Ornella Spagnolello, Richmond Dixon Cole, Jalloh Unisa, Hawa Vandi, Marian Macarthy, Sofia Gatti, Manuela Cormio, Gina Portella, Martina Baiardo Redaelli
OBJECTIVES: Despite the large burden of critically ill patients in developing countries, mechanical ventilation (MV) is scarce in these low-resource settings. In the absence of data, issues like costs and lack of training are often felt to outweigh the benefits of potential MV implementation in such places. We aimed to investigate the impact and feasibility of MV in a surgical ICU in West Africa. DESIGN: This is a 7-month retrospective observational study (from October 25, 2022, to May 25, 2023), covering all patients consecutively admitted to ICU...
April 15, 2024: Critical Care Medicine
Anil N Makam, Judith Burnfield, Ed Prettyman, Oanh Kieu Nguyen, Nancy Wu, Edie Espejo, Cinthia Blat, W John Boscardin, E Wesley Ely, James C Jackson, Kenneth E Covinsky, John Votto
OBJECTIVES: Understanding the long-term effects of severe COVID-19 illness on survivors is essential for effective pandemic recovery planning. Therefore, we investigated impairments among hospitalized adults discharged to long-term acute care hospitals (LTACHs) for prolonged severe COVID-19 illness who survived 1 year. DESIGN: The Recovery After Transfer to an LTACH for COVID-19 (RAFT COVID) study was a national, multicenter, prospective longitudinal cohort study...
April 10, 2024: Critical Care Medicine
Mario Henríquez-Beltrán, Rafaela Vaca, Iván D Benítez, Jessica González, Sally Santisteve, Maria Aguilà, Olga Minguez, Anna Moncusí-Moix, Clara Gort-Paniello, Gerard Torres, Gonzalo Labarca, Jesús Caballero, Carme Barberà, Antoni Torres, David de Gonzalo-Calvo, Ferran Barbé, Adriano D S Targa
OBJECTIVES: To investigate the sleep and circadian health of critical survivors 12 months after hospital discharge and to evaluate a possible effect of the severity of the disease within this context. DESIGN: Observational, prospective study. SETTING: Single-center study. PATIENTS: Two hundred sixty patients admitted to the ICU due to severe acute respiratory syndrome coronavirus 2 infection. INTERVENTIONS: None...
April 10, 2024: Critical Care Medicine
Sara Nikravan, Michael J Lanspa, Enyo Ablordeppey, Anthony T Gerlach, Lori Shutter, Hariyali Patel, Karin Reuter-Rice, Kim Lewis, Sameer Sharif, José L Díaz-Gómez
OBJECTIVES: Clinical practice guidelines are essential for promoting evidence-based healthcare. While diversification of panel members can reduce disparities in care, processes for panel selection lack transparency. We aim to share our approach in forming a diverse expert panel for the updated Adult Critical Care Ultrasound Guidelines. DESIGN: This process evaluation aims to understand whether the implementation of a transparent and intentional approach to guideline panel selection would result in the creation of a diverse expert guideline panel...
April 8, 2024: Critical Care Medicine
Teodor Svedung Wettervik, Erta Beqiri, Anders Hånell, Stefan Yu Bögli, Michal Placek, Joseph Donnelly, Mathew R Guilfoyle, Adel Helmy, Andrea Lavinio, Peter J Hutchinson, Peter Smielewski
OBJECTIVES: The first aim was to investigate the combined effect of insult intensity and duration of the pressure reactivity index (PRx) and deviation from the autoregulatory cerebral perfusion pressure target (∆CPPopt = actual CPP - optimal CPP [CPPopt]) on outcome in traumatic brain injury. The second aim was to determine if PRx influenced the association between intracranial pressure (ICP), CPP, and ∆CPPopt with outcome. DESIGN: Observational cohort study...
April 8, 2024: Critical Care Medicine
John C Greenwood, Fatima M Talebi, David H Jang, Audrey E Spelde, Emily K Gordon, Jiri Horak, Michael A Acker, Todd J Kilbaugh, Frances S Shofer, John G T Augoustides, Jacob S Brenner, Vladimir R Muzykantov, Jan Bakker, Benjamin S Abella
OBJECTIVES: Quantify the relationship between perioperative anaerobic lactate production, microcirculatory blood flow, and mitochondrial respiration in patients after cardiovascular surgery with cardiopulmonary bypass. DESIGN: Serial measurements of lactate-pyruvate ratio (LPR), microcirculatory blood flow, plasma tricarboxylic acid cycle cycle intermediates, and mitochondrial respiration were compared between patients with a normal peak lactate (≤ 2 mmol/L) and a high peak lactate (≥ 4 mmol/L) in the first 6 hours after surgery...
April 5, 2024: Critical Care Medicine
Vikram B Gondhalekar, Amir Gandomi, Sarah L Gilman, Negin Hajizadeh, Zubair M Hasan, Matthew A Bank, Daniel M Rolston, Allison Cohen, Timmy Li, Mitsuaki Nishikimi, Mangala Narasimhan, Lance Becker, Daniel Jafari
OBJECTIVES: Nonconventional ventilators (NCVs), defined here as transport ventilators and certain noninvasive positive pressure devices, were used extensively as crisis-time ventilators for intubated patients with COVID-19. We assessed whether there was an association between the use of NCV and higher mortality, independent of other factors. DESIGN: This is a multicenter retrospective observational study. SETTING: The sample was recruited from a single healthcare system in New York...
April 2, 2024: Critical Care Medicine
Lachlan H Donaldson, Ruan Vlok, Ken Sakurai, Morgan Burrows, Gabrielle McDonald, Karthik Venkatesh, Sean M Bagshaw, Rinaldo Bellomo, Anthony Delaney, John Myburgh, Naomi E Hammond, Balasubramanian Venkatesh
OBJECTIVES: To derive a pooled estimate of the incidence and outcomes of sepsis-associated acute kidney injury (SA-AKI) in ICU patients and to explore the impact of differing definitions of SA-AKI on these estimates. DATA SOURCES: Medline, Medline Epub, EMBASE, and Cochrane CENTRAL between 1990 and 2023. STUDY SELECTION: Randomized clinical trials and prospective cohort studies of adults admitted to the ICU with either sepsis and/or SA-AKI...
April 1, 2024: Critical Care Medicine
Shaurya Taran, Bastien Perrot, Federico Angriman, Raphael Cinotti
OBJECTIVES: To evaluate the association between the pre-extubation sum of eye and motor components of the Glasgow Coma Score (GCS-EM) and odds of extubation failure in patients with acute brain injury being liberated from mechanical ventilation. DESIGN: Secondary analysis of a prospective, multicenter observational study ( identifier NCT03400904). SETTING: Sixty-three hospital sites worldwide, with patient recruitment from January 2018 to November 2020...
April 1, 2024: Critical Care Medicine
Yuichiro Matsuo, Taisuke Jo, Hideaki Watanabe, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga
OBJECTIVES: Thyroid storm is the most severe manifestation of thyrotoxicosis. Beta-blockers are among the standard treatment regimens for this condition, with propranolol being the historically preferred option. However, 2016 guidelines issued by the Japan Thyroid Association and the Japan Endocrine Society recommend the use of beta-1 selective beta-blockers over nonselective beta-blockers, such as propranolol. Nevertheless, evidence supporting this recommendation is limited. Herein, we aimed to investigate the in-hospital mortality of patients with thyroid storms based on the choice of beta-blockers...
March 29, 2024: Critical Care Medicine
Ailiana Santosa, Jonatan Oras, Huiqi Li, Chioma Nwaru, Brian Kirui, Fredrik Nyberg
OBJECTIVES: Some studies have examined survival trends among critically ill COVID-19 patients, but most were case reports, small cohorts, and had relatively short follow-up periods. We aimed to examine the survival trend among critically ill COVID-19 patients during the first two and a half years of the pandemic and investigate potential predictors across different variants of concern periods. DESIGN: Prospective cohort study. SETTING: Swedish ICUs, between March 6, 2020, and December 31, 2022...
March 28, 2024: Critical Care Medicine
Aarti Sarwal, Nicholas A Morris, Janet Crumpler, Terri Gordon, Ian Saunders, James E Johnson, Jeff E Carter
OBJECTIVES: Transitions to new care environments may have unexpected consequences that threaten patient safety. We undertook a quality improvement project using in situ simulation to learn the new patient care environment and expose latent safety threats before transitioning patients to a newly built adult ICU. DESIGN: Descriptive review of a patient safety initiative. SETTING: A newly built 24-bed neurocritical care unit at a tertiary care academic medical center...
March 27, 2024: Critical Care Medicine
Ruben Crespo-Diaz, Julian Wolfson, Demetris Yannopoulos, Jason A Bartos
OBJECTIVES: Extracorporeal cardiopulmonary resuscitation (ECPR) has been shown to improve neurologically favorable survival in patients with refractory out-of-hospital cardiac arrest (OHCA) caused by shockable rhythms. Further refinement of patient selection is needed to focus this resource-intensive therapy on those patients likely to benefit. This study sought to create a selection model using machine learning (ML) tools for refractory cardiac arrest patients undergoing ECPR. DESIGN: Retrospective cohort study...
March 27, 2024: Critical Care Medicine
Su Yeon Lee, Mi Hyeon Park, Dong Kyu Oh, Chae-Man Lim
OBJECTIVES: In 2018, the Centers for Disease Control and Prevention introduced the Adult Sepsis Event (ASE) definition, using electronic health records (EHRs) data for surveillance and sepsis quality improvement. However, data regarding ASE outside the United States remain limited. We therefore aimed to validate the diagnostic accuracy of the ASE and to assess the prevalence and mortality of sepsis using ASE. DESIGN: Retrospective cohort study. SETTING: A single center in South Korea, with 2732 beds including 221 ICU beds...
March 26, 2024: Critical Care Medicine
Chinh D Nguyen, Haustine P Panganiban, Timothy Fazio, Amalia Karahalios, Melissa Akravs, Christopher M MacIsaac, Thomas Rechnitzer, Lucy Arno, An Tran-Duy, Scott McAlister, Yasmine Ali Abdelhamid, Adam M Deane
OBJECTIVES: Hypophosphatemia occurs frequently. Enteral, rather than IV, phosphate replacement may reduce fluid replacement, cost, and waste. DESIGN: Prospective, randomized, parallel group, noninferiority clinical trial. SETTING: Single center, 42-bed state trauma, medical and surgical ICUs, from April 20, 2022, to July 1, 2022. PATIENTS: Patients with serum phosphate concentration between 0.3 and 0.75 mmol/L. INTERVENTIONS: We randomized patients to either enteral or IV phosphate replacement using electronic medical record-embedded program...
March 25, 2024: Critical Care Medicine
Maniraj Neupane, Nathaniel De Jonge, Sahil Angelo, Sadia Sarzynski, Junfeng Sun, Bram Rochwerg, John Hick, Steven H Mitchell, Sarah Warner, Alex Mancera, Diane Cooper, Sameer S Kadri
OBJECTIVES: COVID-19 pandemic surges strained hospitals globally. We performed a systematic review to examine measures of pandemic caseload surge and its impact on mortality of hospitalized patients. DATA SOURCES: PubMed, Embase, and Web of Science. STUDY SELECTION: English-language studies published between December 1, 2019, and November 22, 2023, which reported the association between pandemic "surge"-related measures and mortality in hospitalized patients...
March 22, 2024: Critical Care Medicine
Emily J See, Anis Chaba, Sofia Spano, Akinori Maeda, Caroline Clapham, Louise M Burrell, Jasmine Liu, Monique Khasin, Grace Liskaser, Glenn Eastwood, Rinaldo Bellomo
OBJECTIVES: The relationship between renin levels, exposure to renin-angiotensin system (RAS) inhibitors, angiotensin II (ANGII) responsiveness, and outcome in patients with vasopressor-dependent vasodilatory hypotension is unknown. DESIGN: We conducted a single-center prospective observational study to explore whether recent RAS inhibitor exposure affected baseline renin levels, whether baseline renin levels predicted ANGII responsiveness, and whether renin levels at 24 hours were associated with clinical outcomes...
March 21, 2024: Critical Care Medicine
Peter J Dunbar, Ryan Peterson, Max McGrath, Raymond Pomponio, Tyree H Kiser, P Michael Ho, R William Vandivier, Ellen L Burnham, Marc Moss, Peter D Sottile
OBJECTIVES: To describe U.S. practice regarding administration of sedation and analgesia to patients on noninvasive ventilation (NIV) for acute respiratory failure (ARF) and to determine the association of this practice with odds of intubation or death. DESIGN: A retrospective multicenter cohort study. SETTING: A total of 1017 hospitals contributed data between January 2010 and September 2020 to the Premier Healthcare Database, a nationally representative healthcare database in the United States...
March 20, 2024: Critical Care Medicine
Megan E Feeney, Anica C Law, Allan J Walkey, Nicholas A Bosch
OBJECTIVES: To describe practice patterns surrounding the use of medications to treat opioid use disorder (MOUD) in critically ill patients. DESIGN: Retrospective, multicenter, observational study using the Premier AI Healthcare Database. SETTING: The study was conducted in U.S. ICUs. PATIENTS: Adult (≥ 18 yr old) patients with a history of opioid use disorder (OUD) admitted to an ICU between 2016 and 2020. INTERVENTIONS: None...
March 19, 2024: Critical Care Medicine
Kateřina Jiroutková, František Duška, Petr Waldauf
OBJECTIVES: We published a meta-analysis in March 2020 to assess the impact of rehabilitation in the ICU on clinical outcomes. Since then, 15 new randomized controlled trials (RCTs) have been published; we updated the meta-analysis to show how the recent studies have tipped the scale. DESIGN: Systematic review and meta-analysis. SETTING: An update of secondary data analysis of RCTs published between January 1998 and July 2023 performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines...
March 19, 2024: Critical Care Medicine
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