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Critical Care Medicine

Prashant J Purohit, Mohammed H Elkomy, Adam Frymoyer, Scott M Sutherland, David R Drover, Gregory B Hammer, Felice Su
OBJECTIVES: Little is known on the impact of continuous renal replacement therapy on antimicrobial dose requirements in children. In this study, we evaluated the pharmacokinetics of commonly administered antimicrobials in an ex vivo continuous renal replacement therapy model. DESIGN: An ex vivo continuous renal replacement therapy circuit was used to evaluate drug-circuit interactions and determine the disposition of five commonly used antimicrobials (meropenem, piperacillin, liposomal amphotericin B, caspofungin, and voriconazole)...
July 15, 2019: Critical Care Medicine
Ammar Majeed, Avik Majumdar, Michael Bailey, William Kemp, Rinaldo Bellomo, David Pilcher, Stuart K Roberts
OBJECTIVES: We aimed to describe changes over time in admissions and outcomes, including length of stay, discharge destinations, and mortality of cirrhotic patients admitted to the ICU for variceal bleeding, and to compare it to the outcomes of those with other causes of ICU admissions. DESIGN: Retrospective analysis of data captured prospectively in the Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation Adult Patient Database...
July 15, 2019: Critical Care Medicine
Annelies Wassenaar, Lisette Schoonhoven, John W Devlin, Frank M P van Haren, Arjen J C Slooter, Philippe G Jorens, Mathieu van der Jagt, Koen S Simons, Ingrid Egerod, Lisa D Burry, Albertus Beishuizen, Joaquim Matos, A Rogier T Donders, Peter Pickkers, Mark van den Boogaard
OBJECTIVES: To externally validate two delirium prediction models (early prediction model for ICU delirium and recalibrated prediction model for ICU delirium) using either the Confusion Assessment Method-ICU or the Intensive Care Delirium Screening Checklist for delirium assessment. DESIGN: Prospective, multinational cohort study. SETTING: Eleven ICUs from seven countries in three continents. PATIENTS: Consecutive, delirium-free adults admitted to the ICU for greater than or equal to 6 hours in whom delirium could be reliably assessed...
July 15, 2019: Critical Care Medicine
Majid Afshar, Erum Arain, Chen Ye, Emily Gilbert, Meng Xie, Josh Lee, Matthew M Churpek, Ramon Durazo-Arvizu, Talar Markossian, Cara Joyce
OBJECTIVES: Assess patient outcomes in patients with suspected infection and the cost-effectiveness of implementing a quality improvement program. DESIGN, SETTING, AND PARTICIPANTS: We conducted an observational single-center study of 13,877 adults with suspected infection between March 1, 2014, and July 31, 2017. The 18-month period before and after the effective date for mandated reporting of the sepsis bundle was examined. The Sequential Organ Failure Assessment score and culture and antibiotic orders were used to identify patients meeting Sepsis-3 criteria from the electronic health record...
July 15, 2019: Critical Care Medicine
Sai Saran, Mohan Gurjar, Vikas Kanaujia, Pralay S Ghosh, Anshi Gupta, Prabhaker Mishra, Afzal Azim, Banani Poddar, Arvind Baronia, Ritu Singh
OBJECTIVES: To evaluate the effect of prolonged duration of prone position (with head laterally rotated) on intraocular pressure in acute respiratory distress syndrome patients. DESIGN: Prospective observational study. SETTING: University hospital ICU. PATIENTS: Twenty-five acute respiratory distress syndrome patients, age 60 years (51-67 yr), Sequential Organ Failure Assessment score 10 (10-12), PaO2/FIO2 ratio of 90 (65-120), and all in septic shock...
July 11, 2019: Critical Care Medicine
Ann C Long, Lyndia C Brumback, J Randall Curtis, Alexander Avidan, Mario Baras, Edoardo De Robertis, Linda Efferen, Ruth A Engelberg, Erin K Kross, Andrej Michalsen, Richard A Mularski, Charles L Sprung
OBJECTIVES: To develop an enhanced understanding of factors that influence providers' views about end-of-life care, we examined the contributions of provider, hospital, and country to variability in agreement with consensus statements about end-of-life care. DESIGN AND SETTING: Data were drawn from a survey of providers' views on principles of end-of-life care obtained during the consensus process for the Worldwide End-of-Life Practice for Patients in ICUs study...
July 11, 2019: Critical Care Medicine
Asha M Anandaiah, Jennifer P Stevens, Amy M Sullivan
OBJECTIVES: A bundled consent process, where patients or surrogates provide consent for all commonly performed procedures on a single form at the time of ICU admission, has been advocated as a method for improving both rates of documented consent and patient/family satisfaction, but there has been little published literature about the use of bundled consent. We sought to determine how residents in an academic medical center with a required bundled consent process actually obtain consent and how they perceive the overall value, efficacy, and effects on families of this approach...
July 11, 2019: Critical Care Medicine
Djillali Annane
No abstract text is available yet for this article.
June 27, 2019: Critical Care Medicine
Kimberley J Haines, Joanne McPeake, Elizabeth Hibbert, Leanne M Boehm, Krishna Aparanji, Rita N Bakhru, Anthony J Bastin, Sarah J Beesley, Lynne Beveridge, Brad W Butcher, Kelly Drumright, Tammy L Eaton, Thomas Farley, Penelope Firshman, Andrew Fritschle, Clare Holdsworth, Aluko A Hope, Annie Johnson, Michael T Kenes, Babar A Khan, Janet A Kloos, Erin K Kross, Pamela Mactavish, Joel Meyer, Ashley Montgomery-Yates, Tara Quasim, Howard L Saft, Andrew Slack, Joanna Stollings, Gerald Weinhouse, Jessica Whitten, Giora Netzer, Ramona O Hopkins, Mark E Mikkelsen, Theodore J Iwashyna, Carla M Sevin
OBJECTIVES: Data are lacking regarding implementation of novel strategies such as follow-up clinics and peer support groups, to reduce the burden of postintensive care syndrome. We sought to discover enablers that helped hospital-based clinicians establish post-ICU clinics and peer support programs, and identify barriers that challenged them. DESIGN: Qualitative inquiry. The Consolidated Framework for Implementation Research was used to organize and analyze data...
June 21, 2019: Critical Care Medicine
Mohammad M Ghassemi, Edilberto Amorim, Tuka Alhanai, Jong W Lee, Susan T Herman, Adithya Sivaraju, Nicolas Gaspard, Lawrence J Hirsch, Benjamin M Scirica, Siddharth Biswal, Valdery Moura Junior, Sydney S Cash, Emery N Brown, Roger G Mark, M Brandon Westover
OBJECTIVES: Electroencephalogram features predict neurologic recovery following cardiac arrest. Recent work has shown that prognostic implications of some key electroencephalogram features change over time. We explore whether time dependence exists for an expanded selection of quantitative electroencephalogram features and whether accounting for this time dependence enables better prognostic predictions. DESIGN: Retrospective. SETTING: ICUs at four academic medical centers in the United States...
June 21, 2019: Critical Care Medicine
Steven P Keller
OBJECTIVES: Cardiogenic shock is a highly morbid condition in which inadequate end-organ perfusion leads to death if untreated. Peripheral venoarterial extracorporeal membrane oxygenation is increasingly used to restore systemic perfusion despite limited understanding of how to optimally titrate support. This review provides insights into the physiologic basis of extracorporeal membrane oxygenation support and presents an approach to extracorporeal membrane oxygenation management in the cardiogenic shock patient...
June 18, 2019: Critical Care Medicine
Kathryn Ann Lambe, Sinéad Lydon, Caoimhe Madden, Akke Vellinga, Aoife Hehir, Mary Walsh, Paul O'Connor
OBJECTIVES: To synthesize the literature describing compliance with World Health Organization hand hygiene guidelines in ICUs, to evaluate the quality of extant research, and to examine differences in compliance levels across geographical regions, ICU types, and healthcare worker groups, observation methods, and moments (indications) of hand hygiene. DATA SOURCES: Electronic searches were conducted in August 2018 using Medline, CINAHL, PsycInfo, Embase, and Web of Science...
June 18, 2019: Critical Care Medicine
Angela J Rogers, Jiazhen Guan, Anna Trtchounian, Gary M Hunninghake, Rajani Kaimal, Manisha Desai, Lori-Ann Kozikowski, Lesley DeSouza, Susan Mogan, Kathleen D Liu, Michael A Matthay, Jay Steingrub, Art Wheeler, Joo Heon Yoon, Kiichi Nakahira, Augustine M Choi, Rebecca M Baron
OBJECTIVE: A high plasma level of inflammasome mediator interleukin-18 was associated with mortality in observational acute respiratory distress syndrome cohorts. Statin exposure increases both inflammasome activation and lung injury in mouse models. We tested whether randomization to statin therapy correlated with increased interleukin-18 in the ARDS Network Statins for Acutely Injured Lungs from Sepsis trial. DESIGN: Retrospective analysis of randomized controlled clinical trial...
June 14, 2019: Critical Care Medicine
Maximiliano A Hawkes, Stephen W English, Jay N Mandrekar, Alejandro A Rabinstein, Sara Hocker
OBJECTIVES: To determine the causes of death in patients with status epilepticus. To analyze the relative contributions of seizure etiology, seizure refractoriness, use of mechanical ventilation, anesthetic drugs for seizure control, and medical complications to in-hospital and 90-day mortality, hospital length of stay, and discharge disposition. DESIGN: Retrospective cohort. SETTING: Single-center neuroscience ICU. PARTICIPANTS: Patients with status epilepticus were identified by retrospective search of electronic database from January 1, 2011, to December 31, 2016...
June 14, 2019: Critical Care Medicine
Andrej Michalsen, Ann C Long, Freda DeKeyser Ganz, Douglas B White, Hanne I Jensen, Victoria Metaxa, Christiane S Hartog, Jos M Latour, Robert D Truog, Jozef Kesecioglu, Anna R Mahn, J Randall Curtis
OBJECTIVES: There is growing recognition that high-quality care for patients and families in the ICU requires exemplary interprofessional collaboration and communication. One important aspect is how the ICU team makes complex decisions. However, no recommendations have been published on interprofessional shared decision-making. The aim of this project is to use systematic review and normative analysis by experts to examine existing evidence regarding interprofessional shared decision-making, describe its principles and provide ICU clinicians with recommendations regarding its implementation...
June 4, 2019: Critical Care Medicine
Anisha Wijeyesekera, Josef Wagner, Marcus De Goffau, Sarah Thurston, Adilson Rodrigues Sabino, Sara Zaher, Deborah White, Jenna Ridout, Mark J Peters, Padmanabhan Ramnarayan, Ricardo G Branco, M Estee Torok, Frederic Valla, Rosan Meyer, Nigel Klein, Gary Frost, Julian Parkhill, Elaine Holmes, Nazima Pathan
OBJECTIVES: Adverse physiology and antibiotic exposure devastate the intestinal microbiome in critical illness. Time and cost implications limit the immediate clinical potential of microbial sequencing to identify or treat intestinal dysbiosis. Here, we examined whether metabolic profiling is a feasible method of monitoring intestinal dysbiosis in critically ill children. DESIGN: Prospective multicenter cohort study. SETTING: Three U.K.-based PICUs...
June 4, 2019: Critical Care Medicine
Connor W Woodward, Joshua Lambert, Victor Ortiz-Soriano, Ye Li, Marice Ruiz-Conejo, Brittany Bissell, Andrew Kelly, Paul Adams, Lenar Yessayan, Peter E Morris, Javier A Neyra
OBJECTIVES: We examined the association between fluid overload and major adverse kidney events in critically ill patients requiring continuous renal replacement therapy for acute kidney injury. DESIGN: Retrospective cohort study. SETTING: ICU in a tertiary medical center. PATIENTS: Four-hundred eighty-one critically ill adults requiring continuous renal replacement therapy for acute kidney injury. INTERVENTIONS: None...
June 3, 2019: Critical Care Medicine
David B Antcliffe, Anthony C Gordon
No abstract text is available yet for this article.
June 3, 2019: Critical Care Medicine
Arvind Rajamani, Michelle Miu, Stephen Huang, Henry Elbourne-Binns, Florian Pracher, Sutrisno Gunawan, Ramanathan Lakshmanan, Gordon Flynn, Kandasamy Sasidaran, Shyama Subasinghe, Jinal Parmar, Trieu Hyunh
OBJECTIVES: Competence in point-of-care ultrasound is recommended/mandated by several critical care specialties. Although doctors commonly attend point-of-care ultrasound short-courses for introductory training, there is little follow-up data on whether they eventually attain competence. This study was done to determine the impact of point-of-care ultrasound short-courses on point-of-care ultrasound competence. DESIGN: Web-based survey. SETTING: Follow-up after point-of-care ultrasound short-courses in the Asia-Pacific region...
June 3, 2019: Critical Care Medicine
Jan Schildmann, Stephan Nadolny, Joschka Haltaufderheide, Marjolein Gysels, Jochen Vollmann, Claudia Bausewein
No abstract text is available yet for this article.
June 3, 2019: Critical Care Medicine
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