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Critical Care Medicine

Phillip J Schulte, David O Warner, David P Martin, Atousa Deljou, Michelle M Mielke, David S Knopman, Ronald C Petersen, Toby N Weingarten, Matthew A Warner, Alejandro A Rabinstein, Andrew C Hanson, Darrell R Schroeder, Juraj Sprung
OBJECTIVES: Patients requiring admission to an ICU may subsequently experience cognitive decline. Our objective was to investigate longitudinal cognitive trajectories in older adults hospitalized in ICUs. We hypothesized that individuals hospitalized for critical illness develop greater cognitive decline compared with those who do not require ICU admission. DESIGN: A retrospective cohort study using prospectively collected cognitive scores of participants enrolled in the Mayo Clinic Study of Aging and ICU admissions retrospectively ascertained from electronic medical records...
May 17, 2019: Critical Care Medicine
Mahrukh S Rizvi, Andrea M Nei, Ognjen Gajic, Kristin C Mara, Erin F Barreto
OBJECTIVES: Midodrine is an α1-agonist approved for orthostatic hypotension. Recently, it has received attention as an oral vasopressor to facilitate ICU discharge. The purpose of this study was to identify the incidence of continuation of newly initiated midodrine upon ICU and hospital discharge and identify risk factors associated with its occurrence. DESIGN: Single-center retrospective study. SETTING: ICU patients from January 2011 to October 2016 at Mayo Clinic, Rochester...
May 17, 2019: Critical Care Medicine
Elliott D Crouser, Joseph E Parrillo, Christopher W Seymour, Derek C Angus, Keri Bicking, Vincent G Esguerra, Octavia M Peck-Palmer, Robert T Magari, Mark W Julian, Jennifer M Kleven, Paarth J Raj, Gabrielle Procopio, Diana Careaga, Liliana Tejidor
OBJECTIVES: Most septic patients are initially encountered in the emergency department where sepsis recognition is often delayed, in part due to the lack of effective biomarkers. This study evaluated the diagnostic accuracy of peripheral blood monocyte distribution width alone and in combination with WBC count for early sepsis detection in the emergency department. DESIGN: An Institutional Review Board approved, blinded, observational, prospective cohort study conducted between April 2017 and January 2018...
May 17, 2019: Critical Care Medicine
Karla Tuanny Fiorese Coimbra, Flávio Geraldo Rezende de Freitas, Antônio Tonete Bafi, Tuanny Teixeira Pinheiro, Nathaly Fonseca Nunes, Luciano César Pontes de Azevedo, Flávia Ribeiro Machado
OBJECTIVES: To assess whether an increase in mean arterial pressure in patients with septic shock and previous systemic arterial hypertension changes microcirculatory and systemic hemodynamic variables compared with patients without arterial hypertension (control). DESIGN: Prospective, nonblinded, interventional study. SETTING: Three ICUs in two teaching hospitals. PATIENTS: After informed consent, we included patients older than 18 years with septic shock for at least 6 hours, sedated, and under mechanical ventilation...
May 13, 2019: Critical Care Medicine
Thomas Fux, Manne Holm, Matthias Corbascio, Jan van der Linden
OBJECTIVES: Mortality after cardiac arrest remains high despite initiation of venoarterial extracorporeal membrane oxygenation. We aimed to identify pre-venoarterial extracorporeal membrane oxygenation risk factors of 90-day mortality in patients with witnessed cardiac arrest and with greater than or equal to 1 minute of cardiopulmonary resuscitation before venoarterial extracorporeal membrane oxygenation. The association between preimplant variables and all-cause mortality at 90 days was analyzed with multivariable logistic regression...
May 13, 2019: Critical Care Medicine
Arnaud Gacouin, Mathieu Lesouhaitier, Aurelien Frerou, Benoit Painvin, Florian Reizine, Sonia Rafi, Adel Maamar, Yves Le Tulzo, Jean Marc Tadié
OBJECTIVES: Unhealthy use of alcohol and acute kidney injury are major public health problems, but little is known about the impact of excessive alcohol consumption on kidney function in critically ill patients. We aimed to determine whether at-risk drinking is independently associated with acute kidney injury in the ICU and at ICU discharge. DESIGN: Prospective observational cohort study. SETTING: A 21-bed polyvalent ICU in a university hospital...
May 13, 2019: Critical Care Medicine
Shuang Ma, Dongmei Chu, Litao Li, Jennifer A Creed, Yu-Mi Ryang, Huaxin Sheng, Wei Yang, David S Warner, Dennis A Turner, Ulrike Hoffmann
OBJECTIVES: We tested the hypothesis that prolonged inhalation of 70% argon for 24 hours after in vivo permanent or temporary stroke provides neuroprotection and improves neurologic outcome and overall recovery after 7 days. DESIGN: Controlled, randomized, double-blinded laboratory study. SETTING: Animal research laboratories. SUBJECTS: Adult Wistar male rats (n = 110). INTERVENTIONS: Rats were subjected to permanent or temporary focal cerebral ischemia via middle cerebral artery occlusion, followed by inhalation of 70% argon or nitrogen in 30% oxygen for 24 hours...
May 13, 2019: Critical Care Medicine
Rupak Desai, Bishoy Hanna, Sandeep Singh, Ahmed Omar, Abhishek Deshmukh, Gautam Kumar, Marilyn G Foreman, Rajesh Sachdeva
OBJECTIVES: Atrial fibrillation is frequently seen in sepsis-related hospitalizations. However, large-scale contemporary data from the United States comparing outcomes among sepsis-related hospitalizations with versus without atrial fibrillation are limited. The aim of our study was to assess the frequency of atrial fibrillation and its impact on outcomes of sepsis-related hospitalizations. DESIGN: Retrospective cohort study. SETTING: The National Inpatient Sample databases (2010-2014)...
May 13, 2019: Critical Care Medicine
John C Hayden, Dermot R Doherty, Ian Dawkins, Finbarr P Leacy, Martina Healy, Cormac V Breatnach, Gráinne Cousins, Paul J Gallagher
OBJECTIVES: There is limited evidence supporting the widespread use of α2 agonists (clonidine and dexmedetomidine) in pediatric critical care sedation. This study sought to test the association between the use of α2 agonists and enhanced sedation. DESIGN: A retrospective observational cohort study was conducted. Noninferiority of time adequately sedated (COMFORT Behavior Score 11-16) while mechanically ventilated was assessed. Secondarily, dosing of opioids and benzodiazepines was examined...
April 26, 2019: Critical Care Medicine
Cécile Aubron, Zoe McQuilten, Michael Bailey, Jasmin Board, Heidi Buhr, Bruce Cartwright, Mark Dennis, Carol Hodgson, Paul Forrest, David McIlroy, Deirdre Murphy, Lynne Murray, Vincent Pellegrino, David Pilcher, Jayne Sheldrake, Huyen Tran, Shirley Vallance, D James Cooper
OBJECTIVES: To determine whether randomization of patients undergoing extracorporeal membrane oxygenation to either therapeutic or a low-dose anticoagulation protocol results in a difference in activated partial thromboplastin time and anti-Xa. DESIGN: Randomized, controlled, unblinded study. SETTING: Two ICUs of two university hospitals. PATIENTS: Patients admitted to the ICU, who required extracorporeal membrane oxygenation (venovenous or venoarterial) and who did not have a preexisting indication for therapeutic anticoagulation...
April 25, 2019: Critical Care Medicine
Adam Irving, Alisa Higgins, Bridget Ady, Rinaldo Bellomo, D James Cooper, Craig French, Dashiell Gantner, Anthony Harris, David O Irving, Lynne Murray, Alistair Nichol, Dennis Petrie, Zoe K McQuilten
OBJECTIVES: Trials comparing the effects of transfusing RBC units of different storage durations have considered mortality or morbidity as outcomes. We perform the first economic evaluation alongside a full age of blood clinical trial with a large population assessing the impact of RBC storage duration on quality-of-life and costs in critically ill adults. DESIGN: Quality-of-life was measured at 6 months post randomization using the EuroQol 5-dimension 3-level instrument...
April 18, 2019: Critical Care Medicine
Pablo Tapia, Sebastian Gatica, Cristian Cortés-Rivera, Carolina Otero, Alvaro Becerra, Claudia A Riedel, Claudio Cabello-Verrugio, Alexis M Kalergis, Felipe Simon
OBJECTIVES: To determine whether circulating endothelial cells from septic shock patients and from nonseptic shock patients are transformed in activated fibroblast by changing the expression level of endothelial and fibrotic proteins, whether the level of the protein expression change is associated with the amount of administered resuscitation fluid, and whether this circulating endothelial cell protein expression change is a biomarker to predict sepsis survival. DESIGN: Prospective study...
April 15, 2019: Critical Care Medicine
Robert Y Lee, Ruth A Engelberg, J Randall Curtis, Catherine L Hough, Erin K Kross
OBJECTIVES: Family members of ICU survivors report long-term psychologic symptoms of posttraumatic stress disorder. We describe patient- and family-member risk factors for posttraumatic stress disorder symptoms among family members of survivors of acute respiratory distress syndrome. DESIGN: Prospective cohort study of family members of acute respiratory distress syndrome survivors. SETTING: Single tertiary care center in Seattle, Washington...
April 15, 2019: Critical Care Medicine
Verena Rass, Max Gaasch, Mario Kofler, Alois Josef Schiefecker, Bogdan-Andrei Ianosi, Fabian Steinkohl, Ronny Beer, Bettina Pfausler, Elke R Gizewski, Claudius Thomé, Erich Schmutzhard, Raimund Helbok
OBJECTIVES: Optimal fluid management is important in patients with acute brain injury, including subarachnoid hemorrhage. We aimed to examine the relationship between daily fluid intake and fluid balance with hospital complications and functional outcome. DESIGN: Retrospective observational cohort study. SETTING: Neurocritical care unit at a tertiary academic medical center. PATIENTS: Two-hundred thirty-seven consecutive nontraumatic subarachnoid hemorrhage patients admitted to the neurologic ICU between 2010 and 2016...
April 15, 2019: Critical Care Medicine
M Elizabeth Wilcox, Kelsey Vaughan, Christopher A K Y Chong, Peter J Neumann, Chaim M Bell
OBJECTIVES: Cost-effectiveness analyses are increasingly used to aid decisions about resource allocation in healthcare; this practice is slow to translate into critical care. We sought to identify and summarize original cost-effectiveness studies presenting cost per quality-adjusted life year, incremental cost-effectiveness ratios, or cost per life-year ratios for treatments used in ICUs. DESIGN: We conducted a systematic search of the English-language literature for cost-effectiveness analyses published from 1993 to 2018 in critical care...
April 15, 2019: Critical Care Medicine
Rita N Bakhru, Mathias Basner, Meeta Prasad Kerlin, Scott D Halpern, John Hansen-Flaschen, Ilene M Rosen, David F Dinges, William D Schweickert
OBJECTIVES: To compare sleep, work hours, and behavioral alertness in faculty and fellows during a randomized trial of nighttime in-hospital intensivist staffing compared with a standard daytime intensivist model. DESIGN: Prospective observational study. SETTING: Medical ICU of a tertiary care academic medical center during a randomized controlled trial of in-hospital nighttime intensivist staffing. PATIENTS: Twenty faculty and 13 fellows assigned to rotations in the medical ICU during 2012...
April 12, 2019: Critical Care Medicine
Keith A Corl, Michael Prodromou, Roland C Merchant, Ilana Gareen, Sarah Marks, Debasree Banerjee, Timothy Amass, Adeel Abbasi, Cesar Delcompare, Amy Palmisciano, Jason Aliotta, Gregory Jay, Mitchell M Levy
OBJECTIVES: It is unclear if a low- or high-volume IV fluid resuscitation strategy is better for patients with severe sepsis and septic shock. DESIGN: Prospective randomized controlled trial. SETTING: Two adult acute care hospitals within a single academic system. PATIENTS: Patients with severe sepsis and septic shock admitted from the emergency department to the ICU from November 2016 to February 2018. INTERVENTIONS: Patients were randomly assigned to a restrictive IV fluid resuscitation strategy (≤ 60 mL/kg of IV fluid) or usual care for the first 72 hours of care...
April 12, 2019: Critical Care Medicine
S Jean Hsieh, Olufisayo Otusanya, Hayley B Gershengorn, Aluko A Hope, Christopher Dayton, Daniela Levi, Melba Garcia, David Prince, Michele Mills, Dan Fein, Silvie Colman, Michelle Ng Gong
OBJECTIVES: To measure the impact of staged implementation of full versus partial ABCDE bundle on mechanical ventilation duration, ICU and hospital lengths of stay, and cost. DESIGN: Prospective cohort study. SETTING: Two medical ICUs within Montefiore Healthcare Center (Bronx, NY). PATIENTS: One thousand eight hundred fifty-five mechanically ventilated patients admitted to ICUs between July 2011 and July 2014. INTERVENTIONS: At baseline, spontaneous (B)reathing trials (B) were ongoing in both ICUs; in period 1, (A)wakening and (D)elirium (AD) were implemented in both full and partial bundle ICUs; in period 2, (E)arly mobilization and structured bundle (C)oordination (EC) were implemented in the full bundle (B-AD-EC) but not the partial bundle ICU (B-AD)...
April 10, 2019: Critical Care Medicine
Scott A Helgeson, Ashley V Fritz, Mehmet M Tatari, Craig E Daniels, Jose L Diaz-Gomez
OBJECTIVES: Awareness of the impact of bedside ultrasound to reduce iatrogenic pneumothoraces while performing bedside pleural procedures has increased but with little understanding in how ultrasound is used for these procedures. DESIGN AND SETTING: We conducted a retrospective chart review at a tertiary referral center in the United States from January 1, 2014, to March 31, 2017. Our study assessed adverse effect rates between real-time ultrasound-guided and ultrasound-marked thoracenteses and thoracostomy tube placements...
April 10, 2019: Critical Care Medicine
Ashish K Khanna, Kamal Maheshwari, Guangmei Mao, Liu Liu, Silvia E Perez-Protto, Praneeta Chodavarapu, Yehoshua N Schacham, Daniel I Sessler
OBJECTIVES: Hypotension thresholds that provoke renal injury, myocardial injury, and mortality in critical care patients remain unknown. We primarily sought to determine the relationship between hypotension and a composite of myocardial injury (troponin T ≥ 0.03 ng/mL without nonischemic cause) and death up to 7 postoperative days. Secondarily, we considered acute kidney injury (creatinine concentration ≥ 0.3 mg/dL or 1.5 times baseline). DESIGN: Retrospective cohort...
April 10, 2019: Critical Care Medicine
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