Critical Care Medicine

Maria P Diaz-Soto, Brooks W Morgan, Long Davalos, Phabiola Herrera, Joshua Denney, Rollin Roldan, Enrique Paz, Amador A Jaymez, Eduardo E Chirinos, Jose Portugal, Rocio Quispe, Roy G Brower, William Checkley
OBJECTIVES: Weaning protocols establish readiness-to-wean criteria to determine the opportune moment to conduct a spontaneous breathing trial. Weaning protocols have not been widely adopted or evaluated in ICUs in low- and middle-income countries. We sought to compare clinical outcomes between participants whose weaning trials were retrospectively determined to have been premature, opportune, or delayed based on when they met readiness-to-wean criteria. DESIGN: Prospective, multicenter observational study...
January 14, 2020: Critical Care Medicine
Mari Rosenqvist, Maria Bengtsson-Toni, Johan Tham, Peter Lanbeck, Olle Melander, Per Åkesson
OBJECTIVES: To assess whether the triage model Sepsis Alert for Emergency Departments results in improved initial care of patients with severe infections. DESIGN: Interventional study comparing patient care before and after the start of a new triage model, including 90-day follow-up. SETTING: Eight emergency departments in Skåne County, Sweden. SUBJECTS: Patients with suspected severe infection. INTERVENTIONS: Patients with severely deviating vital signs and suspected infection were triaged into a designated sepsis line called Sepsis Alert, for rapid evaluation supported by an infectious disease specialist...
January 13, 2020: Critical Care Medicine
Sakari Jukarainen, Henriikka Mildh, Ville Pettilä, Unto Häkkinen, Mikko Peltola, Tero Ala-Kokko, Matti Reinikainen, Suvi T Vaara
OBJECTIVES: The number of critical care survivors is growing, but their long-term outcomes and resource use are poorly characterized. Estimating the cost-utility of critical care is necessary to ensure reasonable use of resources. The objective of this study was to analyze the long-term resource use and costs, and to estimate the cost-utility, of critical care. DESIGN: Prospective observational study. SETTING: Seventeen ICUs providing critical care to 85% of the Finnish adult population...
January 10, 2020: Critical Care Medicine
Adriano Y O Silva, Érica A Amorim, Maria C Barbosa-Silva, Maiara N Lima, Helena A Oliveira, Marcelo G Granja, Karina S Oliveira, Paula M Fagundes, Rômulo L S Neris, Raquel M P Campos, Carolina A Moraes, Adriana L Vallochi, Patricia R M Rocco, Fernando A Bozza, Hugo C Castro-Faria-Neto, Tatiana Maron-Gutierrez
OBJECTIVES: Survivors of sepsis are frequently left with significant cognitive and behavioral impairments. These complications derive from nonresolving inflammation that persists following hospital discharge. To date, no study has investigated the effects of mesenchymal stromal cell therapy on the blood-brain barrier, astrocyte activation, neuroinflammation, and cognitive and behavioral alterations in experimental sepsis. DESIGN: Prospective, randomized, controlled experimental study...
January 9, 2020: Critical Care Medicine
Jason Phua, Mohammad Omar Faruq, Atul P Kulkarni, Ike Sri Redjeki, Khamsay Detleuxay, Naranpurev Mendsaikhan, Kyi Kyi Sann, Babu Raja Shrestha, Madiha Hashmi, Jose Emmanuel M Palo, Rashan Haniffa, Chunting Wang, Seyed Mohammad Reza Hashemian, Aidos Konkayev, Mohd Basri Mat Nor, Boonsong Patjanasoontorn, Khalid Mahmood Khan Nafees, Lowell Ling, Masaji Nishimura, Maher Jaffer Al Bahrani, Yaseen M Arabi, Chae-Man Lim, Wen-Feng Fang
OBJECTIVE: To assess the number of adult critical care beds in Asian countries and regions in relation to population size. DESIGN: Cross-sectional observational study. SETTING: Twenty-three Asian countries and regions, covering 92.1% of the continent's population. PARTICIPANTS: Ten low-income and lower-middle-income economies, five upper-middle-income economies, and eight high-income economies according to the World Bank classification...
January 9, 2020: Critical Care Medicine
Fanny Garnier, Delphine Daubin, Romaric Larcher, Anne-Sophie Bargnoux, Laura Platon, Vincent Brunot, Yassir Aarab, Noémie Besnard, Anne-Marie Dupuy, Boris Jung, Jean-Paul Cristol, Kada Klouche
OBJECTIVES: Urinary biomarkers and renal Doppler sonography remain considered as promising tools to distinguish transient from persistent acute kidney injury. The performance of the urinary biomarker, tissue inhibitor of metalloproteinase-2 x insulin-like growth factor-binding protein 7 and of renal resistive index to predict persistent acute kidney injury showed contradictory results. Our aim was to evaluate the performance of tissue inhibitor of metalloproteinase-2 x insulin-like growth factor-binding protein 7 and renal resistive index in predicting reversibility of acute kidney injury in critically ill patients...
January 9, 2020: Critical Care Medicine
Nicholas B Simpson, Manu Shankar-Hari, Kathryn M Rowan, Maurizio Cecconi, Peter von Dadelszen, Emily Y-S Huning, Laura A Magee, Beth A Payne, Audrey C Quinn, David A Harrison
OBJECTIVES: We aimed to develop and validate an accurate risk prediction model for both mortality and a combined outcome of mortality and morbidity for maternal admissions to critical care. DESIGN: We used data from a high-quality prospectively collected national database, supported with literature review and expert opinion. We tested univariable associations between each risk factor and outcome. We then developed two separate multivariable logistic regression models for the outcomes of acute hospital mortality and death or prolonged ICU length of stay...
January 9, 2020: Critical Care Medicine
Chang Gao, Yeming Wang, Xiaoying Gu, Xinghua Shen, Daming Zhou, Shujun Zhou, Jian-An Huang, Bin Cao, Qiang Guo
OBJECTIVES: To evaluate the prevalence of cardiac injury and its association with mortality in hospitalized patients infected with avian influenza A (H7N9) virus. DESIGN: Retrospective cohort study. SETTING: A total of 133 hospitals in 17 provinces, autonomous regions, and municipalities of mainland China that admitted influenza A (H7N9) virus-infected patients between January 22, 2015, and June 16, 2017. PATIENTS: A total of 321 patients with influenza A (H7N9) virus infection were included in the final analysis...
January 9, 2020: Critical Care Medicine
Andrew Jones, Anne P Toft-Petersen, Manu Shankar-Hari, David A Harrison, Kathryn M Rowan
OBJECTIVES: Major increases in the proportion of elderly people in the population are predicted worldwide. These population increases, along with improving therapeutic options and more aggressive treatment of elderly patients, will have major impact on the future need for healthcare resources, including critical care. Our objectives were to explore the trends in admissions, resource use, and risk-adjusted hospital mortality for older patients, admitted over a 20-year period between 1997 and 2016 to adult general ICUs in the United Kingdom, Wales, and Northern Ireland...
January 9, 2020: Critical Care Medicine
Dipayan Chaudhuri, David Granton, Dominic Xiang Wang, Sharon Einav, Yigal Helviz, Tommaso Mauri, Jean-Damien Ricard, Jordi Mancebo, Jean-Pierre Frat, Sameer Jog, Gonzalo Hernandez, Salvatore M Maggiore, Carol Hodgson, Samir Jaber, Laurent Brochard, Karen E A Burns, Bram Rochwerg
OBJECTIVE: The role of high-flow nasal cannula during and before intubation is unclear despite a number of randomized clinical trials. Our objective was to conduct a systematic review and meta-analysis examining the benefits of high-flow nasal cannula in the peri-intubation period. DATA SOURCES: We performed a comprehensive search of relevant databases (MEDLINE, EMBASE, and Web of Science). STUDY SELECTION: We included randomized clinical trials that compared high-flow nasal cannula to other noninvasive oxygen delivery systems in the peri-intubation period...
January 9, 2020: Critical Care Medicine
Federico Angriman, Ruxandra Pinto, Jan O Friedrich, Niall D Ferguson, Gordon Rubenfeld, Andre Carlos Kajdacsy-Balla Amaral
OBJECTIVES: We sought to evaluate the impact of transitions of care among staff intensivists on the compliance with evidence-based processes of care. DESIGN: Cohort study using data from the Toronto Intensive Care Observational Registry. SETTING: Seven academic ICUs in Toronto, Ontario. PATIENTS: Critically ill mechanically ventilated adult patients. INTERVENTIONS: We explored the effects of the weekly transition of care among staff intensivists on compliance with three evidence-based processes of care (spontaneous breathing trials, lung-protective ventilation, and neuromuscular blocking agents)...
January 8, 2020: Critical Care Medicine
Joerg C Schefold, Joël L Gerber, Michelle C Angehrn, Martin Müller, Anna S Messmer, Alexander B Leichtle, Georg M Fiedler, Aristomenis K Exadaktylos, Carmen A Pfortmueller
OBJECTIVES: Diagnosing thromboembolic disease typically includes D-dimer testing and use of clinical scores in patients with low to intermediate pretest probability. However, renal dysfunction is often observed in patients with thromboembolic disease and was previously shown to be associated with increased D-dimer levels. We seek to validate previously suggested estimated glomerular filtration rate-adjusted D-dimer cutoff levels. Furthermore, we strive to explore whether the type of renal dysfunction affects estimated glomerular filtration rate-adjusted D-dimer test characteristics...
January 7, 2020: Critical Care Medicine
Daren K Heyland, Francois Marquis, Francois Lamontagne, Martin Albert, Alexis F Turgeon, Kosar A Khwaja, Allan Garland, Richard Hall, Martin G Chapman, Demetrios J Kutsiogannis, Claudio Martin, Daniel I Sessler, Andrew G Day
OBJECTIVES: To evaluate the effect of esophageal stimulation on nutritional adequacy in critically ill patients at risk for enteral feeding intolerance. DESIGN: A multicenter randomized sham-controlled clinical trial. SETTING: Twelve ICUs in Canada. PATIENTS: We included mechanically ventilated ICU patients who were given moderate-to-high doses of opioids and expected to remain alive and ventilated for an additional 48 hours and who were receiving enteral nutrition or expected to start imminently...
January 6, 2020: Critical Care Medicine
Merrick Miles, Dorothee Mueller, Daniel Gay-Betton, Sarah H Baum Miller, Scott Massa, Yaping Shi, Matthew S Shotwell, Meghan Lane-Fall, Joseph J Schlesinger
OBJECTIVES: Team rounding in the ICU can tax clinicians' finite attentional resources. We hypothesized that a novel approach to rounding, where patients are seen in a decreasing order of acuity, would decrease attentional attrition. DESIGN: Prospective interventional internal-control cohort study in which stop signal task testing was used as a proxy for attentional reserves. Stop signal task is a measure of cognitive control and response inhibition in addition to performance monitoring, all reflective of executive control abilities, and our surrogate for attentional reserves...
December 24, 2019: Critical Care Medicine
Gunnar Lachmann, Cornelia Knaak, Gerald Vorderwülbecke, Paul La Rosée, Felix Balzer, Thomas Schenk, Friederike S Schuster, Peter Nyvlt, Gritta Janka, Frank M Brunkhorst, Didier Keh, Claudia Spies
OBJECTIVE: Hyperferritinemia is frequently seen in critically ill patients. A rather rare though life-threatening condition related to severely elevated ferritin is hemophagocytic lymphohistiocytosis. We analyze ferritin levels to differentiate hemophagocytic lymphohistiocytosis from other causes of hyperferritinemia in a mixed cohort of critically ill patients. DESIGN: Retrospective observational study. SETTING: Adult surgical, anesthesiologic, and medical ICUs of a university hospital...
December 24, 2019: Critical Care Medicine
Keith A Corl, Fatima Zeba, Aisling R Caffrey, Matthew Hermenau, Vrishali Lopes, Gary Phillips, Roland C Merchant, Mitchell M Levy, Kerry L LaPlante
OBJECTIVES: The relationship between the timing of antibiotics and mortality among septic shock patients has not been examined among patients specifically with Staphylococcus aureus bacteremia. DESIGN: Retrospective analysis of a Veterans Affairs S. aureus bacteremia database. SETTING: One-hundred twenty-two hospitals in the Veterans Affairs Health System. PATIENTS: Patients with septic shock and S. aureus bacteremia admitted directly from the emergency department to the ICU from January 1, 2003, to October 1, 2015, were evaluated...
December 24, 2019: Critical Care Medicine
Farah Din, Saptharishi Lalgudi Ganesan, Tomoyuki Akiyama, Craig P Stewart, Ayako Ochi, Hiroshi Otsubo, Cristina Go, Cecil D Hahn
OBJECTIVES: To evaluate the performance of commercially available seizure detection algorithms in critically ill children. DESIGN: Diagnostic accuracy comparison between commercially available seizure detection algorithms referenced to electroencephalography experts using quantitative electroencephalography trends. SETTING: Multispecialty quaternary children's hospital in Canada. SUBJECTS: Critically ill children undergoing electroencephalography monitoring...
December 24, 2019: Critical Care Medicine
Claudio M Martin, Melody Lam, Britney Allen, Lucie Richard, Vincent Lau, Ian M Ball, Hannah Wunsch, Rob A Fowler, Damon C Scales
OBJECTIVE: To describe trends and patient and system factors associated with direct discharge from critical care to home in a large health system. DESIGN: Population-based cohort study of direct discharge to home rates annually over 10 years. We used a multivariable, multilevel random-effects regression model to analyze current factors associated with direct discharge home in a subcohort from the most recent 2 years. SETTING: One hundred seventy-four ICUs in 101 hospitals in Ontario...
December 23, 2019: Critical Care Medicine
Guillaume Coutance, Nicolas Jacob, Pierre Demondion, Lee S Nguyen, Adrien Bouglé, Nicolas Bréchot, Shaida Varnous, Pascal Leprince, Alain Combes, Guillaume Lebreton
OBJECTIVES: Heart transplantation in patients supported by venoarterial extracorporeal membrane oxygenation has been associated with poor prognosis. A specific protocol for extracorporeal membrane oxygenation management encompassing patient selection, implantation strategy, and preoperative and perioperative treatment is applied at our institution. Our aim was to compare posttransplant outcomes of patients supported or not by extracorporeal membrane oxygenation at the time of heart transplantation...
December 23, 2019: Critical Care Medicine
Timothy N Kwan, Lara Zwakman-Hessels, Nada Marhoon, Ray Robbins, Johan Mårtensson, Elif Ekinci, Rinaldo Bellomo
OBJECTIVES: Relative hypoglycemia is a decrease in glucose greater than or equal to 30% below prehospital admission levels (estimated by hemoglobin A1C) but not to absolute hypoglycemia levels. It is a recognized pathophysiologic phenomenon in ambulant poorly controlled diabetic patients but remains unexamined during critical illness. We examined the frequency, characteristics, and outcome associations of relative hypoglycemia in diabetic patients with critical illness. DESIGN: Retrospective cohort study...
December 23, 2019: Critical Care Medicine
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