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Critical Care Medicine

Michèle Shemilt, Amélie Boutin, François Lauzier, Ryan Zarychanski, Lynne Moore, Lauralyn A McIntyre, Linda Nadeau, Dean A Fergusson, Eric Mercier, Patrick Archambault, François Lamontagne, Caroline Perron, Caroline Léger, Alexis F Turgeon
OBJECTIVES: Biomarkers have been suggested as potential prognostic predictors following a moderate or severe traumatic brain injury but their prognostic accuracy is still uncertain. The objective of this systematic review is to assess the ability of the glial fibrillary acidic protein to predict prognosis in patients with moderate or severe traumatic brain injury. DATA SOURCES: MEDLINE, Embase, CENTRAL, and BIOSIS electronic databases and conference abstracts, bibliographies of selected studies, and narrative reviews were searched...
March 19, 2019: Critical Care Medicine
Ana P A Praça, Antonio P Nassar, Pedro Caruso
OBJECTIVES: Many cancer patients are admitted to an ICU and decisions to forgo life-sustaining therapies are frequent during ICU stay. A significant proportion of these patients are subsequently discharged from ICU, but their outcomes are unknown. DESIGN: Retrospective. SETTING: ICU of oncological hospital. PATIENTS: Adult cancer patients admitted to ICU, then with a decision to forgo life-sustaining therapies and that were discharged from ICU...
March 19, 2019: Critical Care Medicine
Chunyan Li, Amrit Chiluwal, Adil Afridi, Wayne Chaung, Keren Powell, Weng-Lang Yang, Ping Wang, Raj K Narayan
OBJECTIVES: To determine if trigeminal nerve stimulation can ameliorate the consequences of acute blood loss and improve survival after severe hemorrhagic shock. DESIGN: Animal study. SETTING: University research laboratory. SUBJECTS: Male Sprague-Dawley rats. INTERVENTIONS: Severe hemorrhagic shock was induced in rats by withdrawing blood until the mean arterial blood pressure reached 27 ± 1 mm Hg for the first 5 minutes and then maintained at 27 ± 2 mm Hg for 30 minutes...
March 19, 2019: Critical Care Medicine
Nita Khandelwal, Lindsay White, J Randall Curtis, Norma B Coe
OBJECTIVES: Use of intensive care is increasing in the United States and may be associated with high financial burden on patients and their families near the end of life. Our objective was to estimate out-of-pocket costs in the last year of life for individuals who required intensive care in the months prior to death and examine how these costs vary by insurance coverage. DESIGN: Observational cohort study using seven waves of post-death interview data (2002-2014)...
March 19, 2019: Critical Care Medicine
Tiago Gregório, Sara Pipa, Pedro Cavaleiro, Gabriel Atanásio, Inês Albuquerque, Paulo Castro Chaves, Luís Azevedo
OBJECTIVES: To systematically assess the discrimination and calibration of the Intracerebral Hemorrhage score for prediction of short-term mortality in intracerebral hemorrhage patients and to study its determinants using heterogeneity analysis. DATA SOURCES: PubMed, ISI Web of Knowledge, Scopus, and CENTRAL from inception to September 15, 2018. STUDY SELECTION: Adult studies validating the Intracerebral Hemorrhage score for mortality prediction in nontraumatic intracerebral hemorrhage at 1 month/discharge or sooner...
March 19, 2019: Critical Care Medicine
Lucie Biard, Michaël Darmon, Virginie Lemiale, Djamel Mokart, Sylvie Chevret, Elie Azoulay, Matthieu Resche-Rigon
OBJECTIVES: We aimed to investigate center effects on hospital mortality of ICU patients with hematologic malignancies and to explore interactions between center and patients characteristics. DESIGN: Multicenter prospective cohort. SETTING: Seventeen ICUs across France and Belgium. PATIENTS: One-thousand eleven patients with hematologic malignancies hospitalized in ICUs. INTERVENTIONS: Reanalysis of the original data using state-of-the-art statistical methods with permutation procedures for testing multiple random effects...
March 19, 2019: Critical Care Medicine
Simon Bourcier, Patrick Hindlet, Bertrand Guidet, Agnès Dechartres
OBJECTIVES: Many recent randomized controlled trials in the field of septic shock failed to demonstrate a benefit on mortality. Randomized controlled trials increasingly report organ support duration and organ support-free days as primary or secondary outcomes. We conducted a methodologic systematic review to assess how organ support outcomes were defined and reported in septic shock randomized controlled trials. DATA SOURCES: MEDLINE via PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science...
March 19, 2019: Critical Care Medicine
Mypinder S Sekhon, Peter Gooderham, David K Menon, Penelope M A Brasher, Denise Foster, Danilo Cardim, Marek Czosnyka, Peter Smielewski, Arun K Gupta, Philip N Ainslie, Donald E G Griesdale
OBJECTIVES: In patients at risk of hypoxic ischemic brain injury following cardiac arrest, we sought to: 1) characterize brain oxygenation and determine the prevalence of brain hypoxia, 2) characterize autoregulation using the pressure reactivity index and identify the optimal mean arterial pressure, and 3) assess the relationship between optimal mean arterial pressure and brain tissue oxygenation. DESIGN: Prospective interventional study. SETTING: Quaternary ICU...
March 19, 2019: Critical Care Medicine
Gabriel Prada, Paul M Vespa
No abstract text is available yet for this article.
March 19, 2019: Critical Care Medicine
Sachin Agarwal, Alex Presciutti, Talea Cornelius, Jeffrey Birk, David J Roh, Soojin Park, Jan Claassen, Mitchell S V Elkind, Donald Edmondson
OBJECTIVES: To compare 1-year all-cause mortality and major adverse cardiovascular events in cardiac arrest survivors with and without posttraumatic stress disorder symptomatology at hospital discharge. DESIGN: Prospective, observational cohort. SETTING: ICUs at a tertiary-care center. PATIENTS: Adults with return of spontaneous circulation after in-hospital or out-of-hospital cardiac arrest between September 2015 and September 2017...
March 18, 2019: Critical Care Medicine
Nevin M Katz, John A Kellum, Claudio Ronco
Critical care physicians continue to be challenged to recognize an environment that has the potential to result in acute kidney injury, with its associated short- and long-term consequences. The recent development of cell cycle arrest biomarkers that signal the potential development of acute kidney injury is part of an evolution in the molecular diagnosis and understanding of acute kidney injury. A preinjury phase that may lead to acute kidney injury has been described as "acute kidney stress." This concept has the potential to stimulate research and innovation that will lead to early implementation of measures to prevent or reverse acute kidney injury...
March 15, 2019: Critical Care Medicine
Ashish Agrawal, Roger Cheng, Julin Tang, Debbie Y Madhok
OBJECTIVES: Intracranial pressure over 20 mm Hg is associated with poor neurologic prognosis, but measuring intracranial pressure directly requires an invasive procedure. Dilation of the optic nerve sheath on axial ultrasound of the eye has been correlated with elevated intracranial pressure, but optimal cutoffs have been inconsistent possibly related to the measurement technique. A coronal technique has been studied on healthy volunteers but not on patients with high intracranial pressure...
March 15, 2019: Critical Care Medicine
Tommaso Pettenuzzo, Hiroko Aoyama, Marina Englesakis, George Tomlinson, Eddy Fan
OBJECTIVES: Patient-ventilator asynchrony is common among critically ill patients undergoing mechanical ventilation and has been associated with adverse outcomes. Neurally adjusted ventilatory assist is a ventilatory mode that may lead to improved patient-ventilator synchrony. We conducted a systematic review to determine the impact of neurally adjusted ventilatory assist on patient-ventilator asynchrony, other physiologic variables, and clinical outcomes in adult patients undergoing invasive mechanical ventilation in comparison with conventional pneumatically triggered ventilatory modes...
March 15, 2019: Critical Care Medicine
Lise De Cloedt, Nadia Savy, France Gauvin, Stephen Taylor, Jacques Lacroix, Guillaume Emeriaud
Transfusion-associated circulatory overload is the most frequent serious adverse transfusion reaction, with an incidence close to 1% of transfused patients in the general adult population. Patients in ICUs are probably more at risk of transfusion-associated circulatory overload as they are more frequently transfused and associated with more comorbidities. However, the epidemiology of transfusion-associated circulatory overload in ICU is not well characterized, leading to a risk of underdiagnosis. OBJECTIVES: We conducted a scoping review to describe the incidence, risk factors, and outcomes of transfusion-associated circulatory overload in PICU and adult ICU...
March 15, 2019: Critical Care Medicine
Alison E Turnbull, Margaret M Hayes, Roy G Brower, Elizabeth Colantuoni, Pragyashree Sharma Basyal, Douglas B White, J Randall Curtis, Dale M Needham
OBJECTIVES: The Critical Care Choosing Wisely Task Force recommends that intensivists offer patients at high risk for death or severe functional impairment the option of pursuing care focused on comfort. We tested the a priori hypothesis that intensivists who are prompted to document patient prognosis are more likely to disclose prognosis and offer comfort-focused care. DESIGN: Randomized controlled trial ( NCT02721810). SETTING: High-fidelity Simulation Center in Baltimore, MD...
March 15, 2019: Critical Care Medicine
Gianluigi Li Bassi, Ana Motos, Laia Fernandez-Barat, Eli Aguilera Xiol, Chiara Chiurazzi, Tarek Senussi, Maria A Saco, Carla Fuster, Marco Carbonara, Joaquim Bobi, Rosanel Amaro, Francesca De Rosa, Talitha Comaru, Hua Yang, Otavio T Ranzani, Joan-Daniel Marti, Mariano Rinaudo, Oscar Comino Trinidad, Montserrat Rigol, Josep Bringué, Jose Ramirez, David P Nicolau, Paolo Pelosi, Massimo Antonelli, Francesco Blasi, Antonio Artigas, A Bruce Montgomery, Antoni Torres
OBJECTIVES: Latest trials failed to confirm merits of nebulized amikacin for critically ill patients with nosocomial pneumonia. We studied various nebulized and IV antibiotic regimens in a porcine model of severe Pseudomonas aeruginosa pneumonia, resistant to amikacin, fosfomycin, and susceptible to meropenem. DESIGN: Prospective randomized animal study. SETTING: Animal Research, University of Barcelona, Spain. SUBJECTS: Thirty female pigs...
March 15, 2019: Critical Care Medicine
Federico Longhini, Lara Pisani, Ramona Lungu, Vittoria Comellini, Andrea Bruni, Eugenio Garofalo, Maria Laura Vega, Gianmaria Cammarota, Stefano Nava, Paolo Navalesi
OBJECTIVES: Assessing gas exchange, diaphragm function, respiratory rate, and patient comfort during high-flow oxygen therapy and standard oxygen at the time of noninvasive ventilation discontinuation. DESIGN: Randomized crossover physiologic study. SETTING: Two ICUs. PATIENTS: Thirty chronic obstructive pulmonary disease patients with hypercapnic acute respiratory failure receiving noninvasive ventilation greater than 24 hours...
March 15, 2019: Critical Care Medicine
Kathryn A Morbitzer, J Dedrick Jordan, Kelly A Dehne, Emily A Durr, Casey M Olm-Shipman, Denise H Rhoney
OBJECTIVES: To evaluate enhanced renal clearance over time in patients with aneurysmal subarachnoid hemorrhage or intracerebral hemorrhage via measured creatinine clearance and to compare measured creatinine clearance to creatinine clearance calculated by the Cockcroft-Gault equation and estimated glomerular filtration rate calculated by the Modification of Diet in Renal Diseases equation. DESIGN: Prospective, observational study. SETTING: Neurosciences ICU in a tertiary care academic medical center...
March 13, 2019: Critical Care Medicine
Venkatakrishna Rajajee, José L Díaz-Gómez
No abstract text is available yet for this article.
March 13, 2019: Critical Care Medicine
Rachelle L Firestone, Patricia L Parker, Komal A Pandya, Machelle D Wilson, Jeremiah J Duby
OBJECTIVES: Insulin infusion therapy is commonly used in the hospital setting to manage diabetic ketoacidosis and hyperosmolar hyperglycemic state. Clinical evidence suggests both hypoglycemia and glycemic variability negatively impact patient outcomes. The hypothesis of this study was that moderate-intensity insulin therapy decreases hospital length of stay and prevalence of hypoglycemia in patients with diabetic ketoacidosis and hyperosmolar hyperglycemic state. DESIGN: Pre-post study...
March 7, 2019: Critical Care Medicine
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