James Richard Mattson, Kunal Dhiren Gada, Randeep Jawa, Xiaoyue Zhang, Sahar Ahmad
Background: Endotracheal tube (ETT) occlusion is reported at a higher frequency among coronavirus disease-2019 (COVID-19) patients. Prior to the COVID-19 pandemic, literature examining patient and ventilator characteristics, including humidification, as etiologies of ETT occlusion yielded mixed results. Our study examines the relationship of humidification modality with ETT occlusion in COVID-19 patients undergoing invasive mechanical ventilation (IMV). Methods: We conducted a retrospective chart review of COVID-19 patients requiring IMV at a tertiary care center in New York from April 2020 to April 2021...
April 18, 2024: Journal of Intensive Care Medicine
Koji Endo, Kayoko Mizuno, Satomi Yoshida, Koji Kawakami
Purpose: Specialized pressure transducers for arterial pulse waveform analysis (S-APWA) devices are dedicated kits connected to an arterial pressure catheter that monitors hemodynamic parameters, such as cardiac output, pulse pressure variation, and stroke volume variation, less invasively. While the association between the use of S-APWA devices and clinical outcomes in perioperative patients has been previously evaluated, its assessment in patients with septic shock remains inadequate. Materials and Methods: This retrospective cohort study utilized a nationwide Diagnosis Procedure Combination database in Japan...
April 18, 2024: Journal of Intensive Care Medicine
Sidney Hilker, Amundam Mancho, Geetanjali Srivatsava, Dileep Raman, Sitarah Mathias, Ryan Brewster, Carl Britto
Low- and middle-income countries face limited critical care capacity due to constraints in staffing, resources, and technology. "Smart ICUs" that integrate telehealth to augment care delivery, communication, and data integration have the potential to bridge these gaps and reduce preventable morbidity and mortality. While their efficacy has been well validated in adult populations, applications of Smart-ICU services in the neonatal population have not been studied. Neonatal intensive care units (NICUs) in India using a common Smart-NICU platform, developed by CloudPhysician, utilize a hub-and-spokes framework along with locally designed technology to facilitate remote patient care in collaboration with local health systems...
April 18, 2024: Journal of Intensive Care Medicine
M Cristina Vazquez Guillamet, Rodrigo Vazquez Guillamet, Ashraf Rjob, Daniel Reynolds, Bijal Parikh, Vladimir Despotovic, Derek E Byers, Ali H Ellebedy, Marin H Kollef, Philip A Mudd
RATIONALE: Recent studies suggest that both hypo- and hyperinflammatory acute respiratory distress syndrome (ARDS) phenotypes characterize severe COVID-19-related pneumonia. The role of lung Severe Acute Respiratory Syndrome - Coronavirus 2 (SARS-CoV-2) viral load in contributing to these phenotypes remains unknown. OBJECTIVES: To redefine COVID-19 ARDS phenotypes when considering quantitative SARS-CoV-2 RT-PCR in the bronchoalveolar lavage of intubated patients...
April 17, 2024: Journal of Intensive Care Medicine
Jing Tao, Kenneth P Seier, Sanjay Chawla, Kay See Tan, Amanda Wheeler, Joanna Sanzone, Carina B Marasigan-Stone, Justina-Sheila S Simondac, Analin V Pascual, Natalie T Kostelecky, Louis P Voigt
BACKGROUND: Little is known on the effects of delirium onset and duration on outcome in critically ill patients with cancer. OBJECTIVES: To determine the impact of delirium onset and duration on intensive care unit (ICU) and hospital mortality and length of stay (LOS) in patients with cancer. METHODS: Of the 915 ICU patients admitted in 2018, 371 were included for analysis after excluding for terminal disease, <24-h ICU stay, lack of active cancer and delirium...
April 17, 2024: Journal of Intensive Care Medicine
Danielle S Murray, Brian W Gilbert, Tessa R Cox
Purpose/Background: Recent studies have shown improved outcomes with the initiation of earlier subcutaneous (SQ) basal insulin. The purpose of this study was to examine the effects of early SQ basal insulin administration on hospital length of stay in patients with mild to moderate diabetic ketoacidosis (DKA). Methods: This was a retrospective, single-center study from a large community teaching hospital that included patients 18 years or older with mild to moderate DKA, identified using ICD-10 codes, who received intravenous (IV) insulin...
April 17, 2024: Journal of Intensive Care Medicine
Anaas Moncef Mergoum, Abigail Rebecca Rhone, Nicholas James Larson, David J Dries, Benoit Blondeau, Frederick Bolles Rogers
Shock is a life-threatening circulatory failure that results in inadequate tissue perfusion and oxygenation. Vasopressors and inotropes are vasoactive medications that are vital in increasing systemic vascular resistance and cardiac contractility, respectively, in patients presenting with shock. To be well versed in using these agents is an important skill to have in the critical care setting where patients can frequently exhibit symptoms of shock. In this review, we will discuss the pathophysiological mechanisms of shock and evaluate the current evidence behind the management of shock with an emphasis on vasopressors and inotropes...
April 13, 2024: Journal of Intensive Care Medicine
Christine Lawson, Daniel J McCabe, Ryan Feldman
Aconite poisoning refers to toxicity resulting from plants belonging to the Aconitum genus, which comprises over 350 different species of perennial flowering plants that grow in temperate mountainous areas of the northern hemisphere (North America, Europe, Asia). These plants contain a group of toxins known as aconite alkaloids, which encompass numerous closely related toxic compounds. Conventional teaching from toxicology textbooks has broadly classified these alkaloids based on their mechanism of action, often simplifying them as substances that prevent sodium channel inactivation...
April 13, 2024: Journal of Intensive Care Medicine
Christopher Nguyen, Gaurav Singh, Karen Rubio, Karen Mclemore, Ware Kuschner
Malnutrition in adult intensive care unit patients is associated with poor clinical outcomes. Providing adequate nutritional support to the critically ill adult should be an important goal for the intensivist. This narrative review aims to delineate the role of parenteral nutrition (PN) in meeting nutritional goals. We examined the data regarding the safety and efficacy of PN compared to enteral nutrition. In addition, we describe practical considerations for the use of PN in the ICU including patient nutritional risk stratification, nutrient composition selection for PN, route of PN administration, and biochemical monitoring...
April 11, 2024: Journal of Intensive Care Medicine
Yau-Lam Alex Chau, Tessa Milic, Jerrold Perrott
Background: Helicobacter pylori is implicated in the development of gastritis, ulcers, and various gastric cancers, representing significant morbidity, mortality, and healthcare spending. Patients with H. pylori infection have traditionally been treated with oral antibiotics, however, oral therapy is not feasible in all clinical situations. We examined the available evidence supporting the use of intravenous (IV) antibiotics in H. pylori . Methods: This systematic review was carried out by reviewing multiple electronic databases: MEDLINE, CENTRAL, EMBASE, CINAHL, Clinicaltrials...
April 11, 2024: Journal of Intensive Care Medicine
Shahla Siddiqui, Lovkesh Arora, Monica I Lupei, S Veena Satyapriya, Michael Wall, Miguel Cobas, Samuel Justice, Raquel R Bartz
INTRODUCTION: By using a novel survey our study aimed to assess the challenges ECMO and Critical Care (CC) teams face when initiating and managing patient's ECMO support. METHODS: A qualitative survey-based observational study was performed of members of 2 Critical Care Medicine organizations involved in decision-making around the practice of Extracorporeal Membrane Oxygenation (ECMO). The range of exploratory questions covered ethical principles of informed consent, autonomy and goals of care discussions, beneficence, non-maleficence (offering life-sustaining treatments in end-of-life care), and justice (insurance-related limitations of treatment)...
April 4, 2024: Journal of Intensive Care Medicine
Christopher S Schenck, Fouad Chouairi, David M Dudzinski, P Elliott Miller
Over the last several decades, the cardiac intensive care unit (CICU) has seen an increase in the complexity of the patient population and etiologies requiring CICU admission. Currently, respiratory failure is the most common reason for admission to the contemporary CICU. As a result, noninvasive ventilation (NIV), including noninvasive positive-pressure ventilation and high-flow nasal cannula, has been increasingly utilized in the management of patients admitted to the CICU. In this review, we detail the different NIV modalities and summarize the evidence supporting their use in conditions frequently encountered in the CICU...
April 4, 2024: Journal of Intensive Care Medicine
Hideki Endo, Hiroshi Okamoto, Satoru Hashimoto, Hiroaki Miyata
Purpose: To elucidate the relationship between in-hospital mortality and the institutional factors of intensive care units (ICUs), with a focus on the intensivist-to-bed ratio. Methods: A retrospective cohort study was conducted using a Japanese ICU database, including adult patients admitted between April 1, 2020 and March 31, 2021. We used a multilevel logistic regression model to investigate the associations between in-hospital mortality and the following institutional factors: the intensivist-to-bed ratios on weekdays or over weekends/holidays, different work shifts, hospital-to-ICU-bed ratio, annual-ICU-admission-to-bed ratio, type of hospital, and the presence of other medical staff...
April 3, 2024: Journal of Intensive Care Medicine
Tanmay Kanitkar, Nicholas Bakewell, Oshani Dissanayake, Maggie Symonds, Stephanie Rimmer, Amit Adlakha, Marc C I Lipman, Sanjay Bhagani, Banwari Agarwal, Caroline A Sabin, Robert F Miller
BACKGROUND: Despite widespread use of combination antiretroviral therapy, people with HIV (PWH) continue to have an increased risk of admission to and mortality in the intensive care unit (ICU). Mortality risk after hospital discharge is not well described. Using retrospective data on adult PWH (≥18 years) admitted to ICU from 2000-2019 in an HIV-referral centre, we describe trends in 1-year mortality after ICU admission. METHODS: One-year mortality was calculated from index ICU admission to date of death; with follow-up right-censored at day 365 for people remaining alive at 1 year, or day 7 after ICU discharge if lost-to-follow-up after hospital discharge...
April 2, 2024: Journal of Intensive Care Medicine
Andrés Ferre, Andrés Giglio, Brenda Zylbersztajn, Rodolfo Valenzuela, Nicolette Van Sint Jan, Christian Fajardo, Andres Reccius, Jorge Dreyse, Pablo Hasbun
Introduction: Critically ill patients undergoing extracorporeal membrane oxygenation (ECMO) exhibit unique pharmacokinetics. This study aimed to assess the achievement of vancomycin therapeutic targets in these patients. Methods: This retrospective cohort study included patients on ECMO treated with vancomycin between January 2010 and December 2018. Ninety patients were analyzed based on ECMO connection modality, baseline creatinine levels, estimated glomerular filtration rate (eGFR), renal replacement therapy (RRT) requirements, and vancomycin loading dose administration...
March 31, 2024: Journal of Intensive Care Medicine
Mostafa Al Turk, Michael Abraham
Venous thromboembolism (VTE) is a common but preventable complication observed in critically ill patients. Deep vein thrombosis (DVT) is the most common type of VTE, with clinical significance based on location and symptoms. There is an increased incidence of DVT and pulmonary embolism (PE) in ischemic stroke patients using unfractionated heparin (UFH) for VTE prophylaxis compared with those using enoxaparin. However, UFH is still used in some patients due to its perceived safety, despite conflicting literature suggesting that enoxaparin may have a protective effect...
March 26, 2024: Journal of Intensive Care Medicine
May-Kristin Torp, Kåre-Olav Stensløkken, Jarle Vaage
Common for major surgery, multitrauma, sepsis, and critical illness, is a whole-body inflammation. Tissue injury is able to trigger a generalized inflammatory reaction. Cell death causes release of endogenous structures termed damage associated molecular patterns (DAMPs) that initiate a sterile inflammation. Mitochondria are evolutionary endosymbionts originating from bacteria, containing molecular patterns similar to bacteria. These molecular patterns are termed mitochondrial DAMPs (mDAMPs). Mitochondrial debris released into the extracellular space or into the circulation is immunogenic and damaging secondary to activation of the innate immune system...
March 20, 2024: Journal of Intensive Care Medicine
Sun Jingyi, Gao Cunliang, Chen Biao, Xie Yingguang, Ma Jinluan, Cao Xiaohua, Li Wenqiang
BACKGROUND: Sepsis is a serious complication that occurs after trauma, burns, and infections, and it is an important cause of death in intensive care unit (ICU) patients. Despite many new measures being proposed for sepsis treatment, its mortality rate remains high; sepsis has become a serious threat to human health, and there is an urgent need to carry out in-depth clinical research related to sepsis. In recent years, it has been found that septic shock-induced vasoplegia is a result of vascular hyporesponsiveness to vasopressors...
March 11, 2024: Journal of Intensive Care Medicine
Margot Kelly-Hedrick, Sunny Yang Liu, Jordan Komisarow, Jordan Hatfield, Tetsu Ohnuma, Miriam M Treggiari, Katharine Colton, Evangeline Arulraja, Monica S Vavilala, Daniel T Laskowitz, Joseph P Mathew, Adrian Hernandez, Michael L James, Karthik Raghunathan, Vijay Krishnamoorthy
BACKGROUND: There is limited evidence that beta-blockers may provide benefit for patients with moderate-severe traumatic brain injury (TBI) during the acute injury period. Larger studies on utilization patterns and impact on outcomes in clinical practice are lacking. OBJECTIVE: The present study uses a large, national hospital claims-based dataset to examine early beta-blocker utilization patterns and its association with clinical outcomes among critically ill patients with moderate-severe TBI...
March 6, 2024: Journal of Intensive Care Medicine
Tamyah Pipkin, Stuart Pope, Alley Killian, Sarah Green, Benjamin Albrecht, Katherine Nugent
Background: The combination of vancomycin and piperacillin-tazobactam (VPT) has been associated with acute kidney injury (AKI) in hospitalized patients when compared to similar combinations. Additional studies examining this nephrotoxic risk in critically ill patients have not consistently demonstrated the aforementioned association. Furthermore, patients with baseline renal dysfunction have been excluded from almost all of these studies, creating a need to examine the risk in this patient population. Methods: This was a retrospective cohort analysis of critically ill adults with baseline chronic kidney disease (CKD) who received vancomycin plus an anti-pseudomonal beta-lactam at Emory University Hospital...
February 28, 2024: Journal of Intensive Care Medicine
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