Alvin Richards-Belle, Mathieu Hylands, Fiona Muttalib, Shaurya Taran, Bram Rochwerg, Andrew Day, Paul R Mouncey, Peter Radermacher, Rachel Couban, Pierre Asfar, Neill K J Adhikari, Francois Lamontagne
OBJECTIVES: Balancing the risks of hypotension and vasopressor-associated adverse effects is a daily challenge in ICUs. We conducted a systematic review with meta-analysis to examine the effect of lower versus higher exposure to vasopressor therapy on mortality among adult ICU patients with vasodilatory hypotension. DATA SOURCES: We searched Ovid Medline, Embase, and the Cochrane Central Register of Controlled Trials for studies published from inception to October 15, 2021...
November 18, 2022: Critical Care Medicine
Eline G M Cox, Renske Wiersema, Ruben J Eck, Thomas Kaufmann, Anders Granholm, Suvi T Vaara, Morten Hylander Møller, Bas C T van Bussel, Harold Snieder, Rick G Pleijhuis, Iwan C C van der Horst, Frederik Keus
OBJECTIVES: In a recent scoping review, we identified 43 mortality prediction models for critically ill patients. We aimed to assess the performances of these models through external validation. DESIGN: Multicenter study. SETTING: External validation of models was performed in the Simple Intensive Care Studies-I (SICS-I) and the Finnish Acute Kidney Injury (FINNAKI) study. PATIENTS: The SICS-I study consisted of 1,075 patients, and the FINNAKI study consisted of 2,901 critically ill patients...
November 16, 2022: Critical Care Medicine
Emilie Lambourg, Heather Walker, Jacqueline Campbell, Chrissie Watters, Martin O'Neil, Lorraine Donaldson, Moneeza K Siddiqui, Alison Almond, Katharine Buck, Zoe Cousland, Nicola Joss, Wendy Metcalfe, Shona Methven, Vinod Sanu, Elaine Spalding, Jamie P Traynor, Nazir I Lone, Samira Bell
OBJECTIVES: To determine the incidence and characteristics of ICU admissions in the Scottish population of patients treated with chronic kidney replacement therapy (KRT) over an 11-year period and determine factors associated with post-ICU admission mortality. DESIGN: Retrospective observational cohort study. SETTING: We analyzed admissions to Scottish intensive care environments between January 1, 2009, and December 31, 2019. PATIENTS: All patients receiving chronic KRT-including maintenance dialysis and kidney transplant-in Scotland...
November 15, 2022: Critical Care Medicine
Brian M Fuller, Nicholas M Mohr, Enyo Ablordeppey, Olivia Roman, Dylan Mittauer, Yan Yan, Marin H Kollef, Christopher R Carpenter, Brian W Roberts
OBJECTIVES: Mechanically ventilated emergency department (ED) patients experience high morbidity and mortality. In a prior trial at our center, ED-based lung-protective ventilation was associated with improved care delivery and outcomes. Whether this strategy has persisted in the years after the trial remains unclear. The objective was to assess practice change and clinical outcomes associated with ED lung-protective ventilation. DESIGN: Secondary analysis of individual patient-level data from prior clinical trials and cohort studies...
November 14, 2022: Critical Care Medicine
Eddine Bendiab, Fanny Garnier, Marion Soler, Maxime Fosset, Samir Jaber, Nicolas Molinari, Boris Jung
OBJECTIVES: Long-term prognosis of ICU survivors is a major issue. Severe acidemia upon ICU admission is associated with very high short-term mortality. Since the long-term prognosis of these patients is unknown, we aimed to determine the long-term health-related quality of life and survival of these patients. DESIGN: Post hoc analysis of a multicenter, randomized, controlled trial. SETTING: Twenty-six French ICUs. PATIENTS: Day 28 critically ill survivors admitted with severe acidemia and enrolled in the BICAR-ICU trial...
November 9, 2022: Critical Care Medicine
Christopher E Cox, Jessie Gu, Deepshikha Charan Ashana, Elias H Pratt, Krista Haines, Jessica Ma, Maren K Olsen, Alice Parish, David Casarett, Mashael S Al-Hegelan, Colleen Naglee, Jason N Katz, Yasmin Ali O'Keefe, Robert W Harrison, Isaretta L Riley, Santos Bermejo, Katelyn Dempsey, Kimberly S Johnson, Sharron L Docherty
OBJECTIVES: While palliative care needs are assumed to improve during ICU care, few empiric data exist on need trajectories or their impact on long-term outcomes. We aimed to describe trajectories of palliative care needs during ICU care and to determine if changes in needs over 1 week was associated with similar changes in psychological distress symptoms at 3 months. DESIGN: Prospective cohort study. SETTING: Six adult medical and surgical ICUs...
November 3, 2022: Critical Care Medicine
Karen E A Burns, Marc Moss, Edmund Lorens, Elizabeth Karin Ann Jose, Claudio M Martin, Elizabeth M Viglianti, Alison Fox-Robichaud, Kusum S Mathews, Kathleen Akgun, Snigdha Jain, Hayley Gershengorn, Sangeeta Mehta, Jenny E Han, Gregory S Martin, Janice M Liebler, Renee D Stapleton, Polina Trachuk, Kelly C Vranas, Abigail Chua, Margaret S Herridge, Jennifer L Y Tsang, Michelle Biehl, Ellen L Burnham, Jen-Ting Chen, Engi F Attia, Amira Mohamed, Michelle S Harkins, Sheryll M Soriano, Aline Maddux, Julia C West, Andrew R Badke, Sean M Bagshaw, Alexandra Binnie, W Graham Carlos, Başak Çoruh, Kristina Crothers, Frederick D'Aragon, Joshua Lee Denson, John W Drover, Gregg Eschun, Anna Geagea, Donald Griesdale, Rachel Hadler, Jennifer Hancock, Jovan Hasmatali, Bhavika Kaul, Meeta Prasad Kerlin, Rachel Kohn, D James Kutsogiannis, Scott M Matson, Peter E Morris, Bojan Paunovic, Ithan D Peltan, Dominique Piquette, Mina Pirzadeh, Krishna Pulchan, Lynn M Schnapp, Curtis N Sessler, Heather Smith, Eric Sy, Subarna Thirugnanam, Rachel K McDonald, Katie A McPherson, Monica Kraft, Michelle Spiegel, Peter M Dodek
OBJECTIVES: Few surveys have focused on physician moral distress, burnout, and professional fulfilment. We assessed physician wellness and coping during the COVID-19 pandemic. DESIGN: Cross-sectional survey using four validated instruments. SETTING: Sixty-two sites in Canada and the United States. SUBJECTS: Attending physicians (adult, pediatric; intensivist, nonintensivist) who worked in North American ICUs. INTERVENTION: None...
October 27, 2022: Critical Care Medicine
Lindsay Rein, Karel Calero, Ronak Shah, Charles Ojielo, Kristin M Hudock, Saba Lodhi, Farid Sadaka, Shashi Bellam, Christopher Palma, David N Hager, Jeannie Daniel, Richard Schaub, Kevin O'Hayer, Nicole M Theodoropoulos
OBJECTIVES: Evaluate the safety and efficacy of the Janus kinase (JAK)1/JAK2 inhibitor ruxolitinib in COVID-19-associated acute respiratory distress syndrome requiring mechanical ventilation. DESIGN: Phase 3 randomized, double-blind, placebo-controlled trial Ruxolitinib in Participants With COVID-19-Associated Acute Respiratory Distress Syndrome Who Require Mechanical Ventilation (RUXCOVID-DEVENT; NCT04377620). SETTING: Hospitals and community-based private or group practices in the United States (29 sites) and Russia (4 sites)...
October 13, 2022: Critical Care Medicine
Kathrin Knochel, Katharina Adaktylos-Surber, Eva-Maria Schmolke, Lukas J Meier, Katja Kuehlmeyer, Kurt Ulm, Alena Buyx, Gerhard Schneider, Markus Heim
OBJECTIVES: Simulation and evaluation of a prioritization protocol at a German university hospital using a convergent parallel mixed methods design. DESIGN: Prospective single-center cohort study with a quantitative analysis of ICU patients and qualitative content analysis of two focus groups with intensivists. SETTING: Five ICUs of internal medicine and anesthesiology at a German university hospital. PATIENTS: Adult critically ill ICU patients (n = 53)...
October 12, 2022: Critical Care Medicine
Julien Carvelli, Ferhat Meziani, Jean Dellamonica, Pierre-Yves Cordier, Jerome Allardet-Servent, Megan Fraisse, Lionel Velly, Saber Davide Barbar, Samuel Lehingue, Christophe Guervilly, Maxime Desgrouas, Fabrice Camou, Christelle Piperoglou, Frederic Vely, Olivier Demaria, Joyson Karakunnel, Joanna Fares, Luciana Batista, Federico Rotolo, Julien Viotti, Agnes Boyer-Chammard, Karine Lacombe, Erwan Le Dault, Michel Carles, Nicolas Schleinitz, Eric Vivier
OBJECTIVES: Severe COVID-19 is associated with exaggerated complement activation. We assessed the efficacy and safety of avdoralimab (an anti-C5aR1 mAb) in severe COVID-19. DESIGN: FOR COVID Elimination (FORCE) was a double-blind, placebo-controlled study. SETTING: Twelve clinical sites in France (ICU and general hospitals). PATIENTS: Patients receiving greater than or equal to 5 L oxygen/min to maintain Spo2 greater than 93% (World Health Organization scale ≥ 5)...
October 11, 2022: Critical Care Medicine
Kimberley J Haines, Nina Leggett, Elizabeth Hibbert, Tarli Hall, Leanne M Boehm, Rita N Bakhru, Anthony J Bastin, Brad W Butcher, Tammy L Eaton, Wendy Harris, Aluko A Hope, James Jackson, Annie Johnson, Janet A Kloos, Karen A Korzick, Pamela Mactavish, Joel Meyer, Ashley Montgomery-Yates, Tara Quasim, Andrew Slack, Dorothy Wade, Mary Still, Giora Netzer, Ramona O Hopkins, Mark E Mikkelsen, Theodore J Iwashyna, Joanne McPeake, Carla M Sevin
OBJECTIVES: To engage critical care end-users (survivors and caregivers) to describe their emotions and experiences across their recovery trajectory, and elicit their ideas and solutions for health service improvements to improve the ICU recovery experience. DESIGN: End-user engagement as part of a qualitative design using the Framework Analysis method. SETTING: The Society of Critical Care Medicine's THRIVE international collaborative sites (follow-up clinics and peer support groups)...
October 7, 2022: Critical Care Medicine
Moises Muley, Panaiotis Finamore, Claudio Pedone, Domenico Paolo Emanuele Margiotta, Emanuele Gilardi, Federica Sambuco, Antonio De Vincentis, Umberto Vespasiani-Gentilucci, Francesco Travaglino, Raffaele Antonelli-Incalzi
OBJECTIVES: Pneumomediastinum (PNM) is a rare complication of mechanical ventilation, but its reported occurrence in patients with acute respiratory distress syndrome secondary to COVID-19 is significant. The objective is to determine the incidence, risk factors, and outcome of PNM in non-ICU hospitalized patients with severe-to-critical COVID-19 pneumonia. DESIGN: Retrospective observational study. SETTING: Population-based, single-setting, tertiary-care level COVID treatment center...
October 6, 2022: Critical Care Medicine
Debora Stripari Schujmann, Adriana Claudia Lunardi, Claudia Neri Peso, José Eduardo Pompeu, Raquel Annoni, Mieko Claudia Miura, Caroline Maschio de Censo, Luzia Noriko Takahashi Taniguchi, Marisa de Moraes Regenga, Elaine Cristina de Campos, Renato Fraga Righetti, Wellington Pereira Yamaguti, Christina May Moran de Brito, Adriana Lourenço, Sabrina Castaldi Aguera, Clarice Tanaka, Carolina Fu
OBJECTIVES: To analyze functional recovery groups of critically ill COVID-19 survivors during their hospital stay and to identify the associated factors. DESIGN: Prospective observational multicenter study. SETTING: Demographic, clinical, and therapeutic variables were collected, and physical and functional status were evaluated. The Barthel index was evaluated at three time points: 15 days before hospitalization, at ICU discharge, and at hospital discharge from the ward...
December 1, 2022: Critical Care Medicine
Aurelie Gouel-Cheron, Bruce J Swihart, Sarah Warner, Lauren Mathew, Jeffrey R Strich, Alex Mancera, Dean Follmann, Sameer S Kadri
OBJECTIVES: Bloodstream infections (BSIs) acquired in the ICU represent a detrimental yet potentially preventable condition. We determined the prevalence of BSI acquired in the ICU (ICU-onset BSI), pathogen profile, and associated risk factors. DESIGN: Retrospective cohort study. DATA SOURCES: Eighty-five U.S. hospitals in the Cerner Healthfacts Database. PATIENT SELECTION: Adult hospitalizations between January 2009 and December 2015 including a (≥ 3 d) ICU stay...
October 3, 2022: Critical Care Medicine
Hiroyuki Ohbe, Takashi Tagami, Takayuki Ogura, Hiroki Matsui, Hideo Yasunaga
OBJECTIVES: Although existing guidelines recommend commencing cannulation for extracorporeal cardiopulmonary resuscitation (ECPR) within 10-20 minutes of failed conventional resuscitation efforts for cardiac arrest, there is little supportive evidence. The present study aimed to determine the association of low-flow duration with survival-to-discharge rate in in-hospital cardiac arrest patients who received ECPR. DESIGN: A nationwide retrospective cohort study analyzed a nationwide inpatient database in Japan...
October 3, 2022: Critical Care Medicine
Cecilia Cuzco, Pedro Castro, Raquel Marín Pérez, Samuel Ruiz García, Ana I Núñez Delgado, Marta Romero García, M Antonia Martínez Momblan, Llucia Benito Aracil, Inmaculada Carmona Delgado, Montse Canalias Reverter, José M Nicolás, Gemma Martínez Estalella, Pilar Delgado-Hito
OBJECTIVES: To assess the impact of a nurse-driven patient empowerment intervention on anxiety and depression of patients during ICU discharge. DESIGN: A prospective, multicenter, randomized clinical trial. SETTING: Three ICUs (1 medical, 1 medical and surgical, and 1 coronary) of three tertiary hospitals. PATIENTS: Adults admitted to the ICU greater than 18 years old for greater than or equal to 48 hours with preserved consciousness, the ability to communicate and without delirium, who were randomized to receive the nurse-driven patient empowerment intervention (NEI) (intervention group [IG] or standard of care [control group (CG)]) before ICU discharge...
September 30, 2022: Critical Care Medicine
Ricardo Teijeiro-Paradis, Whitney D Gannon, Eddy Fan
OBJECTIVES: Despite increasing use and promising outcomes, venovenous extracorporeal membrane oxygenation (V-V ECMO) introduces the risk of a number of complications across the spectrum of ECMO care. This narrative review describes the variety of short- and long-term complications that can occur during treatment with ECMO and how patient selection and management decisions may influence the risk of these complications. DATA SOURCES: English language articles were identified in PubMed using phrases related to V-V ECMO, acute respiratory distress syndrome, severe respiratory failure, and complications...
September 12, 2022: Critical Care Medicine
Aaron Shoskes, Merry Huang, Aron Gedansky, Catherine Hassett, A Blake Buletko, Abhijit Duggal, Ken Uchino, Sung-Min Cho
OBJECTIVES: Cerebrovascular injury associated with COVID-19 has been recognized, but the mechanisms remain uncertain. Acute respiratory distress syndrome (ARDS) is a severe pulmonary injury, which is associated with both ischemic and hemorrhagic stroke. It remains unclear if cerebrovascular injuries associated with severe COVID-19 are unique to COVID-19 or a consequence of severe respiratory disease or its treatment. The frequency and patterns of cerebrovascular injury on brain MRI were compared among patients with COVID-19 ARDS and non-COVID-19 ARDS...
September 12, 2022: Critical Care Medicine
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December 1, 2022: Critical Care Medicine
Brian T Wessman, Nicholas M Mohr
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December 1, 2022: Critical Care Medicine
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