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Journal of Intensive Care

Ken Kuwajima, Kyungho Chang, Ai Furuta, Masahiko Bougaki, Kanji Uchida, Shigehito Sawamura, Yoshitsugu Yamada
Background: One of the main pathophysiological manifestations during the acute phase of sepsis is massive production of proinflammatory mediators. Clinical trials involving direct suppression of inflammatory mediators to relieve organ dysfunction in sepsis have been extensively performed; however, the clinical outcomes of such trials remain far from satisfactory. Given the need for better sepsis treatments, we have screened various agents with anti-inflammatory properties for cytoprotective effects...
2019: Journal of Intensive Care
Atthasit Komindr, Ryuzo Abe, Yoshihisa Tateishi, Yuka Takahashi, Jun Goto, Keita Wada, Yutaka Furukawa, Atsushi Sugiura, Taro Imaeda, Natsumi Suga, Noriyuki Hattori, Shigeto Oda
Background: For patients treated with extracorporeal membrane oxygenation (ECMO), employing a well-coordinated, multidisciplinary team specializing in ECMO has reportedly been effective in delivering better clinical outcomes. This study aims to assess the impact of establishing such a specialized team for patients treated with ECMO. Method: This retrospective cohort study was performed at a tertiary-care hospital in Japan. We reviewed medical records of all consecutive patients treated with ECMO during October 2010-September 2016...
2019: Journal of Intensive Care
Kenichiro Morisawa, Shigeki Fujitani, Yasuhiko Taira
Management of fluid therapy in an intensive care unit (ICU) tends to be volume restriction after initial fluid resuscitation, since it has been the consensus that volume overload is associated with complications and poor clinical outcomes. Aggressive volume administration without cautious monitoring should be avoided in the ICU, because it could lead to excessive volume administration. However, there are limited consensus on determining the completion of resuscitation phase, in other words, when to stop aggressive infusion and initiate infusion restriction...
2019: Journal of Intensive Care
Katsura Hayakawa
Background: This review is a "Pro-Con" discussion about the optimal fluid volume in critically ill patients in the intensive care unit (ICU). This article argues that fluids should be aggressively managed in critically ill patients. Main body: In recent years, restrictive fluid management has been thought to be beneficial for critically ill patients. Thus, to investigate whether fluid volumes have actually been restricted in practice, fluid volumes were compared between those used in the early goal-directed therapy (EGDT) study by Rivers et al...
2019: Journal of Intensive Care
Norbert Banjas, Hans-Bernd Hopf, Ernst Hanisch, Benjamin Friedrichson, Julia Fichte, Alexander Buia
[This corrects the article DOI: 10.1186/s40560-018-0352-2.].
2019: Journal of Intensive Care
Akira Endo, Atsushi Shiraishi, Yasuhiro Otomo, Kiyohide Fushimi, Kiyoshi Murata
Background: Although it has been reported that high hospital patient volume results in survival and cost benefits for several diseases, it is uncertain whether this association is applicable in burn care. Methods: We conducted a retrospective observational study on severe burn patients, defined by a burn index ≥ 10, using 2010-2015 data from a Japanese national administrative claim database. A generalized additive mixed-effect model (GAMM) was used to evaluate the nonlinear associations between patient volume and the outcomes (in-hospital mortality, healthcare costs per admission, and hospital-free days at 90 days)...
2019: Journal of Intensive Care
Tiago Antonio Tonietto, Marcio Manozzo Boniatti, Thiago Costa Lisboa, Marina Verçoza Viana, Gustavo Adolpho Moreira Faulhaber
We have read the study about the association between high red blood cell distribution width and higher ward mortality after intensive care unit discharge. The study increases the evidence that RDW may be a marker of severity for patients discharged from the ICU. However, in this letter, we comment on issues that need further discussion.
2019: Journal of Intensive Care
Reza Goharani, Amir Vahedian-Azimi, Behrooz Farzanegan, Farshid R Bashar, Mohammadreza Hajiesmaeili, Seyedpouzhia Shojaei, Seyed J Madani, Keivan Gohari-Moghaddam, Sevak Hatamian, Seyed M M Mosavinasab, Masoum Khoshfetrat, Mohammad A Khabiri Khatir, Andrew C Miller
Objective: To determine if real-time compression feedback using a non-automated hand-held device improves patient outcomes from in-hospital cardiac arrest (IHCA). Methods: We conducted a prospective, randomized, controlled, parallel study (no crossover) of patients with IHCA in the mixed medical-surgical intensive care units (ICUs) of eight academic hospitals. Patients received either standard manual chest compressions or compressions performed with real-time feedback using the Cardio First Angel™ (CFA) device...
2019: Journal of Intensive Care
Atsuko Shono, Toru Kotani
Mechanical ventilation can initiate ventilator-associated lung injury (VALI) and contribute to the development of multiple organ dysfunction. Although a lung protective strategy limiting both tidal volume and plateau pressure reduces VALI, uneven intrapulmonary gas distribution is still capable of increasing regional stress and strain, especially in non-homogeneous lungs, such as during acute respiratory distress syndrome. Real-time monitoring of regional ventilation may prevent inhomogeneous ventilation, leading to a reduction in VALI...
2019: Journal of Intensive Care
Catherine Clarissa, Lisa Salisbury, Sheila Rodgers, Susanne Kean
Background: Mechanically ventilated patients often develop muscle weakness post-intensive care admission. Current evidence suggests that early mobilisation of these patients can be an effective intervention in improving their outcomes. However, what constitutes early mobilisation in mechanically ventilated patients (EM-MV) remains unclear. We aimed to systematically explore the definitions and activity types of EM-MV in the literature. Methods: Whittemore and Knafl's framework guided this review...
2019: Journal of Intensive Care
Hironori Matsumoto, Jun Takeba, Kensuke Umakoshi, Yuki Nakabayashi, Naoki Moriyama, Suguru Annen, Muneaki Ohshita, Satoshi Kikuchi, Norio Sato, Mayuki Aibiki
Background: Heat stroke induces coagulofibrinolytic activation, which leads to life-threatening disseminated intravascular coagulation (DIC). However, treatment strategies for DIC in heat stroke have not yet been established, and also, the time course changes in coagulofibrinolytic markers have not been thoroughly evaluated. We report a severe heat stroke case with DIC who was eventually saved by anti-DIC treatments in accordance with changes in coagulofibrinolytic markers. Case presentation: A 45-year-old man was found unconscious outside, and his body temperature was elevated to 41...
2019: Journal of Intensive Care
Timothy G Scully, Robert Grealy, Anthony S McLean, Sam R Orde
Background: Despite the evidence for calibrated cardiac monitored devices to determine fluid responsiveness, there is minimal evidence that the use of cardiac output monitor devices leads to an overall change in IV fluid use. We sought to investigate the feasibility of performing a randomised controlled study using calibrated cardiac output monitoring devices in shocked ICU patients and whether the use of these devices led to a difference in total volume of IV fluid administered. Methods: We performed a single-centre non-blinded randomised controlled study which included patients who met the clinical criteria for shock on admission to ICU...
2019: Journal of Intensive Care
Inge T Bootsma, Thomas W L Scheeren, Fellery de Lange, Johannes Haenen, Piet W Boonstra, E Christaan Boerma
Background: Right ventricular (RV) dysfunction is a known risk factor for increased mortality in cardiac surgery. However, the association between RV performance and ICU morbidity is largely unknown. Methods: We performed a single-centre, retrospective study including cardiac surgery patients equipped with a pulmonary artery catheter, enabling continuous right ventricular ejection fraction (RVEF) measurements. Primary endpoint of our study was ICU morbidity (as determined by ICU length of stay, duration of mechanical ventilation, usage of inotropic drugs and fluids, and kidney dysfunction) in relation to RVEF...
2018: Journal of Intensive Care
Norbert Banjas, Hans-Bernd Hopf, Ernst Hanisch, Benjamin Friedrichson, Julia Fichte, Alexander Buia
Background: Based on promising results over the past 10 years, the method of extracorporeal membrane oxygenation (ECMO) has developed from being used as a 'rescue therapy' to become an accepted treatment option for patients with acute lung failure (ARDS). Subsequently, the indication was extended also to patients suffering from cardiogenic and septic shock. Our aim was to evaluate hospital mortality and associated prognostic variables in patients with lung failure, cardiogenic, and septic shock undergoing ECMO...
2018: Journal of Intensive Care
Shota Yokoyama, Toru Hifumi, Tomoya Okazaki, Takahisa Noma, Kenya Kawakita, Takashi Tamiya, Tetsuo Minamino, Yasuhiro Kuroda
Background: In patients with aneurysmal subarachnoid hemorrhage (SAH), an association between hypocapnia and poor clinical outcomes has been reported. However, the optimal arterial carbon dioxide tension (PaCO2 ) remains unknown. The present retrospective study aimed to examine the association of abnormal PaCO2 levels with neurological outcomes and investigate the optimal target PaCO2 level in patients with SAH. Methods: We retrospectively selected consecutive adult patients hospitalized in the intensive care unit (ICU) for SAH between January 2009 and April 2017...
2018: Journal of Intensive Care
Shinichiro Ohshimo, Takuma Sadamori, Nobuaki Shime
The western Japan rainstorm disaster on July 6, 2018, was one of the most serious natural catastrophes in Japan, excluding earthquake events. Its main characteristics were severe and widespread flooding and landslides which cut off many areas, interrupting both traffic and telecommunication, and loss of clean water supply. We explored the utility of unmanned aerial vehicles to collect precise information on traffic disruption and damage to hospitals for patient rescue and for efficient allocation of resources...
2018: Journal of Intensive Care
Vijay Hadda, Rohit Kumar, Gopi Chand Khilnani, Mani Kalaivani, Karan Madan, Pawan Tiwari, Saurabh Mittal, Anant Mohan, Ashu Seith Bhalla, Randeep Guleria
Background and aims: Data regarding trends of muscle loss on ultrasonography (USG) and its relationship with various outcomes among critically ill patients is limited. This study aimed to describe the trends of loss of muscle thickness of the arm and thigh (assessed using USG) and to determine the relationship between loss of muscle thickness and in-hospital and post-discharge outcomes. Methods: Muscle thickness of 70 patients with sepsis was measured at the level of the mid-arm and mid-thigh using bedside USG on days 1, 3, 5, 7, 10 and 14 and then weekly till discharge or death...
2018: Journal of Intensive Care
Julie C Reid, Janelle Unger, Devin McCaskell, Laura Childerhose, David J Zorko, Michelle E Kho
Background: Physical rehabilitation (PR) interventions in the intensive care unit (ICU) can improve patients' functional outcomes, yet systematic reviews identified discordant effects and poor reporting. We conducted a scoping review to determine the extent of ICU PR interventions and how they were reported and measured. Methods: We searched five databases from inception to December 2016 for prospective studies evaluating adult ICU PR interventions. Two independent reviewers screened titles, abstracts, and full texts for inclusion...
2018: Journal of Intensive Care
Takashi Ito, Mayumi Nakahara, Yoshiki Masuda, Sachie Ono, Shingo Yamada, Hiroyasu Ishikura, Hitoshi Imaizumi, Chinatsu Kamikokuryo, Yasuyuki Kakihana, Ikuro Maruyama
Background: Nuclear histone proteins are released into the extracellular space during sepsis and act as major mediators of death. However, circulating histone levels have not been precisely quantified. Methods: We developed a novel enzyme-linked immunosorbent assay (ELISA) for detection of circulating histone H3 levels and evaluated its performance. Using the ELISA, we measured plasma histone H3 levels in C57BL/6 J mice subjected to cecal ligation and puncture (CLP)-induced sepsis...
2018: Journal of Intensive Care
Ahmad Sabry Saleh
The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 suggested against the use of the early goal-directed therapy (EGDT) in patients with septic shock. This recommendation was based on the three large-scale trials (ProCESS, ARISE, and ProMISe). Although the three trials showed no difference in mortality between EGDT and usual care, the guidelines determined that the potential harms presented by EGDT likely outweigh its potential benefits. On the contrary, analysis of data from the three trials showed an approaching statistical significance lower risk of serious adverse events in the EGDT group compared to usual care (risk difference = - 1%, 95% confidence interval; - 2% to 0%, P  = 0...
2018: Journal of Intensive Care
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