generate a better characterization of epidemiology, treatments, and outcomes of patients. National ICU registries were created almost 3 decades ago to improve the understanding of case-mix, resource use, and outcomes of critically ill patients. This narrative review describes the challenges, proposed solutions, and evidence generated by National ICU registries as facilitators for research and quality improvement...
September 12, 2023: Critical Care Medicine
Tim M Tartler, Elena Ahrens, Ricardo Munoz-Acuna, Basit A Azizi, Guanqing Chen, Aiman Suleiman, Luca J Wachtendorf, Eduardo L V Costa, Daniel S Talmor, Marcelo B P Amato, Elias N Baedorf-Kassis, Maximilian S Schaefer
OBJECTIVES: High mechanical power and driving pressure (ΔP) have been associated with postoperative respiratory failure (PRF) and may be important parameters guiding mechanical ventilation. However, it remains unclear whether high mechanical power and ΔP merely reflect patients with poor respiratory system mechanics at risk of PRF. We investigated the effect of mechanical power and ΔP on PRF in cohorts after exact matching by patients' baseline respiratory system compliance...
September 11, 2023: Critical Care Medicine
Andrew R Moore, Shaun M Pienkos, Pratik Sinha, Jiazhen Guan, Cecilia M O'Kane, Joseph E Levitt, Jennifer G Wilson, Manu Shankar-Hari, Michael A Matthay, Carolyn S Calfee, Rebecca M Baron, Daniel F McAuley, Angela J Rogers
OBJECTIVES: Interleukin-18 (IL-18) plasma level and latent class analysis (LCA) have separately been shown to predict prognosis and treatment response in acute respiratory distress syndrome (ARDS). IL-18 is a measure of inflammasome activation, a pathway potentially distinct from inflammation captured by biomarkers defining previously published LCA classes. We hypothesized that elevated IL-18 would identify distinct "high-risk" patients not captured by prior LCA classifications. DESIGN: Statins for acutely injured lungs from sepsis (SAILS) and hydroxymethylglutaryl-CoA reductase inhibition with simvastatin in acute lung injury to reduce pulmonary dysfunction trial (HARP-2) are two large randomized, controlled trials in ARDS in which both LCA assignments and IL-18 levels were shown to predict mortality...
September 11, 2023: Critical Care Medicine
Jorik Simons, Michele Di Mauro, Silvia Mariani, Justine Ravaux, Iwan C C van der Horst, Rob G H Driessen, Jan Willem Sels, Thijs Delnoij, Daniel Brodie, Darryl Abrams, Thomas Mueller, Fabio Silvio Taccone, Mirko Belliato, Mike Lars Broman, Maximilian V Malfertheiner, Udo Boeken, John Fraser, Dominik Wiedemann, Jan Belohlavek, Nicholas A Barrett, Joseph E Tonna, Federico Pappalardo, Ryan P Barbaro, Kollengode Ramanathan, Graeme MacLaren, Walther N K A van Mook, Barend Mees, Roberto Lorusso
OBJECTIVES: Peripheral venoarterial extracorporeal membrane oxygenation (ECMO) with femoral access is obtained through unilateral or bilateral groin cannulation. Whether one cannulation strategy is associated with a lower risk for limb ischemia remains unknown. We aim to assess if one strategy is preferable. DESIGN: A retrospective cohort study based on the Extracorporeal Life Support Organization registry. SETTING: ECMO centers worldwide included in the Extracorporeal Life Support Organization registry...
September 6, 2023: Critical Care Medicine
Jack O Zhao, Bhakti K Patel, Paulette Krishack, Matthew R Stutz, Steven D Pearson, Julie Lin, Paola A Lecompte-Osorio, Karen C Dugan, Seoyoen Kim, Nicole Gras, Anne Pohlman, John P Kress, Jesse B Hall, Anne I Sperling, Ayodeji Adegunsoye, Philip A Verhoef, Krysta S Wolfe
OBJECTIVES: To identify cytokine signature clusters in patients with septic shock. DESIGN: Prospective observational cohort study. SETTING: Single academic center in the United States. PATIENTS: Adult (≥ 18 yr old) patients admitted to the medical ICU with septic shock requiring vasoactive medication support. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: One hundred fourteen patients with septic shock completed cytokine measurement at time of enrollment (t1) and 24 hours later (t2)...
September 6, 2023: Critical Care Medicine
Felix Gerhardinger, Christoph Fisser, Maximilian V Malfertheiner, Alois Philipp, Maik Foltan, Florian Zeman, Andrea Stadlbauer, Clemens Wiest, Dirk Lunz, Thomas Müller, Matthias Lubnow
OBJECTIVE: Analysis of the prevalence and risk factors for weaning failure from venovenous extracorporeal membrane oxygenation (VV-ECMO) in patients with severe acute respiratory insufficiency. DESIGN: Single-center retrospective observational study. SETTING: Sixteen beds medical ICU at the University Hospital Regensburg. PATIENTS: Two hundred twenty-seven patients with severe acute respiratory insufficiency requiring VV-ECMO support between October 2011 and December 2017...
September 4, 2023: Critical Care Medicine
Jesús Villar, Jesús M González-Martín, Jerónimo Hernández-González, Miguel A Armengol, Cristina Fernández, Carmen Martín-Rodríguez, Fernando Mosteiro, Domingo Martínez, Jesús Sánchez-Ballesteros, Carlos Ferrando, Ana M Domínguez-Berrot, José M Añón, Laura Parra, Raquel Montiel, Rosario Solano, Denis Robaglia, Pedro Rodríguez-Suárez, Estrella Gómez-Bentolila, Rosa L Fernández, Tamas Szakmany, Ewout W Steyerberg, Arthur S Slutsky
OBJECTIVES: To assess the value of machine learning approaches in the development of a multivariable model for early prediction of ICU death in patients with acute respiratory distress syndrome (ARDS). DESIGN: A development, testing, and external validation study using clinical data from four prospective, multicenter, observational cohorts. SETTING: A network of multidisciplinary ICUs. PATIENTS: A total of 1,303 patients with moderate-to-severe ARDS managed with lung-protective ventilation...
August 30, 2023: Critical Care Medicine
Asad E Patanwala, Benjamin Moran, Charlotte Johnstone, Heike Koelzow, Jonathan Penm
OBJECTIVES: The objective of this study was to compare pain control and opioid consumption in critically ill patients who were treated with buprenorphine sublingual or oxycodone oral/enteral during ICU admission. DESIGN: This was a retrospective, parallel, cohort study. SETTING: General medical or surgical ICUs of a quaternary, urban hospital in Sydney, NSW, Australia. PATIENTS: Data were obtained for all patients admitted to two general medical or surgical ICU from January 2019 to January 2023...
August 29, 2023: Critical Care Medicine
Anuj B Mehta, Daniel D Matlock, Andrew F Shorr, Ivor S Douglas
OBJECTIVES: To define healthcare trajectories after tracheostomy to inform shared decision-making efforts for critically ill patients. DESIGN: Retrospective epidemiologic cohort study. SETTING: California Patient Discharge Database 2018-2019. PATIENTS: Patients who received a tracheostomy. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We tracked 1-year outcomes after tracheostomy, including survival and time alive in and out of a healthcare facility (HCF...
August 28, 2023: Critical Care Medicine
Sae-Yeon Won, Thomas M Freiman, Sara Sujin Lee-Müller, Daniel Dubinski, Laurent M Willems, Philipp S Reif, Elke Hattingen, Joana Ullmann, Eva Herrmann, Nico Melzer, Volker Seifert, Florian Gessler, Felix Rosenow, Juergen Konczalla, Adam Strzelczyk
OBJECTIVES: Seizures and status epilepticus (SE) are frequent complications of acute subdural hematoma (aSDH) associated with increased morbidity and mortality. Therefore, we aimed to evaluate whether invasive subdural electroencephalogram recording leads to earlier seizure detection and treatment initiation in patients with aSDH. DESIGN: Prospective, single-center, cohort trial. SETTING: Neurologic and neurosurgical ICUs of one academic hospital in Germany...
August 28, 2023: Critical Care Medicine
Nader M Habashi, Penny L Andrews, Jason H Bates, Luigi Camporota, Gary F Nieman
No abstract text is available yet for this article.
August 24, 2023: Critical Care Medicine
Christina A Dony, Lijo C Illipparambil, Tetsuro Maeda, Susan K Mroczek, Amy Rovitelli, Orren Wexler, Michelle Malnoske, Tristan Bice, Alex Z Fe, Casey R Storms, Jimmy Zhang, Rebecca D Schultz, Anthony P Pietropaoli
OBJECTIVES: Impaired nitric oxide (NO) bioavailability may contribute to microvascular dysfunction in sepsis. Excessive plasma NO consumption has been attributed to scavenging by circulating cell-free hemoglobin. This may be a mechanism for NO deficiency in sepsis and critical illness. We hypothesized that plasma NO consumption is high in critically ill patients, particularly those with sepsis, acute respiratory distress syndrome (ARDS), shock, and in hospital nonsurvivors. We further hypothesized that plasma NO consumption is correlated with plasma cell-free hemoglobin concentration...
August 18, 2023: Critical Care Medicine
Marc Heymann, Raoul Schorer, Alessandro Putzu
OBJECTIVES: The effectiveness of CytoSorb at removing inflammatory mediators in critically ill patients is controversial. DATA SOURCES: Electronic databases were searched from inception to May 2023. STUDY SELECTION: Randomized controlled trials reporting the effects of CytoSorb therapy on inflammatory parameters in critically ill patients with hyperinflammatory conditions were included. DATA EXTRACTION: Two authors screened articles for eligibility, extracted data, and assessed the risk of bias, conflicts of interest, and certainty of evidence (CoE)...
August 18, 2023: Critical Care Medicine
Brandon Foreman, Gregory Kapinos, Mark S Wainwright, Laura B Ngwenya, Kristine H O'Phelan, Kerri L LaRovere, Matthew P Kirschen, Brian Appavu, Christos Lazaridis, Ayham Alkhachroum, Carolina B Maciel, Edilberto Amorim, Jason J Chang, Emily J Gilmore, Eric S Rosenthal, Soojin Park
OBJECTIVES: To address areas in which there is no consensus for the technologies, effort, and training necessary to integrate and interpret information from multimodality neuromonitoring (MNM). DESIGN: A three-round Delphi consensus process. SETTING: Electronic surveys and virtual meeting. SUBJECTS: Participants with broad MNM expertise from adult and pediatric intensive care backgrounds. INTERVENTIONS: None...
August 18, 2023: Critical Care Medicine
Matthew J Cummings, Barnabas Bakamutumaho, Alin S Tomoiaga, Nicholas Owor, Komal Jain, Adam Price, John Kayiwa, Joyce Namulondo, Timothy Byaruhanga, Moses Muwanga, Christopher Nsereko, Irene Nayiga, Stephen Kyebambe, Stephen Sameroff, Xiaoyu Che, Julius J Lutwama, W Ian Lipkin, Max R O'Donnell
OBJECTIVES: In high-income countries (HICs), sepsis endotypes defined by distinct pathobiological mechanisms, mortality risks, and responses to corticosteroid treatment have been identified using blood transcriptomics. The generalizability of these endotypes to low-income and middle-income countries (LMICs), where the global sepsis burden is concentrated, is unknown. We sought to determine the prevalence, prognostic relevance, and immunopathological features of HIC-derived transcriptomic sepsis endotypes in sub-Saharan Africa...
August 7, 2023: Critical Care Medicine
Ryszard Gawda, Maciej Marszalski, Maciej Piwoda, Maciej Molsa, Marek Pietka, Kamil Filipiak, Izabela Miechowicz, Tomasz Czarnik
OBJECTIVES: To examine whether an ultrasound-guided infraclavicular cannulation of the axillary artery is noninferior to an ultrasound-guided cannulation of the common femoral artery for arterial catheter placement in critically ill patients. DESIGN: Prospective, investigator-initiated, noninferiority randomized controlled trial. SETTING: University-affiliated ICU in Poland. PATIENTS: Mechanically ventilated patients with indications for arterial catheter placement...
August 7, 2023: Critical Care Medicine
Brian P O'Gara, Matthew G Tung, Kevin F Kennedy, Juan P Espinosa-Leon, Shahzad Shaefi, Jason Gluck, Yuval Raz, Raghu Seethala, John A Reich, Anthony J Faugno, Daniel Brodie, A Reshad Garan, E Wilson Grandin
OBJECTIVES: To determine whether multisite versus single-site dual-lumen (SSDL) cannulation is associated with outcomes for COVID-19 patients requiring venovenous extracorporeal membrane oxygenation (VV-ECMO). DESIGN: Retrospective analysis of the Extracorporeal Life Support Organization Registry. Propensity score matching (2:1 multisite vs SSDL) was used to control for confounders. PATIENTS: The matched cohort included 2,628 patients (1,752 multisite, 876 SSDL) from 170 centers...
August 7, 2023: Critical Care Medicine
David V Pilcher, Tamishta Hensman, Shailesh Bihari, Michael Bailey, Jason McClure, Mark Nicholls, Shaila Chavan, Paul Secombe, Melissa Rosenow, Sue Huckson, Edward Litton
OBJECTIVES: ICU resource strain leads to adverse patient outcomes. Simple, well-validated measures of ICU strain are lacking. Our objective was to assess whether the "Activity index," an indicator developed during the COVID-19 pandemic, was a valid measure of ICU strain. DESIGN: Retrospective national registry-based cohort study. SETTING: One hundred seventy-five public and private hospitals in Australia (June 2020 through March 2022). SUBJECTS: Two hundred seventy-seven thousand seven hundred thirty-seven adult ICU patients...
July 24, 2023: Critical Care Medicine
Jia-Jin Chen, Pei-Chun Lai, Tao-Han Lee, Yen-Ta Huang
OBJECTIVES: This study aimed to conduct a comprehensive and updated systematic review with network meta-analysis (NMA) to assess the outcome benefits of various blood purification modalities for adult patients with severe infection or sepsis. DATA SOURCES: We conducted a search of PubMed, MEDLINE, clinical trial registries, Cochrane Library, and Embase databases with no language restrictions. STUDY SELECTION: Only randomized controlled trials (RCTs) were selected...
July 20, 2023: Critical Care Medicine
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