Matteo D'Alessandro, Margherita Ricci, Tommaso Bellini, Benedetta Chianucci, Maria Grazia Calevo, Emanuela Piccotti, Andrea Moscatelli
Vein line positioning represents one of the first diagnostic and therapeutic steps in Pediatric Emergency Department (PED); however, the outcome of this maneuver is frequently not as expected, especially for difficult-to-access (DIVA) patients. The standard technique (visual-palpatory) has a low success rate; hence ultrasound (US) assistance has been suggested for DIVA patients, although controversial results have been obtained. Our study compared the success rate of an intravascular (IV) access procedure at the first attempt, with and without ultrasound assistance, in pediatric DIVA patients...
September 21, 2023: Journal of Intensive Care Medicine
Richard G Trohman
Electrical storm (ES) is characterized by three or more discrete sustained ventricular tachyarrhythmia episodes occurring within a limited time frame (generally ≤ 24 h) or an incessant ventricular tachyarrhythmia lasting > 12 h. In patients with an implantable cardioverterdefibrillator (ICD), ES is defined as three or more appropriate device therapies, separated from each other by at least 5 min, which occur within a 24-h period. ES may constitute a medical emergency, depending on the number arrhythmic episodes, their duration, the type, and the cycle length of the ventricular arrhythmias, as well as the underlying ventricular function...
September 20, 2023: Journal of Intensive Care Medicine
Heather Torbic, Alyssa Chen, Mollie Lumpkin, Jason Yerke, Omar Mehkri, Susamma Abraham, Xiaofeng Wang, Abhijit Duggal, Rachel G Scheraga
Purpose: We sought to evaluate critically ill patients with delirium to evaluate inflammatory cytokine production and delirium progression and the role of antipsychotics. Materials and Methods: Adult critically ill patients with confirmed delirium according to a positive CAM-ICU score were included and IL-6 and IL-8 levels were trended for 24 h in this single-center, prospective, observational cohort study. Results: A total of 23 patients were consented and had blood samples drawn for inclusion. There was no difference in IL-6 and IL-8 levels at baseline, 4 to 8 h, and 22 to 28 h after enrollment when comparing patients based on antipsychotic exposure...
September 19, 2023: Journal of Intensive Care Medicine
Hongbo Luo, Wen Han, Jiahui Zhang, Wei Cheng, Dongkai Li, Mingxi Zhao, Na Cui, Huadong Zhu
Objectives: To investigate the effect of our improved nursing strategy on prognosis in immunosuppressed patients with pneumonia and sepsis. Methods: Immunosuppressed patients (absolute lymphocyte count <1000 cells/mm3 ) with pneumonia and sepsis were enrolled and divided into a control group and treatment group. The treatment group received the improved nursing strategy. The primary outcome in this study was 28-day mortality. Results: In accordance with the study criteria, 1019 patients were finally enrolled...
September 18, 2023: Journal of Intensive Care Medicine
David Ragoonanan, Paige Nickelsen, Nicolas Tran, Bryan Allen, Rebecca Emborski, Anit Legare, Antonia Villela, Lauryn Hampson, Kirsten Busey, Eileen Shomo, Abby Broomfield, Kirubel Hailu
BACKGROUND: Vasopressin is recommended as a second-line vasoactive agent for the management of septic shock; however, a paucity of data to guide its optimal use remains. The aim was to evaluate the effect of time-to vasopressin initiation and norepinephrine (NE) dose at vasopressin initiation on clinical outcomes in patients presenting with septic shock. METHODS: This was a multi-centered, retrospective, observational study conducted in patients with septic shock...
September 16, 2023: Journal of Intensive Care Medicine
Nicolas Terzi, Alicia Fournier, Olivier Lesieur, Julien Chappé, Djillali Annane, Jean-Luc Chagnon, Didier Thévenin, Benoit Misset, Jean-Luc Diehl, Samia Touati, Hervé Outin, Stéphane Dauger, Arnaud Sement, Jean-Noël Drault, Jean-Philippe Rigaud, Alexandra Laurent
There is a growing interest in the quality of work life (QWL) of healthcare professionals and staff well-being. We decided to measure the perceived QWL of ICU physicians and the factors that could influence their perception. Methods: We performed a survey coordinated and executed by the French Trade Union of Intensive Care Physicians (SMR). QWL was assessed using the French version of the Work-Related Quality of Life (WRQoL) scale, perceived stress using the French version of 10 item-Perceived Stress Scale (PSS-10) and group functioning using the French version of the Reflexivity Scale, the Social Support at Work Questionnaire (QSSP-P)...
September 14, 2023: Journal of Intensive Care Medicine
Scott Fassas, Daniel King, Molly Shay, Erica Shockett, David Yamane, Katrina Hawkins
Background: Although palliative medicine (PM) is more commonly being integrated into the intensive care unit (ICU), research on racial disparities in this area is lacking. Our objectives were to ( a) identify racial disparities in utilization of PM consultation for patients who received ICU care and (b) determine if there were differences in the use of code status or PM consultation over time based on race. Materials and Methods: Retrospective analysis of 571 patients, 18 years and above, at a tertiary care institution who received ICU care and died during their hospital stay...
September 6, 2023: Journal of Intensive Care Medicine
Antonious Anis, Ravi Patel, Maged A Tanios
Unplanned extubations (UE) frequently occur in critical care units. These events are precipitated by many risk factors and are associated with adverse outcomes for patients. We reviewed the current literature to examine factors related to UE and presented the analysis of 41 articles critical to the topic. Our review has identified specific risk factors that we discuss in this review, such as sedation strategies, physical restraints, endotracheal tube position, and specific nursing care aspects associated with an increased incidence of UE...
September 6, 2023: Journal of Intensive Care Medicine
Colin J Sallee, Joseph A Hippensteel, Kristen R Miller, Kaori Oshima, Andrew T Pham, Robert P Richter, John Belperio, Yamila L Sierra, Andreas Schwingshackl, Peter M Mourani, Eric P Schmidt, Anil Sapru, Aline B Maddux
BACKGROUND: Sepsis-associated destruction of the pulmonary microvascular endothelial glycocalyx (EGCX) creates a vulnerable endothelial surface, contributing to the development of acute respiratory distress syndrome (ARDS). Constituents of the EGCX shed into circulation, glycosaminoglycans and proteoglycans, may serve as biomarkers of endothelial dysfunction. We sought to define the patterns of plasma EGCX degradation products in children with sepsis-associated pediatric ARDS (PARDS), and test their association with clinical outcomes...
September 6, 2023: Journal of Intensive Care Medicine
Eiman Saeed Almuhairi, Monica Badejo, Aneesa Peer, Mervi Pitkanen, Cathrine A McKenzie
BACKGROUND: Delirium is a neuropsychiatric syndrome common in critical illness. Worsening delirium severity is associated with poorer clinical outcomes, yet its assessment remains under-reported with most severity assessment tools not validated for critical care. The DRS-R98 is a widely applied and validated tool. The aim of this project is to report the validation and utility of the DRS-R98 in critical illness. METHODS: This prospective, cohort study was conducted in adults with delirium admitted to a critical care unit and predicted to stay for ≥ 24 h...
September 5, 2023: Journal of Intensive Care Medicine
Zahra Ghotbi, Mehrdad Estakhr, Mehdi Nikandish, Reza Nikandish
Purpose: Percutaneous dilatational tracheostomy (PDT) is widely used in mechanical ventilation patients to facilitate weaning. This modified technique aims to reduce accidental intraprocedural airway loss and desaturation associated with current PDT techniques. Materials and Methods: This is a single-center, prospective cohort study of 100 patients who underwent a modified technique between September 8, 2022, and January 18, 2023. The procedure was performed at Shiraz University of medical science at the tertiary center, Namazi teaching hospital...
August 31, 2023: Journal of Intensive Care Medicine
Yonatan Y Greenstein, Scott Ferrara, Jerry Jomi, Vanessa Soetanto, Omry Zuckerman, Ariel Sena, Ilya Ostrovsky, Stephen Alerhand
Purpose: Intraosseous (IO) catheters allow healthcare workers to rapidly administer fluids and medications to critically ill patients when intravenous access is inadequate or unable to be obtained. An improperly placed IO catheter can lead to delays in care, as well as serious complications such as limb necrosis. Methods: In this single-center, prospective, observational study, we compared 2 established methods of confirming proper IO catheter placement to a novel pressure waveform analysis technique in which the IO catheter is attached to a standard pressure transducer...
August 30, 2023: Journal of Intensive Care Medicine
Jennifer Connell, Brittany McCann, Xiaoke Feng, Matthew S Shotwell, Christopher G Hughes, Christina S Boncyk
PURPOSE: We investigated the association of age, sex, race, and insurance status on antipsychotic medication use among intensive care unit (ICU) patients. MATERIALS AND METHODS: Retrospective study of adults admitted to ICUs at a tertiary academic center. Patient characteristics, hospital course, and medication (olanzapine, quetiapine, and haloperidol) data were collected. Logistic regression models evaluated the independent association of age, sex, race, and insurance status on the use of each antipsychotic, adjusting for prespecified covariates...
August 30, 2023: Journal of Intensive Care Medicine
Victor Penaud, Thibault Duburcq, Côme Bureau, Charlotte Salmon Gandonnière, Romain Arrestier, Samuel Henri, Martin Dres, Sophie Jacquier, Nicolas De Prost, Raphael Giraud, Jean-Damien Ricard, Damien Roux, Fabrice Uhel, David Legouis, Charles Verney
PURPOSE: Acute kidney injury is a frequent complication of acute respiratory distress syndrome (ARDS). We aim to study the evolution of kidney function in patients presenting severe ARDS and requiring veno-venous extracorporeal membrane oxygenation (VV ECMO). METHODS: We conducted a multicenter retrospective study, including adult patients requiring VV ECMO for ARDS. The primary outcome was the evolution of the serum creatinine level after VV ECMO initiation. Secondary outcomes were change in urine output, and urine biochemical parameters after VV ECMO initiation...
August 25, 2023: Journal of Intensive Care Medicine
Ebru Ortac Ersoy, Begüm Erdemir, Burcin Halacli, Goksel Guven, Mehmet Yildirim, Ismail Tuna Geldigitti, Nur Yazdali Koylu, Arzu Topeli
COVID-19 pneumonia causes acute respiratory distress syndrome (ARDS). Prone positioning (PP) is beneficial to pulmonary physiology and improves oxygenation in patients with ARDS. We aimed to investigate the effect of the PP on oxygenation, respiratory rate (RR) and ROX index in non-intubated patients with COVID-19 associated respiratory failure and to determine whether ROX index predicts intubation. Awake critically-ill patients with confirmed diagnosis of COVID-19 who underwent PP were enrolled in the retrospective, single-center study...
August 23, 2023: Journal of Intensive Care Medicine
Charles B Rothschild, Kathryn A Balistreri, Kathryn Mulligan, K Jane Lee, Jeffrey Karst, Miranda Privatt, Kristin Magner, Han-Joo Lee, Matthew Scanlon, W Hobart Davies
INTRODUCTION: Parents of children in the pediatric intensive care unit (PICU) experience substantial stress; a parent's perception of their child's illness severity, more than objective measures, predicts psychological outcomes. No tools exist to assess parents' real-time experiences. This pilot study evaluated the feasibility and acceptability of a text-based tool to measure parental experience. METHODS: Inclusion criteria included PICU stay >48 h, physician approval, smartphone access, and English-speaking caregiver...
August 21, 2023: Journal of Intensive Care Medicine
Maya Cohen, Debasree Banerjee
Sepsis syndromes have been recognized since antiquity yet still pose significant challenges to modern medicine. One of the biggest challenges lies in the heterogeneity of triggers and its protean clinical manifestations, as well as its rapidly progressive and lethal nature. Thus, there is a critical need for biomarkers that can quickly and accurately detect sepsis onset and predict treatment response. In this review, we will briefly describe the current consensus definitions of sepsis and the ideal features of a biomarker...
August 18, 2023: Journal of Intensive Care Medicine
Abdalla K H Hasandarras, Gustav F Strandvik, Ahmed El Faramawy, Noreddin Nasereldin Areibi, Basil Younis, Ahammed Mekkodothil, Ayman El-Menyer, Sandro Rizoli, Hassan Al-Thani
Background: Cervical spine clearance in intubated patients due to blunt trauma remains contentious. Accumulating evidence suggests that a normal computed tomography (CT) cervical spine can be used to clear the cervical spine and remove the collar in unconscious patients presenting to the emergency department. However, whether this strategy can safely be employed by critical care physicians with intubated patients admitted to the trauma intensive care unit (TICU) with cervical collars in situ, has not been definitively studied...
August 15, 2023: Journal of Intensive Care Medicine
Jarrod Kh Tan, Wei-Ling Koh, Cherie Hui Peh, Ailica Wx Lee, Jerrald Lau, Corissa Chee, Ker-Kan Tan
BACKGROUND: Surgical high dependency (SHD) allows for intermediate care provision between general ward (GW) and intensive care unit (ICU) for surgical patients but no universally accepted admission criteria exists. Unnecessary SHD admissions should be minimized to limit resource wastage and maintain spare critical care capacity. This study evaluates the utility of SHD admissions following elective laparoscopic colectomy by comparing post-operative outcomes and interventions performed between SHD and GW patients...
August 15, 2023: Journal of Intensive Care Medicine
Shaurya Taran, Robert D Stevens, Bastien Perrot, Victoria A McCredie, Raphael Cinotti, Karim Asehnoune, Paolo Pelosi, Chiara Robba
Background: Acute respiratory distress syndrome (ARDS) is an important pulmonary complication in brain-injured patients receiving invasive mechanical ventilation (IMV). We aimed to evaluate the incidence and association between ARDS and clinical outcomes in patients with different forms of acute brain injury requiring IMV in the intensive care unit (ICU). Methods: This was a preplanned secondary analysis of a prospective, multicenter, international cohort study (NCT03400904). We included brain-injured patients receiving IMV for ≥ 24 h...
August 11, 2023: Journal of Intensive Care Medicine
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