Journal of Intensive Care Medicine

Mitchell S Buckley, Pamela L Smithburger, Adrian Wong, Gilles L Fraser, Michael C Reade, Michele Klein-Fedyshin, Thomas Ardiles, Sandra L Kane-Gill
BACKGROUND: Agitation and delirium are common in mechanically ventilated adult intensive care unit (ICU) patients and may contribute to delayed extubation times. Difficult-to-wean ICU patients have been associated with an increased risk of longer ICU length of stays and mortality. The purpose of this systematic review and meta-analysis is to evaluate the evidence of dexmedetomidine facilitating successful mechanical ventilation extubation in difficult-to-wean ICU patients and clinical outcomes...
July 6, 2020: Journal of Intensive Care Medicine
Michael Nair-Collins, Franklin G Miller
The legal standard for the determination of death by neurologic criteria in the United States is laid out in the Uniform Determination of Death Act (UDDA), which requires the irreversible cessation of all functions of the entire brain. Most other nations endorse a "whole-brain" standard as well. However, current practice in the determination of death by neurologic criteria is not consistent with this legal standard, because some patients who are diagnosed as brain-dead, in fact retain some brain function, or retain the capacity for the return of some brain function...
July 6, 2020: Journal of Intensive Care Medicine
Bernhard Wernly, Nadia Heramvand, Moritz Mirna, Malte Kelm, Michael Lichtenauer, David Dudzinski, Christian Jung
No abstract text is available yet for this article.
June 30, 2020: Journal of Intensive Care Medicine
Adeel Abbasi, Mohammed Nayeemuddin, Nader Azab, Alexandra Schick, Thomas Lopardo, Gary S Phillips, Roland C Merchant, Mitchell M Levy, Michael Blaivas, Keith A Corl
BACKGROUND: Respiratory variation in carotid artery peak systolic velocity (ΔVpeak) assessed by point-of-care ultrasound (POCUS) has been proposed as a noninvasive means to predict fluid responsiveness. We aimed to evaluate the ability of carotid ΔVpeak as assessed by novice physician sonologists to predict fluid responsiveness. METHODS: This study was conducted in 2 intensive care units. Spontaneously breathing, nonintubated patients with signs of volume depletion were included...
June 29, 2020: Journal of Intensive Care Medicine
Amelia Barwise, Chung-Il Wi, Ryan Frank, Bojana Milekic, Nicole Andrijasevic, Naresh Veerabattini, Sidhant Singh, Michael E Wilson, Ognjen Gajic, Young J Juhn
BACKGROUND: Little is known about the impact of socioeconomic status (SES) as a key element of social determinants of health on intensive care unit (ICU) outcomes for adults. OBJECTIVE: We assessed whether a validated individual SES index termed HOUSES (HOUsing-based SocioEconomic status index) derived from housing features was associated with short-term outcomes of critical illness including ICU mortality, ICU-free days, hospital-free days, and ICU readmission...
June 25, 2020: Journal of Intensive Care Medicine
Lauren Page Black, Michael A Puskarich, Morgan Henson, Taylor Miller, Srinivasa T Reddy, Rosemarie Fernandez, Faheem W Guirgis
BACKGROUND: Reduced cholesterol levels are associated with increased organ failure and mortality in sepsis. Cholesterol levels may vary by infection type (gram negative vs positive), possibly reflecting differences in cholesterol-mediated bacterial clearance. METHODS: This was a secondary analysis of a combined data set of 2 prospective cohort studies of adult patients meeting Sepsis-3 criteria. Infection types were classified as gram negative, gram positive, or culture negative...
June 24, 2020: Journal of Intensive Care Medicine
Emily J Witcraft, Jeffrey P Gonzales, Hyunuk Seung, Ian Watt, Asha L Tata, Siu Yan Amy Yeung, Mojdeh S Heavner, Danya M Qato, Mangla S Gulati, Leah S Millstein
PURPOSE: Opioids are one of the high-risk medication classes that are administered to critically ill patients during their intensive care unit (ICU) stay. However, little attention has been given to inpatient opioid prescribing practices, especially in critically ill patients. The purpose of our study was to characterize opioid prescribing practices across 2 transitions of care during an inpatient hospital stay: medical ICU (MICU)/intermediate care unit (IMC) to floor and floor to hospital discharge and identify potential patient-specific factors that impact opioid continuation...
June 18, 2020: Journal of Intensive Care Medicine
Tara L Ruder, Kevin R Donahue, A Carmine Colavecchia, David Putney, Mukhtar Al-Saadi
BACKGROUND: Dexmedetomidine (DEX) can cause hypotension complicating its use in critically ill patients with labile hemodynamics secondary to an underlying disease state such as heart failure. The aim of this study was to determine the effect of DEX on mean arterial pressure (MAP) in nonsurgical patients with heart failure and reduced ejection fraction (HFrEF). METHODS: This retrospective single-center cohort study evaluated patients who received DEX in the cardiac care and medical intensive care units at a large academic hospital...
June 17, 2020: Journal of Intensive Care Medicine
Justin K Lui, Lidia Spaho, Shahrad Hakimian, Michael Devine, Rosa Bui, Sunkaru Touray, Erik Holzwanger, Boskey Patel, Daniel Ellis, Svetlana Fridlyand, Adedotun A Ogunsua, Paria Mahboub, Jennifer S Daly, Adel Bozorgzadeh, Scott E Kopec
INTRODUCTION: This was a single-center retrospective study to evaluate incidence, prognosis, and risk factors in patients with postoperative pleural effusions, a common pulmonary complication following liver transplantation. METHODS: A retrospective review was performed on 374 liver transplantation cases through a database within the timeframe of January 1, 2009 through December 31, 2015. Demographics, pulmonary and cardiac function testing, laboratory studies, intraoperative transfusion/infusion volumes, postoperative management, and outcomes were analyzed...
June 12, 2020: Journal of Intensive Care Medicine
Jonathan M Norton, Prathibha K Reddy, Keshab Subedi, Carly A Fabrizio, Neil J Wimmer, Luis E Urrutia
OBJECTIVE: To subjectively identify low-risk ST-elevation myocardial infarction (STEMI) patients and triage this low-risk population to an intermediate level of care. BACKGROUND: Many patients with STEMI are admitted to the intensive care unit (ICU), however, a large portion do not merit ICU admission. We sought to examine whether, among post-STEMI patients admitted to the ICU, if an easily obtainable subjective scoring system could predict low-risk patients and safely triage them to an intermediate level of care...
June 10, 2020: Journal of Intensive Care Medicine
Jun Hyoung Kim, Yongseop Lee, Yun Suk Cho, Yu Jin Sohn, Jong Hoon Hyun, Sang Min Ahn, Woon Ji Lee, Hye Seong, Jung Ho Kim, Jin Young Ahn, Su Jin Jeong, Nam Su Ku, Jun Yong Choi, Joon-Sup Yeom, Young Goo Song
BACKGROUND: Recently, a new scoring system was developed that uses the red blood cell distribution width (RDW), delta neutrophil index (DNI), and platelet count (PC) to predict mortality in patients with sepsis. We investigated whether a modified simple scoring system based on the RDW, DNI, and mean platelet volume-to-PC (MPV/PC) ratio could predict the mortality of patients with sepsis, and compared it to the previous scoring system. METHODS: We conducted a retrospective cohort study of 264 adults who had been treated for sepsis in an emergency department between January 2016 and February 2019...
June 9, 2020: Journal of Intensive Care Medicine
Joseph M Yabes, Laveta Stewart, Faraz Shaikh, Paul M Robben, Joseph L Petfield, Anuradha Ganesan, Wesley R Campbell, David R Tribble, Dana M Blyth
BACKGROUND: Multidrug-resistant infections complicating combat-related trauma necessitate the use of broad-spectrum antimicrobials. Recent literature posits an association between vancomycin (VANC) and piperacillin-tazobactam (VPT) combination therapy and acute kidney injury (AKI). We examined whether therapy with VPT was associated with an increased risk of AKI compared to VANC and other broad-spectrum β-lactam antibiotics (VBL) following combat-related injuries. METHODS: Patients within the Trauma Infectious Disease Outcomes Study (TIDOS) who received ≥48 hours concomitant VPT or VBL started within 24 hours of each other were assessed...
June 8, 2020: Journal of Intensive Care Medicine
Timothy W Jones, Susan E Smith, Joseph S Van Tuyl, Andrea Sikora Newsome
Preexisting heart failure (HF) in patients with sepsis is associated with worse clinical outcomes. Core sepsis management includes aggressive volume resuscitation followed by vasopressors (and potentially inotropes) if fluid is inadequate to restore perfusion; however, large fluid boluses and vasoactive agents are concerning amid the cardiac dysfunction of HF. This review summarizes evidence regarding the influence of HF on sepsis clinical outcomes, pathophysiologic concerns, resuscitation targets, hemodynamic interventions, and adjunct management (ie, antiarrhythmics, positive pressure ventilatory support, and renal replacement therapy) in patients with sepsis and preexisting HF...
June 4, 2020: Journal of Intensive Care Medicine
Asad E Patanwala
No abstract text is available yet for this article.
June 3, 2020: Journal of Intensive Care Medicine
Sarah L Nizamuddin, Atul Gupta, Usman Latif, Junaid Nizamuddin, Avery Tung, Mohammed M Minhaj, Jeffrey Apfelbaum, Sajid S Shahul
STUDY OBJECTIVE: To identify risk factors for pediatric postoperative respiratory failure and develop a predictive model. DESIGN: This retrospective case-control study utilized the US National Inpatient Sample (NIS) from 2012 to 2014. Significant predictors were selected, and the predicted probability of pediatric postoperative respiratory failure was calculated. Sensitivity, specificity, and accuracy were then calculated, and receiver-operator curves were drawn...
June 3, 2020: Journal of Intensive Care Medicine
Jeremy K Lessing, William J H Ford, Peter A Steel, Sunday Clark, Rahul Sharma, John E Arbo
BACKGROUND: Knowledge of patient weight is required to guide initial intravenous fluid therapy for patients with sepsis-associated hypotension or elevated lactate. Previous studies have shown patients are better estimators of their weight than medical providers are; critically ill patients, however, may be unable to provide this information. OBJECTIVES: This study compares the accuracy of physician-estimated and patient self-reported weights to subsequent inpatient bed/stretcher scale weights for guiding initial protocol-based intravenous fluid therapy in the treatment of emergency department patients with suspected sepsis...
April 22, 2020: Journal of Intensive Care Medicine
Jacob C Jentzer, Bradley Ternus, Mackram Eleid, Charanjit Rihal
Structural heart disease (SHD) emergencies include acute deterioration of a stable lesion or development of a new critical lesion. Structural heart disease emergencies can produce heart failure and cardiogenic shock despite preserved systolic function that may not respond to standard medical therapy and typically necessitate surgical or percutaneous intervention. Comprehensive Doppler echocardiography is the initial diagnostic modality of choice to determine the cause and severity of the underlying SHD lesion...
April 21, 2020: Journal of Intensive Care Medicine
Vishesh Paul, Shawn Patel, Michelle Royse, Mazen Odish, Atul Malhotra, Seth Koenig
It has been well known for decades that prone positioning (PP) improves oxygenation. However, it has gained widespread acceptance only in the last few years since studies have shown significant survival benefit. Many centers have established prone ventilation in their treatment algorithm for mechanically ventilated patients with severe acute respiratory distress syndrome (ARDS). Physiologically, PP should also benefit awake, non-intubated patients with acute hypoxemic respiratory failure. However, proning in non-intubated (PINI) patients did not gain any momentum until a few months ago when the Coronavirus disease 2019 (COVID-19) pandemic surged...
August 2020: Journal of Intensive Care Medicine
Shawn Kaku, Christopher D Nguyen, Natalie N Htet, Dominic Tutera, Juliana Barr, Harman S Paintal, Ware G Kuschner
The acute respiratory distress syndrome (ARDS) has multiple causes and is characterized by acute lung inflammation and increased pulmonary vascular permeability, leading to hypoxemic respiratory failure and bilateral pulmonary radiographic opacities. The acute respiratory distress syndrome is associated with substantial morbidity and mortality, and effective treatment strategies are limited. This review presents the current state of the literature regarding the etiology, pathogenesis, and management strategies for ARDS...
August 2020: Journal of Intensive Care Medicine
Angel Joel Cadena, Sara Habib, Fred Rincon, Stephanie Dobak
Malnutrition is frequently seen among patients in the intensive care unit. Evidence shows that optimal nutritional support can lead to better clinical outcomes. Recent clinical trials debate over the efficacy of enteral nutrition (EN) over parenteral nutrition (PN). Multiple trials have studied the impact of EN versus PN in terms of health-care cost and clinical outcomes (including functional status, cost, infectious complications, mortality risk, length of hospital and intensive care unit stay, and mechanical ventilation duration)...
July 2020: Journal of Intensive Care Medicine
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