Critical Care Medicine

Eric M Liotta, Ameeta Karmarkar, Ayush Batra, Minjee Kim, Shyam Prabhakaran, Andrew M Naidech, Matthew B Maas
OBJECTIVES: We tested the hypothesis that admission serum magnesium levels are associated with extent of hemorrhage in patients with aneurysmal subarachnoid hemorrhage. DESIGN: Single-center prospective observational study. SETTING: Tertiary hospital neurologic ICU. PATIENTS: Patients with aneurysmal subarachnoid hemorrhage. INTERVENTIONS: Clinically indicated CT scans and serum laboratory studies...
October 31, 2019: Critical Care Medicine
Traci A Wolbrink, Sandrijn M van Schaik, David A Turner, Steven J Staffa, Eleanor Keller, Donald L Boyer, Grace Chong, Jarrod Cross, Sylvia Del Castillo, Andrew Feng, R Stanley Hum, Ebor Jacob James, Amanda Johnson, Sarah Kandil, Martin Kneyber, Ramachandran Rameshkumar, Amanda Levin, Rakesh Lodha, Muralidharan Jayashree, Anthony Olivero, Felix Oberender, Rahul S Panesar, Puneet A Pooni, Kyle J Rehder, Shuba Sankaranarayanan, Margaret Scheffler, Rana Sharara-Chami, Ashley L Siems, Rajakumar Padur Sivaraman, Ken Tegtmeyer, Stacey Valentine, Florencia Villois, Amelie von Saint Andre-von Arnim, Margaret Winkler, Chris Dede, Jeffrey P Burns
OBJECTIVE: Rapid advancements in medicine and changing standards in medical education require new, efficient educational strategies. We investigated whether an online intervention could increase residents' knowledge and improve knowledge retention in mechanical ventilation when compared with a clinical rotation and whether the timing of intervention had an impact on overall knowledge gains. DESIGN: A prospective, interventional crossover study conducted from October 2015 to December 2017...
October 30, 2019: Critical Care Medicine
Samuel H Howitt, Jordan Oakley, Camila Caiado, Michael Goldstein, Ignacio Malagon, Charles McCollum, Stuart W Grant
OBJECTIVES: The Kidney Disease: Improving Global Outcomes urine output criteria for acute kidney injury lack specificity for identifying patients at risk of adverse renal outcomes. The objective was to develop a model that analyses hourly urine output values in real time to identify those at risk of developing severe oliguria. DESIGN: This was a retrospective cohort study utilizing prospectively collected data. SETTING: A cardiac ICU in the United Kingdom...
October 29, 2019: Critical Care Medicine
Tadanaga Shimada, Elena Topchiy, Alex K K Leung, HyeJin J Kong, Kelly R Genga, John H Boyd, James A Russell, Shigeto Oda, Taka-Aki Nakada, Hiroyuki Hirasawa, Keith R Walley
OBJECTIVES: Obese patients have lower sepsis mortality termed the "obesity paradox." We hypothesized that lipopolysaccharide, known to be carried within lipoproteins such as very low density lipoprotein, could be sequestered in adipose tissue during sepsis; potentially contributing a survival benefit. DESIGN: Retrospective analysis. SETTING: University research laboratory. SUBJECTS AND PATIENTS: Vldlr knockout mice to decrease very low density lipoprotein receptors, Pcsk9 knockout mice to increase very low density lipoprotein receptor, and Ldlr knockout mice to decrease low density lipoprotein receptors...
October 23, 2019: Critical Care Medicine
Juliette Chommeloux, Santiago Montero, Guillaume Franchineau, Nicolas Bréchot, Guillaume Hékimian, Guillaume Lebreton, Loic Le Guennec, Simon Bourcier, Ania Nieszkowska, Pascal Leprince, Charles-Edouard Luyt, Alain Combes, Matthieu Schmidt
OBJECTIVES: Despite the increasing use of venoarterial extracorporeal membrane oxygenation to treat severe cardiogenic shock patients, microcirculation data in this context are scarce. We evaluated the venoarterial extracorporeal membrane oxygenation impact on macrocirculatory hemodynamics and microcirculation in patients with refractory cardiogenic shock and compared the evolutions of those parameters between patients successfully weaned-off extracorporeal membrane oxygenation and those who died on extracorporeal membrane oxygenation...
October 21, 2019: Critical Care Medicine
Xuanfei Li, Junyu Zhu, Lixing Tian, Xiaoyuan Ma, Xia Fan, Li Luo, Jing Yu, Yu Sun, Xue Yang, Wanqi Tang, Wei Ma, Jun Yan, Xiang Xu, Huaping Liang
OBJECTIVES: The knowledge that agmatine is found in the human body has existed for several years; however, its role in sepsis has not yet been studied. In the present study, we investigate the role of agmatine in the progression and treatment of sepsis. DESIGN: Clinical/laboratory investigations. SETTING: Medical centers/University-based research laboratory. SUBJECTS: Elective ICU patients with severe sepsis and healthy volunteers; C57BL/6 mice weighing 18-22 g...
October 21, 2019: Critical Care Medicine
Jacob Herrmann, Weerapong Lilitwat, Merryn H Tawhai, David W Kaczka
OBJECTIVES: The theoretical basis for minimizing tidal volume during high-frequency oscillatory ventilation may not be appropriate when lung tissue stretch occurs heterogeneously and/or rapidly. The objective of this study was to assess the extent to which increased ventilation heterogeneity may contribute to ventilator-induced lung injury during high-frequency oscillatory ventilation in adults compared with neonates on the basis of lung size, using a computational model of human lungs...
October 21, 2019: Critical Care Medicine
Elizabeth Y Killien, Roel L N Huijsmans, Iesha L Ticknor, Lincoln S Smith, Monica S Vavilala, Frederick P Rivara, R Scott Watson
OBJECTIVES: To assess the incidence, severity, and outcomes of pediatric acute respiratory distress syndrome following trauma using Pediatric Acute Lung Injury Consensus Conference criteria. DESIGN: Retrospective cohort study. SETTING: Level 1 pediatric trauma center. PATIENTS: Trauma patients less than or equal to 17 years admitted to the ICU from 2009 to 2017. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We queried electronic health records to identify patients meeting pediatric acute respiratory distress syndrome oxygenation criteria for greater than or equal to 6 hours and determined whether patients met complete pediatric acute respiratory distress syndrome criteria via chart review...
October 18, 2019: Critical Care Medicine
Georgios D Kitsios, Libing Yang, Dimitris V Manatakis, Mehdi Nouraie, John Evankovich, William Bain, Daniel G Dunlap, Faraaz Shah, Ian J Barbash, Sarah F Rapport, Yingze Zhang, Rebecca S DeSensi, Nathaniel M Weathington, Bill B Chen, Prabir Ray, Rama K Mallampalli, Panayiotis V Benos, Janet S Lee, Alison Morris, Bryan J McVerry
OBJECTIVES: Classification of patients with acute respiratory distress syndrome into hyper- and hypoinflammatory subphenotypes using plasma biomarkers may facilitate more effective targeted therapy. We examined whether established subphenotypes are present not only in patients with acute respiratory distress syndrome but also in patients at risk for acute respiratory distress syndrome (ARFA) and then assessed the prognostic information of baseline subphenotyping on the evolution of host-response biomarkers and clinical outcomes...
October 18, 2019: Critical Care Medicine
Xingxing Yan, Hongmei Tu, Yi Liu, Tangtian Chen, Ju Cao
OBJECTIVES: Interleukin-17D has been shown to participate in the control of viral infections and cancer. Here we hypothesized that interleukin-17D may play a potential role in sepsis. DESIGN: Prospective randomized animal investigation and in vitro human blood studies. SETTING: Research laboratory from a university hospital. SUBJECTS: Female C57BL/6J mice, sepsis patients by Sepsis-3 definitions, ICU patient controls, and healthy individuals...
October 17, 2019: Critical Care Medicine
Justin R Shinn, Kyle S Kimura, Benjamin R Campbell, Anne Sun Lowery, Christopher T Wootten, C Gaelyn Garrett, David O Francis, Alexander T Hillel, Liping Du, Jonathan D Casey, E Wesley Ely, Alexander Gelbard
OBJECTIVES: Upper airway injury is a recognized complication of prolonged endotracheal intubation, yet little attention has been paid to the consequences of laryngeal injury and functional impact. The purpose of our study was to prospectively define the incidence of acute laryngeal injury and investigate the impact of injury on breathing and voice outcomes. DESIGN: Prospective cohort study. SETTING: Tertiary referral critical care center. PATIENTS: Consecutive adult patients intubated greater than 12 hours in the medical ICU from August 2017 to May 2018 who underwent laryngoscopy within 36 hours of extubation...
October 17, 2019: Critical Care Medicine
Hanne Irene Jensen, Stine Hebsgaard, Tina Charlotte Bitsch Hansen, Rikke Frank Aagaard Johnsen, Christiane S Hartog, Ioanna Soultati, Orsolya Szucs, Michael E Wilson, Bo van den Bulcke, Dominique D Benoit, Ruth Piers
OBJECTIVES: To examine perceptions of nurses and physicians in regard to ethical decision-making climate in the ICU and to test the hypothesis that the worse the ethical decision-making climate, the greater the discordance between nurses' and physicians' rating of ethical decision-making climate with physicians hypothesized to rate the climate better than the nurses. DESIGN: Prospective observational study. SETTING: A total of 68 adult ICUs in 13 European countries and the United States...
October 16, 2019: Critical Care Medicine
Léa Lemasle, Alice Blet, Christopher Geven, Ményssa Cherifa, Benjamin Deniau, Alexa Hollinger, Marie-Céline Fournier, Xavier Monnet, Isabelle Rennuit, Michael Darmon, Pierre-François Laterre, Joachim Struck, Oliver Hartmann, Andreas Bergmann, Alexandre Mebazaa, Etienne Gayat
OBJECTIVES: Adrenomedullin has vascular properties and elevated plasma adrenomedullin levels were detected in sepsis. We assessed, in septic and nonseptic ICU patients, the relation between circulating adrenomedullin, the need for organ support and mortality, using an assay of bioactive adrenomedullin. DESIGN: Prospective multicenter observational cohort study. SETTING: Data from the French and euRopean Outcome reGistry in ICUs study. PATIENTS: Consecutive patients admitted to intensive care with a requirement for invasive mechanical ventilation and/or vasoactive drug support for more than 24 hours following ICU admission and discharged from ICU were included...
October 16, 2019: Critical Care Medicine
Ludhmila Abrahão Hajjar, Cristiane Zambolim, Alessandro Belletti, Juliano Pinheiro de Almeida, Anthony C Gordon, Gisele Oliveira, Clarice Hyesuk Lee Park, Julia Tizue Fukushima, Stephanie Itala Rizk, Tais Felix Szeles, Nestor Cordeiro Dos Santos Neto, Roberto Kalil Filho, Filomena Regina Barbosa Gomes Galas, Giovanni Landoni
OBJECTIVES: Previous trials suggest that vasopressin may improve outcomes in patients with vasodilatory shock. The aim of this study was to evaluate whether vasopressin could be superior to norepinephrine to improve outcomes in cancer patients with septic shock. DESIGN: Single-center, randomized, double-blind clinical trial, and meta-analysis of randomized trials. SETTING: ICU of a tertiary care hospital. PATIENTS: Two-hundred fifty patients 18 years old or older with cancer and septic shock...
October 14, 2019: Critical Care Medicine
Niina Kleiber, Elisa Calvier, Miriam G Mooij, Elke H J Krekels, Wouter H J Vaes, Dick Tibboel, Catherijne A J Knibbe, Saskia N de Wildt
OBJECTIVES: Decreasing morbidity and mortality by rationalizing drug treatment in the critically ill is of paramount importance but challenging as the underlying clinical condition may lead to large variation in drug disposition and response. New microtracer methodology is now available to gain knowledge on drug disposition in the intensive care. On the basis of studies in healthy adults, physicians tend to assume that oral doses of acetaminophen will be completely absorbed and therefore prescribe the same dose per kilogram for oral and IV administration...
October 14, 2019: Critical Care Medicine
Jessica Ma, Stephen Chi, Benjamin Buettner, Katherine Pollard, Monica Muir, Charu Kolekar, Noor Al-Hammadi, Ling Chen, Marin Kollef, Maria Dans
OBJECTIVES: To assess the impact of early triggered palliative care consultation on the outcomes of high-risk ICU patients. DESIGN: Single-center cluster randomized crossover trial. SETTING: Two medical ICUs at Barnes Jewish Hospital. PATIENTS: Patients (n = 199) admitted to the medical ICUs from August 2017 to May 2018 with a positive palliative care screen indicating high risk for morbidity or mortality. INTERVENTIONS: The medical ICUs were randomized to intervention or usual care followed by washout and crossover, with independent assignment of patients to each ICU at admission...
October 14, 2019: Critical Care Medicine
Yiorgos Alexandros Cavayas, Roberto Eljaiek, Élise Rodrigue, Yoan Lamarche, Martin Girard, Han Ting Wang, Sylvie Levesque, André Y Denault
OBJECTIVES: Postoperative pulmonary complications increase mortality, length, and cost of hospitalization. A better diaphragmatic strength may help face an increased work of breathing postoperatively. We, therefore, sought to determine if a low preoperative diaphragm thickening fraction (TFdi) determined by ultrasonography helped predict the occurrence of postoperative pulmonary complications after cardiac surgery independently of indicators of frailty, sarcopenia, and pulmonary function...
October 14, 2019: Critical Care Medicine
Lutea A A de Jong, Annemiek G Otten-Helmers, Peter E Spronk, Hendrikus J M van Kan
OBJECTIVES: To evaluate the use of multifrequency bioelectrical impedance analysis to predict creatinine/urea clearance based on 24 hours urine collection. A practical formula was developed, and its performance was compared with that of established formulas such as Cockcroft-Gault, Modification of Diet in Renal Disease, and Jelliffe's. DESIGN: An open-label prospective observational cohort study. SETTING: A 12-bed ICU at a nonuniversity major teaching hospital (Gelre ziekenhuizen Apeldoorn/Zutphen, The Netherlands)...
October 14, 2019: Critical Care Medicine
Regis G Rosa, Maicon Falavigna, Caroline C Robinson, Evelin C Sanchez, Renata Kochhann, Daniel Schneider, Daniel Sganzerla, Camila Dietrich, Mirceli G Barbosa, Denise de Souza, Gabriela S Rech, Rosa da R Dos Santos, Alice P da Silva, Mariana M Santos, Pedro Dal Lago, Tarek Sharshar, Fernando A Bozza, Cassiano Teixeira
OBJECTIVES: To identify the frequency, causes, and risk factors of early and late mortality among general adult patients discharged from ICUs. DESIGN: Multicenter, prospective cohort study. SETTING: ICUs of 10 tertiary hospitals in Brazil. PATIENTS: One-thousand five-hundred fifty-four adult ICU survivors with an ICU stay greater than 72 hours for medical and emergency surgical admissions or greater than 120 hours for elective surgical admissions...
October 11, 2019: Critical Care Medicine
Sung-Min Cho, Salia Farrokh, Glenn Whitman, Thomas P Bleck, Romergryko G Geocadin
OBJECTIVES: To review the neurocritical care aspects of patients supported by extracorporeal membrane oxygenation, including cerebral physiology, neurologic monitoring, use of sedatives and anti-seizure medications, and prevalence and management of extracorporeal membrane oxygenation associated brain injury. DATA SOURCES: PubMed database search using relevant search terms related to neurologic complications, neurocritical care management, and brain injury management in patients with extracorporeal membrane oxygenation...
October 10, 2019: Critical Care Medicine
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