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Critical Care Medicine

Alejandro Durán-Crane, Andrés Laserna, María A López-Olivo, John A Cuenca, Diana Paola Díaz, Yenny Rocío Cardenas, Catherine Urso, Keara O'Connell, Kian Azimpoor, Clara Fowler, Kristen J Price, Charles L Sprung, Joseph L Nates
OBJECTIVES: To identify and synthesize available recommendations from scientific societies and experts on pain management at the end-of-life in the ICU. DATA SOURCES: We conducted a systematic review of PubMed, EMBASE, the Cochrane Database of Systematic Reviews, and Biblioteca Virtual en Salud from their inception until March 28, 2019. STUDY SELECTION: We included all clinical practice guidelines, consensus statements, and benchmarks for quality...
September 12, 2019: Critical Care Medicine
Eliotte L Hirshberg, Emily L Wilson, Valoree Stanfield, Kathryn G Kuttler, Sarah Majercik, Sarah J Beesley, James Orme, Ramona O Hopkins, Samuel M Brown
OBJECTIVES: Increasingly, patients admitted to an ICU survive to hospital discharge; many with ongoing medical needs. The full impact of an ICU admission on an individual's resource utilization and survivorship trajectory in the United States is not clear. We sought to compare healthcare utilization among ICU survivors in each year surrounding an ICU admission. DESIGN: Retrospective cohort of patients admitted to an ICU during one calendar year (2012) in a multipayer healthcare system...
September 12, 2019: Critical Care Medicine
Shadnaz Asgari, Hadie Adams, Magdalena Kasprowicz, Marek Czosnyka, Peter Smielewski, Ari Ercole
OBJECTIVES: Continuous assessment of physiology after traumatic brain injury is essential to prevent secondary brain insults. The present work aims at the development of a method for detecting physiologic states associated with the outcome from time-series physiologic measurements using a hidden Markov model. DESIGN: Unsupervised clustering of hourly values of intracranial pressure/cerebral perfusion pressure, the compensatory reserve index, and autoregulation status was attempted using a hidden Markov model...
September 10, 2019: Critical Care Medicine
Jolene Lim, Edward Litton
OBJECTIVES: To evaluate the efficacy and safety of airway pressure release ventilation in critically ill adults with acute hypoxemic respiratory failure. DATA SOURCES: A systematic literature search of MEDLINE via PUBMED, EMBASE, the Cochrane Library, published conference proceedings and abstracts, reference lists of eligible studies and review articles, and hand searches of relevant journals and trial registers. STUDY SELECTION: Eligible studies included randomized controlled trials published between years 2000 and 2018, comparing airway pressure release ventilation to any ventilation mode, in critically ill adults with acute hypoxemic respiratory failure and reporting at least one mortality outcome...
September 10, 2019: Critical Care Medicine
Benjamin Sansom, Shyamala Sriram, Jeffrey Presneill, Rinaldo Bellomo
OBJECTIVES: To study hemodynamic changes within continuous renal replacement therapy circuits and evaluate their relationship with continuous renal replacement therapy longevity. DESIGN: Analysis of downloaded variables recorded by continuous renal replacement therapy machines during multiple episodes of clinical care. SETTING: Tertiary ICU in Melbourne, Australia. PATIENTS: Cohort of 149 ICU patients: 428 episodes of continuous renal replacement therapy...
September 10, 2019: Critical Care Medicine
Paulien A M A Raymakers-Janssen, Marc R Lilien, Dick Tibboel, Martin C J Kneyber, Sandra Dijkstra, Job B M van Woensel, Joris Lemson, Karlien Cransberg, Marry M van den Heuvel-Eibrink, Roelie M Wösten-van Asperen
OBJECTIVE: Acute kidney injury requiring continuous renal replacement therapy is a serious treatment-related complication in pediatric cancer and hematopoietic stem cell transplant patients. The purpose of this study was to assess epidemiology and outcome of these patients requiring continuous renal replacement therapy in the PICU. DESIGN: A nationwide, multicenter, retrospective, observational study. SETTING: Eight PICUs of a tertiary care hospitals in the Netherlands...
August 27, 2019: Critical Care Medicine
Deepshikha Charan Ashana, Craig A Umscheid, Alisa J Stephens-Shields, Rachel Kohn, Vanessa Madden, Michael O Harhay, Yong Chen, Meeta Prasad Kerlin
OBJECTIVES: As ICUs are increasingly a site of end-of-life care, many have adopted end-of-life care resources. We sought to determine the association of such resources with outcomes of ICU patients. DESIGN: Retrospective cohort study. SETTING: Pennsylvania ICUs. PATIENTS: Medicare fee-for-service beneficiaries. INTERVENTIONS: Availability of any of one hospital-based resource ( palliative care consultants) or four ICU-based resources ( protocol for withdrawal of life-sustaining therapy, triggers for automated palliative care consultation, protocol for family meetings, and palliative care clinicians embedded in ICU rounds)...
August 27, 2019: Critical Care Medicine
Davide Chiumello, Michele Umbrello, Giuseppe Francesco Sferrazza Papa, Alessio Angileri, Martina Gurgitano, Paolo Formenti, Silvia Coppola, Sara Froio, Antonio Cammaroto, Gianpaolo Carrafiello
OBJECTIVES: Lung CT is the reference imaging technique for acute respiratory distress syndrome, but requires transportation outside the intensive care and x-ray exposure. Lung ultrasound is a promising, inexpensive, radiation-free, tool for bedside imaging. Aim of the present study was to compare the global and regional diagnostic accuracy of lung ultrasound and CT scan. DESIGN: A prospective, observational study. SETTING: Intensive care and radiology departments of a University hospital...
August 26, 2019: Critical Care Medicine
Wytske W Geense, Mark van den Boogaard, Johannes G van der Hoeven, Hester Vermeulen, Gerjon Hannink, Marieke Zegers
OBJECTIVE: ICU survivors suffer from long-lasting physical, mental, and cognitive health impairments, also called "postintensive care syndrome". However, an overview of the effectiveness of interventions to prevent or mitigate these impairments is lacking. The aim of this study is to assess the effectiveness of nonpharmacologic interventions. DATA SOURCES: PubMed, CINAHL, PsycINFO, Embase, and Cochrane Library were systematically searched from inception until July 19, 2018...
August 26, 2019: Critical Care Medicine
Casey A Cable, Seyed Amirhossein Razavi, John D Roback, David J Murphy
OBJECTIVES: To critically assess available high-level clinical studies regarding RBC transfusion strategies, with a focus on hemoglobin transfusion thresholds in the ICU. DATA SOURCES: Source data were obtained from a PubMed literature review. STUDY SELECTION: English language studies addressing RBC transfusions in the ICU with a focus on the most recent relevant studies. DATA EXTRACTION: Relevant studies were reviewed and the following aspects of each study were identified, abstracted, and analyzed: study design, methods, results, and implications for critical care practice...
August 23, 2019: Critical Care Medicine
Marianne E Nellis, Heidi Dalton, Oliver Karam
OBJECTIVES: To evaluate the association between bleeding from chest tubes and clinical outcomes in children supported by extracorporeal membrane oxygenation. DESIGN: Secondary analysis of a large observational cohort study. SETTING: Eight pediatric institutions within the Eunice Kennedy Shriver National Institute of Child Health and Human Development's Collaborative Pediatric Critical Care Research Network. PATIENTS: Critically ill children supported by extracorporeal membrane oxygenation...
August 23, 2019: Critical Care Medicine
Paul E Wischmeyer
No abstract text is available yet for this article.
August 14, 2019: Critical Care Medicine
Ruth M Kleinpell, W Robert Grabenkort, April N Kapu, Roy Constantine, Corinna Sicoutris
OBJECTIVES: To provide a concise review of the literature and data pertaining to the use of nurse practitioners and physician assistants, collectively called advanced practice providers, in ICU and acute care settings. DATA SOURCES: Detailed search strategy using the databases PubMed, Ovid MEDLINE, and the Cumulative Index of Nursing and Allied Health Literature for the time period from January 2008 to December 2018. STUDY SELECTION: Studies addressing nurse practitioner, physician assistant, or advanced practice provider care in the ICU or acute care setting...
August 13, 2019: Critical Care Medicine
Anuj B Mehta, Allan J Walkey, Douglas Curran-Everett, Ivor S Douglas
OBJECTIVES: Tracheostomy utilization has dramatically increased recently. Large gaps exist between expected and actual outcomes resulting in significant decisional conflict and regret. We determined 1-year patient outcomes and healthcare utilization following tracheostomy to aid in decision-making and resource allocation. DESIGN: Retrospective cohort study. SETTING: All California hospital discharges from 2012 to 2013 with follow-up through 2014...
August 8, 2019: Critical Care Medicine
David M Greer
No abstract text is available yet for this article.
August 8, 2019: Critical Care Medicine
Soo Min Jang, Manjunath P Pai, Alexander R Shaw, Bruce A Mueller
OBJECTIVES: To determine whether the probability of target attainment over 72 hours of initial therapy with beta-lactam (cefepime, ceftazidime, piperacillin/tazobactam) and carbapenem (imipenem, meropenem) antibiotics were substantially influenced between intensive and less-intensive continuous renal replacement therapy groups in the Acute Renal Failure Trial Network trial and The RENAL Replacement Therapy Study trial. DESIGN: The probability of target attainment was calculated using pharmacodynamic targets of percentage of time that free serum concentrations (fT): 1) were above the target organism's minimum inhibitory concentration (≥ fT > 1 × minimum inhibitory concentration); 2) were above four times the minimum inhibitory concentration (≥ % fT > 4 × minimum inhibitory concentration); and 3) were always above the minimum inhibitory concentration (≥ 100% fT > minimum inhibitory concentration) for the first 72 hours of antibiotic therapy...
August 8, 2019: Critical Care Medicine
Anica C Law, Jennifer P Stevens, Allan J Walkey
OBJECTIVES: To assess trends in timing of mortality among patients with septic shock. DESIGN: Retrospective cohort study. SETTING: Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project's National Inpatient Sample, 1994-2014. PATIENTS: Hospitalized adults (≥ 18 yr) with International Classification of Diseases, 9th Edition, Clinical Modification codes consistent with septic shock; secondary analysis: adults with International Classification of Diseases, 9th Edition, Clinical Modification codes consistent with acute respiratory failure receiving invasive mechanical ventilation and patients with both septic shock and acute respiratory failure receiving invasive mechanical ventilation...
August 8, 2019: Critical Care Medicine
Hani I Kuttab, Joseph D Lykins, Michelle D Hughes, Kristen Wroblewski, Eric P Keast, Omobolawa Kukoyi, Jason A Kopec, Stephen Hall, Michael A Ward
OBJECTIVES: Rapid fluid resuscitation has become standard in sepsis care, despite "low-quality" evidence and absence of guidelines for populations "at risk" for volume overload. Our objectives include as follows: 1) identify predictors of reaching a 30 mL/kg crystalloid bolus within 3 hours of sepsis onset (30by3); 2) assess the impact of 30by3 and fluid dosing on clinical outcomes; 3) examine differences in perceived "at-risk" volume-sensitive populations, including end-stage renal disease, heart failure, obesity, advanced age, or with documentation of volume "overload" by bedside examination...
August 7, 2019: Critical Care Medicine
Brian M Fuller, Brian W Roberts, Nicholas M Mohr, William A Knight, Opeolu Adeoye, Ryan D Pappal, Stacy Marshall, Robert Alunday, Matthew Dettmer, Munish Goyal, Colin Gibson, Brian J Levine, Jayna M Gardner-Gray, Jarrod Mosier, James Dargin, Fraser Mackay, Nicholas J Johnson, Sharukh Lokhandwala, Catherine L Hough, Joseph E Tonna, Rachel Tsolinas, Frederick Lin, Zaffer A Qasim, Carrie E Harvey, Benjamin Bassin, Robert J Stephens, Yan Yan, Christopher R Carpenter, Marin H Kollef, Michael S Avidan
OBJECTIVES: To characterize emergency department sedation practices in mechanically ventilated patients, and test the hypothesis that deep sedation in the emergency department is associated with worse outcomes. DESIGN: Multicenter, prospective cohort study. SETTING: The emergency department and ICUs of 15 medical centers. PATIENTS: Mechanically ventilated adult emergency department patients. INTERVENTIONS: None...
August 7, 2019: Critical Care Medicine
Cherylee W J Chang
No abstract text is available yet for this article.
August 7, 2019: Critical Care Medicine
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