Journal of Intensive Care Medicine

Daniel G Fein, Fiore Mastroianni, Charles G Murphy, Michael Aboodi, Ryan Malik, Nader Emami, Matthew Abramowitz, Ariel L Shiloh, Lewis Eisen
BACKGROUND: There has been limited investigation into the procedural outcomes of patients undergoing emergent endotracheal intubation (EEI) by a critical care medicine (CCM) specialist outside the intensive care unit (ICU). We hypothesized that EEI outside an ICU would be associated with lower rates of first pass success (FPS) as compared to inside an ICU. METHODS: We performed a retrospective cohort study of all adult patients admitted to our academic medical center between January 1, 2016, and July 31, 2018, who underwent EEI by a CCM practitioner...
November 10, 2019: Journal of Intensive Care Medicine
Folafoluwa O Odetola, Achamyeleh Gebremariam
OBJECTIVE: To describe patient and hospital characteristics associated with in-hospital mortality, length of stay (LOS), and charges for children with severe sepsis or septic shock who often require specialized organ-supportive technology to enhance outcomes, availability of which might vary across hospitals. DESIGN: Retrospective study among children hospitalized for severe sepsis or septic shock, using the 2012 Kids' Inpatient Database. Multivariate regression methods identified factors associated with mortality, LOS, and charges...
November 10, 2019: Journal of Intensive Care Medicine
Selina M Parry, Swaroopa R Nalamalapu, Krishidhar Nunna, Anahita Rabiee, Lisa Aronson Friedman, Elizabeth Colantuoni, Dale M Needham, Victor D Dinglas
BACKGROUND AND OBJECTIVES: Impaired physical functioning is common and long lasting after an intensive care unit (ICU) admission. The 6-minute walk test (6MWT) is a validated and widely used test of functional capacity. This systematic review synthesizes existing data in order to: (1) evaluate 6-minute walk distance (6MWD) in meters over longitudinal follow-up after critical illness, (2) compare 6MWD between acute respiratory distress syndrome (ARDS) versus non-ARDS survivors, and (3) evaluate patient- and ICU-related factors associated with 6MWD...
November 5, 2019: Journal of Intensive Care Medicine
Amy Huaishiuan Huang, Ye Liu, Yenh-Chen Hsien, Tzu-Chun Hsu, Debra Yen, Wan-Ting Hsu, Hsin-Yang Lin, Shyr-Chyr Chen, Chien-Chang Lee
PURPOSE: The impact of gastrointestinal bleeding (GIB) on outcomes of patients with bloodstream infection (BSI) has not been studied. We aim to evaluate the risk factors and survival impact of GIB on the outcome of BSI. MATERIALS AND METHODS: This study was conducted prospectively at National Taiwan University Hospital Yunlin Branch between January 1, 2015, and December 31, 2016. Patients aged ≥18 years for who BSI was confirmed by blood cultures were enrolled and followed for 90 days...
November 4, 2019: Journal of Intensive Care Medicine
Justin Xavier Moore, Tomi Akinyemiju, Alfred Bartolucci, Henry E Wang, John Waterbor, Russell Griffin
BACKGROUND: Few studies have examined whether community factors mediate the relationship between patients surviving cancer and future development of sepsis. We determined the influence of community characteristics upon risk of sepsis after cancer, and whether there are differences by race. METHODS: We performed a prospective analysis using data from the REasons for Geographic and Racial Differences in Stroke cohort years 2003 to 2012 complemented with county-level community characteristics from the American Community Survey and County Health Rankings...
November 4, 2019: Journal of Intensive Care Medicine
Mitchell S Buckley, Sumit K Agarwal, Robert MacLaren, Sandra L Kane-Gill
PURPOSE: Nonbenzodiazepines are preferred for continuous sedation in mechanically ventilated intensive care unit (ICU) patients. Although dexmedetomidine and propofol have blood pressure lowering properties, limited data exist about the hemodynamic effects of concomitant administration. The purpose of this study was to compare the adverse hemodynamic event rate with concomitant dexmedetomidine and propofol compared to either agent alone in mechanically ventilated ICU patients. METHODS: This retrospective cohort study was conducted at a university medical center...
October 31, 2019: Journal of Intensive Care Medicine
Klaus Stahl, Nina Rittgerodt, Markus Busch, Sabine K Maschke, Andrea Schneider, Michael P Manns, Jan Fuge, Bernhard C Meyer, Marius M Hoeper, Jan B Hinrichs, Sascha David
BACKGROUND: Intensive care patients with nonocclusive mesenteric ischemia (NOMI) show mortality rates of 70% to 90%. Besides emergency surgery, different interventional local vasodilatory treatment (LVT) attempts have been described. We performed a systematic review and a meta-analysis to evaluate feasibility, efficacy, and tolerability of LVT in patients with life-threatening NOMI. METHODS: Searches of PubMed, EMBASE, Web of Science, and Cochrane Library databases were performed until February 2019...
October 23, 2019: Journal of Intensive Care Medicine
Rebeccah M Brusca, Catherine E Simpson, Sarina K Sahetya, Zeba Noorain, Varshitha Tanykonda, R Scott Stephens, Dale M Needham, David N Hager
BACKGROUND: Intermediate care units (IMCUs) are heterogeneous in design and operation, which makes comparative effectiveness studies challenging. A generalizable outcome prediction model could improve such comparisons. However, little is known about the performance of critical care outcome prediction models in the intermediate care setting. The purpose of this study is to evaluate the performance of the Acute Physiology and Chronic Health Evaluation version II (APACHE II), Simplified Acute Physiology Score version II (SAPS II) and version 3 (SAPS 3), and Mortality Probability Model version III (MPM0 III) in patients admitted to a well-characterized IMCU...
October 21, 2019: Journal of Intensive Care Medicine
Robert J H Miller, Danielle Southern, Stephen B Wilton, Matthew T James, Bryan Har, Greg Schnell, Sean van Diepen, Andrew D M Grant
OBJECTIVES: Despite advances in medical therapy, reperfusion, and mechanical support, cardiogenic shock remains associated with excess morbidity and mortality. Accurate risk stratification may improve patient management. We compared the accuracy of established risk scores for cardiogenic shock. METHODS: Patients admitted to tertiary care center cardiac care units in the province of Alberta in 2015 were assessed for cardiogenic shock. The Acute Physiology and Chronic Health Evaluation-II (APACHE-II), CardShock, intra-aortic balloon pump (IABP) Shock II, and sepsis-related organ failure assessment (SOFA) risk scores were compared...
October 14, 2019: Journal of Intensive Care Medicine
Keith A Corl, Nader Azab, Mohammed Nayeemuddin, Alexandra Schick, Thomas Lopardo, Fatima Zeba, Gary Phillips, Grayson Baird, Roland C Merchant, Mitchell M Levy, Michael Blaivas, Adeel Abbasi
OBJECTIVES: Inferior vena cava collapsibility (cIVC) measured by point-of-care ultrasound (POCUS) has been proposed as a noninvasive means of assessing fluid responsiveness. We aimed to prospectively evaluate the performance of a 25% cIVC cutoff value to detect fluid responsiveness among spontaneously breathing intensive care unit (ICU) patients when assessed with POCUS by novice versus expert physician sonologists. METHODS: Prospective observational study of spontaneously breathing ICU patients...
October 14, 2019: Journal of Intensive Care Medicine
Aluko A Hope, Jammie Law, Rahul Nair, Mimi Kim, Joe Verghese, Michelle Ng Gong
PURPOSE: We aimed to describe the association between prehospital frailty (PHF), acute organ dysfunction (AOD), and posthospital disability (PHD) outcome in older adults admitted to the intensive care unit (ICU). METHODS: In a prospective observational cohort study, we assessed PHF using the Clinical Frailty Scale (CFS) and assessed the level of AOD using Sequential Organ Failure Assessment (SOFA) scores on ICU day 1. We assessed Activities of Daily Living disability levels through to 6 months after discharge and used generalized estimating equations (log link and negative binomial family) to determine the independent association of PHF and AOD with PHD...
October 13, 2019: Journal of Intensive Care Medicine
Matthew M Bower, Alexander J Sweidan, Jordan C Xu, Sara Stern-Neze, Wengui Yu, Leonid I Groysman
Quantitative pupillometry provides a noninvasive and objective assessment within the neurological examination. This review details the physiology of the pupillary light response, the clinical significance of changes in pupillary reactivity, and the variables that compose the Neurological Pupil index or NPi are discussed. This article reviews the most recent applications and advances in quantitative pupillometry for noninvasive intracranial pressure monitoring, postcardiac arrest prognostication, and subarachnoid hemorrhage...
October 10, 2019: Journal of Intensive Care Medicine
Elena Diaz, Irene Diaz, Cecilia Del Busto, Dolores Escudero, Silvia Pérez
BACKGROUND: Intensive care unit (ICU) environment disrupts the circadian rhythms due to environmental and other nonphotic synchronizers. The main purpose of this article is to establish whether critically patients have desynchronization at the molecular level after 1 week of stay in the ICU. METHODS: The rhythm of Clock, Bmal1, Cry1, and Per2 genes in neuro-ICU patients (n = 11) on the first day after admission in the unit (1 day) and 1 week later (1 week) was studied, 4 time points throughout the day, at 6, 12, 18, and 24 hours...
September 11, 2019: Journal of Intensive Care Medicine
Peter M Reardon, Michael Hickey, Shane W English, Benjamin Hibbert, Trevor Simard, Ariel Hendin, Krishan Yadav
Resuscitation after out-of-hospital cardiac arrest can be one of the most challenging scenarios in acute-care medicine. The devastating effects of postcardiac arrest syndrome carry a substantial morbidity and mortality that persist long after return of spontaneous circulation. Management of these patients requires the clinician to simultaneously address multiple emergent priorities including the resuscitation of the patient and the efficient diagnosis and management of the underlying etiology. This review provides a concise evidence-based overview of the core concepts involved in the early postcardiac arrest resuscitation...
September 5, 2019: Journal of Intensive Care Medicine
Marjorie Bateman, Ala Alkhatib, Thomas John, Malhar Parikh, Fayez Kheir
BACKGROUND: Pleural effusions are common in critically ill patients. However, the management of pleural fluid on relevant clinical outcomes is poorly studied. We evaluated the impact of pleural effusion in the intensive care unit (ICU). METHODS: A large observational ICU database Multiparameter Intelligent Monitoring in Intensive Care III was utilized. Analyses used matched patients with the same admission diagnosis, age, gender, and disease severity. RESULTS: Of 50 765, 3897 (7...
September 4, 2019: Journal of Intensive Care Medicine
Adrian Wong, Afrah Alkazemi, I Mary Eche, Camille R Petri, Todd Sarge, Michael N Cocchi
PURPOSE: Catecholamines are first-line vasopressors for hemodynamic support in distributive shock but are associated with adverse effects, which may be mitigated with noncatecholamine vasopressors. Angiotensin II (ATII) is a noncatecholamine vasopressor recently approved for the management of distributive shock, but limited data support its clinical utility. The purpose of this study was to describe our institution's usage of ATII including patient outcomes (eg, response to therapy, safety profile)...
September 3, 2019: Journal of Intensive Care Medicine
Gulrukh Z Zaidi, Juliana A Rosentsveyg, Katayoun F Fomani, James P Louie, Seth J Koenig
OBJECTIVE: Red blood cell exchange (RBCE) is the standard of care for patients with sickle cell disease (SCD) who present with severe vaso-occlusive crisis (VOC). However, subsets of these critically ill patients have progressive multiorgan failure (MOF) despite RBCE therapy. The purpose of this case series is to describe the use of plasma exchange (PLEX) for the treatment of SCD-related MOF that is refractory to RBCE. METHODS: A retrospective case review of patients with severe MOF from sickle cell crisis unresponsive to RBCE who underwent PLEX in a 14-bed adult medical intensive care unit (ICU) at a tertiary care university hospital over a 4-year time period...
September 2, 2019: Journal of Intensive Care Medicine
Michael N Cocchi, Justin Salciccioli, Tuyen Yankama, Maureen Chase, Parth V Patel, Xiaowen Liu, Timothy J Mader, Michael W Donnino
BACKGROUND: Outcome prediction after out-of-hospital cardiac arrest (OHCA) is difficult. We hypothesized that lactate and need for vasopressors would predict outcome, and that addition of a mitochondrial biomarker would enhance performance of the tool. METHODS: Prospective observational study of OHCA patients presenting to an academic medical center September 2008 to April 2016. We conducted univariate and multivariate logistic regressions. RESULTS: Patients were divided based on 2 variables: vasopressor status and initial lactate (<5 mmol/L, 5-10, ≥10)...
August 29, 2019: Journal of Intensive Care Medicine
Brian M Sheehan, Areg Grigorian, Sahil Gambhir, Shelley Maithel, Catherine M Kuza, Matthew O Dolich, Michael E Lekawa, Jeffry Nahmias
OBJECTIVES: To determine whether, similar to adults, early tracheostomy in pediatric patients with severe traumatic brain injury (TBI) improves inhospital outcomes including ventilator days, intensive care unit (ICU) length of stay (LOS), and total hospital LOS when compared to late tracheostomy. DESIGN: Retrospective cohort analysis. SETTING: The Pediatric Trauma Quality Improvement Program (TQIP) database. PATIENTS: One hundred twenty-seven pediatric patients <16 years old with severe (>3) abbreviated injury scale TBI who underwent early (days 1-6) or late (day ≥7) tracheostomy between 2014 and 2016...
August 27, 2019: Journal of Intensive Care Medicine
Nicholas M Gourd, Nikitas Nikitas
Multiple organ dysfunction syndrome (MODS) is one of the most common syndromes of critical illness and the leading cause of mortality among critically ill patients. Multiple organ dysfunction syndrome is the clinical consequence of a dysregulated inflammatory response, triggered by clinically diverse factors with the main pillar of management being invasive organ support. During the last years, the advances in the clarification of the molecular pathways that trigger, mitigate, and determine the outcome of MODS have led to the increasing recognition of MODS as a distinct disease entity with distinct etiology, pathophysiology, and potential future therapeutic interventions...
August 27, 2019: Journal of Intensive Care Medicine
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